Women (has a lot of bad habit) and pregnant at 12 weeks, which of these is the worst impact on fetal?

a) 3 glass of beer daily

b) 4 glass of wine daily think of alcohol, look for reference.
c) use of cocaine 3 times/week
d) use of marajuana every week
e) smoking 25 cigg everyday

Biceps tendon rupture in a man taking warfarin. ask management

a) Surgical exploration
b) Tendon repair–distal

Patient taking warfarin with h/o DVT; now comes with black colour passing stool (seems GI bleeding); PR 90; INR 9.8. How to manage?

a) Tranexamic acid and FFP

b) PCC and FFP

c) FFP

d) Platelet and FFP

e) Vit K

Man came and complains that his mother is giving money to a nurse and also giving the nurse part of her property as well. What will you do?

a) make appointment with mother

b) do nothing
c) refer to another gp
d) talk to the nurse

A man 42 yrs,with a calculus 4mm at the right uretero-vescicular junction,his right ureter ,pelvi-calyseal system are dilated due to mild hydronephrosis. What will be your next step in the management ?

a) ESWL

b) PCNL
c) Ureteroscopy with basket removal of stone
d) Ureteroscopy with removal of stone and placement of a stent
e) Cystoscopic removal of stone

A 60-year-old man comes to the physician because of a 2-week history of worsening fatigue. He has chronic renal insufficiency, hypertension, diabetes mellitus, hypercholesterolemia, hypothyroidism, polymyalgia rheumatica and depression. He was started on lisinopril for the prevention of proteinuria from diabetic nephropathy. Physical examination shows a few basal crackles. He is being considered for dialysis. Laboratory studies show hyperkalemia with serum K+ of 6.0 mEg/L. EKG shows no abnormalities. Which of the following is the best treatment to remove K + from his body?

a) Sodium bicarbonate

b) Beta agonists

c) Calcium gluconate

d) Kayexalate

e) Insulin plus glucose

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Patient 55 year old male came to your office and wanting to do colonoscopy, father died at 70 from colon CA. Fobt was done to pt and was negative next step?

a) do colonoscopy now

b) repeat fobt

c) come back if with symptoms

A child brought to the clinic by his parents with abdominal pain ,u have decided to refer the child what is the next step .

a) call the pediatrician by yourself
b) give reference letter to the parents .
c) bring the child to op tomorrow.

d) refer the child to er.
e) send him to a pediatric

Pt with depression, started venlafaxine, now controlled, suddenly developed elevated mood, euphoria, now treatment?

a) Add olanzapine
b) Add escitalopram
c) Add clozapine
d) Cease venlafaxine

16yr old with theralche at 12 years and amenorrhea but having pain in the abdomen.. dx?

a) Imperforate hymen

b) Septate vagina

c) Atresia vagina

d) Atresia uterus without vagina

Patient comes at 36 weeks, fungal height at 36 cm and when she lifts her 2yr old her underwear gets wet. What’s the initial investigation?

a) Cystogram

b) Urodynanic studies ?

c) Urine c/s ?
d) Ultrasound

A patient has 0.9 cm pituitary adenoma on treatment with bromocriptine. Now she wants to conceive. Previously prolactin was 1315 & now 1135. What to do next?

a) Cabergoline
b) Clomiphene

c) Transsphenoidal surgery
d) Repeat MRI ??

29yo man comes with a 5 day x of diarrhea & abd pain. Diarrhea initially watery but has become bloody. Severe pain with associated nausea & decreased appetite but no vomiting. Periumbilical & right lower quadrant tenderness. Brown stool mixed with blood. Cause?

a) Clostridioides difficile
b) Clostridium perfringens
c) Escherichia coli

66 yr-old COPD man comes due to gradually worsening shortness of breath & wheezing. Has hypertension & hypercholesterolemia. ECG shows an irregular narrow complex tachycardia with 3 different P-wave morphologies & a variable PR interval. Next step?

a) Antiarrhythmic medication to convert to normal sinus rhythm

b) Monitoring while treating COPD exacerbation

37 yo woman comes due to increased tearfulness. Frequently goes a wk without leaving home & has to force herself to eat & clean. Father died age 41 by suicide & grandfather age 49 by “mental disease”. Restless & losing points on measures of exec function & memory. Disease associated with?

a) Dopamine

b) GABA

31 yr-old man comes for follow-up of sinusitis-associated frontal lobe abscess. Culture identified strepcoccus and bacteroides. Receiving ceftriaxone & metronidazole therapy. Physical exam shows loss of pain, touch & vibration sensations in the feet & bilateral fingers. Next step?

a) Discontinue metronidazole
b) Obtain serum protein electrophoresis

55 yr-old man is brought due to altered mental status. Has a history of chronic migraines & major depression. BP 80/60, pulse 125. Oral membranes dry. ECG reveals sinus tachycardia with a QRS duration of 120 ms & frequent premature ventricular beats. I hydration started. Next step?

a) Amiodarone
b) Sodium bicarbonate

56- yr-old man with 3 mths of dyspnea is now breathless even at rest. Smokes a pack of cigarettes daily the last 30 yrs & drinks alcohol heavily the past 5 yrs. Cardiac silhouette enlargement & signs of pulmonary venous congestion. Left ventricular ejection fraction 25%. How to reverse heart function?

a) Abstinence from alcohol

b) Cessation of cigarette smoking

18 yr-old, nulliparous comes with lower abdominal pain, nausea & vomiting. Sexually active & uses oral contraceptive pills. 3 lifetime sexual partners. Purulent discharge from the cervical os. Uterus is small, anteverted & tender to palpation & motion. Adnexa markedly tender. Next step?

a) Admit the patient and wait for nucleic acid amplification test results

b) Inpatient treatment with cephalosporin plus doxycycline

14 yr-old girl ill with fever, sore throat & malaise. Enlarged, erythematous tonsils bilaterally with white exudates & diffuse bilateral cervical lymphadenopathy. Mild hepatosplenomegaly. An erythematous, polymorphous, maculopapular rash is present over the entire body. Dx?

a) Acute rheumatic fever

b) Infectious mononucleosis

65 yr-old woman comes due to worsening memory impairment. Often forgets parts of recent conversations & has misplaced her car keys multiple times. Regularly eats out at restaurants & drinks a glass of wine 3-4 times a wk. Medical history includes allergic rhinitis. Appropriate statement?

a) neuropsychological testing can determine the extent of your symptoms.
b) Some meds can contribute x you experience. What meds u take?

75 yr-old man with progressive hearing loss reports a decline in his ability to hear conversations, especially in noisy places like restaurants & difficulty tolerating loud sounds. Hears a constant buzzing noise in both ears. Has hypertension & type 2 diabetes mellitus. Diagnosis?

a) Cholesteatoma
b) Presbycusis

76- yr-old woman with progressively worsening memory & language difficulties is now dependent on her daughter for cooking & cleaning. Becoming more paranoid & agitated; she frequently claims to have seen her niece stealing from her purse. Has hyperlipidemia & osteoarthritis. Diagnosis?

a) Alzheimer disease

b) Dementia with LB

45 yr-old man comes due to persistent nausea & vomiting of partially digested food. Has 2 type 2 diabetes, a suicide attempt 3 mths ago in which he ingested acid, peptic ulcer disease & often takes antacids for heartburn. Succussion splash on the epigastrium. Diagnosis?

a) Achalasia

b) Pyloric stricture

13 yr-old boy for the past 3 wks has a mild pain in his right hip with an associated limp, attributed to a muscle strain from skateboarding. Worsened pain after a fall while skateboarding. Runny nose & nasal congestion for a few days last wk. Limited range of motion with internal rotation. Given X-ray frog view noted SLCE???? Diagnosis?

a) Femoral neck fracture
b) Osteomyelitis
c) Slipped capital femoral epiphysis

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52 yr-old woman with known liver cirrhosis comes with bright red bleeding per rectum for 2 days. On daily furosemide & spironolactone as well as water & sodium restriction. Abdominal distension & 2+ peripheral edema. Had variceal banding. Urine sodium is 5 mmol. Cause of acute kidney injury?

a) Glomerular disease
b) Renal hypoperfusion

31 yr-old obese woman with chronic abdominal pain for the past 2 yrs. Consulted several physicians & undergone endoscopy, colonoscopy, CT scan &exploratory laparoscopy, all without any significant findings. Hypertension & diabetes in her father, who died of colon cancer at age 59. Diagnosis?

a) Conversion disorder
b) Factitious disorder

c) Somatic symptom disorder

70 yr-old woman comes due to worsening bilateral shoulder pain, tingling in hand & forearm. Has diabetic nephropathy & end-stage renal disease. Receiving hemodialysis 3 times a wk. X-ray reveals radiolucent bone cysts in both shoulders. Increased rotator cuff thickness & deposits. Diagnosis?

a) Acromegaly

b) Amyloidosis

34 yr-old gravida 2 para 1, at 30 wks gestation comes due to a severe, unilateral headache on the right side. Has a history of migraine headaches. Initial pharmacotherapy?

a) Acetaminophen

b) Ergotamine

43 yr-old primigravida at 37 wks gestation complains of a severe headache & dark spots in her vision. Has myasthenia gravis & takes pyridostigmine. Rectovaginal screening for group B Streptococcus was positive. Admitted for induction of labor due to severe preeclampsia. Medication contraindicated?

a) Acetaminophen
b) Magnesium sulfate

29 yr-old gravida 2 para 1, at 10 wks gestation comes due to vaginal bleeding with passage of large clots & intense lower abdominal cramping. Active bleeding from an open cervical os. Transvaginal US reveals a 9-wk-sized fetus in the lower uterine segment with no cardiac activity. Next step?

a) Administration of misoprostol
b) Suction curettage

68 yr-old man comes due to worsening nocturia for the past several mths. Has increased urinary urgency & frequency during the day. History of hypertension & takes lisinopril. Rectal exam shows a diffusely enlarged & nontender prostate with a smooth surface. Next step?

a) Cystoscopy
b) Urinalysis

32 yr-old woman comes due to 7 mths of irregular periods & 3 mths of amenorrhea. Has hypothyroidism treated with levothyroxine. Breast cancer in her mother. Exam shows mild vaginal dryness. MRI reveals a 7 mm pituitary microadenoma. Treatment to prevent?

a) Bone loss

b) Breast cancer

25 yr-old man comes due to abdominal pain, nausea & vomiting bilious fluid. Has not moved his bowels in 2 days; frequently passes flatus. Has Crohn disease with ileal involvement, currently managed with infliximab. Abdomen is distended, tympanic & tender. Explain patient’s presentation?

a) Adverse reaction to infliximab

b) Fibrotic intestinal stricture

5 yr-old, previously healthy, girl is brought due to lethargy & altered mental status after she developed a fever, malaise, headache, cough & nasal discharge. Patient is not oriented to person, place, or time. Hepatomegaly is present. CT scan reveals diffuse cerebral edema. Cause?

a) Adrenal insufficiency
b) Hyperammonemia

18 yr-old man comes due to several mths of excessive urination. Significant for seasonal allergies, takes antihistamine. Sexually active & does not use condoms. His mother had sickle cell disease & died from stroke at age 32. Afebrile & normotensive. Cause of polyuria?

a) Central diabetes insipidus
b) Hvposthenuria

2 yr-old girl with abrupt onset of dysphagia, drooling & vomiting after eating sausage. Esophagoscopy showed complete occlusion of esophageal lumen with impacted food. Frequent choking, respiratory tract infections & 2 episodes of middle lobe pneumonia. Weight at 15th percentile. Cause?

a) Congenital vascular malformation

b) Eosinophilic inflammation of the esophagus

78 yr-old woman comes due to an enlarging growth on the right wrist for the past yr. The lesion is round, rubbery, mobile & nontender; it transilluminates on penlight exam. Initial management?

a) Intralesional corticosteroid injection

b) Observation

16 yr-old girl is brought due to a day of joint pain & pruritic rash. Just completed a 10-day course of amoxicillin-clavulanate for an episode of otitis media. Has a blanchable, erythematous, urticarial rash on the hands & feet. Generalized lymphadenopathy is present. Multiple joints are tender. Outcome?

a) Chronic glomerulonephritis
b) Chronic, progressive arthritis
c) Complete resolution without sequelae

3 day-old girl is brought due to a day of copious, purulent eye drainage. Family declined routine prophylactic med including vit K, erythromycin ointment & hepatitis B vacc for newborn. Breastfeed exclusively. Bilateral eyelid edema, conjunctival injection & purulent discharge. Diagnosis?

a) Chemical conjunctivitis

b) Chlamydial conjunctivitis
c) Gonococcal conjunctivitis

29 yr-old primigravida at 30 wks gestation is concerned that she has not felt the baby move or kick for the past day. On ultrasound, no fetal heartbeat is detected. Patient cries, “I was following all the recommendations & I only missed appointment.” Appropriate response?

a) I know this is very distressing; you will get through this and feel better in time.

b) You did everything you could for your baby, this loss was not your fault.

33 yr-old woman comes complaining of 2 days of urinary frequency, fever & nausea. Left costovertebral angle tenderness. WBC count of 17,000L with 8% bands. Urinalysis shows positive nitrite, many WBC, and > 100 bacteria/hpf. Appropriate indication for CT scan?

a) No clinical improvement within first 72 hours

b) Obtain now to rule out hydronephrosis

32 yr-old man fell while shouting at people who are not visible. Significant for a bruise on his forehead, which he cannot recall acquiring. Has flat affect & disconnected thoughts. Hearing voices since age 12 & recently stopped taking his medication. Neuroimaging findings?

a) Atrophy of the caudate

b) Enlargement of cerebral ventricles

65 yr-old man successfully defibrillated after cardiac arrest. Has an episode of sustained ventricular tachycardia treated with IV amiodarone. Thrombotic occlusion of the right coronary artery treated with percutaneous coronary intervention. Full neurologic recovery on the 2nd day. Cause?

a) Acalculous cholecystitis
b) Acute viral hepatitis
c) Hepatocyte ischemia

59 yr-old woman was given scheduled-dose oral morphine for chronic back pain caused by a motor vehicle collision. Pain no longer interferes with activities of daily living. Other medications include naproxen, acetaminophen & lidocaine patch as needed. Early detection of prescription opioid misuse?

a) Assessing back range of motion at each visit
b) Assessing pain level at each visit
c) Querying the prescription drug monitoring database at each visit

45 yr-old woman with fever, malaise, progressive dyspnea on exertion, dry cough, abdominal pain & watery diarrhea with bright red blood. Underwent allogeneic renal transplantation 6 mths ago; 2 mths ago developed severe drug-induced leukopenia. Bilateral interstitial infiltrates. Cause?

a) Aspergillus fumigatus

b) Cytomegalovirus

35 yr-old woman with burning substernal chest pain & “excruciating” pain with swallowing. History of HIV, asthma & uterine fibroids. CD4 count 30/mm3. Significant dental caries. Cause?

a) Candida albicans

b) Viral esophagitis

38 yr-old man with schizoaffective disorder is brought due to a 5-day history of malaise, loss of appetite, nausea & abdominal pain. Exam reveals right upper quadrant tenderness, fine bilateral hand tremor, drowsiness & oriented to person, place & yr but not mth/day. Med responsible for findings?

a) Haloperidol
b) Trazodone
c) Valproate

A newborn delivered at 34 wks gestation due to premature rupture of membranes. Left hemiscrotum is normal with a palpable testicle; right hemiscrotum is hypoplastic & poorly rugated with no palpable testicle. Next step?

a) Measure testosterone level
b) No further work-up at this time

43 yr-old woman comes due to nausea, dizziness & headache for a day. Menses began 2 days ago. Has a history of von Willebrand disease, causing recurrent, heavy menstrual blood loss & is scheduled for an endometrial ablation procedure. Only med is intranasal desmopressin. Next step?

a) Arterial blood gas
b) Liver function studies
c) Serum electrolytes

62 yr-old man comes due to malaise & fatigue for the past several wks. Severe flank pain 3 mths ago. Has a history of chronic back pain from a work-related injury 10 yrs ago for which he underwent surgery. The prostate is mildly enlarged. Renal ultrasonogram reveals bilateral small kidneys. Cause?

a) Chronic glomerulonephritis

b) Renal artery stenosis

c) Tubulointerstitial nephritis

24 yr-old bicycle courier struck by a car & was initially unconscious. BP 84/54, pulse 130, respirations 28 & oxygen saturation 88%. Trauma team preparing for intubation but the patient refuse to use tube. Soon afterward, patient loses consciousness while resuscitative efforts ongoing. Action?

a) Consult the medical ethics committee emergently

b) Intubate the patient without obtaining consent

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