437- Pt diagnosis with STEMI, PCI not available, and BP 178/99, what medication to give?
A. ASA, streptokinase, nitro,BB
B. ASA, heparin, streptokinase,BB
C. ASA,nitro,BB

438- 40 or 50 female k/c of dm Came with retrosternal pain at rest for 3 hours ECG done T inversion in (V2 v3 not sure about leads)
Labs :
high troponin 10
What is your diagnosis
A-Stable angina
B-Unstable angina
C-St elevation infraction
D- Non St elevation infraction

439- Years old male presenting with memory loss and difficulty remembering grandsons name, medically free apart from occasional alcohol intake. What is the likely diagnosis of his presentation?
A) Multi Infract Dementia
B) Alzahimers Disease
C) Alcohol Induced encephalopathy
D) Parkinsonism with Dementia

440- 70 old male with forgetfulness, progressive gradually for 2 years.. devolop signs of aggression and violence after he was calm ,caring ,and kind:
A. Lewi body
B. Alzheimer’s
C. Vascular dementia

441- Patient female and young in her 30s with all meningitis s&s and CT done with area of low attenuation of temporal lobe. what is the causative organism:
A- HSV
B- pneumococcus
C- N meningitis

442- Pt presented to ER with signs of peritonitis dx as perforated appendicitis managed surgically, post op day 4 he developed vomiting and abdominal pain with obstipation
xray showed multiple air fluids level in small bowl
Pt is vitally stable
Most likely dx is?
A. Paralytic ilues

((Same idea of this Q but it was perforated PUD
And same finding in image post op(multiple air-fluids level+dilated small bowel) asking about what NEXT?
A. -check if pt has hypokalmia
B. -Expiatory laparotomy

443- Female with symptoms then diagnosed with addison’s disease and started on hydrocortisone and flurocortisone At 9:00 12:00 15:00 Then she informed the doctor that she have night shift What is appropriate??!
A- No change in the treatment plan
B- Emit using cortisone during her night shift
C- Take the first dose at 9:00 then the rest at her night shift
D- Take her first dose at the beginning of night shift then 3 hours later then 6 hours later

444- Pt with poor apetite, fatigue, low self-esteemand feeling hopelessness. For 2 yrs. Dx?
A. Depressive disorder
B. dysthymia ✅
C. Mood ..

445- 23 Y.O. male patient K/C of UC presented with 7-8 bouts of bloody diarrhea per day. Associated with fever and joint pain. O~E patient looks ill and in pain. What is the best next step in management?
A. Sulfasalazine
B. IV methylprednisolone ✅
C. Oral 5-ASA
D. Azathioprine

446- Q about lesion in labia majora in post menopausal female showed dysplasia (carcinoma in situ I think) what to do:
A. Steroid cream
B. Local excision ✅
C. Vulvectomy
D. Repeat test after 6 months

Pictures
-Heart block ECG
-leiomyoma MRI
-Pic of baby with Down syndrome (T21)
-CTG

447- Most appropriate test to diagnose endometriosis
A. US
B. Diagnostic laparoscopy ✅
C.
D.

448- 16 YO came to ER after vomiting once with blood , she had recurrent N/V before her period in the last time there was slight blood with vomiting , after 4-6 hours they mention also ,all labs and exams are normal what you should so?

A- admit her for observation
B- reassure and ask to come if it recur again
C- prepare for urgent EGD ✅
D- Discharge

449- 6 m/o infant present to ER with sudden apnea & color change. Mother gave history of recurrent vomiting and multiple chest infections. On exam he looks failing to thrive with dystonic neck posturing while crying. Which of the following considers as high risk case for the above disease?
A- Obese baby
B- Preterm infant ✅
C- Post pertussis infection
D- Following inguinal hernia repair

450- Primary infertility with scanty irregular cycle and very high FSH, most important work up?
A-FSH/LH in urine I think
B-CBC
C-Pelvic US
D-chromosomal analysis

451- 41-year-old P5 +3 presented to the clinic complaining of abnormal uterine bleeding her Menstrual period is regular every 30-day associated with blood clots and pain that is not relieved by simple analgesic she had previous myomectomy, she is a known case of PCOS And her BMI is 40?
A-Adenomyosis ✅
B-Endometriosis
C-Uterine fibroid
D-Endometrial hyperplasia

452- A 42w pregnant come to antenatal care. Head well fixed in pelvis and cervix is favorable. Most appropriate management?
A. CTG
B. IOL
C. CS
D.

453- 12 y/o presented with chronic diarrhea for 3 months, sometimes it’s bloody and mucus. Abdominal pain , bloating. History weight loss and joint pain and ache. Exam : pale, abdomen: soft, lax and no tenderness
Temperature was 38.5.. CRP 1.5? lab low Hb and high urea
Diagnosis?
1- UC
2- Crohn’s disease ✅
3- Celiac disease
4- Chronic dysentery

454- G2P0 20 weeks of gestation, with cervical incompetence (cervix length 30mm), whats the most appropriate management?
A. Cervical cerclage
B. Strict bed rest
C. Progesterone supplementation✅

455- woman with spotting scanty blood after intercourse. She had a history of warts on vulva with cryotherapy done 2 yrs back what is the site of the bleeding?
A. vulva
B. vagina
C. Uterine cervix ✅
D. Uterine body