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Medicine 200- Flashcards

1
Q

A 44-year-old obese woman presents with sudden onset dyspnea. No cough, chest pain orthopnea or PND. History is signifcant for hemorrhoidectomy 2 weeks ago (see image, lab results and report). Blood pressure 110/70 mmHg Heart rate 105 /min Test Result Normal Values ABG HCO3- 20 22-28 mmol/L ABG PCO2 4.5 4.7-6.0 kPa pH 7.5 7.36-7.45 ABG PO2 10 10.6-14.2 ka Chest x-ray: Normal except for the obliterated left costophrenic angle. Which of the following has the highest diagnostc value?
A. D-dimer
B. Spirometry
C. Spiral CT-scan
D. Echocardiogram

A

C. Spiral CT-scan

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2
Q

A 30-year-old woman with rheumatoid arthrits presents with progressive dyspnea and dry cough for 3 months. No fever or weight loss. Physical examinaton revealed cyanosis, digital clubbing and bibasilar end-inspiratory crackles (velcro type) on lung auscultaton. Which of the following is the most likely diagnosis?
A. Lung abscess
B. Bronchiectasis
C. Bronchogenic carcinoma
D. Intersttal pulmonary fbrosis

A

D. Intersttal pulmonary fbrosis

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3
Q

A 44-year-old man with poorly controlled epilepsy presented with fever, cough and left side chest pain for 6 weeks. The cough is productve of copious foul-smelling sputum. Physical examinaton revealed digital clubbing and course crepitatons in the right infra-clavicular area. Heart examinaton is normal (see image and report). Blood pressure 110/70 mmHg Heart rate 100 /min Respiratory rate 25 /min Temperature 39 °C Sputum culture: Mixture of aerobic and anaerobic organisms. What is the most likely mechanism for the underlying conditon?
A. Aspiraton
B. Vegetaton embolism
C. Bronchogenic carcinoma
D. Direct extension from infected chest wall

A

A. Aspiraton

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4
Q

A 30-year-old woman with bronchial asthma developed worsening dyspnea and cough following paint inhalaton from neighborhood apartment. On examinaton, she is in respiratory distress, cannot complete a sentence and cyanosed. Chest auscultaton revealed reduced breath sounds in both sides with short inspiratory and exploratory rhonchi (see lab results). Blood pressure 110/70 mmHg Heart rate 130 /min Respiratory rate 20 /min Oxygen saturaton 85 % Test Result Normal Values ABG HCO3- 24 22-28 mmol/L ABG PCO2 7.8 4.7-6.0 kPa pH 7.3 7.36-7.45 ABG P02 7.5 10.6-14.2 kPa Which of the following is the best immediate acton in management?
A. Intravenous magnesium infusion
B. Intravenous aminophylline infusion
C. Intubation and mechanical ventlaton
D. Nasal contnuous positve airway pressure ventlaton

A

C. Intubation and mechanical ventlaton

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5
Q

A patent with poorly controlled bronchial asthma developed hypertension, which of the following anthypertensive medicatons is contraindicated?
A. Beta blocker
B. Calcium channel blocker
C. Angiotensin II receptor blocker
D. Angiotensin convertng enzyme inhibitor

A

A. Beta blocker

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6
Q

A 60-year-old man with advanced squamous cell bronchogenic carcinoma presents with massive malignant right pleural efusion. He has been admited several times with similar fndings for which he undergoes several therapeutc pleural taps. Which of the following is the next best option in management?
A. Diuretcs
B. Ultrafltraton
C. Chemical pleurodesis
D. Low salt human albumin

A

C. Chemical pleurodesis

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7
Q

A 40-year-old woman presents with progressive dyspnea, dry cough and reddish nodular skin lesion over both shins. On examinaton, she has palpable cervical lymph nodes and bilateral difuse fne crepitatons in both lungs (see reports). Chest radiograph: Difuse bilateral intersttal infltrates with bilateral hilar lymph nodes enlargement. Purifed protein derivatve (PPD): Negatve. Cervical lymph node biopsy: Non-caseatng granuloma. Which of the following is the next best opton in management?
A. Montelukast
B. Glucocortcoids
C. Ant-tuberculosis
D. Salmeterol inhaler

A

B. Glucocortcoids

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8
Q

A 60-year-old man with post pulmonary tuberculosis bronchiectasis presents with massive hemoptysis. Physical examinaton shows course crepitatons in the right scapular area (see image). Which of the following is the most appropriate inital management?
A. Sedaton
B. Pneumonectomy
C. Chest physiotherapy
D. Positoning on right lateral decubitus

A

D. Positoning on right lateral decubitus

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9
Q

A 78-year-old woman is admited with fever and confusion due to pneumonia. The doctors decided to start her IV antbiotcs. However, her son, who is the next of kin, disagreed and argued that antbiotcs will cause more harm. What is the best way to deal with this situaton?
A. Ignore the opinion of the son and give the antbiotcs to save the patent
B. Counsel the son in the presence of the consultants
C. Respect the opinion of the next of kin
D. Take the opinion of the patent

A

B. Counsel the son in the presence of the consultants

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10
Q

A young woman with long-standing rheumatoid arthrits is diagnosed to have non-specifc intersttal lung disease. The physician decided to start her on oral glucocortcoid. However, the patent is concerned about the side efects related to this treatment. What is the best approach to deal with this situaton?
A. Stress the importance of the treatment and give the patent time to decide
B. Inform the patent that refusing this treatment might cause death
C. Inform the patent that there is no alternatve treatment
D. Tell the patent that most of the side efects are not serious

A

A. Stress the importance of the treatment and give the patent time to decide

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11
Q

An elderly patent is diagnosed with pulmonary tuberculosis and started on ant-TB treatment. He developed jaundice, which progressed to liver failure for which he was admited to the Critcal Care Unit. His son was very angry and decided to complain against the treatng team. What is the appropriate response to the son?
A. Tell him that this incident can happen to anyone
B. Inform him that the doctors ofered the right management
C. Advise him against complaining as there is no medical error
D. Calm him down and inform him that this incident will be investgated

A

D. Calm him down and inform him that this incident will be investgated

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12
Q

An elderly patent who has poorly controlled bronchial asthma with repeated admission to the hospital is found to be non-compliant with his medicatons. Which of the following is the most appropriate acton?
A. Tell the patent that it is not acceptable to disrespect the advice of doctors
B. As the patent is noncompliant, just keep him in the hospital
C. Involve the next of kin to help to give his medicatons as prescribed
D. Tell the patent that he might die if he does not comply with the medicatons

A

C. Involve the next of kin to help to give his medicatons as prescribed

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13
Q

A 71-year-old man who has been admited due to clostriduim difcile infecton last year. In order to search for possible risk factors that increase the risk of recurrent infecton, his medicatons have been reviewed thoroughly. Which of the following medicatons is associated with increased risk of C. difcile infecton?
A. Omeprazole
B. Ferrous sulfate
C. Calcium carbonate
D. Multvitamin tablet

A

A. Omeprazole

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14
Q

A 69-year-old man with chronic obstructve pulmonary disease on oxygen therapy for the last 5 years. Which of the following markers is most useful for monitoring the progression of this patent?
A. Oxygen saturatons
B. Number of exacerbatons per year
C. FEV1/FVC rato
D. FEV1

A

D. FEV1

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15
Q

A 48-year-old man with a history of cirrhotc liver disease presents with abdominal distenton. Clinical examinaton reveals tense ascites, which was drained. What is the appropriate type of diuretc to help prevent re-accumulaton of ascites?
A. Aldosterone antagonist
B. Thiazide diuretc
C. Osmotc diuretc
D. Loop diuretc

A

A. Aldosterone antagonist

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16
Q

A 43-year-old woman with complex regional pain syndrome comes to the clinic. She sufers from pain around her hand and wrist, which started afer carpal tunnel release surgery. She was reviewed by orthopaedics and a specialist in Pain Clinic. Which of the following is the most appropriate management opton?
A. Opiate analgesia
B. Physiotherapy
C. Counselling
D. Triptans

A

B. Physiotherapy

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17
Q

A 41-year-old man complains of double vision. Whilst looking forward the patents lef eye turns towards the nose. On looking to the patent’s right there is no obvious squint. However, on looking to the lef, the patent is unable to abduct the lef eye and double vision worsens. Which of the following is the most likely cranial nerve palsy?
A. Lef 3rd
B. Lef 6th
C. Right 3rd
D. Right 6th

A

D. Right 6th

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18
Q

A 42-year-old man comes to the clinic with his brother. The brother is concerned that he has been actng strangely over the past 4 months. In partcular, he has been irritable and critcizes everyone at home. The changes were subtle at frst but now arguments arise every other day. He has difculty initatng conversaton and even pauses halfway through sentences. There is no family history of note and he is not taking any medicatons. Which of the following is the most likely diagnosis?
A. Alzheimer’s disease
B. Vascular dementa
C. Huntngton’s disease
D. Frontotemporal dementa

A

D. Frontotemporal dementa

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19
Q

A 71-year old man with history of osteoarthrits and previous cervical laminectomy for degeneratve cervical myelopathy presents with a 2-month history of worsening gait instability and urinary urgency. Which of the following is the most likely explains his symptoms?
A. Multple sclerosis
B. Transverse myelits
C. Cauda equina syndrome
D. Recurrent degeneratve cervical myelopathy

A

D. Recurrent degeneratve cervical myelopathy

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20
Q

A 66-year-old man is referred to Neurology Outpatents with arm pain, stfness and imbalance. Following investgatons, he is diagnosed with degeneratve cervical myelopathy. He misses his next Outpatent Clinic due to admission with acute coronary syndrome. He atends his appointment 2 months later and mentons his ongoing neurological symptoms. Which of the following is the most important next step in his care?
A. Refer to spinal surgery
B. Refer for physiotherapy
C. Commence neuropathic analgesia
D. Reassure the patent of his diagnosis

A

A. Refer to spinal surgery

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21
Q

A 20-year-old man is noted to bleed excessively during an electve dental extracton. Following the procedure, examinaton reveals petechial skin hemorrhages. Blood results showed factor VIII, actvity 87% (see lab results). Test Result Normal Values Hb 125 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 288 150-400 × 109/L WBC 8 4.5-10.5 x 109/L Prothrombin tme 13.5 10-13 sec APTT 38 30-40 sec Which of the following is the most likely diagnosis?
A. Idiopathic thrombocytopenic purpura
B. Von Willebrands disease
C. Haemophilia B
D. Haemophilia A

A

B. Von Willebrands disease

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22
Q

A 26-year-old man with sickle cell anemia presents with pallor, lethargy and headache (see lab results). Test Result Normal Values Hb 44 130-170 g/L (Male) 120-160 g/L (Female) Retculocyte 2.8 0.2-1.2 % Which of the following is the most likely diagnosis?
A. Sequestraton crisis
B. Thrombotc crisis
C. Haemolytc crisis
D. Aplastc crisis

A

D. Aplastc crisis

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23
Q

A 66-year-old woman presents with lethargy for the past 2 weeks. Her past medical history includes polymyalgia rheumatc and ischemic heart disease. Clinical examinaton is unremarkable (see lab results). Test Result Normal Values Hb 131 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 144 150-400 x 109/L WBC 21 4.5-10.5 x 109/L Neutrophils 44 40-60% Lymphocytes 60 20-40 % Which of the following is the most likely diagnosis?
A. Chronic lymphocytc leukemia
B. Infectous mononucleosis
C. Transient viral illness
D. Lymphoma

A

A. Chronic lymphocytc leukemia

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24
Q

A 55-year-old man known case of liver cirrhosis with ascites presented to the Emergency Department complaining of progressive non- specifc abdominal pain for 6 days, which was associated with vomitng. Examinaton confrmed generalized abdominal tendemess (see lab result and report). Blood pressure 100/55 mmH
Test Result Normal Values WBC 23.3 4.5-10.5 x 109/L. CT scan abdomen: Moderate ascites with cirrhotc liver. Which of the following is the most appropriate step in treatment?
A. Antibiotics
B. Observaton
C. Diagnostc laparoscopy
D. Exploratory Laparotomy

A

A. Antibiotics

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25
Q

A 45-year-old man presented to the Emergency Department complaining of lower abdominal pain for 3 days. He gave a history of being hit by a piece of wood in the same site of pain 4 days back. Examinaton revealed lethargic patent in pain, which was aggravated by moving his leg. there was grayish turbid semipurulent secretons from a small break in the skin of right lower quadrant (see lab result). Test Result Normal Values WBC 33.1 4.5-10.5 x 109/L Which of the following is the most appropriate next step in the management?
A. Observaton
B. Surgical drainage
C. CT scan abdomen
D. Culture and sensitvity for secretons

A

B. Surgical drainage

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26
Q

A 37-year-old man was involved in a fght and sustained a stab wound to the neck. On presentaton, patent was conscious, alert. Examinaton showed a 2 cm wound anterior to the lef ear and close to the angle of the mandible with blood ooze. which of the following is the most appropriate next step?
A. Chest X ray
B. Observaton
C. CTA of the neck
D. Exploraton of the wound

A

C. CTA of the neck

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27
Q

A 19-year-old woman brought to the Emergency Department afer being stabbed to the right upper quadrant. On arrival, she was conscious and oriented. Examinaton showed only a penetratng wound to the anterior abdominal wall at anterior axillary line just below the right costal margin. Which of the following is the most appropriate next step?
A. Observaton
B. CT scan abdomen
C. Ultrasound abdomen
D. Exploratory laparotomy

A

B. CT scan abdomen

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28
Q

A 25-year-old man brought to the Emergency Department afer he was involved in motor vehicle crash, which was driving at a speed of 130 km/hour. Patent was wearing seat belt. On arrival to the Emergency Department, he was conscious, and alert (see report). Chest X-ray: Normal. Which of the following is the most appropriate next step?
A. US abdomen
B. CT scan abdomen
C. Diagnostc laparoscopy
D. Exploratory Laparotomy

A

B. CT scan abdomen

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29
Q

A 33-year-old man was involved in a motor vehicle crash. On arrival to the Emergency Department, he was conscious and alert. Examinaton showed an open wound to the anterior surface of the neck with devitalized tssue. Blood pressure 100/60 mmHg Heart rate 104 /min Respiratory rate 28 /min Oxygen saturaton 87% Which of the following is the most appropriate next step?
A. Oxygen mask
B. Tracheostomy
C. Cricothyroidotomy
D. Endotracheal intubaton

A

D. Endotracheal intubaton

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30
Q

A 56-year-old woman was exposed to chemical burns to her trunk. On arrival to the Emergency Department, she was conscious and alert. Examinaton showed a 6 cm x 11 cm wound at her back with burned clothe and powder of chemicals on her clothes and skin. Which of the following is most appropriate next step afer removing her clothes?
A. Antbiotcs
B. Powder sweeping
C. Surgical debridement
D. Water irrigaton for 30 minutes

A

B. Powder sweeping

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31
Q

A 23-year-old man presented to the Emergency Department afer he fell down from 3 m height on his right leg. Examinaton revealed a deformity of right leg with an open wound in the mid-leg and devitalized tssue and dirt in the wound. The leg was put in a splint. Blood pressure 112/70 mmHg Heart rate 99 /min Respiratory rate 22 /min Oxygen saturaton 95 % Which of the following is the most appropriate next step?
A. Antbiotcs
B. External fxator
C. Surgical debridement
D. Urgent internal fxaton

A

C. Surgical debridement

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32
Q

A 17-year-old man had a crush injury to his lef leg afer a heavy object fell on it, 5 hours prior to presentaton. He was complaining of severe pain in his leg. Examinaton revealed a conscious and alert patent. His lef leg was cold with delayed capillary reflling. Blood pressure 116/67 mmHg Heart rate 95 /min Respiratory rate 23 /min Oxygen saturaton 95 % Which of the following is the most appropriate next step?
A. Angiography
B. CT angiography
C. Duplex ultrasound
D. Compartment pressure

A

D. Compartment pressure

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33
Q

A 37-year-old man presented to the Emergency Department with vomitng blood afer atacks of excessive vomitng (see lab results). Blood pressure 112/63 mmH Heart rate 89 /min Respiratory rate 21 /min Oxygen saturaton 96 % Test Result Normal Values Hb 135 130-170 g/L (Male) 120-160 g/L (Female) WBC 7.8 4.5-10.5 x 109/L. Which of the following is the most appropriate management plan?
A. Upper Gl endoscopy
B. Conservatve treatment
C. Exploratory laparotomy
D. Sengstaken-blakmore tube

A

B. Conservatve treatment

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34
Q

A 63-year-old woman presented to the Surgical Clinic complaining of upper abdominal pain and shortness of breath and occasional atacks of palpitaton afer meals, for several years. These symptoms relieved by vomitng. Which of the following is the most appropriate method of investgatons?
A. CT scan abdomen
B. Upper Gi endoscopy
C. Plain abdominal X-Ray
D. Upper GI barium study

A

D. Upper GI barium study

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35
Q

A 40-year-old woman presented with heartburn at the epigastric and retrosternal areas, and symptoms of regurgitaton. The patent has tried conservatve measures, including proton pumps inhibitors with no improvement in symptoms (see report). Endoscopy: Erythema of the esophagus consistent with refux esophagits. Which of the following is the most appropriate next step?
A. Manometry study
B. 24-hour pH monitoring
C. Lifestyle modifcaton
D. Nissin’s fundoplicaton

A

C. Lifestyle modifcaton

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36
Q

A 73-year-old woman underwent percutaneous trans-hepatc cholangiography for treatment of obstructve jaundice. 24 hours afer the procedure, she started to have upper gastrointestnal bleeding (see lab results). Blood pressure 105/62 mmHg Heart rate 89 /min Respiratory rate 22 /min Oxygen saturaton 94 % Test Result Normal Values Hb 103 130-170 g/L (Male) 120-160 g/L (Female) WBC 7.8 4.5-10.5 x 109/L Which of the following is the most appropriate next step in the management plan?
A. CT scan
B. Endoscopy
C. Ultrasound
D. Angiography

A

D. Angiography

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37
Q

A 24-year-old man recovers from an atack of severe pancreatts. He has mild epigastric discomfort, sensaton of bloatng, and loss of appette. Examinaton reveals an epigastric fullness. The swelling increases in size over a 3-week period of observaton (see report). Ultrasound: Confrmed to be a pseudocyst. Which of the following is the most appropriate next step in management?
A. Observaton
B. Internal drainage
C. Percutaneous drainage
D. Excision of pseudocyst

A

C. Percutaneous drainage

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38
Q

A 32-year-old diabetc woman has taken contraceptve pills for 12 years develops right upper quadrant pain (see report). CT scan: A 5-cm hypodense lesion in the right lobe of the liver. Which of the following is the most appropriate next step in management?
A. Excision
B. Follow up CT scan
C. Right hepatectomy
D. Stop oral contraceptve

A

D. Stop oral contraceptve

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39
Q

A 68-year-old man has been advised to undergo surgical treatment for a lef reducible inguinal hernia. He is otherwise healthy. Which of the following is the most appropriate treatment?
A. Simple repair
B. Open mesh repair
C. Laparoscopic repair
D. Non-surgical treatment

A

B. Open mesh repair

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40
Q

A 27-year-old man presented to the Surgical Clinic complaining of right groin pain for few weeks, which is aggravated by exercising. Examinaton confrmed normal external genitalia and groin region. Which of the following is the most appropriate next step?
A. MRI
B. CT scan
C. Ultrasound
D. Re-examinaton afer 3 months

A

C. Ultrasound

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41
Q

A 42-year-old woman underwent an uneventul laparoscopic cholecystectomy. 2 weeks later, she presents to the Emergency Department with vague abdominal pain (see lab results and report). Blood pressure 117/59 mmHg, Heart rate 83 /min Respiratory rate 19 /min Temperature 37.4 °C Oxygen saturaton 95 % Test Result Normal Values Hb 103 130-170 g/L (Male) 120-160 q/L (Female) WBC 7.8 4.5-10.5 x 109/L
Total bilirubin 3.7 3.5-16.5 mol/L CT scan: Large collecton in the sub-hepatc area. Which of the following is most appropriate next step?
A. Operatve drainage
B. CT-guided drainage
C. Laparoscopic drainage
D. ERCP with biliary stent placement

A

D. ERCP with biliary stent placement

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42
Q

A 57-year-old man presents with 2 days of abdominal pain, nausea, and vomitng. Examinaton revealed a distended, tympanic and mildly tender abdomen without rebound or guarding (see lab results and reports). Test Result Normal Values Hb 153 130-170 g/L (Male) 120-160 g/L (Female) WBC 12.6 4.5-10.5 x 109/L Plain Abdominal X-ray: Multple air-fuid levels. CT scan: Multple dilated loops of small bowel with a transiton point in the distal small bowel, with some adjacent mesenteric fat stranding. Which of the following is the most appropriate next step in management?
A. Observaton
B. Colonoscopy
C. Diagnostc laparoscopy
D. Exploratory laparotomy

A

D. Exploratory laparotomy

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43
Q

A 35-year-old woman 1-day post total thyroidectomy was observed by the nurses to develop a spasm of her right hand during blood pressure measurement from the right arm. Which of the following is the most appropriate next step?
A. Reassurance
B. Give analgesia
C. Check her calcium level
D. Recheck the blood pressure

A

C. Check her calcium level

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44
Q

A 30-year-old man presented to Surgical Clinic with right inguinal hernia. He was complaining of cough for the last 6 months. and did not use any treatment for it. He insisted to have the surgery and threatened the surgeon that he will raise a complain if did not book him for surgery. Which of the following is the most appropriate acton?
A. Do the surgery
B. Call the social worker
C. Consult the physician
D. Inform the administraton

A

B. Call the social worker

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45
Q

During a laparoscopic cholecystectomy, the surgeon encountered a difcult anatomy and there was a CBD injury, which was repaired and patent did very well. Which of the following is the most appropriate post-operatve acton?
A. Talk to the family
B. Talk to the patent
C. No need to tell them
D. Call a colleague to tell them

A

B. Talk to the patent

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46
Q

A 32-year-old man was operated for a self-induced rectal injury. Afer the surgery, the family was asking about the cause of his illness. Which of the following is the most appropriate response?
A. Inform the police
B. Tell them the truth
C. Involve social worker
D. Refer them to the patent

A

D. Refer them to the patent

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47
Q

A 5-year-old girl brought by her family with rectal bleeding. During examinaton, it was observed that there is an abnormal relaton between the parents. Examinaton confrmed multple bruises over the child body. which of the following is the most appropriate acton?
A. Inform the police
B. Admit the patent
C. Inform the social worker
D. Talk to the family about your concern

A

B. Admit the patent

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48
Q

A 60-year-old woman was admited for electve laparoscopic cholecystectomy. During the procedure, the surgeon found a big mass in the stomach Which of the following is the most appropriate acton?
A. Cholecystectomy
B. Stop the procedure
C. Resecton of the mass
D. Cholecystectomy and mass resecton

A

B. Stop the procedure

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49
Q

A 28-year-old man is brought to Emergency Room with head injury afer motor vehicle accident, he is making incomprehensive sounds, open his eyes to painful stmuli and fexes his limbs to painful stmuli, and his pupils react sluggishly to light. What is his Glasgow Coma Score?
A. 5
B. 6
C. 7
D. 8

A

C. 7

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50
Q

A 33-year-old woman diagnosed with papillary thyroid cancer and planed for total thyroidectomy, she have mitral valve prolapse with mild regurgitaton, no other co-morbidity. Which of the following is most appropriate opton to prevent infecton?
A. Amoxicillin to prevent endocardits
B. Cefazolin to prevent wound infecton
C. No indicaton for antbiotc prophylaxis
D. Administer both cefazolin and amoxicillin

A

C. No indicaton for antbiotc prophylaxis

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51
Q

A 55-year-old woman is admited with obstructed ventral hernia for emergency exploraton; patent is obese, diabetc and was discharged 7 days ago afer surgical correcton of retnal detachment. Which of following is most appropriate DVT prophylaxis? A. Subcutaneous heparin
B. Mechanical prophylaxis
C. Subcutaneous enoxaparin
D. Enoxaparin and mechanical prophylaxis

A

B. Mechanical prophylaxis

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52
Q

A 65-year-old man diagnosed with obstructng lower esophageal cancer and planed for surgery, patent is cachectc with more than 20% weight loss over 3 months. The treatng team decided to start on preoperatve TPN. Which of the following is the most expected electrolyte abnormality?
A. Hypokalemia
B. Hypocalcemia
C. Hypernatremia
D. Hyperphosphatemia

A

A. Hypokalemia

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53
Q

A 33-year-old woman otherwise healthy, underwent laparoscopic sleeve gastrectomy. complicated by pulmonary embolism, she was started on heparin infusion, and afer 5 days (see lab resuits). Test Result Normal Values Platelets count 59 150-400 × 109/L APTT 53 30-40 sec INR 1.2 0.8-1.2 Prothrombin tme 14 10-13 sec Which of the following is the most appropriate management?
A. Stop heparin and start lepirudin
B. Increase IV heparin to reach PTT 60-70
C. Shif to subcutaneous therapeutc enoxaparin
D. Contnue on same dose and repeat labs afer 6 hours

A

A. Stop heparin and start lepirudin

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54
Q

A 17-year-old man presented to Emergency Room with right lower quadrant pain and anorexia. Examinaton revealed tendemess and rebound tenderness at Mc Burney’s point (see image, lab result and report). Heart rate 92 /min, Temperature 38.2 °C Test Result Normal Values WBC 21.3 4.5-10.5 x 109/L Abdominal X-ray: Round 1.5 cm Radio opaque area at right iliac fossa. Which of the following is the most appropriate next step?
A. Appendectomy
B. Urgent urology consult
C. Non contrast CT abdomen
D. Ultrasound of the gall-bladder

A

A. Appendectomy

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55
Q

A 44-year-old woman is admited electvely for laparoscopic cholecystectomy for chronic cholelithiasis. She is obese, diabetc and sickle cell trait. Which of the following is most likely type of her gallstones?
A. Mixed
B. Oxalate
C. Pigmented
D. Pure cholesterol

A

A. Mixed

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56
Q

A 65-year-old man presented to Emergency Room with history of vague upper abdominal pain and loss of appette and weight. Examinaton revealed he was jaundiced; abdomen is sof and lax with palpable non-tender gallbladder. Which of the following is the most likely diagnosis?
A. Liver cancer
B. Pancreatc cancer
C. Primary choledocholithiasis
D. Secondary choledocholithiasis

A

B. Pancreatc cancer

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57
Q

A 75-year-old man admited to Coronary Care Unit with acute MI, complicated with bacterial pneumonia, patent on tazocin for 12 days. Examinaton revealed abdomen severe tenderness in the right upper quadrant (see report). Blood pressure 100/60 mmH Heart rate 96 /min Respiratory rate 22 /min Temperature 38.3 °C Ultrasound abdomen: Distended gallbladder with thick wall and pericystc fuids, there is no gallstones. which of following is the most appropriate management?
A. ERCP drainage
B. Emergency cholecystectomy
C. Change tazocin to meropenem
D. US guided tube cholecystostomy drainage

A

D. US guided tube cholecystostomy drainage

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58
Q

A 35-year-old woman presented to Emergency Room with vague upper abdominal pain, She underwent electve cholecystectomy for cholelithiasis 7 days ago. Examinaton revealed she was jaundiced with mild right upper quadrant tenderness (see lab results and report). Temperature 37.1 °C Test Result Normal Values WBC 9.3 4.5-10.5 x 109/L Alkaline phosphatase 169 39-117 IU/L Alanine aminotransferase 35 5-40 IU/L Amylase 102 24-151 IU/L Direct bilirubin 10 1.5-6.5 mol/L Total bilirubin 17 3.5-16.5 mol/L Ultrasound: Minimal fuids in gall-bladder fossa, CBD measure 9 mm Which of the following is the most likely diagnosis?
A. CBD injury
B. Retained CBD stone
C. Sub-hepatc collecton
D. Slipped cystc duct clip

A

B. Retained CBD stone

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59
Q

A 70-year-old women p7+1 with chronic constpaton presented to Emergency Room with abdominal distension and vomitng. Examinaton revealed abdomen is distended, tympanic, with round tender non-reducible swelling in the right groin bellow and lateral to pubic tubercle (see report). X-ray abdomen: Distended small bowel with multple fuid levels. Which of the following is the most likely diagnosis?
A. Femoral hernia
B. Direct inguinal hernia
C. Metastatc lymphnode
D. Indirect inguinal hernia

A

A. Femoral hernia

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60
Q

A 61-year-old man presented to Outpatent Clinic with general fatgue and mild on and of stool mixed with streaks of blood for 4 months. Examinaton revealed he was pale; abdomen is sof and lax, per rectal examinaton revealed 2nd degree piles (see lab result). Test Result Normal Values
Hb 8.3 130-170 g/L (Male) 120-160 q/L (Female) Which of the following is the most likely diagnosis?
A. Cecal cancer
B. Rectal cancer
C. Sigmoid cancer
D. Chronically bleeding haemorrhoids

A

A. Cecal cancer

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61
Q

A 52-year-old woman presented to Emergency Room with abdominal distension and vomitng, she has history of ventral hemia repair with mesh 12 years back. Examinaton revealed distended abdomen, no tenderness, and no signs of hernia recurrence (see reports). X-ray abdomen: Dilated bowels with air/fuid levels. CT scan: Contrast cut of at terminal ilium with sof tssue mass and target sign. Which of the following is likely diagnosis?
A. Small bowel cancer
B. Adhesion to the mesh
C. Meckel’s divertculum
D. Late onset crohn’s disease

A

A. Small bowel cancer

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62
Q

A 12-year-old boy is brought to the Emergency Room 30 min afer accidentally ingestng bleach; vital signs are stable with maintained airway. He was kept NPO, started on IV fuids and broad- spectrum antbiotcs. Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 95 % Which of the following is most appropriate next step?
A. Induce emesis
B. Close observaton
C. Water ingeston to dilute the bleach
D. Insert NGT and drain gastric content

A

B. Close observaton

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63
Q

An 18-year-old man involved in burn accident, he has 2nd degree burn to his both lower limbs. Weight 70 kg Using Parkland formula, which of the following is most appropriate fuid resuscitaton?
A. Lactate ringer’s 200 ml/hr for 24 hrs
B. Normal saline 1L bolus then 120ml/hr
C. Lactate ringer’s 5 L over 1st 6 hrs then 5 L over next 16 hrs
D. Lactate ringer’s 2.5 L over 1st 6 hrs then 2.5 L over the next 16 hrs

A

C. Lactate ringer’s 5 L over 1st 6 hrs then 5 L over next 16 hrs

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64
Q

A 32-year-old healthy woman had neck ultrasound to evaluate lipoma; incidentally, there was right thyroid lobe 2.3 cm solid hypochoic nodule (see lab results and report). Test Result Normal Values Thyroid-Stmulatng Hormone 2.3 0.4 - 5.0 pU/mL. Thyroxine (T4 free serum) 11.3 8.5 - 15.2 pmol/L. Fine Needle Aspiraton: Follicular neoplasm, Bethesda 4. Which of the fowing is most appropriate management?
A. Nodule excision
B. Hemithyroidectomy
C. Repeat US in 3 months
D. Radiofrequency ablaton

A

B. Hemithyroidectomy

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65
Q

A 27-year-old man is brought to Emergency Room afer motor vehicle accidents, he was complaining of severe pain in his right leg. Examinaton revealed intact skin, tens swollen leg. foot paresthesia at the 1st web space with palpable distal puises (see reports). Blood pressure 121/70 mmHg Heart rate 109 /min Respiratory rate 23 /min Temperature 37.0 °C Oxygen saturaton 95 % X-ray: Comminuted, right bicondylar tbial plateau fracture. Posterior leg deep compartment pressure: 35 mmHg. Which of the following is the most appropriate management?
A. Closed reducton and elevaton
B. External fxaton and leg elevaton
C. Internal fxaton and leg elevaton
D. External fxaton and 4 compartment fasciotomy

A

D. External fxaton and 4 compartment fasciotomy

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66
Q

A 24-year-old man had gunshot wound in the lef side of his chest; chest tube was inserted with minimal hemothorax and no air leak. The bullet entry lateral the nipple, exit point was below the lef scapula. Suddenly patent becomes agitated and hypotensive. Examinaton revealed distended neck veins, good air entry both side of the chest with unclear heart sounds Which of the following is the most appropriate management?
A. Fluid bolus
B. Pericardiocentesis
C. Emergency room thoracotomy
D. Needle thoracostomy in the lef 2nd intercostal

A

B. Pericardiocentesis

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67
Q

A 2-month-old baby is brought to the clinic because of umbilical bulge that appears when child is crying. Examinaton revealed 1 cm reducible umbilical hernia. Which of the following is most appropriate treatment?
A. Observaton
B. Hernia sling
C. Surgical repair
D. Delayed surgical repair at age of 6 months

A

A. Observaton

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68
Q

A 12-year-old boy had isolated blunt abdominal injury, is complaining of vague upper abdominal pain. Examinaton revealed the abdomen was sof with mild lef upper quadrant tenderness (see lab results and report). Blood pressure 100/65 mmH Heart rate 91 /min Respiratory rate 18 /min Temperature 37.3 °C Oxygen saturaton 97 % Test Result Normal Values Hb 11.3 130-170 g/L. (Male)
120-160 g/L (Female) HCT 0.39 0.42-0.52 (Male) 0.37-0.48 (Female) Platelets count 238 150-400 x 109/L WBC 14.1 4.5-10.5 x 109/L CT scan: Minimal pelvic fuids, 4 cm splenic tear with 7 cm subcapsular hematoma (Grade 3), no other abnormality. Which of the following is most appropriate management?
A. Close observaton
B. Open splenectomy
C. Splenic preserving surgery
D. Per-cutaneous drainage of pelvic fuids

A

A. Close observaton

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69
Q

A 28-year-old man has chronic history of episodes of sharp anal pain with defecaton, occasionally associated with small amount of fresh blood. Examinaton revealed posterior anal fssure with skin tag. All conservatve treatments failed. Which of the following is most appropriate surgical management?
A. Anal dilataton
B. Lateral internal sphincterotomy
C. Lateral external sphincterotomy
D. Curetage of the fssure and excision of skin tag

A

B. Lateral internal sphincterotomy

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70
Q

A 55-year-old man presents to the clinic. He is a smoker with long history of sever gastrointestnal refux disease on proton bump inhibitors. His last endoscopy revealed lower esophageal redness and ulceraton (see report). Biopsy from lower esophagus: Squamous cells with high-grade dysplasia. Which of the following is the most appropriate therapeutc opton?
A. Add ranitdine
B. Council to stop smoking
C. Repeat endoscopy afer 6 months
D. Refer for possible esophageal resecton

A

D. Refer for possible esophageal resecton

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71
Q

A 37-year-old P5+0 woman comes to the clinic. History reveals she has grave’s disease since 5 years; her conditon is well-controlled with antthyroid medicatons, trials of stopping medicaton failed. Examinaton reveals she has severe exophthalmos (see report). Ultrasound thyroid: Hypervascular homogenous normal size thyroid. Which of the following indicates thyroidectomy over radioactve iodine?
A. The patents age
B. Severe exophthalmos
C. Hypervascular thyroid
D. Failure of medical treatment

A

B. Severe exophthalmos

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72
Q

Which of the following is most appropriate management of penetratng zone 3 neck vascular injury?
A. Vascular ligaton
B. Open primary repair
C. Open vascular bypass
D. Endovascular interventon

A

D. Endovascular interventon

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73
Q

Which of the following is the most common locaton for blunt thoracic aortc injury?
A. Aortic arch
B. At the ligamentum arteriosum
C. Disal to lef subclavian artery
D. Proximal to the lef subclavian artery

A

B. At the ligamentum arteriosum

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74
Q

A 32-year-old man fell from his motorbike and broke his femur. Which of the following is most essental before reducton?
A. Give sedaton
B. Give analgesia
C. Call the operatng room
D. Examine his peripheral pulses

A

D. Examine his peripheral pulses

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75
Q

Which of the following is the most appropriate diagnostc gold standard in critcal limbs ischemia?
A. Ultrasound
B. CT Angiography
C. MR Angiography
D. Conventonal angiography

A

B. CT Angiography

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76
Q

Which of the following is an absolute indicaton for treatment of vascular malformatons?
A. Pain
B. Cosmesis
C. Claudicaton
D. Congestve heart failure

A

D. Congestve heart failure

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77
Q

Which of the following is the most appropriate strategy in managing medical risk factors in Peripheral Atrial disease?
A. Weight reducton
B. Aerobic exercised
C. Supervised exercised program
D. Non supervised exercised program

A

C. Supervised exercised program

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78
Q

A 40-year-old healthy woman presents to Emergency Room with a 4-hour history of sudden onset right lower limb pain. Her examinaton reveals intact femoral pulse but absent distal pulses, diminished sensory exam with an altered motor exam. Her labs are normal (see report). Blood pressure 110/70 mmH Heart rate 95 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 98 % ECG: Shows atrial fbrillaton. Which of the following is the most appropriate next step?
A. Heparin
B. Morphine
C. CT angiogram
D. Vascular Ultrasound

A

A. Heparin

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79
Q

A 40-year old healthy woman presents to Emergency Room with a 4-hour history of sudden onset right lower limb pain. Her examinaton reveals intact femoral pulse but absent distal pulses, diminished sensory exam with an altered motor exam. Her labs are normal (see report). Blood pressure 110/70 mmHg Heart rate 95 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 98 % ECG: Shows atrial fbrillaton. Which of the following is the most appropriate management?
A. Femoral embolectomy
B. Above knee amputaton
C. Catheter-directed thrombolysis
D. Heparinizaton and observaton

A

A. Femoral embolectomy

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80
Q

A 40-year old healthy woman presents to Emergency Room with a 4-hour history of sudden onset right lower limb pain. Her examinaton reveals intact femoral pulse but absent distal pulses, diminished sensory exam with an altered motor exam, Her labs are normal (see report). Blood pressure 110/70 mmHg Heart rate 95 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 98 % ECG: Shows atrial fbrillaton. Which of the following is the most appropriate investgaton?
A. CT angiogram
B. Vascular ultrasound
C. Conventonal angiogram
D. Embolectomy with no imaging

A

D. Embolectomy with no imaging

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81
Q

A 62-year-old man known diabetes and hypertension presents with 4-hour history of sudden lef leg pain, he had a history of lef leg pain afer walking 200 meters that make him stop and is relieved by rest. He is on oral hypoglycemic and statn but not compliant to medicaton and has been smoking for the last 40 years. Pulse examinaton on the lef reveals present femoral absent popliteal and distal, his right leg revealed intact femoral and popliteal but diminished distal pulses (see lab results and report). Blood pressure 110/70 mmH Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 95 % Test Result Normal Values Random Glucose 10 3.9-5.5 mmol/L НА1C 8 4.7-5.6 % ECG: Normal. Which of the following is the most appropriate investgaton?
A. CT angiogram
B. Vascular ultrasound
C. Conventonal angiogram
D. Magnetc resonant angiogram

A

A. CT angiogram

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82
Q

A 62-year-old man known diabetes and hypertension presents with 4-hour history of sudden lef leg pain, he had a history of lef leg pain afer walking 200 meters that make him stop and is relieved by rest. He is on oral hypoglycemic and statn but not compliant to medicaton and has been smoking for the last 40 years. Pulse examinaton on the lef reveals present femoral absent popliteal and distal, his right leg revealed intact femoral and popliteal but diminished distal pulses (see lab result and report). Test Result Normal Values Random Glucose 7 3.9-5.5 mmol/L ECG: Normal. Which of the following is the most appropriate next step?
A. Heparin
B. Morphine
C. CT angiogram
D. Vascular Ultrasound

A

A. Heparin

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83
Q

A 62-year-old man known case of DM HT presents with 4-hour history of sudden lef leg pain, the patent had a history of lef leg pain afer walking 200 meters that make him stop and is relieved by rest. He is on an oral hypoglycemic and a statn but he is not compliant to his medicaton. He has been smoking for the last 40 years. His pulse exam on the lef reveals present femoral absent popliteal and distal, his right leg revealed intact femoral and popliteal but diminished distal pulses His labs are normal apart from an elevated BSL (see report). ECG: Normal. Which of the following is the most appropriate management?
A. Catheter-directed thrombolysis
B. Femoral thrombectomy
C. Above knee amputaton
D. Heparinizaton and observaton

A

A. Catheter-directed thrombolysis

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84
Q

A 62-year-old man known diabetes and hypertension presents with 4-hour history of sudden lef leg pain, he had a history of lef leg pain afer walking 200 meters that make him stop and is relieved by rest. He is on oral hypoglycemic and statn but he is not compliant to medicaton. He has been smoking for the last 40 years. Pulse examinaton on the lef reveals present femoral absent popliteal and distal, his right leg revealed intact femoral and popliteal but diminished distal pulses. The patent had a successful thrombolysis with an endovascular correcton of a long stenosis segment (see lab result and report). Test Result Normal Values Random Glucose 7 3.9-5.5 mmol/L ECG: Normal. Which of the following is the most common cause of death during his hospital stay?
A. Stroke
B. Bleeding
C. Pulmonary embolism
D. Myocardial infarcton

A

D. Myocardial infarcton

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85
Q

A 54-year-old man known diabetc and heavy smoker presents with a history of classic vascular claudicaton of his lef leg afer 100m walk to the mosque. His pulse examinaton reveals intact pulses on the right leg and diminished distal pulses below the popliteal artery. Which of the following is the most appropriate way to improve his claudicaton distance?
A. Dual antplatlet therapy
B. Supervised exercise program
C. Supervised smoking cessaton
D. Aggressive blood sugar control start program

A

B. Supervised exercise program

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86
Q

A 54-year-old man known diabetc and heavy smoker presents with a history of classic vascular claudicaton of his lef leg afer 100m walk to the mosque. His pulse examinaton reveals intact pulses on the right leg and diminished distal pulses below the popliteal artery. Which of the following is the most appropriate investgaton?
A. MRA
B. CT angiogram
C. Conventonal angiogram
D. None-invasive vascular lab exam

A

D. None-invasive vascular lab exam

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87
Q

A 54-year-old man known diabetc and heavy smoker presents with a history of classic vascular claudicaton of his lef leg afer 100m walk to the mosque. His pulse examinaton reveals intact pulses on the right leg and diminished distal pulses below the popliteal artery. Which of the following is the most appropriate management?
A. Medical risk factor stratfcaton
B. Surgical bypass of the stenosis lesion
C. Endovascular repair of the stenotc lesion
D. Smoking cessaton aggressive blood sugar level control

A

A. Medical risk factor stratfcaton

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88
Q

A 32-year-old woman presents with 5-year history of spider veins that are asymptomatc but she wants to treat it cosmetcally. Her pulse examinaton is normal and there is no other varicosites noted part from the anterior thigh spider veins. Which of the following is the most appropriate investgaton?
A. CT venography
B. Venous plethysmography
C. No investgaton needed
D. Venous duplex ultrasound

A

C. No investgaton needed

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89
Q

A 32-year-old woman presents with 5-year history of spider veins that are asymptomatc but she wants to treat it cosmetcally. Her pulse examinaton is normal and there is no other varicosites noted part from the anterior thigh spider veins. Which of the following is the most appropriate management?
A. Sclerotherapy
B. Endovenous ablaton
C. Ligaton and stripping of GSV
D. Dafon, micronized purifed favonoid fracton 500m PO twice daily

A

A. Sclerotherapy

90
Q

A 46-year-old woman presented with a 6-year history of bilateral varicosites, she complained of heaviness during standing and bilateral lower limb swelling. There is no history of claudicaton or rest pain. Examinaton revealed intact distal pulses and bilateral varicose on the GS territory Which of the following is the most appropriate investgaton?
A. CT venography
B. Venous plethysmography
C. No investgaton needed
D. Venous duplex ultrasound

A

D. Venous duplex ultrasound

91
Q

A 46-year-old woman presented with a 6-years history of bilateral varicosites, she complained of heaviness during standing and bilateral lower limb swelling. There is no history of claudicaton or rest pain. Examinaton revealed intact distal pulses and bilateral varicose on the great saphynous vein (GS) territory. Which of the following is the most appropriate management?
A. Sclerotherapy
B. Endovenous ablaton
C. Ligaton and stripping of GSV
D. Dafon, micronized purifed favonoid fracton 500mg PO twice daily

A

B. Endovenous ablaton

92
Q

A 62-year-old man presents with an incidental fnding of a 4.5 cm abdominal aortc aneurysm and gallstones on an ultrasound done for biliary colic, the general surgeon decided to do a laparoscopic cholecystectomy and referred him to vascular surgery for an opinion. Which of the following is the most appropriate recommendaton of the vascular surgeon?
A. Proceed with surgery and follow up with US
B. CT angiography before proceeding for surgery
C. Proceed with surgery and follow up with CT angiography
D. Conventonal angiography before proceeding for surgery

A

B. CT angiography before proceeding for surgery

93
Q

A 72-year-old man known to have diabetes and hypertension presents with an ingrowing toenail. Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 99 % Height 160 cm BMI 20 kg/m2 Which of the following is the most appropriate step before operatng on the toe?
A. Start antbiotcs
B. Examine the other toes
C. Swab the toe for culture
D. Examine peripheral pulses

A

D. Examine peripheral pulses

94
Q

A 54 year old man known to have diabetes and hypertension presents to the clinic with an ulcer over the right lateral malleolus for 3 months. Examinaton revealed intact distal pulses. Which of the following the most appropriate next step?
A. MRA
B. CT angio
C. Conventonal angio
D. Venouse duplex of right lower limb

A

D. Venouse duplex of right lower limb

95
Q

A 32-year-old woman presents with a 2-day history of right lower limb swelling, no history of trauma. Examinaton reveals bluish discoloraton of the foot and intact distal pulses. Blood pressure 110/70 mmH Heart rate 90 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 99 % Which of the following is the most appropriate next best step in diagnosis?
A. CT angio
B. CT venogram
C. Venouse duplex
D. Arterial duplex

A

C. Venouse duplex

96
Q

A 55-year-old man hypertensive with renal insufciency was fully evaluated for arteriovenous fstula creaton, he has intact distal pulses and no history of trauma or vascular procedures on his non-dominant hand. Which of the following fstula type should be ofered frst?
A. Radio-cephalic
B. Brachio-basilic
C. Brachio-cephalic
D. Basilic vein transpositon

A

A. Radio-cephalic

97
Q

A 50-year-old man post-kidney transplant, 2-year on steroid treatment underwent emergency exploratory laparotomy for intestnal obstructon. Which of the following will most likely promotes his wound healing?
A. Vitamin A
B. Vitamin B1
C. Vitamin B2
D. Vitamin C

A

A. Vitamin A

98
Q

A 45-year-old man had laparoscopic cholecystectomy, developed fever on 3rd postoperatve day. He had no abdominal pain. Temperature 38.6 °C Which of the following is most likely diagnosis?
A. Chest infecton
B. Wound infecton
C. Urinary tract infecton
D. Intra-abdominal abscess

A

C. Urinary tract infecton

99
Q

A 40-year-old woman complains of painful right breast mass for 6 months increasing in size. Examinaton confrms a 3 cm mass at 9 O’clock (see report). Core biopsy: Benign phyliodes tumor. Which is the following the most appropriate treatment?
A. Wide local excision
B. Simple mastectomy
C. No surgical interventon
D. wide local excision with radiaton therapy

A

A. Wide local excision

100
Q

A 35-year-old woman had abdominal ultrasound as part of screening for essental hypertension. She has no abdominal symptoms (see report). Ultrasound Abdomen: Gall bladder single polyp measures 0.6 cm, no stones, and normal bile ducts. Which is the following is the most appropriate management?
A. Surgical consultaton
B. No further interventon
C. Check Liver functon test
D. Follow up ultrasound within 6 months

A

A. Surgical consultaton

101
Q

A 33-year-old women presents with history of right upper quadrant pain and yellow sclera. Examinaton reveals unwell patent with abdominal tendemess but no guarding (see lab results and report). Test Result Normal Values Total bilirubin 30 3.5-16.5 mol/L WBC 15 4.5-10.5 x 109/L Alkaline phosphatase 280 39-117 IU/L Ultrasound of Abdomen: Multple gallstone, no precholecystc fuid, common bile duct is dilated and measures 1 cm. Which is the following is most likely diagnosis?
A. Acute pancreatts
B. Acute chioecystts
C. Choledocholithiasis
D. Ascending cholangits

A

D. Ascending cholangits

102
Q

A 19-year-old man was involved in road trafc accident underwent emergency splenectomy. Which the following is the optmal post-operatve tming for administraton of pneumococcal vaccine?
A. 2 day
B. 1 week
C. 2 weeks
D. 1 month

A

C. 2 weeks

103
Q

A 31-year-old man was involved in road trafc accident; examinaton revealed he is fully oriented GCS15/15 before reaching the hospital paramedic reported interval unresponsiveness. The patent suddenly lost consciousness and dilataton of lef pupil was noted (see report). X-ray of the skull: Lef temporal fracture. Which is the following most likely diagnosis?
A. Ruptured arteriovenous malformaton
B. Subdural hematoma
C. Epidural hematoma
D. Basal skull fracture

A

C. Epidural hematoma

104
Q

A 30-year-old man presented with history of bleeding per rectum. Anoscopy examinaton revealed swelling at 3,7 o’clock positon. A treatment with injecton of sclerosing agents is planned. Which of the following is most indicated for sclerosing therapy?
A. External haemorrhoids
B. Internal haemorrhoids
C. Prolapsed haemorrhoids
D. Thrombose haemorrhoids

A

B. Internal haemorrhoids

105
Q

A 5-year-old boy presents to Emergency Room because the parents notced that there is only one tests in the scrotum. Examinaton reveals that one tests is in the scrotum while the other one is felt in the inguinal canal. Which the following is the most appropriate treatment?
A. Orchidopexy
B. Orchidectomy
C. Wait tll puberty
D. Androgens administraton

A

A. Orchidopexy

106
Q

A 6-year-old boy presents with a fracture of femur (mid shaf) with 30% of anterior angulaton. Which of the following is the most appropriate treatment?
A. Tracton and bed rest
B. Closed reduction and hip a Spica cast
C. Open reducton and intramedullary fxaton
D. Open reducton and internal fxaton (plate)

A

B. Closed reduction and hip a Spica cast

107
Q

A 45-year-old man diagnosed as short bowel syndrome on total parenteral nutriton developed weakness vertgo and convulsions. Which of the following is the most like diagnosis?
A. Hyperkalemia
B. Hypokalemia
C. Hyperammonemia
D. Hypomagnesemia

A

D. Hypomagnesemia

108
Q

A 30-year-old women 16-week pregnant presents with nausea, vomitng and right sided abdominal pain. The obstetrician excluded any pregnancy related cause for pain. Temperature 37.8 °C Which of the following is the most likely cause?
A. Gastrits
B. Pancreatts
C. Cholecystts
D. Appendicits

A

D. Appendicits

109
Q

A 45-year-old man farmer presented with history of right side abdominal pain, vomitng and fever. Examinaton confrmed tenderness in right upper quadrant (see report). Temperature 37.6 °C CT abdomen: Calcifed cyst 5X6 cm. Hydatd cvst (echinococous ) was confrmed. Which of the following is the most appropriate treatment?
A. Surgical excision
B. Administraton of steroid
C. Percutaneous catheter drainage
D. Administraton of metronidazole

A

A. Surgical excision

110
Q

A 45-year-old man farmer presented with history of right side abdominal pain, vomitng and fever. Examinaton confrmed tenderness in right upper quadrant (see report). Temperature 37.6 °C CT abdomen: Calcifed cyst 5X6 cm. Hydatd cvst (echinococous ) was confrmed. Which of the following is the most appropriate treatment?
A. Surgical excision
B. Administraton of steroid
C. Percutaneous catheter drainage
D. Administraton of metronidazole

A

A. Surgical excision

111
Q

A 35-year-old man presents with history of dyspnea during sleep and swallowing discomfort for 4 month. He is a known case of asthma (see report). Chest X-ray: Midline mass compressing trachea. Which of the following is the most like diagnosis?
A. Goiter
B. Thymoma
C. Lymphoma
D. Lung cancer

A

A. Goiter

112
Q

A 20-year-old women presents with history of dysphagia that was more with liquid than solid. Which of the following is the most appropriate frst investgaton?
A. Barium swallow
B. Upper GI endoscopy
C. Ultrasound of chest
D. CT scan of the chest

A

A. Barium swallow

113
Q

A 55-year-old woman complained of difculty in breathing 6-hour post total thyroidectomy. Examinaton confrmed the presence of large neck swelling. Which of the following is the most appropriate next step in management?
A. Treacheostomy
B. IV calcium glucante
C. Epinephrine injecton
D. Open the wound sutures in the ward

A

D. Open the wound sutures in the ward

114
Q

A 20-year-old man presents to Emergency Department with renal colic. Which of the following is most diagnostc imaging?
A. MRI abdomen
B. X-ray KUB region
C. CT scan abdomen
D. Ultrasound abdomen

A

C. CT scan abdomen

115
Q

A 4-year-old boy presented with history of pain above his right knee. Examinaton revealed there is swelling at distal femur no limitaton of knee movement (see report). X-ray: 3x3 sclerotc bone lesion at distal femur. Which of the following is most likely diagnosis?
A. Osteosarcoma
B. Chondrosarcoma
C. Ewing’s sarcoma
D. Periosteal sarcoma

A

A. Osteosarcoma

116
Q

A 23-year-old military man presented to the clinic with history of bilateral groin swelling. Examinaton revealed there was bilateral inguinal hernia. Which of the following is the most appropriate treatment?
A. Observaton
B. Open repair with mesh
C. Open repair without mesh
D. Laparoscopic repair with mesh

A

D. Laparoscopic repair with mesh

117
Q

A 50-year-old woman presented with history of right upper guardant pain for the last 5 months associated with jaundice for 4 days. Examinaton revealed unwell patent, tender abdomen but no rebound. The patent started on I.V antbiotc (see report). Blood pressure 99/70 mmH, Heart rate 100 /min, Temperature 38 °C Ultrasound: Gall bladder stones, dilated common bile duct with stone. Which is the following is the most appropriate treatment?
A. Lithotripsy
B. Open surgery
C. Laparoscopic cholecystectomy
D. Endoscopic retrograde cholengiopancreatography ERCP

A

D. Endoscopic retrograde cholengiopancreatography ERCP

118
Q

A 64-year-old man is involved in a high-speed car crash. He is resuscitated initally in a small hospital with limited resources he has head injury. It was decided to transfer this patent to trauma center, which is 40 km away (see report). Blood pressure 110/70 mmHg, Heart rate 100 /min Respiratory rate 18 /min Temperature 36.6 °C X-ray chest: Widened mediastnum with fractures lef ribs 2-5 but no pneumothorax. Which is the following the most appropriate next step?
A. Insert chest tube
B. Intubate the patent
C. Perform diagnostc peritoneal lavage
D. Call the receiving hospital and speak to the surgeon on call

A

D. Call the receiving hospital and speak to the surgeon on call

119
Q

A 30-year-old man presented to the Surgical Clinic while taking medical history he want his perceptons of why he felt ill and the doctor wants more detail about his symptoms and medical problems. Which is the following the most appropriate response?
A. Allow him to complete his thought
B. Inform him to change his appointment with other doctor
C. Till him other patent are waitng outside and clinic is busy now
D. Politely interrupt him and contnue with close-ended queston

A

A. Allow him to complete his thought

120
Q

A 22-year-old women presented to Surgery Clinic wearing revealing cloths, she come up very close to the doctor asking personal queston in sedatve tone with a language that is diferent from atending nurse language. Which is the following is the best response by the doctor?
A. Shout at here
B. Call the security
C. Refer to other doctor
D. Call for other nurse talk same language

A

D. Call for other nurse talk same language

121
Q

A 70-year-old man presented with history of skin lesion over the right check (see report). Skin biopsy: Malignant melanoma. Which is the following is best way to make the patent comply with medical advice?
A. The illness has serous symptoms
B. He believes you are professional and right
C. Explain pathophysiology using medical terminology
D. Taking tme to provide informaton and gain his trust

A

D. Taking tme to provide informaton and gain his trust

122
Q

A 23-year-old woman presented to the Surgical Clinic with a 1 X2 cm skin lesion in the lef forearm since childhood. Which of the following is the most appropriate treatment?
A. Laser
B. Excision
C. Radiation
D. Follow up

A

B. Excision

123
Q

A 43-year-old man presented to the Surgical Clinic complaining of a dark colored pigmented skin lesion in the upper thigh for few months. Examinaton revealed a 3 X 4 cm dark colored skin lesion at the anterior aspect of right thigh with irregular borders and it was elevated above the skin. Which of the following is the most appropriate next step in management?
A. Excision
B. Bunch biopsy
C. Radiotherapy
D. Chemotherapy

A

A. Excision

124
Q

A 47-year-old woman presented to the Emergency Department complaining of painful cord-like swelling in the calf of lef leg for 48 hours. She gave history of varicose veins for 20 years. Which of the following is the most appropriate inital treatment?
A. Non-steroidal ant-Infamatory drugs
B. Clexane
C. Heparin
D. Antbiotcs

A

A. Non-steroidal ant-Infamatory drugs

125
Q

A 45-year-old man presents to the Emergency Department complaining of severe abdominal pain, which was increasing in intensity with tme. Patent underwent laparoscopic sleeve gastrectomy 3 weeks back. Which of the following is the most appropriate diagnostc test?
A. Ultrasound Abdomen
B. Plain Abdominal X-ray
C. Diagnostc laparoscopy
D. CT scan abdomen with contrast

A

D. CT scan abdomen with contrast

126
Q

A 45-year-old man presents to the Emergency Department complaining of severe abdominal pain, which was increasing in intensity with tme. Patent underwent laparoscopic sleeve gastrectomy 3 weeks back. which of the following is the most appropriate management?
A. Endoscopy
B. Exploraton
C. Nil per mouth
D. Antcoagulaton

A

D. Antcoagulaton

127
Q

A male newborn develops sudden respiratory distress (see report). Chest radiograph: A hyperlucent lef upper lobe with adjacent lobar compression and mediastnal shif to the right. Which of the following is most appropriate treatment?
A. Intubaton
B. Thoracotomy
C. Bronchoscopy
D. Thoracostory

A

B. Thoracotomy

128
Q

A 5-week-old boy presents with persistent progressive projectle vomitng. Which of the following is the most appropriate next step in management?
A. Antemetcs
B. Normal saline
C. Ringer lactate
D. Potassium chloride

A

B. Normal saline

129
Q

A 3-year-old boy presented to Emergency Department with progressive abdominal pain and vomitng. Examinaton revealed distended abdomen. Which of the following is the most appropriate inital management?
A. MRI abdomen
B. CT scan abdomen
C. Ultrasound abdomen
D. Plain abdominal X-ray

A

C. Ultrasound abdomen

130
Q

A 10-month-old girl brought by her family because of swelling in the umbilicus, which becomes more obvious when she is crying and disappears during sleeping. Which of the following is the most appropriate management?
A. Follow up
B. Mesh repair
C. Simple repair
D. Laparoscopic repair

A

A. Follow up

131
Q

A 40-old woman had laparoscopic Roux-en-Y gastric bypass 5 days ago, presented with pain at the lef shoulder, fever and rigors. Blood pressure 90/60 mmH Heart rate 120 /min Temperature 38.6 °C Which of the following is the most appropriate next step in management?
A. Endoscopy
B. Ultrasound abdomen
C. Diagnostc laparoscopy
D. CT scan abdomen with contrast

A

D. CT scan abdomen with contrast

132
Q

A 26-year-old woman presented 17 days afer laparoscopic sleeve gastrectomy complaining of persistent vomitng and change of her mode according to the family. Examinaton revealed sof abdomen (see reports). Ultrasound abdomen:Normal. CT scan abdomen: Normal. Which of the following is the most appropriate management?
A. Endoscopy
B. Reassurance
C. Diagnostc laparoscopy
D. Psychiatry consultaton

A

D. Psychiatry consultaton

133
Q

A 30-year-old woman who is 10-week pregnant and known case of gallstone presents to the Surgical Clinic complaining of recurrent atacks of biliary colic for the last 5 weeks. Which of the following is the most appropriate management?
A. Immediate laparoscopic cholecystectomy
B. Laparoscopic cholecystectomy afer delivery
C. Laparoscopic cholecystectomy in 2nd trimester
D. Laparoscopic cholecystectomy in 3rd trimester

A

C. Laparoscopic cholecystectomy in 2nd trimester

134
Q

A 73-year-old man presented with abdominal pain and constpaton for 1 week. Workup revealed a sigmoid cancer. He underwent laparoscopic surgery with a plan to perform a resecton with a proximal colostomy. During the operaton, his vital signs changed. Blood pressure 86/45 mmHg Heart rate 124 /min Temperature 36.8 °C Which of the following is the most appropriate next step in management?
A. Chest X-ray
B. Echocardiography
C. Convert laparotomy
D. Terminate the surgery

A

B. Echocardiography

135
Q

A 65-year-old man presented to the Emergency Department with pain over the angle of his mouth for 24 hours. He underwent laparoscopic cholecystectomy 8 days prior to presentaton. Blood pressure 110/72 mmHg Heart rate 104 /min Temperature 38.8 °C Which of the following is the most appropriate management?
A. CT scan
B. Plain X-ray
C. Antibiotics
D. Paracetamol

A

C. Antibiotics

136
Q

A 25-year-old woman underwent appendectomy. 20 hours afer the surgery, she was complaining of severe pain at the wound site with purulent discharges. Blood pressure 100/55 mmHg Heart rate 114 /min Temperature 38.8 °C Which of the following is the most appropriate management?
A. Dressing
B. Antbiotcs
C. Observaton
D. Wound exploraton

A

D. Wound exploraton

137
Q

A 35-year-old man has been in the Intensive Care Unit with severe pancreatts, ventlator dependence, and pneumonia for 2 weeks. He is receiving nutriton parenterally (see lab results). Test Result Normal Values Platelets count 184 150-400 x 109/L Total bilirubin 4.6 3.5-16.5 mol/L APTT 36 30-40 sec INR 2,1 0.8-1.2 Which of the following is the most appropriate management?
A. Factor X
B. Vitamin K
C. Vitamin C
D. Factor VIll

A

B. Vitamin K

138
Q

A 58-year-old man had laparotomy with sigmoidectomy and colostomy for perforated divertculits, presented to the clinic complaining of intermitent atacks of fever for 1 week, Examinaton revealed normal chest and abdominal examinaton with healthy looking wound. Blood pressure 116/68 mmH Heart rate 106 /min Temperature 38.2 °C Which of the following is the most appropriate next step?
A. Exploraton
B. Reassurance
C. CT scan abdomen
D. Plain chest X-ray

A

C. CT scan abdomen

139
Q

A 41-year-old man underwent laparoscopic cholecystectomy 5 days back started to experience severe abdominal pain and distension. Examinaton revealed a distended tender abdomen (see report). Blood pressure 100/55 mmHg Heart rate 103 /min Temperature 37.9 °C Ultrasound: Revealed the presence of ascites. Which of the following is most appropriate management? A. Endoscopic retrograde cholangio pacreatcogram
B. Diagnostc laparoscopy
C. Exploratory laparotomy
D. Percutaneous aspiraton

A

B. Diagnostc laparoscopy

140
Q

A 36-year-old man was stabbed in the right lower quadrant of his abdomen 1 hour back. He complained of pain at the wound site. Local wound exploraton revealed penetraton of the anterior abdominal fascia. Blood pressure 110/62 mmHg Heart rate 87 /min Temperature 37.2 °C Which of the following is the most appropriate next step?
A. CT scan abdomen
B. Hospital observaton
C. Diagnostc laparoscopy
D. Exploratory laparotomy

A

A. CT scan abdomen

141
Q

A 40-year-old man had abdominal surgery 12 hours back; he noted drainage of 20 mL of fuid from her midline abdominal wound. Which of the following is the most appropriate management?
A. Dressing
B. Antbiotcs
C. CT scan abdomen
D. Wound exploraton

A

D. Wound exploraton

142
Q

A 40-year-old man who underwent a laparotomy and lysis for adhesive intestnal obstructon. On his regular follow up afer discharge, there was discharges from the middle of the wound. Which of the following is the most appropriate management? A. Daily dressing
B. Wound inspecton
C. Abdominal CT scan
D. Wound exploraton

A

B. Wound inspecton

143
Q

A 63-year-old woman comes to the clinic for an annual check-up. On examinaton, she has a small and asymptomatc right femoral hernia. Which of the following is the most appropriate management?
A. Observaton
B. Open mesh repair
C. Open simple repair
D. Laparoscopic repair

A

D. Laparoscopic repair

144
Q

A 45-year-old woman presented with postprandial right upper quadrant abdominal pain, nausea, and emesis for few days that became persistent for the last 20 hours (see lab results and report). Blood pressure 110/70 mmHg, Heart rate 87 /min Temperature 37.2 °C Test Result Normal Values WBC 11 4.5-10.5 x 109/L Direct bilirubin 9.5 1.5-6.5 mol/L Total bilirubin 18.5 3.5-16.5 mol/L Alkaline phosphatase 463 39-117 IU/L Ultrasound: Cholelithiasis, gallbladder wall thickening, and a common bile duct of 12 mm. Which of the following is the most appropriate management?
A. Endoscopic retrograde cholangio pacreatcogram (ERCP)
B. Magnetc resonant cholangio pacreatcogram (MRCP)
C. Laparoscopic cholecystectomy
D. Conservatve treatment

A

A. Endoscopic retrograde cholangio pacreatcogram (ERCP)

145
Q

A 73-year-old woman presents with new onset jaundice, generalized fatgability, weight loss and loss of appette (see report). CT scan: Multple lesions replacing approximately 70% of the liver parenchyma. Which of the following is the most appropriate management?
A. Colonoscopy
B. Upper Gl endoscopy
C. Percutaneous biopsy
D. Diagnostc laparoscopy

A

A. Colonoscopy

146
Q

Which of the following confrms proper positon of orotracheal intubaton?
A. Carbon dioxide monitor
B. Easy inserton
C. Movement of the chest
D. Distended abdomen

A

A. Carbon dioxide monitor

147
Q

A trauma patent who lost 25% of his blood volume. Which of the following is most expected to be decreased?
A. Urine output
B. Pulse pressure
C. Respiratory rate
D. Glasco coma scale

A

B. Pulse pressure

148
Q

Which of the following is the frst priority when managing long bone fracture?
A. Pain management
B. Improve functon
C. Decrease blood loss
D. Decrease sof tssue trauma

A

C. Decrease blood loss

149
Q

A 36-year-old man fell from a height of 4 meters, his GCS is 15 and vital signs are stable but he complains of severe bilateral heal pain. Which of the following the most appropriate next step?
A. Pain control
B. Examine pulses
C. Bilateral splint
D. Bilateral foot x-ray

A

B. Examine pulses

150
Q

An 18-year-old man involved in a hit and run, presented to the Emergency Room with multple facial fractures and signs of severe brain injury. Which of the following is the most appropriate next step?
A. Secure airway
B. Consult neurosurgery
C. Secure cervical spine
D. Minimize fuid resuscitaton

A

A. Secure airway

151
Q

Which of the following is a hard sign for vascular injury in a trauma patent?
A. Week pulse
B. Palpable thrill
C. Skin color change
D. Extensive fractures

A

B. Palpable thrill

152
Q

Which of the following is a hard sign for vascuoar injury?
A. Week pulse
B. Audible bruit
C. Skin color change
D. Extensive fractures

A

B. Audible bruit

153
Q

A 23-year-old woman involved in a motor vehicle accident, afer completng her primary and secondary survey and getng ready to transfer her to defnitve care. Her pregnancy test was positve. Which of the following will most indicates Rh immunoglobulin?
A. Rh positve, and abdominal trauma
B. Rh negatve, and abdominal trauma
C. Rh positve, and has a wrist fracture
D. Rh negatve, and has a wrist fracture

A

B. Rh negatve, and abdominal trauma

154
Q

A 42-year-old woman involved in a head on collision arrived at the Emergency Room talking coherently, with the following vital signs. Her examinaton revealed equal air entry bilaterally with ecchymosis on her anterior chest wall, distended neck veins and her abdomen is sof and lax. Blood pressure 90/60 mmH, Heart rate 130 /min, Respiratory rate 18/min Which of the following is the most likely diagnosis?
A. Cardiac tamponade
B. Cardiac contusion
C. Massive heamothorax
D. Bilateral tension pneumothorax

A

A. Cardiac tamponade

155
Q

An 18-year-old man presented to a tertary care hospital afer he was involved in a motor vehicle accident. Primary survey was conducted and he was stabilized. While getng ready to transfer him his pressure dropped down (see report). Blood pressure 60/40 mmHg CT scan: Thoracic aortc injury and a splenic laceraton with free fuid in the abdomen. Which of the following is the most appropriate transfer?
A. Angiography
B. Operatng room for laparotomy
C. Operatng room for thoracotomy
D. A center that has a vascular surgeon

A

B. Operatng room for laparotomy

156
Q

An 18-year-old man presented to the Emergency Room with bleeding from a deep 10 cm anterior laceraton of his right thigh. Which of the following is the most appropriate next step?
A. Apply tourniquet
B. Call a vascular surgeon
C. Put direct pressure on the wound
D. Put pressure on the femoral artery above the wound

A

C. Put direct pressure on the wound

157
Q

A 17-year-old girl was admited with a 20% burn transferred to the burn unit for proper resuscitaton. Which of the following goals will most indicates that adequate resuscitaton is achieved?
A. Normalizing heart rate
B. Normalizing blood pressure
C. Urine out of 0.6 ml/kg/hr
D. Central venous pressure of 12

A

C. Urine out of 0.6 ml/kg/hr

158
Q

The vascular surgeon was called for help in the Operatng Room by the colorectal surgeon who is doing a low anterior resecton for colon cancer as he encountered pelvic bleeding that he could not control, Which of the following is the most appropriate next step?
A. Do on table angiogram
B. Heavily pack the pelvis
C. Infra renal aortc clamp
D. Supra celiac aortc clamp

A

B. Heavily pack the pelvis

159
Q

The vascular surgeon was called for help in the Operatng Room by the colorectal surgeon who is doing a low anterior resecton for colon cancer as he encountered pelvic bleeding that he could not control, the pelvis was packed and the bleeding slowed down but the patent dropped his pressure again. Blood pressure 60/40 mmH. Which of the following is the most appropriate next step?
A. Do on table angiogram
B. Infra renal aortc clamp
C. Supra celiac aortc clamp
D. Remove the packs and repair the injury

A

C. Supra celiac aortc clamp

160
Q

A 56-year-old woman presents to the clinic with a non-healing ulcer over her right lateral Malleolus, she is hypertensive but not diabetc. Which of the following is the most appropriate next step?
A. Venous duplex
B. Arterial doppler US
C. Examine distal pulses
D. Do ankle brachial index

A

C. Examine distal pulses

161
Q

A 56-year-old woman presents to the clinic with a non-healing ulcer over her right lateral Malleolus, she is hypertensive but not diabetc. Her pulse examinaton is normal and her local examinaton shows dark discoloraton of the skin around the ulcer and a viable ulcer bed. Which of the following is the most appropriate next step?
A. CT angiogram
B. Venous duplex US
C. Arterial doppler US
D. Conventonal angiogram/venogram

A

B. Venous duplex US

162
Q

A 7-year-old girl presents with a vascular anomaly on her lef cheek. Which of the following is the most likely diagnosis?
A. Heamangioma
B. Venous malformatons
C. Arterio-venouse fstula
D. Lymphatc malformatons

A

A. Heamangioma

163
Q

A 13-year-old girl presents with a vascular malformaton of her lef leg that is growing over the years. Which of following will most indicates treatment and interventon?
A. Pain
B. Claudicaton
C. Cosmetc reasons
D. Congestve heart failure

A

D. Congestve heart failure

164
Q

A 38-year-old woman presents with swelling of her lef leg that is gradually increasing over the last 3 months, no history of travel or and surgeries over the last 6 months. Which of the following is the most important further history to obtain?
A. Smoking
B. History of trauma
C. Medicaton history
D. Family history of similar problems

A

B. History of trauma

165
Q

A 38-year-old woman presents with swelling of her lef leg that is gradually increasing over the last 3 months, no history of travel or surgeries or trauma over the last 6 months. Her distal pulses are palpable and her leg shows non-pitng edema with thickened skin and a dark discoloraton. Which of the following is the most appropriate next step in management?
A. CT angio
B. Conventonal venogram
C. Venous duplex ultrasound
D. Magnetc resonant venograoghy

A

C. Venous duplex ultrasound

166
Q

A 38-year-old woman presents with swelling of her lef leg that is gradually increasing over the last 3 months, no history of travel or surgeries or trauma over the last 6 months, no family history of similar problems. Her distal pulses are palpable and her leg shows non-pitng edema with thickened skin and a dark discoloraton. Which of the following is the most appropriate diagnostc test?
A. Lymphoscintgraphy
B. Venous duplex ultrasound
C. Conventonal angiography
D. Magnetc resonant venography

A

A. Lymphoscintgraphy

167
Q

A 38-year-old woman presents with swelling of her lef leg that is gradually increasing over the last 3 months, no history of travel or surgeries or trauma over the last 6 months. Her distal pulses are palpable and her leg shows non-pitng edema with thickened skin and a dark discoloraton. Which of the following is the most appropriate management?
A. Antcoagulaton
B. Lymphatc bypass
C. Prophylactc heparin
D. Lymphatc massage and compression bandage

A

D. Lymphatc massage and compression bandage

168
Q

A 70-year-old man presents with abdominal pain. Examinaton revealed a pulsatle abdominal mass felt on deep palpaton with mild tenderness just above the umbilicus (see lab results and report). Blood pressure 110/70 mmH Heart rate 76 /min Respiratory rate 14 /min Temperature 36.6 °C Oxygen saturaton 99 % Test Result Normal Values RBC 6.0 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 135 130-170 g/L (Male) 120-160 g/L (Female) HCT 0.42 0.42-0.52 (Male) 0.37-0.48 (Female) Platelets count 155 150-400 x 109/L WBC 13.5 4.5-10.5 x 109/L Sodium 136 134-146 mmol/L Potassium 4 3.5-5.1 mmol/L Bicarbonate 25 21-28 mmol/L Upright chest x-ray: No air under diaphragm. Which the following is the most appropriate lab investgaton to be ordered next?
A. Cl level
B. Amylase level
C. Calcium level
D. Arterial blood gas

A

B. Amylase level

169
Q

A 70-year-old man presents with abdominal pain. Examinaton revealed a pulsatle abdominal mass felt on deep palpaton with mild tenderness just above the umbilicus (see lab results and report). Blood pressure 110/70 mmH Heart rate 76 /min Respiratory rate 16 /min Temperature 36.6 °C Oxygen saturaton 99 %
Test Result Normal Values RBC 6.0 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 135 130-170 g/L (Male) 120-160 g/L (Female) HCT 0.42 0.42-0.52 (Male) 0.37-0.48 (Female) Platelets count 155 150-400 x 109/L WBC 13.5 4.5-10.5 x 109/L Sodium 136 134-146 mmol/L Potassium 4 3.5-5.1 mmol/L Bicarbonate 25 21-28 mmol/L Alanine aminotransferase 10 5-40 IU/L Aspartate aminotransferase 20 12-40 IU/L Amylase 100 24-151 IU/L Lactate dehydrogenase 70 60-160 IU/L Lipase 100 0-160 IU/L Urea 3.5 2.75-7.4 mmol/L Blood urea nitrogen 7.0 2.8 to 8.9 mmol/. Creatnine 69 44-115 mol/L Upright chest x-ray: No air under diaphragm. Abdominal X-Ray: Unremarkable. Which of the following is the most appropriate diagnostc test?
A. US abdomen
B. CT angiogram
C. MR angiography
D. Conventonal angiography

A

B. CT angiogram

170
Q

A 5-day-old cyanotc infant with a diagnosis of Tricuspid Atresia. Which of the following is the most important issue to consider during the discussion with parents?
A. Make sure that you have lef no queston unanswered
B. Make sure the parents understand the dismal prognosis
C. Make sure the parents understand that you are doing everything you can
D. Make sure you leave the parents with a follow-up plan and provide them cardiac consultaton

A

D. Make sure you leave the parents with a follow-up plan and provide them cardiac consultaton

171
Q

A 3-month-old infant diagnosed with congestve heart failure with follow-up by cardiology. Mother asks regarding the nutritonal needs for her infant. What is the most appropriate counseling should be given?
A. Less than a healthy infants
B. The same as 2-year-old infant
C. The same as a healthy infants
D. Greater than a healthy infants

A

D. Greater than a healthy infants

172
Q

A 7-year-old boy case of congestve heart failure on digoxin. Which of the following is the most important step to improve his compliance?
A. Explain to child’s parents
B. Send a nurse to his home to check on compliance
C. Having the child partcipate in devising the plan
D. Inform the family about side efects of medicaton

A

C. Having the child partcipate in devising the plan

173
Q

Which of the following is the best advice to decrease anxiety of a child’s parents who is scheduled for cardiac surgery?
A. Obtain an order for ant-anxiety medicaton for the parents
B. Explain the steps that will occur before and afer surgery
C. Send educaton material to parents and the child about the surgery
D. Tell the parents not to worry, because the surgeon performs this procedure daily

A

B. Explain the steps that will occur before and afer surgery

174
Q

A child with tetralogy of fallot present for regular check-up. Mother asks why her child squats afer exerton. Which of the following is the best explanaton?
A. Reduces muscle aches
B. Increases cardiac efciency
C. Enhances the pull of gravity
D. Decreases blood volume in the extremites

A

B. Increases cardiac efciency

175
Q

A 6-week-old infant presents to Well Baby Clinic by the mother complains that her baby “spitng up” all for julia since birth. The baby weighs 5.5 kg and birth weight was 3.4 Kg What is the most appropriate counseling should be given?
A. Refer the child to a pediatric gastroenterologist
B. Return home and relax; the child will grow out of it
C. Start investgatng the child for pyloric stenosis immediately
D. Increase the tme spent burping the infant and keep the infant semi upright afer feedings

A

D. Increase the tme spent burping the infant and keep the infant semi upright afer feedings

176
Q

A 10-years-old boy diagnosed atenton defcit hyperactvity disorders, presents with his mother the clinic. She complains about his behavior. She is advised to identfy and reward positve behaviors and ignore disruptve. Which of the following helps to achieve this advice?
A. Systemic family therapy
B. Parent training programs
C. Behavior management techniques
D. Time-out from positve reinforcement

A

C. Behavior management techniques

177
Q

A 2-year-old boy presents with his mother complains that her child rebelling constantly with temper tantrums. What is the most appropriate counseling should be given?
A. Use tme out technique
B. Set limits on the child’s behavior
C. Punish the child every tme the child says “no*
D. Allow the behavior because this is normal at this age period

A

B. Set limits on the child’s behavior

178
Q

Advising a mother regarding introducing solid foods to her child diet. Which of the following is the most appropriate advice?
A. Mix diferent foods together
B. Begins with one tablespoon of food
C. Eliminate a refused food from the diet
D. Introduces each new food 4 to 7 days apart

A

D. Introduces each new food 4 to 7 days apart

179
Q

When assessing development in a 9-month-old infant, which of the following is expected to observe at this age?
A. Creeping along the foor
B. Speaking in 2-word sentences
C. Grasping objects with palmar grasp
D. Beginning to use a spoon rather sloppily

A

C. Grasping objects with palmar grasp

180
Q

A 7-month-old infant visits Well Baby Clinic. Which of the following this infant should be able to do?
A. Release cubes into a cup
B. Hold crayon and draw a circle
C. Transfer objects from one hand to the other
D. Use thumb and index fnger in crude pincer grasp

A

C. Transfer objects from one hand to the other

181
Q

A 4-year-old child known to have bronchial asthma presents with the mother for primary clinic checkup. There is family history of asthma and father smokes at home. What is the most appropriate counselling should be given?
A. Reassure the mother for now
B. Refer the child for allergy test
C. Prescribe inhaled steroid for regular use
D. Counseling his parents regarding smoking cessatons

A

D. Counseling his parents regarding smoking cessatons

182
Q

A 12-year-old boy complains of bilateral leg pain at night tme. He is diagnosed with growing pain. What would be the best management?
A. Refer to orthopedic clinic
B. Use aspirin to relive the pain
C. Request bilateral lower limp X-ray
D. Reassure the mother and the child

A

D. Reassure the mother and the child

183
Q

A 2-day-old baby seen in clinic with mother for counselling about breasteeding. Which of the following indicates adequate breasteeding in a baby?
A. Stool 4 tmes/day
B. Urine 2-3 tmes/ day
C. Does not cry frequently
D. Baby sleeps 2 hour afer feeds

A

A. Stool 4 tmes/day

184
Q

A 20-day-old premature baby brought to the clinic with the mother for counselling about breast feeding. Which of the following is low in mother’s milk afer premature delivery?
A. Fat
B. Protein
C. Lactose
D. Sodium

A

C. Lactose

185
Q

A 2-week-old baby girl brought by her mother to the clinic because she notced mucus vaginal discharge. Baby is product of spontaneous vaginal delivery with normal urine and stool. Diagnosis is mucoid vaginal discharge. Which of the following is the best response to this mother’s concern?
A. Take swab
B. Request urinalysis
C. Refer to pediatrician
D. Reassure the mother

A

D. Reassure the mother

186
Q

A 7-year-old boy presented to Emergency Department with newly diagnosed acute diabetc ketoacidosis. which of the following is most essental element in management plan to ensure compliance?
A. Refer to health educator
B. Provide writen management plan
C. Involve the child in type diabetc patent’s group
D. Listen closely to the child’s concerns and questons

A

D. Listen closely to the child’s concerns and questons

187
Q

A 7-year-old boy admited with acute diabetc ketoacidosis. Mother states that her son was diagnosed with type diabetes mellitus started on insulin but she decided to stop it, as she was not sure of her son’s diagnosis and thought to give chance for his pancreas to recover. Which of the following term describes the mother acton?
A. Denial
B. Anxiety
C. Neglect
D. Depression

A

A. Denial

188
Q

A 9-year-old boy just diagnosed with growth hormone defciency. In family meetng with the child and his patents afer making introductons, the doctor makes the following comment, “I’d like to go over the diagnosis, then talk about what might happen next, that’s to say how you might progress. then I’ll try to answer all your questons” Which of the following describes doctor phrase?
A. Probing
B. Agenda setng
C. Safety netng
D. Checking understanding

A

B. Agenda setng

189
Q

An 8-year-old girl complaints of recurrent periumbilical pain lastng for 10-15 min morning tme, no vomitng or loose stools. Abdomen examinaton is normal. Urine and stool analysis are normal. Mother says this pain is only during school days. Counseling to the mother and the teacher to manage school phobia/refusal includes behavior-management strategies such as providing positve reinforcements. Which of the fowling is an example of positve reinforcements?
A. Allow student to have more TV tme at home
B. Comments focus on what the student did right
C. Give the student moderately challenging task to perform
D. Keep records of number of absent days during the semester

A

B. Comments focus on what the student did right

190
Q

A 6-year old girl presents to the clinic with malnutriton. She seems to be neglected with poor hygiene. Her mother express feeling anxious and busy with other children at home with poor social circumstances. During consultaton, it is essental to explore mother perspectve, feeling. ideas and beliefs. Which of the following is the best next step?
A. Refer to social worker
B. Use close ended questons
C. Refer mother to psychiatry
D. Encourage the mother to use her own words to clarify the issues

A

D. Encourage the mother to use her own words to clarify the issues

191
Q

A 6-year-old boy presents with his mother to outpatent clinic with malnutriton, he seems to be neglected with poor hygiene. Which of the following is an important skill needed to conduct consultaton?
A. Lay out the consultng room with toys
B. Ask the mother to leave the room
C. Call the nurse to take vital sings, height and weight
D. Put aside tme at the beginning to build rapport with him

A

D. Put aside tme at the beginning to build rapport with him

192
Q

A 42 hours-old full-term infant has not yet passed meconium was diagnosed with cystc fbrosis afer Sweat chloride test. Family meetngs with parents to discuss the diagnosis, management plan. The physician pulls together the main ideas, plan of management, prognosis and feelings of the parents to show understanding. Which of the following describe the technique in this communicaton skill?
A. Refecton
B. Summarizing
C. Paraphrasing
D. Verbal mirroring

A

B. Summarizing

193
Q

A 14-month-old child is brought by his father with 2nd degree burns on both feet. He states that the child dipped in very hot bathtub water. There is a clear distncton line on the burn with no splash burns. There are other burses on the child limps of diferent age. Child abuse suspected. Which of the following is the correct order of the four important advocacy skills for mandated reporters of child abuse?
A. Observing, documentng, reportng, self-care
B. Documentng, confrming, reportng. conferencing with parents
C. Observing. gathering informaton, making referrals, following up
D. Observing, making referrals, gathering informaton, following up

A

D. Observing, making referrals, gathering informaton, following up

194
Q

A 10-year-old boy comes with his uncle for follow-up afer major car accident where he lost his mother and his 2 brothers. The uncle is worried afer receiving teacher’s note regarding child behavior in the class. Teacher wrote that the child becomes unresponsive sometmes, has a lapse in atenton. He stares at nothing, and act as if he just woke up in response to being called to atenton.Which of the following term describe child’s response mechanism?
A. Blame
B. Anger
C. Denial
D. Disassociaton

A

D. Disassociaton

195
Q

A 15-year-old boy brought by concerned mother for an evaluaton her son problem of 3 months afer the death of his friend in car accident, reluctantly mentoned to his mother that he wished he were dead, but would never do anything about these wishes. Which of the following is the most appropriate acton?
A. Asking him about his suicide may increase the risk
B. Indirect inquiries about his suicide risk will foster rapport
C. Since this is a normal grief reacton, he should be lef alone
D. Detailed questons about his suicidality are essental for preventon

A

D. Detailed questons about his suicidality are essental for preventon

196
Q

Surgical intern is assigned to stay with a 6-year-old boy who is waitng to have surgery to repair a clef palate. The boy does not speak Arabic and appears anxious. The charge nurse has requested a translator but the translator has not yet arrived. Which of the following is the most appropriate acton for the intern to do?
A. Insert IV cannula and start preanesthetc
B. Sedate the child to decrease her anxiety level
C. Suggest that the nurse stay with the child so that he can review her chart
D. Listen to the child’s heart with a stethoscope and then let the child try to use the stethoscope to listen to his heart

A

D. Listen to the child’s heart with a stethoscope and then let the child try to use the stethoscope to listen to his heart

197
Q

A 15-year-old girl presents to the Emergency Department with chest pain, nausea, dizziness, and sweatng. She states that she is afraid he is going to die. History includes 3 previous episodes during the past 2 months, each episode lastng about 15 minutes. She has been afraid to visit the doctor but she has become more afraid during the past month of having yet another episode. Which of the following is the most likely diagnosis?
A. Malingering
B. Agoraphobia
C. Panic atack
D. Facttous disorder

A

C. Panic atack

198
Q

An efectve interviewing skill behaviors of listening carefully by entering the world of the patent and communicatng that you imagine the patents world as the patent sees and experiences it. Yet, not becoming the patent and remain separate from the patent. Which of the following is the communicaton skill described above?
A. Empathy
B. Transferce
C. Respect and warmth
D. Authentcity or congruence

A

A. Empathy

199
Q

An angry father comes to the clinic because his 16-year-old daughter request to join sport class. He claims that she was encouraged by her mother to do so and ask the doctor if he can convince her afer physical examinaton that she is not ft. During consultaton, the doctor needed to gather more informaton using confrontatonal communicaton skills. Which of the following is an example of a confrontatonal response?
A. “I totally agree with your opinion*
B. “I can see that you have been worried a lot”
C. “you have been through this very thing myself*
D. “You are looking very upset. What is happening?”

A

D. “You are looking very upset. What is happening?”

200
Q

Which of the following is the appropriate acton when caring for parents immediately afer a newborn death?
A. Discussing future risk of malformed baby
B. Ask the father if he wants to fle complaint
C. Arrange for early follow up with primary care
D. Allowing the mother to spend tme with her dead baby

A

D. Allowing the mother to spend tme with her dead baby

201
Q

A 15-month-old child brought to the clinic by his parents. He was born at 36 weeks by normal vaginal delivery. At 8 month’ test for hearing was done, which was normal. The parents say that he babbles, but does not speak 2-3 word phrases yet. On physical examinaton, the child appears normal. Which of the following is the appropriate acton?
A. Refer to ENT
B. Reassess at 24 months
C. Arrange for audiometry testng
D. Reassure the parents that this is a normal variant

A

D. Reassure the parents that this is a normal variant

202
Q

A 12-month-old child with acute gastroenterits seen in Emergency Department and being discharged with dietary advice and important worrying symptoms that need immediate care. Which of the following describes the technique in this step?
A. Refecton
B. paraphrasing
C. Safety netng
D. Verbal mirroring

A

C. Safety netng

203
Q

Which of the following is a common reacton to a parent’s illness in 12-year old girl considering her developmental stage?
A. Difculty speaking directly about strong or difcult feelings
B. Unable to understand or appreciate details of diagnosis, prognosis and treatment
C. Incorporate themes of illness in their play, such as pretending to have their parent’s symptoms
D. Likely to shif to earlier, less mature behaviors (e.g., fussiness, difculty with separatons or bedtme

A

A. Difculty speaking directly about strong or difcult feelings

204
Q

Which of the following is the most successful strategy to prevent poisoning among young children?
A. Educaton about the risk using social media
B. Educatng daycare providers on poisoning risks
C. Provide parents with educaton material regarding safety
D. Enforce legislaton to require childproof caps on hazardous household cleaners and medicines

A

D. Enforce legislaton to require childproof caps on hazardous household cleaners and medicines

205
Q

An 8-week-old infant presents by his mother to Well-Baby Clinic worried about her baby crying with diagnosis of infantle colic. Which of the following is the most appropriate counseling should be given?
A. Infants cry an average of 5 hours per day, peaking at 6 weeks of age and gradually decreasing
B. Infants cry an average of 6 hours per day, peaking at 6 weeks of age and gradually increasing
C. Infants cry an average of 2 hours per day, peaking at 6 month of age and gradually decreasing
D. Infants cry an average of 2.2 hours per day, peaking at 6 weeks of age and gradually decreasing

A

D. Infants cry an average of 2.2 hours per day, peaking at 6 weeks of age and gradually decreasing

206
Q

A 2-year-old boy brought by his mother to clinic asking for help to control her child behavior. The child seems to be stubborn and he throws his toys away. When she walks him to daycare, he refuses to hold her hand, atempts to run away from her. Which of the following is the most appropriate technique dealing with his behavior?
A. Spanking
B. Time-out
C. Scolding
D. Verbal waming

A

B. Time-out

207
Q

Which of the following best describes tme-out technique to control child behavior?
A. Last 1 min/yr. of age
B. Last at least 10-15 min
C. If accompanied by penalty
D. If accompanied by verbal warnings

A

A. Last 1 min/yr. of age

208
Q

A 7-year-old boy with a diagnosis of separaton anxiety. The mother asks for consultaton. Which of the following is the most appropriate strategy that the mother should do?
A. Let your child focus on what unlikely bad things might happen
B. Let your child stay home when he does not want to go to school
C. Punish for behaviors that are a result of separaton anxiety/fears
D. Help him think of ways a favorite superhero might handle the situaton

A

D. Help him think of ways a favorite superhero might handle the situaton

209
Q

Which of the following is most appropriate counseling regarding storage and handling of breast milk?
A. Can be frozen for up to 12-18 months
B. Afer freezing can be refrozen if not used
C. Can be stored up to 4-6 months in the refrigerator
D. Can be safely stored up to 4-10 hours at room temperature

A

D. Can be safely stored up to 4-10 hours at room temperature

210
Q

In consultng a new mother about vaccinaton, the doctor mentoned, “Giving your child a vaccinaton against a disease dramatcally lowers the risk of him catching the illness which could be extremely harmful to him both in the short and long-term. By stopping the disease developing in your child, we also stop your child being able to spread the disease.” The doctor asked the mother “Does everything I’ve said so far make sense?” Which of the following describes doctor last phrase?
A. Paraphrasing
B. Safety netng
C. Verbal mirroring
D. Check understanding

A

D. Check understanding

211
Q

A 2-hour-old baby delivered by emergency cesarean secton because of placental abrupton, and required resuscitaton with intubaton and cardiac message (see lab results). Test Result Normal Values ABG HCO3- 7 13-22 mmol/L ABG PCO2 65 27-40 mmHg pH 6.9 7.36-7.45 ABG PO2 5 8-24 mmHg (Newbor) 55-80 mmHg (Child) Base access -18 -2 to 2 mmol/L Which of the following proven to reduce death and sever disability within 6 hours?
A. Fluid restricton
B. Mild hypothermia
C. Respiratory support
D. Treatment of hypotension

A

B. Mild hypothermia

212
Q

Newborn delivered with ventouse due to malpositon. While assessment in the nursery, a hematoma from bleeding below the periosteum confned within the margins of the skull sutures noted. Which of the following is the most likely diagnosis?
A. Chignon
B. Cephalohematoma
C. Caput succedaneum
D. Subaponeurotc hematoma

A

B. Cephalohematoma

213
Q

A 30-minute-old, preterm at 27-week, delivered by emergency cesarean secton for maternal reason have tachypnea, labored breathing and chest wall recession. Blood pressure 55135 mmH Heart rate 135 /min Respiratory rate 65 /min Temperature 36.2 °C Oxygen saturaton 86 % Which of the following is the most likely diagnosis?
A. Pneumothorax
B. Apnea of prematurity
C. Respiratory distress syndrome
D. Transient tachypnea of newborn

A

C. Respiratory distress syndrome

214
Q

Necrotzing enterocolits is a serious illness afectng preterm infants in the frst few weeks of life Which of the following is true in regard this conditon?
A. Its associated with bacterial invasion of ischemic bowel wall
B. Treatment required antbiotcs but rarely parenteral nutriton
C. Has low morbidity and mortality compared with inguinal hemia
D. Preterm infants fed cow’s milk formula have low risk to develop it

A

A. Its associated with bacterial invasion of ischemic bowel wall

215
Q

A 5-day-old girl brought to Emergency Room with lethargy and poor feeding. On examinaton, she was irritable, deeply jaundiced and dehydrated. The mother gave history of previous babies’ required admission and exchange transfusion (see lab results). Blood pressure 90/55 mmHg, Heart rate 95 /min, Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturaton 94 % Weight 3 kg Test Result Normal Values Hb 95 165-195 g/L (Newborn) 112-165 g/L (Child) Retculocyte 3 0.2-1.2 % Total bilirubin 360 <274 mol/L (Preterm (3-5) days) <205 mol/L (Term (3-5) days) <21 mol/L (Older infant pre-term) <20.5 mol/L (Older infant term) Which of the following is important to be obtained in the history?
A. Apgar score
B. Birth weight
C. Type of delivery
D. Maternal blood group

A

D. Maternal blood group

216
Q

A term baby delivered by cesarean secton, started to be tachypnic with nasal faring and expiratory gruntng. Chest X-ray showed fuid in the horizontal fssure Blood pressure 60/35 mmHg Heart rate 140 /min Respiratory rate 65 /min Temperature 36.6 °C Oxygen saturaton 92 % Which of the following is the most likely diagnosis?
A. Pneumonia
B. Meconium aspiraton
C. Respiratory distress syndrome
D. Transient tachypnea of the newborn

A

D. Transient tachypnea of the newborn

217
Q

A 6-hour-old newborn delivered by cesarean secton because of sever fetal deceleraton and meconium stained fuid. He required intubaton and ventlaton with iontropic support. Few hours later, he started to have low saturaton with increase oxygen requirement. The pre ducal saturaton is 92 while the post ductal saturaton is 81. Chest X-ray done and showed no pneumothorax. Which of the following is the next step in the management?
A. Surfactant lavage
B. Diuretcs infusion
C. Inhaled Nitric Oxide
D. Chest tube inserton

A

C. Inhaled Nitric Oxide

218
Q

A term infant delivered with antenatal diagnosis of diaphragmatc hernia. She required vigorous resuscitaton in the delivery room. Which of the following is the frst step in managing this infant afer stabilizaton?
A. Startng antbiotcs
B. Chest tube inserton
C. Immediate surgical repair
D. Large nasogastric tube inserton

A

D. Large nasogastric tube inserton

219
Q

In colonized mother with Group B Streptococcal infectons, which of the following is risk factor for infecton in the newborn?
A. Preterm baby
B. Twin pregnancy
C. Gestatonal diabetes
D. Rupture of membranes for 6 hours

A

A. Preterm baby

220
Q

In managing infant of diabetc mother who required high level of glucose infusion concentraton up to 20% to control the hypoglycemia. Which of the following route is preferred to give the glucose infusion?
A. Orogastric tube
B. Nasogastric tube
C. Central venous catheter
D. Peripheral venous catheter

A

C. Central venous catheter

SMLE (8 decks)

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