620- Premature delivery of 23weeks old with fetal congenital anomalies. After delivery he needed
intubation and resuscitation. The mother who also works at the same hospital is refusing to
resuscitate.?
1-do you respect her wishes ✅
2-consult hospital ethical commute
3-continues with the resuscitation.
4- can’t remember

621- child had meningitis, and he contacted his brother & sister, what will give as prophylaxis ?
A- penicillin and rifampicin for 1 week
B– penicillin
C- Ciprofloxacin one dose ✅
D- Ceftriaxone 3 doses IM

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

623- you have limited influenza vaccine, which of the following demographic will you prioritise?
— school aged children
— pregnant women ✅
— isolated HTN adults
— child with IDA

624- MRI of large fibroid and mensterural bleeding hg 7 what’s next step in management?
A correct anemia ✅
B. Ocp
C. Myomectomy

625- Amenorrhea for 6-7 weeks. Did pregnancy test at home and it was positive. Came now for Dating of gestation:
A- US after 3-4 weeks
B- Believe home pregnancy test
C- Quantitative Bhcg ✅

626- 65 years old man admitted for elective ventral hernia repair, K/C of hypertension and BA, upon examination bilateral crepitation, ascites and bilateral edema, what to do?
A- Proceed with hernia repair.
B- Don’t repair unless obstruction has occurred ✅
C- Delay until situation is controlled.

627- A female presented with back pain and fever, she was given NSAIDs and advised for bed rest at home, then she presented with inability to move her lower limbs, O/E there was tenderness on the midback. Spinal MRI: Diffuse discitis on T6, What is the most appropriate next step?
A- Reassurance
B- Specimen from T6 vertebra
C- Brucella titer
D- Bone marrow aspiration for culture

628- A case of Pancreatitis 5 weeks ago. Now she has epigastric tenderness and cannot tolerate food with vomiting each time. By ultrasound, you found large about 12X10 mass with thick wall and fluid inside which is heterogenous and non-liquefied. Labs: 346 amylase, Wbc 15k. What is the diagnosis?
A. Pancreatic Pseudocyst
B. Pancreatic Abscess
C. Walled off pancreatic necrosis✅

629- Old lady clinical presentation of pylonephritis
Culture was done show E. coli
Already on I’ve abx susceptible to the E. coli for 5 days now with no improvement
What to do
1. Kidney us ✅
2. Repeat culture
3. Change abx
4. Observe

630- Patient K/C of cirrhotic liver disease with severe hematemesis. He is drowsy and disoriented. There is blood coming out of his mouth. What do to next?
A - Intubation ✅
B - Octerotide
C - IV fluid
D- Endoscopy

631- male presents to ER with RUQ pain, fever, chills and rigors and SOB. He is three weeks post laparotomy for perforated duodenal ulcer. On examination, he is febrile and tender in the right hypochondrium. Chest X atelectasis with some pleural effusion. What is the most appropriate next step :
A-CT chest
B-Abdominal Ultrasound ✅
C-Exploratory laparotom
D- Antibiotics

632- 40 yrs. Chronic diarrhea and significant weight loss for 10 months. No melena or bleeding. BMI is 18 Hb normal No fecal occult blood. Mx?
A- Glutin free diet
B- PPI
C- Loperamide
D- Metronidazol

If Giardiasis — Metronidazole
If Celiac — Glutin free diet

633- 23 male presents with sudden onset of RLQ pain while playing tennis 3 h prior. Vitals temp 37, HR 97, BP 124/79 mmHg , O2 99% . P/E absent bowel sounds, RLQ tenderness and rebound, firm mass noted in that area. Most appropriate step in management?
— CT abdomen✅
— US abdomen
— X ray
— Discharge with analgesics and follow up

634- Diabetic type 1 had dka,, on discharge what is the best regimen:
⁃ Twice nph
⁃ Once mix??
⁃ Basal bolus with once glargine ✅
⁃ Short acting before meals and no long acting agent

635- COPD acute exacerbation. Quick drug to administer?
A- Salmeterol
B- Albuterol
C- Ipratrobium ✅
D- Inhaled corticosteroid

636- Women 33 weeks with severe placental abruption(written exactly like this), with IUFD and DIC, contraction with cervix is dilated 3 cm, how to manage?
( no vitals mentioned)
1- observation
2- augment labor ✅
3- CS

637- 550-finding of biopsy in celiac disease?
A- subtotal villous atrophy✅
B- Crypt flattening

638- Whenever sending a research to the ethical committee, the reveiw proposal purpose
is:
A: giving friendly reveiw for your colleges
B: to check the results after conducting the research
C: to gain ethical approval before condecting the reesearch ✅

639- Patient had a sigmoid polyp removed. They found on histopathology well differentiated adenocarcinoma and the margins are free from cancer. No lymph node or extention to muscularis. What is the. best next step?
-Observation ✅
-Segmoidectomy
-Segmental colectomy
-Fulguration of the polyp site