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 ?

71 / 100

71. 52s woman comes to the ed due to speech arrest and right arm weakness. The symptoms began suddenly at breakfast but resolved after 30 minutes, the patient has a history of relapsing-remitting multiple sclerosis. Three months ago she was hospitalized due to blurry vision in the left eye, which was treated w/ corticosteroids and improvement after several weeks. The patient’s other medical issues include HTN and hyperlipidemia. She is currently not taking any disease-modifying therapy for her MS. BP is 170/96 and pulse is 92. BMI is 35kg there is a mild afferent pupillary defect in the left eye w/ diminished visual acuity, which of the following is the next step in treatment of this patient?

72 / 100

72. 55 Years old male DM type 2 Complain of left arms weakness for 5 hour then improved before 2 days , Now on examination everything normal no carotid beruit except new cardiac murmur noticed on auscultation What is the initial investigation ?

73 / 100

73. Female patient came with history of sudden loss of vision in the left eye that resolved spontaneously after 60 minutes What is the most likely diagnosis?

74 / 100

74. 25-year-old female known case of epilepsy came with generalized tonic clonic seizure for 35 minutes and started on 20 mg IV lorazepam but did not respond, what are you going to give her next?

75 / 100

75. An 18-year boy known to have epilepsy since childhood is brought to the Emergency Department after having repeated tonic-donic seizures at home. He is compliant with his medication, which is sodium valproate. In the Emergency Department, he is unconscious and continuously convulsing, After oxygenation and securing which of the following intravenous drugs should be administered?

76 / 100

76. A 9-month-old Infant presents to Emergency Room with active generalized tonic-clonic seizure for 5 minutes ago. He has flu-like illness today and the review of system was unremarkable. The child was connected to cardiopulmonary monitor and intravenous access immediately attained. Blood pressure 80/50 mmHg Heart rate 132/min Respiratory rate 31 /min Temperature 39.6 “COxygen saturation 95 % which of the following Is the most appropriate next step In management?

77 / 100

77. 5 month old infant. mother brought him to clinic because he stopped smiling and low activity. While examining the patient, he suddenly started to flex his arms and legs with back arching and jerkiness. What is the possible finding on ECG?

78 / 100

78. 4 months on breastfeeding, This is her first baby came with 2 days history of lethargy constipation, fever, response weak when light directed to his eyes , long scenario cause ?

79 / 100

79. 17- days old baby brought to the hospital because of reluctant to feed and seizure since last night. On exam the baby weight is 3Kg, inactive, has generalized increased tone. CSF: clear, Glucose 3 mmol (normal 2.8-5), protein 0.22 (normal 0.22-0.33), cells 10 (normal up to 10). Which of the following is the most likely diagnosis?

80 / 100

80. 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?

81 / 100

81. 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?

82 / 100

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

83 / 100

83. A 6 years old was brought by his parents with history of sudden abrupt loss of environmental awareness with lip smacking followed by sudden return to normal baseline. Brain Imaging= Normal, EEG= 3-Hz spikes Which of the following is the most appropriate diagnosis?

84 / 100

84. 7 yeas came with history of focal seizures in upper limps that lasts 7 minutes. He is aware to surroundings Seizer happened in the morning Cause

85 / 100

85. years old girl HER mother noted 8 abnormal movements in form of tonic colonic some time associated with mouth deviation and last few seconds and resolve with out intervention and in the morning she noticed the same movements when the patient comb her hair and resolve, systemic review and .examination unremarkable EEG-show Focal sharp spick in the cenrto-temporal area What is the DX?

86 / 100

86. Female pt complaining of amenorrhea for 4-months T4 low Prolactin 200 What the diagnosis

87 / 100

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

88 / 100

88. A 40-year woman was incidentally detecied to have a 13-mm pituitary macro-adenoma on a CT of the head arranged to evaluate cause for her recurrent headaches. Apart from the headaches that she had suffered for the last 8 months, she had no history ol any significant medical illness and was not on any regular medications. Her general physical and systemic examination was unremarkable. Which of the following is the most appropriate next step in her management’’

89 / 100

89.  -patient complain of Erection, Thyroid hormone normal

90 / 100

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

91 / 100

91. Q-Patient with history of thyroid nodules also she have milky discharge from the breast and amenorrhea since 6 m lap result show that TSH high T4 high Prolactin level 6000 very high , What is the most appropriate management?
Q-Patient was present with hyperthyroidism symptoms (Weight loss, ect) and there were small Goiter in the neck, she missed her period lately, and develop milky discharge from nipples. What will you do ?

92 / 100

92. Y.O female diagnosed with hyperprolactinemia for one year on cabergoline. Which of the following is an indication for brain MRI in this patient?

93 / 100

93. patient came with low libido and low activity BMI 40 ,refer to endocrinologist FSH LH TSH T3 low ,MRI brain show 2.5 cm pituitary adenoma what’s most likely dx?

94 / 100

94. A 55-year-old man presents with excessive sweating and headache. An oral glucose toferance test and MRI brain were ordered to confirm the diagnosis of acromegaly. What other investigation will De required in the future?

95 / 100

95.  A 33-year-woman is evaluated in the Emergency Department for the sudden severe headache, vomiting and right eye vision toss she has had mild headaches that come and go over the past 2 years and for amenorrhea for the past 2 years On physical examination, she has loss of vision in her right eye, other cranial nerves are intact. Strength and sensatton in all extremities are normal, as are her speech and gait (see reports).
CT of the head: Shows acute pituitary hemorrhage.
Pituitary MRI: Shows a 4 1 x 2.5 x 3.2-cm pituitary mass compressing the opt>c chiasm and the right cavernous sinus with central haemorrhage.
Blood pressure 120/65 mmHg Heart rate 99 /min
Respiratory rate 15/min Temperature 37 °C
BMI 25 kgfm2
Which of the following is the most appropriate immediate management in the Emergency Room?

96 / 100

96. A 44-year-man is evaluated for an 8-month history of decreased libido and severe erectile dysfunction, including absence of morning erections. He and his wife would like to conceive. His medical history is otherwise unremarkable, and he takes no medications. On physical examination, vital signs are normal with unremarkable clinical examination (see lab results and report). 
Test Result                                                                Normal Values
Thyroid-Stimulating Hormone 2.5                            0.4 – 5.0 pU/mL
Follicle-stimulating hormone 1.2                            5-20IU/L (Follicular phase) 15-35 IU/L (Mid cyde peak) 5-15 IU/L (Luteal phase)                                                                                          50-100 IU/L (Postmenopausal women)
Testosterone 4.2 10.4-416 nmoVL (Male)               0 7-2.8 nmol/L (Female)
Luteinizing hormone 1.0 3-15 U/L (Male)
5-22 UA. (Follicular phase) 5-22 U/L (Luteal phase) 30-250 U/L (ovulatory phase) > 30 U/L (Postmenopausal)
Prolactin 1500                                                   < 652 pmol/L (Male) < 870 pmoVL (Female)
MRI of the piturtary : Reveals a 0.8-cm anterior pituitary mass consistent with an adenoma. Which of the following is the most appropriate treatment?

97 / 100

97. Case about Acromegaly, female patient care with bitemporal hemianopia and obstructive symptoms (prolactinoma) *definitive* management

98 / 100

98. A 48-year-old woman has a 2-year history of a slowly progressive bilateral tremor. The tremor interferes with her writing and eating. She has recently noted head bobbing and a change in her voice. Which of the following would be an appropriate first-line medication for her problem?

99 / 100

99. Shuffling gite , tremor what is the diagnosis?

100 / 100

100. one of this is Symptoms Of Parkinson

Your score is

إختبر نفسك 3

1 / 100

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

2 / 100

2. Clear case scenario with Mask face, bradykinesia, tremors what is the diagnosis ?

3 / 100

3. 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?

4 / 100

4. Calculate cerebral perfusion pressure MAP= 65 ICP= 15 ?

5 / 100

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

6 / 100

6. A 67-year man comes to the clinic complaining that he has a tremor in the right hand. It is best displayed when he reaches for a pen and is manifested easily in the finger-to-nose test. In which of the following locations is the lesion’

7 / 100

7. Child 3 years presented with his mother to the clinic complaining of night walking after 3 hours of sleep and agitation, screaming and tachycardia (i suspect sleep terror disorder

8 / 100

8. A mother brought her 4 years old child cause he frequently wakes up in the middle of the night setting on the bed , eyes opened but unresponsive for 2-3 min then he go back to sleep , in the morning he doesn’t remember what happened?

9 / 100

9. Old female with history of epilepsy had seizure and fell down the stairs, presented with back pain with urine and fecal incontinence and inner thigh pain, what is the appropriate management?

10 / 100

10. Q- Question about women who have gradual loss of vision, affection of right part of the face, the left side of the body affected with hyperflxia and weakness and decrease sensation on the part effected symptoms.. asking what is the appropriate investigation?
Q_ Young age patient with multiple neurological symptoms in different parts of the body in different times in past 2 years, what is the best diagnostic test?

11 / 100

11. 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 ?

12 / 100

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

13 / 100

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

14 / 100

14. patient 60 years old wants prophylaxis for meningitis?

15 / 100

15. 7 years old baby with sign of meningitis on CSF analysis you found gram positive diplococcai what is treatment? 

16 / 100

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

17 / 100

17. late complication of meningitis? 

18 / 100

18. 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? 

19 / 100

19. bacterial meningitis in 14 month child, Gram positive cocci, what is the management?

20 / 100

20. Neonate came with fever and poor feeding full septic screen done including lumbar puncture lumbar puncture + diplococci Management

21 / 100

21. An adolescent girl presents with fever, headache, and myalgia. After a few hours, she developed a petechial rash. On examination, she has a mottled skin and her extremities are cool. Kernig’s sign is positive. What is the most likely diagnosis?

22 / 100

22. There was a tricky Q about pt develop sudden headache when he was bending to take his keys from the ground, describe it as severe headache in his life which is the most likely diagnosis ?

23 / 100

23. headache with eye symptoms (Cluster headache) what is acute management ?

24 / 100

24. -headache at 3 am with eye symptoms what is best prophylaxis ?

25 / 100

25. Female, with 6 months headache, unilateral, mild relieved to NSAID, now came with nausea and vomiting, neuro and fundus  examination normal, how to reach diagnosis?

26 / 100

26. A young female presents with unilateral throbbing headache. Her headache is associated with nausea and vomiting. She tells you that she is sensitive to light. Which of the following is used for acute treatment?

27 / 100

27. Migraine patient doesn’t want daily drug as a prophylactic therapy. Treatment ?

28 / 100

28. Man awake from his sleep at night with severe unilateral headache last less than one hour. And the attack is repeated every day at night what’s the prophylactic that you can give for him?

29 / 100

29. Man awake from sleep at night with sever unilateral headache last less than one hour, and the attack is repeated every day at night what is the prophylactic that you can give for him?

30 / 100

30. Migraine patient and has headache 3-4 times a week , (unilateral sensitive to the light , nausea , vomting .. etc ) headache that is throbbing and unilateral aggravating with light and movement: Asked about acute management:

31 / 100

31. Lady with migraine ,during pregnancy it improved. trying to reduce work stress. What is best accomplishment of preventing migraine attack?

32 / 100

32. Clear case with headache that is throbbing and unilateral aggravating with light and movement

33 / 100

33. 17-year-old girl complained of anorexia nervosa was admitted for initiation of nutrition, the blood samples revealed hypophosphatemia, hypokalaemia, hypomagnesemia, what is the cause of the laboratory investigation?

34 / 100

34. Q-17y girl with refusal to maintain a weight within a normal range for her height and age, fear of weight gain, severe body image disturbance and amenorrhea for >3 cycles, what is the diagnosis?
Q-Patient BMI 18 but think of oneself as obese thus dieting, Diagnosis?

35 / 100

35. Q- Loss of sensation of lateral of left calf and lateral of left foot with back pain , what is the level of lesion?
Another recall : Old lady complaining of pain in calf and lateral aspect of her leg, she have spinal stenosis. Where are the level of stenosis she have ?

36 / 100

36. female complain of back pain with morning stiffness, bilateral knee and ankle pain.
Examination showed limited range of motion of the back, bilateral knee arthritis and tenderness over the achilles tendon. Labs: high ESR. What is your diagnosis?

37 / 100

37. Case of back pain and the diagnosis was written (Lumbar Spinal stenosis). What is the appropriate management?

38 / 100

38. 65 year old patient known to have spinal stenosis. He presents with central back pain. His pain starts in the morning and usually resolves after 30 minutes with no treatment. Yet, his symptoms improve with acetaminophen. Upon examination, you found mild paraspinal muscle spasm. Which of the following is the most appropriate management?

39 / 100

39. Female came to the clinic complaining of lower limb pain upon walking 50 meters. The pain is relived when walking uphill or with bending her back. The pain is aggravated by walking downhill. Physical examination showed stooping gait and normal other exams.
What is the most likely diagnosis?

40 / 100

40. 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?

41 / 100

41. A 3-year-old boy presents with acute knee pain for several hours. His temperature is elevated. On examination, the knee is swollen, erythematous, and there’s limitation of range of motion. He’s refusing to bear weight. Which of the following tests is the most important to obtain?

42 / 100

42. 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 ?

43 / 100

43. Baby with septic arthritis (scenario not directly saying the diagnosis) what is the best study:

44 / 100

44. Patient known case of RA now presented with acute knee pain, swelling, redness and effusion, synovial fluid analysis showed WBC: 35000, culture pending, febrile and tender on examination, what to do?

45 / 100

45. A 4-year-old boy previously healthy came to the clinic with history of limping for the last 2 days. On physical examination, he is keeping his left leg flexed and refusing to move it or allowing anyone to touch it. Imaging is showing effusion of the
left hip.
Blood pressure 90/61 mmHg
Heart rate 126’min
Respiratory rate 29 /min
Temperature 38.8 ‘C
Oxygen saturation 98 %
Which of the following is the most likely causative organism?

46 / 100

46. A 63-year. woman known diabetic for the last 20-years on insulin, presented to the Emergency Department with 3-days history of right knee pain and swelling. Right knee exam-nation revealed, red. swollen and tender with severely limited range of
movement. Other joints were normal (see lab result and report).
Temperature 39 ºC
Test Result Normal Values
WBC 17 4.5-10.5 x 109/L
Synovial fluid:
WBC: 55.000
Crystals: Pending
Culture: Negative
Which of the following is the most likely diagnosis?

47 / 100

47. left thigh sarcoma how to assess metastasis:

48 / 100

48. The most common site of distant spread of sarcomas is the ?

49 / 100

49. Patient known case of HTN, DM, with chronic joint pain on paracetamol with minimal improvemt what to give him?

50 / 100

50. Typical of Osteoarthritis case improve on ibuprofen and paracetamol, what’s the next?

51 / 100

51. A 71-year old man with history of osteoarthritis and previous cervical laminectomy for degenerative cervical myelopathy presents with a 2-month history of worsening gait instability and urinary urgency. Which of the following is the most likely explains his
symptoms?

52 / 100

52. A 75-year-old man with difficulty walking and left-sided leg weaknesses due to osteoarthritis of the hip. In which hand should a cane be used by this patient?

53 / 100

53. A 50-year-old woman presented to the clinic with polyarthralgia affecting distal and proximal interphalangeal joints bilaterally for 3 years. She does not have significant early morning stiffness. Clinical examination revealed no active arthritis, but there were
non-tender hard nodules over some distal interphalangeal joints (see lab results).

Test result

Hb 140

Platelets count 190

WBC 11

ESR 15

C-reactive peptide 5

Rheumatoid factor 30

Urea 4

creatine 75

Normal values

Hb 130-190 g/L (Male) 120-160 (Female)

Platelets count 150-400 *10^9 g/L

WBC 4.5-10.5 * 10^9 g/L

ESR 2-10 mm/h (Male) 3-15 mm/h (Female)

C-reactive peptide <8.2 mg/L

Rheumatoid factor <58 KIU/L

Urea 2.75-7.4 mmol/L

Creatine 44-115 pmol/L

Which of the following is the most likely rheumatological disease?

54 / 100

54. A 75-year-old man with difficulty walking and left-sided leg weaknesses due to osteoarthritis of the hip. In which hand should a cane be used by this patient?

55 / 100

55. 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 ?

56 / 100

56. 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?

57 / 100

57. A 65-year-old woman presented to the clinic with a 5-day history of pain and swelling in the left knee. Her pain is aggravated by walking and relieved by rest. There is no history of small joint involvement or significant morning stiffness. On examination, the left knee is swollen but not warm or erythematous. Left knee X-ray shows osteophytes and joint space narrowing. Joint aspiration reveals 280 leukocytes/mm³ (see lab results).
Blood pressure: 140/80 mmHg
Temperature: 36.6 °C
BMI: 35 kg/m²

test result

Hb 125

platelets count 300

WBC 11.5

ESR 8

Normal values

Hb 130-170 g/L (Female)

platelets 150-400 * 10^9/L

WBC 4.5-10.5 * 10^9 /L

ESR 2-10 mm/h (Male) 3-15 mm/h (Female)

Which of the following is the most likely arthritis?

58 / 100

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

59 / 100

59. Old women with knee pain in the morning that relief with rest and increase with walking?

60 / 100

60. Adolescent patient with tenderness all over the tibial tuberosity he recently had a growth spurt what is the most likely diagnosis:

61 / 100

61. Female patient complains of medial knee pain that increases with activity , tenderness on medial knee, Diagnosis?

62 / 100

62. on microscope there is calcium pyrophosphate crystals what is diagnosis ?

63 / 100

63. Patient presented with feature of gout attack first line ?

64 / 100

64. Patient came with sever joint pain, needle like crystals, negative birefringent, (its acute attack). What Medication contraindicated in acute crystal-induced arthritis?

65 / 100

65.  A58-year-old man presents to the Outpatient Clinic with very severe pain, swelling, and redness of the first metatarsophalangeal joint. Some joint fluid is withdrawn (see lab results and reports).

Test result : 
• Color: yellow
• Clarity: clear
• WBC per mm³: 100,000
• PMNs: 75%

Normal values:

Color: yellow
• Clarity: clear
• WBC per mm³: <200
• PMNs: < 25%

Fluid Exam: Negatively birefringenturate crystals are seen on polarizing examination of the synovial fluid.
Hands X-ray: Juxta-articular punched-out sclerotic erosions involving the first metatarsophalangeal and interphalangeal joints with associated per articular soft tissue swelling. Which of the following treatments should be avoided in the current situation?

66 / 100

66. A 40 YO male came with pain and swelling of first metatarsophalangeal joint , upon examination there is swelling and redness. He is febrile. What is the diagnosis?

67 / 100

67. Typical case about gout (big toe inflamed and tender), Patient presented with right metatarsal Swelling and redness also he has fever ,what are the possible causes?

68 / 100

68. Typical case about gout (big toe inflamed and tender), what is the name of deposited material . What is the characteristic of gout crystals?

69 / 100

69. A 32-year-old man comes with a history of right ankle swelling that occurred t night before. He has noticed that his ankle has been red, warm, and very painful. H occasionally drinks alcohol. On examination you find a red swollen ankle with evidence of an effusion.
The range of motion is restricted. . What is the characterist of gout crystals ?

70 / 100

70. In an elderly patient with numerous comorbidities, notably a history of gout, and a recent presentation with decompensated heart failure, having received aspirin, Lasix, and Plavix, which medication is most likely to be implicated in the subsequent development of acute gout 1 week later?

71 / 100

71. A 28-year-old woman referred to the clinic with 3-week history of generalized fatigability, malaise, arthralgia, back pain and fever. Positive history of raw milk ingestion. Abdominal examination. mild hepato-splenomegaly (see lab results and reports). Temperature 38.5 ºC Test Hb 10.5 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 120 150-400 x 109/L Blood culture: Gram negative cocco-bacllll.
MRI of the back: Sacroiliac joint spondylitis. Which of the following is the optimal duration of therapy?

72 / 100

72. Brucellosis in joints only. Doxycycline treatment for how long?

73 / 100

73. Q_Case of brucellosis with neuro sx .. pt on doxycycline and streptomycin. What is the most appropriate duration of the treatment?
Q- Another recall : Q-Treatment duration for brucellosis with neurological symptoms:
Q- Another recall : Patient was diagnosed with neuro-brucellosis for how long the treatment ?
Q- A 43-year man was recently diagnosed with neurobrucellosis. He Is started on rifampicin (600 mg/day) and doxycycline (100 mg twice daily orally). Which of the following is the recommended treatment duraton

74 / 100

74. Patient with clear case of brucellosis. Hx of Drinking unpasteurized milk. Which if the following is the first line treatment of brucellosis?

75 / 100

75. A 41-year-old veterinarian man presents with 3-months history of progressive fatigue, back pain and fever. He also noticed a recent history of headache, mood ‘behaviour changes and paraesthesia. He does not smoke and with no history of alcohol or other significant medical history. On examination, he was uncooperative and agitated. Abdomen examination showed mild hepatosplenomegaly and tender right sacroiliac joint (see lab results).
Blood pressure 110/70 mmHg Head rate 86 /min Temperature 38.6 C Hb 98 130-170 g4. (Male) 120-160 gA. (Female) Platelets count 122 150-400 x 109/L WBC 8 4.5-10.5 x 109/L
Which of the following is the most appropriate next step in management

76 / 100

76. A 43-year veterinarian man presents with 2-months history of progressive fatigue, back pain and fever He also noticed a recent history of headache, mood /behaviour changes and paraesthesia. He is does not smoke with no history of alcohol or other significant medical history. On examination, he was uncooperative and agitated. Abdomen examination showed mild hepatosplenomegaly and tender nght sacroiliac joint (see lab results).
Blood pressure 110/70 mmHg Heart rate 88 /min Temperature 38.6 ºC RBC 4 4.7-6.1 x 1012/L (Male) 4
2-5.4 x 1012A. (Female) Hb 93 130-170 gA. (Male) 120-160 gl (Female) Platelets count 120 150-400 x 109/WBC 9 4.5-10.5 x 109/L Which of the following is the most likely diagnosis

77 / 100

77. Paediatric patient family was camping drinking alot of unpasturized milk with fever , loss of weight and appetite, night sweats, Back pain nodular tender lower back pain. Diagnosis ?

78 / 100

78. Patient with reactive arthritis ,coming with active pain give ?

79 / 100

79. A 40-year man presented to Emergency Department with fever and painful swelling in the left knee for 2 days. 2 weeks ago, he had watery, non-bloody diarrhea and abdominal pain for 5- days after eating from a restaurant On physical examination, left knee is warm and lender, with a moderate effusion. The right wrist is mildly swollen and tender. The left Achilles tendon is mildly tender and swollen at its Insertion into the calcaneus. Blood, stool and synovial cultures are negative. However, testing for Clostridium difficile toxin is positive (see lab results). Blood pressure 140/90 mmHg , Heart rate 76 min , Temperature 38.5
Test Result Normal Values
ESR 75 2-10 mnVh (Male) 3-15 mm/h (Female)
WBC 18 4.5-10.5 x 109/L
Uric acid 260 200-410 pmol/L (Male) 140-360 pmol. (Female)
C-reactive peptide 20 <8.2 mg/L
Rheumatoid factor 35 <58 klU/L
Which of the following is the most likely Arthritis

80 / 100

80. Young girl with diarrhea came with left knee swelling, right elbow, left Achilles tendon. Stool analysis shows +ve clostridium toxins. What is the dx?

81 / 100

81. Cause of psoriasis (pathophysiology)

82 / 100

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

83 / 100

83. Patient with psoriasis.. best regarding bathing?

84 / 100

84. 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?

85 / 100

85. patient who had right big toe pain and because of that “written like this” he was diagnosed with gout and treated with allopurinol. He’s a known case of psoriasis.
He presented now with right big toe pain, right ankle pain and bilateral knee pain and there was no improvement with allopurinol. What’s the diagnosis? Labs shows high uric acid

86 / 100

86. Patient known case of schizophrenia on two medications had abnormal orofacial and limb movements What is the most likely explanation?

87 / 100

87. Patient with schizophrenia, which of the following medications treat both negative and positive symptoms?

88 / 100

88. Clozapine for which disease?

89 / 100

89. Women with Auditory hallucinations, starts to think that these voices tell others what she thinks of. What’s the most likely diagnosis?

90 / 100

90. 21 year old college student, came with her parents, they said she had four month ago auditory hallucinations, she believed that the TV inserted ideas in her brain and she had social issues and withdrawn from the last semester, but no mood issues, then now she become fine and retuned normal. What is the diagnosis?

91 / 100

91. A young has symptoms of delusions false believes… etc since 3 months . What is the Diagnosis ?

92 / 100

92. A young has symptoms of delusions false believes… etc since 3 months . What is the Diagnosis ?

93 / 100

93. 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 :

94 / 100

94. Q- Drug abuser comes to er a lot, complains of issues but acts normal when nobody is looking.
Q- young adult, drug addict came to the hospital acting like he was sick and when the doctors looked away he was acting fine what is this?

95 / 100

95. 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?

96 / 100

96. A father dies and his son upon hearing the news experiences auditory hallucinations, disorganized speech and thoughts for one day with full return to premorbid level of functioning

97 / 100

97.  Patient presented with psychomotor agitation, grandiose delusions, auditory hallucinations, flight of ideas, and lack of insight, what does he have?

98 / 100

98. Pt came to the clinic; he is talkative jumping from topic to topic without completing each one. What is this called?

99 / 100

99. Female with self-inflicted injuries on the wrist, because she thought her therapist abandoned her. He claims she her voices but when asked she denied. She caused a problem between psychiatry resident doctor and head nurse over her condition. What type of personality disorder ?

100 / 100

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

Your score is

إختبر نفسك 4

1 / 100

1. 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?

2 / 100

2. 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?

3 / 100

3. Which disorder present with mania?

4 / 100

4. Case of social phobia treatment?

5 / 100

5. – Postpartum female who is not sleeping and not eating, she has postpartum depression what, way to optimize her treatment?

6 / 100

6. Q-Female with postpartum depression for 5 days, the baby is breastfed well, but she is sad and cry, what is appropriate initial step?
Q- A women delivered her baby 5 days ago. Her baby is healthy and breast feeding. She looked depressed, teary eyes, and had insomnia. How would you manage?

7 / 100

7. mother postpartum  but after 1 week it resolve . What is the diagnosis?

8 / 100

8. -Elderly with depression. He is on 30 mg amitriptyline taken at night. In the morning, he feels dizziness. What will you do

9 / 100

9. Alternative treatment for severe depression?

10 / 100

10. 2.5-year-old girl seen m the screening clinic. The mother gave history of yelling, hitting and saying “no” with other oppositional behaviour. Which of the following is the most appropriate counselling should be given?

11 / 100

11. 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?

12 / 100

12. Women with history of insomnia and crying for 5 days due to sibling death , what is the quick drug to used?

13 / 100

13. Q– What drug cause insomnia and headache ?
Q — lady who lost her close friend in grief and complaining from trouble sleeping Which is drug causes ?

14 / 100

14. drugs cause irritation and anxiety and insomnia:

15 / 100

15. Q_ Which of the following antidepressants causes constipation?
Q-Pt on antidepressant then developed constipation, Which class of antidepressants is suspected to cause this constipation?

16 / 100

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

17 / 100

17. Q- Case of Depressed patient and the doctor will prescribe a drug for her. asking which reuptake inhibitors should be prescribed?
Q- Another Recall : low mood patient which inhibitors reuptake responsible ?
Q- Another Recall : Female pt presented with fatigue, loss of interest and she feels hopeless and her life is worthless, which hormone reuptake inhibitor you will give?

18 / 100

18. Personality disorder patient came to clinic with his brother, brother reported increased violence, which imbalance responsible for violence ?

19 / 100

19. Q- Husband worried about wife with depression Significant risk factor for suicide:
Q-another recall : Depressed female her spouse is asking for most risk of suicidal thoughts ?

20 / 100

20. elderly, recently transferred to a nursing home 3 months ago, since then he lost interest in activity, cry every day, decrease appetite and his symptoms worse in the morning along with short memory impairment, what is the Diagnosis?

21 / 100

21.  old patient presented with symptoms of 2 years memory loss and behavior changes. once a caring parent, note he is agitated and aggressive. he is independent with his daily needs. (Early Alzheimer) which of the following is the most appropriates next step?

22 / 100

22. 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?

23 / 100

23. what is most early sign of dementia ?

24 / 100

24. what is the earliest symptom that indicate dementia?

25 / 100

25. What is the Symptom suggest severity of dementia ?

26 / 100

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

27 / 100

27. Old patient, parkinsonism + visual hallucinations. Diagnosis?

28 / 100

28. Old Male , drowsy and forgetful, history of femoral embolization 12 hrs ago. Diagnosis ?

29 / 100

29. A 75-year 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 hyperintensities.
Which of the following is most likely diagnosis?

30 / 100

30. Patient with history of major atherosclerosis risks DM, HTN, Smoking, hyperlipidemia He complain of Recent memory loss and behaviour changes there is history of multiple brain infarct what is diagnosis ?

31 / 100

31. 42 year man present came with his brother complaining of change in personality, fights and argues with everyone and increased incidences of forgetfulness over 4 months, There is no family Hx of the same problem. what is the diagnosis ?

32 / 100

32. Old patient had severe progressive memory loss and unable to identify his siblings :

33 / 100

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

34 / 100

34. Elderly with two years history of progressive memory loss. He can do his daily chores and wear clothes independently. He used to be a kind and a caring person. But in the last 3 months his personality changed and he became aggressive, Diagnosis ?

35 / 100

35. elderly 70 years old with loss of short & intermediate memory, can be frustrated & annoyed easily. has low mood & want to be alone most of the time. Mini mental exam : 22/30. What is the Diagnosis ?

36 / 100

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

37 / 100

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

38 / 100

38. Which of the following is side effect of atropine?

39 / 100

39. A 7-year-old boy who has recently visited his grandfather’s farm, now presents to you with diarrhea, miosis, vomiting, lacrimation, salivation, excessive urination, and a garlic odor in his mouth. Which of the following should be administered?

40 / 100

40. A 7-year-old boy who has recently visited his grandfather’s farm, now presents to you with diarrhea, miosis, vomiting, lacrimation, salivation, excessive urination, and a garlic odor in his mouth. diagnosis?

41 / 100

41. A patient is brought in to the emergency department after being found down by her mother. She admits to the attending physician that she ingested a large dose of her prescribed amitriptyline approximately seven hours prior. Which of the following pieces of information would be MOST helpful in risk stratification of likelihood of having a major cardiac or neurologic event due to her medication overdose?

42 / 100

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

43 / 100

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

44 / 100

44. A 70-year-old man with ischemic heart disease developed dizziness and confusion following accidental ingestion of a higher dose of atenolol.
Blood pressure 70/40 mmHg Heart rate 46 /mln In addition to holding atenolol and administration of intravenous fluid, which of the following drugs Is the most appropriate?

45 / 100

45. Case of heroin withdrawal which was treats, now as a rehabilitation of heroin addiction doctor should use a heroin. substitute which is:

46 / 100

46. man presents to the emergency department with perspiration, euphoria and confusion. His vitals are as follows, BP is 80/55, respiration is 10 and pulse 60 irregular with pupillary constriction and clouded sensorium, which of the medication is the appropriate antidote in this emergency?

47 / 100

47. clinical picof (pin point pupils) opioid toxicity, asking about the antidote?

48 / 100

48. Boy came with history of Alkali causative ingestion with no symptoms. What is the management ?

49 / 100

49. Q9 – Iron overload is managed within 8 hours ?
Q- Child of iron ingestion came after several hour Iron was 90, What you will do?

50 / 100

50. patient with paracetamol overdose now she has Right upper Quadrate pain + nausea + vomiting

51 / 100

51. Q-The same scenario asking about stage or phase of paracetamol toxicity, she was complained of nausea and vomiting what is stage of paracetamol toxicity?
Q- y/o boy ingested bottle of acetaminophen tablets brought by his parents 20 hour later, asking about which stage of toxicity?

52 / 100

52. Pediatric age pt presented with his mom to ED she said that her child ingested large amount of paracetamol (i think) the pt was healthy no signs of any toxicity on presentation, they observed the pt for 4 hours with no any change in health no signs and symptoms of toxicity, the mom then mentioned that she found some of the drug was spilled on his clothes and in the floor, what is next?

53 / 100

53. Patient ingested unknown level of paracetamol 3 hours ago then came to ER asymptomatic with no signs of liver injury. Paracetamol level was above the toxic level for liver in The Rumack Matthew nomogram what to give

54 / 100

54. Case of paracetamol toxicity 1 day passed since ingestion still having nausea and vomiting with RUQ pain, what will you do ?

55 / 100

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

56 / 100

56. 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 ?

57 / 100

57. 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?

58 / 100

58. Pregnant woman with recurrent UTI for 3rd time during current pregnancy, what to do?

59 / 100

59. Women with recurrent UTI post coital what is management ?

60 / 100

60. After a motor vehicle accident, a woman is admitted to the surgery department, received resuscitation, and underwent multiple surgical operations. Candida albicans spores were detected in her urine culture, yet she remains asymptomatic and does not complain of anything. What is the most appropriate choice of anti-fungal treatment in this case?

61 / 100

61. asymptomatic UTI with fungal infection and patient have indwelling catheter?

62 / 100

62. Child with nausea vomiting, fever and UTI signs gone through renal Xray with contrast it showed vesicoureteral reflux unilaterally. What is the Dx?

63 / 100

63. case with frequency and urgency, most appropriate investigation 

64 / 100

64. UTI patient allergic to penicillin and sulfa and shellfish what drug can be used?

65 / 100

65. child present to the clinic with pain in micturition and lower abdominal pain all symptoms of UTI and his parents observe in his urine foul smell, which organism can cause this condition?

66 / 100

66. 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?

67 / 100

67. midstream urine culture show klebsiella pneumonia

68 / 100

68. 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?

69 / 100

69. -Patient came with UTI symptoms what is the most sensitive urine collection method ?
– the best way to take sample of urine in UTI ?

70 / 100

70. 9 year old patient his mom complaining about he is wetting his bed since one month. He used to be dry since 7 years The urine is foul smelling , His lab showing high WBC and turbid in colour and showed nitrate Diagnosis ?

71 / 100

71. Pediatric case with UTI clear symptoms, fever 39, mentioned that child look unwell, asking about treatment

72 / 100

72. Most common site of urethra affected by surgical trauma in male?

73 / 100

73. Which part of the urethra is the most vulnerable to injury?

74 / 100

74. Patient with renal artery stenosis what medication to give

75 / 100

75. 27 years old male k/c of HTN, on physical exam there was renal bruit (case of renal artery stenosis) Which of the following is most diagnostic:

76 / 100

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

77 / 100

77. 32-year-old patient on 4 anti hypertensive medications but still his BP is high, renal imaging showed asymmetrical kidneys, what is the most likely diagnosis?

78 / 100

78. 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?

79 / 100

79. a 77-year-old man with a history of ischemic heart disease is seen the Hypertension Clinic. He is taking 4 anti- hypertensives drugs. Physical examination unremarkable. Abdominal ultrasound shows Asymmetrical kidneys.
Blood pressure Heart rate 169/99 mmHg 79 /min the most likely diagnosis?

80 / 100

80. Asymptomatic hematuria in a child Urinanalysis : +ve RBC What to do next ?

81 / 100

81. Patient is known nephrotic syndrome, she just finished steroid course and want MMR vaccine, she takes 2 mg/kg steroid for 6 weeks – What you will do ?

82 / 100

82. A 5-year boy who is known to have nephrotic syndrome presents to the clinic with severe abdominal pain and distention. He has omitted once a clear stomach content of his last meal. No diarrhea or constipation.
Which of the following this patient is at higher risk to have?

83 / 100

83. A 5-year boy presented with eye puffiness and tower limb edema He has no fever, vomiting or abdominal pain. His physical examination revealed we” perfused extremities and tower limb pitting edema. The rest of his exam is unremarkable (see lab results).
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 is the most common cause of nephrobc syndrome in such patient?

84 / 100

84. Common cause of nephrotic syndrome in 5 years old child ?

85 / 100

85. A 5-year boy presented with eye puffiness and tower limb edema. His testing confirmed the diagnosis of nephrotic syndrome After starting him on treatment, which of the following defines complete remission?

86 / 100

86. A 5-year-o4d boy presented with eye puffiness and lower limb edema He has no fever, vomiting or abdominal pain. His physical examination revealed perfused extremities and lower limb pitting edema The rest of his exam is unremarkable His laboratory testing confirmed the diagnosis of nephrotic syndrome. He is started on steroid treatment.
Which of the following used to define steroid resistant nephrotic syndrome?

87 / 100

87. A 26-year woman is recently diagnosed as nephrotic syndrome secondary to minimal change glomerunephritis after being presented with proteinuria Which of the following is the most appropriate initial treatment to reduce proteinuria?

88 / 100

88. A 5-year-old boy presented with eye puffiness and lower limb edema He has no fever, vomiting or abdominal pain. His physical examination revealed perfused extremities and lower limb pitting edema The rest of his exam is unremarkable. His laboratory testing confirmed the diagnosis of nephrotic syndrome. Which of the following is the first line of treatment in this patient?

89 / 100

89. A 6-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 in distress and no lower limb edema. Eye. chest and abdomen exams are normal (see lab result).
Total Cholesterol 3 Trigly 10 Protein +4 Leukocytes 0 Erythrocytes 0
Which of The following is the most appropriate management?

90 / 100

90. 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?

91 / 100

91. All of the following is essential features of nephrotic syndrome except:

92 / 100

92. Q- 30-year-old man, all Labs were provided and a picture of urine dipstick test +2 proteinuria Also on microscope , Oval fat bodies and hyaline casts?
Q-Long case about a patient with edema Urine analysis: Oval fat body, some hyaline cast.

93 / 100

93. A 5-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 in distress and no lower limb edema. Eye. chest and abdomen exams are normal (see lab results).
Blood pressure 100/70 mmHg
Heart rate 88 /min
Respiratory rate 18/min
Temperalure 36 6 ‘C
Oxygen saturation 95 %
Test Result Normal Values Total Proteins 35 56-80 g/L
Albumin 16 36-52 g/L
Protein *4 Absent
Which of the following Is the most likely diagnosis?

94 / 100

94. 0ld women with dizziness and fatigue and her symptoms began 8 hours prior, she also complains of orthostasis and gradually worsening blurry vision, two days prior, n/v and decreased oral intake, those symptoms have since resolved, her past medical history is remarkable for chf, htn, Dyslipidemia and T2DM, she is on multiple medications including digoxin and spiromclactone , lisinopril, carvedilol, metformin, simvastatin and aspirin and her BP is 95/65 mmhg, bradycardia secondary to a 2:1 atrioventricular nodal black. potassium little high, BUN= 55، creatinine high, glucose high. which of the following precipitated her current condition?

95 / 100

95. Patient with dysuria and cloudy urine with bubbling for 2 months, history of recurrent left iliac fossa pain for the past 2 years!
Colonoscopy: no diverticulosis or polyp Cystoscopy: erythema on dome of the bladder. Most likely diagnosis:

96 / 100

96. 50 something Man has occasional red urine for 3 months, he states that his urine stream appears normal first but turns red by the end of voiding, he has also noticed small clots in his urine, no fever, edema, flank pain, weight loos, but bp is high and urinalysis is positive only for blood, cause of this symptoms?

97 / 100

97. Man work in military field with heavy exercises presented with fatigue and weakness Labs show:
CR high
K high
Urea high . I think there is RBC in cast What is the diagnosis?

98 / 100

98. A 70-year man presented to Emergency Department with generalized fatiguability 2 days ago. he had CT brain with contrast for possible transient ischemic attack. Physical examination is unremarkable (see lab results).
Blood pressure 130/70 mmHg Heart rate 76 /min
Test Result Normal Values
Hb 170 130-170 gn_ (Male) 120-160 g^_ (Female)
Urea 30.4 2.75-7.4 mmol/L
Creatinin 378 44-115 pmol/L
Which of the following is the most likely mechanism for the renal impairment?

99 / 100

99. patient with 8 hours post-operation, urine output is 50 cc, what to do next?

100 / 100

100. -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?

Your score is

إختبر نفسك 5

1 / 100

1. A 52-year-old man, who has been medically treated as peptic ulcer tor a long time, underwent upper endoscopy, which showed a malignant ulcer. During the visit, he started Warning his primary physician and wanted to file a complaint. Which of the following is the most appropriate response?

2 / 100

2. woman have epigastric pain and shortness of breath for many years . Relive by vomit only What to do ?

3 / 100

3. A 38-year man presents to the dime complaining of severe epigastric pain that is worse after eating. He describes the pain as burning in nature with mild Improvement with antacid therapy. Physical examination is unremarkable (see lab results).
Test Result Normal Values
Hb 120 130-170 ga_ (Male) 120-160 gl. (Female)
Platelets count 450 150-400 x 109/L
WBC 10 4.5-10.5 x 109/L
Urea 8.5 2.75-7.4 mmol/L
Createnine 65 44-115 pmol/L
What is the most appropriate test to establish the diagnosis?

4 / 100

4. A 40-year-old woman is under treatment for a recurrent helicobacter-associated duodenal ulcer She noticed that her stool is turned non-tarry black (see lab result)
Blood pressure 110/70 mmHg Heart rate 70 /mln
Test Result Normal Values Hb 152 130-170 ga_
(Male) 120-160 g/L (Female)
What drug is likely to be the cause of the black stools?

5 / 100

5. A 60-year-old man with chronic hepatitis C and liver cirrhosis presented to Emergency Room with
perforated peptic ulcer that requires urgent laparotomy (see lab results).
Test Result Normal Values
Hb 90 130-170 g/L (Male)
120-160 g/L (Female)
Platelets count 90 1 50-400 x lOO’L
INR 2 0.8-1.2
Prothrombin time 17 10-13 sec
Q- Which of the following is the most appropriate next step in the management prior to the procedure?

6 / 100

6. Patient complaining of epigastric pain, better with vomiting, worse with eating. He’s taking medications for her his joint pain. What’s the diagnosis?

7 / 100

7. A 40-year-old man is evaluated in the Emergency Department for several episodes of hematemesis He has no previous similar episodes His history is unremarkable He takes no medications.
There is no jaundice or other signs of chronic liver disease Abdominal examination reveals no tenderness, guarding, or rebound (see lab results).
Blood pressure 105/65 Heart rate 110/mln
Temperature 36.8 °C
Test Result Normal Values
Hb 95 130-170 g/L (Male) 120-160 g/L (Female)
Platelets count 250 150-400 x 109/L
WBC 12 4.5-10.5 x 109/L
Prothrombin time 11 10-13 sec
Alanine aminotransferase 30 5-40 IU/L Alkaline phosphatase 26 39-117 IU/L
Blood urea nitrogen 14 2.8 to 8.9 mmol/L
Creatinine 88 44-115 Mmol/L
Which of the following Is the most likely cause of his gastrointestinal bleeding?

8 / 100

8. A 46-year-old man came to the clinic asking for advice about eradication of H.pylon.
He is known to have GERD on daily dose of PPI for 8 years with good control. He developed new onset of epigastric pain and was found to have helicobacter pylori By ELISA testing.
Which of the following can happen post H.pylon eradication in such patient?

9 / 100

9. -A 65-year-old man known case of diabetes mellitus and hypertension presents to Emergency Room with 1-day history of vomiting
fresh blood and melena. He is taking aspirin 81 mg daily. After fluid resuscitation. he was started on IV PPI. He underwent upper Gl
endoscopy, which revealed a 2 cm duodenal ulcer at the bulb with visible vessel seen, endoscopic hemostasis was done using endo
dip Which of the following is the recommended duration for IV PPI post endoscopic management?

10 / 100

10. A 60-year-dd man with a history of diabetic, hypertension and osteoarthritis presents with melena. He gave a history of NSAID use for knee pain.He underwent upper Gl endoscopy which showed 1 cm duodenal ulcer with bleeding vessel, hemostasis was applied with goodhemostasis (see lab result).
Blood pressure 100/60 mmHg
Heart rate 110/min
Oxygen saturation 95 %
Test Result Normal Values
Hb 8.4 130-170 g/L (Male) 120-160 g/L (Female)

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

11 / 100

11. A 65-year-old man presented with melena and hematemesis. He is a known case of diabetes mellitus, hyperlipidaemia, and he is on aspirin 81 mg, lipitor 20 mg, diamicron 80 mg and warfarin 3 mg a day. Underwent upper Gl endoscopy and showed multiple superficial ulcers at the antrum and duodenal bulb. Which of the following medications is most strongly associated with his presentation?

12 / 100

12. Q- patient with history of peptic ulcer disease and he has joint pain which analgesic to give ?
Q- patient had knee pain, no trauma no fever and also have epigastric pain?

13 / 100

13. A 40-year-old man presented with several months history of dyspepsia He denies any history of dysphagia, vomiting, or weight lost He has no significant past medical history and not on any medications. He received helicopter pylori eradication (PPI standard dose, clarithromycin 500mg, and amoxil 1g bid for 10 days) with partial response Basic routine lab was normal (see reports). Endoscopy:
Showed gastric erosions. Showed h pylori organism. Which of the following is the best treatment regimen?

14 / 100

14. Child diagnosed with peptic ulcer +have H.pylori. He’s already on PPI. What medication is appropriate to add?

15 / 100

15. A patient presents with chronic dyspepsia and recurrent upper Gl bleeds. Urea breath test is positive.
Which of the following regimen Is the best to treat the underlying cause?

16 / 100

16. A 6-year-boy diagnosed previously with gastroesophageal disease. He is on proton pump inhibitor for long time is complaining of dysphagia and epigastria discomfort Which of the following is important history clue for Eosinophilic Esophagitis?

17 / 100

17. Case about Esophagitis in children what symptom you expect ?

18 / 100

18. Patient with chronic use of NSAID for osteoarthritis, Present with sudden severe abdominal pain , guarding and tenderness, What most appropriate next step?

19 / 100

19. similar recall: Ederly man presented to the ER with rigid distended abdomen prepared for laparotomy with hypotension and fever (38), X-ray showed free air under diaphragm What is the best initial resuscitation option?

20 / 100

20. A male patient was planned for exploratory laparotomy due to perforated peptic ulcer he is unstable, what is the best next step?

21 / 100

21. (male with rheumatoid arthritis (RA) on NSAIDs, complaining of epigastric pain radiating to the back and vomiting, along with an increased white blood cell count), the initial management?

22 / 100

22. Esophageal carcinoma management?

23 / 100

23. 58Y OLD male, came with symptom of Peptic Ulcer with weight loss. what to do?

24 / 100

24. elderly patient with epigastric discomfort and fullness , weight loss Decrease appetite What appropriate investigation?

25 / 100

25. Q- Patient after endoscopy found cancer in stomach, and he has h pylori +ve , what will do ?
Q-Patient with h pylori has cancer What will do ?

26 / 100

26. A 56-year-old man presents with epigastric pain, bloating and weight loss.
Gastroscopy showed multiple ulcers and there is mass , biopsy is taken (see reports). Helicobacter pylori breath test: Positive. Biopsy report: Mucosa-Associated Lymphoid Tissue lymphoma (MALToma).
Which of the following is the next step in management?

27 / 100

27. A 45-year-old man with several months of worsening dyspepsia. He denies any history of diarrhoea・ fever, or weight toss.
He has no medical problems. He was prescribed pantoprazole 40 mg daily with no relieve of his symptom (see reports). Upper Gl
endoscopy : Showed multiple aniral superficial ulcers Revealed mucosa-associated lymphoid tissue (malt lymphoma ) with numerous H.pylori organism CT scan of abdomen and chest: Which of the following is the best management option?

28 / 100

28. Q-What is the ACCURATE test to reveal h.pylori ?
Q-How to follow patient after Treatment of H.pylori ?
Q-Confirm eradication of H.pylori ?

29 / 100

29. Child with Abdominal pain, +ve urea breath test. Given Triple therapy. How to monitor the response for pt taking H. Pylori medication?

30 / 100

30. Patient her father has gastric ulcer, urea breath test done for her shows positive result. What is the organism?

31 / 100

31. 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?

32 / 100

32. 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?

33 / 100

33. A 35-year woman presented with chronic vague gastric pain for several years. The pain is revealed by food. Serum immunoglobulin studies for IgG against helicobacter pylori was positive. Upper Gl endoscopy showed antral gastritis with small clean bases ulcer at duodenum. The patient was treated for H.pylon. Which of the following is the most appropriate test to ensure h pylori eradication?

34 / 100

34. 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?

35 / 100

35. A 30-year-old woman presented with hematemesis after a bout of prolonged vomiting She has no significant medical history and not on any medications.
Which of the following is the most likely diagnosis?

36 / 100

36. 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 ?

37 / 100

37. 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?

38 / 100

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

39 / 100

39. A 30-year-old woman with left-sided ulcerative colitis presented to the Emergency Room with 7-8 episodes of bloody diarrhea per day associated with low-grade fever, abdominal pain, and joint pain at her knees. On examination, she looks ill and is in pain. All stool cultures were negative.
Blood pressure: 90/70 mmHg
Heart rate: 120/min
Respiratory rate: 18/min
Temperature: 37.3 °C
Oxygen saturation: 95%
Test Result Normal Values
Hb: 9 (Normal Range: 130-170 g/L for males, 120-160 g/L for females)
Platelet count: 456 (Normal Range: 150-400 x 10^9/L)
WBC: 10 (Normal Range: 4.5-10.5 x 10^9/L)
ESR: 122 (Normal Range: 2-10 mm/h for males, 3-15 mm/h for females)
After fluid resuscitation, what is the best next step in management?

40 / 100

40. Case of schizophrenia patient with recurrent vomiting and constipation episodes, presents with severe abdominal pain and distention it was colon dilated more than 10 cm, conservative therapy was done with IV fluids, PO, and antibiotics asking about the proper management:

41 / 100

41. lead pip point on X.ray ?

42 / 100

42. patient with history and physical examination of Ulcerative colitis asking about common site of ulcerative colitis ?

43 / 100

43. 35 yeas old women diagnosed with ulcerative colitis They ask about need of colonoscopy ?

44 / 100

44. In a patient with ulcerative colitis, which of the following is associated with an increased risk of colorectal cancer?

45 / 100

45. A 35-year-old man with a 7-year history of ulcerative colitis presented with an insidious onset of progressive fatigue, pruritus, and jaundice. He underwent MRCP, which demonstrates multiple short strictures of the biliary tree at both intrahepatic and extrahepatic ducts (see lab results).
Test Result Normal Values
Alkaline phosphatase: 785 (Normal Range: 39-117 IU/L)
Alanine aminotransferase: 60 (Normal Range: 5-40 IU/L)
Aspartate aminotransferase: 40 (Normal Range: 12-40 IU/L)
Creatinine kinase: 34 (Normal Range: 24-170 IU/L for females, 24-195 IU/L for males)
Which of the following is the most likely diagnosis?

46 / 100

46. 12-year-old complain of recurrent epigastric pain with occasional vomiting since 1 year otherwise, normal stool analysis is positive for blood and mucus and positive blood occult test what is dx?

47 / 100

47. A 17-year-old man with no previous medical history presented with a 3-week history of bloody diarrhea. He reported frequent urges to defecate, associated with mild lower abdominal cramps.
He had experienced similar attacks in the past, but milder, associated with bloating and loose stool, which was mucus with a few blood drops. Abdominal examination was soft with mild tenderness at the left lower quadrant but no guarding.
Blood pressure: 110/70 mmHg
Heart rate: 76 /min
Temperature: 36.6 °C
Oxygen saturation: 95%
Which of the following is the most likely diagnosis?

48 / 100

48. A previously healthy 22-year-old woman reports a 3-month history of frequent bloody bowel movements with mucus and occasional right hip pain. She has had no history of contact with sick patients and no recent intake of drugs. Physical examination findings are within normal limits, except for gross blood on rectal examination and knee pain (see lab results and report).
Test Result Normal Values
Hb: 110 (Normal Range: 130-170 g/L for males, 120-160 g/L for females)
MCV: 72 (Normal Range: 80-95 fl)
Stool analysis: Shows many RBCs and few WBCs
Which of the following is the most likely diagnosis?

49 / 100

49. A 30-year. woman complains of epigastric pain, heartburn and bloating after meals for 3 months.
No history of hematemesis or weight loss. A trial of esomeprazole 40mg for 8 weeks did not relief her symptoms Hb 140 130-170 gA. (Male) 120-160 gfL (Female) Gastroscopy Normal Urea breath test: Negative Ultrasound of abdomen: Normal.
Which of the following is the best next step in management?

50 / 100

50. 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?

51 / 100

51. A 24-year-old woman presents with 9 months of intermittent abdominal pain and anxiety. Occasionally, the pain is associated with loose stools. She denies any alarming symptoms. All basic work-up (CBC, LFT, TSH, CRP, and Celiac serology) were normal. Stool cultures and fecal calprotectin were negative. the most appropriate treatment?

52 / 100

52. 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?

53 / 100

53. A 30-year-old man with 3 years history of intermittent abdominal pain, bloating and diarrhoea is seen in the clinic.
Which of the following complains is highly suggestive ๙ irritable bowel syndrome’

54 / 100

54. A 28-year- old man with 4-months history of non-specific crampy abdominal pain and diarrhea alternate with constipation that is not related to any specific food. He has no history of food allergy. No history of weight toss. Blood pressure 110/70 mmHg Heart rate 76 ‘min Temperature 36.6 C BMI 23 kgfm2
Which of the following is the most likely diagnosis?

55 / 100

55. 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?

56 / 100

56. A case of typical of a male with IBS presentation ( abdominal pain somewhat relieved with defecation, frequent loose stool, feeling of incomplete emptying, no loss of weights) on abdominal examination: normal. How to confirm diagnosis?

57 / 100

57. 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?

58 / 100

58. A 70-year-man is mechanically ventilated in The Intensive Care Unit following massive cerebral hemorrhage. 7 days later, he developed coffee ground vomitus.
history is only significant for hypertension. Which of the following is the most likely the cause?

59 / 100

59. A 45-year woman was diagnosed with GERD for 4 years on daily dose of PPI with a good control of her symptoms However, she reported occasionally heartburn She underwent endoscopy, which was normal. Gastric biopsy revealed Helicobacter pylori. She gave history of smoking 20 pack-year but she quit 3 years ago. but she gave history of alcohol drink. On examination, she is obese otherwise normal. Which of the following Risk factors is mostly contribute to worsening of her GERD and she should control it?

60 / 100

60. A 33-year-old man with 2- years history of heartburn and food regurgitation, he was taking 40 mg of pantoprazole daily with good response. He stopped it 4 months ago and started to have recurrence of his symptoms and becoming worse No dysphagia or weight loss o< nocturnal symptoms. Clinically was normal. All routine laboratory workup was normal. Which of the following is the best next step in his management?

61 / 100

61. 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?

62 / 100

62. 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?

63 / 100

63. A 40-year-old woman presented with heartburn at the epigastric and retrosternal areas, and symptoms
of regurgitation. The patient has tried conservative measures. proton pumps inhibitors with no improvement In symptoms (see
report). Endoscopy: Erythema of the esophagus consistent with reflux esophagitis. Which of the following is the most appropriate next step?

64 / 100

64. A 22 old female complains of heartburn, which mainly at pregnant women was night started after the on dinner
when she lying on the bed.
she antacid Syrup with some what response to that. She denied history of abdominal pain or nausea. Which of the following the best next step in the management?

65 / 100

65. A 22 old female complains of heartburn, which mainly at pregnant women was night started after the on dinner when she lying on the bed.
she antacid Syrup with some what response to that. She denied history of abdominal pain or nausea. Which of the following the best next step in the management?

66 / 100

66. A 34-year-old man presents to the clinic with symptoms of gastroesophageal reflux disease that not responding well to esomeprazole 20 mg once a day.
Despite mild improvement in his symptoms, he continues to wake up with an acid taste in the middle of the night. He has not had difficulty swallowing. He confirms that he takes the medication properly. Physical examination is unremarkable His laboratory investigation are within normal range. Which of the following is the most appropriate management for this patient?

67 / 100

67. A 35-year-woman with heartburn and regurgitation for 6 months is referred for evaluation of chronic GERD symptoms. The patient stales that she notes burning In her chest primarily after meals and occasionally experiences episodes of chest pain. She denies change In weight or lifestyle. She often consumes dinner 2 hours Before going to bed Her heartburn occurs mainly during the night. Physical examination is normal except for a body mass index (BMI) of 28 kg/m2. A complete blood count and metabolic panel are normal. The patient has been taking omeprazole 20 mg daily. An upper endoscopic examination is performed, and the appearance of distal esophagitis Which of the following is the best next step?

68 / 100

68. A 53-year man with liver cirrhosis presents with several episodes of vomiting of blood and black tarry stool.
Blood pressure: Supine 105/60 mmHg Sitting 85/50 mmHg
Heart rate: Supine 90 ‘min Sitting 110‘min
Which of the following is the most appropriate next step in management?

69 / 100

69. Coffee floor emesis:

70 / 100

70. 56 years old patient had an upper Gl bleeding due to esophageal varices and was given IV fluid. Which of the following should be given to reduce mortality?

71 / 100

71. 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. after initial ER management, what to give before endoscopy?

72 / 100

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

73 / 100

73. Patient with esophageal bleeding, How to prevent?

74 / 100

74. 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?

75 / 100

75. A 46 year old male presented with abdominal pain for one day with vomiting and hematemesis. He is a heavy alcohol drinker and has history of previous admission due to peptic Ulcer and taking PPI. P/ : He has epigastric tenderness. Physical examination revealed splenomegaly and ascites , epigastric tenderness. BP: 110/70, HR: 112

76 / 100

76. 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?”

77 / 100

77. 12 years old boy diagnosed with type 1 diabetes, he has been compliant with insulin since the diagnosis 2 months ago,.. (but still hasn’t reach perfect control yet).
What is this called?

78 / 100

78. Long scenario of diabetic patient and some renal problems when to stop metformin regarding the GFR?

79 / 100

79. Which of the following is the best screening test to detect diabetic nephropathy?

80 / 100

80. Elderly K/c case of long time poorly controlled DM2 and hypertension she is on aspirin atenolol metformin ,insulin,
multivitamin She complains of dizziness when she stands what is the cause In examination There is decreasing of BP when standing but the HR *didn’t change*

81 / 100

81. Which of the following is the most appropriate intervention for primary prevention of type 2 diabetes’?

82 / 100

82. Q-pt with non insulin dependent DM Come with upper back swelling lesion + multiple opening discharge What is the diagnosis?

83 / 100

83. Target of HA1Cindiabetic patient?

84 / 100

84. Old patient with type 1 DM was sitting in the waiting area of outpatient clinic, after a while patient developed symptoms of hypoglycemia, they checked blood sugar it was low. What is the next appropriate step?

85 / 100

85. A 39-year-old woman with type 1 diabetes tor 20 years was married recently; she and her husband want to get pregnant. The woman has hypertension treated with an angiotensin converting enzyme (ACE) Inhibitor and a diuretic with maintenance of blood pressure at 118/80 mmHg. Her insulin doses are all administered through a continuous Insulin infusion pump using insulin aspart. She reported that she would try to become pregnant next month What is the best advice at this moment to control her blood sugar and prevent congenital malformation?

86 / 100

86. At which estimated GFR level, metformin should be stopped in diabetic patients?

87 / 100

87. A 27-year-old woman presents with 2-day history of generally unwell, nausea, vomiting and lethargy. She is a known type 1 diabetic using a long-standing subcutaneous insulin regime She was started on treatment for diabetic ketoacidosis with intravenous fluids and fixed rate Insulin. Her blood sugar is reviewed 3 hours after treatment was initiated. On admission, blood tests are done (see lab results).
Test Result Normal Values
ABG HCO3- 8 22-28 mmol/L
pH 7.2 7.36-7.45
Random Glucose 32 3.9-5.5 mmol/L
What should De the aim in managing hyperglycemia in a diabetic ketoacidosis patient?

88 / 100

88. 5-year-old child managed in Pediatric Intensive Care Unite for diabetic ketoacidosis with insulin infusion and fluid correction (see lab result).
Test Result normal Values
Sodium 138 134-146 mmol/L
Potassium 2.8 3.5-5.1 mmol/L
Chloride 101 97-108 mmol/L
Bicarbonate 22 21-28 mmol/L
Which of the following is the most likely explanation of low potassium?

89 / 100

89. A 17-year-oid man is evaluated in the Emergency Department for polyuria, polydipsia, polyphagia and an unintentional weight loss over the past month. He has abdominal pain and drowsiness for the last 12 hours. His medical and family history are unremarkable. He is not of any medications. On physical examination, he looks sick with dry mucous membrane, tachypnea, and tachycardia with dear chest auscultation. Abdominal examination shows diffuse mild tenderness with normal bowel sounds Intravenous 0.9% saline is initiated. An electrocardiogram shows sinus tachycardia 120/min Chest radiograph is normal (see lab results).
Blood pressure 95/53 mmHg Heart rate 119/minRespiratory rate 20 /min Temperature 37.2 °CBM119 kg/m2
Test Result Normal Values
Sodium 130 134-146 mmol/L
Potassium 4.4 3.5-5.1 mmol/L
Chloride 96 97-108 mmol/L
Bicarbonate 10 21-28 mmol/L
Blood urea nitrogen 15 8 to 8.9 mmol/Creatinine 115 44-115 pmol/L
Random Glucose 25 3.9-5 5 mmol/L
ABG HCO3- 10 22-28 mmol/L
pH 7.10 7.36-7.45
Hb 130 130-170 ga_ (Male) 120-160 g/L (Female) WBC 14 4.5-10.5 x 109’L
Q- Which of the following is the most appropriate next step in the management?

90 / 100

90. A 7-year old presents to Emergency Department with vomiting and abdominal pain for 1 day. The child has had history of polydipsia, polyuria and weight loss for the last 3 weeks. Examination reveals dehydration and hypoactivity . Blood pressure 90/50 mmHg Heart rate 110/min Respiratory rate 24 /min Temperature 38.6 CC Oxygen saturaton 95 % Weght 23 kg
Test Result Normal Values
ABG HCO3- 5 13-22 mmol’L
ABG PCO2 22 27-40 mmHg
ABG PO2 100 8^24 mmHg (Newborn) 55-80 mmHg (Child)
Base access -17 -2 to 2 mmol/L
Color light yellow clear or light yellow Appearance
clear clear Specific gravity 1025 1001-1030 Protein +1
Absent Glucose *4 Absent Ketones «4 Absent Nitrite absent Absent Leukocytes 3 0-3 per high power field
Which of the following is the most likely diagnosis?

91 / 100

91. A 61-year-old man with a 20-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 8 months, which worsens at night His Haemoglobin A1c levels have remained less than 7 0% for the last 1 years but were between 9 0% and 10.0%before adding insulin therapy to metformin 1 years ago His medical history includes coronary artery disease. non proliferative diabetic retinopathy, hypertension, and hyperlipidemia Medications are aspart insulin, glargine. Aspirin . metoprolol, atorvastatin, and lisinopril. On physical examination, findings are compatible with distal symmetrical polyneuropathy. Which of the following is the most appropriate management of this patient’s neuropathy?

92 / 100

92. 55-year-old man with diabetes and hypertension complains of pain in the right eye and double vision when looking to the left On examination, there is ptosis, limited adduction, elevation, and depression of the right eye The pupils are equal and reactive in both sides Fundoscopy and other cranial nerve are normal as well as the resi of neurological examination of the upper and lower limbs. Which of the following is the most likely cause of these findings?

93 / 100

93. A 58-year-old man with diabetes mellitus came for follow-up He is on metformin (Glucophage), 1000 mg/day, as well as Atorvastatin (Lipitor), 40 mg dally for hyperlipidaemia . There Is no diagnosis of hypertension His urine albumin/creatinine ratio is in the microalbuminuria range for the first time (see lab results)
Blood pressure 128/77 mmHg
Test Result Normal Values
HbA1C 6.3 4.7-5 6%
LDL (cholesterol) 2.1 <4.0 mmol/L
Which of the following would be most appropriate next step?

94 / 100

94. A 78-year-old man was admitted to hospital with lethargy and back pain.
He had a history of type 2 diabetes mellitus and rheumatoid arthritis (see lab results).
Test Result Normal Values
Calcium 2.72 2.15-2.62 mmol/L
Creatnine 196 44-115 pmol/L
Urinary protein: creatinine ratio 154 mg/mmol (<30)
Which of the following is most likely diagnosis?

95 / 100

95. Target of HA1C in diabetic patient ?

96 / 100

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

97 / 100

97. A new screening test for Diabetes has a sensitivity of 90% and specificity of 80% Which is best interpretation?

98 / 100

98. A 7-year-old boy admitted with acute diabetic ketoacidosis Mother states that her son was diagnosed with type 1 diabetes mellitus started on insulin but she decided to stop it, as she was not sure of her son’s diagnosis and thought to give chance for his pancreas to recover. Q- Which of the following term describes the mother action?

99 / 100

99. 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?

100 / 100

100. A 29-year-old woman comes to the clinic for a follow-up. She Is diagnosis with gestational diabetes mellitus (GDM) at week 24. She is asking for an advice regarding the best dietary habits she can follow to control her blood sugar and avoid insulin injection. Which of the following is the best diet option?

Your score is

إختبر نفسك 6

1 / 100

1. A 70-year-old woman known to have type 2 diabetes mellitus. She is currently taking metformin 1g bid physical examination is unremarkable (see lab results).
Test Result Normal Values
Creatinine 80 44-115 mmol/L
Glucose, fasting 6 3.5-6 5 mmol/L
Random Glucose 7.5 3.9-5 5 mmol/L
HbA1C6.9 4 7-5 6%
Which of the following Is the most appropriate next step in management plan?

2 / 100

2. A 59-year old man is admitted to the hospital for evaluation of chest pain.
medical history is significant for type 2 diabetes mellitus. coronary artery disease, hypertension, and hypeflipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin His other medications are aspirin, metoprolol, atorvastatin. and sublingual nitroglycerin as needed (see lab results}.
Test Result Normal Values
HbAIC 8.5 4.7-5.6%
Plasma Glucose 9.4-14.9 mmol/L
Which of the following is the most appropriate diabetes treatment for this patient while hospitalized?

3 / 100

3. A 37-year-old man with type 1 diabetes mellitus presents to the office with history of prolonged hypoglycemia during intense exercise, despite eating a meal prior to the activity. He Is using insulin glargine and insulin aspart with meals (see lab result). Test Result HbAIC 7.0
Which of the following is the most appropriate management of this patient’s hypoglycemia on the days that he exercises?

4 / 100

4. A 20-year-old man with type 1 diabetes presents to the Emergency Department with vomiting and abdominal pain. He has been suffering from …. for 2 days then became severely dehydrated and started to vomit. He has not had his insulin for the last 24 hours. Normally, he has a basal bolus regime with Giargine as a long-acting insulin, and Humalog as short-acting On admission, he Is found to have acidosis, elevated serum ketones and elevated blood glucose, and was diagnosed with diabetic ketoacidosis. He is started on IV fluid What insult should he be prescribed now?”

5 / 100

5. A 20-year-old woman is diagnosed of type 1 diabetes mellitus after presenting with diabetic ketoacidosis. Her blood sugars are now stable and she is ready for discharge Which of the following is the best insulin regime she should be offered as outpatient?

6 / 100

6. A 19 -year- old woman is evaluated for management of type 1 diabetes. She was diagnosed 4 months ago after presenting to the Emergency Department with Diabetic ketoacidosis . Her hemoglobin A1c level at the BME of diagnosis was 14.5%. She was discharged from the hospital on a basal and prandial insulin regimen with minor adjustments required as an outpatient. Recently she started to have episodes of both fasting and postprandial hypoglycemia. Medications are insulin glargme and insulin aspart. Her systemic examinations are unremarkable (lab results).
Blood pressure 115/77 mmHg Heart rate 80 /min
BMI 22 kg/m2 HbA1C 6.0 4.7-56% Random Glucose 4 5 3.9-5 5 mmol/L
Which of the following Is the most appropriate management for her hypoglycemia?

7 / 100

7. A 35-year-ofd pregnant woman with gestational age of 30-weeks comes for a follow-up. She was diagnosed to have gestational diabetes meintus (GDM) at week 24. she was maintained on diet control but unfortunately her blood sugar reading between (150-200 mg/dl). The physician decided to start Insulin but she is totally refusing injections and she asks about any safe oral
medication to be used in pregnancy. Which of the following oral hypoglycemic agents has safety data and recommended to be used in pregnancy?

8 / 100

8. Female just gave birth 2 weeks ago and was having GDM and family history of DM type2 and came for screening HBA1C was 5.5 Fasting was normal And she is obese What drug to give?

9 / 100

9. 48 Year old female Patient diagnosed with type 2 diabetes. She started lifestyle modification with diet and exercise. After 3 months her HbA1c is 6.9.
which of the following is the best next step?

10 / 100

10. 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?

11 / 100

11. A 43-year-old man comes to the clinic for a follow-up. He has been recently diagnosed with type 2 diabetes and has
been following a plan of lifestyle measures to improve his diet and increase his level of exercise (see lab result). Blood pressure 129/80 mmHg HbA1C6.9 Which of the following is the most appropriate treatment option now?

12 / 100

12. 44-year-o!d man with a strong family history of type 2 diabetes and cardiovascular disease was recently diagnosed with pre-diabetes. He came for advice regarding healthy eating patterns and physical activity that will help him to prevent type 2 diabetes (see lab result) BMI 31 kg/m2 HbA1C 6.1 In helping this individual to achieve and maintain his target weight loss, which of the following is the best advice?

13 / 100

13. A 55-year-old man Is referred to the Diabetes Clinic after presenting with polyuria and polydipsia with strong family history of type 2 diabetes mellitus. Physical examination is unremarkable .Blood pressure 136/85 mmHg. BMI 34 km2 (see lab results)
Test Result Normal Values
Glucose, fasting 9 3.5-6 5 mmol/L
HbA1C 7.8 4.7-5 6%
Which of the following is the most appropriable first-line treatment?

14 / 100

14. A 55-year-old man presented to the Colonoscopy Unit to perform a screening colonoscopy. The consent was taken, and the procedure started. During the colonoscopy, a large 4 cm polyp was seen, which needs to be removed by snare polypectomy. This carries a high risk of bleeding and perforation compared to the screening colonoscopy. Which of the following is the best action?

15 / 100

15. Pt underwent colonoscopy and a mass was seen and biopsy showed adenocarcinoma. What is the next step?

16 / 100

16. Which of the following types of polyps is associated with the greatest risk of malignant transformation?

17 / 100

17. A 73-year-old woman presents with new onset jaundice, generalized fatigability, weight loss and loss of appetite (see report).CT scan Multiple lesions replacing approximately 70% of the liver parenchyma Which of the following is the most appropriate management?

18 / 100

18. 63 years old male came with rectal bleeding with unintentional weight loss, he was pale, on PE empty rectum and no masses were identified but bleeding with fresh blood was noted. Which of the following is most appropriate next step?

19 / 100

19. Elderly male patient present with History of bleeding on defecation On examination there is anal hemorrhoid stage 3 What is your next step in management?

20 / 100

20. A 60-year-old woman with a recent history of feeling tired, fatigue, and weight loss has also noticed a worsening of her chronic constipation. A stool test for occult blood was positive Test Result. Normal Values RBC 3 4.7-6.1 x 10^12/L (Male) 4 2-5.4 x 10^12/L (Female) Hb 89 130-170 g/L (Male) 120-160 g/L (Female) HCT 0.25 0.42-0.52 (Male) 0.37-0.48 (Female) Platelet count 234 150-400 x 10^9/L
Which of the following is the best next step in the diagnosis?

21 / 100

21. A 45 years old male smoker has an adenoma removed from his colon. Pathology report shows a benign lesion. What advice should you give this patient to prevent him from getting colon cancer?

22 / 100

22. After the resection of a benign adenomatous pedunculated polyp, and considering the patient has no family history of colon cancer, what is the most appropriate advice for reducing the risk of colon cancer?

23 / 100

23. A 55-year-old man presented to the Colonoscopy Unit to perform screening colonoscopy.
The consent was taken, and the procedure started. During colonoscopy, a large 4 cm polyp was seen, which needs to be removed by snare polypectomy. Snare polypectomy carries a higher risk of bleeding and perforation than the screening colonoscopy. Which of the following is the best action?

24 / 100

24. A 20-year-old man presents to the clinic for advice. He has a positive family history of familial polyposis syndrome and is asymptomatic with normal lab tests. Which of the following is the best advice at this stage?

25 / 100

25. An 8 years old healthy male, presented with a history of 2 months of abdominal pain with 2 episodes of bloody stool. Proctoscope was done and showed numerous polyps covered the linings and multiple biopsies taken. What is the most likely diagnosis?

26 / 100

26. Colon cancer common metastasis to?

27 / 100

27. A national screening program is going to establish which cancer according to priority and impact ?

28 / 100

28. Q about the interval of colonoscopy for a polyp size of 0.9 cm and results of histopathology is adenoma ??

29 / 100

29. 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?

30 / 100

30. 51y woman presents to colon screening, Her HX. is significant for HTN and her mother developed colon cancer at age 85. Her examination is unremarkable. She underwent colonoscopy during which 2 small (8mm) hyper plastic polyps were removed, which of the following is the next step in management?

31 / 100

31. A 35-year-old man presents to his primary care physician (PCP) for a routine physical exam. His only past medical history includes seasonal allergies for which he uses fluticasone nasal spray. He does not smoke cigarettes or drink alcohol. There is no family history of colorectal cancer, although his mother did have two documented sessile polyps (one ≥ 1cm) at age 55. When should he
undergo his first screening colonoscopy?

32 / 100

32. What is a recommended age in years for a low-Risk adult man to start screening for colon cancer?

33 / 100

33. A 40-year-old healthy man has come to the clinic requesting a screening colonoscopy. He is asymptomatic with no family history of colon cancer. Clinical examination is unremarkable, and his lab results are as follows:
RBC 4 4.7-6.1 x 10^12/L (Male) Hb 13.3 130-170 g/L (Male)
Platelet count 321 150-400 x 10^9/L WBC 4 4.5-10.5 x 10^9/L
Based on the latest recommendations from local and international gastroenterology associations, what is the recommended age for screening colonoscopy for this average-risk patient?

34 / 100

34. 45-year-old women medically free with no personal or family history of cancer.
Asking about when to to start colon cancer screening?

35 / 100

35. Q- Years old female medically & surgically free, with no family history of colon cancer, which colon cancer screening test iS appropriate for her?
Q-another recall A 50 years old male not complaining of anything , screening modality?

36 / 100

36. A 10-year-old boy complains of chronic watery diarrhea and abdominal discomfort. His diarrhea is mixed with blood and mucus sometimes. He has lost weight during the past 3 months and reports on/off joint pain. His CBC is consistent with anemia (Hb 8.7). Which of the following is the most appropriate initial step in management?

37 / 100

37. A 25-year-old woman with inflammatory bowel disease (IBD) who is taking steroids presents with abdominal pain and bilious vomiting. On examination, her abdomen is distended and tender in the right iliac fossa. She had a colonoscopy two weeks ago, which was normal. A contrast barium study showed a single stricture at the terminal ileum, 1 cm from the ileocecal valve. Which
of the following is the most appropriate management?

38 / 100

38. A 32-year-old man diagnosed with fibrostenotic ileal Crohn’s disease underwent ileocecal resection of 70 cm from the ileum. One month post-operative, he started to complain of watery diarrhea (five times per day) with no mucus or blood. He has no history of abdominal pain. On examination, he is unremarkable. All basic workup was normal, including stool culture. His ESR (erythrocyte sedimentation rate) is 7 (normal values: 2-10 mm/h for males). A CT scan of the abdomen showed a normal anastomosis site. Which of the following is the most appropriate treatment?

39 / 100

39. 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?

40 / 100

40. A 25-year-old woman presented with a few months’ history of increased forgetfulness, fatigue, and numbness of the lower limbs. She is a known case of Crohn’s disease, post-terminal ileum resection 2 years ago, and she is on azathioprine. She denies abdominal pain or diarrhea (see lab results). Test results and normal values are as follows:
• RBC: 4.5 (Normal Range for Male: 4.7-6.1 x 10^12/L, Female: 4.2-5.4 x 10^12/L)
• Hb: 90 (Normal Range for Male: 130-170 g/L, Female: 120-160 g/L)
• MCH: 38 (Normal Range: 28-33 pg/cell)
• MCV: 99 (Normal Range: 80-95 fl)
• Platelet count: 199 (Normal Range: 150-400 x 10^9/L)
َQ- A deficiency of which of the following nutrients would be responsible for her current clinical presentation?

41 / 100

41. A 34-year-old man, diagnosed with ileocolonic Crohn’s disease and currently on infliximab and azathioprine, visited the clinic with complaints of perianal pain, purulent discharge, low-grade fever persisting for 3 weeks, and having 3-4 non-bloody bowel movements per day. He presents with perianal induration and purulent discharge on pressure. His vital signs are as follows:
• Blood pressure: 110/70 mmHg
• Heart rate: 76/min
• Temperature: 37.9 °C
What is the appropriate next step in managing this patient?

42 / 100

42. A patient presented to the clinic complaining only of perianal discharge (no abdominal pain or bleeding), on examination three sinuses were noted at the 3 5 7 o’clock positions. Proctoscopy was clear. What is the most appropriate next step?

43 / 100

43. Case of chrons disease what is the most complication ?
 Another case of Crohn’s disease, asking which of the followings came with it?

44 / 100

44. A 32-year-old man came to the clinic for a follow-up visit. He has been diagnosed with ileocolonic Crohn’s disease and has been on steroids and Pentasa for 3 months. He has noticed perineal pain and discharges for the past 3 weeks. His abdominal symptoms are well controlled, with no abdominal pain or diarrhea. Upon examination, two perianal fistulas were observed. His laboratory results are as follows:
• RBC: 4 (Normal Range: 4.7-6.1 x 10^12/L for males) Hb: 130 (Normal Range: 130-170 g/L for males)
• Platelet count: 421 (Normal Range: 150-400 x 10^9/L) WBC: 7 (Normal Range: 4.5-10.5 x 10^9/L)
• ESR: 36 (Normal Range: 2-10 mm/h for males)
An MRI of the pelvis confirmed the presence of perianal fistulae. Which of the following is the best next step ?

45 / 100

45. Case of abdominal pain and diarrhea colonoscopy showed non contagious patches in the terminal ileum and colon Pathology shows transmural inflammation what is the Diagnosis ?

46 / 100

46. What is the most common location of Crohn’s disease?

47 / 100

47. A 29-year- man he is smoker for 5 years had appendectomy 2 years ago. He came to the clinic to discuss with you his risk to develop Crohn’s disease because his brother has Crohn’s disease that difficult to be controlled.
Which of the following increase the Risk for the development of Crohn’s disease?

48 / 100

48. Osteoporosis is one of common extra-intestinal manifestations of crohn’s disease, which carries a concomitant fracture Risk .Which of the following risk factors are more likely to be strongly associated with increase osteoporosis risk in crohn’s disease?

49 / 100

49. An 18-year-old girl presents with chronic diarrhea and intermittent abdominal pain. No history of upper or lower Gl bleeding. On examination, she is slim and has pallor No jaundice (see lab results).
Test Result Normal Values
Hb 100 130-170 g/L (Male) 120-160 gn_ (Female)
MCV 100 80-95 fl
Platelets count 540 150-400 x 109/L
WBC 6 4.5-10.5 x 109/L
Vitamin B12 (Women) 0.074 0.12-0.66 nmol/L
Folic Ac^ (Women) 0.099 <0.1 pmol/L
Which of the following is the most likely diagnosis?

50 / 100

50. A 28-year-old woman presents with right lower quadrant abdominal pain, loose bowel motions, and weight loss for 3 months. Colonoscopy and biopsy of the terminal Ileum demonstrated non-caseating granulomas.
Which of the following is the most likely diagnosis?

51 / 100

51. Which of the following extra-intestinal manifestabons of Crohn’s disease activity?

52 / 100

52. 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?

53 / 100

53. 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?

54 / 100

54. A 34-year-old man comes to the office due to abdominal pain ,loss of wight , foul-smelling anal discharge and perianal discomfort for the past several weeks.
The patient has a history of recurrent anal fissures and takes a fiber supplement, stool softeners, and a topical analgesic. He also has occasional canker sores and recurrent abdominal pain and diarrhea, which he attributes to the use oflaxatives.
The patients mokesa pack of cigarettes daily but does not use alcohol or Illicit drugs. Temperature Is 38 C (100.4 F). blood pressure is 120n6 mm Hg, and pulse Is 86/min. Tenderness Is present in the right lower quadrant on deep palpation.
Perianal examination shows a large posterior skin tag. A fistula anterolateral to the anus Is draining whitish material. Biopsy form ileum showed non-caseating granuloma. What is the diagnosis?

55 / 100

55. Case of multiple gastroduodenal ulcers with UGIB, asking about what lab test to do? Pt with recurrent esophagitis with multiple gastric ulcers what investigation will you order?
 45 male came to the ER 12 hours ago complaining of vomiting fresh blood, he has a history of 10 years recurrent peptic ulcer. Upper endoscopy showed Esophagitis multiple ulcers distal one is in the 4th part of duodenum.
What is the best diagnostic value ?

56 / 100

56. Epigastric pain , diarrhea and recurrent peptic ulcer with increase secretin of acid ?

57 / 100

57. Epigastric pain, diarrhea, started 8 months prior and only partially improved with eating and use of omeprazole, his hx recurrent Nephrolithiasis, EGD shows multiple ulcers throughout the transverse portion of the duodenum and jejunum, diagnosis?

58 / 100

58. Pregnant with history of placental abruption 2 times before came in 3rd pregnancy with same condition and severe bleeding she’s on 37 week, when to admit patient?

59 / 100

59. A 28-year pregnant woman In her 34 weeks of gestation presented to Emergency Room with heavy vaginal bleeding. Abruption placentae is suspected (see lab result). Blood pressure 88/42 mmHg Heart rate 129 /min Respiratory rate 26 /min Oxygen saturation 96 % Test Result Normal Value Hb 86 130-170 gA_، the best next approach to save her life?

60 / 100

60. A 38-year-old presented to Labor Ward with severe abruptio placentae. She was diagnosed with intrauterine fetal death and disseminated intravascular coagulopathy (DIC). Vaginal examination revealed a 6 cm dilated cervix. The most appropriate management?

61 / 100

61. What is the most common cause of disseminated intravascular coagulation in pregnancy?

62 / 100

62. What is the most common risk factor for abruptio placentae?

63 / 100

63. A 22-year pregnant at 37 weeks gestation presents after fainting and has severe abdominal pain. She is cold and diaphoretic. Fundal height is 39 cm; the cervical os is closed, and there is no vaginal bleeding. Blood pressure 90/56 mmHg, Heart rate 130 /min. Which of the following is the most likely diagnosis?

64 / 100

64. A 32-year pregnant woman with polyhydramnios presented at 37 weeks of gestation with painful vaginal bleeding and uterine tenderness following spontaneous rupture of membranes. Cardiotocography shows persistent bradycardia. The most likely diagnosis?

65 / 100

65. A 24-year-old primigravida who is a heavy smoker presented at 34 weeks of gestation to the Emergency Department with sudden heavy painful vaginal bleeding associated with uterine tenderness. What is the most likely diagnosis?

66 / 100

66. 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?

67 / 100

67. A primigravida (at 28 weeks) and a heavy smoker presented with severe vaginal bleeding and abdominal pain. Most likely cause is?

68 / 100

68. A 25-year-old woman G2 P1001 at 36+4 weeks gestation with a history of prior cesarean section presents with abdominal pain and vaginal bleeding. Fetal heart baseline 160 bpm with minimal variability and repetitive late deceleration. The diagnosis?

69 / 100

69. A 32-year-old primigravida at 34 weeks’ gestation presents for urgent care after falling down a flight of stairs. The patient complains of uterine tenderness and reduced fetal movement in the 45 minutes since the fall. There has been a small amount of dark red vaginal bleeding. The fetal heart monitoring revealed a heart rate of 150 bpm with Irregular uterine contractions every 3 to 4 minutes. Her pregnancy has been uncomplicated. She has a positive history of cigarette smoking. Which of the following is the most likely diagnosis?

70 / 100

70. Pregnant in 27 GA, came with minimal bleeding us showed placenta totally covers the mother’s cervix . What is the most imp Mx?

71 / 100

71. placenta previa 38 weeks with bleed now Unstable, what to do?

72 / 100

72. A pregnant woman at 37 weeks with profuse bleeding and contractions, and ultrasound shows placenta previa. What is the management?

73 / 100

73. In a case of third-trimester pregnancy with vaginal bleeding, abdominal exam showing a length less than the gestational age, and CTG showing late decelerations, what is the diagnosis?

74 / 100

74. When should cesarean section (C/S) be performed in a case of placenta previa?

75 / 100

75. A pregnant woman at 32 weeks gestational age presents with mild painless vaginal bleeding, few hours ago (placenta previa). What is the appropriate management?

76 / 100

76. A patient presents with painless mild vaginal bleeding at 34 weeks. What is the next step?

77 / 100

77. A pregnant unbooked patient presents with painless vaginal bleeding at 34 weeks, with a fundal height of 34 weeks. She lives far away and has difficulty in transport. What is the most appropriate thing to do?

78 / 100

78. A 39-year-old primigravida presents at 39 weeks gestation for a routine visit. Physical examination reveals cervical dilation, effacement, and elevated blood pressure. What is the most appropriate management?

79 / 100

79. A pregnant lady at 23 weeks gestation comes with mild vaginal bleeding. Ultrasound shows the placenta partially covering the internal os. What will you do for her?

80 / 100

80. In a patient who underwent uterine myomectomy for fibroids, and it was noted in the surgery note that it entered the uterine cavity, what’s the percentage of placenta accreta?

81 / 100

81. What is the predisposing factor for placenta previa?

82 / 100

82. A pregnant woman at 27 weeks gestational age presents with minimal bleeding, and ultrasound shows Placenta totalis. What is the most important management?

83 / 100

83. In a pregnant woman with a history of previous surgery, where the placenta is implanted into the uterus, what is the diagnosis?

84 / 100

84. In a case of retained placenta after spontaneous vaginal delivery, where the patient refuses hysterectomy and is managed by ligating the placenta and started on Methotrexate therapy, what is the complication of this case?

85 / 100

85. case of a previous surgery pregnant the placenta into uterus.?

86 / 100

86. In a case where the placenta is implanted deep into the uterine wall, what is the diagnosis?

87 / 100

87. Placenta is implanted in the superficial uterine wall. What is that?

88 / 100

88.
A 37-year-old P4 with a history of 3 previous cesarean sections is undergoing an elective cesarean section at 37 weeks of gestation. The placenta was found to be attached deeply into the uterine wall. What is the most likely diagnosis?

89 / 100

89. A woman with breast cancer is on tamoxifen. What is a side effect of this drug?

90 / 100

90. A 60-year-old postmenopausal woman complains of a 1-year history of recurrent vulvar itching associated with blood-streaked secretions. She has recently developed a pea-sized mass in the labia. What is the likely diagnosis?

91 / 100

91. A 45-year-old woman has undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a benign reason. She started to have acute vasomotor symptoms post-operation and agreed to hormone replacement therapy. What is the most appropriate hormone replacement therapy regimen?

92 / 100

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

93 / 100

93. A 36-year-old lady with secondary amenorrhea (elevated FSH & LH). What is the most likely complication for this patient?

94 / 100

94. A menopausal woman complains of insomnia and flushing. What is the most appropriate treatment?

95 / 100

95. A postmenopausal woman with dyspareunia and vaginal itching. What is the management?

96 / 100

96. A postmenopausal patient complaining of itching in the vulva and watery discharge. On examination, scratches and scaly areas are found. What is the diagnosis?

97 / 100

97. A 60-year-old postmenopausal woman complains of vaginal dryness and itching. What is the management?

98 / 100

98. A 51-year-old woman presents with hot flashes, irregular periods, and asks about the possibility of entering menopause. Which parameter is required to diagnose menopause?

99 / 100

99. A 45-year-old woman with a history of 7 months of amenorrhea, negative pregnancy test, and the desire to get pregnant. What is the most appropriate investigation to do?

100 / 100

100. A 23-year-old woman is evaluated after a recent diagnosis of polycystic ovary syndrome. She is concerned about hirsutism and irregular menses. She is not planning for pregnancy at this time and takes no medications. On physical examination, she has mild hirsutism, and the remaining of her physical examination, including pelvic examination, are normal. What is the most appropriate treatment?

Your score is

إختبر نفسك 7

1 / 100

1. A 45-year-old obese nulligravida patient with polycystic ovary syndrome has had irregular vaginal bleeding since menarche. Lab results show elevated estrogen, FSH, and testosterone levels. Endometrial biopsy shows adenomatous hyperplasia. What is the most likely cause of the adenomatous hyperplasia?

2 / 100

2. A 25-year-old obese female with hirsutism, amenorrhea for about 5 months, and a dark rash on her neck and shoulders. What is the diagnosis?

3 / 100

3. A patient with irregular periods, hirsutism, increased LH, normal FSH, and increased testosterone levels. What is the next test to order?

4 / 100

4. A 20-year-old female with hair loss for 6 months, extensive facial and back acne, BMI of 33 kg/m2, thinning hair at the forehead with a receding hairline, normal thyroid, and negative urine pregnancy test. Serum prolactin and thyroid function tests are normal. Which additional test is indicated in this patient?

5 / 100

5. What is the action of metformin in the treatment of polycystic ovarian syndrome?

6 / 100

6. A patient with PCOS (polycystic ovary syndrome) who is obese and wants to get pregnant. How should she be managed?

7 / 100

7. What is the mechanism of action of clomiphene?

8 / 100

8. A patient with polycystic ovary syndrome who wants to become pregnant. What treatment should be given?

9 / 100

9. In polycystic ovary syndrome, what blood test is used for evaluating hirsutism?

10 / 100

10. In a patient with polycystic ovary syndrome, what investigation would you expect?

11 / 100

11. A patient complains of infertility, obesity, irregular menses, acne, and hirsutism. An ultrasound shows multiple small cysts on the peripheries of the ovaries. What is the diagnosis?

12 / 100

12. A patient with irregular menses, acne, and hirsutism. What is the cause?

13 / 100

13. A 25-year-old obese female with hirsutism, amenorrhea for about 5 months, and a dark rash on her neck and shoulders. What is the diagnosis?

14 / 100

14. In a patient with irregular periods, hirsutism, increased LH, normal FSH, and increased testosterone levels, what is the next test to order?

15 / 100

15. A 20-year-old female with hair loss for 6 months, extensive facial and back acne, BMI of 33 kg/m2, thinning hair at the forehead with a receding hairline, normal thyroid, and negative urine pregnancy test. Serum prolactin and thyroid function tests are normal. Which additional test is indicated in this patient?

16 / 100

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

17 / 100

17. A woman did some procedure (pelvic procedure but forgot what it was) and then came complaining of urine from the vagina during urination (micturition). What is the diagnosis?

18 / 100

18. A multiparous woman presents with pelvic fullness and the feeling of something coming out of her vagina. How do you establish a diagnosis?

19 / 100

19. A woman had 7 kids, now she is complaining of a vaginal mass protruding more with a cough. What is the next step?

20 / 100

20. A pregnant woman in the third trimester has vaginal prolapse grade 2. CTG is normal, vital signs are normal. What to do?

21 / 100

21. A 70-year-old woman, sexually active, had a hysterectomy done before, and she complains of prolapse and an enlarged vaginal opening, what is the appropriate procedure?

22 / 100

22. A female, P6, feels heaviness and discomfort in her pelvic region, exam showed a mass coming from the introitus, diagnosis?

23 / 100

23. An old lady, medically free with difficulty defecation and constipation, during defecation she introduces her finger in the vagina to initiate movement, management?

24 / 100

24. A 70-year-old lady had a hysterectomy 15 years ago now she has a very large vaginal vault prolapse which covers something I don’t remember and reaches the perineum. What is the appropriate treatment?

25 / 100

25. Intrauterine device with brown discharge. What’s the side effect?

26 / 100

26. Pt with chlamydia infection what to give?

27 / 100

27. Commonest Contraindication for intrauterine device?

28 / 100

28. Couples came to infertility clinic; the wife had Pelvic inflammatory disease 2 years ago with chlamydia infection and got treated, the husband’s semen was normal. What is the appropriate step?

29 / 100

29. Woman with a history of PID twice who has normal regular menses and her husband has a normal semen analysis but failed to get pregnant

30 / 100

30. Pt with chlamydia infection what to give?

31 / 100

31. Adhesion in the pelvis postoperative organism?

32 / 100

32. A patient with PID (brown discharge), she was treated with IV ceftriaxone but did not improve. What is the most likely causative organism?

33 / 100

33. 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

34 / 100

34. patient with post-partum hemorrhage who was resuscitated then they found that there is persistent bleeding at several puncture sites what is the next important step?

35 / 100

35. Patient delivered without episiotomy, placenta was check and all parts were delivered, then patient had gush of blood coming, what is your next step?

36 / 100

36. Patient was on labor after delivery had inverted uterus and started to have bleeding what is the most imp cause for postpartum hemorrhage ?

37 / 100

37. 35 Year old , G4p3L2 , medically free, presented in labor which take 16 hrs to deliver a 3 kg baby boy healthy, after delivering the placenta the patient had large amount of bleeding , what could be the cause?

38 / 100

38. In a patient with postpartum hemorrhage on oxytocin, where the source of bleeding cannot be determined due to excessive bleeding, what should be done?

39 / 100

39. In a woman with persistent bleeding who wants to conceive in the future, which structure should be ligated?

40 / 100

40. What percentage of maternal deaths worldwide is due to postpartum hemorrhage?

41 / 100

41. How do you differentiate between hypovolemic shock and postpartum hemorrhage?

42 / 100

42. In a patient with a precipitous labor, what is the most likely cause of postpartum bleeding?

43 / 100

43. During vaginal delivery with postpartum hemorrhage not controlled by manual compression and oxytocin, and the patient is hemodynamically unstable (hypotensive), what should be done next?

44 / 100

44. During a C-section with postpartum hemorrhage not controlled by manual compression and oxytocin, what should be done next?

45 / 100

45. In a woman who delivered a macrosomic baby at 38 weeks and now presents with postpartum hemorrhage, what is the treatment?

46 / 100

46. A lady who just delivered, her uterus was lax with mild post-partum hemorrhage, there were no lacerations and no remaining products of conception in the uterus. What is the appropriate management?

47 / 100

47. What is the highest success rate drug used in postpartum hemorrhage?

48 / 100

48. What is the best method to stop bleeding after delivery (postpartum bleeding)?

49 / 100

49. What is the most accurate method to ensure full placental separation?

50 / 100

50. Patient post delivery massage is done, oxytocin done. She was bleeding. On inspection you found it is due to laceration 2 cm you tried sutures but it’s not possible due to perfuse bleeding from above, what is the most appropriate next step?

51 / 100

51. What is the initial step in managing excessive vaginal bleeding in a postpartum patient after delivering a 4020-g baby with a history of chronic hypertension?

52 / 100

52. In a patient who delivered without an episiotomy, and all parts of the placenta were delivered, but she experienced a gush of blood afterward, what is the next step?

53 / 100

53. In a patient with postpartum hemorrhage, what is the most common cause?

54 / 100

54. What is the definition of primary postpartum hemorrhage?

55 / 100

55. What is the cause of bleeding when a pregnant woman experiences bleeding after 10 hours following delivery?

56 / 100

56. What type of bleeding occurs when a patient has 800 ml of vaginal bleeding after the delivery of the baby?

57 / 100

57. Pregnant lady at the third trimester came to the ER complaining of headache and sharp RUQ pain, BP 165/100, Protein +4. What is the cause of her pain?

58 / 100

58. Pregnant, now blood pressure 140/90, platelets 50,000, history of previously severe preeclampsia. What indication here of severe preeclampsia in this scenario?

59 / 100

59. Case of preeclampsia with very low platelets and high urea. What indicators suggest that it is preeclampsia?

60 / 100

60. A 30-year-old woman G2P1001 at 32 weeks’ gestation is admitted to labor and delivery complaining of lower abdominal and back pain. She has a significant previous history of severe preeclampsia (see lab results). Blood pressure: 140/90 mmHg. Test Result: Platelet count: 80 (Normal Values: 150-400 x 10^9/L), Uric Acid: 460 (Normal Values: 140-360 pmol/L). Which of the following findings would indicate severe preeclampsia?

61 / 100

61. A 27-year-old primigravida presented at 36 weeks of gestation with a headache, blurred vision, and proteinuria +++ Blood pressure 160/110 mmHg, heart rate 76/min, respiratory rate 18/min, temperature 36.8°C. Which of the following is the most appropriate medication for acute treatment of hypertension?

62 / 100

62. A 39-week pregnant woman with proteinuria and blood pressure 140/90. Your action?

63 / 100

63. A patient at 34 weeks of gestation with eclampsia. She was managed and stabilized. What is the most appropriate next step?

64 / 100

64. A woman at 34 weeks of gestation with the onset of eclampsia and controlled symptoms. What is the next step?

65 / 100

65. A primigravida at 32 weeks came with a mild headache with no abdominal pain or visual disturbance. Blood pressure 150/90, urine analysis +3 protein. What is the appropriate management?

66 / 100

66. A 38-year-old woman G3 P2002 at 34 weeks’ gestation is admitted to labor and delivery complaining of a headache, epigastric pain, and blurred vision. Non-stress test is reassuring. Blood pressure 170/120 mmHg. Which of the following is the most appropriate management?

67 / 100

67. A patient at 32 weeks presented with a seizure and high blood pressure. What is the next appropriate step?

68 / 100

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

69 / 100

69. A 26-year-old primigravida woman presented to the clinic at 37 weeks’ gestation for routine antenatal care. She reports feeling ill and has a frontal headache. A urine dipstick analysis is performed and shows proteinuria 2+. She is admitted to the hospital High Risk Unit and started on an intravenous infusion of magnesium sulfate. Blood pressure 152/102 mmHg, heart rate 72/min, respiratory rate 16/min, temperature 37.2°C orally. Which of the following is the primary reason for administering the intravenous medication?

70 / 100

70. A 23-year-old primigravida presented at 32 weeks of gestation with seizures (see lab result). Protein +++ Blood pressure 160/110 mmHg Heart rate 78 min Respiratory rate 18/min Temperature 36.6 °C. Which of the following is the most appropriate next step in management?

71 / 100

71. A 23-year primigravida presents at 38 weeks of gestation in active labor. She complains of headache. Her laboratory studies show normal complete blood count, normal liver function tests, and elevated protein/creatinine ratio, blood pressure 150/100 mmHg. What is the diagnosis?

72 / 100

72. A female, para 6, presents with secondary dysmenorrhea and abnormal uterine bleeding. On physical examination, the uterus is enlarged and tender. What is the definitive treatment?

73 / 100

73. A patient with dysmenorrhea uses NSAID with no improvement. Laparoscopy was performed (finding in the picture). What is the most appropriate drug for her?

74 / 100

74. A 13-year-old girl presented with her mother with primary dysmenorrhea since her menarche a year ago. What is the best management?

75 / 100

75. A patient with severe abdominal pain with menstrual cycle (dysmenorrhea), affecting her work. What can you give?

76 / 100

76. A 19-year-old woman presents with crampy, lower abdominal pain beginning with the onset of menses every month, lasting for 2 to 3 days. She reports radiation of pain to the lower back and upper thighs, along with nausea, fatigue, and headache that have been present for several years and progressively getting worse. Physical examination is normal. What is the most likely diagnosis?

77 / 100

77. A 25-year-old woman complains of cramps and lower abdominal pain that occurs during the first day of her menses and usually improves by the third day. Her periods are regular, and all clinical assessments and pelvic ultrasounds are normal. What most likely explains her clinical presentation?

78 / 100

78. A female complains of menstrual pain that goes away on the 2nd and 3rd day of her period. It is associated with nausea, vomiting, and back pain radiating to the thighs, which is progressively getting worse. What is the diagnosis?

79 / 100

79. A 25-year-old woman complains of recurrent behavioral symptoms that start a few days before her menstrual cycles and usually disappear around the second day of the cycle. These symptoms have led to reduced work productivity and increased healthcare visits. What is the most reliable method to establish the diagnosis?

80 / 100

80. A 25-year-old woman complains of recurrent behavioral symptoms that start a few days before her menstrual cycles and usually disappear around the second day of the cycle. These symptoms have led to reduced work productivity and increased healthcare visits. What is the most common affective or behavioral symptom for her diagnosis?

81 / 100

81. A 12-year-old obese girl, 5 months after menarche, presents with irregular menstrual bleeding and increased weight. She has mild acne and is agitated during the examination. What is the most likely disorder to consider in communicating with this patient?

82 / 100

82. 27-year-old woman presents to your practice with complaint of premenstrual abdominal bloating. irritability and uneasiness for the past 6 months. These symptoms begin 3-4-days before her anticipated periods and ease off with in 1 to 2 days of her menstrual flow. Recently, she had to take few days off work because of the intensity of her symptoms. Which one of the following is the most appropriate next step in management?

83 / 100

83. A 17-year-old with a change in behavior before every menstrual cycle that lasts for 3 days. What is the diagnosis?

84 / 100

84. A preterm patient at 30 weeks with 80% effacement and 2 cm dilatation, stable mom and fetus is admitted to labor. What should be done?

85 / 100

85. A patient with PPROM at 27 weeks presents with a fever. What should be done first?

86 / 100

86. A pregnant woman presented in recent days with premature rupture of membranes, then came with fever and abdominal pain. What is the likely diagnosis?

87 / 100

87. A 55-year-old woman complains of a mass protruding through her vagina when standing for quite some time, especially during coughing and straining. She has 7 children delivered vaginally, with the last delivery being complicated by prolonged second stage and ended up with vacuum extraction delivery of a 4.2 Kg baby. What is the most appropriate next step?

88 / 100

88. A patient on tocolytic beta-mimetics (terbutaline) experiences what is the most common side effect?

89 / 100

89. At 38 weeks gestational age, a patient experiences spontaneous rupture of membranes 24 hours ago, is not in labor, and has reassuring fetal status. What is the next step?

90 / 100

90. A 38-year-old primigravida presents at 38 weeks of gestation with a history of spontaneous rupture of membranes 24 hours ago. She has no labor pains, the uterus is soft, and the fetus is in cephalic presentation. Cardiotocography shows a normal fetal heart rate. What is the most appropriate next step in management?

91 / 100

91. A healthy lady experiences preterm labor. What should be administered?

92 / 100

92. At 32 weeks gestation, a patient experiences preterm labor and rupture of membranes. She was given steroids and antibiotics. What should be administered next?

93 / 100

93. A preterm patient at 30 weeks with 80% effacement and 2 cm dilatation, stable mom and fetus is admitted to labor. What is the appropriate action?

94 / 100

94. A patient at 27 weeks in labor with a 6cm cervical dilatation. What should be administered?

95 / 100

95. A 27-week lady with a history of PPROM. The CTG is reassuring, normal CBC, she is medically free, she denies any uterine contractions. What is the appropriate management?

96 / 100

96. A primigravida with preterm labor, known case of DM1, presents with severe contractions and a closed cervix. What should be given?

97 / 100

97. A pregnant woman at 32 weeks’ gestation presents to the Emergency Department with lower abdominal and back pain, cervical changes, and contractions. What is the most appropriate step in management?

98 / 100

98. A G3I known PPROM patient admitted on the 5th day develops a fever with a GBS count of 10,000. How will you manage?

99 / 100

99. A 27-year-old woman with a history of PPROM at 27 weeks presents with fever. What should be done first?

100 / 100

100. A 33-year-old patient presents with preterm rupture of membranes at 34 weeks of gestation. What is the most appropriate next step in management?

Your score is

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