EMLE November 2024 Exams 1

November 2024, 28th October (First Trial Exam Medicine)

1. A 40- year- old man who had undergone a vagotomy for duodenal ulcer suffered a
recurrent painful ulcer not responsive to treatment. At an operation for hemorrhage an
inflammatory peripyloric ulcer mass was avoided by performing an antrectomy and Billroth
II (Polya) partial gastrectomy. Soon afterwards he developed a stomal ulcer, confirmed on
endoscopy. What laboratory Investigations should be performed to diagnosis?

A. Blood gases.
B. Serum gastrin.
C. Serum glucagon.
D. Serum Na & K.
E. Serum T3, T 4, TSH.

2. A 37-week newborn is delivered through vaginal delivery. At 1 minute after birth, the
baby was blue, limp, with irregular gasping respiration, heart rate of 60 bpm, and no
response to nasal catheter. What is his most probable APGAR score?

A. 0
B. 2
C. 4
D. 5
E. 6

3. During a training session for medical staff, a lecturer emphasizes the importance of
maintaining patient confidentiality. What does “confidentiality” mean in the context of
patient-doctor relationships?

A. Sharing patient information with friends and family

B. Keeping patient information private and secure
C. Releasing patient information to the media
D. Only disclosing information to insurance companies
E. Publishing patient information without can sent.

4. An 80-year-old female presents with confusion associated with a chest infection. She
received standard treatment, and four days later she developed green, then bloody
diarrhea. Sigmoidoscopy showed yellow white plaques adherent to hyperemic mucosa.
Which one of the following organisms is most likely to be responsible for her diarrhea?

A. Campylobacter jejuni
B. Clostridium difficile
C. Escherichia coli
D. Methicillin-resistant Staphylococcus aureus
E. Vancomycin- resistant enterococcus
2 EMLE November 2024 Exams

5. A 2700- g, 36- wk's-GA white male is born after 22 hrs of premature rupture of the
amniotic membranes. The Apgar scores are 3 and 5. He immediately experienced
respiratory distress and cyanosis requiring ET Intubation and MV with 100% O2. Vital signs
are T: 36.2°C, HR 195 bpm, mean BP 22 mm Hg. WBC 1500/ 11 l, platelets 59,000/ 11 L.
Which of the following Is the most appropriate treatment for this baby?

A. Surfactant by aerosol
B. IV ampicillin and gentamicin/cefotaxime
C. IV steroids
D. IV acyclovir
E. High frequency oscillatory ventilation

6. A 60-year-old woman comes to the emergency room in a coma. The patient's temperature
is 32.2°C. She is bradycardic with puffy eyes and face. Her thyroid gland is enlarged. There
is diffuse hyporeflexia. BP is 100/60. Which of the following is the best next step in
management?

A. Await results of T 4 and TSH.

B. Obtain T4 & TSH; begin IV thyroid hormone & glucocorticoid.
C. Begin rapid rewarming.
D. Obtain CT scan of the head.
E. Begin intravenous fluid resuscitation.

7. A 36-year-old female presented with pallor, puffiness of the eye lids and edema of the
lower limbs. Her BP was 180/100. Investigations revealed a 24 hour protein of 8 gm/dl, 2-3
RBCs in urine, serum creatinine of 1mg/dl, her complement levels were normal. ANA and
antiDNA were negative. Which of the following is the likely diagnosis?

A. Nephritic syndrome
B. Heart failure
C. Lupus nephritis
D. Nephrotic syndrome
E. Cluster headache

8. A 60-year-old woman has had a 6-month history of bloody diarrhea. She presents to the
ER with severe abdominal pain and constipation. On examination, her abdomen is
distended and tender on the left side. Rectal examination reveals small amount of feces.
Blood tests show Hb 11.0 g/dl TLC 15.6 x 109/1. platelets 450 x 109/L Sodium is 139 mmol/l
(N: 135-145), potassium is 4.6 mmol/l (N: 3.5-5), urea 25 mg/dl creatinine 1.3 mg/dl and C-
reactive protein (CRP) is 75 mg/l. What is the next best of further investigation?

A. Colonoscopy
B. CT of the abdomen
C. Magnetic resonance imaging (MRI) of abdomen
D. Sigmoidoscopy
E. X-ray of abdomen
 EMLE November 2024 Exams 3

9. A 75-year-old man develops bleeding per rectum and presents with blood pressure of
90/60 mmHg and heart rate of 120 beats/mm. His vital signs improved slightly with
crystalloid and packed red cells infusion. Which of the following is considered the
appropriate next step in management?

A. Barium enema
B. Colonoscopy
C. Conservative medical treatment
D. CT scan with double contrast (IV and oral)
E. Radioactive labeled RBCs study

10. A 21-year-old man presents with jaundice after receiving trimethoprim

sulfamethoxazole for sore throat. Examination: scleral icterus and pallor. No
hepatosplenomegaly is present. Laboratory studies: Hemoglobin 10 g/dL, Total bilirubin 6.2
mg/dL, Conjugated bilirubin 0.8 mg/dL. alkaline phosphatase 60 iu/l (normal 20 to 140), AST
24 units/liter (normal 5-40), ALT 22 units/liter (normal 7-56). Which one of the following is
the most likely cause for his jaundice?

A. Gall bladder stones.

B. Acute infectious hepatitis
C. Cholestatic liver disease
D. Thalassemia major
E. Glucose-6-phosphate dehydrogenase deficiency

11. A 3-year-old boy with fair hair color and bad smell of urine presented with intellectual
disability, he has an affected older sister with inborn error of metabolism. Which of the
following is a possible diagnosis?

A. Phenylketonuria
B. Galactosemia
C. Mucopolysaccharidosis
D. Gaucher disease
E. Tyrosinemia

12. A 2-year-old girl comes to the clinic with fever, bruising and generalized petechiae all
over her body. Temperature 37.8 C. Two weeks before she had rhinitis and mild cough for 3
days. Examination shows no other physical abnormality. Hemoglobin 12.3 gm/dl, Platelet
count of 21,000/mm3. What the most probable diagnosis?

A. Von Willebrand disease

B. Systemic lupus erythematosus
C. Aplastic anemia
D. Acute leukemia
E. Immune thrombocytopenic purpura
4 EMLE November 2024 Exams

13. A 62-year-old businessman presents to the emergency department with significant

bright red rectal bleeding for the past 6 h. he has no abdominal pain or vomiting. There is
no previous history of altered bowel habit. His appetite is normal, and he reports no recent
weight loss. On examination he looks pale and sweaty. His blood pressure is 80/50 mm Hg
and pulse rate 128/min and temp is normal. His abdomen is soft with no evidence of
distension. Rectal examination reveals altered blood mixed with the stool and there are
some blood clots on the glove. What is the immediate management?

A. Contrast radiological examination.

B. Diagnostic Rigid sigmoidoscopy.
C. Enema to wash the stool and blood.
D. Intravenous fluid resuscitation until the patient stabilized.
E. Schedule the patient tor examination under general anesthesia

14. A 6-year-old has a sore throat and has been given antibiotics. Three weeks later, he
represents feeling feverish with nausea, vomiting and tea-colored urine. Urine dipstick
confirms hematuria and protein. Pressure is 100/60mmHg. What is the most likely
diagnosis?

A. Nephritic syndrome
B. UTI
C. Acute tubulointerstitial nephritis
D. Minimal change glomerulonephritis
E. Post streptococcal glomerulonephritis.

15. A 34-year-old, non-lactating Para3, started to use combined oral contraceptive pills
(COCs) after delivery as before. Her last pregnancy was complicated by lower limb deep
venous thrombosis (DVT). Which of the following is the proper advice for contraception?

A. Continue on COCs with follow-up.

B. Shift to low dose estrogen COCs.
C. Use barrier methods for contraception.
D. Insert an intra-uterine contraceptive device.
E. Laparoscopic bilateral tubal ligation.

16. A 67-year-old man is complaining of easy fatigability. A routine complete blood count
(CBC) reveals a platelet count of 800,000/ml, and the hemoglobin and WBC counts are
normal. He reports no other symptoms, and his clinical examination is normal. Which of the
following characteristics is most likely to be helpful in differentiating essential (primary)
from reactive (secondary) thrombocytosis?

A. Increased megakaryocyte number

B. Increased total platelet mass
C. Increased platelet turnover
D. Normal platelet survival
E. Thromboembolism and hemorrhage
 EMLE November 2024 Exams 5

17. A 21-year-old woman complaining of shortness of breath and productive cough of 2

months duration. She came to the outpatient clinic because she noticed bilateral leg
swelling. Physical examination revealed: pulse is 110 b/min. Bp 105/60. General
examination revealed Raised JVP with bilateral pitting lower limb edema. Loud 1st heart
sound with mid-diastolic murmur over her cardiac apex and ejection systolic murmur over
the 2nd left intercostal space. Chest X-ray revealed cardiomegaly. What is the most likely
diagnosis?

A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation
E. Ventricular septal defect

18. You are called to see an 85-year-old female patient as the nursing staff is concerned
that the patient has not passed stool for 4 days. The patient has been admitted after family
members became increasingly concerned regarding her general deterioration in health and
level of function. She is orientated but frail and complains of increasing abdominal
discomfort. On examination bowel sounds are increased. The abdomen is distended with
generalized tenderness, but no rebound or guarding. There is a firm palpable mass in the
left iliac fossa. Digital rectal examination shows an empty rectum. What diagnosis must be
excluded?

A. Simple constipation
B. Paralytic ileus
C. Sigmoid volvulus
D. Peritonitis secondary to diverticular disease
E. Neoplasia

19. An 8-month-old boy presents to the emergency room with jerky movement of all limbs.
He was a full-term baby, with no neonatal problems. He is exclusively breast fed. He is
afebrile with height and weight at 50th percentile. What is the next investigation to be
carried out?

A. Lumbar puncture
B. Electromyography
C. Nerve conduction velocity
D. Serum calcium
E. Serum sodium

20. A 5-year-old male presents with confirmed rotavirus diarrhea. He is tachycardic and
lethargic with sunken eyes, poor skin turgor, and dry mucous membranes. Which of the
following is the most appropriate next step in management?

A. 0.48 NS (normal saline) 100 ml/hour drip

B. 0.9 NS 100 ml/hour drip
C. DS 0.45 NS 20 ml/kg bolus
D. 0.9 NS 10 ml/kg bolus
E. 0.9 NS 20 ml/kg bolus
6 EMLE November 2024 Exams

21. A 12-day-old girl born at 32 weeks becomes lethargic and hypothermic over the last 24
h. She is not tolerating her formula feeds, has 2-episodes of bilious vomitous, and 3-times
bloody diarrhea. On examination: abdominal distention, visible bowel loops, abdominal
wall erythema, and absent bowel sounds. Which of the following is the most likely
diagnosis?

A. Hirschsprung's disease
B. Duodenal atresia
C. Esophageal atresia
D. Necrotizing enterocolitis
E. Meconium ileus

22. A 25-year-old G3 P1+1 presents to the emergency room complaining of lower abdominal
crampy pain 6 weeks from her last normal period. She had significant vaginal bleeding, but
no passage of tissue & pregnancy test is Positive. Which of the following is the most
important step in this patient's evaluation?

A. Sonography
B. Physical exam
C. CBC
D. Quantitative B-hCG
E. Detailed menstrual history

23. A 30-year-old primigravida presents at 34 weeks' gestational age with blood pressure of
170/100 mmHg, headache, epigastric pain, visual abnormalities and 3+ proteinuria.
Biophysical profile of the fetus is 10/10. Which of the following is the immediate step in
management?

A. Start anti-hypertensives
B. Start magnesium sulfate
C. Give betaclomethasone to induce fetal lung maturity.
D. Perform an amniocentesis to assess fetal lung maturity.
E. Repeat the biophysical profile daily.

24. A 25-year-old man developed bilateral loin pain, frank hematuria, and edema in feet. His
symptoms had started 24 hours after developing a sore throat, his blood pressure was
130/80 mmHg. Urine analysis was positive for blood (4+) and protein (2+). Which of the
following is the most likely diagnosis?

A. IgA nephropathy
B. Microscopic polyangiitis
C. Nephrolithiasis
D. Post-streptococcal glomerulonephritis
E. Septicemia
 EMLE November 2024 Exams 7

25. A 15-year-old adolescent girl is diagnosed with meningococcemia. She has a 4-year-old
brother and an 11-month-old sister at home. What is the appropriate management of her
siblings?

A. Nasopharyngeal culture for N-meningitides

B. Meningococcal quadrivalent vaccine
C. Single dose of azithromycin to both children
D. Rifampin given every 12 hours for 2 days
E. Close observation for febrile illness

26. A 27-year-old man was brought to casualty by ambulance following a fall from the third
floor of a tower block. He was conscious and fully oriented. The casualty officer achieved
venous access with two 14-gauge cannula and requested a full blood count and 2 units of
group-specific blood. Cervical spine and chest radiographs were normal; however, the
radiograph of the pelvis showed a clearly displaced fracture through the left pubic rami and
disruption of the left sacroiliac joint. On examination he had a pulse of 120 beats/min and a
blood pressure of 95/70 mmHg. His scrotum was severely bruised and swollen and a small
amount of blood was present at the external penile meatus. Abdominal examination
revealed a suprapubic tender swelling reacting to the level of the umbilicus which of the
following is other injury suggested in association with this fracture?

A. Membranes urethral injury

B. Urinary bladder injury
C. Penile urethral injury
D. Seminal vesicle injury
E. Prostatic injury

27. A 38-year-old woman presents to the GP with pain in the subareolar region of the left
breast associated with occasional blood-stained nipple discharge. Apart from being
extremely anxious she has no other associated symptoms. Examination is unremarkable.
What is the most likely diagnosis?

A. Duct ectasia
B. Galactocoele
C. Intraductal papilloma
D. Paget disease
E. Prolactinoma

28. A 60-year-old diabetic man complains of chest pain of 2 hours duration. He is diabetic.
The patient is sweaty, pulse is 110 b/min and Bp is 90/60. There is bilateral basal crepitation
over the back of his chest. ECG showed raised ST segment in V1 till V6. Troponin is
positive. Which of the following is the most likely diagnosis?

A. Stable angina
B. Unstable angina
C. Acute myocardial infarction
D. Acute pulmonary embolism
E. Acute pericarditis
8 EMLE November 2024 Exams

29. A 65-year-old man who underwent an anterior resection for rectal cancer complains of
pain in his left calf on the first postoperative day. On examination he has low-grade pyrexia
(37.5°C), and the calf looks swollen with shiny skin and is tender. The patient experiences
pain on dorsi flexing his foot. What is the appropriate diagnosis?

A. Deep vein thrombosis (DVT)

B. Klippel-Trenaunay syndrome
C. iatrogenic vascular injury to iliac arteries
D. Pelvic collection
E. Superficial thrombophlebitis

30. A 16-year-old girl presents with acute onset of maculopapular rash, fever, and oliguria
one week after receiving ampicillin for streptococcal pharyngitis. Her temperature is 38.7 C,
blood pressure is 110/70 mmHg, pulse is 94/min, and respirations 16/mm Urine analysis
shows microscopic hematuria, increased leukocytes with numerous eosinophils, and
occasional white blood cell casts. No proteinuria. Blood tests: elevated antistreptolysin O
titer and moderate eosinophilia. Blood urea nitrogen BUN Is 42 mg/dL, and serum
creatinine is 2 5 mg/dL Which one of the following is the most likely diagnosis?

A. Acute interstitial nephritis

B. Acute pyelonephritis
C. Acute tubular necrosis
D. Post streptococcal glomerulonephritis
E. Vasculitis

31. A 65-year-old woman with a past medical history of hypertension and stable angina
presents to the GP practice complaining of episodes of severe central abdominal pain.
They occur around half an hour after meals and can last up to an hour. She is becoming
reluctant to eat because of the pain and as a result she has lost nearly a stone in weight
over the past 2 months. Examination is unremarkable. Which of the following of these
investigations would be the most informative?

A. Barium follow through

B. CT scan
C. Colonoscopy
D. Exercise tolerance test
E. Mesenteric angiography

32. The parents of an 18-month-old girl bring her to the ER after she had a seizure. They
reported she was in a good health, her temperature 39,5 C. She is oriented and playing
now. Which of the following suggest the good outcome of her condition?

A. A CSF cells 100 WBCs

B. Otitis media examination
C. The seizure lasted 30 minutes
D. The seizures was reported to effect the right side of the body
E. The seizure recurred 3 times before coming to the ER
 EMLE November 2024 Exams 9

33. A 28-year-old, Para2 used combined oral contraceptive pills for the last 8 months as
advised by one of her friends. Her mother died of breast cancer 3 years ago. What is the
appropriate advice regarding contraception?

A. Request regular serum sex-hormone profile.

B. Regular screening for breast cancer.
C. Shift to another non-hormonal method.
D. Ask for pathology report of her mother’s tumor.
E. Use prophylactic anti-estrogen drugs

34. A 33-year-old man with a history of scaly skin lesions in the elbows and knees
condition. Two years after onset of skin lesions he develops destructive deformity of the
joints in hands, which of the following is the most likely diagnosis?

A. Rheumatoid arthritis
B. Gout
C. Ankylosing spondylitis
D. Arthritis mutilans
E. Osteoarthritis

35. 63-year-old man, with an 8-year history of hepatitis C infection and well-documented
cirrhosis and portal hypertension, presents with a large hematoma on his thigh. On
preoperative screening, his prothrombin time is noted to be 17.4 seconds (N: 11-13.5
seconds). Transfusion of which of the following is the most appropriate next step in
management of this patient prior to his procedure?

A. Cryoprecipitate
B. Fresh frozen plasma
C. Packed red blood cells
D. Platelets
E. Whole blood

36. A 34-year-old primigravida, at 28 weeks, presented at her routine antenatal visit with a
complaint of vaginal discharge diagnosed to be vaginal candidiasis, for which she received
two successive courses of local treatment with incomplete resolution. Her Urine analysis
showed pus cells 50-60/high power field, sugar 1+. On ultrasound examination, the
amniotic fluid index was 23. What is the next step of management?

A. Schedule for the next prenatal visit after 2 weeks

B. Repeat local treatment for infection using another preparation.
C. Systemic antifungal treatment
D. Request a glucose tolerance test.
E. Termination of pregnancy
10 EMLE November 2024 Exams

37. After a year of 4-monthly follow-up, a healthy 75-year-old woman with a 5 cm simple
unilocular ovarian cyst and a normal serum CA-125 level decides that she would prefer to
have surgical treatment, which of the following treatment would you recommend?

A. Aspiration of the cyst

B. Laparoscopic bilateral oophorectomy
C. Laparoscopic ovarian cystectomy
D. Laparoscopic unilateral oophorectomy
E. Total abdominal hysterectomy and bilateral salpingooophorectomy

38. A 2-year-old boy with the spastic diplegic cerebral palsy is being evaluated. He was
born prematurely and spent 2 weeks in the NICU for respiratory distress management.
What findings can MRI of his brain show?

A. Multicystic encephalomalacia
B. Periventricular leukomalacia
C. Normal anatomy
D. Basal ganglia abnormalities
E. Agenesis at the corpus callosum

39. 26-year-old Para 1+2 came to the emergency department 3 weeks after an abortion, with
severe vaginal bleeding. She reported undergoing surgical evacuation 3 weeks earlier but
did not return to receive the pathology report of the specimen. Her beta- subunit titer was
above 100,000 milli-international units/milliliter, her ultrasound showed an intra-uterine
mass 4x4 centimeters. What is the most appropriate management?

A. Resuscitation and uterotonics

B. Resuscitation and re-evacuation
C. Resuscitation followed by conservative management
D. Start chemotherapy
E. Hysterectomy

40. A 28-year-old girl presents with oligo-hypomenorrhea, and facial hirsutism. Her physical
examination is normal, and transvaginal ultrasound shows multiple subcortical small cysts
4-6 mm in both ovaries. Which of the following is the most likely laboratory finding?

A. Increased FSH level.

B. Increase in androgens level.
C. Increased prolactin.
D. Decrease in estrogen level.
E. Decreased fasting serum insulin.

41. A 60-year-old heavy smoker man presented with hemoptysis for one month. CT showed
bronchogenic carcinoma with liver metastases. The diagnosis was confirmed by
bronchoscopic biopsy. To whom should you explain the situation and prognosis?

A. Brother
B. Daughter
C. Son
D. Patient himself
E. Wife
 EMLE November 2024 Exams 11

42. A 7-month-old infant is evaluated for gastrointestinal bleeding and easy bruising.
Physical examination shows shortened forearms, bruising and petechias. Radiograph of
her forearms shows bilateral absent radii. Her CBC is normal with the exception of a
platelet count of 13,000/mm3. What management do you offer to the family?

A. Gene testing to confirm the diagnosis

B. Chromosome breakage analysis
C. Referral for bone marrow transplantation
D. Splenectomy
E. Supportive care with platelet transfusions

43. A 52-year-old man has been recently diagnosed with type 2 diabetes and has been
following a plan of lifestyle measures to improve his diet and increase his level of exercise
for the last 3 months. On returning to clinic his BMl is 28, fasting plasma glucose 154
mg/dl, glycated hemoglobin HbA1c 7.5%, s creatinine 0.9 mg/dL, BP 135/80 mmHg. Which
of the following is the most appropriate next management step?

A. Glibenclamide
B. Metformin
C. Insulin
D. Continue diet and exercise regimen only
E. Sleeve gastrectomy

44. A previously fit 59 years old male presented with a small amount of dark red blood and
mucous mixed in the stool. There has been a recent change of bowel habits, but no
significant abdominal or anal pain and plain abdominal radiographs were normal, which of
the following is mostly a cause of this pattern of gastrointestinal bleeding?

A. Diverticular disease.
B. Ulcerative colitis.
C. Hemorrhoids
D. Colonic neoplasia
E. Ischemic colitis

45. A 65-year-old diabetic patient is hospitalized because of acute cholecystitis. His

diabetes is controlled with metformin1000 mg twice daily; a recent hemoglobin A1C level
was 5.9. Cholecystectomy is performed but is complicated by postoperative pneumonia
and septic shock. The patient requires endotracheal intubation and ICU care. Blood
cultures grow gram-negative rods and are required to maintain peripheral perfusion. Which
of the following is the best method of controlling blood sugars in this patient?

A. Continue metformin via nasogastric tube

B. IV insulin infusion to maintain blood glucose 140 to 180 mg/dL
C. Sliding scale regular insulin to maintain blood glucose 80 to120 mg/dL
D. IV insulin infusion to maintain blood glucose below 100 mg/dL
E. Contact endocrinology for subcutaneous insulin pump and continuous glucose
monitoring
12 EMLE November 2024 Exams

46. A 14-year-old male presents to his GP due to shortness of breath and chest discomfort
whilst exercising. On examination there is a double apical impulse and a harsh mid systolic
murmur loudest between the apex and the left sternal border. His ECG shows left
ventricular hypertrophy (LVH) and widespread Q waves. You suspect Hypertrophic
Obstructive Cardiomyopathy (HOCM), which of the following is associated with increased
risk of sudden death?

A. Degree of left ventricular hypertrophy

B. Asymmetrical septal hypertrophy
C. Loudness of murmur
D. Family history of sudden death
E. Age

47. A 30-year-old woman presents with fever, night sweats, and muscles ache for the past 1
month. She was previously well. On examination, she has axillary and cervical lymph
nodes, but no active joints or hepatosplenomegaly. She currently works in a pig farm. Her
investigations are negative for EBV, CMV, and HIV. Serologic tests for the infecting agent
confirm the diagnosis in her. Which of the following is the most likely diagnosis?

A. Brucellosis
B. Histoplasmosis
C. Leprosy
D. Infectious mononucleosis
E. TB

48. A 56-year-old man with recently diagnoses of chronic obstructive lung disease (COPD)
presents with shortness of breath and wheeze. Blood gases reveal a PO2 of 60 mm Hg
(Normal: 75 to 100 mm Hg), PCO2 of 53 mm Hg (Normal: 35 to 45 mm Hg), PH of 7.25 and a
bicarbonate of 24 mEq/L (Normal: 22 to 26). What do these gases indicate?

A. Acute respiratory acidosis

B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis with metabolic compensation
E. Acute on chronic respiratory acidosis

49. A female patient, 75-year-old presented with epigastric mass & weight loss with change
in bowel habit towards constipation, the patient passed stool today in the morning.
Colonoscopy was done early and revealed a nearly obstructing mass in the transverse
colon and biopsy showed adenocarcinoma grade III. What is the surgical option?

A. Urgent Hartmann’s procedure

B. Total colectomy
C. Extended right hemicolectomy
D. Transverse colectomy
E. Colostomy only.
 EMLE November 2024 Exams 13

50. A 21-year-old woman is suspected of having mycoplasma pneumonia based on

symptoms of a dry cough, fever, the lung examination is normal. Chest x-ray shows
bilateral infiltrates, her hemoglobin of 10.5 g/dl, reticulocyte count 7%, and WBC 12,000/mL
Hemolytic anemia from cold agglutinins is suspected as the cause. Which of the following
tests will confirm an autoimmune cause of the anemia?

A. Positive antinuclear antibody (ANA)

B. Positive rheumatoid factor
C. Polyclonal gammopathy
D. Presence of Heinz bodies
E. Positive Coombs test

51. A 3-year-old girl brought to the emergency room for evaluation of fever and cough for 3
days. Her temperature was 39.5 °C, HR 120bpm, RR 30/min, SpO2 96% on room air. On
exam, she is alert with no respiratory distress. Diminished breath sounds are noted in the
right base. Which antibiotic would be the most appropriate for that girl?

A. Trimethoprim sulfamethoxazole
B. Acyclovir
C. Ceftriaxone
D. Azithromycin
E. Amoxicillin

52. A 53-year-old man presents to the GP with a deep, painful ulcer over the big toe. He
gives a 3-month history of severe calf pain on walking which is only eased on resting.
Examination shows cool peripheries with reduced distal pulses. Which ulcer does the
patient most likely have?

A. Arterial ulcer
B. Curling ulcer
C. Marjolin ulcer
D. Neuropathic ulcer
E. Venous ulcer

53. A 66-year-old man had an anterior resection of the rectum five days ago. Now, he has
increased abdominal pain, his temperature is 38.5°C, pulse is 120 bpm, and his blood
pressure is 90/60 mmHg. His abdomen is tender and there is generalized rigidity. What is
the most likely diagnosis?

A. hypovolemia
B. leaking anastomosis
C. secondary hemorrhage
D. urinary tract infection
E. wound infection
14 EMLE November 2024 Exams

54. A patient is in a critical condition and needs immediate surgery to survive however the
patient refuses the surgery based on personal religious beliefs. What legal and ethical
principles should guide the healthcare team in this situation?

A. Autonomy and beneficence

B. Justice and veracity
C. Non-maleficence and fidelity
D. Confidentiality and content
E. Respect for persons and distributive justice

55. Which of the following is the most effective method to prevent the transmission of
healthcare associated infections?

A. Proper hand hygiene

B. Wearing gloves at oil times
C. Regular use of face masks
D. Disinfecting surfaces twice a day
E. Increasing ventilation in healthcare settings

56. A 5-year-old girl presented with prolonged fever, progressive pallor, arthralgia, and skin
ecchymosis. Which of the following is the MOST likely diagnosis?

A. Wilms’ tumor
B. Hepatoblastoma
C. Leukemia
D. Rhabdomyosarcoma
E. Brain tumor

57. A 26-year-old female patient presents with increase in the vaginal discharge and
dysuria for two days duration. She is sexually active with her husband and uses condoms
intermittently. Examination reveals some erythema of the cervix. Urine culture is negative.
Sexually transmitted disease testing revealed gonorrheal infection. Which one of the
following infections should be treated concomitantly?

A. Bacterial vaginosis.
B. Chlamydia.
C. Herpes.
D. Syphilis.
E. Trichomoniasis.

58. After 3 months of marriage, a couple (husband 38 years old and wife 31 years old),
Consulted their doctor being anxious about their fertility. Their premarital assessments
were unremarkable. Which of the following is the appropriate management?

A. To wait until completion of one year of marriage.

B. Repeat pre-marital tests.
C. Request hysterosalpingogram.
D. Full clinical assessment, pelvic ultrasound, and the husband’s semen analysis.
E. Request semen analysis of the husband.
 EMLE November 2024 Exams 15

59. An 18-year-old male patient had long term history of suppurative otitis media, was
presented to neurology department with high grade fever, headache, vomiting, and
photophobia. On examination, chills, severe prostration and neck stiffness were prominent.
The neurologist started immediate treatment after receiving a CSF sample. CSF profile
showed elevated protein and decreased sugar. What is the causative organism of this
condition?

A. Mycobacteria
B. Fungal
C. Bacterial
D. Protozoal
E. Viral

60. A 31-year-old man is brought to the emergency room following a motor car accident in
which his chest struck the steering wheel. Examination reveals stable vital signs, but the
patient exhibits multiple palpable rib fractures and paradoxical movement of the right side
of the chest. Chest X-ray shows no evidence of pneumo-or hemothorax but a large
pulmonary contusion is developing. What is the proper management for this case?

A. Immediate operative stabilization

B. Observation and nasal mask
C. Stabilization of the chest wall with sandbags
D. Stabilization with towel clips
E. Tracheostomy, mechanical ventilation, and positive end-expiratory pressure

61. A 3-week-old male infant cries after feeds that last 2-hours. He often calms down after
passing gas. He passes stools after each feed. He receives cows' milk formula His mother
recently noted flocks of blood in the stools. Which of the following is most likely causes his
symptoms?

A. Malrotation
B. Pyloric stenosis
C. Hirschsprung disease
D. Milk protein intolerance
E. Mild ulcerative colitis

62. A 25-year-old woman consulted her gynecologist regarding her primary infertility for
one year. Her husband's semen analysis revealed azoospermia in spite of his satisfactory
hormonal profile. Which of the following is the appropriate next step for the management of
this couple?

A. In-vitro fertilization.
B. Intra-uterine insemination.
C. Testicular biopsy.
D. Post-coital test.
E. Prostate ultrasound
16 EMLE November 2024 Exams

63. What is the purpose of the time-out procedure in surgical settings?

A. To take a break during surgery

B. To review the patient's medical history
C. To discuss the surgical procedure with the patient
D. To ensure the correct patient and procedure are identified
E. To allow the surgical team to rest

64. A 25-year-old female patient, sustained a laceration of the perineum during delivery, it
involved the muscles of perineal body but not the anal sphincter. Which of the following is
the degree of this laceration?

A. First degree
B. Second degree
C. Third degree
D. Forth degree
E. Fifth degree

65. A 23-year-old man presents with prolonged nasal bleeding. He has always noted easy
bruising, and ongoing bleeding after minor cuts. There is no prior history of surgery or
dental procedures. His hemoglobin is 14.5 g/dL, platelets 200,000/ml, and PT/PPT is normal.
Further testing reveals that the bleeding time is elevated; the factor VIII level is reduced, as
is the ristocetin cofactor assay, which of the following is the most likely diagnosis?

A. Hemolytic uremic syndrome (HUS)

B. Factor 5 mutation
C. Antiphospholipid syndrome
D. Disseminated intravascular coagulation (DIC)
E. Von Willebrand disease (VWD)

66. A female patient 59-year-old presented with attacks of hematemesis, on examination

pulse rate was 118 bpm., blood pressure 90/55 mmHg, nasogastric tube was inserted and
revealed active bleeding then wash is started. What is the best option for this patient's
management after initial resuscitation?

A. admission and preparation for elective surgery

B. medical home treatment
C. ultrasound to detect state of the liver cirrhosis
D. urgent refer for surgery
E. urgent endoscopic work up

67. A 40-year-old man, 18 hours after a gastrectomy, suddenly becomes hypotensive with a
blood pressure of 80/60, tachycardia of 110/min, CVP +2 cm, H2O and a temperature of
39oC. The likely diagnosis is:

A. Ruptured anastomosis
B. Hemorrhage
C. Acute gastric dilatation
D. Pulmonary embolism
E. Septicemia
 EMLE November 2024 Exams 17

68. A 13-year-old boy arrives to the ED 3-hours after feeling a sudden left testicular pain
white playing basketball. Ho had nausea and vomiting. On examination a tender and
swollen left testicle. It is displaced superiorly and lying transversely. There is absent
cremasteric reflex on the left. The right testicle is normal in location and is non-tender.
Which of the following should be the next step in management?

A. Color Doppler ultrasound

B. Left orchiopexy
C. Bilateral orchiopexy
D. Scrotal support and rest
E. Nonsteroidal anti-inflammatory drugs

69. A 27-year-old man presents to the GP practice having noticed a painless swelling of his
right testicle. He is otherwise well. On examination, the testis is enlarged, firm and has a
nodular texture. What is the most likely diagnosis?

A. Epididymal cyst
B. Gumma
C. Hematocele
D. Orchitis
E. Testicular cancer

70. A 40-year-old woman, with a history of depression, presents to the emergency

department complaining of feeling unwell with headaches and blurred vision. She says the
headaches have been getting worse over the last two weeks and seem to be worse in the
mornings. Her pulse is 40bpm and her blood pressure (BP) is 190/110 mmHg. Fundoscopy
reveals bilateral swollen discs and there is diplopia on lateral gaze bilaterally, which of the
following is the best next step in her management?

A. Request an urgent CT of the brain

B. Perform a lumbar puncture and measure the CSF pressure
C. Commence Cefotaxime and Acyclovir
D. Administer steroids urgently
E. MRI angiography

71. A 61-year-old man presents with rapid onset left iliac fossa pain and fever. He is tender
in the left iliac fossa but there is no obvious palpable mass. Temperature is 38.7°C, pulse
94 bpm, white cell count 16 X 109/L, and CRP 60 mg/L. Which of the following is the single
most likely diagnosis?

A. Acute appendicitis
B. Sigmoid cancer
C. Crohn’s disease of the colon
D. Acute sigmoid diverticulitis
E. Ureteric colic
18 EMLE November 2024 Exams

72. A 62-year-old man presents to the GP with a lump in the left groin which has been
present for over 2 months. On examination, the lump is above the inguinal ligament. It is
reducible and has a cough impulse but does not extend into the scrotum. Which of the
following is the most likely diagnosis?

A. Direct inguinal hernia

B. Femoral hernia
C. Gluteal hernia
D. Indirect inguinal hernia
E. Obturator hernia

73. A 3-month-old baby with low grade fever, wheezing and dry cough. His older brother
had recent upper respiratory tract infection. On examination: RR 72/min, hypoxia. CXR
shows hyperinflation and some infiltrate. What is the most likely diagnosis?

A. Croup
B. Epiglottitis
C. Bronchial asthma
D. Bronchiolitis
E. Pneumonia

74. A 9-month-old boy brought to the ER with history of watery diarrhea for the past week.
His blood pressure = 90/54, pulse = 102, respiratory rate = 18, and altered Level of
consciousness. Which of the following lab is expected?

A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
E. Normal ABG

75. A 14-month-old boy presented to emergency room with disturbed level of

consciousness. Laboratory studies revealed: plasma glucose 650 mg/dl; arterial PH; 7.35,
serum bicarbonate 17 mmol/L, effective serum osmolarity 340 mOsm/kg, anion gap 12
mmol/L, absent ketonuria. What is the most likely diagnosis?

A. Diabetic ketoacidosis
B. Lactic acidosis.
C. Hyperglycemic hyperosmolar state.
D. Hyperchloremic acidosis
E. Salicylate intoxication

76. A 30-year-old man cut his hand while changing his flat tire yesterday evening. He says
that he had a tetanus booster 4 years ago and full childhood immunization. Which is the
single most appropriate management?

A. Giving a booster dose of anti-tetanus vaccine only

B. Giving a dose of anti-tetanus immunoglobulin only
C. Giving a dose of anti-tetanus vaccine and anti-tetanus immunoglobulin
D. Giving a dose of anti-tetanus vaccine followed by further doses by the GP
E. No action required with regard to tetanus prophylaxis
 EMLE November 2024 Exams 19

77. A one-year old boy brought to the well-baby clinic to assess his developmental
milestone. Which of the following this infant is age appropriate?

A. Kicks a ball
B. Climbs up and down from furniture without assistance
C. Says short sentences with two to four words
D. Builds towers with four or more blocks
E. Stand unsupported

78. A 27-year-old Primigravida came for her first antenatal visit at 6 weeks gestation. Her
routine antenatal care was unremarkable. Which of the following should be given as
necessary supplement?

A. Iron
B. Calcium.
C. Iron and folic acid.
D. Vitamin C
E. Pregnancy multivitamin formula

79. A 26-year-old lady P2+0 presented with secondary amenorrhea of three years duration.
FSH and LH were found to be high. What is the most likely diagnosis?

A. Sheehan syndrome
B. Asherman syndrome
C. Premature ovarian failure
D. Imperforated hymen
E. Pituitary adenoma

80. A 3-year-old child presented with fever for 6 days not responding to parenteral
antibiotics. Mouth cavity showed significant erythema without ulcers. Cervical lymph
nodes were bilaterally enlarged but larger on the left in addition to conjunctival congestion.
Platelet count was 780,000/mms. What is the most effective line of treatment?

A. Combined IV antibiotics
B. IV acyclovir
C. IV IG
D. Antifungal therapy
E. IV steroid

81. A 35-year-old non-lactating Para 2 has inserted an intra-uterine contraceptive device 6

weeks after her last delivery. Two weeks later, she started to notice offensive vaginal
discharge, lower abdominal pain and a temperature of 38°c. Her urine culture revealed
insignificant bacterial growth. C-reactive protein was elevated, and pregnancy test was
negative. Otherwise, she is clinically free. Pelvic ultrasound findings were unremarkable
with the device in place. Which of the following is the appropriate management?

A. Remove the device and reinsert after one month.

B. Combined antibiotic therapy.
C. Laparotomy
D. Hysterosalpingogram.
E. Hysteroscopy.
20 EMLE November 2024 Exams

82. A 25-year-old unmarried female patient, consulted her doctor about her menstrual
pattern during the last five months. Inspite of having regular menses, she has mid-cycle
vaginal spotting and cramping pelvic pain. Her examination was unremarkable, and she
has normal pelvic ultrasound scan as well as a normal vaginal cytology. Which of the
following is the most likely cause of her complaint?

A. Ovulatory mid-cycle pain and bleeding.

B. Anovulatory mid-cycle bleeding.
C. High estrogen breakthrough bleeding.
D. Undiagnosed bleeding tendency.
E. Severe mixed vulvo-vaginitis.

83. A 24-year-old man, who has been suffering from intermittent fresh bleeding per rectum,
presents to the emergency department with a 6-hour history of right-sided abdominal pain,
fevers, and nausea. On examination, he has tenderness and guarding in the right iliac
fossa. His temperature is 38.2°C. What is the most likely diagnosis?

A. Appendicitis
B. Hemorrhoids
C. Meckel diverticulitis
D. Renal colic
E. Shigella infection

84. A 45-year-old male patient, presented to the outpatient clinic with a 3-month history of
epigastric pain associated with epigastric fullness, diarrhea and weight loss. Computed
tomographic (CT) scan showed calcification in the pancreatic head and a 7 cm cystic lesion
in the tail of the pancreas. Which of the following is the most likely diagnosis?

A. Acute pancreatic.
B. Chronic pancreatic.
C. Mucinous cystadenoma of pancreas.
D. Papillary cystadenoma of pancreas
E. Pseudo pancreatic cyst

85. A 39 male patient complains of right iliac fossa pain and swelling right sided tumors of
the large bowel present more frequently with which of the following characteristics when
compared to left sided tumors?

A. Large bowel obstruction

B. Small bowel obstruction
C. Blood mixed in with stools
D. Change in bowel habit
E. Iron deficiency anemia
 EMLE November 2024 Exams 21

86. A 22-year-old man presented to you complaining of abdominal pain. On clinical

examination: A left upper quadrant mass of his abdomen is felt. Which of the following
features diagnose clinically a kidney rather than a spleen?

A. Cannot palpate above it

B. Presence of a notch
C. Dullness to percussion
D. Extends towards the right lower quadrant
E. Ballotable

87. A 3-month-old male comes to the emergency room with a history of upper respiratory
symptoms for 3 days, fever, decreased appetite and increased work of breathing. On exam
his vitals are T37.2°C, RR 40, HR 185, BP 90/65, and Sat 95% on room air; he has mild
retractions and coarse breath sounds. Which of the following is the MOST appropriate next
step in management?

A. Give oral corticosteroid

B. Start antihistamine
C. Start albuterol
D. Suction to remove secretions
E. Supplementary oxygen

88. A 36-year-old Para 5 has just delivered vaginally. After delivery of the placenta, brisk
vaginal bleeding is noticed. The uterus is soft and fails to maintain adequate contraction.
Her pulse rises to 125 beats per minute and blood pressure drops to 80/40 mmHg. Which of
the following the FIRST step of management?

A. IV fluids and prepare for possible blood transfusion.

B. Uterotonic drugs.
C. Exploration of genital tract.
D. Bimanual uterine compression.
E. Hysterectomy

89. A 27-year-old man complains at perianal itching bleeding, discharge, pain and lumps for
a few months. On examination he has pinkish-white swelling outside and inside the anal
canal partially obscuring the anal orifice. What is the appropriate diagnosis?

A. anal fissure
B. fistula in-ano
C. hemorrhoids
D. hidradenitis suppurativa
E. sebaceous cyst
22 EMLE November 2024 Exams

90. A male patient 61-year-old complained of progressive yellowish discoloration of the

sclera & itching with vague abdominal pain. Carcinoembryonic antigen (CEA) was 523
ng/mL (0-2.4 ng/mL), CA 19-9 was 450 Unit/mL (0-37 unit/mL), ultrasound study was
unremarkable, serum bilirubin was 12 mg/dl (0.3-1.2 mg/dl) and CT scan of the abdomen
revealed bulky pancreas and multiple scattered hepatic metastatic nodules. What is the
management for this patient?

A. ERCP stenting
B. pancreaticoduodenectomy
C. Pancreaticoduodenectomy + hepatic resection
D. total pancreatectomy
E. radiotherapy only

91. A 23-year-old woman has a 6-month history of amenorrhea and galactorrhea. Physical
examination confirms that milk can be expressed from both breasts, but it is otherwise
unremarkable. The pelvic examination is also unremarkable. Visual field examination is
normal. A pregnancy test is negative. Magnetic resonance imaging (MRI) showed a pituitary
microadenoma (4 mm in diameter) and serum prolactin 160 ng/ml (normal level up to 25
ng/ml). Which of the following is the most appropriate management?

A. Transsphenoidal surgical excision of the pituitary tumor

B. Bromocriptine
C. Sellar radiotherapy
D. Cyclic hormone replacement with estrogen and progesterone
E. Systemic chemotherapy

92. A 79-year-old man with no significant past medical history has become progressively
more forgetful in the past 9 months. He has trouble remembering familiar places and
people can no longer balance her checkbook and has increased trouble verbally
expressing her thoughts. These symptoms have progressively worsened in the past
several months. He has no history of head trauma or of anxiety disorder. His neurologic
examination is within normal limits except for a mini-mental status examination score of 22
of 30, missing points on calculation, recall, and orientation. A rapid plasma reagin antibody
test (to assess allergic reactions) was negative, and the thyroid stimulating hormone,
vitamin B12, folate, and electrolytes were normal. Which of the following is the most likely
diagnosis?

A. Alzheimer's disease
B. Creutzfeldt-Jakob disease
C. Delirium
D. Depression
E. Normal pressure hydrocephalus
 EMLE November 2024 Exams 23

93. A 20-year-old female is brought to casualty with a one-day history of not talking to
anyone, not taking food and incontinence. On examination all vital parameters are stable,
but she is entirely unresponsive and responds only to painful stimulus, her eyes are open
and lusterless (dimmed or unable to see clearly). What is the most likely diagnosis?

A. Delirium
B. Malingering
C. Intoxicated with unknown substance
D. Stupor
E. Drowsy

94. In a pediatric ward, a child with chickenpox has been admitted. The nursing staff is
discussing precautions to prevent the spread of the virus. What precaution should be
primarily implemented to limit transmission among other patients and staff?

A. Administering antibiotics to all patients in the ward

B. Strictly enforcing hand hygiene among staff member
C. Using face masks for all patients in the vicinity.
D. Segregating the infected child in a separate room
E. Regularly disinfecting surfaces with alcohol-based solutions

95. An 18-year-old man presented to casualty with a 3-hours history of acute pain in the
right hemiscrotum. There were no associated symptoms. There was no history of
frequency, dysuria or urethral discharge. The patient gave a history of similar shorter
episodes of right-sided scrotal pain of sudden onset, short duration and rapid resolution in
the preceding 12 months. On examination the patient was afebrile with a soft abdomen.
Examination of the scrotum revealed that the right testicle was lying higher in the scrotum
than its companion and the spermatic cord was noted to feel thicker than the left spermatic
cord. The right testicle and spermatic cord were extremely tender. Which of the following is
the expected outcome from treatment?

A. Complete preservation of testicular function if surgical treatment during the first 4

hours of this attack
B. Loss of the endocrine function of testis regardless the time of intervention,
C. Loss of this testis
D. Malignant transformation is the final outcome.
E. Secondary hydrocele.

96. A 25-year-old woman presents in the emergency department with acute palpitations.
She is fully conscious, pulse 150 bpm, BP 125/75 mmHg, respiratory rate 20/min, oxygen
saturation 99% on air, chest auscultation is clear with no evidence of cardiac failure. ECG
shows narrow complex regular tachycardia. What is the most appropriate initial
management step?

A. DC Cardioversion
B. Intravenous lidocaine
C. Carotid sinus massage.
D. Intravenous adenosine
E. Digitalis
24 EMLE November 2024 Exams

97. During routine follow-up of a 38-year-old lady on oral contraceptives for 7 years, a Pap
smear was done. The result showed presence of cells suggestive of high grade squamous
intra-epithelial lesion (HSIL). Which of the following is the proper further management?

A. Repeat cytology after 3-6 months.

B. Colposcope directed biopsy.
C. Fractional curettage.
D. Cervical conization.
E. Hysterectomy

98. A 32-year-old, Para4 committed an illegal abortion at 8 weeks’ gestation by an

unqualified doctor at his clinic. One week later she presented with moderate vaginal
bleeding with offensive odor her temperature 39°C. Pulse 120/m, blood pressure 100/60.
Which of the following is the most likely diagnosis?

A. Incomplete evacuation of conceptus.

B. Incomplete septic abortion.
C. Undiagnosed extra-uterine pregnancy.
D. Trichomonas vaginalis infection.
E. Severe urinary tract infection.

99. A 32-year-old man presented with low back pain for 3 months. The pain is worse on
awakening and gets better on movements. On examination, there was limitation in forward
and lateral bending of the trunk. What is the most useful test for diagnosing the cause of
his back pain?

A. Bone mineral density by DEXA scan

B. CT scan of lumbar spines and pelvis
C. HLA B27 detection
D. Nerve conduction studies for lower limbs
E. Plain x-ray lumbosacral spines

100. A 33-year-old presents with a one-week history of malaise, fever, headache, myalgia
with a sore throat, dry cough and pleuritic chest pain. On examination there is bilateral
basal crepitations. There is evidence of erythema nodosum and bloods reveal a hemolytic
anemia and cold agglutinins. Given the most likely diagnosis, what treatment should be
commenced?

A. Erythromycin
B. Ciprofloxacin
C. Amoxicillin
D. Co-trimoxazole.
E. Co omoxiclav