641- Pt was treated for pneumonia after 3 days he developed sob and cough x-ray done shows bilateral lung infiltrate PaO2/FiO2 was 180 what's the dx?
A. ARDS ✅
B. MI
C. atypical pneumonia

642- man had recurrent episodes of arthritis in his big toe, he diagnosed with gout and he is k/c of psoriasis. He is compliant to gout medications but with no improvement and high uric acid level. Now he presented bilateral ankle arthritis, the diagnosis is?
A- Pseudogout arthritis
B- Gout arthritis
C- Psoriasisarthritis ( not sure)

Better recall: patient who had right big toe pain and because of that “written like this” he was diagnosed with gout and treated with allopurinol. He’s a known case of psoriasis. He presented now with right big toe pain, right ankle pain and bilateral knee pain and there was no improvement with allopurinol. Labs shows high uric acid What’s the diagnosis?
A- active pseudo-gout arthritis
B- active gout arthritis
C- psoriasis arthritis ✅
D- Osteoarthritis

643- 9 years diagnosed with shigella. What is the most appropriate antibiotic?
A- Azithromycin ✅
B- Ceftriaxone
C- Metronidazole
D- Amoxicillin

644- 30 something year old lady presented 1 week after birth with Bilateral crackles and dyspnea What is the likely cause?
1- MI
2- Pericarditis
3- Peripartum Cardiomyopathy ✅

Same recall: Best investigation?
A- Echo
B- Chest x ray and ECG

645- 61 patient with DM HA1C below 7 other examination all normal “eye, urine and sensation”
Blood pressure 149/90 of 3 times
Newly diagnosed wants to start Antihypertensive Med
what to add ?
A) no change
A) Add ACE ✅
C) Add gliptin
D) add others

646- DM with history of IHD. your goal in management
A-triglyceride less than 150
B- Cholestrol <240
C- LDL less than 70✅
D - HDL more than 70



Goals :
Cholesterol < 200
Triglyceride < 150
HDL >40
LDL < 100 ، Cardiac patient <70

647- Elderly kc of htn well controlled c/o confusion and irritability. he injured his left thigh 5 days ago and he has been bed bound ever since. vitals shows hypotension and o2 of 88% Also shows Sinus tachycardia and he has arrhythmia on ecg. Dx?
A - PE ✅
B - cerebral infarction
C - brain hemorrhage
D – arrhythmia

648- Heroin addict want to start a program to eliminate the addiction, which drug would you choose?
A- Naloxone
B-Methadone ✅

648- Scenario suspect endometriosis, most appropriate way to diagnose?

US
Laparascopy ✅
MRI
Biopsy

649- .Marfan features what investigation to do to rule out life threatening
complications
Echo ✅
Eeg
Ecg

650- Pt. Post. Surgery admitted to ICU for MV his COP:25ml. And pul. Wedge pr. Elevated 20

What is the type of shock
- cardio ✅
- hypovol

652- pt diagnosed with Parkinson's and hallucination which of the following is associated with a high risk of dementia?

A. Irritability
B. Difficulty finding the word
C. forgetting a future appointment ✅
D. Forgetting places of things

653- Pedia. (Not sure about age) presented with peteical rash all over his body with fever and pale + bil. Leg pain

Hb : low
Plt. : low
WBC: high

What is the most appropriate inv. ?

-BM aspiration ✅
- Electrophoresis

654- Child Walk independently and have an immature pinsle grip say 6-7 word can name 2 part of his body

20
19 ✅
17
12

655- Male did cholecystectomy 1 week ago now he’s complaining of pain in the angle of mouth , vitally stable
Temp is 38.8
- ct abdomen ithink
- x-ray
-AB ✅
-paracetamol

656- Long case of COPD patient with oxygen saturation 88% and PHTN is 50 What improve
survival?
A) Long term oxgen ✅
B)oral steroid
C) over night pulse oximeter

657- A young female on labor GA 38/40. Her pregnancy was normal, uneventful, with normal fetal development. The labor was normal but the was difficulty delivering the placenta which complicated with uterine inversion accompanied with vaginal bleeding 1200cc. Which of the following is the source of her bleeding?
A- Trauma blood vessels
B- Muscular injury and laceration
C- Uterine muscles fail to contract✅

658- A child ingested a caustic material. Had episodes of nausea and vomiting.
Which of the following is most appropriate?
Activated charcoal
Establish airway✅

659- A boy was playing football and felt sudden pain in his groin while kicking the ball or aiming to the goal smth like that, there is a swelling at the groin but no cough impulse and not reducible, vitals showed fever and wbcs were high, whats ur management?
A. aspiration to rule out hematoma
B. give analgesics and check after 8 hrs
C. surgical exploration for hernia ✅
D. force reduction manually or smth like that

660- Pregnant women with history previous pregnancies with ICU admissions and multiple blood transfusions recently delivered newborn with severe anemia and high reticulcytes. Most important part in the history:
A- Mother’s blood group ✅
B- Gestational age