إختبر نفسك 1

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1. Patient presented with symptoms of anemia, laboratory results showed MICV: 68, red blood cells count: 6, what is the diagnosis?

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2. year child with hepatomegaly Lab show hbA2 and hbF high, what is the diagnosis?

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3. 29,m, with acute rt upper quadrant pain. episodes each occurring while eating meals. history is sickle cell dieses. right upper quadrant tenderness with palpitation.
Right upper quadrant US reveals numerous gallstones and edema of the gallbladder wall. cause of gallstones in this patient?

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4. Hyposlpesism common with

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5. How to prevent acute chest syndrome?

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6. patient with Sickle cell disease and has recurrent splenic sequestration ask about management ?

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7. Which of the following represent a fetal complication from maternal infection with Parvovirus B19?

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8. Q- 8 year with respiratory distress, pale and tired. Hb 31 (Pt is anemic according to normal values provided in the exam). Dx?
Q-Sickle cell anemia child hb 3 severe pallor and respiratory symptoms what mostly causes this?
Q-Pediatric Known case of sickle disease have respiratory distress and fever ( just like that) what is the organism responsible for this?

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9. scenario of anemic patient, Lab showed pancytopenia diagnosis ?

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10. Q- Mother with sickle cell disease child want to married what should be screen to reduce sickle cell disease ?
Q – women had sicker disease child , which test to do before her second marriage?
َQ- Mother has her first child and he turned out to have sickle cell disease. She has since remarried and what’s to go for premarital testing. What is the first test you should do?

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11. Q- Female had a girl with SCD from her ex-husband. Now she remarried and wants to know if her future child would have SCD or not. Came for test What is the most appropriate *initial* test to order?
Q- A mother had child with SCA, she remarried again Which is the best to know the recurrence in baby

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12. 24 years old complain of sickle cell anemia came with headache, lethargy, pallor, Lab: hg: very low, Reticulocytes: high, what most likely diagnosis?

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13. 5year old with wrist pain and ankle pain and fever for one week. History of sickle cell anemia what causes ?

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14. 7 years old presented to ER with shortness of breath and fatigue Labs showed anemia + thrombocytopenia (no WBC) Sickle screen was positive. Which one of the following is the most important investigation?

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15. Female with sickle cell disease presentation with hepatospleenomegaly what is complication ?

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16. 24 month old child came to clinic with his mother for taking hepatitis A vaccine , mother tell he is know sickle cell disease patient and he receive blood transfusion since one week what to do ?

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17. Couple came to a preconception clinic. The father, 2 of his brothers have sickle cell disease and he has sickle cell trait and what is the risk of sickle cell disease ?

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18. A patient known to have sickle cell disease presented to the emergency department complaining of both legs pain for three hours. Lower limb exam is normal with no sign of DVT. The abdomen and exam reveals spleen enlargement. Hemoglobin is 3.2. Which of the following is the best next step?

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19. Sickle cell disease boy with pain in hands and foots. What is the initial management?

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20. patient came To ER complain of sever limps pain with chest pain , cough hypoxia , Question Ask about the Diagnosis ?

Patient with respiratory distress and high fever also carsales , effected right lobe and low hb and high reticulocyte count and pulmonary systolic murmur what is the diagnosis

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21. Question with a description of blood smear that shows (Crescent RBC’s) = what is Diagnosis ?

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22. patient from African came to ER with pleuritic Chest pain, cough, fever , his Vital sign is Respiratory rate is 36 , O2 sat 90%, temperature 38 , there is History of sickle cell disease and History of crises , immunization up to date, this symptoms are MOST Suggestive of:

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23. hyper-segmented neutrophils are associated with which type of anemia ?

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24. 73-year-old man comes to the office with fatigue that has become progressively worse over the last several months. He is also short of breath when he walks up one flight of stairs. He drinks 4 vodka martinis a day. He has numbness and tingling in his feet. On physical examination he has decreased sensation of his feet. His hematocrit is 28% and MCV is 114 fL (elevated). What is the most appropriate next step in management?

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25. A 48-year- woman had terminal Ileum resection due to Crohn’s disease She presents this time with difficulty in walking. She is anaemic and has lost position sense bilaterally.
Which of the following is the most likely diagnosis?

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26. A 25-year woman presented with few months history of increase forgetfulness, fatigue and numbness of lower limbs.
She is a known case of crohn’s disease, post terminal ilium resection 2 years ago. She is on azathioprine She denies abdominal pain or diarrheas’ (see lab results). 

Test Result                   Normal Values
RBC 4 5                           4 7-6.1 x 1012/L (Male)
                                        4.2-5 4 x 1012fl_ (Female)
Hb 90                              130-170 g/L (Male)
                                        120-160 g/L (Female)
MCH 38                             28-33 pg/cell
MCV 99                             80-95 fl
Platelets count 199         150-400 x 109/L
A deficiency of which of the following nutrients would be responsible for her current clinical presentation?

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27. A 65-year-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
Vitamin B12 was low
Which of the following would be found on further testing?

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28. B12 deficiency is associated with an increased which of the following :

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29. 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).
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
Which of the following is the most appropriate test to be ordered next?

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30. A 46-year-old man has dyspnea on exertion and palpitations. On examination, he has patches of vitiligo and has absent reflexes with positive Babinski in the lower limbs (see lab results».
Test Result                              Normal Values
Hb91                                        130-170 g/L (Male) 120-160 g/L (Female)
MCV 103                                  80-95 fl
Platelets count 129                150-400 x 109/L
Ferritin 120                             20-300 pg/L
Vitamin B12(Men)                  124 160-900 ng/L
 Folic Aad (Men) 6                        <4 pg/l.
Which of the following is the most appropriate management?

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31. A 59-year- man has unsteady gait. On examination, he has decreased proprioception in the lower limbs with positive planter reflexes (positive Babnski) and absent ankle and knee’s reflexes He has anemia Peripheral smear done (see image)
Which of the following is the most likely diagnosis?

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32. what is Type of anemia in alcoholism?

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33. patient came only with fever and history of Southeast Asia?

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34. Patient came only with fever and history of Sub saharan Africa? 

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35. A 40-year- man comes to the clinic complaining of fever, He just arrived back from a short trip to a country in Southeast Asia Which of the following is the most likely cause of his Fever’

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36. What is the most common disease diagnosed among travelers returning with fever from Southeast Asia?

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37. 34-year male presents with chills, fever to 39 °C. Retro-orbital pain, and severe muscle and joint pains

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38. Which of the following is the peak biting period for Aedes aegypli mosquito (the primary vector of dengue fever)?

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39. Which of the following medications is the most likely that malaria parasites develop resistance to?

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40. A 30-year-old man presents to the Emergency Department with history of fever and headache. He recently came from a trip to Sudan, where he stayed there for 10-days. Abdominal examination, palpable spleen 3 cm below costal margin (see lab results).
Temperature 40 ºC
Test Result                                               Normal Values
Hb 9                                                         130-170 g/L (Male) 120-160 g/L (Female)
Platelets count 90                                   150-400 x 109/L
Aspartate aminotransferase 88             12-40 IU/L
Alanine aminotransferase 94                  5-40 IU/L
Which of the following Is the first line treatment option?

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41. Which of the following measures is recommended to avoid malaria infection in people traveling to an endemic country?

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42. A 27-year-old soldier going to a military mission at the Southern border of Saudi Arabia . His medical history is insignificant apart from a positive history of depression, which is controlled by medication. He came for counselling regarding malaria prevention. Which of the following is the best malaria chemoprophylaxis regimen?

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43. A 40-year-old man is planning to travel to Sudan for a short trip Which of the following prophylactic medications is recommended for malaria prevention?

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44. A 35-year-old Indian man came to Saudi Arabia for HaJ. He presented with a 4-day history of intermittent fever, shortness of breath, drowsiness, convulsion and confusion. Which of the following is the most probable diagnosis?

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45. What is the most common diagnosis for travelers returning with fever from sub-Saharan Africa?

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46. A 35-years-old man comes to the clinic complaining of fever He Just come back from a 2-weeks trip to a country in sub-Saharan Africa Which of the following is the most likely cause of his fever?

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47. Hodgkin lymphoma case , pt deteriorated Labs ( increase K , phosphate and uric acid , low calcium? What the diagnosis ?

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48. 60 years old male with history of Hodgkin lymphoma, taking potassium sparing diuretic for severe hypertension, he is diabetic for 20 years, he had an chemotherapy appointment 1 week before he die
his lab:
Hyperkalemia
High uric acid
High creatinine
What is the cause of his hyperkalemia?

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49. A 63-year man has  lymphocytic leukemia started on chemotherapy. His initial lymphocyte count was 73.000. 2 days after chemotherapy, he presents with fatigue and dry mouth which of the following electrolyte abnormality is associated with the above condition?

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50. An 18-year- 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 appropriate management?

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51. A 66-year-old woman presents with lethargy for the past 2 weeks.
Her past medical history includes polymyalgia rheumatic and ischemic heart disease. Clinical examination is unremarkable             Test Result                                                    Normal Value
WBC21                                                         4.5-10.5 x 109/L
Neutrophils 44                                                40-60%
Lymphocytes 60                                             20-40 %
the most likely diagnosis?

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52. old patient with Chronic kidney disease present with labs show high WBC and very high lymphocytes with arthritis past medical history includes polymyalgia rheumatic what is diagnosis ?

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53. A 4-year-old boy presented to the clinic with history of decreased appetite and activity over the past month. He lost significant weight since his last outpatient visit. Which of the following is the most common cause of cancer ๓ such patient?

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54. Which of the following leukemia is the most common in pediatric age group?

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55. 60 years old patient after 10 minutes of blood transfusion developed pain in the site of the cannula, difficulty breathing, and is febrile. What is the most likely blood transfusion reaction?

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56.  Patient on Total parenteral Nutrition give abnormal value of PT and INR what is the cause ?

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57. An elderly man on NSAIDs developed dyspepsia. Endoscopy showed gastritis. Labs showed iron deficiency anemia with Hb= 9. What is the best method of treatment?

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58. Child *confused* and fatigued laps microcitic hypochromic anemia with low ferritin , high TIBC, what treatment ?

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59. A 9-month infant is suspected to have iron deficiency anemia.
CBC and iron profile ordered pending the results. Which of the following indexes is expected to be high?

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60. A 2-year-old girl is seen in the clinic for pallor and Vredness. On examination, she looks healthy with normal vital signs: growth parameter and physical exam apart from conjunctival pallor Blood pressure 90/70 mmHg Heart rate 97 ‘min Respiratory rate 18/min Temperature 36.6 °C Oxygen saturation 95 % (see lab results)
Test Result                                                           Normal Values
RBC 4.5                                                           4.8-7.1 x 1012/L (Newborn) 4.6-48 x 1012A.(ChUd)
Hb 87                                                              165-195 g/L (Newborn) 112-165 (Child»
HCT 0.3                                                          2 0.44-0.64 (Newborn) 0.32-0.42 (Child)
MCH 25                                                           28-33 pg/cell
MCV 74                                                            80-95
Reticulocyte 1.1                                             0.2-1.2%
Platelets count 350                                       150-400 x 109/L
Iron 7                                                               7 2-17.9 pmol/L (Infant) 9-21.5 pmol/L (Child)
Total iron binding capacity 94                      17 9-71.6 pmol/L
Ferritin 12                                                      20-200 pg/L
Which of the following Is the most likely diagnosis?

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61. A 2-year- girl brought to Primary Clinic because the mother noticed she is pale. History of drinking 3 pints of cow’s milk daily and is a very picky eater. The mother gave history of similar presentation on 2 of her brother (see lab results).
Test Result                                                  Normal Values
RBC 3                                                           4.8-7.1 x 1012/L (Newborn)
Hb 4                                                             165-195 g/L (Newborn) 112-165 g/L (Child)
MCH 18                                                         28-33 pg/cell
MCV 62                                                         80-95 fl
Reticulocyte 3                                              0.2-1.2%
Platelets count 480                                    150-400 x 109/L
Ferritin 9                                                      20-200 pg/L
Which of the following is the most likely diagnosis?

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62. A 59-year woman comes to the clinic with headache 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?

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63. A 5-year-old child presented with bruising and skin rash that developed over 24 hours. She had had upper respiratory tract infection a week ago. On examination, she appeared well but had purpura skin rash with some bruises on legs No lymphadenopathy or
hepatosplenomegaly (see lab results).
Test Result                      Normal Values
RBC 4.7                           4.8-7.1 x 1012/L (Newborn) 4.64.8×1012/L (Child)
Platelets count 17             150-400 x 10»’L
ESR    3                                 2-10mnVh
Clotting time 5                      5-10 min
Bleeding time 3                   up to 4 min
APTT 35                             30-40 sec
INR 1.1                                0.9-1.2
diagnosis?

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64. which of following will curable by splenectomy?

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65. Child previous URTI came with petechiae and abrasion Every thing is normal except platelets 15000 ask about Treatment?

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66. A 5-year-old boy is brought to your clinic with generalized petechial rash and bruises all over his body. He had an episode of upper respiratory tract infection (URTI) 3 weeks ago. On examination, he is otherwise healthy. His blood tests is only significant for a platelet count of 74,000/mm3• Red blood cells and white cells are within normal range. Which one of the following is the most appropriate management option in this child?

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67. 4-year-old boy is brought to the emergency department by his parents wit h bruising and a generalized rash for the past two days. He also had an episode of nose bleed this morning that stopped after 10 minutes of pressure and ice application. He also had a runny nose, mild fever and sneezing 10 days ago that was resolved after one week of conservative management. On examination, There are three bruises over the abdomen, right arm and left buttock as well as generalized non -blanching petechial rash over the trunk
and limbs. A full blood count results:
WBC: 9700 (normal: 4,000-11,000)
RBC: 4.2×10 power 12/L (normal: 3.9-5.6x 10 power 12/L)
Hb: 13.7g/dl (normal : 13-18g/dl ) MCV: 90fl (normal: 76-96fl )
Platelet count: 56×10 power 9/L (normal: 150-400×10 power 9/L)
What is most appropriate next step in management?

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68. 7-year-old girl is brought to your practice by her parents, who are extremely concerned about several bruises on the child’s arms, legs and trunk she has developed over the past 2 days. recent medical problem upper respiratory tract infection (URTI) 2 weeks ago with complete resolution. On examination, there are several non-blanching petechial over the trunk and limbs and some bruises. There has been no bleeding event other than bruises and the petechial rash. The rest of the exam is insignificant with no lymphadenopathy or
heptosplenomegaly. A full blood test result :
WBC: 10500 (normal: 4,000-11,000)
RBC: 5×10 (power) 12/L (normal: 3.9-5.6×10(power)12/L)
Hb: 13g/dl (normal . 11.5-16g/dl ) MCV: 85fl (normal: 76-96fl )
Platelet count: 35×10(power)9/L (normal: 150-400×10(power)9/L)
What is next step in management of this child?

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69. Two weeks after a viral syndrome, a 2- year-old child develops bruising and generalized petechiae, more prominent over the legs. No heptosplenomegaly or lymph node enlargement is noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have a normal hemoglobin, hematocrit, and white blood cell (WBC) count and differential. The platelet count is 15,000/μL. Which of the following is the most likely diagnosis?

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70. 3-year-old boy is being evaluated in your general practice. A week ago, he was having upper respiratory tract infection. For the past 2 days, he has been having bruises over his trunk and limbs and a petechial rash over his body. This morning he had an episode of nose bleed lasting about 1o minutes. On examination, he looks well and healthy with no distress. He has no fever. There is no splenomegaly or hepatomegaly. He has several non­ blanching petechiae over his trunk and legs and recent bruises on his body. There is no family history of blood disorders. Complete blood count and peripheral blood smear showed thrombocytopenia
with no morphologic platelet abnormalities. Which one of the following is the most likely diagnosis?

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71. A 50-year-old man presents with 3-months history of jaundice, arthralgia, 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 colour 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 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
Ferritin 400 20-300 pg/l (Male) 20-120 pg/L (Female)

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

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72. A 39-year-old man with asymptomatic hereditary hemochromatosis presentej to the clinic for a check-up (see laD results).
Test Result Normal Values
Alkaline phosphatase 42 39-117 IU/L
Aianlne aminotransferase 20 5-40 IU/L
Aspanate aminotransferase 22 12-40 IU/L
Ferritin 860 20-300 pg/L (Male) 20-120 pg/L (Female)
Which of the following Is the most appropriate management?

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73. A case of young male asymptomatic presented abnormal LFT. He is a smoker and drinks alcohol in the weekends . Labs showed high
AST ALT and slightly high iron and TIBC and very high ferritin (450).
What is the cause of his abnormal LFT ?

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74. The case about febrile neutropenia and treated with ceftazidime and not improving after 10 days what to add?

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75. Q- Patient has leukemia and developed febrile neutropenia what’s the treatment:
Q- Patient was on chemotherapy and after 5 days developed fever with low WBC which of the following is the best initial drug to start the patient on:
Q- Patient with febrile neutropenia, what is the appointment initial antibiotic

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76. An 18-year- 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 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 %

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77. Patient with Mediterranean fever implied by history of fever and similar occurrence in the family asking about which drug to avoid?

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78. A 2-years-old boy presents to the clinic with complain of sudden jaundice, fever for the last 3 days and passage of dark urine. Family history is positive for one brother who has severe neonatal jaundice required exchange transfusion, and they are originated from Mediterranean region (see lab result ).
Blood pressure 110/70 mmHg Heart rate 120 /min
Respiratory rate 22 /min Temperature 38.5 “C
Normal Values
RBC 4 48-7.1 x 1012/L (Newborn) 4 6-48 x 1012/L (Child)
HD 9 165-195 g/L (Newborn)
112-165 gfl. (Child) Reticulocyte 3 0.2-1.2%
Platelets count 300 150-JOO x 109/L
WBC 10 4.5-13.5 x 109/L (2-10 years) 4.5-11.1 X 109/L (11 years-older adult)
Which of the following medications should be avoided in the management?

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79. Smoker and obese female patient on combined OCP, at imagining there is 4×4 cm hepatic hemangioma. What is the most important thing to advise the pt.?

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80. 48 years old male patient known with hyperlipidemia with recurrent history of acute pancreatitis presented with vomiting with hemoptysis 1 day ago, all labs are normal, and on examination, the patient had splenomegaly, on radiological examination, there were normal portal veins with enlarged pyloric varicose veins. What is the diagnosis?

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81. A 45 year old with history of pancreatitis , then recurrent vomiting, + upper GI bleeding After resuscitation what should be done Splenomegaly, normal portal , thrombo-splenic . He became stable after injection of sclerotherapy , which of the following best way to management ?

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82. 52-year-old man comes to the office due to decreased libido and inability to achieve and maintain erections for the past several months. He has also had fatigue, anorexia, and a 5-kg weight loss over the same duration. The patient is married and has one child. He drinks alcohol but does not use tobacco or illicit drugs. Blood pressure is 110/70 mm Hg and pulse is 82/min. Physical examination shows bilateral gynecomastia and firm and small testes.
Laboratory testing shows normal TSH with decreased levels of total triiodothyronine (T3) and thyroxine (T4).

Which of the following is the most likely diagnosis?

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83. hepatitis B patient ultrasound showed nodule ,What is the best next step

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84. hepatitis B patient ultrasound showed nodule ,What is the best next step

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85. A 42-year-old man with hepatitis B cirrhosis evaluated for focal lesion at US abdomen. He is asymptomatic. Currently on diuretics with well-controlled ascites (see lab results and report).
Test Result Normal Values
Hb 110 130-170 gA. (Male) 120-160 g/L (Female)
Platelets count 123 150-400 x 109/L INR 1.5 0.8-1.2 Total bilirubin 16 3.5-16.5 pmol/L
Aspartate aminotransferase 98 12-40IU/L Alanine aminotransferase 65 5-40 IU/L
Alkaline phosphatase 120 39-117 IU/L Albumin 30 34-56 g/L
CT scan of liven Demonstrated a 6 cm lesion with arterial enhancement at RT lobe, portal vein and hepatic veins were patent.
Which of the following is the best treatment option?

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86. A 55-year man with chronic hepatitis C present to the clinic for regular follow-up. His examination reveals a palpable right upper quadrant mass. CT scan of his abdomen shows a large 6*6 cm mass in the right lobe of the liver. A mass biopsy confirms the diagnosis hepatocellular carcinoma
What is the most appropriate management steps at this stage?

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87. Alcoholic patient with Cirrhosis have multiple hypo-dense lesions in the liver?

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88. Which of the following diagnostic tools is the best option for screening for hepatocellular carcinoma in cirrhotic patients?

89 / 100

89.  Patient Complain of cirrhosis after hepatitis C virus. Now treated and hepatitis C virus, mRNA is negative, PE/ unremarkable except for mild angiomata and nevi. To do?

90 / 100

90. A 60-year man presented with jaundice for 2 months. Physical examination revealed a nodular enlarged liver (see report). Showed cirrhotic liver with 2 lesions at right lobe measuring 4 x 5 cm. Which of the following risk factors is strongly associated with this condition?

91 / 100

91. a 47-year-old alcoholic patient with a 6-week history of weight loss, fever, right hypochondrium pain, elevated alpha-fetoprotein, ascites, and a focal liver lesion in a cirrhotic liver, the most likely diagnosis is?
Test Result Nomal Values
Alpha fetoprotein 120 0-40 ng’mL
Abdominal Ultrasound : Showed ascites and focal liver lesion in a cirrhotic liver
Which of the following is the most likely diagnosis?

92 / 100

92. diabetic man rotin follow up asymptomatic HIGH liver ENZYMES , whats the cause :

93 / 100

93. Non-alcoholic hepatostatehorrea ( same mean Non-alcoholic Fatty liver ) what would be your best advice:

94 / 100

94. Elderly with jaundice, RUQ pain (not sure about presentation ) , but investigations shows dilated extra and intra hepatic duct , dx :

95 / 100

95. A 28-year-woman has 2-week history of jaundice and an 11-month history of progressive fatigue and arthralgia. She is not on any regular medication and does not drink alcohol. Her examination reveals hepatosplenomegaly. Viral hepatitis screening tests are negative (see lab results).
Test Result Normal Values
Hb 10 130-170 gA. (Male) 120-160 g/L (Female)
Platelets count 120 150-400 x 109/L WBC 7 4.5-10.5 x 109/L
Total bilirubin 26 3.5-16.5 pmol/L
Aspartate aminotransferase 920 12-40IU/L Alanine aminotransferase 890 5-40 IU/L
Alkaline phosphatase 160 39-117 IU/L Albumin 30 34-56 g/L
Which of the following is the most likely diagnosis?

96 / 100

96. A 36-year-old man presented to the clinic for evaluation of elevated liver enzyme He is asymptomatic with no significant past medical history. He is a smoker and drinks alcohol every weekend. Examination was unremarkable (see lab results and reports).
Total bilirubin 12 3.5-16.5 pmol/L
Aspartate aminotransferase 147 12-40IU/L
Alanine aminotransferase 76 5-40 IU/L
Alkaline phosphatase 119 39-117 IU/L
Albumin 33 34-56 g/L
Iron 3511.7-31.8 pmol/L (Male) 9-30.4 pmol/L (Female)
Total iron binding capacity 34 11.6-31.3 pmol/L (Male) 9-30.4 pmol/L (Female)
Ferritin 423 20-300 pg/L (Male) 20-120 pg’L (Female)
Liver function tests:
Hepatitis screen; Negative HCV, HBsAg was negative with positive HBsAb US Abdomen:
Enlarged liver with no focal lesion.
Which of the following is the most likely cause for his underlying liver disease?

97 / 100

97. A 25-year patient came to the clinic concerned about her sexual relationship after discovering that her husband was diagnosed with hepatitis B and was just started treatment She was tested and all her serology came negative.
What would be the best advice for her sexual relationship with her husband?

98 / 100

98. A 34-year pregnant woman, known case of chronic hepatitis B, comes to the clinic for counselling regarding the risk of hepatitis B transmission to her baby
Test Result Normal Values
Alkaline phosphatase 198 39-117 IU/L
Alanine aminotransferase 120 5-40 IU/L
Aspartate aminotransferase 67 12-40 IU/L
Hepatitis B viral load
1 million copies/ml
Which one of the following the baby should receive to reduce the vertical transmission risk?

99 / 100

99. The patient is known to have hepatitis B. The nurse is known to be vaccinated and a full responder. What will you give the nurse?

100 / 100

100. A 35-year-old nurse is seen in the dime after a recent routine screening for viral hepatitis infection. She was found to have positive antibody to hepatitis C virus (HCV). Her medical history is unremarkable; she has not used drugs or had any history of blood transfusions. She currently feds well and takes no medications. Vital signs and physical examination are normal.
Laboratory studies reveal a positive HCV antibody test but HCV RNA testing is negative
Hb 120 130-170 ga. (Male) 120-160 g/L (Female)
Platelets count 300 150-400 x 109/L WBC 8 4.5-10.5 x 109/L
Aspartate aminotransferase 26 12-40 IU/L Alanine aminotransferase 30 5-40 IU/L
Alkaline phosphatase 80 39-117 IU/L Gamma glutamyl transferase 25 6 to 37 IU/L
Which of the following is the most appropriate action to be done?

Your score is

إختبر نفسك 2

1 / 100

1. A 50-year man referred to the clinic with positive HCV He is asymptomatic with no history of drug use or previous Wood transfusion Physical examination was unremarkable Reviewing of his lab test showed normal LFT with positive ant.-HCV (ELISA). Hepatitis C RNA was negative. US abdomen showed normal liver.
Which of the following is the most appropriate next step in management?

2 / 100

2. what is the meaning of the following liver serology:
Anti-HBc positive
Anti-HBs positive
HBsAg *negative*

3 / 100

3. A 34-year-old man previously healthy brought a laboratory results for hepatitis B virus from test result
• HBsAg Negative
• HBeAg Negative
• Anti-HBc IgG Negative
• Anti-HBsAg Positive
What is the clinical state the laboratory results indicate?

4 / 100

4. Q- Young male c/o fatigue, nausea, vomiting, loss of appetite, jaundice history of eating from outside what is the initial investigation?
Q60-Patient is caucasian and symptoms started when he was introduced to regular food Patient has no history of drug use or alcohol drinking, presented with vomiting, diarrhea and jaundice since 5 days :

5 / 100

5. A 28-year man who was previously healthy, presented to the Emergency Department with 5- days history of right upper quadrant abdominal pain, which was associated with nausea and 2 episodes of vomiting. 2 days later, his family noticed yellowish discolourations of his eyes and skin. No history of alcohol or drug use. On examination, he was jaundiced. Abdominal exam showed tender right upper abdomen
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?

6 / 100

6. A 23-year woman was informed that her husband has chronic hepatitis B infection She was worried that he had transmitted the virus to her. She is currently asymptomatic apart from fatigue. What is the first evidence of acute infection in her case?

7 / 100

7. A 40-year-old woman is noticed to be jaundiced
 Result Test
Anti-HBs Negative
Anti-HBc Positive
HBs antigen Positive
IgM anti-HBc Negative
What is the patient’s hepatitis B status?

8 / 100

8. A 30-year- asymptomatic woman to the clinic as pre-employment screening Her examinations are unremarkable. Her laboratory tests revealed, positive HbsAg , anti-HBc(IgG) and anti-HBe but negative anti-HBs and HBeAg
Which of the following statements is the most accurate?

9 / 100

9. A 23-year woman was informed that her husband has chronic hepatitis B infection She was worried that he had transmitted the virus to her. She is currently asymptomatic apart from fatigue. What is the first evidence of acute infection in her case?

10 / 100

10. A 40-year-old woman is noticed to be jaundiced
 Result Test
Anti-HBs Negative
Anti-HBc Positive
HBs antigen Positive
IgM anti-HBc Negative

What is the patient’s hepatitis B status?

11 / 100

11. A 30-year- asymptomatic woman to the clinic as pre-employment screening Her examinations are unremarkable. Her laboratory tests revealed, positive HbsAg , anti-HBc(IgG) and anti-HBe but negative anti-HBs and HBeAg
Which of the following statements is the most accurate?

12 / 100

12. what is- HCV most common genotype in Saudi Arabia ?

13 / 100

13. Q11- Risk of HCV after needle stick injury?
Q11-a drug addict has HCV positive and the physician accidentally got needle stick injury what is the percentage of transmission ?

14 / 100

14. A 43-year-old man with is known to have chronic hepatitis B presents to the clinic for evaluation. He is asymptomatic with normal physical examination (see lab results and report)
Hb 11.9 130-170 g/L (Male) 120-160 g/L (Female)
Platelets count 145 150-400 x 109/L WBC 3.9 4 5-10.5 x 109/L
Direct bilirubin 17 1.5-6.5 pmol/L
Total bilirubin 21 3.5-16.5 pmol/L
Aspartate aminotransferase 89 12-40IU/L
Alanine aminotransferase 61 5-40 IU/L
Alkaline phosphatase 160 39-117 IU/L
US Abdomen: Showed mild coarse liver echotexture. most appropriate treatment option?

15 / 100

15. A 45-year-healthy man recently diagnosed with hepatitis C virus (HCV) infection and was referred to the clinic for initiation of HCV therapy. HCV RNA viral load quantitation was 2 million lU/ml and a Genotype 4. a Liver ultrasound that was normal with no cirrhosis or focal liver lesions
Test Result Normal Values
RBC 5 4.7-6.1 x 1012/L (Male) 4.2-5.4X 1012/L (Female)
Hb 13 130.170 g/L (Male) 120-160 g/L (Female)
Platelets count 233 150-400 x 109/L WBC 5 4.5-10.5 x 109/L
Alanine aminotransferase 89 5-40 IU/L
Aspartate aminotransferase 56 12-40IU/L
Creabnine 100 44-115 pmol/L
Fibroscan: Showed fibrosis score of F3.
Which of the following Is the recommended treatment?

16 / 100

16. A 62-year patient known case of chronic hepatitis C presented with abdominal pain and swelling Examination showed ascites, abdominal tenderness and peripheral edema Diagnostic ascitic tap done and revealed a neutrophil count of 400/mm (<250 mm) Blood pressure 110/70 mmHg Heart rate 90 /min Temperature 37.6 °C
Which of the following is the appropriate next step in the management?

17 / 100

17. A 60-year-old man presented wrth jaundice for 2 months. Physical examination revealed a nodular enlarged liver (see report).Showed cirrhotic liver with 2 lesions at right lobe measuring 4 x 5 cm. Which of the following risk factors is strongly assoaated with this condition?

18 / 100

18. known case of liver cirrhosis secondary to Hepatitis C has completed treatment. Hepatitis C RNA is negative. How will you follow up this patient?

19 / 100

19. Patient k/c cirrhosis after hepatitis C virus. Now treated and HCV mRNA is negative. on examination unremarkable except for mild angiomata and nevi. what to do?

20 / 100

20. the elevated levels of indirect bilirubin, total bilirubin, AST, ALT, and ALP (alkaline phosphatase) in a 10-year-old child presenting with 2 days of jaundice and fatigue, the most likely diagnosis?

21 / 100

21.  6 YO patient brought by his parents to the hospital because they noticed yellowish discoloration of the sclera. Symptoms started around a week ago. What is the type of hepatitis he has? (No hint at recent travel of needle sticks or eating from contaminated place)

22 / 100

22. acute hepatitis After Restaurant possible cause

23 / 100

23. Q- 6 years old with Jaundice and hepatosplenomegaly what’s is diagnosis ?
Q- child with fever , fatigued, and describes right upper quadrant abdominal pain and nausea. On examination, her skin tone, conjunctivae, and mucous membranes are yellow-tinged diagnosis?

24 / 100

24. A 62-year patient known case of chronic hepatitis C presented with abdominal pain and swelling Examination showed ascites, abdominal tenderness and peripheral edema Diagnostic ascitic tap done and revealed a neutrophil count of 400/mm (<250 mm) Blood pressure 110/70 mmHg Heart rate 90 /min Temperature 37.6 °C
Which of the following is the appropriate next step in the management?

25 / 100

25. A 60-year-o!d man presents with low-grade fever, insomnia and progressive abdominal distention with vague abdominal pain. Physical examination reveals flapping tremor and moderate ascites Ascitic fluid analysis showed high SAAG and neutrophil count of 350 cells/L Which of the following is the most appropriate management?

26 / 100

26. Case of chronic Cirrhosis presented to the ER for decrease level of consciousness for 2 days, PE shows Tense abdomen + lower limb edema, What to do next?

27 / 100

27. Q- Patient did hernia surgery years ago. He has Cirrhosis with progressive ascites. Hernia is present now with cough test. What to do?
Q-another recall : 60y pt with chronic liver disease and ascites came complaining with umbilical hernia. How to treat it?

28 / 100

28. Elderly with signs of heart failure ( lung crpeteaion , lower limb edema , raised jvp ) has a small ventral hernia booked for elective surgery :

29 / 100

29. Women K/C of liver cirrhosis, + ascites, confused. Na level: 126 (normal 135 to 145) Potassium level: within normal range Glucose: 8 (normal 3.9 to 5.5 mmol/L)

30 / 100

30. Q- Cirrhosis patient. Which of the following drugs prevent recurrence of ascites ?
Q- A 48-year-old man with a history of cirrhotic liver disease presents with abdominal distension. Clinical examination reveals tense ascites, which was drained. What is the appropriate type of diuretic to help prevent re accumulation of ascites?

31 / 100

31. Patient known to have liver cirrhosis due to hepatitis C infection presents with ascites which did not respond to repeated paracentesis. Which of the following is the appropriate management?

32 / 100

32. woman with hepatomegaly underwent upper abdomen MRI and found to have a 3cm lesion In the liver that shows peripheral beaded enhancement in the early phase with progressive central filling in the delayed phase.
Which of the following is the most likely diagnosis?

33 / 100

33. Patient with hepatic benign tumor diagnosis is hemangioma (mentioned), decided to be managed conservatively, but we should advise the Patient to ?

34 / 100

34. Smoker and obese patient, at imagining there is 4×4 cm hepatic hemangioma. What is the most important thing to advise the pt ?

35 / 100

35. an 18 -month-old- child presents to the emergency center having had a brief, generalizing tonic-clonic seizure. he is now postictal and has a temperature of 40 c (104 f) during the lumber puncture (which ultimately proves to be normal), he has a large, watery stool that has both blood and mucus in it. which of the following is the most likely diagnosis in this patient?  

36 / 100

36. Pediatric patient with shigella toxin positive

37 / 100

37. female presented with back pain and fever, she was given NSAIDs and advised for bed rest at home, then presented with inability to move lower limbs, O/E tenderness on the midback. Spinal MRI: Diffuse discitis on T6, What is the most appropriate next step?

38 / 100

38. 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?

39 / 100

39. patient is receiving clindamycin and ceftazidime as treatment for endometritis after a cesarean section. the patient subsequently develops diarrhea, and stool testing reveals the presence of bacterial enterotoxin. What is the most appropriate course of action?

40 / 100

40. A 34-year-old man, a known case of ulcerative colitis on azathioprine 100mg/day with tapering doses of steroids, presented to the clinic with 6-7 episodes of bloody diarrhea, lower abdominal pain, and low-grade fever. On abdominal examination, there was mild tenderness in the left lower abdomen. Stool culture was negative, but the stool test for Clostridium difficile toxins was positive (see lab results).
Blood pressure: 110/70 mmHg
Heart rate: 100/min Temperature: 38.4 °C
Oxygen saturation: 95%
Test Results (Normal Values):
• RBC: 5 (4.7-6.1 x 10^12/L for males, 4.2-5.4 x 10^12/L for females)
• Hb: 11 (130-170 g/L for males, 120-160 g/L for females)
• Platelets count: 456 (150-400 x 10^9/L)
• WBC: 16 (4.5-10.5 x 10^9/L)
• ESR: 67 (2-10 mm/h for males, 3-15 mm/h for females)
• Albumin: 29 (34-56 g/L)
Which of the following is the most appropriate treatment?

41 / 100

41. 53-year-old woman with a known history of diabetes recently returned from Egypt. She presented to the Emergency Department with a 3-day history of progressive redness and pain on her right shin. She has a positive history of allergy to penicillin. On examination, her right leg had a red lesion, which was tender but without an ulcer. She was started on oral antibiotics. The next day, she complained of abdominal pain, watery diarrhea, and fever (temperature 37.8°C). What is the most likely diagnosis?

42 / 100

42. old man came complain of tender abdominal bloody stool and history of take amoxicillin from 3 wks for UTI sigmoidoscopy inflamed mucosa with plaque like lesions?

43 / 100

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

44 / 100

44. 16YO with camping presents after 7 days of Flatulence and greasy foul-smelling diarrhea, when asked about his camping
activities, he reports that his friend collected water from a stream but did not boil or chemically treat the water before they drank it, reports nausea, weight loss and abdominal cramps followed by sudden diarrhea, what is the most appropriate treatment?

45 / 100

45. 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 ?

46 / 100

46. 17y man complains of intense left flank pain that radiates to the groin, stone passage, which he has experienced so many times since
childhood, his uncle had the same problem, urinalysis shows hexagonal crystals, the urinary cyanide nitroprusside test is positive, cause of this condition?

47 / 100

47. signs of infection diagnosed as deep aspergillosis, What is the treatment?

48 / 100

48. A 62-year-old woman comes to the emergency department due to 3 days of fever, chest pain, shortness of breath, and cough. The cough has been occasionally productive of small amounts of bright red blood. The patient was diagnosed with giant cell arteritis a month ago after developing new headaches, jaw claudication, and transient vision loss. She was started on high-dose prednisone, which has since been tapered to 40 mg daily. She also has a history of hypertension, which is well controlled with amlodipine. The patient has a 30-pack-year smoking history. Temperature is 38.4 (101.1 F), blood pressure is 120/72 mm Hg, pulse is 94/min, and respirations are 18/min; oxygen saturation is 93% on room air. Physical examination shows a frail woman in mild distress with moist mucous membranes and no lymphadenopathy. Lung auscultation reveals occasional crackles in the left lung. Leukocyte count is 7,400/mm3 with 15% neutrophils, hemoglobin is 13.2 g/dL, and creatinine is 0.8 mg/dL. CT scan of the lungs reveals a 1-cm cavitation and multiple nodules surrounded by ground-glass infiltrates. The patient is admitted to the hospital and started on empiric broad-spectrum antibiotics.
Further laboratory results are as follows:
Serum and urine Histoplasma antigen negative Serum and urine Blastomyces antigen negative Serum galactomannan positive. Blood cultures no growth to date Sputum cultures mixed bacterial flora
What is the most likely diagnosis in this patient?

49 / 100

49. 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?

50 / 100

50. 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 ?

51 / 100

51. Long case with Kayser–Fleischer ring and low Ceruloplasmin how to treat?

52 / 100

52. 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?

53 / 100

53. Question of a coworker how got exposed and spilled on himself radioactive fluid what he should do next ?

54 / 100

54. 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?

55 / 100

55. Burn patient, resuscitation done, which of the following reflect a good resuscitation has been achieved?

56 / 100

56. 25% Total body surface area(TBSA) burn case what would be present ?

57 / 100

57. Female patient had massive burn 40% she is intubated with 100% o2 How to determine her outcome by ?

58 / 100

58. burn patient and resuscitation done, which of the following reflect a good resuscitation has been achieved?

59 / 100

59. 70 kg with 2nd degree burn, head and right arm . How would you resuscitate?

60 / 100

60. An 18-year man involved in bum accident, he has 2nd degree bum to his both lower limbs Weight 70 kg , Using Parkland formula, which of the following is most appropriate fluid resusatation?

61 / 100

61. Pt with stroke, confirmed by imaging haemorrhage asking Most definitive treatment of haemorrhage stroke?

62 / 100

62. Patient presented with left side hemiparesis , absent gag reflex and fecal incontinence of tarry stool diagnosed as stroke what is the best next step :

63 / 100

63. 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?

64 / 100

64. 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

65 / 100

65. 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?

66 / 100

66. Elderly pt after fall down had altered level of consciousness, Ct brain shows extradural hematoma..
which artery injured?

67 / 100

67. A 73-year-old diabetic man presents with right-sided weakness.
The weakness is equal in the right face, arm and leg. Sensation, speech and comprehension are intact. Which of the following arteries is affected?

68 / 100

68. Elderly man brought by his wife to the ER with a change in personality.
He is medically free. Left leg power is 2/5 with loss of sensation in the same leg. All other limbs are normal. Where is the lesion?

69 / 100

69. patient has a sudden onset of seizure. He is medically free, has no family history of epilepsy, and no history of recent infection. He has never had any previous episodes of seizures or lapse in consciousness. He is not on any medications. Electrolytes and other blood tests were all normal.
What is the next investigation that should be done for this patient?

70 / 100

70. Case of stroke came in 4 hours what is the most important next step ?