2018 Flashcards
1
Q
A man came with right flank pain radiating to the groin, no fever, he was unable to sit still on an ER stretcher, hematuria was detected on dipstick, no fever. What is the most likely diagnosis?
A
Renal Calculi
2
Q
2-month-old child brought by mother for follow-up. on exam he has a
continuous machinery pansystolic murmur best heard over the left first and
second intercostal spaces. The patient most likely has
A
PDA
3
Q
80-year-old man has diabetes & dementia brought by his family because he can’t take his medication or control his diet; what’s your advice to the family?
A
Avoid hypoglycemia
4
Q
17-year-old female came with irregular periods last month and amenorrhea for 2 months, when should you ask about sexual activity?
A
If it is relevant to her care
5
Q
30-year-old man diabetic has history of weight loss, decreased libido for 6 months and testicular atrophy, he is unable to conceive; lab tests showed low testosterone. How to diagnose?
A
Brain CT
6
Q
A 3-year-old child was playing beside his family then suddenly began to
rock his head forward and backward with his eyes closed. What to do?
A
Upper endoscopy
7
Q
A boy fell in extended arm while playing football, he has shoulder pain. Which of the following would be the most possible complication?
A
Axillary nerve injury
8
Q
Mother came for her first prenatal visit after 6 weeks of delivery,
complaining of tearfulness and sadness, but she has no sleep disturbance,
change in appetite or suicidal thoughts, what is the most likely diagnosis?
A
Postpartum depression
9
Q
Patient had burn involving his entire right arm and right leg. What would be an accurate percentage of the area involved?
A
27%
10
Q
Female patient presented with history of abdominal pain last week. on exam: there is a bulge below and lateral to the pubic tubercle. What is the most likely diagnosis?
A
Femoral hernia
11
Q
Patient has epigastric pain at night that is relieved by eating food. What is the most likely diagnosis?
A
Duodenal ulcer
12
Q
Patient came 2 weeks after gastric bypass surgery complaining of
abdominal bloating, flushing of the face, sweating, dizziness and palpitations
shortly after eating, what is the most likely diagnosis?
A
Dumping syndrome
13
Q
A mother, 3 days postpartum was not breastfeeding her baby because she says that she has no milk in her breast, what to do?
A
Referral to lactation clinic
14
Q
A breast-feeding lady came with erythema & swelling of the breast. What’s your next step?
A
Oral antibiotic and cont. breast feeding
15
Q
A pregnant female presents early in pregnancy with vaginal spotting and
abdominal pain, US shows intrauterine gestational sac with viable cardiac beat,
by examination; cervix is close. What is the most likely diagnosis?
A
Threatened abortion
16
Q
A female, nonsmoker, with history of controlled seizure, on
carbamazepine. What’s the best contraception for her
A
IUD
17
Q
13 years old boy came with parents at 5th percentile, parenteral height at 50th percentile, parents were concerned about his short stature. What is your next step?
A
Bone age (constitutional delay)
18
Q
Female with headache around her right eye for the last week that lasts for 1 hour at night, with eye miosis, ptosis and anhidrosis. What is the most likely diagnosis?
A
Cluster headache
19
Q
48-year-old patient, smoker with recurrent productive cough and
shortness of breath with exertion, PFT result showing:
Before bronchodilator:
FEV1/FVC = 58%
FVC = 41
After bronchodilator:
FEV1/FVC = 65%
FVC = 49
A
COPD
20
Q
Asthmatic patient came with daily symptoms frequently at night. on SABA,
what to add as outpatient therapy?
A
Inhaler corticosteroid
21
Q
60-year-old Patient with SOB, pink frothy sputum, raised JVP, bibasilar crepitations & lower limb edema, what is the most likely diagnosis?
A
Pulmonary edema
22
Q
A female patient came with 3 days history of tenderness at the right iliac fossa & guarding, vomiting, high WBC (Only); what’s your next step?
A
US
23
Q
A child brought by mother. she was concerned that he had low grade fever, shortness of breath and barking cough. What is
he most likely diagnosis?
A
Croup
24
Q
Old patient, hypertensive, smoker, came with past history of stroke. Came for follow-up after his stroke. What could be done as tertiary prevention?
A
Stroke rehabilitation program
25
A guy got stung by a bee then developed stridor, wheeze, edema in the lipsand hypotension, what’s the next step?
Subcutaneous adrenaline1:1000
26
38 weeks pregnant lady went into labor. Vaginal examination reveals; 5 cm opened cervix and 40% effacement, at what stage of labor is she?
1st stage
27
A study about the relation between tobacco and Asthma was conducted by
randomly interviewing people by phone. What is the design of study that have
been used?
Cross sectional
28
An ill-appearing 2-year-old with fever (38.4 C) and stiff neck appears to have meningitis. His parents refuse a lumbar puncture on the grounds that they have
heard spinal taps are extremely dangerous and painful. How should you proceed?
Start empirical antibiotic
29
A drug was studied and found to reduce risk of stroke from 8% to 4%,
calculate the NNT?
25
30
62-year-old man with episodic substernal chest tightness occurs after
physical exertion and is relieved by rest, the patient has noted that the amount of
activity sufficient to trigger the pain is relatively constant, such as climbing three
flights of stairs or walking uphill for a few minutes. ECG recorded at rest;
however, fail to show any abnormalities, which of the following is the most
appropriate next step in diagnosis?
Exercise ECG
31
2 by 2 table asking for specificity of a test. ( D was 130, total was 140)
92%
32
A study was done on the effect of regular exercise in prevention of
diabetes. Which of the following will affect validity of the study?
Loss of patient follow up
33
A patient with abdominal pain on right lower side. Colonoscopy showed inflammation around the cecal area and a ileocecal stricture. What is the most likely diagnosis?
Crohn’s disease
34
A man was playing soccer. Got hit on his knee, lachman test was positive, which of the following is the most likely injured ligament?
Anterior Cruciate Ligament
35
A 42-year-old female came with right hand pain and stiffness in the right
hand including multiple PIP and DIP joints, with one Heberden’s nodule. Which
of the following is the most likely diagnosis?
Osteoarthritis
36
A 35-year-old guy came worried about his risk as his father died from heart disease at his 50’s. he is asymptomatic, his lab results reveals; elevated LDH,
total cholesterol, TG and low HDL, what’s your next step?
Start statin
37
26-year-old male asthmatic, follows for HTN, standing BP and sitting BP difference is lower than 10 systolic and 5 diastolic. Below his lab results;
Na = 142
K = 2.9
Glucose = 5
Bun = 4
Which of the following is the most likely diagnosis?
Conn syndrome
38
A patient with back pain has loss of sensation in the anterior thigh and
dorsum of the foot and weak dorsiflexion. Which root is affected?
L4-L5
39
A baby brought by mother has runny nose and cough, ear examination
showed erythema & bulging of the tympanic membrane, how will you treat this patient?
Oral antibiotic
40
Pregnant asymptomatic lady with positive urine dipstick. what is the
treatment of choice?
Ampicillin
41
A lady with frothy greenish to yellowish vaginal discharge with punctate red
spots in the cervix, and inflamed vaginal wall. What is the most likely diagnosis?
Trichomonas vaginalis
42
55-year-old female postmenopausal complaining of vaginal dryness and dyspareunia, O/E; there is decrease in hair pale pink vagina, loss of rugae what is
the most likely diagnosis?
Atrophic vaginitis
43
A 20-year-old guy came complaining of dry cough, fever (symptoms of pneumonia), x-ray reveals left mid zone consolidation. His colleagues at his
university have the same symptoms, which of the following is the most likely causative organism?
Mycoplasma pneumonia
44
Patient with history of hiatal hernia had two episodes of abdominal pain and one episode of emesis came with painless hematemesis, what is the most
likely diagnosis?
Mallory-Weiss syndrome
45
A pregnant mother in week 38 and her 3 years old child got exposed to
chickenpox from her daughter. Both the mother and child are susceptible. What
should be given to them?
Immunoglobulin to the pregnant mother and vaccine to the sibling
46
Asymptomatic nurse with negative PPD test last year tested positive this
year with 10 mm induration. Chest X-ray is normal. What is the most appropriate
management?
Isoniazid (INH) for 6 months
47
A nurse accidentally got pricked with a needle of an HIV patient, which of
the following is considered to have the highest risk for transmission?
Depth of the injury
48
A patient is traveling soon. He will be traveling to a rural area in Saudi
Arabia and staying there for 3 months. He asks you about prevention of
amebiasis. Which of the following is the most effective strategy for prevention?
Avoid uncooked vegetables
49
20 year old patient fell on an outstretched arm, he has deep tenderness at the anatomical snuff box, what is the most likely cause?
Scaphoid fracture
50
Child can ride a tricycle, can say his name, dresses with help except for buttoning, and says a few sentences. How old is he?
3 years
51
6 year old came for a visit. The patient is considered to have completed his tetanus vaccination if he has received?
5 doses
52
An old postmenopausal lady came with vaginal bleeding; last pap smear
was normal, what will you do for her?
Vaginal US 1st
53
1-month-old baby with watery discharge from one of his eyes for the last 2 weeks, normal conjunctiva, no fever, what’s the management?
Lacrimal duct massage
54
Patient with foot drop, which nerve is affected? Patient came for follow up after total hip replacement 2 weeks ago presented with foot drop and high
stepping gait
Sciatic nerve
55
A lady with bloody unilateral nipple discharge without mass, no abnormality
on examination or skin changes. What is the most likely diagnosis?
Intraductal papilloma
56
Patient with severe epigastric pain that is radiating to the back, guarding
and vomiting, has history of gallstones? What is the most likely diagnosis?
Acute pancreatitis
57
7-year-old boy came with parents with history of 2 weeks of intermittent limping, knee and hip pain. On examination, there is pain with hip internal
rotation and abduction. Imaging shows; femoral head deformity with widening and flattening, what is the most likely diagnosis?
Legg-Calve-Perthes disease
58
Obese hypertensive patient came complaining of severe foot pain for 3
days. She can’t walk on it. There was no history of trauma, (*x-ray attached),
what is the most likely diagnosis?
Acute gout
59
10 weeks pregnant lady presents with one day history of vaginal bleeding.
Examination reveals uterine enlargement greater than expected for gestational
age, snowstorm appearance on US and her BHCG = 100,000, what is the most
likely diagnosis?
Hydatidiform mole
60
A guy had a RTA and hit the dashboard with direct hit on one of his knees, by examination the leg looked shorter than the other leg with adduction and internal rotation position, what is the most likely diagnosis?
Posterior hip dislocation
61
Male patient with history of trauma to the groin area. He got kicked 2
weeks ago while playing football. There is tense scrotal swelling. No redness or
tenderness. It was hard to feel the underlying testes. What is the most likely
diagnosis?
Hydrocele
62
Patient smoker presented for HTN follow up. He stated that he still didn’t think seriously to stop smoking but his family encouraged him to quit smoking. Which stage is the patient in?
Precontemplation phase
63
Lady with vaginal bleeding, generalized abdominal pain mainly on the left side, last period was 6 weeks ago, what is the most likely diagnosis?
Ectopic pregnancy
64
Patient with complete hearing loss, the doctor wants to examine him, what can he do to gain consent form the patient?
Try to find another way of communication
65
A girl was visiting the clinic complaining of acne, she was so talkative and jumps from a subject to another, how would you deal with her?
Prioritization
66
A female patient comes to the doctor’s clinic wearing revealing clothes. She
comes up very close to the doctor and starts asking him personal questions
in a seductive tone. What would be the appropriate response by the doctor?
Call in a nurse
67
Child had URTI 3 days ago presented with left eye swelling. Which of the following tests has the highest diagnostic value?
Orbital CT
68
Case of female with irregular bleeding, BMI 28. labs are listed; LH:18,
FSH:6, FSH / LH value was 1:3. What is the most likely diagnosis?
PCOS
69
Patient with uterine cancer asked you not to tell her husband about her treatment plan. This coincides with which ethical principle?
Confidentiality
70
60-year-old patient with uncontrolled DM and renal disease came with
symptoms of pneumonia, vitals provided; temp: 40, RR: 34/min, what is your management? X-ray revealed pneumonia.
Admission
71
When a patient expresses anger about a physician's colleague, which of the following statements would be the most appropriate response?
What concerns do you have about how you were treated?
72
Patient post MI and PCI. Upon discharge, he’s asking you when can he drive?
After 4 weeks
73
A 3 year old child with cervical lymphadenopathy and cracked lips, swollen, and erythematous palms and soles, painless conjunctivitis, and other symptoms.
What is your management?
IVIG
74
Diabetic female patient with confusion, lab results showed; hyponatremia,
high glucose, what will you give her?
Normal saline and insulin
75
Patient with fever, night sweating, weight loss, and hepatosplenomegaly.
X-ray showed multiple diffuse symmetrical pulmonary nodules. what is the most
likely diagnosis?
Miliary TB
76
Female patient married G2P0 obese with irregular period for 2 months, what to do first?
B-hCG
77
Female patient with amenorrhea and milk secretion from her breast, no headache or visual symptoms. B-hCG was negative. What is the next step?
Serum prolactin
78
16-year-old girl presents with cyclic abdominal pain each month, last for about 6 days. She never had menses. Secondary sexual characteristics present.
Her mother is worried because all of her sisters got their menses by the age of
13. Tense bulge at lower abdomen. What is the most likely diagnosis?
Imperforate hymen
79
Old age diabetic patient came with confusion, lab results showed:
Glucose = 20 I think
Normal Na
Normal bicarbonate
Normal K
What is the most likely diagnosis?
HHS- Hyperosmolar coma
80
Child with puncture wound in his leg by wood splinter, there were red streaks around the wound. What’s the treatment?
Cefuroxime
81
Patient with rheumatoid arthritis complains of progressive breathlessness, no crackles, no fever. which of the following is the most likely cause?
Fibrosing alveolitis
82
Patient with rheumatoid arthritis complains of neck pain, upper and lower limb weakness for 1 year, what to do next?
Cervical x-ray
83
27 year old man came with diplopia in lateral gaze. MRI showed white matter lesions in callosal and pericallosal areas. What is the most likely diagnosis?
Multiple Sclerosis
84
A 22 year old female patient with a 2 week history of abdominal cramping and loose stools especially when stressed, no loss of weight, what is the most likely diagnosis?
IBS
85
Young male patient presents with painless bright red bleeding after defecation, no bleeding on PR examination, no skin changes around the anus,
what is the most likely diagnosis?
Hemorrhoid
86
Chronic hepatitis B patient, has no abdominal pain, on follow up with US they accidentally discovered multiple gallstones. What to do for him?
Reassurance and follow up
87
A mother brought her 3 months old child with full thickness skin burn on his back, the mother said he was burned by rolling over floor heating grates,
which of the following will make you suspect abuse the most?
Child can't roll at this age
88
A 40-year-old lady was worried that she might have or get breast cancer because her sister had breast cancer at 56 years old, mammogram was done and
was normal. What to do for her?
BRCA testing
89
20-year-old patient had trauma to the back of his head while playing football, he had severe headache and neck rigidity along with nausea and
vomiting, what is the most likely diagnosis?
SAH
90
A 30-year-old patient with recurrent syncope after exercise since last years, what is the most likely diagnosis?
Hypertrophic cardiomyopathy
91
One week following an uncomplicated delivery, a 27 year-old-woman
presents with polyuria and excessive thirst. Her pregnancy was normal, but she
reports that she began to feel an unusual craving for ice water in the last month of gestation. She is forced to get up at night several times to void and drinks
large amounts of water. Her blood pressure is 120/80 mmHg. Serum electrolytes
are within normal limits. A 24-hour urine yields the following results:
Total volume 10 L
Specific gravity < 1.006
Glucose Absent
Protein < 150 mg
Which of the following is the most appropriate next step in management?
Perform vasopressin challenge test
92
An asymptomatic lady was having premarital tests, labs showed microcytic
anemia (Hb 10 g/dL) and HbA2 was high. What is the most likely diagnosis?
Beta thalassemia trait
93
A patient with uncontrolled DM using herbs. His last labs show elevated
HbA1C, elevated creatinine and liver enzymes. What is the most appropriate action?
Take history about the herbs
94
Diabetic patient with 30% ejection fraction, he’s on metformin & glipizide,
bilateral lower limb edema up to mid-thigh. What would you add to this patient?
Empagliflozin
95
Male Patient with joint pain, swelling and fever. on exam, knee was swollen and tender to touch. Which of the following has the highest diagnostic value?
Joint Aspiration
96
Patient brought to the ER with history of gasping, pulse and blood pressure
can’t be obtained, with VT showing on ECG, what’s your immediate action?
Immediate defibrillator
97
Family physician invited to give a talk about HTN. A pharmaceutical
company wants to meet the doctor and inform him about their new
antihypertensive drug. There is no evidence against this drug. What should he
do
Give the lecture but don't speak about the drug
98
New cases of corona in doctors and you want to know the number of cases, what will you use?
Incidence
99
2-month-old child with vigorous feeding, weight drop, vomiting after each feeding, the vomiting is non-bullous & non-projectile, what is the most likely diagnosis?
Poor feeding technique
100
A female with history of weight loss, palpitations and diarrhea, difficulty falling asleep. What is the most likely diagnosis?
Hyperthyroidism
101
Diabetic patient on basal bolus insulin regimen, presents with decreased sensation in his foot and proprioception. He was started on pregabalin, what to
consider in safety netting?
Medication technique
if mention self examination of the foot choose it
102
lady patient has rheumatoid arthritis is complaining of lower back pain and
started having wide gait, normal sensation and continence. what is the next step management?
Cervical X-ray
103
Pregnant lady at 16 weeks with past history of GDM, what is your next step?
Oral glucose tolerance test now
104
A patient had cholecystectomy. At 5th day developed pleuritic chest pain and shortness of breath. What is the most likely diagnosis?
PE
105
Mother came with her child to clinic. She states her child doesn’t speak except for a few words. He likes to play with the same toys in the same way; He
plays with his cars by counting them and arranging them. Not communicating with others except for his parents. What is the likely diagnosis?
Autism
106
A child with failure to thrive was brought to your clinic, (*x-ray attached shows Rachitic Rosary). What is the most likely diagnosis?
Rickets
107
58-year-old male seen in outpatient clinic. He reports weight loss over 3 months, but his history is otherwise unremarkable. On examination his abdomen is soft with no palpable masses, A PR examination is normal. His blood tests
show: Hemoglobin: 8.0 g/dL, MCV 70 fl, which of the following is the most appropriate investigation for this patient?
Colonoscopy
108
A mother came to the clinic with her baby reporting weight loss and chronic diarrhea. There is a rash on the extensors of upper extremity. he has positive anti tTG. which of the following is the definitive test for diagnosis?
Small bowel biopsy for celiac disease
109
A patient complaining of a mass at the back of the wrist. It is smooth round
shaped slightly mobile compressible transilluminating lump on the back of the
wrist. What is the most likely diagnosis?
Ganglion cyst
110
A father came complaining that his 7-year-old child frequently blacks out and stares into space for a few seconds then resumes his activity. What is the
most likely diagnosis?
Absence seizure
111
Post RTA patient with bruises on the chest, he is breathing and responds to shouting commands. What is the next step?
Establish airway patent
112
A 5-month-old child presented with 3 days history of vomiting and diarrhea with poor oral intake. On examination patient looks moderately
dehydrated with dry mucous membranes. What is your management?
Oral rehydration solution
113
58-year-old man, diabetic patient complains of an ulcer in his right foot.
Physical examination reveals a 1 cm irregular ulceration over the right metatarsal
head, surrounded by an area of black gangrenous skin. The patient is admitted
for right foot amputation. Which of the following measures would have been most
effective in preventing this complication?
Appropriate self-care of feet
114
Multiple studies correlate between smoking and lung cancer. Family physicians want to reach a conclusion from these studies, what type of design
did they use?
Systematic review
115
55-year-old man with progressive weakness of his hands over period of 1
year, examination reveals wasting of the muscles of the hands and forearms and
fasciculation. There is hyperreflexia of his lower limbs and upgoing plantar
reflexes, normal sensation. Which of the following is the most likely diagnosis?
Motor neuron lesion
116
Patient with back pain increased by movement, decrease reflexes of the lower limb, x-ray shows degenerative changes, wide base gait, no incontinence
and normal sensation. what is the most likely diagnosis?
Spinal stenosis
117
Case of multiple joint pain after sore throat, on examination there was fever, subcutaneous nodules, and a heart murmur, ESR was high, what is the
most likely diagnosis?
Rheumatic fever
118
G4P1, had her first child 9 years ago, followed by 3 miscarriages, labs
revealed normal FSH and LH, positive anticardiolipin antibody and lupus antibody.
What is the most likely diagnosis?
Antiphospholipid syndrome
119
Patient presented with headache and vomiting in the morning, increased by cough or lying down. What is the next step?
Brain CT
