178- 11 year old girl with excesize intolerance and wight (did not mention loss or gain) Hx is unremarkable and PE is normal Pb:160/100 HR:130 T:36.6 O2: 95 ECHO shows normal heart function and anatomy. What is the most appropriate ? managment?
1- ABG
2-electrolyte level
3-CBC anemia )
4-TFT

179- unilateral neck swelling in the RT side by investigations : hot thyroid nodule remaining of the gland cold TSH is low, T3, T4 high No LN enlargement (dx hyperthyroidism toxic nodule) What is the initial Treatment?
A- antithyroid drug
B- RT thyroidectomy
C- Hemithyroidectomy
D- radioactive iodine

180- Hyperthyroidism pt had 2 nodules, One is hot the other is cold. Most importantly immediate management!
A- Antithytoid med
B- Radioactive ablation
C- lobectomy
D- Total thyrodectomy

181- Cold thyroid nodule 3x3 was removed by thyroid lobectomy , 8mm papillary will defined focus was found distant to the leison, what is the appropriate?
A. Complete thyroidectomy
B. Follow up 3 months
C .RAI

182- Middle age Pt with papillary thyroid cancer , planned for total
thyroidectomy how to follow up ?
A- serial post op US
B- calcitonin
C- TSH , T3 , T4
D- Thyroglobulin

183- Patient with hyperthyroidism on anti thyroid medications for 10 months, still symptomatic. TSH: 0.1 and T4 was 27 I think. Best next step?
A. Continue anti thyroid
B. Subtotal thyroidectomy
C. Near total thyroidectomy
D. RAI or increase the dose of drug

184- 28 year old female presented following radiation of neck with neck swelling. Ultrasound showed swelling in the left lobe of the thyroid of 3x4cm of papillary thyroid cancer. Which of the following is the best management?
A) Left Lobectomy
B) Left Lobectomy with Isthmusectomy
C) Subtotal Thyroidectomy
D) Total Thyroidectomy

185- 48 yo lady with diffuse goiter, high T4 low TSH, US show bilateral thyroid nodules , right 3x4 in size , left is 1x2 size what to do?
A. FNA both
B. FNA the larger one
C. total thyroidectomy

186- 2 weeks post thyroidectomy came with high tsh how to manage?
A- reevaluate after 2-3 months
B-Increase or decrease the dose

187- Hypothyroidism clear Hx and labs with low Na (it was 129) normal 134
What to do next ?
A. Levothyroxine
B. treat the hyponatremia with hyper Na fluid

188- A patient with renal failure presents with low calcium, high alkaline phosphatase, and high PTH. What is the best form of vitamin D to give this patient?
A- Calcitriol
B- Vitamin D2

189- Most effective method to decrease stone formation in pt with hypercalcemia ?
A-decrease ptn
B-thiazide
C-allopurinol
D-decrease calcium intake

190- Pt with diffuse thyroid enlargement on exam there is 1 nodule in each lobe, labs showed hyperthyroidism what will you do?
A. Thyroid scan.
B. FNA from both nodule

191- 32 year old pregnant lady in 3rd trimester was complaining of palpitations
and sweating and heat intolerance along being restless she have notice a large goiter but no dyspnea or difficult swallowing and change in both orbits that became more prominent. ECG - sinus tachycardia. CBC -LFT - RFT
within normal. TSH 0.1 ( low ) , T4 10 ( high ). Thyroid Scan showed diffuse homogenous uptake. Anti-Thyroid Stimulating Antibody is pending. what is your next step for management ?*
A-Thyroidectomy
B-Radio-active Iodine Therapy
C-Methimazole
D-Propylthiouracil.

192- Old pt have painless heamaturia whats is most appropriate investigation
1 cystoscopy
2 us
3 ct

193- Pt have white coated tounge that removed with scratch and treated with nystatn what is diagnosis
1 erythymetus candidiasis
2 leukoplakia
3 oral thrush

194- 31 year female have pap smear negative in the last 5 year now also clear when to do it
1 after 1 year
2 after 3 year
3 after 5 year
4 no need

195- Female pt have history of previous myomectomy and several induction for fertility due to polycystic ovary
Now present with uterine bleeding what's the cause
1 endometrial hyperplasia
2 endometriosis
3 adenomyosis

This picture and ask about management

Also picture of p.falciprum