32 yr-old woman abdominal pain, nausea & bleeding from the cervix. Dx bicornuate uterus 2 yrs ago. UPT +ve. USG reveals a gestational sac at the upper left uterine cornu & free fluid in the posterior pelvis. Next step?

1. Dilation and curettage
2. Methotrexate administration
3. Surgical exploration

Man lower abdominal pain, nausea & 2 episodes of watery diarrhea. The patient’s father died at age 60 from abdominal aortic aneurysm rupture. All Gl sx resolve in 2 hours without any intervention. Next step?

1. Antibiotics
2. Percutaneous aspiration
3. Reassurance only

A 64yo man psa=4 with stent? Treatment?

1. conservative tx
2. ebrt

A group of GP want to study STI in australia what to do?

1. speak with ethics committee to knw the steps
2. go door to door and fill questionnaires

Right upper quadrant pain, CT showing inflamed gall bladder, dx?

1. cholecystitis

A 80 yo female having sensation of womb protrusion when defecating, in physical examination noted mild cystocele and rectocele, next step?

1. stool softener
2. pelvic exercise

35 yo woman chronic carrier hep b has a history of injection drug use. Drinks alcohol. Mild tender hepatomegaly. Test shows elevated serum AST levels & positive serum hep D ag. Which of following is required to make a diagnosis of acute liver failure?

1. Decreased urine output
2. Elevated portal venous pressure
3. Signs of hepatic encephalopathy

62 yo man complains of increasing discomfort & bulging at the R groin. previously diagnosed with a direct inguinal hernia. Smokes a pack of cigarettes daily. BMI around 24. Surgical hernia repair is planned. Which of following most increases risk for postoperative wound infection?

1. Body mass index
2. Comorbid conditions
3. Smoking history

65 yo woman comes due to decreased urine output for the past 24hr. Underwent angio 5 days ago. Has T2DM, HPT & coronary artery disease. Now creatinine 300; BUN 14. Most appropriate response for her concern?

1. Given your u/L health condition, this is unfortunately a EXPECTED event that occurs OCCASIONALLY after angio.
2. Let me ask your physician to call you and discuss what might have happened
3. This may be related to angio, but I need to discuss it with your regular
4. physician b4 I can g u an answer.FORGOT the other option

1 day-old girl undergoes routine congenital heart disease screening.Born via SVD to a 23-yr-old primid after an induction of labor at 40 wks gestation. Pulse oximetry is 99% oxygen saturation in the right hand & 1% in the right foot. Cause?

1. Hypoplasia of the aortic arch
2. Left-to-right intracardiac shunt
3. Persistence of fetal circulation

A 70 yo man is brought due to intense, constant chest & neck pain. Hx of pt & t2dm. BP 189/110. ECG shows sinus tachycardia, voltage criteria for left ventricular hypertrophy & T-wave inversions in leads V5 & V6. Next step?

1. Coronary angiography
2. Low-dose aspirin and troponin I levels
3. Transesophageal echocardiography

A 38-yr-old man comes for follow-up after his blood pressure was found to be elevated at a health fair. B/P 148/96. BMI is 36 kg/m2. Exam shows a regular heart rate & rhythm with no heart murmurs or carotid & bdominal bruits. Ans?

1. Neuroblastoma
2. Pheochromocytoma
3. Wilms tumor (nephroblastoma)

A 34 yo sexually active female complaint of urinary frequency & dysuria. + suprapubic tenderness & her urinalysis is positive for nit, leuk sterase, many WBC & a moderate amount of bacteria. Reason for the higher incidence of UTI in females than in males?

1. Closer proximity of the urethral meatus to the anus in females
2. Frequent use of spermicide and diaphragms in females
3. Shorter urethral length in females

55 yr-old man is brought due to sudden onset of palpitations & chest tightness. Has hypertension, gout & t2dm. AF at 120-140/m. Patient becomes unresponsive, no palpable pulse over the carotids or femoral arteries & has agonal breathing. Next step?

1. ABG
2. Chest compressions

38-yr-old man comes with exertional shortness of breath over the past 6 mths. His exercise capacity has significantly decreased compared to hat of last yr. Exam shows impaired spinal mobility & limited chest xpansion. Maximal apical impulse is displaced to the left. Dx?

1. Aortic regurgitation
2. Atrial septal defect

27 yr-old woman, gravida 1 para 1, suffers generalized tonic-clonic seizure that occurred 30 hrs after a vaginal delivery. Delivery omplicated by postpartum hemorrhage that was treated with bimanual uterine massage & an oxytocin bolus & infusion. Cause of seizure?

1. Acute blood loss anemia
2. Alcohol withdrawal
3. Oxytocin side effect

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Newborn male infant born to a 29-yr-old gravida 3 para 0+2, did not receive prenatal care. Forceps-assisted vaginal delivery due to fetal eart rate abnormalities. Exam shows microcephaly, a wide anterior fontanelle, cleft palate & hypoplasia of the distal phalanges. Evaluation of the mother?

1. Alcohol use
2. Cocaine use
3. Phenytoin use

55 yr-old man comes for evaluation of new-onset pain in the right knee. Has Paget bone & t2dm. X-ray reveals medullary & cortical bone destruction with lucency area and surrounding periosteal elevate along the femur. Cause?

1. Borrelia something induced arthritis
2. Destruction of articular cartilage
3. Malignant proliferation of osteoid sarcoma unsure the rest

27 yr-old nulligravid woman comes due to inability to conceive. Patient has a period every 28 days that lasts 5 days with 2 days of heavy flow. In her late teens, was hospitalized for a pelvic infection Her sister has polycystic ovarian syndrome. Next step?

1. Hysterosalpingogram
2. Laparoscopy

33 yr-old woman comes with severe bilateral facial pain, lasts several secs & occurs 10-20 times a day. Pain sometimes triggered by a cold breeze, brushing of teeth, or chewing. 4 wks ago, she was treated for acute sinusitis. Pain elicited by lightly touching the patient’s cheeks. Cause?

1. Cerebral vasospasm involving the brainstem
2. Demyelination of the nerve axon

43 yr-old man comes due to a 1-mth history of worsening frontal headaches, blurred vision & occasional falls. The blurry vision is provoked when he leans forward. His mother has a history of glaucoma. Cause?

1. High intraocular pressure
2. Intracranial hypertension

21 yr-old woman is brought due to anxiety disorder. Feels overwhelmed & unprepared for her graduate school entrance exam. Takes sertraline, tramadol & 2 cups of coffee a day. Appears jittery & has perspiration on her forehead. Diagnosis?

1. Caffeine intoxication
2. Hyperthyroidism
3. Serotonin syndrome

21 day-old girl is brought due to difficulty feeding, irritable & difficult to console. Has a full fontanelle & dry mucous membranes. Scleral icterus & jaundice of the face & chest is present. Neurologic exam shows Equal movement of all 4 extremities with mildly decreased muscle tone. Next step?

1. Blood, urine, and cerebrospinal fluid cultures
2. T scan of the head

68-yr-old man complains of worsening fatigue & exertional dyspnea.Was diagnosed with early-stage leukemia a yr ago. Exam shows generalized lymphadenopathy & hepatosplenomegaly. Cause of anemia?

1. Cytokine-mediated iron dysregulation
2. Folate consumption by leukemic cells
3. Immune-mediated hemolysis

52 yr-old man comes for a regular health check-up. A chronic smoker & consumed 1 to 2 beers 2 to 3 times a wk for the past 10 years. Also drinks 6 to 7 cups of coffee daily. Has type 2 diabetes mellitus. His older brother died of pancreatic cancer at age 58. Intervention?

1. Achieve better glycemic control with insulin
2. Stop alcohol intake
3. Stop smoking

27-yr-old woman is brought with severe epigastric pain, nausea & 28-vomiting. Recently diagnosed with functional biliarysphincter of Oddi dysfunction for which she underwent ERCP with sphincterotomy 24 hrs ago. Next step?

1. CT abdomen
2. HIDA scan
3. Serum lipase

Which of following can be observed with brain death?

1. Deep tendon reflexes
2. Heart rate acceleration after atropine injection

A 6 wks postpartum lady came to you with pain at wrist. Got it from her 1st child & the pain is most severe when she lifts the infant from the crib. Exam shows tenderness over the radial side of the wrist & first dorsal compartment. Diagnosis?

1. De Quervain tendinopathy
2. Flexor carpi radials tenosynovitis

24 yr-old woman, 26wk gestation with increased urinary frequency & back pain. Has recurrent nephrolithiasis before getting pregnant. Renal & pelvic US reveals bilateral enlargement of the kidneys; dilation of the renal pelvis & proximal ureter on both sides. No stones. Next step? ?? physiological hydroureter??

1. Cystoscopy with ureteral stent insertion
2. Foley catheter placement
3. No additional management indicated

50-yr-old unemployed man comes due to feeling fatigued & weak for a yr. Drinks 2- 3 beers a day but has been charged multiple times with driving under the influence. His parents died of old age. Peripheral smear shows anisocytosis, poikilocytosis & basophilic stippling. Next step?

1. Blood lead levels
2. Bone marrow biopsy
3. Serum B12 and folate levels

10 hr-old baby presented with jitteriness. Was born at 38 weeks gestation to a 36-yr-old primigravid via cesarean delivery due to non- reassuring fetal heart tones. Pregnancy was complicated by maternal gestational diabetes. He has not yet a had a bowel movement. Next step?

1. Abdominal x-ray
2. Arterial blood gas
3. Serum calcium level

Ecg on multi drugs, showing first degree av block, what to do?

1. cease the medication
2. Reassure

Rapid ventricular af (ecg), tx? metoral Tia case with bilateral 60% carotide stenosis,pt with a cardiac

1. stent on ASA, what to do?
2. add clopidegrol

A female wants to work night shifts, outdoor active, concerned about vit D deficiency, what to do?

1. check vit D levels
2. tell patient to have sun exposure when not on shifts

Abdominal pelvic ct scan, left urether nephrolythiasis, 2-3cm above upj, no hydronephrosis, tx?

1. laser lithitropsy

A 24yo man with fever 37.5 and 3wk cough, treated with AB and symptomatic asthma tx, the reason of cough?

1. gord
2. pnd

61-yr-old woman complains of low back pain, more pronounced atnight. Notable for HPT & breast ca at age 55, which was treated with op and radio + hormone therapy. SLR is negative. Next step?

1. Epidural corticosteroid injection
2. Lumbosacral spinal imaging

34-yr-old previously healthy man comes due to severe back pain while moving a bag of soil. There is weakness of left ankle dorsiflexion & toe extension. Exam shows spasm of lower paraspinal muscles & loss of pinprick sensation over the dorsum of the left foot. Cause?

1. Acute spinal cord compression
2. Common peroneal nerve entrapment
3. L5 nerve root compression

68-yr-old man comes due to right knee pain & swelling. Has hypertension & type 2 diabetes mellitus. Erythema & warmth are present at the anterior right knee. Palpation reveals a 5-cm, tender, fluctuant swelling just anterior to the patella. Next step?

1. Aspiration of the bursal fluid
2. Aspiration of the knee joint

20-yr-old man complains of worsening right leg pain. Runs 5 miles daily. Pain occurs even with light walking. Tenderness of the right lower anterior tibia. X-ray reveals a small tibial stress fracture. Patient becomes distressed that he has to stop running. Next step?

1. Advise participation in different sports
2. Inquire about exogenous steroid use
3. Obtain comprehensive dietary history

19 yr-old man trapped in cold chain logistic container. Lie on the ice without gloves. Brought due to suspected hypothermia. Warm intravenous fluids is started immediately; the left hand is submerged in 38 C water bath. 30 min later, body temp is 36.5 C. but left hand is still grayish, with sensory loss to the level of the metacarpophalangeal joints. Next step?

1. Amputation of the fingers
2. Angiography of the left arm

Gord case with dysphagia to both solid and liquid, what to do?

1. barium swallow

LBD case, which was treated as parkinson with levodopa that caused worsening of sx, dx?

1. Ibd

A pt with d: cholangitis, was hydrated and treated with AB, next step?

1. ercp
2. mrcp
3. us

Biostat: pap smear was done in 2018 and x% malignancy was detected, next year y% malignancy was detected, what is the reason of increasing malignancy detected with this screening test?

1. low sensitivity
2. not specific
3. short latent period of disease

Migraine x, radiating pain to shoulders and neck, photophobia, aura, brain ct scan shows point cortical calcification, dx?

1. herpetic encephalitis

A 10-year-old kid complained of haematuria, proteinuria (nephriticsynd) Asking for rx:

1. Fluid restrictions and lasix

Low pitched diastolic murmur d Al A pregnant lady, BMI 40, some other clues in favour of GDM next step GTT A case of macrosomia fetus next step GTT Multiple cases of measles in a school Asking about exclusions Newborn with diffused hypotonia and jaundice with palpable liver. Dx?

1. Biliary atresia
2. Breastfeeding failure jaundice
3. Galactosemia

A case of knee pain with BMI 31. Knee swollen and tender unable to flex right knee. Mild, bilateral atrophy of the quadriceps. Radiographs reveal osteopenia of the distal femur, multiple periarticular erosions & soft tissue swelling. Long-term management? RA methotrexate

1. Antifolate immunosuppressant
2. Knee braces and weight loss

67 yr-old man complains of chest pain. 2 wks ago, percutaneous coronary intervention was performed with placement of a drug- eluting stent in the left circumflex artery. Has hypertension & hyperlipidemia. ECG shows sinus tachycardia with nonspecific T wave changes. Next step?

1. CT pulmonary angiography
2. Emergency coronary angiography

32-yr-old man comes for follow-up a mth after being hospitalized for treatment of a manic episode related to schizoaffective disorder. His mania has resolved & he appears calm. The voice he hears has diminished in frequency & intensity. Medication administered?

1. Aripiprazole
2. Lithium
3. Olanzapine

42-yr-old woman comes with a 4-mth history of heartburn. Experience dyspnea on exertion & joint pain. Manometry shows lack of peristaltic waves in the lower 2/3 of the esophagus & a significant decrease in lower esophageal sphincter tone. Reason for manometric findings?

1. Dysfunctional impairment of inhibit neurons
2. Eosinophilic infiltration of esophagus mucosa
3. Smooth muscle atrophy and fibrosis

48 yr-old man is brought after being stabbed once in the abdomen during a robbery. Abdominal exam shows a nonbleeding puncture wound to the left upper quadrant measuring approximately 2.5×1 cm. The abdomen is rigid & diffusely tender. Resuscitation with IV crystalloid is ongoing. Next step?

1. CT scan of the abdomen IV contrast
2. Diagnostic peritoneal lavage
3. ex lap

68 yr-old woman comes due to persistent right-sided chest pain. Had a transient rash in the same region prior to the onset of symptoms. Notable for breast cancer treated with surgery & chemotherapy, as well as hypertension & type 2 diabetes mellitus. Next step?

1. Gabapentin therapy
2. Glucocorticoid therapy

21 yr-old woman, gravida 1 para 0, at 36 wks gestation comes for aroutine prenatal visit. No contractions, vaginal bleeding, or leakage of fluid. History of genital herpes simplex virus but has not had an outbreak in several yrs. Next step?

1. Administer acyclovir suppressive therapy until delivery
2. Continue routine prenatal care only

-Melanoma 0.6 mm safe margin 6mm. Next? Rexcise, node biopsy,bone scan Vulvar adheision in child, what else will you screen after rx? Option of urine analysis, std. and old women same problem asking treatment.Infertility in the 40 age women with hx of clamedia10 years ago and 1 miscarriage, what is the reason of infeterlity from history. Anterior mi Rx ecg Angina, 2 hours next? Causes of fatigue, drugs combination, antidepressants with paracetamol and tramadol Premature ejaculation rx Statin (rusovostatin) myopathy, stoped 6 weeks now normal, next? mRNA vaccine myopathy Studies, prevelance and also one for efficacy Travel to asia, had lower quadrant pain and sever crump, then one month later have upper quadrant pain fever chills. Cause? Cholicystitis, liver abscess,Farmer 48 years, last vist to doctor 15 years ago, which risk assesment to do? Lipid, alcohol, drugs, poisons Schizophrenia with high blood pressure, multi hospital vist with high blood pressure, reason for his condition? Many bla bla medical record options and stigma 20 years amenorrhea, how do you check ovulation? Fsh, Ih ultrasound 2 years menopausal, bloody discharge, next? Women with right jaw margin swelling, biopsy confirm cancer? Next? US, MRI, CT XRay Rt hand muscle wasting with history of lung disease smoker and alcoholic, next? Xray chest, nerve conduct, bone scan.. Painless haematureia old lady,next? Ct abdomen, mri, xray urine analysis, swab Female with multiple parteners came with lower abd pain fever, what nest exam finding? Cervical exitation, rectal blood, .. Vomiting arterial gas workup, giving all abnormality and choose the correct combination. History of epigastric pain after spicy food, next? Endoscopy, urea breath, xray bla bla bla Adopted child 3 years, depressed not sleeping not playing, cause?Depression, bcs of foster, seperation anxiety? Emptigo school exclution Brain ct, looks like glioma( tiny bear ) but could be intracranial hemorrhage ( lesion was white like cranium), next? Mri, xray, coagulation study, echo, ultrasound neck Case similar to cm infection, what to advise? Reassure, antiviral, Antibiotics Ecg, Ivhypertrophy, Ibbb and atrial fibrilation, what to give? Bb, ccb amiodarone cardioversiin adinosine Young schizophrenia on med 4 weeks with thought insertion, what to do, same drug, add another, change to another cant remmeber the names Young lady with paranoia, what drug can help, lorazepam, diazepam, haloperidol resperidol You are working in a hospital and staff are having problem in lunch, so a pharmacutical company want to organize a lunch to your department, what you will do next

1. refuse them politely
2. complaint the company with CEO
3. take the offer coz you have lunch problem
4. do nothing

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