158- A 72 year old man presented with an episode of right sided weakness that lasted 10 minutes and fully resolved and he is clinically stable, he has no other medical illness. On examination: BP 110/70, HR 95, T 36.6 Which of
the following is the most appropriate next step in the management?
A.Aspirin.
B. Warfarin, INR 3-4
C. Warfarin, INR 2-3
D. No additional drug treatment

159- Pt has diabetes hypertension and on medication slept having nothing his wife stated he couldn’t wake up and has half of his body weakness given pic Which drug to be used
A-clopidogrel
B -Aspirin
C- Thrombolytic

160- Eldry k/c HTN DM smoker since 40 years Underwent thromplysis for stenosis in hospital , HA1c = 7 What the risk condition could be happened during his admission!?
A-stroke
B-bleeding
C-PE
D -MI

161- patient complaining of chest pain, diaphoresis and other symptoms of Ml that started 2 hours ago. He has a history of ischemic stroke (2 months ago). what would you give him next? ]
A- Thrombolytic Therapy
B- Aspirin
C– PCI
D – Statin

162- 50 years male returned from vacation ,drowsy, poor concentration,difficult awaking from sleep ,he described multuple fulls but all labs and brain images are free:
A-Post concussion syndrome
B-Chronic subdural hemorrhage

163- 9-month Hx of MI came to clinic for smoking cessation he was in respiratory distress raised JVP nicotine tear in his hand what is the most appropriate drug?
- A. Nicotine replacement therapy
- B. Varenicline
- C. Bupropion

164- Pt with systemic sclerosis ..comes with fatigue and dizziness Bp188/90 Renal impairment. What medications to add?
A.Lisinopril
B.Amilodipin
C. BB

165- 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

166- child had meningitis, and he contacted his brother & sister, what will give as prophylaxis ?
A- penicillin + rifampicin 2 times
B– penicillin
C- Ciprofloxacin one dose
D- Ceftriaxone 3 doses IM

167- 78y/o male presented with change level of consciousness and fever , lumber puncture was doe show CSF gram +ve bacilli , hem catalase +ve , how will you treat ?
A-ceftriaxone + vancomycin + steroid
B- ceftriaxone + ampicillin + vancomycin
C- ceftriaxone + vancomycin + ampicillin
D- ampicillin

168- Question about Meningitis, a 7-year-old patient infected with a gram- positive diplococcus.Treatment is:
- A.Ceftriaxone
- B.Penicillin + gentamycin
- C.Gentamycin /
- D.Gentamycin plus vancomycin

169- In a patient with suspected transient Ischemic attack full recovery should take place within:
- A. 6 Hours
- B. 12 Hours
- C. 18 Hours
- D. 24 Hours
- E. 48 Hours

170- old patient came with subdural hematoma with signs of lateralization imaging revealed 13 mm shifting. his GCS 7/15 then was intubated and resuscitated what to do next
A- iv mannitol
B- elevate head of bed
C-hyperventilate
D- urgent craniotomy

171- Pediatric patient had a fall from 1 story high and direct trauma to the head, presents with hemotympanium No loss of consciousness, no vomiting , neuro exam Normal Ear : Ruptured tympanic membrane with intact external auditory canal Most likely bone fracture:
A- Mastoid
B- Maxillary
C- Basal skull

172- stroke patient developed new weakness on ex papilledema CT finding: hemorrhagic stroke. Most definitive Mx ?
A-Craniotomy and decompression
B-Iv mannitol
C iv dexa

173- A patient who presented with signs of stroke and a CT shows subarachanoid hemorrhage. He was resuscitated but he is still hypotensive. What is the next best step?
A. Craniotomy and evacuation
B. Iv mannitol

174- Young male had pharyngitis, then cough and fever, what is the most
likely organism?
a) Staph aureus
b) Streptococcus pneumonia

175- DM obese on life modifications his A1c 8 what to add
A-dulaglutide
B-DPP-4 inhibitors
C-GLP-1 receptor agonists
D-SGLT2 inhibitors

176- 36 year-old female presented with left neck mass 2x2cm in posterior angle of mandible. US: Normal thyroid, left large LN with cystic component. FNA: All smear shows follicular thyroid What is the most likely diagnosis?
A. Metastatic thyroid cancer
B. Apparent thyroid
C. Ectopic thyroid (in the pathway of thyroid )
D. Thryoglossal cyst

177- Patient with hyperthyroidism and palpitations, heat intolerance.tmt
A-Propriouracil
B-Methimazole
C-Carbimaxole
D-Propranolol