2021 Flashcards
36 weeks G2P1 women presented to ER after history of falling from 5
stairs, there is painful vaginal bleeding. Patient currently vitally and
clinically stable. Fetal heart sound present. No other abnormality.
What is the most likely diagnosis of this case?
abruptio placenta
A pregnant women come to the primary health care for antenatal
visit. After history and examination, the doctor informed that she is at
24 weeks of gestation. Which of the following reflect the supposed
number of gestational weeks?
24 cm above symphysis pubis
A 33week pregnant women presented to ER, she has contractions
that started at average of 2 contractions for 30sec in the past 10min.
Among examination, patient is stable, there is no vaginal discharge or
bleeding and was no pooling of fluids. The cervix was dilated 3 cm.
Nitrazine test is -ve. what is the most likely cause of her contractions?
preterm labor
34-year-old Female patient presented in the clinic with her husband.
He said that she was complaining of low mood, difficulty
concentrating, and some other signs of depression. Then for 2 weeks
she has enough energy to clean the home , talkative, sleep just for
short time and that was enough for her and etc. Examination was
unremarkable -what is the next step in management:-
Aripiprazole - this case is rapid cycling
A 2-year child brought to the clinic with history UTI 2nd time. In the
previous episode, he was treated with antibiotic after which he is
improved. Currently, patient is clinically and vitally stable. Which of
the following is the best next step in management? investigate (next
step):-
vioiding cystourethrogram (VCUG)
- 20YO Patient come with recurrent seasonal SOB and cough 2
attacks per week, not on medications, and has family history of atopy
,no cough at night what to give:- Intermittent asthma )
daily salmeterol-fluticasone is good for rapid action
patient come with White coating erosive erythematous base lesion is
seen in web space of toes with picture, what is the best treatment:
terbinafine
Patent come with itchy lesion silver in color scaly in BILATERAL knee,
Mention something test it bleed with scratch (auspitz sign),, with
picture, ask about diagnosis:-
psoriasis
3 year child who saw doctor 3 days ago given antibiotic amoxicillin
and no improvement on examination he has soft palate enlargement
and bad breath and unilateral deviation of uveli short breathing with
muffled sound, What is the most appropriate management?
Emergent refer to ENT for aspiration and drainage
Child 4-month baby came by his parent with umbilical hernia, it
doesn’t seem to bother the child, his parent asking are about
management?
surgery by age 4-5 years if not reduced
43 year old male came with compline of bilateral hearing loss he
had Examination hard to visualize the canal and the tympanic
membrane, he use ear pad during sleep for 3years , what is the most
likely diagnosis :-
cermon impaction ( It is Conductive hearing loss type
Child came with few month history of skin lesion on dorsum or
proximal hand I think, with pic. Ask about diagnosis:
cutaneous wart
2 weeks infant with poor weight gain for check up, on Ex there is
machinery murmur, at the upper left sternal border and bounding pulse
,what do you think:-
PDA
Patient having low mood and loss of interest in which his doctor
prescribed a medication, presented with history of dryness of his eyes and
blurry vision, with Hx of urine retention, which one of these medications
is most likely causing his symptoms?
Amitriptyline
-Px was having numbness /sweating /chocking, those symptoms had
occurred also when he went to school and meet his friends and intense
fear of having it again?
panic disorder
40-30 year old, nulliparous, hx of irregular cycle and dyspareunia,
presented with Lower abdominal pain, starts 1-2 days before menses,
increase during menses, , then get better, on examination TENDERNESS
AND NODULARITY IN THE POSTERIOR CUL-DE-SAC, sister has similar
issue, diagnosis?
- Endometriosis( cul- de sac is the hallmark for endometriosis as
mentioned in the question above. as well as dyspareunia with lower
abdominal pain before menses and during menses)
-Primigravida week 29, Painless bright red vaginal bleeding, Fetal heart
beat was 150 , next step:
Obstetric US (the best initial step when suspected placenta previa
18 month came with compline of clear runny nose throat congestion
he was at day care center where other child has similar symptoms What’s
best to do in this age:-
-nasal saline drop and humidifier air steam
Child with Hx of fall down, pain at the elbow ( x-ray attached ) asking
about what kind of injury can occur on his case:
radial head fracture
-Foot ankle twist while football game, with minimal bearing of weight,
tenderness on the inferior lateral malleolus, no ecchymosis or bruises ((
not fit for Ottawa rule )) what to Do
Analgesics and support
Case of patient fall on outstretched hand , he was having tenderness in
base of thumb X ray attached : what’s is the management»_space;
Forearm thumb spica
Infants 2 mo old presented by his parents with clear-white discharge
without conjunctivitis from his eye:
Duct massage (this first step then follow up)
nasolacrimal duct (NLD) atresia/obstruction in an infant dacryostenosis
pt hit on face by football c/o FB sensation , Examination was normal,
ask about next management:
antibiotics if dirty wound
53 year old patient , Diabetic/o dyspepsia mildly respond to anti acids
(H2 BLOCKER )with epigastric tenderness No weight loss, no hx of
bleeding per rectum What’s the most appropriate management ?
H. Pylori testing
-Case of family want to travel to Indonesia , came asking you for
traveral diarrhea !!!
loperamide for small diarrhea
School age boy came after fight in school ..vitally stable on exam
minimal left ear tenderness, fluctuant , with picture ,, what to do?
referral for I & D
Patient with dysphagia was to solid and liquids and chest pain ,
frequent regurgitation of undigested food not relived by PPI attached
barium study
Achalasia
-Child brought by his mother, he had chicken box last week. And now
he had honey- colored lesion around his nose. How to manage?
Cephalexin
Adult Patient with ear pain for 5 days, he visited the clinic 2 days ago,
and the physician assured him and give him Abx( amoxicilline) is
prescribed, now he is still in pain. What is next step?
Amoxicillin - clavinc acid
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
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
Old pt came to Er complaining of chest pain radiating to the shoulder,
he has same issue 3times before pain with exercise reliving by rest but
today have chest pain while reading newspaper ECG: sinus tachycardia
Troponin: normal
unstable angina
-Patient with night blindness mainly when he drives at night, her aunt
has blindness also. What is the diagnosis
Retinitis pigmentosa
-Child with white spots in his nail bed moves with nail growing no not
disappear after put pressure on it scales…..??
leukonychia
Female with 2 years amenorrhea and mentioned MRI show suprasellar
something High FSH High LH , Prolactin :normal Ask about diagnosis:
premature ovarian failure
Female presented with comedones and pustules and (moderate acne)
want to take oral retinoid what test to do before starting treatment:
-Pregnancy test (should always be done as first test prior to oral
Isotretinoin in female patient due to its teratogenicity )
Infant with intense PRURITIC rash all over the body , on Examination
show crusted papules and vesicles mainly in the hands, buttock & groin
What is the diagnosis
Scabies
Mom bring her child, exclusive breast feeding, he wasn’t on any
supplements or medication. Have bossing forehead What is the diagnosis
Rickets
12 y old boy with pic of complete fracture of radius and ulna
Close reduction with splint
A man came to you for pre travel counseling to Egypt 3week before
traveling which of following recommendations vaccinations by CDC ?
-HAV vaccine
Pt have trauma to elbow joint showing dislocation complain of
numbness and tingling sensation of volar aspect of little finger and can’t
abducted the finger which of following nerve injury?
ulnar
You are evaluating a 30-year-old male patient in the office with
hematochezia. He has had chronic constipation, and reports bright red
blood from his rectum associated with extremely painful bowel
movements. After defecation, he complains of a dull ache and a feeling of
“spasm” in the anal canal. The pain resolves within a few hours. On
external examination, no abnormalities are noted. Which of the following
is his most likely diagnosis?
Anal fissure
62 year Old patient came with hx of constipation for 6 months and
thin stool, barium study done (Couldn’t find same pic) stool occult of
blood is +ve , digital rectal examination is normal, what’s the dx?
rectal cancer
A study demonstrated a drug A had a greater reduction of HBA1C
levels than drug B. The author concludes that this should male drug A
better choice for patients with DM than drug B. This study is a good
example of:
Disease oriented evidence
3-year-old child brought by his family immediately to the ER, with
choking while he was (eating or playing) what’s the next step
abdominal thrust
A female complaining of lower adnominal pain and vaginal discharge ,
fever (38)on examinations : there was adnexal tenderness , Best treatment
is :
Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg
orally twice a day for 14 days
Young female complaining of abdominal pain, relieved after
defecation. Have episodes of constipation followed by diarrhea ( i think it
was associated with stressful event ) there’s change in stool form or
frequency , what is the most likely diagnosis :
IBS
-Male with progressive cough worsen at night with change in voice no
other symptoms, what’s most likely to confirm the diagnosis? ( Which one
has the highest diagnostic value ???!!
Esophageal PH monitoring
A teenager female with abnormal posture brought by her parents with
a picture of scoliosis
idiopathic scoliosis
A 5-week-old infant presented with 1-week of non-bilious vomiting,
dehydrated, eager for feeding, what’s the management?
IV fluid and surgical referral
Infantile pyloric stenosis should be considered in a neonate with vomiting and weight loss. The classic presentation of infantile pyloric stenosis is in a neonate one to three months of life with progressively forceful, non-bilious emesis
Painter w/ FHx of asthma, has episodes of cough, he is worried that his
work is the cause of his sx. How to confirm his concern?
Symptoms resolves when he is on Holiday
Old patient, hypertensive, smoker, came with past history of stroke.
Came for follow-up after his stroke. What could be done as tertiary
prevention?
Stroke rehabilitation program
Teenager part of sport team, presented w/ anterior knee pain
increasing w/ movement (I think stair climbing) decrease by rest.
Tenderness over tibial tuberosity
Osgood-shlatter
Management includes ice, NSAIDs, acetaminophen, quadriceps stretching
Pt w/ progressive hands weakness. O/E: muscle weakness +
fasciculation, LL > Babinski
motor neuron disease
DM female uncontrolled on metformin & glyburide does NOT want
weight gain, what to add?
SGLT2
Female with green vaginal frothy discharge, cervix showed multiple
micro petechia (i.e. strawberry cervix)
Trichomonas
Female has fore foot pain , burning sensation , Increase by wearing
thigh Haigh heal Tenderness on 3th and 4th metatarsal
-Morton neuroma
4 year old with abdominal mass growing oblique cross midline
Neuroblastoma
old pt k/C of HTN on amlodipin.. GERD on Lansoprazol.. Latent TB on
isoniazid and depression on esatalopram. what is the Drug that cause breast pain and enlargement:
-Isoniazid
-Pt came for hepatitis check up after her husband was diagnosed with
hepatitis B Serology:
- HBV DNA +
- HBe Ag -
- HB Igm +
- HBc IgM+
-HBsAb -
- HBsAg -
What is the Diagnosis:
Acute hepatitis B, window period
Pt has single episode of hematemesis after 5 hours of aspirin 300 mg
what most common cause?
Gastric erosion
Pt presented to you, he is worried about extra beat he had in ECG,
another doctor told him not to worry & this is normal. The patient also
was afraid of lung cancer previously, and he treated in the past from
pneumonia, and preoccupied about his health, Dx?
Illness anxiety disorder(hypochondoriosis)
Pt with anphlactic shock came with SOB and BP:80/60..next step :
1:1000 epi
-Pt presented, shouting and refusing the nurse to vital him. When the
doctor came, the patient took the gloves box and threaten the doctor
saying he will kill him (I think), what to do?
Restrain the patient by calling security
Pt believes someone is stealing his ideas (persecutory delusion), for
more than 6 months. No mood symptoms, he sometimes enjoys with his
friends.
delusional disorder
-30% of the persons had the test, had the disease, what does that
mean?
PPV 30%
Teenager w/ testicular pain, relived when lifted up, normal cremasteric
reflux
Epididymitis
-2 years Child present to clinic and prescribed abx OM return back after
5 days with no improvement & effusion in ear, your management: also
Augmentin
-Female with more than 3 years of low mood & loss of interest, MOST
of the days, along most of the day, increasing with menses, fatigue,
hypersomnia, decreased eating, what is the diagnosis?
Persistent Depressive Disorder (PDD) aka Dysthymia
Headache, Throbbing pain Migraine, what is the preventive?
-propranolol
picture of child with enlarged tonsils without exudate, pt have sore
throat, watery nasal discharge, what to give:
ascorbic acid (vit C)
19-year-old with right elbow and left knee then the pain in next day
In left elbow and right ankle, has heart murmur, with nodules on elbows,
what is the best test?
ASO (To confirm Rhematic fever)
51y/o is asking about colorectal cancer screening what is
recommended for him?
-FIT
The illegible housemaid what to do?
- informed authority and treat her accordingly
Chronic Epigastric pain with nausea and vomiting with abdominal
bruit ask about diagnosis: -
superior mesenteric artery syndrome
Dm and ischemic stroke and asthma best anti hypertensive
Hydrochlorothiazide + lisinopril
ectopic pregnancy
-Patient with psoriasis with acute unilateral photophobia and teary
with normal florescin uptake
Anterior uveitis
Child with failure to thrive / wt loss, foul Odder diarrhea , steatorrhea
and fat cell in stool analysis no history of travel
giardiasis
Pt complain of headache and blurred vision chest pain? Bp
:210/110 Management?
clevidipine
A
A
B
E
A
D
androgenic hair loss female pattern
Parents came with their child. He has runny nose and mild fever
(viral infection) … They insist that their child needs antibiotic:
Apologies, and explain why
20-29 y old patient female and obese have family history of
osteoarthritis and gout (and rheumatoid arthritis??) and came to
complain about pain at left knee and feel severe pain early morning i
think Ask about ttt
paracetamol 1g QID
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 ( the most common knee ligamentous
injury ) to confirm : + Lachman or +anterior drawer test , or + Pivot
test
The Lachman test is the most accurate test for detecting an anterior cruciate ligament tear, and MRI is the best imaging study to diagnose an anterior cruciate ligament tear
Treatment includes conservative management and surgery. Individuals who wish to continue participating in sports are recommended to have reconstructive surgery.
patient with ankle twist, he bears weight immediately after,
tenderness in the inferior border of the lateral malleolus
dressing and crutches for the ankle
A 40-year-old woman presents to your office with a painful right
eye. She reports a gritty, burning sensation in her eye. On exam there
is crusting and erythema of the superior lid margin. There are no
masses appreciated on either lid. Which of the following is the most
likely diagnosis?
Blepharitis
67y old man came to FM clinic for routine follow up and all previous
lab test normal except recent last CBC which show low Hemoglobin level
how to manage such case?
give iron supplements and colonoscopy
pt came middle age complain of lesion grow in hand over few months
progressively and cause bothersome sensation not painful at Dorsum of
wrist pen light test show transillumination +ve
ganglion cyst
mother bring her 3month old baby with full thickness burn on body
the mother state cause by something (child abuse scenario) which of
following make you suspect abuse?
Mechanism of event ? child can not no roll at this age
pt have egg allergy , What of the following would make him
susceptible for further allergic complication?
-influenza (IF yellow fever it will be the correct answer)
mom came to you concerning that one of her children develop
varicella and asking you how to prevent this form affecting her other
child?
contact precaution till crust
child came complain of temp 39.3 and conjunctivitis bilateral and
sneezing also developed rash that start at his head then spread down to
body with mouth pic showing (koplik spots) What is diagnosis ?
measles
middle age man came complain of dysuria and frequency no fever
on DRE have enlarged painful prostate what the diagnosis?
-acute prostatitis
pt his lab show prolactin level to be high his medications include
risperidone, HTN medication and ,DM medication and , dyslipidemia med
which of following cause increased prolactin level?
risperidone
elderly came to clinic complain of headache and vision blurred and
temporal area tenderness lab show ESR:120 diagnosis?
temporal arteritis
8 years child came to clinic complain of fever and sore throat temp
:38.7 and no cough on exam have tonsillar exudate and anterior cervical
adenopathy what your management?
(CENTOR CRITERIA- 4-5 point go
for penicillin treatment )
mother came with her child complain of that her child have
persistent cough and post -tussive vomiting his immunization is not up to
date which vaccine could prevent this ?
DTap
male pt who have been in MVA came to ER and performed a FAST
scan on abdomen shows peri splenic fluid Vital bp:110/70 Temp:37 HR:80
What is next step?
ct scan If unstable»_space; EX lap
patients go to a doctor for something and doctor prescribes
penicillin without asking about allergies hx and pt develop reaction which
principles did doctor violate?
non harm
female pregnant on labor and cervix. by exam was 3cm dilated and
the pt ask for female doc to deliver her what to do?
respect he’s wishes and call another female colleague
male adolescents have shoulder dislocation and was re located and
ask you when he can return to his usual activity for playing something
-immobilized for2-3 week then physiotherapy
female postpartum depression which of following is used to screen
for postpartum depression?
Edinburgh postnatal screening
middle age man came to ER complain of sudden severe left flank
pain Radiate to groin with vomiting and Nausea without fever or dysuria
which of following highest dx value?
non contrast CT
man. came to Er complain of abdomen pain and constipation and
vomiting for days with no fever and on exam no tenderness or guarding
but there is distension, and hyperactive bowel sound past hx including
appendectomy what is the most appropriate next step ?
-nil by mouth Iv fluid and gastric decompression
- Pt with history of blood transfusion came with ascites and shifting
dullness, the most probable cause?
portal hypertension
Female known case of paranoid schizophrenia came to Er with sister
complain of visual hallucinations and sister told you 1week ago have dry
eye cannot urinate and cold and worm cervical area?
anticholinergic delirium
ERCP
Pt with neurological symptoms ( in hand and LL) with MRI report.
The report: periventricular lesions (plaques or oval shape…?):
MS
A
A
Child presents with recurrent URTI. Growth chart of patient with low
height and weight but weight more sever. What important investigation?
Growth chart attached of failing to thrive
Sweat chloride (for cystic fibrosis )
Child with FATIGUE.. Loss of WIGHT and lymph node enlargment
and xray showed wide mediastinum:
non-Hodgkin lymphoma
rapid rewarming
bone marrow biopsy
vasopressin challenge test
if it says water deprivation test then choose it
- pt coming to er after insect by bee complain of stridor and wheezing
(anaphylaxis) What is the first thing you should do?
epinephrine
fibrosing alveolitis
15 yo female pt come with amenorrhea ,breast and uterus present +
secondary sexual feature normal to her age, what is the most common
cause for amenorrhea:-
imperforate hymen
Female diabetic pt came complaining of burning pain in both legs
with marked decreased sensation on exam. What to give?
Pregabaline
female Patient known case of DM on metformin came for evaluation
for her numbness , absent ankle reflex , positive Babinski sign , with
anemia , her MCV 106 What most likely diagnosis ?
Vitamin B12 deficiency
- typical history of rhinitis (sneezing, itching watery eye discharge)
with no seasonal variation, they said also patient take over the counter
medication with some relive which type is it
- allergic rhinitis
Obese and old patient complaining of day time fatigue taking
medication for insomnia (which let his condition getting worse) what’s
the most common diagnosis?
-Obstructive sleep apnea
25 years old complain of foot pain. they mentioned (Thompson test
positive):- What is the best management ?
-Surgical repair for Achilles’s rupture
- female medical free g2p2 present for annual gynecological clinic
with hx of milk discharge from nipple, FSH + LH attached was in normal
range?
-reassurance
- headache, left red eye, blurred vision, right eye vision 20/20 left eye
20/100, attached picture showed dilated pupil with injected conjunctiva,
diagnosis
acute angle closure glaucoma
female patient with severe itching, erythematous and white
discharge for 1 week , physical examination was normal and not
mentioned any investigations?
oral fluconazole 150 once dose ( candidiasis)
Elderly patient complained of both knees pain for 2 weeks, pain
mildly increased in LT knee, by examination: notice swelling, effusion??
and tenderness:
Osteoarthritis
- Man, who works in a company, have a lot of works to be done but he
can’t let others to finish them because he thinks it will not be perfect, this
affects his relationship with his wife
-OCD personality
Child presented to ED with Drooling and refuse eat, what to do as
next step:
intubation
- HTN + newly diagnosed DM what to add in his regimen:
-ACE inhibitor
adolescent male present with acute pluretic chest pain , in LT side of
the chest.. increased by breathing , chest and cvs examination normal
except tenderness at level of LT 3rd rib
-costochondritis
A 63 y.o female pt postmenopausal came with vaginal bleeding, last
pap smear was normal, Next step
Endometrial biopsy
44 years female post partum return from trip , after some day found
knee swelling and pitting edema , she on OCP What is the best to do ?
venous US
- Male pt came with hx of ankle sprain. He can bear WIGHT. Mild
swelling and tenderness with pic of normal foot x-ray.. What is the
diagnosis?
-Ankle sprain
Pleuritic chest pain +dysnea+ pain improves by leaning forward and
there is friction rub on exam.
diffuse ST segment elevation
I can’t recall the scenario but I Remember they mention a repetitive
talk in the clinic and other autistic behavior
behavior therapy
Child with fever and erythema more on cheek
parvo virus b19 ( 5th disease )
