513- Pt w/ back pain and tenderness by exam, gram negative coccobacilli, dx :
A- TB
B- Brucellosis ✅
C- Schistosomiasis
D- Leishmania

514- paralytic ileus post surgery low K what to do next ?
A. ECG ✅
B. Urine k
C. Stool k
D. Urine osmolality

515- 40 years old male with left neck mass, thyroid ultrasound done and showed 1.5*2 cm cold mass, FNA cytology revealed suspicious follicular neoplasm,
which of the following the best initial management?
A. Left hemithyroidectomy. ✅
B. Repeat FNA.
C. Prescribe thyroxine.
D. Radioactive ablation.

516- 18 yr complain vaginal pruritus & discharge 5 days ago, no fevers or abd pain.PEx: normal genitalia. speculum exam:thick yellow cervical discharge with easy bleed on touch.
Cervical swabs done & reveal no organism on gram stain. most appropriate TTT?

A Azithromycin and ceftriaxone
B. Ceftriaxone only
C. Azithromycin only
D. Metronidazole only ✅

517- 22 y/o femal C/o 3 hx of intermittent bloody Bowel movement with mucus and rt hip pain. No hx of drug intake or contact with sick patient. On P/E every thing normal except for groos blood per rectum. Low Hg and MCV
stool analysis: many rbcs and few wbc , Dx ?
A-internal hemorrhoids
B-UC ✅
C-infectious colitis
D-celiac

518- 59 y/o male C/O jaundice for 2 month P/E enlarged liver nodule. CT : cirrhotic liver with rt 4*5 nodule which of the following risk factor strongly associated with this condition?
A-aflatoxin
B-lead toxin
C-wilams dis
D-HBV ✅

519- 18 y/o male present to ER with hx 1 week of euphoria , increase BP , tachycardia, nausea , wt loss , agitation, visual hallucinations Dx ?
A-amphetamine toxicity ✅
B-acute schizophrenia
C-coccain withdrawal

520- Patient with endomateriosis. Best way to diagnose:
A) MRI
B) Diagnostic Laproscopy ✅
C) Endomaterial Biopsy
D) Ultrasound

521- 65 year old with seizures for 3 days
Labs:
Sodium 112 (low)
Potassium 3.9 (normal)
Serum osmolality 240 (low)
Urine osmolality 860 (normal)

A- Inappropriate antidiuretic hormone ✅
B- Addison's disease
C- Cushing’s disease
D- Conn’s syndrome

522- patient has previous treated surgically for diverticulitis perforation , 4 days after the operation he developed high fever with spiking on RDE he there was pogging mass anteriorly
A-antibiotics
B-drainage ✅
C-colonoscopy

523- 10 years old child with 2 days jaundice and fatigue, indirect billirubin is high, total bil high, ast alt alsi high
A-infectious hepatitis ✅
B-creglar syndrom
C-obstructive jaundice

524- Elderly has epigastric pain and heart bun between meal with weight loss nothing on history other than weight loss is remarkable
A-colonoscopy
B-endoscopy ✅
C-blood test for h.pylori
D-start PPI therapy

525- Man presented to ER after lifting heavy object with abdominal swelling in the LLQ tender no impulse with cough
A. Ventral hernia
B. Rectus hematoma ✅

526- 23 year old female patient, history of ASD when she was 3 Years, now she has decrescendo diastolic murmur, 2/6, on the left sternum, what is your diagnosis?
A. Mitral stenosis
B. Aortic regurge ✅
C. Tricuspid regurge

527- Patient presented with dysphagia to liquids more than solid Which is the most appropriate initial investigation?
A- endoscopy ✅
B- barium swallow
C- US
D- biopsy

528- PROM IN THE 34 weeks , what to give ?
a-AB
b- tocolytics
C - steroid ✅

529- 17 years old male presented with severe asthma exacerbation on albuterol and long acting glucocorticoid, hx of admission 2 yrs ago on the exam: respiratory distress and diffuse expiratory wheezing, he Received systemic glucocorticoid and beta-agonist inhaler but no improvement, CXR: hyperinflation, Ph 7.3, What do next?
A- admission to ICU ✅
B- discharge and reassurance
C- discharge and follow up next day
D- Admit to the medical ward

Intubation should not be done in medical ward.

Pics:
sickle cell
Malaria
3ed degree heart block
valva صورة غريبة اول مره اشوفها

530- RTA Trauma patient came with open chest wound 2x2 with low air entry, resonance and he is stable
A - 3 sides dressing ✅
B - X-ray
C - chest tube

531- Patient came with bailateral hand joints pain proximal and distal, no morning stiffness, progressing, afebrile
A- RA
B- Hand osteoarthritis ✅
C- Septic arthritis