1

OCTOBER 2018 SMLE

Color code: Question, Answer, Explanation

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14/10/2018
1- Preferred method for testing hypersensitivity type 2?
Skin test
Prick
RAST?
Answer: Depends on choices.

2- Which of the following has high diagnostic value for gonorrhea?

PCR
Gram stain
NAAT
Culture
Answer: NAAT
3-Baby with no head lag?
Answer: 4 months
Babies develop from head to toe and in a proximal to distal pattern. According to About Kids Health, by 4
months of age, babies should show no signs of head lag

4- Sit briefly, transfers objects?

Answer: 7 months

5- Tells stories, draw a body?

Answer: 4 y/o
6- Gonorrhea, what’s the best test to diagnose it?
Answer: NAAT
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7- Fishy odor, positive whiff test, what test are you going to confirm with?
Answer: Gram stain.
Dx is bacterial vaginosis, confirm by gram staining

8- ECG atrial flutter, treatment?

Warfarin?
Answer: In general, atrial flutter should be managed the same as atrial fibrillation. Because both rhythms
can lead to the formation of a blood clot in the atrium, individuals with atrial flutter usually require some
form of anticoagulation or antiplatelet agent

9- ECG, 2nd degree heart block, what are you going to do?
Answer: Pacemaker Mobitz2, there is high risk of developing third degree block, treatment is
pacemaker
Mobitz1: atropine

10- Patient hypertensive with gouty arthritis, treatment?

Colchicine
Ibuprofen
Intra articular corticosteroids
Answer: Colchicine
Side effect of long use of thiazides will increase uric acid so it's contraindication to use
thiazide in gouty patient
NSAIDs would be the recommended first- line treatment for patients not otherwise
4

contraindicated. However, colchicine (if patients are able to tolerate) or corticosteroids (in
the absence of sepsis) should be prescribed instead of NSAIDs to
1- NSAID
2- colchicine
3- steroid

11- Two cystic fibrosis career parents?

1:2
2:4
1:25
2:3
Answer: 1:4
12- What type of hypersensitivity is anaphylaxis?
1
2
3
4
Answer: 1
Type I reactions (ie, immediate hypersensitivity reactions) involve immunoglobulin E (IgE)–
mediated release of histamine and other mediators from mast cells and basophils. Examples
include anaphylaxis
13- Child with epiglottitis caused by H.influenza, treatment?
Gentamicin
Ceftriaxone
Answer: Ceftriaxone
Intravenous antibiotics such as ceftriaxone and possibly vancomycin or clindamycin is then given.[2][4] If allergy
to penicillins is present, co-trimoxazole or clindamycin may be an alternative.
5

14- Bone tumor that arises from pelvis?

Answer:
The majority of tumors in the pelvis are malignant (metastases, myeloma, chondrosarcoma, Ewingsarcoma,
osteosarcoma, and MFH/fibrosarcoma)
https://www.sciencedirect.com/science/article/pii/S0720048X11003780
Chondrosarcoma happens most often in people between 40 and 70. The hip, pelvis, leg, arm,
and shoulder are common sites of this cancer, which begins in cartilage cells
15- Most common skin manifestation with antimalarial drugs
Answer: Hyperpigmentation or itching
In general: itching or pruritus
In skin: hyperpigmentation
16- Most common risk factor for fibroid?
Age
African race
Smoking
Multipara
Answer: Depends on choices.

17- Malaria endemic region prophylaxis?

Answer:
Malaria prophylaxis areas with choloroquine-sensitive Pladmodium falciparum:
Chloroquine phosphate, Hydroxychloroquine sulfate, Atovaquone-proguanil, Mefloquine hyrdocholride,
Doxycycline hyclate. http://medup.ir/uptodate/contents/UTD.htm?8/19/8510&utdPopup=true

Chemoprophylaxis in general by quinelone related compounds

18- Artery affect with hearth block?
Right coronary artery?
Answer: Right coronary artery
Inferior wall mi, Right coronary artery
19- Most common type of study that risks a recall bias?
Answer: Case control
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Recall bias is a type of information bias common in case-control studies where the cases (or
their families) are more likely to recall a prior exposure than the controls
https://www.sciencedirect.com/topics/neuroscience/recall-bias
20- Most common type of study that risks a publication bias?
Answer: Meta-analysis
21- Most common type of study that risks a non-response bias?
Answer: Cross-sectional
22- Most common gene with hypertrophic cardiomyopathy?
Answer: MHC
Most of the genetic loci in familial HCM encode one of the myocardial contractile proteins of
the cardiac sarcomere the most commonly involved genes are MYH7, MYBPC3, TNNT2, and
TNNI3
23- PCOS have risk for which tumor?
Answer: Endometrial
24- Man complaining of ear pain, tympanic membrane clear when touching the pinna, it was
tender. Diagnosis?
Answer: Otitis externa
25- Hemophilia mode of inheritance?
Answer: X-linked recessive
hemophilia A and hemophilia B are inherited in an X-linked recessive pattern.
26- NF1 gene?
Answer: 17q11.2
NF1 encodes the protein neurofibromin, a GTPase-activating protein, which primarily regulates the protein
Ras.[6] NF1 is located on the long arm of chromosome 17, position q11.2

27- Contraindication for breastfeeding?

HCV
HIV
Varicella
Answer: HIV

28- Picture of dendritic ulcer of cornea?

Associated with corneal hypoesthesia?
Answer:
Herpes simplex keratitis, high recurrence rate can cause hypoesthesia
7

29- Interstitial lung disease with small non-necrotizing granuloma?

Sarcoidosis
Aspergillosis
Hypersensitive pneumonitis
Answer: Sarcoidosis
30- 2-DM type 1 pregnant at 3rd trimester have an increased insulin requirement despite
good control of her glucose level, what is the mechanism causing her hyperglycemia?
Maternal hyperglycemia
Maternal hypoglycemia
Neonatal hyperglycemia
Neonatal hypoglycemia
Answer: Neonatal hypoglycemia

31- young woman came to Primary health care for pregnancy counseling, she had
chickenpox when she was a child. What will you do to her?
Varicella immunoglobulin
Rubella antigen. **
Give MMR vaccine
Answer: Rubella antigen
“Do rubella titer for her in preconception .
She already infected with cheickenpox she had natural immunity.
Dont need to avoid exposure this Answer for pregnant came afarid of chekenpox a
dvice her to Avoid exposure as she is pregnant now.”
I had it today and yes the answer is do rubella titer , there wasn’t even “avoid exposure” in the
choices

32- preferred method for testing hypersensitivity type 2?

skin test
prick
RAST
Answer: IgG serum test.

33- which of the following has high diagnostic value for gonorrhea?
PCR
Gram stain
NAAT
Culture
Answer: NAAT
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34- 2nd degree heart block

Answer: pace maker
First degree AV block= No treatment is required
Second heart block (Mobitz type I)= treatment is unnecessary unless the patient is
symptomatic ,use atropine or a temporary pacemaker in symptomatic cases
Second heart block (Mobitz type 2)= permanent pacemaker
Third degree (complete) AV block= permanent pacemaker unless the cause is reversible (such
as medications)

35- digoxin toxicity

Answer: digoxin immune Fab (Digibind)

36-Child (boy) has cystic fibrosis his parents don’t have the disease what is the chance to have
a carrier daughter (Child sister) ;
1:2
1:25
2:4
2:3
Answer: 2:4
Affected, 1:4 (25%)
Carrier, 2:4 (50%)
CF: Autosomal recessive

36- Proximal Tibial fracture palpable peripheral pulse ABI: .85 what to do:
Angiography
Doppler US.
Ct
Answer: Angiography
If ABI more than 0.9 just follow up for ABI later treat the fracture.
If ABI less than 0.9 and stable amigo
If less than 0.9 unstable go for operative exploration.
37-
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38- which one of the following SSRI has the greatest risk in pregnancy?
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Answer: Paroxetine

39- ADHD diagnostic criteria according to ICD10 CLASSIFICATION, but I cannot remember the
answers:
But it was like this :( number of feature and the description of it) for example:
3 hyperactive, 3 inattentive, and other
2 hyperactive, 3 inattentive
2 hyperactive, 2 inattentive
6 inattention 3 hyperactive 1 impulsive
Answer:

40- Which one of the following patients has worst prognosis to, develops Steven Jonson:
HIV patient receiving sulfa group medication with unknown history?
Gouty arthritis patient with known sensitivity to all
Answer:

41- patient complain of hand pain after bee sting , on examination: tenderness + Axillary
lymph node enlarged, ( + picture: weal on forearm) what is dx:
Urticaria
Lymphangitis
Answer: Lymphangitis

42- Which of the following integrates glucose and fatty acid metabolism
Pyruvate
Citrate
Lactate
Acetyl-CoA
Answer: Acetyl-CoA
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43- DM pt , with chest pain for 3 days , dyspnea with exertion , history of URTI ECG : t
depression
Lab: troponin: high
What is the dx?
Myocarditis?
MI
Constrictive peri
Answer:
Acute myocarditis may mimic MI since chest pain, segmental wall motion abnormalities, and
myocardial necrosis proven by troponin elevation exist in both conditions.71,72 Smith et al
reported the rate of troponin positivity as being 34% in a study population with biopsy-proven
myocarditis
44- case scenario about female with past hx of PROM and now she is pregnant asymptomatic
and ask about indication of screening for bacterial vaginosis:
No indication
Screen at first trimester
Screen at second trimester
Screen at third trimester
Answer: No indication

45- Female with diffuse thyroid swelling and dominant single nodule , lab test result was
increase in T4 and decrease TSH what will you do:
Radionuclide scan
FNA
US
Thyroidectomy
Answer: Radionuclide scan
46 -Child presented with burn in the upper right extremity with bluster what is the degree of
the burn?
2nd degree more than 15%
2nd degree less than 15%
3rd degree more than 15 %
3rd degree less than 15%
Answer: 2nd degree less than 15%
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47- Stress incontinence symptoms in a patient who had evidence of urethral detachment,
next step:
Bonny’s test
Urethroscopy
Cystoscope
Q-tip
Answer Q-tip

48- pregnant women during labor, Iv oxytocin was given the CTG show variable and
acceleration what will you do?
Stop oxytocin
Expectant delivery
Change mother position
Answer: Expectant delivery
49- Colon cancer smoking RR?
Answer: 6.6
50- Lung cancer smoking?
Answer 70%
51- Prostatic cancer and high fat intake OR?
Answer: 5.2
52- A study was done on breast cancer and smoking and alcohol, results shows, First group
OR 1.4 (CI 95%: 1.0 – 2.0), Second group OR 1.6 (CI 95%: 0.7 – 10.8)
Which of the following is correct?
Answer:
53- Tetralogy of Fallot
Answer Pulmonary stenosis
54- Baby with cyanosis every time he feeds, what are you going to give?
NSAIDs
Answer: Indomethacine
55- Chronic granulomatous disease most common organism?
Answer: Staphylococcus aureus
56- Henoch-Schonlein purpura classic presentation, what’s the diagnosis?
Answer: HSP
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57- Pediatric DKA management?

Answer:
Reference: Illustrated Textbook of Pediatrics

58- New born with meningitis, what’s the organism?

Answer Listeria
59- Child came with olive mass and non-bilious vomit, what’s the diagnosis?
Answer: Pyloric stenosis.
60- Ptx on aspirin for CAD. He had a sudden episode of severe epigastric pain that became
generalized and guarding and tympanic percussion & high amylase.
Perforated Ulcer
Acute Pancreatitis??
Answer:

61- DM T2 gene
12?
Answer: short arm of chromosome 20

62- Necrotizing fasciitis and gram+ve cocci in

chains
piperacillin/ tazobactam??
pipercillin/ clinda
Answer:

63- Entameba question

Answer: boiling

64- On HTN medications with hypokalemia, what’s

the cause?
thiazides,
ACEI
Answer: Thiazide diuretics
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65-Cushing scenario
24-hour urine cortisol
AM cortisol only
Answer: 24 hour urine cortisol
66- Conn’s scenario with HTN and hypokalemia another symptom would be?
salt carving
Answer:

67- DI classic scenario. another symptom would be?

polyuria
Answer: Polyuria

68- Hypothyroidism and high TSH but asymptomatic & on meds

Continue same dose and f/u,
Stop med
Decreases dose
Answer: Continue same dose and f/u
69- MG treatment
pyridostigmine
Answer: pyridostigmine

70- Knee reflex/patellar reflex scenario

L3-L4
L4-5
L5-S1
Answer: L3-L4

15/10/2018
71- Pt had encephalitis organism?
Answer: Mumps
Encephalitis caused by varicella-zoster virus (VZV), Epstein-
Barr virus (EBV), cytomegalovirus (CMV), measles virus, or
mumps virus: Rash, lymphadenopathy, hepatosplenomegaly,
and parotid enlargement
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72-What is the most common cancer mets to stomach and stomach ca

Pancreas ca
Lung ca?
Answer:
73- Muscle lateral site dorsalspedis
Answer: Extensor digitorm longus
Medial to it = hallucus longus, Lateral= digitorum longus
74- Picture of SVT – ECG
Answer: Regular narrow QRS without p wave

75- 13 months old baby just finished his steroid dose, which one of these vaccines are you
going to give?
Answer:
76- Humerus shaft fracture
Answert: Radial Nerve
Humeral shaft: Radial, Surgical neck: Axillary.
77- Dorsal of hand which nerve cover it?
Radial?
Answer:
78- Recurrence of UTI and you want to give Nitrofurantoin, what’s the duration and dose
One dose for six month?
Answer:
79- Pt have fever and knee pain on the lab after aspiration cloudy color, what’s your
antibiotic of choice?
Answer:
Gram positive cocci – Vancomycin
Gram negative cocci - Ceftriaxone
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80- Testicular torsion?

Answer: Refer to surgery
81- Surgery in the posterior triangle, Great auricular nerve injury?
Answer:
Loss sensation in lower mandible and ear + Lesions where he feel
paralyzed Inferior to auguries and lower mandible.

82- Picture ulcer in mouth and the penis and the patient complain
difficult eating due to pain of ulcer, what is the diagnosis?
Syphilis
Bechet disease
Answer: Bechet disease
83- Syphilis-blisters
Answer: Pain less
84- Esotropia 25 degree, treatment?
Answer: Medical rectus recession
More than 15 PD: medial rectus recession
Less than 15 PD : eye glasses
85- Pic of corneal abrasion
Answer: Ab ointment + eyepatch
http://medup.ir/uptodate/contents/mobipreview.htm?33/50/34600#H12
86- Which one of the organisms is associated with contact lens induced corneal abrasions?
Pseudomonas

Streptococci

Staphylococci

Fungal
Answer: Pseudomonas
87- Infraorbital artery
Answer:
infraorbital artery is a branch of the third part of the maxillary artery. It runs through the
inferior orbital fissure, orbit, infraorbital canal then the infraorbital foramen
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89- Sphenopalatine artery

Answer:
Supplies nasal septum and it is branch of maxillary artery
90- Mumps complication
Answer:
Adults orchitis
Children meningitis
91- Pt have major depression takes paroxetine she’s pregnant
Stop drug
Continues drug and observe
Answer: Stop drug
92- Patient came from Ghana with neck mass
Answer: Burkitt’s lymphoma
93- Best antiepileptic in pregnancy
Answer:

94- Best anti-psychotic in pregnancy

Answer:
Women taking the antipsychotics quetiapine, olanzapine, or risperidone during pregnancy did
not have higher rates of complications
95- Schizophrenia case, doctor notice the patient is staring at someone not in there, and says
YOU CANT KILL ME? asking about this symptom?
Delusions
Hallucinations
Answer: Hallucinations

96- Patient on statin 20mg od , on routine exam Lipid profile was within normal except for
TG, Asking about which lipid lowering agent would you add :
Ezitembie
Fenofibrate
Niacin
Answer: Fenofibrate
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97- Pregnancy counseling, ask about how to asses of thalassemia in next pregnancy
Answer:
98- When to do OGGT in pregnant women which before pregnancy was in prediabetic range?
12
16
20
24
Answer: 24
24 – 28 weeks.

99- Q about mechanism of HDL protective effect on Heart, which enzyme is responsible?
Acetyl CoA
Cholesterol ester protein
Answer: Cholesterol ester protein
Cholesteryl ester transfer protein (CETP), also called plasma lipid transfer protein, is a plasma
protein that facilitates the transport of cholesteryl esters and triglycerides between the
lipoproteins. It collects triglycerides from very-low-density (VLDL) or low-density lipoproteins
(LDL) and exchanges them for cholesteryl esters from high-density lipoproteins (HDL), and vice
versa ))

100- Q about sudden painful loss of vision within mins to hours associated with very painful
eye movement, fundoscopy showing optic edema?
Multiple sclerosis
Trigeminal Neuralgia
Answer: Multiple sclerosis

101- Child with salmonella, asking about mechanism of Abx used?

Answer: IV ceftriaxone
Ceftriaxone selectively and irreversibly inhibits bacterial cell wall synthesis by binding to
transpeptidases, also called transamidases, which are penicillin-binding proteins (PBPs) that
catalyze the cross-linking of the peptidoglycan polymers forming the bacterial cell wall.

102- Prophylaxis of child going to south east Asia with his father:
cipro
doxycycline
ceftriaxone
Answer: doxycycline
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103- Patient asking about Prevention of Amebia infection:

Wash your hands
don't eat uncooked Vegetables??
two other abxs
Answer:
Avoid raw vegetables when in endemic areas, as they may have been fertilized using human.

104- best modality to Dx Cervical spondylosis:

MRI
CT
conduction studies
Answer: MRI

105- Q about fever and rash all over the body with facial sparing?
Answer: Syphilis

106- Old patient complaining of generalized fatigue and tiredness specially in the morning
with difficulty to stand from the chair, with weakness and stiffness?
RA
OA
Polymyalgia rheumatic
Polymyositis
Answer: polymyositis
Polymyositis, weakness and stiffness
Polymyalgia. stiffness and tenderness with NO weakness

107- Colle’s fracture in a child, your management?

Closed reduction with cast below Elbow??
Closed reduction with cast above Elbow
Answer:
If fx in radius or ulna bone, above elbow

108- Which of the following is a common cause of Cerebral palsy?

prematurity
perinatal Asphyxia
Low birth weight <1.5 kg
Answer: prematurity

109- sensory hair loss with tinnitus and lightheadedness with fullness of the ear sensation,
Answer: Audiogram Low frequency SNHL.
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110- old patient with gastritis low mcv (case of IDA ), what’s your management?
IM iron
Oral Iron
folate
Something else
Answer: IM iron

111- 19 years old young patient presented ER with headache and lightheadedness with
vomiting started 20 min ago ? what is your next step?
alcohol concentration
CT brain??
Answer:

112- Q ask specifically for Scabies Rx?

Answer: Permethrin cream and lindane lotion
Skin scraping to confirm Dx

16/10/2018
113- Mechanism of action of Warfarin?
Answer: Vit K ((vitamin K epoxide reductase))

114- meckle’s diverticulum

Answer: illium

115- safe hypoglycemic medication in pregnancy

Anwer: metformin ((You should avoid hypoglycemic agent during pregnancy))
((Pregnant women who take insulin for type 2 diabetes may also be prescribed metformin
to help with symptoms that develop during pregnancy. The dosage for women with PCOS
also varies based on their reaction to the medication.))

116- picture of xray and both radial and ulnar fracture and displacement and penetrate
skin
Answer: irrigation, debridement, fixation

117- end stage liver disease and fungus

Answer: Caspofungin

118- Young couple try to conceive for 6 months?

Answer: Try more

119- Working in a battery factory, semen analysis showed oligospermia, what’s the
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cause?
Answer: Lead

120- female with BMI 11 and daily measure weight and denied hunger, which of the
following is right:
decrease amylase
hyperkalemia
Answer:
Electolytes are all low like Na ,K,cl and Creatinine is high due to dehydration

121- OCD and ask about mechanism of drug?

Answer: increase availability of serotonin

123- best test to assess asthma severity?

Answer: FEV

124- CREST syndrome, what’s the gene?

Answer: Anticentromere antibody
Anticentromere is with CREST, Scl70 is with scleroderma

125- burkitt’s lymphoma

Answer: c-MYC
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126- known case of depression came to ER after ingestion of bottle of drugs he is

comatose with dilated pupil what drug he ingested?
Answer: Amitriptyline

127- Biopsy was made for lung shows hemosiderin-laden macrophages

What is the diagnosis:
EBV
Heart failure
pneumocystis jiroveci
Answer: HF

128- Scenario about patient had symptoms restless, sweating, heat intolerance on
examination pt is warm and have bradycardia on apical auscultation what is the
diagnosis:
Thyriod cancer
Multinoduler goiter??
Hyperthyroidism
Hyperparathyridosm
Answer:
It’s common with hyperthyroidism, because initial presentation is brady then become tachy
The clinical manifestations of goiter depend upon the presence of thyroid dysfunction and
upon the growth rate of the goiter. Some patients may have symptoms and biochemical
evidence of hypothyroidism or hyperthyroidism. However, most patients with goiter are
asymptomatic and biochemically euthyroid. Patients with longstanding, large goiters may
develop symptoms of obstruction due to progressive compression of the trachea or sudden
enlargement (usually accompanied by pain) secondary to hemorrhage into a nodule

129- Triple GAA replication which diseases:

Answer: Friedreich's ataxia syndrome
Most cases of Friedreich ataxia are caused by loss of function mutations in the frataxin
(FXN) gene located on chromosome 9q13 [1-3]. The great majority of patients have an
expanded trinucleotide (GAA) repeat in intron 1 of both alleles of the frataxin gene. The
repeat expansion results in reduced transcription of the gene (ie, silencing) and decreased
expression of the gene product frataxin , Mode of inherent is AR

130- pathology and neurotransmitter affected in Huntington’s Disease:

Answer: Huntington low GABA and high dopamine

131- lichen planus long term effect:

relapse and remission
malignancy transformation
Answer: relapse and remission
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132- lichen sclerosis cause which malignancy:

Answer: squamous-cell-carcinoma
((The association between lichen sclerosus and vulvar squamous cell carcinoma (VSCC) has
long been recognized))

133- Another scenario with symptom of hyperthyroidism and give you free T4 and TSH
both normal what further test:
TPO??
Total T4
T3
TRH
Answer:
Thyroid peroxidase is a frequent epitope of autoantibodies in autoimmune thyroid disease,
with such antibodies being called anti-thyroid peroxidase antibodies (anti-TPO antibodies).
This is most commonly associated with Hashimoto's thyroiditis. Thus, an antibody titer can
be used to assess disease activity in patients that have developed such antibodies. ))

134- Down syndrome association heart disease

Answer: AVSD

135- Dizygotic definition?

Answer: Dizygotic dichorionic diamniotic

136- confusion, anemia, deranged kidney function, peripheral blood smear showed
schistocytes and fragmented RBCs, hemolytic panel was elevated, antibodies of which is
most likely implicated in the pathogenesis of the disease?
vWB
ADAMTS13
VIII
Answer: ADAMTS13

137- Inside nucleolus

Answer: rRNA

138- Bond between RNG and tRNA?

Answer: Hydrogen bond

139- Myopic patient with glasses, got worse overtime?

Answer Keratoconus

140- Contraindication of Circumcision?

Answer Hypospadias

141- Pap smear screening?

Answer: Transformation zone.
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142- Upper outer quadrant breast cancer, which lymph node is most likely affected?
Anterior axillary
Posterior axillary
Lateral axillary
Answer: Anterior axillary ((Anterior another name for it is pectoral ))

143- Prolactinoma signs, which visual defect might be present?

Answer: Bitemporal Hemianopia ((‫ صح‬due to pressure on optic chiasm ))

144- SCA child with severe hip pain?

Answer: Avascular necrosis

145- How does a protein enter a peroxisome?

Folded using a C terminal
Unfolded using an N terminal
Unfolded using a C terminal
Folded using an N terminal
Answer: Folded using C terminal

146- Anti-HBs+ only?

Answer: Previously vaccinated

147- Asking about type of hip joint?

Answer: ball and socket joint
148- What’s methylergonovine absolute contraindication?
Asthma
Hypertension
Diabetic
Ulcerative colitis
Answer: Hypertension
149- Ice craving?
Answer: Pagophagia
150- HDL receptor in the heart?
Answer SRB1
It’s called Scavenger receptor class B type 1
24

151- Gene associated with gastric cancer?

p53
CDH1
ABC
Answer: CDH1
Cadherin-1 = CDH1 + Hereditary diffuse gastric cancer (HDGC) is an inherited cancer
syndrome that leads to an increased risk for both diffuse gastric cancer and lobular breast
cancer. Patients who inherit the genetic mutation for HDGC are at high risk for developing
stomach cancer at a young age + HDGC is an inherited genetic condition that is rare. The
gene most commonly associated with HDGC is called CDH1. A mutation (alteration) in the
CDH1 gene gives a person an increased risk of developing gastric cancer and other cancers
associated with HDGC.
https://www.cancer.net/cancer-types/hereditary-diffuse-gastric-cancer

152- Picture of syphilis, what’s the treatment and the organism?

Answer:
Organism: Treponema pallidum + Rx: Penicillin G

153- Pathology of Osgood-Schlatter disease?

Answer: inflammation of patellar ligament OR Traction apophysitis
The cause of Osgood-Schlatter disease (OSD) is unknown; however, theories suggest that this
condition is a result of repeated knee extensor mechanism contraction that causes partial micro
avulsions of the chondrofibro-osseous tibial tubercle. This proposed pathophysiology is
supported by the repetitive runner, jumper athletic patient population OSD occurs most
commonly
154- Patient on chemo and radiation, what type of anemia?
Answer: Aplastic

155 -Most common cause of Neovascularization ?

Non-proliferative
Retinal detachment
Central macular atrophy
Answer:
Neovasculrization ‫له سببين‬:
1- CRVO
2- Diabetes proliferative type
retinal neovascularization, or abnormal blood vessel growth in the retina, a hallmark of
advanced diabetic eye disease (proliferative diabetic retinopathy)

156- infraclavicular mass what do for dx

CT??
Biopsy
Answer:
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157-GERD Pt on omeprazole for 7 year whish worse in last 2 months , omaprazole not
affected + dysphasia of solid food , what dx?
Functional dysphasia
Acute gastritis
Barret esophagus??
Haital hernia
Answer:

158-Pt with left jaw mass, increased pain with chewing? What nerve is affected
Facial??
Answer:
Pain with chewing affected nerve is facial

159- Patient on sulfa medication describe the rash?

Blister
Answer:

160- Folic acid dose in pregnancy?

0.4
1
2
4
Answer: 0.4

17/10/2018
161 - Women on fluoxetine for depression for years and now she is abnormally happy. Manic
episode (bipolar). What to give?
Answer: Lithium as mood stabilize.
162 - Patient yelling and shouting and hit in the ER?
Answer: Give Haloperidol (in case of delirium)
163- Elderly with prostatic cancer, had two DVT for the past 3 months. What to give as a
preventive method?
Answer: Low Molecular Weight Heparin (Enoxiparine)
164– What is the third layer of the scalp?
Answer: Aponeurosis
26

165- Most common polyps turn into malignant?

Answer: Adenoma (Fmaiila adenoma polys FAP )
166– Onion skin reaction. What to do next?
Answer: MRI
Ewing’s sarcoma
167- Thenar muscle supplied by?
Answer: Median nerve
168- Which of following muscles pass through lesser sciatic foramen?
Pectineus
Obturator internus muscle
Quadratus femoris
Obturator externus
Answer: Obturator internus muscle
169- Asthma with migraine, what to give prophylaxis?
Answer: Sodium valproate OR amitriptyline
170- Eye drops contraindicated in acute angle closure glaucoma?
Answer: Brimonidine and Atropine
171- Preeclampsia given mgso4 and delivered, in examination: (after hours), Deep tendon
reflex +1, HR 130, Hypertensive. what is the cause?
MgSO4
Hemorrhage
Anesthesia
Answer: MgSO4
172- Child 8-month-old with recurrent fracture with blue sclera?
Answer: Osteogenesis imperfecta
Blue sclera.
173- Female fall of ladder, breath is labored, cyanosed with no breath sound heard over right
side, Percussion is hyper resonant, management?
Answer: Needle thoracostomy
174- Aspirin toxicity?
Answer: Respiratory alkalosis followed by Metabolic acidosis
175– 8-month-old child with dry cough 3 days, on auscultation bilateral wheezes and mild
infiltration. temp was 38.5 What is Dx?
Bronchiolitis
Bronchial asthma
Answer: Bronchiolitis
27

176- Young female married, periumbilical pain then allover abdomen, high temp, Tender DRE,
+ve psoas and obturator signs. What is the dx?
Ectopic pregnancy
Acute appendicitis
Answer: Acute appendicitis
177- At delivery, cervix 4 cm and baby developed distress (FHR decreases 120 to 80), what
type of anesthesia given to mother?
Answer: General anesthesia
178- 4 months of generalized pain, chest pain, pale, history of use of new drug (didn’t
mention the drug), now patient is very anemic, what is the most likely cause?
Antibodies directed to drugs on surface of RBCs
Newly diagnosed RA
Anxiety
Pneumonia
Answer: Antibodies directed to drugs on surface of RBCs
179- 40 male in check up all normal but with his brother died from IHD what lipid level should
achieve?
Answer: 3.4 – 4.1 mmol

180- Patient involved in MVA, the impact especially in forehead examination forehead
laceration & fracture, discharge from nose clear positive glucose test (I think he meant CSF
leak) Which cranial nerve affected?
Optic
Olfactory
Ophthalmic
Oculomotor
Answer: Olfactory
28

181- A patient came for ophthalmology check-up, has optic disc cupping, tonometry showed
high IOP, what would u tell this patient?
Tonometry is sufficient
Do checkup for blood related members
Interventions may reverse these changes??
Answer: Interventions may reverse these changes??
182- Treatment of celiac disease?
Answer: Gluten-free diet.
183- High risk of menopause?
Osteoporosis??
Answer:
If they mean early menopause the answer is ovarian cancer If normal age of menopause it
causes a lot of problems like: Osteoporosis, Heart disease

184- Young male present with history of fever for few days, with hot, swollen, tender skin
of the lower leg, what’s the diagnosis?
Cellulitis??
Answer: Cellulitis

185- Fragile X syndrome feature:

Answer: Macroorchidism

186- Para-follicular c cell origin of

Answer: medullary carcinoma

187- Measles:
Answer:
3Cs cough, coryza ,conjunctivitis + gryish spotin mouth koplik spot

188- Infantile colic: The duration of crying is >3 hours per day, and >3 days per week, > 3
weeks.
189- The most common type stone:
Answer: Cholesterol
Cholesterol in gallbladder
Calcium in kidneys

190- Pt on TB medication with peripheral neuropathy , what is the vitamin to give him?
Answer: Pyridoxine
29

191- Pt on Antipsychotics and developed eye pigmentation; caused by which drug?

Clozapine
Chlorpromazine
Answer:

192- Pheochromocytoma associated with ?

Answer = MEN 2

193--Knee injury from lateral on football player what is the ligament +ve valgus stress?
Answer: Medial collateral ligament (tibial)

194- knee injury before 4 hours with sever pain. What is the best initial thing to do?
Answer: Xray

195- Most common cause of death in adult with SCD?

Aplastic crisis
Sequestration crisis
Vasoclusive crisis
SCD chest syndrome
Answer: Acute chest syndrome

196- Most common cause of cancer in pregnant women

Breast??
Cervical
Uterine
Answer:

197- Most common cause of vaginal bleeding?

cervix ca
cervix polyp
mensuration??
Answer:
((Pregnancy is a common cause. Polyps or fibroids (small and large growths) in the uterus can
also cause bleeding. Rarely, a thyroid problem, infection of the cervix, or cancer of the uterus
can cause abnormal uterine bleeding. In most women, abnormal uterine bleeding is caused
by a hormone imbalance. May 18, 2017.
Normal bleeding: menstruation
Abnormal: dysfunctional uterine bleeding

198- incubation period of mump?

Answer: 16-18 days
A person infected with mumps is contagious from approximately seven days before the
onset of symptoms until about eight days after symptoms start. The incubation period (time
until symptoms begin) can be from 12–25 days, but is typically 16–18
30

199- Ankle joint consistent of?

Answer: tibia, fibula and the talus
200- What type of joint is example of Ball-and-Socket Joints?
Answer: shoulder and Hip
201- What type of joint is example of hinge joint?
Answer: Elbow, knee and ankle
202- Patient with low weight and height percentile, diarrhea and constipation, biopsy taken
and showed Atrophy of villus of small bowel. What is the diagnosis?
Answer: Celiac Disease
203- Patient with impairment memory a CT of brain was done and showed Cerebral Atrophy
and dilatation of ventricles. What is most likely diagnosis?
Answer: Alzheimer disease.
204- 70 years old female with DM type 2 and Hypotension, complaining of short and
intermediate memory loss, annoyed by people, prefer to stay home. What is the most likely
diagnosis?
Alzheimer’s disease
Vascular dementia??
Pick's disease
Dementia with Lewy bodies.
Answer:
DM → vascular dementia + Hypotension, and DM risk for ischemia
205- Pregnant women brought to ED with massive vaginal bleeding, lower abdominal
tenders, Low Vital signs, the attending decide to terminate the pregnancy which one of the
following is the *most appropriate action to take?
Take the consent of the wife only
No need for consent for emergency cases
Take consent of the husband
Take consent of both wife and husband.
Answer: No need for consent for emergency cases
31

206- Epileptic progeny woman asking about which one of the following has the highest effect
on developing birth defects?
Age of the mother
Taking benzodiazepine
Anticonvulsants
Answer: taking benzodiazepine
Data regarding the use of the benzodiazepines (including Klonopin, Xanax, Ativan, and Valium)
during pregnancy are somewhat controversial. Studies suggest there may be an increased risk
of cleft lip and palate associated with first trimester exposure to these medications.
207- Diabetic woman with high-uncontrolled blood sugar planning to get pregnant and asking
about which time has the highest risk to develop birth defects?
Pre-perception??
First trimester
Second trimester
Third trimester
Answer:
Birth defects usually originate sometime during the first trimester of pregnancy. They are more
likely in women with pre-gestational diabetes
208- Patient with Chronic disease using NSAIDs, Lab Result shows: Hg: low, Iron: low, MCV:
Low, TIBC: High. What will you see in peripheral blood smear?
Answer: Microcytic, Hypochromic.
209- Which one of the following structure passes through sciatic foramen?
Answer: Obturator internus
210- Young female presenting with breast mass, No discharge, rubbery in consistently most
likely diagnosis?
Answer: Fibroadenomas
211- Treatment of pyuria:
Ceftriaxone and doxycycline
Penicillin
Amoxicillin and clavulanic acid??
Answer:
212- Child presented with swelling, and electrical microscope showed fusion of
podocyte (minimal change disease) what is the treatment?
Answer: Prednisone
32

213- Male presented with throbbing perianal mass after defection, mass is fluctuate, 2 cm,
what is the most appropriating treatment.
sitz bath
Incision and drainage
Antibiotic
Answer: Incision and drainage
214- What is the mechanism of oxybutynin?
Blocking anti-muscarinic??
Answer:
215- A case of painless enlarged testicular with swelling at lower abdomen. Negative negative
trans-illumination?
Femoral hernia??
Answer:
216- A Question about Research ethics applying without consent
Ask your colleague
Follow your senior
Written complaint to hospital director
Contact with ethics commits in hospitals??
Answer:
217- 4 years old child brought by his mother to doctor, he introduced himself to doctor, said
hello, he can name the objects, reply with clear sentences. Mother complained about her son
sucking thumb habit. What is the best step of management?
Nail crib
Nail painting
Reward him if stop sucking thumb?
Tell him to stop sucking thumb.
Answer:
218- Diabetic patient complaint of lower limb burning, what is the best treatment?
Aspirin
pregablion
Amphtiline
Answer:
219- Diabetic with deep ulcer what is the management?
Penicillin
Mepivacaine
Debridement and antibiotic??
Answer:
33

220- Patient with signs and symptoms of MS. What is the best diagnostic test?
Answer: MRI
221- Abscess case at day 7 with serangoinus discharge at the site of suture, and when its
probing place at suture site it showed abdomen content?
Answer:
222- Injury to Superior thyroidal nerve will lead to.
Answer:
223- Child not vaccinated with swelling at parotid radiating at jaw. Pain occurs during
chewing. What is the most likely complication?
Sterility
Encephalitis??
Hearing loss.
Answer:
224- Female complaining of over production of hair in axilla, face and body. Her menarche at
12, normal secondary sexual Characteristics. What is the diagnosis?
Adrenal congenital hyperplasia
mineral corticosteroid
Insensitivity of androgen.
overproduction of androgen
Answer:
225- Patient presented with unilateral Headache associated with photopia. What is the most
likely diagnosis?
Migraine??
Answer:
226- Old diabetic female presented with left middle and ring pain at palmar surface. , she
cannot extended wrist. Picture was attached. What is the diagnosis?
Diabetic sclerodactyly
Dupuytren's contracture
Ulnar nerve palsy
Median nerve palsy
Answer:
227- Most specific hormone to follow prognosis of treatment of Hypothyroidism?
Thyroxine
T4.
TSH
TRH
Answer:
34

228- Mother had negative Rh and her husband had Positive Rh. First child born normal, what
is the probability of the second child to develop Rh+?
0%
25%
50%
100%
Answer:
229- Patient presented with low Hb, Low MCV, Positive Coombs test, High Reticulocytes, High
Bilirubin. What is the diagnosis?
Autoimmune hemolytic anemia (AIHA)
Answer:
230- Patient with Secretion of milky like discharge from breast what is the next step of
investigation?
Answer:
231- Old patient with had right body sided paralysis for 1 hour and then he returned to
normal status what is the most likely diagnosis?
Answer:
232- Reed Sternberg cells found in?
Answer: Hodgkin’s lymphoma
233- Which of the following will have elevated Gastrin?
Zollinger–Ellison syndrome??
Answer:
234- Patient had modified mastectomy complaining of winged scapula what is the nerve
affected?
Answer: Long thoracic Nerve

18/10/2018
235- What does the term distichiasis refer to?
Extra row of eyelashes
Discoloration of eyelashes
Inward growth of eyelashes
Absent part of eyelashes
Answer: Extra row of eyelashes
236- A study was done on 2 groups control (non-smokers) and smokers followed up for 20
years to see the prevalence of colorectal cancer. What is this type of study?
Case control

35

Cohort
Cross-sectional
Systemic review
Answer: Cohort
237- What is the most common SIGN and SYMPTOM of ectopic pregnancy?
Uterine tenderness and back pain
Abdominal pain and tenderness
Vaginal bleeding
Answer: Abdominal pain and tenderness
238- Women complains of the “worst headache of I’ve ever felt”. What could be the cause?
Ruptured berry aneurysm

Pulmonary embolism

Migraine

Cluster
Answer: Ruptured berry aneurysm
239- Hypertensive elderly patient is on enalapril. He cannot tolerate the cough associated
with this drug. Which drug class should he switch to?
Vasodilator

B-blocker

ARB
ACEI
Answer: ARB
240- A patient develops postpartum hemorrhage. Which one of these conditions is
considered a contraindication to methergine therapy?
Diabetes

Hypertension

Osteoporosis

Answer: Hypertension
241- A Nissen fundoplication was carried out on a patient with a hiatal hernia. During the
operation, the surgeon accidently injures the posterior vagal nerve. What organ will be
affected?
Esophagus

Jejunum

Duodenum

Colon
Answer: Esophagus
36

242- A pediatric patient with projectile vomiting and an olive mass. What would be the most
appropriate initial investigation to perform?
H. Pylori testing

Sonography

X-ray

Endoscopy

Answer: Sonography✔
243- An abdominal ultrasound study was performed on a female patient early in her
gestational period which showed a low-lying placenta. After several weeks later, an US
showed that the placenta might be adherent to the uterine wall. What will you order to
confirm this?
CT
X-ray

MRI??
Transvaginal US

Answer: Magnetic resonance imaging (MRI) is an adjunctive diagnostic tool when the diagnosis
is uncertain,

This is for accrete, I think the case is previa, If the case placenta previa then tans, If the case
placenta accrat then, MRI
244- old lady with corneal abrasion asking about what could be the cause, with picture of
Entropion

Answer: Entropion
37

245- child with eye swelling, mucopurulent discharge, periauricular LN enlargement Gram
stain showed: Gram negative diplococci .. What is the treatment?
IV Cephalosporin
oral Gentamicin
Sulfonamide droplets
Answer: IV Cephalosporin
246-Eosinophilia + Parasite infection, which interleukin associated with it:
IL 5
Answer: IL 5
247- Trauma case with pancreatic injury and leakage into
Omentum Bursa
Subphrenic
Subhepatic
Gutter
Answer: Omentum Bursa✔
248- Apoptosis gene?
Answer: P53 ✔

249- Thyroid cancer responds more to Radioiodine more than others:

Medullary??
Follicular
Anaplastic
Answer: Follicular ✔

250- Total Gastrectomy?

Answer: Loss of Pepsin enzyme ✔

251- GCS child, open eyes when doctor shout to him, crying and confused, moves withdrawal
to painful stimuli?
Answer: 11
https://abg.ninja/apgar
https://abg.ninja/gcs

252- Fluid replacement of 25Kg Child?

Answer: 1600ml
38

253- female with wrist pain and +ve Finketstein test, treatment?
Thumb Spica ✔
Volar Wrist Splint
Surgery
Answer: Thumb Spica
De Quervain's tenosynovitis

254- Diabetic with Upper limb pain lasted for 20 mins then disappeared, what will help you?
BMI
CHAD2
ABCD2
Answer: CHAD2
Scoring for anticoagulation in Afib, Asses risk of vascular diseases

255- CTG late deceleration?

Answer:
Placental insufficiency
((Early - head comperetion))

256- Asthmatic patient, ECG showed MI, which of the following shouldn't give?
Aspirin
Morphine
Bisoprolol
Nitroglycerine
Answer: Bisoprolol

257- labs showed Hypercalcemia and CXR: left hilar mass?

Adenocarcinoma
Squamous cell carcinoma
Answer: SCA
39

258- Old patient with multiple osteoid osteoma, complain of pain and Xray showed
calcification?
Chondrosarcoma
Osteosarcoma
Answer: Chondrosarcoma

259- Lichen planus?

Answer: Remission-Relapses

260- Lichen Sclerosis?

Answer: Squamous cell carcinoma

261- Case of Marfan syndrome features asking about heart abnormality associated with it.
Answer: Aortic Aneurysm

262- Longest phase of cell cycle?

Answer: Interphase

263- HIV case treated initially with Nucleotide analogue, what will indicate the effectiveness
of the treatment?
Answer: Viral load cd4

264- Gallstone developed Fever, RUQ pain, Jaundice treatment?

A- IV antibiotics??
B- Surgery
C- Conservative
Answer: IV antibiotics
Fever, pain and jaundice = charcot triad in cholangitis,This is a case of cholangitis

265- Patient says that people in the Radio and TV stealing his idea and talk about him?
Answer: Delusion Broadcasting

266- Lady came to the psychiatric clinic, when the doctor started to talk with her about
psychosocial life she refused to answer him and left the clinic and didn’t come back?
Answer: acting out

267- Baby with Central and Peripheral cyanosis?

PDA
Tetralogy of Fallot
ASD
Coarctation of Aorta
Answer: Tetralogy of Fallot
40

268- 8 months girl start crying and screaming when any stranger tries to play with her?
Stranger anxiety, at 6 months
Separation Anxiety, 12 months separation
Specific Phobia
Normal
Answer: Normal
from 6-8 months it’s normal ((Because milestones is normal developmental))

269- Child Transfer objects, Roll over, Crawl, but Can't Pincer Grasp?
6m
7m
9m??
5m
Answer:
Mature 12 + Immature 9

270- Heroin addict, which drug used for immediate Rehab?

Answer: Methadone

271- patient came to ER with Dilated pupils, Agitated, Diaphoresis .. Toxicity of?
TCA
Organophosphates
Answer: TCA

272- Difference between delusion and delirium?

Disturbance of consciousness
Answer: Disturbance of consciousness
41

273- Best Antipsychotic for pregnancy?

Risperidone?
Answer: Risperidone?

Lurasidone or quaitipine

274- Husband has symptoms of depression for 2 weeks and history of being happy active and
worked for hours?
Answer: Bipolar

275- SSRI mechanism of action?

Answer: Decreases serotonin reuptake

276- Best hypoglycemic for pregnancy?

Metformin??
Answer: Insulin

277- In alcohol which one will be high?

GGT
ALP
ALT
Answer: GGT

278- False believes and unacceptable by the culture?

Answer: Delusions

279- 12 y/o with symptoms of Myasthenia gravis asking about pathology?

Answer: Anti-acetylcholine antibodies✔
42

280- which antidepressant causes Tardive Dyskinesia?

Answer: Haloperidol + Olanzepin
Other drugs that can cause TD include: Metoclopramide (treats stomach problem called
gastroparesis) Antidepressant drugs such as amitriptyline, fluoxetine, phenelzine, sertraline,
trazodone. Antiparkinson drugs such as levodopa.

281- Mother see Snakes in her baby's bed?

Hallucinations
delusions
Depression
Postpartum psychosis
Answer: Postpartum psychosis

282- Came to ER with Upper limb adducted and internally rotated?

Answer: Posterior dislocation

283- Winged Scapula Which part of Brachial plexus injured?

Answer: Root
Long thoracic nerve

284- If a researcher wants to start a study and wants only the subjects that do not have
diabetes to participate. What will be high in the test?
Answer: Specificity

285- Post-test probability of a diagnostic test?

Likelihood test
Answer: Likelihood test

286- What is the equation of Relative Risk?

Answer: A/A+B ÷ C/C+D

287- A study aims at exploring the association of high fat intake and prostatic cancer., Group
1 has prostatic cancer (1000) patients with 50 high fat intake, group 2 doesn't have cancer
(1000) pt with 10 high fat intake
Answer: OR = 5.2

288- In a cohort study on lubricant oil use and urinary bladder CA done over 20 years 10,000
exposed 10,000 non exposed 750 exposed got CA 150 non exposed got CA Then they asked
about the incidence in 1000 in one year?
Answer: 2.25

289- Lung cancer affected 80 of 100 smokers,6 of 500 nonsmokers. What is Relative risk
reduction?
Answer: 66:1
43

290- Typhoid Fever research question.

Answer: 100

291- which one is contraindicated for instrumental delivery?

A- Breech
B- Cephalopelvic disproportion
C- Facial presentation
Answer: Cephalopelvic disproportion

292- Anaesthesia blocked Pudendal Nerve which one will not be affected?
Answer: Rectum

293- Fishy odour with vaginal discharge

Answer: Metronidazole
Dx: Bacterial vaginosis

294- Kidney Stone Cause Alkalinisation of urine?

Answer: Calcium phosphate

295- Lactic Acidosis + Hyperalaninaemia is deficiency of ?

Pyruvate Carboxylase
Pyruvate dehydrogenase
Answer: carboxylase associated with hyperammonemia only

296- Axillary freckles with café au lea spots?

Answer: Autosomal Dominant

297- tRNA - mRNA bond?

Answer: Hydrogen

298- car accident case with membranous urethra injury next step?
Suprapubic catheter
Urethral catheter
Answer: Suprapubic catheter

299- CXR showed mass in the Rt hilar area asking if a Neoplasm which Vessel will be
compressed?
Superior vena cava
Pulmonary artery
Subclavian vein
Aortic Ascending
Answer: Superior vena cava
44

300- case of Gout asking about the enzyme?

Answer: Xanthine oxidase

301- Burkitt's lymphoma?

Answer: C-MYC

302- which virus associated with Burkitt's?

Answer: EBV

303- patient known to have Osteoporosis and he takes Vitamin D, type of prevention?
Primary
Secondary
Tertiary
Answer: Tertiary to prevent complication
Primary to prevent the disease
Secondary for early diagnosis like screening
Tertiary to prevent complications

304- Emphysema case, which medication will decrease secretion without Bronchodilation?
Salbutamol
Montelukast
Ipratropium
Answer: Ipratropium

305- Treatment of Erosive Gastritis?

Answer: Omeprazole

306- Which is true about erosive Gastritis?

Symptoms after 12 hours from trigger
Symptoms after 2-5 days from trigger??
Abdominal pain and peritonitis
Answer:

307- Snuff box pain indicates?

Answer: Scaphoid fracture

308- Most dangerous to be defected?

IL-2
IL-3
IL-4
IL-8
Answer: IL-4
45

309- Mother bring child with hx of chweing toys, labs show transferrin slightly elevated,
normal ferretin, normal iron binding capacity. pokliocytosis with target cells what is your dx?
IDA
Sideroblastic anemia
Alpha thalassemia
Answer: Sideroblastic anemia

310- Cough, hemoptysis, saddle nose, hematuria, what is the most likely diagnosis?
Answer: Wegner granulomatosis
311- Pediatric difficulty in learning?
Answer: Dyslexia
Dyslexia is a common learning difficulty that can cause problems with reading, writing and
spelling. It's a specific learning difficulty, which means it causes problems with certain abilities
used for learning, such as reading and writing. Unlike a learning disability, intelligence isn't
affected.
312- Case of molar pregnancy. snow storm appearance?
Answer: Complete mole
313 - At a day-care center 10 out of 50 had red eye in the first week, another 30 developed
the same condition in the next 2 weeks. What is The attack rate (cumulative incidence)?
40%
60%
80%
20%
Answer: 80%
314- An adult came to you for varicella vaccine. How will you give it to him?
One dose now and one after 2 weeks.
One dose now and one after 3 months (for children)
One dose now and one after 6 weeks
just give one dose now
Answer: One dose now and one after 6 weeks
315- Someone traveled to Saudi Arabia and wanted to have prophylaxis against?
Answer: meningococcal vaccine
46

316- Pt takes one dose of varicella vaccine, and after one year presents to your clinic. What to
do next?
Give double dose
Give 2nd dose
Start over
Antibody test
Answer: Give 2nd dose
317- Female had previous vertebral fracture was diagnosed with osteoporosis and she is on
(bisphosphonate drug) additional to Ca and multivitamins, what to check for her?
Vitamin D
Ca
Answer: Vitamin D
318- Children who are living in a poor country with poor hygiene will have a high risk to which
type of hepatitis?
HAV
HDV
HEV
Answer: HAV
319- Which drug causes angioedema?
Answer: ACEI
320- Woman who is pregnant and has never had chickenpox nor vaccine what to give her?
Answer: Nothing
Varicella immunoglobulin if she had previous exposure to chickenpox
321- 32 y/o primigravida, hx of recuurent HSV infection every year, received chicken pox
vaccine at 19 what to give?
Varicella titer
HSV immunoglobulin
MMR
Do nothing
Answer: Do nothing

20-21/10/2018

322- what is the likely nerve injury in Nissan fundoplication?

Answer: VAGUS
47

323- pic of abdomen pelvic x-ray with contrast in bladder and ureters asking for dx.
Answer: ureter showing stenosis
- i got two pics of fx with wound one in forearm, the other leg

324-obeisty study BMI what else needed?

Dietary habit
Skin fold thickness
Abdomen circumference
Girth
Answer: Skin fold thickness

Q325/ ECG showing inf MI e mobitz 2 asking about management before PCI ?
Answer : 1/ Atropin2/ Pacemaker

Q326/ ECG e delta waves about dx?

Answer : Wolf-Parkinson-White syndrome

328- Picture of corneal abrasion asking about possible complication?

Answer: Photophobia

329/ pic of red eye w long scenario- bilateral irritation, watery discharge associated e
pharyngitis n fever how to prevent spreading of infection?
hand washing
wet patch
isolation
topical disinfectant
Answer: hand washing
48

330/ pregnant woman thyroid sx and lab confirming what is your tx?
Radiodine
Thyroidectomy
Methimazole
Propylthiuracil
Answer: PTU

331- dx of nodular goiter, e hyperthyroidism thyroid scan showing patch iodine absorption
what is the appropriate tx?
surgery
radio iodine ablation
FNA
Biopsy
Answer: radio iodine ablation

333- months was on steroids now discontinued 1 week ago what vaccine to give
A-MMR
B-Dtap
Answer: DTaP
MMR is live don’t give to immunocompromised pt

334/ patient c/o progressive weakness, choking on saliva for few months, sx began w/
tingling in toes and fingers with bilateral ascending loss of sensation. what is the expected
long term prognosis?
Respiratory failure
Progressive paralysis
Spontaneous resolution
Answer= Respiratory failire
Gillian-barre syndrome

335- appropriate step in management in patient presenting to ER with lower GIT

"hemorrhage". (no vitals no further hx just this)
GS consult
Resusciation
answer: Resusciation

336- child w dm on insulin BID, mother found him unconscious. what should she do next
call ambulance
transport to ER
IV glucagon
oral glucose
answer: IV glucagon
49

338 Infectious mononeucluosis patient, sore throat fever splenomegaly, enlarged tonsils w
exudate. What is tx?
iv acyclovir
oral acyclovir
empiric antibiotics
symptomatic
Answer: symptomatic

339- What test to order after fracture resolution to see bone density?
Answer: DEXA scan.

Q340 patient unable to extend knee, affected muscle?

rectus femoris
biceps femoris
sartorius
Answer: rectus femoris

Knee Extension: Prime Mover: Quadriceps - vastus lateralis, vastus medialis, vastus intermedius,
rectus femoris

341- lower back pain, imaging negative what is tx?

A-injection steroids
B-Physiotherapy
Answer: Physiotherapy
342- tumor with pregnancy?
Answer: Breast

Q343/ 52y/o woman with family hx of breast cancer wants to know risk. Appropriate step?
A- mammogram every 2 years
B- self breast exam
C- refer to genetic clinic
Answer: mammogram every 2 years

Q344/ pneumpnia x ray asking about findings on auscultation?

Answer: Pneumothorax decrease air entry if pneumonaia bronchial breathing
50

Q346/ SCA patent w resp sx likely organism

Parvovirus B19??
Answer:

Q347/ female postmenopausal with vaginal spotting 4 months increase after intercourse, hx
of MI and AF on warfarin. cause of bleeding?
A- endometriosis
B- warfarin induced
C- endometrial cancer
D- atrophic vaginitis
answer: atrophic vaginitis Most common cause of vaginal bleeding in postmonopausal women
is atropthic vaginitis

Q348/ unilateral eye redness, discharge and irritation associate w pharyngitis. What is the
cause?
A-bacterial conjunctivitis
B-viral
C-fungal
D- allergic
Answer: b ((Viral conjunctivitis is a highly contagious acute conjunctival infection usually caused
by adenovirus. Symptoms include irritation, photophobia, and watery discharge. Diagnosis is
clinical; sometimes viral cultures or immunodiagnostic testing is indicated.))

Q349/ female came to ER with constipation, lower abd pain, low appetite, feeling of abd
fullness, bloating and anal discomfort with occasional leakage of watery stool. next step in
management?
A-fecal disimpactement
B-opiod analgesic
C-laxative
Answer: may be Large bowel obstruction so is A or Pseudo-obstructio oglive syndrowe
51

350- Patient with prostate ca and recurrent DVT in last 4 months, prophylaxis
aspirin for life
LMWH 6 month
LMWH short term and then warfarin
Something with unfractionated heparin
Answer: LMWH short term and then warfarin

352- 1 years old child no vaccinations, c/o night time severe "hacking" cough with high pitch
inspiratory noise, cyanosis during attack and is fatigued between attacks. What is the
Treatment?
Answer: Intubation

Q353/child 2 yr old drinks 3 pints milk daily, fussy eater pale c/o diarrhea. labs show high
wbc, low everything else. what hx would help you reach dx.
Giardiasis infection??
Aplastic anemia
SCA
Answer:

Q354/ pregnant lady with RBS i think high , OGT showing gest diabetes. what will you do next
Hba1c
Repeat OGT??
Dietary modification
FBS
Answer:

355- 4 y/o Pregnant diabetic lady came to the clinic at 30 week of gestation with controlled
DM , last pregnancy ended with full term stillbirth , what is your plan for this pregnancy?
induce labour immediately
wait for spontaneous labour
induce labour at 36 weeks
do CS at 38 week
Answer: wait for spontaneous labour
Normal pregnancy 38-42 unless there is indication for current pregnancy we take actions

Q357/ Pt came to ER complaining of diarrhea and abdominal pain, 2 weeks ago had URTI and
took cefaloxine , what to give?
erythromycin
cephalosporin
vancomycin??
Answer:
C.diff?
52

358- Male pt came with gynecomastia , decrease libido and erectile dysfunction , labs normal
except for very high prolactin levels, what do you suspect to find in him?
bitemporal hemianopia
superior quadrantanopia
homonymous hemianopia
Answer: bitemporal hemianopia

359/ HTN + big toe pain what is the drug that used in HTN?
Answer: thiazide

361/ Shigella name of antibiotics

Answer: Ciprofloxacin

362/ Child with typhoid name of antibiotic

Answer: Chloramphenicol
If resistance ceftriaxone
Although fluoroquinolones are not routinely used as first-line therapy for children <18 years
old, their use in children is justified in severe infections, such as typhoid fever, when
alternatives are not appropriate or available.

363- Pt has immunodeficiency with recurrent staph and candida infection, what is common
they present with:
Answer: chronic candida

Q365/Premature menopause age

Answer: 40

Q366/ prolonged pregnancy defined as?

Answer More than 42 weeks

Q367/Pregnant in 34 w , regular contraction + cervix 1 cm , effacement 90, how to manage :

A-Ivf +corticosteroids
B- Iv antibiotics
C- Other Antibiotic (maybe oxytocin)
Answer: Ivf +corticosteroids
Lung still not mature
53

368- Pt poor DM control + HTN with proteinuria and Edema, she is in 8th week of pregnancy
what to do?
A-termination of pregnancy??
B-bed restrict
Answer

369- Pregnant came with abs pain, us show fibroid , rx?

hysterectomy
pain control??
Answer:
It’s depend about fibroid position

370- Newborn with lethargy and urine smell like burned sugar :
A- phenylketonuria
B- Maple syrup urine disease
Answer: Maple syrup urine disease

371- picture of hand: Diabetic pt has severe pain at middle and ring finger without Hx of
trauma. (case of carpal tunnel syndrome) Treatment:
Answer: NSAIDs

372- long scenario describing bacterial vaginosis what you will see under the microscope : (no
clue cells in options)
Granular epithelial cells??
Answer:

Q373/ which drug is contraindicated in acute angle closure glaucoma?

Timolol
Pilocarpine
Methazolamide
Answer: timlol If with asthma
The classes of medications that have the potential to induce angle closure are topical
anticholinergic or sympathomimetic dilating drops, tricyclic antidepressants, monoamine
oxidase inhibitors, antihistamines, antiparkinsonian drugs, antipsychotic medications, and
antispasmolytic
54

375- pt has facial flushing ,telangiectasia on face and neck ,bilateral wheeze, shortness of
breath , weight loss, Hepatology ,harsh systolic murmer at 2nd intercostal space and ( a-lot of
symptoms ) the doctor ordered urinary 5 hydroxyindole acetic acid. Which cell causes his
problems?
Enterocyte
Enterochromaffin
Goblet
Answer: Enterochromaffin

376/ bacteria fragilis treatment:

Clindamycin??
Answer:
Metronidazole wasn’t in the choices
377- site incision of emergency tracheotomy?
Answer: Corcothyroidosuomy
378- what is name artery supply SA and AV node?
Answer: Right coronary
379- What is the most accurate investigation for Wilson syndrome?
Answer: Biopsy then serum ceruloplasmin
Q380- about Wilson syndrome Treatment?
Answer:
Q381- case Alcohol pancreatitis?
Answer: high amylase and GTT

Q383-Triple therapy for peptic ulcer?

Answer amoxicillin, clarithromycin, and a proton pump inhibitor such as omeprazole

Q383/ What is the mode inheritance of Marfan syndrome?

Answer: AD
Q384/two couple are caution have freckle in axillary and brown spot 10 (mode inheritance in
children)?
Answer: Neurofibromatosis, AD

Q385/ calculate anion gab

Answer: Na - ( HCO3 + Cl )

Q386/ Steven Jonson syndrome is high risk in (epilepsy drug).

Answer: Carbamazepine
55

Q387- Treatment of trigeminal neuralgia.

Answer: Carbmazabine

Q388/ if you see Lowe lip SCC what lymph node should palpate
Answer: Submental+submandibular
Central lower lip = submental
Rest of lower lip + upper lip = submandibular

Q389- case of vertigo (menierrs syndrome)

Answer: Vertigo + progressive hearing loss+tannitus+fullness in ear =menier disease

Q390/ dosage amoxicillin in children

90??
Answer:

Q391/ injury external laryngeal nerve during surgery what is result?

Answer: Tones ((When the external superior laryngeal nerve is damaged, it results in the
paralysis of the cricothyroid muscle, which functions to lengthen, stiffen, and thin the true vocal
cord. Voice changes resulting from damage to this nerve may include hoarseness, voice fatigue,
poor vocal volume and projection, and decreased vocal register))

Q392/ lymph node drainage of testicular

Answer: Para aortic
Q393/ fundopulation of case GERD structure injury posterior ?
Answer: Esophagus
56

Q394/ Prognostic factor of Small Cell Lung Cancer?

Answer: Male gender carries a worse prognosis

Q395/ Treatment of first grade of spleen injury

Answer: Surgical ward

Q396/ Cause constipation when used two combinations of drugs

Answer: SSRI + olanzapine

Q397/ case nephrotic syndrome TTTX

Answer: Steriod in acute attack +diuretics for edema

Q399/ case of Otitis media, you should ddx between viral or bacterial and how to treat?
Answer:

Q401/ bronchial asthma control with SAB2 agonist what add?

Answer: Inhaled corticosteroid

Q402/ low back pain radiate to bilateral thigh and foot , worse in stand up and improve when
sit down and leaning forward, diagnosis?
Answer: Spinal stenosis

Q404/ case of thalassemia (newborn is die immediately after delivery)

Answer: 4 abnormal alpha
Hydrops fetalis
Q405/ what is the most common cause of intracerebral hemorrhage?
Trauma
Tumor
Hypertensive encephalopathy??
Ruptured aneurism
Answer:
57

Q406/ Elderly with dementia and Neurofibratory tangles?

Deposition of amyloid
Neuronal loss
Alzheimer
Answer: Alzheimer

Q407/ patient was normal fainted and collapsed in the mall just for seconds then return to
his normal status, what is the diagnosis?
Answer: Vasovagal syncope
If you don’t find it, put fainting.

Q408/ How heart increase the blood flow during working hard?
Increase heart beat??
Dilated coronary
Increase pulmonary resistance
Dilated IVC
Answer:

Q410/ patient had itching at ankle and toe with linear lesion what is the dx?
A-Tanea
B-Scabies??
Answer:

Q411/ Patient came to ER he had sign and symptoms of sudden..?? Xray done showed
pulmonary congestion and enlarged heart the medical and social hx not known on ECG there
is AF HR180 no acute MI changes. What is appropriate investigation?
Echo??
Angiography
VQ perfusion scan
Answer:

Q412/ Female patient last menstruation 7 weeks ago present in severe pain with vaginal
bleeding BCG +ve transvaginal and ab Us showed no uterine sac on examination patient has
lower abdomen tenderness especially in lift side dx?
Rupture corpus luteal
Ovarian torsion
PID
mole pregnancy??
Answer:
58

Q413/ Patient had vasomotor rhinitis w rhinorrhea alone. What will you prescribe?
Ipratropium
Steroid
Antihistamine
Answer: Ipratropium
Medications prescribed to treat vasomotor rhinitis include: corticosteroid nasal sprays such as
mometasone. antihistamine nasal sprays such as azelastine or olopatadine hydrochloride. anti-
drip, anticholinergic nasal sprays such as ipratropium.

Q414/Asthmatic had night symptoms 3-4times a day patient on LABA and High dose steroid
and SABA. What will you do next?
add Theophylline
add Leukotriene inhalation
Answer: add Leukotriene inhalation

Q416/Patient diabetic since 20 years on oral hypoglycemic. Laps shown normal fasting blood
glucose and random slightly high HBA1C within normal(6.1).LDL HDL and creatine was all
within normal except Microalbuminuria which was high 32 i think
What will you do?
Raise dose of oral hypoglycemia
Add ACE??
Switch to insulin
Add hypochlostremic drug
Answer:
59

Q417/Case about hypertensive elderly on diuretic. What will you add?

CCB
ACE
BB
Answer: CCB

Q418 /last option Treatment of GERD

Answer
Antacid initially Aluminum hydroxide (antacid)
Fundoplication if medical therapy fails

Q418/ Pt came to ER with muscle cramping and confusion with hx of vomiting 3 days back he
is on hydrochlorothiazide. What is electrolytes should be in your treatment?
Sodium
Potassium
Calcium
Answer: Potassium
Q419/Patient on omeprazole had GERD since years endoscopic done biopsy showed goblet
cell at mucosa of lower third of esophagus. What he will had?
glandular dysplasia??
SCC
Answer:

Q420/10y child w upper ab pain no other symptoms normal appetite his father had peptic
ulcer. Endoscopic was done and urea breath test +ve. What is the organism?
Campylobacter Jujeni
Salmonella
H .pylori
Answer: H .pylori

Q421 /Pregnant GA34 weeks came with headache and vomiting fundal high equal to GA Fetal
movement normal and CTG normal .They admit here for delivery What is the most likely the
in indication?
Abruptu placentae??
Placenta previa
Fetal distress
Answer:
60

Q422/Pregnant on 28 w of GA no complain Us showed anterior low-lying placenta

What is the risk of placenta Previa?
White rice
Previous placenta Previa
Answer: Previous placenta Previa

Q424/Irritable restlessness and unable to sleep since 8 month What is dx

Generalize anxiety disorder??
Major depression w anxiety
Anxiety with depression
Psychosis
Answer:

Physical signs and symptoms may include: Fatigue, Trouble sleeping, Muscle tension or muscle
aches, Trembling, feeling twitchy, Nervousness or being easily startled, Sweating, Nausea,
diarrhea or irritable bowel syndrome, Irritability

Q425 /Elderly* What is the predictor u can consider as risk of CAD

Occupation
Low education level??
Large Family member
Answer:

Q427 /10y girl had bone marrow transplant since (unknown amount of time) father bring her
sister as she started to have chicken box on examination she is well w no rash
What will you do?
Give her subtract acyclovir
Varicella IG??
Varicella vaccine
Vaccine + IG
Answer:
61

Q428/ Adult has sign and symptom of glomerulonephritis in lap showed RBC and PROTEIN in
urine CD (3) low. What is most likely cause?
A- Mesangeal
B- Membranous
C- Poststreptococal
Answer: Focal segmental glomerulosclerosis — Focal segmental glomerulosclerosis so

Q429/Child w sign and symptoms od nephrotic what is the investigation u will order to
confirm?
Urine analysis
24hr urine protein
Answer: 24hr urine protein ((To check nephrotic range proteinuria ))

Q431/Infant age of months c/o bloody stool US shows donut sign What is the (best step) in
management?
Radiographic reduction
IV hydration
Answer: IV hydration

Q432/ 18y old has ejection systolic murmur at left lower sternal and fixed splitting2 heart dx:
ASD
AS
TOF
Answer: ASD

Q433/ Post abdominal hysterectomy has inconveniences (while micturition ):

Vesicovaginal fistula
Uretrivaginal fistula
Urethrovaginal fistula
Answer: Urethrovaginal fistula

Q436/ Scenario came with details and they gave him drug then patient developed flush in
face. What is the drug?
Answer: vancomycin + niacin
Q437/ Given to pediatric pt after CPR?
Answer: Epinephrine
62

Q438/ patient unresponsive with gasping breath gave him 2 rescue of breath but still no
improve what u will do?
Intubation
Observe And waiting for code blue team
Answer: Intubation

Q439/ patient unresponsive and no breathing what first thing to do

Tow rescue of breath
Check pulse
CPR
Answer: Check pulse

Q440/ Elderly had knee trauma and cannot extend his knee. What is the muscle responsible?
Sartatus
Gastroscenamus
Quadriceps
Answer: Quadriceps

Q441/ SCEF scenario > -13 years obese child, with x-ray attached.
Answer: Slipped capital femoral epiphysis

Q442/ potts disease in spine and something about spreading to chest asking about nerve of
spread through?
Anterior cutaneous
Lateral cutaneous
Answer: Anterior cutaneous

Q443/ ECG w no changes with Scenario of MI .What suspect the dx;

Stable angina
Unstable angina
ST elevation MI
non ST elevation MI??
Answer:

Q444/ patient will go for surgery for ... And afraid of phrenic nerve injury, what is the site of
nerve?
Anterior to medial scalene muscle
Anterior to Anterior scalene muscle
Answer: Anterior to Anterior scalene muscle
63

Q445/ Plural Refereed pain to shoulder by

Costal
Mediastinal
Answer: Mediastinal

Q446/healthy patient with xanthelasma in ankle. What gene responsible?

A-APOB100
B-LDL receptor
Answer: LDL receptor

Q448/ Scenario patient had lung problem and worked in electrical field?
Answer: Asbestos

22/10/2018
448– Stye in eye, what is the commonest sign?
Answer: Discharge
449- Diabetic foot with abscess, which stage is this?
Answer: Stage 3
450- Pregnant women, for how long period should not exposed to radiotherapy or active
radiation?
4 months
6 months
12-24 months??
Answer:
451- 4-year-old with nocturnal enuresis, what is the treatment?
Awake from the sleep
Alarm
Answer:
First-line: Positive reinforcement (REWARD) and bladder training
Second-line: Alarm thereby
452- Diabetic pt, what he should do?
Answer: Aerobic exercise (150 minutes per week)
453- Renal cell carcinoma, characterized by?
Hematuria
Mass
Answer: Hematuria
454- Common signs and Sx of abruption placenta?
Bleeding
Tenderness
Answer: Bleeding
64

455- Pt with blister, what did he use?

Answer: Sulfa drugs
456- Sexually active with –ve screening test for HIV, when to repeat the test?
Answer: after 12 weeks (3 months)
457 – Otitis media, what is the complication in child?
Encephalitis
Hearing loss
Infertility
Answer: Hearing loss
458- Recurrent otitis media in child took Abx, what should you give him?
Amoxicillin
Amoxicillin clavulanate
Ceftriaxone
Answer: Amoxicillin clavulanate
459- 5 days old child full term all normal except puprura on rt thigh. increase pt and appt dx?
Hemophilia
Factor 10 deficiency
Answer: Factor 10 deficiency
460-Newborn with eye discharge, treatment?
Answer:
Topical erythromycin (first day of newborn)
IV cephalosporin (if 3-5 days due to gonorrhea)
Oral erythromycin (if more than 5 days due to chlamydia)
461- Hyperalaninemia and lactate dehydrogenase
Answer: Pyruvate carboxylase deficiency (due to hyperalaninemia)
462- Golf player developed medial epicondylitis, ttt?
Refer to ortho
Refine golf.
Answer: Refine golf
463- Pt take unfractionated heparin, how to follow him?
PTT
PT
Bleeding time
Answer: PTT
464- Child not developed well, has no appetite, blood film showed low hemoglobin and low
MCV, RCC normal, what is the diagnosis?
IDA
Thalassemia
Answer: IDA
65

465- Pt take warfarin, how to follow him?

PT
Bleeding time
INR
Answer: INR
466- PCOS treatment?
Answer: Weight reduction + Metformin + clomafiene (induction of ovulation)
467- What to do with metformin if patient want to become pregnant?
Answer: Stop metformin and shift to insulin
468-Reason of OCP in not married women?
Answer: Managing dysmenorrhea
469- Pt with hx of epilepsy came with shoulder pain, adduct or internally rotate the arm
What is the injury?
Inferior dislocation
Subacromial posterior dislocation
Answer: Subacromial posterior dislocation
470: Female presented with defemenization " breast atrophy & deeping of voice" they found
to have ovarian cancer, dx?
Answer: Sertoli leydig cell

22/10/2018
449/ layer of blood vessel affect most in atherosclerosis?
A- Endothelium??
B- Elastic lamina
C- Adventia
Answer:

450/ disease treated with trabeculotomy?

Answer: Open angel glaucoma

451/pic of ectropion

+
66

452/pic of SVT, what’s the dx?

Answer: SVT
453/pic of corneal abrasion asking about the dye

: +
Answer: Flourescent

455/pic l think for chalazion ask about what other symptoms he will have?
A- decreased vision
B- discharge
Answer: A

456/pic of red eye l think asking about prevention?

Answer: hand wash

457/solitary thyroid nodule without symptoms best thing to do

A- MRI
B- FNA??
C- iodine scan
Answer:
67

458/condyloma lata associated with which virus?

HPV
HSV
Answer: Syphilis
Acuminata: HPV

459/recommendation A for colorectal screening age?

A-35-45
B-50-70
C-40-60
Answer: B

461/Scenario came with details and they gave him drug the patient developed flush in
face.What Is the drug used?
Answer: Vancomycin ((Yes red man syndrome = vanco ))

462/Child with face cellulitis what is the organism?

Answer: Hemophilus infulenza ((Child hemophilus influenza but if infnant GABH ))

463/ Female in labour in pain ask for intrathecal anesthesia what should you order?
A- Red blood cell
B- Platelets
C- Liver enzymes
Answer:B
465/ Person got pricked by flower. What’s the organism?
Answer: Sporotrichosis
468/ Vaginal Greenwich discharge with flagellated organism what is it?
Answer: Trichomoniasis
469/ Winged scapula after mastectomy what’s nerve injured?
Answer: Long thoracic nerve
470/ In appendectomy what the artery we should ligate?
Answer: Appendicular artery
branching of superior mesenteric artery
68

471/ Upper lip something what glands we should check?

Answer: Submandibular
Upper lip + lateral part of lower lip: submandibular
Central lower lip = submental
472/ Drug cause abnormal movement
Answer: Metoclopramide
473/ Picture about dendritic herpes asking about the symptoms?
Answer: hypoesthesia
474/ Hallucinations agitation euphorias
A- Amphetamine intoxication??
B- Cannabis withdrawal
C- Something intoxication
Answer:
477/ Tennis player. What is the most likely sided effected?
Answer: lateral epicondylitis
Tennis, squash = lateral
Golf = medial
478/Lateral injury to the knee and medial side swelling and +ve valgus stress ?
Answer: : Medial collateral injury
479/ Loss of red reflex behind the pupil?
A- Retinoblastoma
B- Neuroblastoma
C- Cataract
Answer:
Abscent red reflex: Cataract
White red reflex(leukocoria): Retinoblastoma
C is the right answer
480/ Bladder cancer removed and contains muscle but it’s completely resected what to do
next?

A- Mitomycin C
B- Intravesical BCG??
Answer: This B according to baily and love textbook
481/ Common result in olecranon bursitis?
A- Repeat trauma
B- wrist pain referred
Answer: A
69

481 /HIV with no opportunistic infections, reserve cells ?

Answer: CD4
482 /Severe combined deficiency after urti come with SOB and pale. Immediate
management?
A- Fluid/Analgesic
B- antibiotics
C- Blood transfusion
Answer: A
483 /why we use inulin to determine GFR ?
A- freely filtering
B- bond to albumin.
Answer: . A
484 /Case of lymphangitis with tender axillary LN treatment?
A- Iv antibiotic
B- oral antibiotic??
Answer:
485 /neck injury can't elevate his shoulder which nerve ?
A- Axillary
B- Accessory
C- Long thoracic
Answer: B
Shrug shoulder: Accessory
Abduct shoulder first 90 degrees: Axillary
Abduct beyond 90 is: Long thoracic
486/ Pt after MVA came to ER unconscious what is the immediate Treatment ?
A- C – Spain
B- Orotracheal intubation
Answer: B
487/Treatment of Kawasaki?
A- Aspirin
B- Morphine
C- IVIG
Answer: C
488/ Child with tea urine , vatig , parents note skin eruption for ( unknown number of days) ?
PSGN?
Answer:
70

489/ Pt with gallstones and jaundice, high ALT , ALP , amylase Treatment?
A- conservative
B- cholecystectomy
C- ERCP??
Answer:
490/ Female 42 y with dysfunctional Uterine bleeding mange for hysterectomy but she ask u
to don’t tell her husband?
A- Informed consent
B- confidential??
C- No harm
Answer:
491/Generalized convulsions in ER what is the RT ?
A- Diazepam
B- phenytoin
C- phenobarbital
Answer: A
493 /When we can say stillbirth?
A- 20
B- 24
C- 28
D- 32
Answer: B
Early stillbirth from 20 to 27, Late more than 28, According to UpToDate
494/Pregnant in 34 w with sign of Labor , what to gave ?
A- Iv corticosteroids with Ab and bed rest??
B- Iv corticosteroids with ab and rehydrate
Answer:
495/ A girl came to clinic with elbow flexed with pronation after her father pull her hand
while up while it was extended, Which ligament is injured ?
Answer:

496/ Blood test to differentiate between DM1 and DM 2 ?

Answer:

499/ Patient with dry eyes how to use lubricant

Answer: One drop in lower fornix

500/ Case of bipolar ask about management

Answer Lithium
71

501/-old age, difficulty swallowing, more saliva,

A. Achalasia
B. Squamous
C. Dysfunction
Answer:

502/ 14 yo, everything normal except irregular pulse on ECG , he at risk of “ FMX is not
mentioned” ?
A. - syncopal attack
B. - MI
Answer: A
503/ multiple hyperpigmentation, decrease hearing, ataxia?
A. NF
B. Hemochroma
C. Multiple myeloma
Answer:
505/ type of reproduction in bacteria?
A. - conjugation
B. - transduction
C. – complementation
Answer A

510/- 18 yo, suddern dyspnea, pluritc chest pain, HR 103, otherwise stable” not mentioned if
he is in ER or OPD” ?
A. - Immediate vent/perf scan
B. - Immediate referral to ER
Answer:

511/ Associated with aggression and violence ?

A. High serotonin
B. Low serotonin
C. high endorphins
D. low endorphins
Answer:

513/- pregnant came at 16 GA, founding that she is Rh - ve, what to do next?
A. - US
B. - Amniocentesis
Answer
72

514/- 61 yo long case, hint she recently used ACEI, but she cannot tolerating the cough?
A. - ARB
B. - CCB
C. - BB
Answer

515/- commonest site of breast cancer?

Answer Sup. Lateral

517/- Contraindication antidepressants in pregnancy?

A. Fluoxetine
B. Paroxetine
Answer: B

518/- 4 wk neonate, his head is alway in same direction, he cries when manipulating his
Sterno. muscle?
A. - Congenital torticollis
B. - Cervical disc disease
Answer

519/- After how many months of Radioactive iodine the female can get pregnant?
A. 2m
B. 4m
C. 6m
D. 8m
Answer:

521/- Long case about burn, qs is how u will give the fluids?
A. All the fluid within 24 hr
B. half in 6 hr
C. 1/4 in 8 hr
Answer

522/- differentiate dm1 & 2?

Answer CCP

523/- contraindication in closure glaucoma?

Answer :Timolol

524/- child with uncomplicated cystitis?

A. - Amox
B. - Nitrof
Answer
73

525/- Typical case of H. zoster?

A. Acyclovir
B. Gancyclovi
Answer:

526/- Case of CML, tx?

A. Rituxmab with PCV
B. Rituximab with Prednisone
C. No tx
Answer:

527/- Case of bacterial vaginosis, Clue cells, tx?

A. - Metro
B. - Doxycycline
Answer:

528/- Typical down syndrome, asking about Asso. cardiac anomalies?

A. - Cushion
Answer:

529/- case of dementia, then he developed delirium, what to do?

A. Haloperidol till symptoms disappears
B. keep his family with him
C. Dark room
Answer:

530/- child came for vaccinations, he had diarrhea 3-4 times/day?

A. - Delays all vaccines
B. - Give All without DTP
Answer:

531/- Tingling, numbness on the little & ring fingers when writing ?
Answer: Ulnar

532/- can’t do dorsiflex?

Answer: Common peroneal

533/ Trauma case, palpate dorsalis pedis artery?

Answer: Lateral to extensor hallucis longus
74

536/ Hand pain, bone pain?

A. Vaso occlusive crisis
B. Sequestration
Answer:
“ all the options about the crisis types”
537/- chest Trauma, arrhythmia, hypotension, “JVP not mentioned “ next?
A. Pericardiocentesis
B. Needle decomp
C. Thoracocentesis
Answer:

538/- Female pt, TYPICAL case of Acute App. with obturator sign +ve, tenderness, rebound,
tender DRE, “Bhcg not mentioned “?
A. Acute App
B. Ectopic
C. torsion
Answer

539/- Case of Ruptured becker cyst, READ ABOUT IT“ cant remember the qs, and the Dx is not
mentioned” they ask about investigations
A. CBC
B. US
Answer

540/- HIV with intestinal obstruction, tumor is excised, what is it?

A. Hodgkin
B. lymphoma
Answer

541/- Typical DVT in pregnant?

Answer: Doppler

542/- case of Abortion, blood leak, cervix closed?

A. Inevitable
B. Threaten
C. Complete
Answer:

544/- child, tetany, decrease Ca?

Answer: 22q11.2 deletion syndrome (DiGeorge syndrome)

547/- Previous CS, low trans and double? ( maybe asking about how to deliver her current
pregnancy)
Answer: SVD
75

548/- mechanism of incretin?

Answer : increase insulin

549/- READ ABOUT MULTIPLE MYELOMA VERY WELL “5Qs”

550/- 28 GA tx befor for UTI, she had +ve test now?

Answer tx now for UTI even if asymptotic

551/- isolated community with MERS, what to do?

A. - influenza vaccines
B. - avoid swimming
Answer

552/- Jaundice, mild Abd pain, high ALT & AST “ but both less then 500”
A. - Cholestasis
B. - hep A
C. - hemochromatosis
Answer

553/- High MCV, GGG, Bilirubin, Alcoholic, RUQ pain radiate back, the cause?
Answer: Alcohol

554/- which of the following can cause Dementia?

Answer: B12

“all other 3 options are CNS diseases and tumors“

555/- Role of OCP to prevent the pregnancy?
A. Decrease the estrogen
B. LH surge and ovulation
Answer:

556/- Specificity = 70%

557/- Incidence = 2.25

558/- Relative risk = 66.1

559/- Prevalence 292.5

560/- OR = 5.2

561/- Typical case of Nephrotic syndrome with all Labs, asking about biopsy findings?
Answer: fusion foot process
76

562/- Old age, loin pain, Bilateral hydronephrosis, Cr 2.8 , “ not mentioned if he is smoker” ?
A. - pelvic cancer
B. - BPH
C. - cancer bladder
D. - another type of cancer can’t remember
Answer

563/- TTP case?

Answer: ADAMTS13

564/- brown spot associated with which one of the antipsychotic?

Answer: Thioridazine

565/ Productive cough for 2 wk, hepatosplenomegaly,normal CXR?

A. Bronchopneumonia
B. Miliary TB
Answer:
566/- male pt, case of osteoporosis and fractures, tx?
A. - Alendronate
B. - Vit d
Answer

567/- old age female, vaginal pruritis, otherwise normal?

A. - Endometrial Cancer
B. - Atrophic vaginitis
Answer

569/ old pt, chronic renal disease, last dialysis 4 days, present with arrhythmia, with ECG pic
“no acute T-wave”?
A. Hyper Na
B. Hypo K
C. Hypo Mg
Answer:

570/- rash, pericarditis, ...?

A. - EBV
B. - Kawasaki
Answer

571/- most frequently sign and symptoms of abruption placenta?

A. - Abd pain and tenderness
B. - back pain
C. - vaginal bleeding
Answer
77

572/ Gyn-Case with positive cheraldin sign?

Answer:

573/- Typical case of Epiglottis, thumb sign +ve, tx ?

Answer: Ceftriaxone

574/ Long case with :( barking cough, steeple sign) dx?

Answer: Croup

575/- that case of pregnant in labour, fetal heart drop, next?

Answer: General anesthesia

576/- Trauma, “wrist drop”, what is the injury ?

Answer: Radial nerve

577/- 38 GA, fetal weight 2.6 kg, why it’s contraindication to do ECV?
A. weight
B. bicornuate uterus
C. age
Answer
580/ Which of the following chemotherapies is used in AML?
Answer:

581/ Blood test to differentiate between DM1 and DM 2?

C-peptide??
Answer:

582/ Contraindications of circumcision?

Answer: Hypospadias

583/Case of meningitis in neonate asked about the treatment

Answer:

584/Case of ADHD asked about the treatment?

Answer:

585/ Case of CHF pt on Furosemide 40, labs was NA 123 and low K, asked about how much
fluid replacement he needs?
Answer

586/Case of pt overdosed on acetaminophen, asked about its effect on the liver

Answer:
78

587/Case of old pt with pneumonia, came to ER with altered level of consciousness, first thing
to do?
Risperidone?
Answer:

588// Case of 3 y/o came with hematuria, fever, tender abdomen, high WBC, high proteinuria
++ and leukocytosis?
Pyelonephritits
Answer:

589/ Question about who needs surgery?

A. Option had Marfan pt,
B. pt with thoracic aneurysm >5cm
C. pt with AAA >5cm
Answer:

590// Case of recurrent OM, asked about the tx

Answer: Amoxicillin or Augmentin

591/ Case of pt with sx headache when comb hair, sudden unilateral visual loss, no pain on
bb, what to do first
CT
Steroid
Answer:

592/ Case where a patient at his work got hit severely on his face and eyes with a foreign
body, which affected his vision, pathology showed T cells and macrophages infiltrates
Polymononuclear cells
Answer:

593/ Case of female pt had IUD for two years developed abnormal brown discharge what's
the organism?
C. Perforangis,
Actinomyces Israelii
Answer: Actinmyces Israelii

594/ Asked about medication acts on ADP on osteoclasts?

Alendronate??
Answer:

595 Question about an 18 months child with leg bowing, labs had high Ca and ALP
options had familial hypophosphatemia, renal something and Vit D rickets
Answer:
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596/ Case of pt came with cellulitis and was treated two weeks ago, now came with watery
diarrhea (Case of C.diff), asked about the treatment:
Ceftriaxone
Metronidazole
Cipro
Answer: Metronidazole

23/10/2018
597- Genital warts treatment?
Answer: Imiquimod
598- Vitiligo wants to get married and medical therapy not effective?
Graft
Melanocytes
Continue treatment
Stop treatment
Answer: Melanocytes
599- Patient with vitiligo and low platelet and high liver enzymes?
Chronic Autoimmune hepatitis
Answer:
600- Trauma to pancreas and release of enzyme anteriorly?
Answer: Omental bursa
601- Patient with pleurisy and pain referred to shoulder, which part of pleura?
Costal
Visreal
Anterior
Mediastinal
Answer: Mediastinal
602- Gene of isolated hyper cholesterol?
LDL receptor??
ApoB 100
Answer:
603- Gene of mismatch DNA causing colon cancer?
Familial polyposis
non-familial
MYH
Answer:
80

604- Ionizing radiation effect on DNA?

Depuration
Denaturation
Disruption of double helical structure
Answer:
605- pregnant with DVT?
Venous duplex
bed rest
heparin
venogram, bed rest
Answer:
606- Pregnant with diabetic nephropathy and chronic htn and 2 previous first trimester
abortion 140/90 and urine +3?
Bed rest
termination of pregnancy
ACEI
hemodialysis
Answer:
607- Pregnant 10 weeks with cervical incompetence what to do ?
Suturing at same time
Suturing at 16 weeks ??
Confirm with some test
Start..? (the one who wrote the question forgot)
Answer:
608Amoeba infection treatment?
Metronidazole??
Answer:
609- Case of elderly did CBC 1 year back was normal and he has changing bowl movement
and he increased his fiber intake and now present with fatigue what is the cause?
Age related or due to changes diet or change in habit.
Answer:
610- Factors decreasing colon cancer?
Answer: Fibers
611- Someone lost his brother he is 52 y/o what to give him for short time?
SSRI
Benzodiazepines
Answer:
81

612- Chest X-ray showing right lower lobe opacity infection what to hear with auscultation?
Ronchi
Absent vesicular breathing
Crackles
Answer:
613- Patient has croup with barking sound notice from parents, what is the diagnosis?
Tracheomalacia
Laryngeotracheo bronchitis
Laryngitis
Answer: Laryngeotracheo bronchitis
614- Someone with mumps when child and did gallbladder removal and now has enlarged
pain?
Answer: Bacterial Siladenitis
615-Pregnant with defuse goiter and symptoms of hyperthyroidism but no autoantibodies?
Antithyroid
thyroidectomy
radiotherapy
Answer:
616- Patient with carpal tunnel what to be atrophied?
Thenar
Intersoues
Answer:
617- Ligament going inside inguinal canal?
Answer: Round
618- Ligament that cause dimpling on breast?
Answer: Cooper ligament
619- Breast cancer but no lymph nodes?
Radiation with lumpectomy??
Answer:
620- Bladder cancer, what will you do after the operation?
Answer: C-mitomycin
621- Hip pain with collection and picture of septic arthritis what to do?
Answer: Aspiration
622- Legg-Calve-Perthes disease complication?
Answer: Avascular necrosis of hip
82

623- Angioedema after 1 day after strawberries allergy what to give?

Steroid
Antihistamine
Paracetamol
Answer: Antihistamine
624- Colles fracture with open wound?
Answer: Irrigation and debridement with ORIF
625- Leishmania drug of choice?
Answer: Miltefosine
626- Forehead herpes?
Answer: Antiviral and referral to ophthalmologist
627- High cholesterol and high Triglycerides and high LDL what to do?
Referral to a specialist?
Answer:
628- What’s the enzyme for statins?
Answer:
629- HIV patient with oral and purple skin lesions what treatment?
Chemotherapy and radiation?? (Kaposi sarcoma?)
Answer:
630- Loss of 2/3 sensation
Answer: Trigeminal
631- Baby at 4 month of age took vaccinations and developed anaphylactic symptoms and
now he come for 6 months vaccine what to do?
Skin
give vaccine but for DTP
don’t give or give all vaccine
Answer:
632- Cardiac anomaly associated with infective endocarditis?
TOF
Answer: VSD
633- Patient age 38 years old and had rheumatic fever 18 years ago and now present with
joint pain and hematuria and fever and splenomegaly after tooth extraction what’s dx?
Recurrence of rheumatic fever??
Answer:
83

634- How GAS cause rheumatic disease?

hematogenous spreading??
cardiac invasion
joint deposition
pharyngitis
Answer:
635- Patient on metformin want to do surgery?
Answer: Shift to insulin
636- A lot of Cases about precious puberty, can’t remember any.
637- Ascites, pleural effusion and abdominal mass? (Meigs’ syndrome)
Answer: Sex stromal cells tumor
638- Patient did Abdominal hysterectomy with bilateral oopherctomy for benign reasons and
now complaining of vasomotor symptoms?
Cyclic estrogens and progesterone
progesterone
Answer:
639- Depression what decreased?
Answer: Serotonin
640- Patient on antidepressants and has decreased libido switch to what?
Fluoxetine
Bupropion
Amitriptyline??
Answer:
641- Treatment of chronic pain?
NSAID
Paracetamol??
Answer:
All choices were NSAIDs besides paracetamol
642- Pudendal nerve what sparing?
Answer: Rectum
643- Anesthesia drug has sub anesthetic effect?
Ketamine
Benzo
Answer:
644- 100 times morphine?
Answer: Fentanyl
645- GERD case asking what it can mimic?
Answer: Ischemic heart disease
84

646- Hyperthyroidism symptoms with Bradycardia?

Multi nodular Goiter??
Answer:
647- Pregnant recurrence of monosomy percentage?
40%??
Answer:
648- What is definition of recurrent miscarriage?
2 or more
3 or more??
Answer:
649- What will cause bone age difference?
Answer: Congenital adrenal hyperplasia
650- Patient 40 years did colonoscopy and found 2 hyperplastic polyps?
Repeat after 10 years??
Answer:
651- What pre-cancerous of colon polyps?
Answer: Adenomatous
652- Boy 18 years played basketball and then developed left paraumbilical tenderness?
Reevaluate after 24 hrs
CT
US
Answer: CT
653- Case of intestinal obstruction and ask management?
Decompression
Surgery
Laparotomy
Antibiotic
Answer:
654- Patient works as a life guard and don’t put sunscreen or cover himself present with
multiple painless lesions?
Keratosis??
Melasma
Answer:
655- Diabetic not controlled and ulcer with deep base?
Admit and debridement for deep tissue cultures
Antibiotics
Answer:
85

656- Organism of cat bite?

Answer: Pasteurella multicoida
657- Molecular level of ectopic pregnancy?
Disappearance of mulecda
Answer:
658- Endometriosis?
Answer: Laparoscopy
659- Antibodies in type 1 diabetes?
Answer:
660- Lactic acidosis with hyperalanin?
Decarpoxlase
Answer:
661- During stress the lymphocytes decrease due to increase Cortisol and catecholamine?
Psycoimmunology
Answer:
662- Old age has weakness in upper limb and UMNL signs and now present with MRI picture?
Spinal cord tumor
Spinal canal stenosis
Cerebral-vascular accident
Answer:
663- Retinoblastoma most common present as what?
Answer: Leukocoria
664- Best thing to decide pregnancy dating?
LMP
US
Fundal height
Answer: US
665- Hepatitis B drugs?
Answer:
666- False positive fragility test?
Increase plasma protein??
Answer:
667- Counseling on autosomal recessive for cousins want to get married?
Answer: Thalassemia
86

24/10/2018
668- Tholidamide causes?
Answer: meromelia

669- Polyuria polydipsia, salt craving and ESRD in child?

Answer: Juvenile nephronophthisis

670- Child bitten by his brother?

Amoxicillin??
Surgical suture
Answer:
https://emedicine.medscape.com/article/218901-treatment#d1

671- Case of endometriosis (dyspareunia, dysmenorrhea and posterity fornix tenderness)?

Answer: levonorgestrel

672- Ankle hairline fracture-> severe heel pain, 1 month in duration

Answer: Anteromedial heel tenderness

673- Wilms tumor with?

Answer: Pulmonary metastasis

674- Chronic lymphocytic leukemia risk factor is?

Radiation therapy
Smoking
Age
Answer: Age

675- Dideoxynucleotide used in?

Answer: DNA sequencing

676- Ancylostoma duodenale, which cells are present in stool?

Eosinophils??
Answer:

678- Trazadone is an anti-depressant given in insomnia, what might the patient complain of?
Answer: Painful erection

679- Post-partum pain fever and vaginal discharge with positive chandelier test what’s the
dx?
Answer: PID
87

680- Where can you palpate the facial nerve?

Answer: Superficial to retromandibular vein and external carotid artery

681- What is the vein that responsible of causing cavernous sinus thrombosis from nose?
Answer: Ophthalmic

682- What can be considered as protective method for ovarian cancer?

Answer: OCP

683- What is the OGTT in population?

equal or less than 7.8??
Answer:

684- if a patient has a cough. And with every cough he has flashes. What is the cause?
Answer: Mechanical effect on retina

685- Patient with vertigo and nystagmus without hearing loss. What is the diagnosis?
Answer: Vestibular neuritis

686- What the clotting parameters associated with Antiphospholipid syndrome?

Answer: prolonged aPTT

687- What cause rib notching in CoA?

Answer: collateral of inferior intercostal artery

688- What is the investigation in case of leshminiasis?

Answer: Blood film to show amastgoid

689- H pylori will inhibit which of gastric cells?

Answer: D cells

690- Bluish painless papule in in the inner surface of lower lip increase after eating?
Answer: mucocele

691- If the patient present only with hoarseness. What will you do next?
Answer: Laryngoscopy

692- What is the stem cells of the trachea?

Answer: Glandular cells

693- What drug consider risk of stroke?

Answer: HRT
88

694- What is the grade of evidence in screening of dyslipidemia in normal patient without
cardiovascular risk?
Grade C??
Answer:

695- What is the best treatment for derealization?

Answer: Alparozolam

696- How to use eye drops?

Answer: One drop in lower fornix

697- Romberg sign assess which part of brain?

Answer: Dorsal column of spinal cord

698- What is the treatment of impetigo?

Answer: Topical mupirocin or clindamycin

699- When child in W position. What that indicate?

Answer: Femoral anteversion (Internal femoral torsion)

700- Patient present with garlic odor and excessive salivation. What is the antidote?
Answer: Atropine or parlidoxeme

701- What is the percentage of recurrence of turner syndrome?

Answer: 40%

702- What is the MOA of vitamin C?

Answer: hydroxylation of proline and lysine in collagen synthesis

703- How many barr bodies in XXX karyotyping?

Answer: 2

704- What are the thyroglobulin producing cells?

Answer: follicular cells

705- What is the acute treatment of sever graving?

Answer: lorazepam

706- Mid foot tenderness while walking and standing. What is the diagnosis?
Answer: Tarsal tunnel syndrome
89

707- Which group of people was postpone for hajj in 2015 for MERS-CoA from the Saudi
MOH?
Lactating women
Children above 12 years old
Elderly diabetic
Answer: Elderly diabetic.