‫بسم هللا الرحمن الرحيم‬

‫‪SLE‬‬
‫‪MARCH 2008‬‬

‫– تجميع بعض أسئلة مارس ‪ 2008‬من ردود األعضاء في منتدى األكاديمية الطبية‬
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‫‪ 1‬هذا سؤال مكرر من االسئلة الماضية حول شخص مصاب ب ‪ hepatocellulat hepatoma metastesis‬و‬
‫المطلوب كيف تخبره عن التشخيص‬
‫‪how to inform the patient‬‬
‫‪ you have to find out how must know‬سأحال ان اكتب السؤال بالكامل النه مكرر‬

‫‪ 2‬سؤال مكرر ‪ :‬امرأة اصيبت ب‪ paralysis‬فجأة و امتشفت في التاريخ المرضي ان زوحها ضربها علما‬
‫بأن فحصها و االعصاب سليمة و فحصها طبيب نيرو ‪ neuro‬و اعتقد ان االحابة ‪:‬‬
‫‪conversion disorder‬‬

‫‪ -3‬حالة امرأة معروفة بالنسبة لك منذ ‪ 3‬سنوات ان عندها ‪ ibs‬و انت فحصت كل شئ عندها ن طلبت‬
‫منك تحويلها الى استشاري ‪ gastroenterology‬كيف ستتصرف و اغطاك ‪ 5‬خيارات ؟؟‬

‫‪ -4‬امرأة مريضة وعدتها تفحصها الساعة ال‪ 10:00‬و تأخرت عن موعدها الى ‪ 11:15‬و عندما قابلت‬
‫المريضة وجدتها غاضبة كيف تتصرف علما بأن سبب تأخرك هو ‪?? complicated patient‬‬
‫‪-5‬ولد ضرب الباب على يدها و صار يوجع و يبكي االم جابت الولد عندك و فيه دم تحت الظفر كيف‬
‫تتصرف ؟؟ الخيارات منها تطمأن االمو تخلي الولد يروح و ال تشيل ال ‪??hematoma‬‬

‫‪All features of tonsillar abscess except :‬‬

‫‪deviation of uvula to affected side:‬‬

‫‪central artery embolism all true except :‬‬

‫‪causes painful visin loss‬‬

‫‪first ECG sign of acute pericarditis :‬‬

‫‪ST elevation‬‬
‫‪q waves‬‬
‫‪porlonged PR interval‬‬

‫‪In initial evaluation couples for infertility:‬‬

‫‪temperature chart‬‬
‫‪semen analysis‬‬
‫?‪refer to reproductive clinic...‬‬
‫بس شاك فيه‬

‫‪Erethema nodosum :‬‬

‫‪painful red nodules‬‬
‫اعتقد ان هذا الجواب الصحيح‬

‫‪initial Inx in small bowel obstruction :‬‬

‫‪Erect & supine abdominal X- ray‬‬
‫اجابته واضحة‬

child with eczema flare up he is on steroid and having itching disturb his sleeping
my answer to give antihistamine??
‫اذا في احد يتذكر الخيارات ياليت‬
Gold standard imaging in acute panceriatitis :
‫ هنا‬CT scan

pregnant lady 28 wks with chlamyda infection :

azithromycin
erythromycin
doxcyline

common cause of male infertility:

primary hypogonadism
secondary hypogonadism
ejaculation obstruction
...‫لست متأكدا‬

18years old boy with back pain investigation to do except :

CBC ?
ESR
X -ray
bone scan

iron deficiency aneamia :

serum iron
ferritin
TIBC

Hypothyroidisim :
free T4
TSH
T4

in which group you will do lower endoscopy for patients with iron deficiency aneamia in with no
benign cause:
male all age group
children
permanupausal women
women + OCP
‫لكن اعتقد انه خطأ‬

child with piece of glass deep in ear canal what to do:

side effects of Levodopa :

dyskinesia
speech
fatal hepatic toxicity..?
1- patient while he playing foot ball there is one come & pop his knee from the lateral side ,come to
the hospital ,
What is the most probably cut injury occur?
-medial meniscus
2- For this case the treatment is:
A- Surgery

3- 50 or 55 Y.O patient present with unilateral shoulder, upper & lower limp pain with morning
stiffness of more intensity after wake up ,there is mild fever & the patient is depressed :
Diagnosis:
A-R.A
B- Polymyalgia rheumatica.

4- Male patient known case of DM II come with Hb A1C : 8% ,he is taking metformin &
glibenclamid, to regulate the blood sugar need :
A- ............insulin
B-............insulin
C- metformin & acarbose .

5- case scenario patient present with constipation ......Dx : hypothyroidism

To confirm that the patient has hypothyroidism:
A-T4
B-TSH
C-free T4

6- Case scenario (patient present with symptoms of hyperthyroidism, tender neck swelling :
Diagnosis:
subacute thyroiditis

7- mother bring her baby to you when she complain of diaper rash , she went to different drug
before she come to you , she used 3 different corticosteroid drug prescribed by different
physician, ..........

the rash is well demarcated & scaly :

Diagnosis:
A-seborrheic dermatitis
B-contact dermatitis
C-?

7- The treatment:
??

8- female patient manger since short time , become depressed , she said she can't manage the
conflicts that happen in the work between the employees.
Diagnosis:
A-Depression.
B-Generalized anxiety disorder.
C-Adjustment Disorders

9- Case scenario (female patient present with excessive fear in her children ....... ...) my opinion it is a
case generalized anxiety disorder.
Treatment:
?

10- Patient before menstruation by 2-3 days present with depressed mood that disappear by 2-3 day
after the beginning of menstruation...
Diagnosis:
A-Premenstrual dysphoric disorder (or premenstrual syndrome ?).

11- Female patient breast feeding present with mastitis in upper outer quadrant:
Treatment:
A-stope breast feeding & evacuate the milk by the breast pump.
B- Give.....antibiotic to the mother & antibiotic to the baby.

12- case scenario , baby present with unilateral deformity in the foot appear when it is become the
weight bearing is in the other foot but when it is the weight bearing the deformity disappear ,the
patient has defect in dorsiflexion of that foot .......I think they are taking about ( club foot )
treatment :
A-orthopedic correction ...?
B-shoe.... C-surgery ....

13- case scenario ( ....patient present planter fascitis)

Treatment:
A-Corticosteroid injection.
B-silicon...

14- Patient present with retinal artery occlusion, which is wrong:

A- Painful loss of vision.
B-- Painless loss of vision.

15- Patient present with corneal abrasion:

Treatment:
A-Cover the eye with a dressing.
B-Antibiotic ointment put it in the home without covering the eye?

16- Patient present with epistaxis:

The best management:
- the patient leaning forward ,make pressure in the lower side of the nose .

17- Patient present with unilateral nasal discharge , foul smelling in the nose . Most probably
diagnosis:
- Adenoid
- Foreign body

- 18‫ مكرر‬baby present that he only saying mama baba which is abnormal for his age , no other
symptoms or sign abnormal , first thing to be asses :
- -hearing assessment .
- -developmental assessment .

19- Case scenario ,child present with rhinorrhea & sore throat for 5 days present with middle ear
perfusion, examination of the ear : no redness in the ear
the cause of perfusion :
- otitis media .
- Upper respiratory infection.
20 – Case scenario (patient known case of coronary artery disease, present with a symptoms of it, to
diagnose that patient has MI or not, by
A- Exercise stress test.
B- Coronary angiography
C- Exercise....

21- Patient present with acute precarditis , In ECG we see :

- S-T segment elevation.
-q waves
-prolonged PR interval

22-case scenario (patient present with carotid artery obstruction by 80%, treatment by
- carotid endarterectomy.
- ........surgical bypass

23- Patient present with generalized seizures not known case before of any siuzer , no pervious
history like that :
The most important thing to do now is:
- EEG.
- Laboratory test .

24- Case scenario patient present with carpal tunnel syndrome,

Treatment:
-corticosteroid injection

N.B they didn't mention a surgery in the MCQ

25-case scenario (..... patient present with SLE)

The least drug has side effect:
- methotrexate
- name of other chemotherapy

26- case scenario ( ....patient present with prostatitis , by culture gram negative rode )
treatment :
- Trimethoprim and Sulfamethoxazole
- ampicillin
- gentamicin

27- case scenario ( patient present with URTI, after 1 week the patient present to have hematuria
,edema ....
most probably diagnosis:
- IgA nephropathy
- post streptococcus GN

28- the most important diagnostic test for that is :

- Microscopic RBC
-Macroscopic RBC.
- RBC cast.
29- case scenario patient known case of hypercholesteremia ,BMI :31
Present with investigation, showing ( numbers ) :high total cholesterol ,high LDL & high TG......
Of these investigation what is the danger one for developing coronary artery diseas :
-LDL

30- Case scenario patient present with acute pancreatitis ,best diagnosis by :
- MRI
- Contrast computed tomography
- X-ray

31- Case scenario patient present with 3 days history of bleeding per rectum , present of pain after
defecation , by examination ( mass at 3 o'clock ) :
Treatment:
A-Put a sitz bath 5 time a day .
B- NSAID ointment locally .
C- ligate the mass then remove it .

32- case scenario ( female patient present with Urticaria, there is a history of swelling in the lip some
times, diagnosis :
Diagnosis:
- angioedema

33- Q about peptic ulcer ,how to know if it is due H.pylori or not .

34- ‫ مكرر‬patient ,your diagnosis for hem is cancer ,how to break that bad new for hem :
- see the patient how many know about the disease.
-

35- 55 Y.O male patient present for check up ,physical examination is normal ,lab investigation
microcytic hypochromic anemia , Hb :9
the most likely cause to exclude is
- lymphoma.
- gastroenterology malignancy.
-
36-patient who is smoker the least disease to occur in him is :
-Urinary cancer.
- Colon cancer.

37- case scenario patient present with acute symptoms of bloody diarrhea ......
Diagnosis ,acute ulcerative colitis :
the initial treatment for this patient :
-corticosteroid therapy .
- methotrexate.
- 5-Aminosalicylic acid

38- Pregnant women present with a mass in her mouth bleeding when brush her teeth
by examination mass 3x2 cm, diagnosis :
- aphthous ulcer.
- .....cancer
- .....granuloma
39- case scenario ,patient present with intestinal obstruction :
Investigation to be done:
- X-ray supine & erect position.
- c-scan

40- Neonate baby present with rash over the face & trunk& bluster formation ,
Diagnosis:
- Erythema toxicum
-
41- Female patient present with itching in the vagina associated with the vaginal discharge , PH : 5 ,
no Trichomonas infection , pseudohyphae by culture diagnosis :
- physiological discharge .
- Candida infection .

42- female patient present with thick vaginal discharge color..... . no itching ,vaginal examination by
speculum normal ,PH : 4
Diagnosis:
-physiological discharge

43- case scenario ( patient who is known case of hepatitis B ,Investigation shows:
high alkaline phosphates & aminotransferase
HBs Ag : +ve
HBs ab : -ve
Diagnosis:
-obstruction of biliary tract ??

44-epidemiological study for smoker said there is 10,ooo smoker in the area , at start of the study
there is 2000 , at the end of the study there is 1000 , the incidence of this study is :
A- 10%
B- 30%

45- epidemiological study want to see the affect of smoking in the bronchogenic carcinoma , they
saw that is 90% of smoker has bronchogenic carcinoma .
30% of non –smoker has the disease , the specificity of the disease as a risk factor is :
-70%
-90%

46- female patient complaining of thirsty & drink a lot of water & frequent urination ,
she has a history of diagnosed as bipolar since ( 2 week ) ,start with a medication
of lithium,
- psychogenic polydipsia.
- central diabetes insipidus.
nephrogenic diabetes insipidus .

47- case scenario female patient present with lower abdominal pain ( or back pain)
2-3 day before menstruation, then 2-3 day after beginning of it :
Diagnosis:
-primary dysmenorrhea.
- secondary dysmenorrhea .

48-eldrly women present with diarrhea, high fever & chills, other physical examination is normal
including back pain is normal ,
Diagnosis:
A- Pyelonephritis.
B- Bacterial gastroenteritis.
C- Viral gastroenteritis.

49- Patient taking antidepressant drug, (names of a drug I cant remember it but what I remember it a
drug of hypertension &.....)
the antidepressant drug make drug –drug interaction with one of the following drug :
- Non of the above.

50- Patient present with sever bronchial asthma which of the following drug , not recommended to
give it :
A- Sodium gluconate .
B- Corticosteroid (injection or orally? )
C- Corticosteroid nebulizer.

51- baby present with pain in the ear ,by examination there is piece of a glass deep in his ear canal ,
the mother mention a history of a broken glass in the kitchen but she clean that completely .... We
treat that by:
A- By applying a stream of solution to syringing the ear.
B- Remove it by forceps.

52- Case scenario.... baby (<2 years age ) present with a history of URTI .... nasal discharge after that
complicated to wheezing , & there is rales in the end inspiratory & early expiratory phase
,prolonged expiratory phase , sever respiratory distress ,using the accessory muscle in respiration.
Diagnosis:
A-Viral pneumonia.
B-Bronchilitis.
C-Bacterial pneumonia.

53- Mother bring her baby to you when he present with hematoma in his nail,
How to manage this patient:
A-No need things & ask him to go to the home.
B-bring a sharp metal ( ‫ & ) ابرة‬press in the middle to evacuate the Hematoma.
C-remove the nail.

54- in the initial evaluation for infertility:

A- Temperature chart.
B- Semen analysis.
C- Refer to reproductive clinic.
D- Urine analysis to detect the ovulation .

55-side effect of levodopa :

- fatal hepatic toxicity .
- fatal renal toxicity.
-dyskinesia
-speech
56- patient present to you , when you see his case , you discover that patient has terminal stage of
chronic illness , how to manage this patient :
- make him go to the home.
57- All features of tonsillar abscess except :
deviation of uvula to affected side:

58-Erethema nodosum :
painful red nodules

59 child with eczema flare up he is on steroid and having itching disturb his sleeping:
management :
- ointment
- antihistamine??
-
60-pregnant lady 28 wks with Chlamydia infection :
-azithromycin ( single dose )
-erythromycin ( this point ,what I remember was not present )
- Doxycycline
- 2 points of 2 drug of oinolon group
-
61- common cause of male infertility:
-primary hypogonadisim
-secondary hypogonadisim
-ejaculation obstruction

62-18years old boy with back pain investigation to do except :

CBC ?
ESR
X -ray
bone scan

63- iron deficiency anemia :

-serum iron
-ferritin
-TIBC

64 -In which group you will do lower endoscopy for patients with iron deficiency anemia in with no
benign cause:
-male all age group
-children
-permanupausal women
-women + OCP

65- female patient known to you since 3 years ago has IBS , she didn’t agree with you about that
,you do all the investigation nothing suggestive other than that , she want you to refer her .
at this case ,what you will do
- ..............you will response to her & refer her to the doctor that he is want .
- ...........you will response to her & refer her to the doctor that you are want .

66- one of your female patient has complicated case ,come to you & give him other appointment for
F/U , when he came her appointment was at 10:00 & didn’t inter to you except at 11:15 , she was
angry because of that , what you will do now :
- Empathy with the patient &........
-empathy with the patient &........
-.................... told to the patient you have other complicated case must inter before you .

67- ‫ مكرر‬female patient present to you complaining of sudden paralysis, she has a history that
husband anointed her (or happen that in the clinic ?)
Physical examination including neurological examination is normal
Diagnosis:
-Conversion disorder

THERE IS Q. ABOUT URTI CAUSEDD BY RSV

HOW TO TREAT THE KNEE INJURY I THINK BY KNEE BRACE NOT INJECTION OF STEROID

GIRL WITH 1RY DYSMENORRHEA AND U WILL GIVE NSAIDS

in question 7 i think it was mension that there was stellate lesion

??

patient came with scrotal swelling what investgation to do:

U/S

there was a question about baby with melanoma:

wide exision and follow up
refer to dermatology
.....
young lady with pelvic pain and menorrhgia ex. shwed uterine mass?
dx.
uterine fibroid
adenomyosis
endometriosis

best inx:
U/S
laproscopy

tennis elbow treatment:

NSAI
NSAI + restrict activity

PPH management :
oxitocin infusion
mesoprosto

management of obesity in ? 10 years boy:

multifactorial

young man with plurisy best management:

NSAI
acetaminophen
cortisone

there Q about patient with diabetes and hyper tension... which one of anti hypertensive madication
you wanna add first
1.ACE
2.b-blocker
3.ca-channel blocker
4.alpha-bloker

then if patient stil hypertensive what the next choice.........?

1.b-bloker
2.thiazide
3.ARB
4.ca-channel blocker

reccurent abortion at 19 week , normal fetus (without any congenetal anomalieis

-cervical incompetence

vaginal itching , white discharg not offensive

candida
vaginal itching , white discharg [b] offensive[/B
bacteial vaginosis

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