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

Which of the following is the most appropoate management?

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

Heart rate 110/min

Temperalure 38.9 °C

Test Result Normal Values

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

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

Which of the following is the most approptiate management?

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

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

Male with non bloody diarrhoea, pale, oral ulcer? This is the exact question with no extra info!

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

Which of the following Is the most appropriate initial management?

woman, has History of miscarriage , Now she's GA of 7 weeks , she came to ER with vaginal spotting. Vaginal exam shows brownish discharge and no active bleeding and OS is closed , Patient denied any History of passing tissue. Everything else is normal What's your diagnosis

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

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

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

When would be the optimal time to administer intravenous antibiotics?

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

 When should the tests be repeated?

Patient Complain of Congestive Heart Failure came with Shortness Of Breath , Orthopnea and crackles , splenomegaly and high JVP what is the diagnosis

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

A mother brings her 6 month old child for a dTap vaccine, but she informs you that he suffered from a febrile seizure after his last dose. What will you do

Case present with right hand weakness with no numbness just for few hours than resolved. Exam normal (case of TIA). What investigation to do next

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

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

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

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

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

Body mass index 35 kg/m2

Transvagmal ultrasound.

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

representing pearl necklace appearance.

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

A 47-year-old alcoholic patient presented with 6-week history of weight loss, fever, and rl hypochondrium pain (see lab result and report).

Test Result Nomal Values

Alpha fetoprotein 120 0-40 ng'mL

Abdominal Ultrasound

Showed ascites and focal liver lesion in a cirrhotic hver

Which of the following is the most likely diagnosis?

Atrial fib , DM , post PCI , came with sever abdominal pain , the pain was 10/10 , on examination abdominal was rigid and sever tenderness , next

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

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

Follicle-stimulating hormone 10 5-20 IU/L

Luteinizing hormone 28 5-22 U/L

Prolactin 890 < 870 pmol/L

Testosterone 3 2 0.7-28 nmoVL

Which additional laboratory values should be obtained?

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

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

agreed.

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

30y old female came for pap screening, all her past results were negative, now results show low grade squamous epithelial lesion. What's the appropriate next step

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

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

A 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?

Vaginal discharge Cheese segment under what is diagnosis

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

Body mass index 37 kg/m2

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

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

Which of the following is the next step m management?

Appropriate position in epistaxis

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

Patient with severe abdominal pain with mensural cycle ( dysmenorrhea) affect her work what can you give

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

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

Dr decided to manage the patient by UltraSound guide per-cuteness drainage , how should take consent

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?

Elderly with MVA on exam "Battle sign" what's the diagnosis

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

Which of the following is associated with the above finding?

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

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

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

Test Result Normal Values

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

Estrogen 630 90-550 pmol/L

Follide-stimulating hormone 38 5-20 IU/L

Testosterone 3.1 0.7-2 8 nmoVL

Prolactin 590 < 870 pmol/L

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

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

Thyroid-Stimulating Hormone 4.5 0.4 - 5.0 pU/L

Endometrial Biopsy:

Adenomatous hyperplasia.

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

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

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

erosions up to splenic flexure (see lab results)

Test Result Normal Values

4.7-6.1 x 1012/L (Male)

4.2-5.4x1012๕ (Female)

Hb 10.9 130-170 g/L (Male)

120-160 g/L (Female)

Platelets count 488 150-400 x 109/L

WBC 6 4.5-10.5 x 109/L

ESR 32 2-10 mnVh (Male)

3-15 mm/h (Female)

Consistency LIQUID (soft or tight)

Color YELLOW Brown

Mucus and blood *♦ absent

Leukocytes +++ solitary

Which of the following is the best treatment option?

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

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

Which of the following complicatons is most likely to occur?

Q- 7 years female with eyelid erythema and thickening of skin over metacarpophalyngeal joints + proximal muscle weakness?

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

What does metformin do in the above condition?

Scenario of a child with celiac disease, +ve anti-endomysial antibodies and Anti- transglutaminase antibodies (ATA), biopsy shows villous atrophy what to do

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

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

Which of the following vaccines is most appropriate to administer?

A-pt with a history of sickle disease present to you office with progressiv hip pain diagnosis

Pregnant woman develop Shortness of breath , ultrasound of uterus shows snow Appearances what is the diagnosis

Female in 20s has diabetic present with confusion. The patient has a long history of type 1 diabetes. She also complains of periorbital swelling, rhinorrhea and black necrotic spot over the face. labs show glucose 600 mg/ dl and ketones. CT scan shows obliteration of all the sinuses. Which of the following is the causative organism

A surgeon was performing a procedure on a patient with chronic hepatitis C infection. He accidentally had a needle slick injury

What is the likelihood of hepatitis C transmission?

A 69-year-oid man seen in Outpatient Clinic for a routine check-up No relevant history, apart from occasionally tow back pain on non-steroidal anti-inflammatory drugs as needed. No chrome medical history On examination, his abdomen was soft with no masses. Rectal examination was normal (see lab results).

Test Result Normal Values

RBC 4 4.7-6.1 X 1012/L (Male)

4 2-5.4 x 1012/L (Female)

Hb 8 130-170 g/L (Male)

120-160 gA_ (Female)

HCT 38 0 42-0 52 (Male)

0.37-0.48 (Female)

MCH 23 28-33 pg/cell

WBC 5 4.5-10.5 x 109/L

Which of the following is the most important next step?

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

Blood pressure 135/88 mmHg

Heart rate 89 /min

Respiratory rate 18/min

Temperature 37.4” C

Which of the following is the most likely diagnosis?

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

 Which of the following Is the most likely diagnosis?

Patient admitted in the hospital and recent do lanryngotomy , suddenly developed vomiting and muscles weakness , labs show potassium level are 8.0meq/l , ECG was done which showed peaked T Waves what is immediately step in management

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

Which of the following is the first step in management?

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

Which of the following is the most appropriate management?

A 39-year-old primigravida attended her routine prenatal visit at 39 weeks' gestation. She denied any headache, visual changes, nausea, vomiting or abdominal pain. Urinalysis was negative for protein (see lab results)

Vital signs at this visit: Blood pressure 160/90 mmHg

Heart rate 84 /min

Vitals signs at all other visits: Blood pressure 120/70 mmHg Heart rate 68 /min

Test Result Ncwmal Values HCT 0.34 0.37-0.48 Platelets count 165 150-400 x 109/L Alanine aminotransferase 12 5-40 IU/L Aspartate aminotransferase 22 12-40 IU/L

Which of the following is the most likely diagnosis?

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

Foetal Heart Rate 120 beat/min

Which of the following is the most appropriate immediate management?

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

Body mass index 30 kg/m2

Which of the following laboratory values is most likely finding?

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

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

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

Postmenopausal women 50-100 IU/L

Men 5-20 IU/L

Men 3-15 U/L

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

Ovulatory phase 30-250 U/L

Postment^ausal Women > 30 U/L

Prolactin 140 ng/ml < 25 ng/ml

Which of the following is the most likely diagnosis?

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

Blood pressure 110/70 mmHg

Heart rate 90 /mln

Standing

Blood pressure 104/66 mmHg

Heart rate 100 /min

Temperature 36.6° C

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

Pregnancy test -ve

Which of the following is the first step in management?

A 72-year-oid man complains of difficulty in getting up from the chair for the last 3 months. History reveals he has controlled type 2 diabetes and long standing hypertension.

Which of the following is the most leading type of injury in this patient?

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

Blood pressure 170/120 mmHg

Which of the following is the most appropriate management?

Which of the following increase risk for ischemic heart dis

Child everything normal except that he had episodes of blinking several times but he is conscious ,aware and talking with parents then resolved .,diagnosis

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

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

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

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

Which of the following Is the most likely diagnosis?

Patient BMI 18 but think of oneself as obese thus dieting, Diagnosis

hypertension , post MI on ACE , BB , aspirin , what to add

New born seizure after delivery with hypoglycemia, management

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

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

A 35-year-o!d woman presented with chronic vague gastric pain for several years. The pain is revealed by food. Serum immunoglobulin studies for IgG against heiicobacter 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 !he following is the most appropriate test to ensure h pylori eradication?

A 16-year-old girl is complaining of infrequent cycle occurring once every 6 to 8 weeks. Which of the following is most likely the cause?

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

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

woman had a C-Section. What is the best way to prevent adhesions

A 19-yearoid woman presented with crampy, lower abdominal pain beginning with the onset of menses every month, and lasting for 2 to 3 days. There was no pan between menses, but reported radiation of pain to the lower back and upper thighs, along with nausea, fatigue, and headache which has been present for several years and progressively getting worse. Physical examination normal.

Which of the following is the most likely diagnosis?

Patient presented with breast abscess was on antibiotic but no improvement What to do?

A 23-year<ud 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?

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

Q- 30 year old pregnant women presented with lower abdominal pain and moderate vaginal bleeding, complain of Bronchial asthma , epilepsy and smoker. What is the highest risk factor for her condition?

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

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

Surgeon is doing OP for patients with Hepatitis C and suddenly he was injured by an injection. What is the percentage of getting infection

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

Which of the following is the most likely diagnosis?

this Picture what does indicate

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 <Male)

20-120 pgn. (Female)

Vitamin B12 (Men) 124 160-900 ng/L

Folic Aad (Men) 6 <4 pg/l.

Which of the following is the most appropfiate management?

Medical student came to you in the clinic wants you to give him sick leave to his final exam tomorrow because he was with his sick mother in hospital last night and couldn’t study for the test, what is your action

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

Which of the following the most appropriate management?

A patient present to the Er after spontaneous collapsing while waiting for the bus. The patient does not have any history of cardiac abnormalities diagnosis?

Patient with Shortness Of Breath only . no other symptoms , lab results showed respiratory alkalosis and  Pulmonary Embolism in  ECG they asked what’s the best diagnostic test?

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

Which of the following is the most appropnate next step?

After resection of a pedunculated polyp the resutls was benign adenoma and patient has no family history of colon cancer what to advice for reduction of colon cancer

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

Temperature 38.6 °C

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

120-160 g'L (Female)

Reticulocyte 5.6 0.2-12 %

Platelets count 32 150-400 x 109/L

Indirect bdirubin 48 3.2-12 1 pmol/L

Total bilirubin 76 3.5-16 5 pmol/L

Lactate dehydrogenase 690 60-160

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

Prothrombin time 10 10-13 sec

Which of the following is the most appropriate treatment?

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

CTG Is reactive with baseline fetal heart of 170 bpm

Blood pressure 138/78 mmHg

Heart rate 111 /min

Respiratory rate 24 /min

Temperature 38.4º C oral

Which of the following Is the next step in management?

A 65-year-old man presented with 6-month symptoms of Parkinsonism, early dementia, fluctuations in cognition and visual hallucinations.

Which of the following is the most likely diagnosis?

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

Which of the following is most likely diagnosis?

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

Blood pressure 120/70 mmHg

Heart rate 90 /min

Respiratory rate 20 /min

Temperature 36.6“ C

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

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

What is the best approach for pneumococcus immumzatton?

A 24-year-oid multiparous woman is In the second stage ๙ labour. She has a history of asthma and she uses an albuterol inhaler as needed She has a prior herpes simplex virus infection and reports outbreaks about once per year As a child, she contracted rheumatic fever and takes prophylactic antibiotics when needed for mitral valve stenosis

Which significant medical history indicates beneficial use of forceps?

A 30-year-old woman gravida 4. para 3 woman presents to Antenatal Clinic at 32 weeks' gestation with headache and swelling of the feet. At the initial antenatal visit, there was *2 pitting edema of the lower extremities and the face appears swollen. Dipstick of the urine shows proteinuria. The fundal height is 28 cm and fetal heart rate was 140-150 beats per minute with good variability. She reports regular fetal movements.

Blood pressure 150/100 mmHg

Heart rate 90 /min

Respiratory rate 26 /min

Temperature 37.1º C

Whtch additional clinical finding would be associated with intrauterine growth restriction?

Young patient with Hx of acute pancreatitis 2 weeks ago, presented now with epigastric abdominal pain, CT showing 4 cm peri pancreatic fluid, no necrotic tissue Management

A 72 year old man present with an episode of right sided weakness that lasted 10 m and fully resolved and he is stable and medical free vital stable Which of the following is the most appropriate next step in the management

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

Which of the following is an appropriate management?

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

cardiovascular risk factors

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

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

Which of the following is the most likely predisposing factor?

which of the following lead to hyposplensim

A 26-year-old pnmigravida woman presented lo the dime at 37 weeks’ gestation for a 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 oral

Which of the following of the primary reason for administering the intravenous medication?

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

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

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

Which of the following is the most likely diagnosis?

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

Hb 89 130-170 g/L (Male)

120-160 g4_ (Female)

MCV 103 80-95 fl

Platelets count 128 150-400 x 109/L

Ferritin 105 20-300 pg/L (Male)

20-120 pg'L (Female)

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

Folic Aod (Men) 8 <4 pg/L

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

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

Which of the following is the most likely finding?

asthma poorly controlled on inhaled steroids and systemic sometimes, patient mentioned she’s using aspirin and NSADI almost daily for her migraine. she also has nasal polyps how would u manage her

Child presents with fever, vomiting and diarrhea on exam of chest there is reduced air entry to right side and murmur was heard , the child CVS and chest exams were previously normal (prior visits) what is the management of murmur

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

Which of the following most likely explains her clinical presentation?

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

4 year recurring pneumonia with Chest X.ray showing right lower lobe collapse what’s the best modality to diagnose i think it’s hinting for foreign body 

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

Blood pressure 110/70 mmHg

Heart rate 100 /min

Respiratory rate 24 /min

Temperature 36.6º C

Test Result Normal Values

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

Which of the following is the best management?

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

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

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

Reveals diffuse penventricular white-matter hypenntensities.

Which of the following is most likely diagnosis?

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

Which investigation is the most helpful in making a diagnosis?

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

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

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

During this pregnancy which of the following risks is increased?

A 63 years old women presents to the Primary Care Physician with haematuria . She reports having had a throat infection 2 weeks ago, for what her doctor prescribed penicillin V for 10 days. On the physical exam she has 150/90 blood pressure, her eyelids and both her ankles are swollen. What is the treatment she must receive now

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

What is the appropriate term of her skin hyperpigmentation?

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

Testosterone 13.86 0.7-2.8 nmoVL

which of the following is the most likely diagnosis?

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

 Which of the following is the best-evidenced treatment?

25 year old healthy female presents with a systolic murmur best heard at the apex radiating to the axilla. She has no past medical history. She has a recent history of dental tooth extraction 2 months ago and sore throat 10 days ago. What is the most likely diagnosis

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

preeclampsia (see lab results).

Blood pressure 140/90 mmHg

Test Result Noimal Values

Platelets count 80 150-400 x 109/L

Uric Acid 460 140-360 pmol/L

Which of the following findings would indicate severe preedampsia^?

Cirrhosis most common cause of Hepatocellular carcinoma

Q- 3 months old baby, brought by the family to hospital dead, he was preterm with chronic lung disease. He was sleeping with his parents in their bed, both parents are smokers. What is the cause of his death?

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

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

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

What is the most appropriate test to exclude cardiac ischemia?

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

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

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

Heart rate 120 beats per minute

Breathing Irregular, gasping

Reflex irrrtaDility Coughs, and cries with stimulation

Activity Arms and legs flexed, little movement

Appearance Rosy with blue extremities

What is the most accurate Apgar score?

How do you confirm premature rupture of membranes

baby with abdominal distention and difficulty passing stool , on PR examination empty rectum, but after finger pulled out there is diarrhea, Diagnosis

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

Which of the following is the most appropriate management?

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

Which of the following is the most appropriate management?

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

Which of the following is most appropnate investigation?

Pregnant women in 10 weeks , came to antenatal care as the first visit , which vaccine is recommended for the mother in this time

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

than a year (see lab result).

Test Result Normal Values

Calcium ionised 3.2 1.1-1.3 mmoVL

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

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

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

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

Blood pressure 150/95 mmHg

Hear! rate 76 'min

Respiratory rate 18/min

Temperature 36.6“ C

Which of the following would be the most appropnate management?

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

Which of the following is the most appropriate management?

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

Test Result Normal Value

Human chorionic gonadotropin N 5000 < 5 mIU.'mL

Which of the following is the most appropriate treatment?

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

Which of the following is the initial step in management?

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

Which of the following is the most appropriate next step?

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

Human chorionic gonadotropin 80.000 < 5 mIU/mL

Ultrasound

"Snowstorm-like’ appearance.

Which of the following is the most likely diagnosis?

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

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

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

Test Result Normal Values

INR 3 9 0.8-1.2

Which of the following is the most appropriate management?

A post-menopausal woman undergoing tamoxifen treatment for breast cancer, she had her last gynecological assessment by ultrasonography during her pre-menopausal period 5 years ago. At that time, she had intramural uterine fibroid measuring 2x3 cm. The patient complained of on and oft moderate amount of vaginal bleeding and her ultrasound confirmed intramural uterine fibroid measuring 5 x 8 cm and homogenous endometrium 5 mm in thickness.

Which of the following is the most likely diagnosis?

patient with MRSA wanted to be treated by Vancomycin. Immediately patient developed rash in the trunk. next step

A 30-year-oid woman presented to the Emergency Department at 03:00 o'clock with nght-sided abdominal pain in the lower quadrant. She rates the pain at a level 9 on the 1-10 pain scale. The pain was sudden, associated with nausea and vomiting. A human chorionic gonadotropin urine test was negative. On palpation, there is tenderness and a mass is noted. An ultrasound confirms a mass ot 6 cm diameter.

Blood pressure 120/70 mmHg

Heart rate 110 'min

Respiratory rate 20 /min

Temperature 37.0° C oral

Which of the following is the most likely diagnosis?

A 68-year-oia woman is admitted to the hospital with first episode of acute heart failure. She has a history of hypertension treated with a thiazide diuretic. An ecliocardiogram reveals no evidence of valvular disease and no segmental wall motion abnormalities Left ventricular hypertrophy is noted, and her ejection fraction is 55%.

Which of the following is the most likely cause of her heart failure?

Case of patient coming to the clinic with heart symptoms and the investigations showed that he needs urgent cardiac catheterisations, the doctor explained the need of catheterisations to the patient but the doctor noticed the patient is slow and have low mood and sadness. The patient acknowledged that he understand the information but he refused to do catheterisations, what to do

old female that had an episode of visual loss for 20 minutes and it came back. What is your diagnosis

Case of nephritic syndrome asking which of the following is important in history for diagnosis

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

Which of the following medication regimen is now most appropriate?

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

Blood pressure B4/50 mmHg

Heart rate 124 /min

Oxygen saturation 84 %

CT-pulmonary angiogram:

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

A patient after 2 day Post Mi complain of chest pain radiate to back with ST segment elevation in leads II, III, and AVF presents now with a new holosystolic murmur and bilateral basal crackles. What is the most likely diagnosis

A 45-year-old woman comes to the clinic complaining of loss of appetite, bloating and abdominal pain. Clinical assessment and investigations confirmed the presence of moderate ascites, pleural effusion and bilateral ovarian masses. Cancer antigen 125 (CA 125) was 95 unit/ml.

Which of the following is the most likely diagnosis?

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

Test Result Normal Values

Hb 89 130-170 g/L (Male)

120-160 (Female)

MCV 106 80-95 fl

Platelets count 129 150-400 x 109/L

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

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

Which of the following would be found on further testing?

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

Which of the following is the most probable diagnosis?

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

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

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

Which of the following is the most likely diagnosis?

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

What is the scientific term for this fetal presentation?

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

Which of the following antibiotics should be avoided?

Pediatric patient family was camping drinking alot of unpasteurized milk with fever

Pediatric Cushing features (obesity + purple stretch marks in the abd + HTN) Initial management

A 64-year-old man, who has hypertension, presents with Increasing shortness of breath. His symptoms are worse at night. On examination, there Is bilateral basal crackles and a third heart sound (S3).

Which of the following is the most likely diagnosis?

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

Which of the following is the first step in management?

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

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

Which of the following is the most appropnate next step?

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

Blood pressure 90/60 mmHg

Heart rate 110'mln

Respiratory rate 13/min

Temperalure 37.6° C

Pregnancy Test:

Negative.

Which of the following is the most likely diagnosis?

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

current medications include alendronate and hydroctilorothiazide.

Which of the following is the most appropriate action?

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

Blood pressure 124/72 mmHg

Heart rate 120 /mln

Respiratory rate 24 /mm

Temperature 37.5º C oral

Which of the following tests Is initially most approphate?

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

Trauma patient with multiple fractured rips, vitally stable, conscious, oriented and normal breathing sounds bilaterally, next management

Which of the following is the causative organism of cat-scratch disease

male complaining of reflux and post prandial discomfort this a main complain in his family What is the risk factor for cancer esophagus

Female patient with a history of DM, HTN, and CHF “on insulin, enalapril, and furosemide” She is Presenting with lower limb edema and diagnosed with DVT. She started haparin. Labs showed high k = 6 Which medication should be stopped at this stage

A 32-year-old woman 30-week pregnant G1*0»0, presented to the clinic with pruritus and jaundice. There is no lever, abdominal pain, or vomiting. She is not on any medications and no chronic medical illness (see lab results).

Test Result Normal Values

Hb11 130-170 g/L (Male)

120-160 g/L (Female)

Platelets count 160 150-400 x 109/L

WBC 7 4.5-10.5 x 109/L

Alkaline phosphatase 700 39-117IU/L

Alanine aminotransferase 79 5-40 lU'L

Aspartate aminotransferase 100 12-40 IU/L

Which of the following is the most likely diagnosis?

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

Which of the following methoOs is most appropriate?

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

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

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

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

A 62-year-oid patient known case of chronic hepatitis C presented with atxlominal 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?

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?

Sandpaper rash what is the organism

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

Ultrasound: Showed dizygotic twin pregnancy.

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

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

Which of the following is most appropriate investigation?

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

Which of the following is the most likely diagnosis?

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

Which of the following is the most likely fetal presentation?

A 25-year-oid woman complains of velvety, hyperptgmented plaques on her neck and under arm. She fails to conceive over the last 2 years despite regular intercourse. Her menses are infrequent and occurring once every 6 to 8 weeks. She notices recently increased facial hair. Her husband is healthy with a normal seminal analysis.

Which of the following is the most likely diagnosis?

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

Which of the following is the most appropriate management?

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

What is the advantage of a medioiaterai episiotomy?

A 80 year old who has been in the ICU for 4 days has developed pneumonia. What is the most likely  organism ?

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

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

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

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

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

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

Which of the following is the most likely diagnosis?

Neonate was born the mother says she had a baby died due to probably immune deficiency and ask about vaccines for the new baby

Epigastric pain stable suddenly sever pain and back pain pulstie mass , next

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

Which of the following intervention is the most important?

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

Heart rate 110/min

Temperature 38.9 ^VC

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

120-160 g4. (Female)

Reticulocyte 3.2 0.2-1.2%

Platelets count 123 150*400 x 109/L

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

Prothrombin time 24 10-13 sec

Direct bdirubin 24.5 1.5-6.5 pmol/L

Total Dilirubin 48.3 3.5-16.5 pmol/L

Lactate dehydrogenase 390 60-160 IU/L

Patient with esophageal bleeding, How to prevent

Patient known SLE, came with pale skin and fatigue, Labs Hb 10 (low) and ferritin 600(high), what is the cause

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

Test Result Normal Values

Hb 95 130-170 g/L (Male)

120-160 g/L (Female)

MCV 68 80-95 fl

Platelets count 530 150-400 x 109/L

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

9-30.4 pmol/L (Female)

Ferritin 3 20-300 pg/L (Male)

20-120 pg'L (Female)

Apart from starting iron supplement

which of the following is the most appropriate next step in

management?