Medpass Exam 2 الأمتحان القطري

A 20 year old woman without any medical history. Has irregular menstruation, every 35 80 days. Taking Rakuten because of Acne. An ultrasound image is attached. What is the best treatment for her
condition?

A 70 years old woman had a colporrhaphy due to pelvic organ prolapse 3 days prior to her presentation with left flank pain. Physical examination revealed severe sensitivity upon percussion and ultrasound shows severe hydronephrosis . Which following procedure is most likely to cause injury to ureter?

For which of the following you will give an oral combined contraceptive?

A 28 year old women with ASCUS in PAP smear, her colposcopy shows the picture below. What is your next step?

Which of the patients have the highest risk of developing ovarian hyperstimulation syndrome ( OHSS)?

Which of the following is not a risk factor for cervical carcinoma?

A 32 year old women has 2 children, trying to conceive beyond the last two years. History of 2 normal delivery and 2 termination of pregnancy with curettage. After the second termination she notice a significant reduction in the menstruation bleeding. Semen analysis of her husband: volume 3 ml, concentration 30 m/ ml, motility 60 %, morphology 5 %.

What is the next step for evaluation?

The definition of the third stage of delivery?

29 year old women without children, after 4 cycles of IVF without pregnancy. The picture below is from a test that you did for her.

What is the most appropriate step?

Which of the following is the most appropriate candidate for trial of labor after cesarean section ( TOLAC)?

Which of the following correct regarding semen analysis?

Which of the following is not considered a risk factor for Severe pre-eclampsia?

The most important prognostic factor in IVF ?

A woman is found to have oligohydramnios at 28 weeks of gestation. Which of the following is the most likely causes?

Which of the following is an absolute indication of the procedure in the image:

A nullipara 33 years old women, 40 weeks of pregnancy. Arrive to the emergency room with vaginal bleeding. Her vital signs: BP 100 55 ,HR 100 , temp 36.6 . the uterus is hypertonic. In the examination moderate bleeding. Biophysical profile is normal. Monitor with variable decelerations.
What is the most common diagnosis in this case?

A 90 years old with a history of heart failure underwent transvaginal hysterectomy and pelvic organ prolapse repair 10 years ago, she now presents with prolapse of the vaginal stump. Examination reveals prolapse grade 4 and trial of pessary insertion failed. What is the most appropriate treatment?

What is your recommendation for a diabetic woman pre pregnancy?

A 35 years old childless woman with irregular menstrual period. Her ultrasound demonstrates a thickened endometrium and biopsy reveal complex hyperplasia with atypia.
What is the most appropriate treatment?

39 years old, who gave birth 5 times vaginally is having now uncontrolled pregnancy diabetes. Last weight of the fetus is approximately 4100 gr. During delivery you are having difficulty to
deliver the shoulder after the head. What is the best next step?

24 year old women with dyspareunia and dysmenorrhea, in ultrasound a cyst of 2 cm in the right ovary. What is the most
appropriate treatment?

Which of the following is normal physiologic change during pregnancy?

Which of the following is a criterion for Bacterial Vaginosis?

A 35 year old in her second pregnancy. 6 weeks according to her LMP. She came to the emergency room because bloody discharge. Beta hCG 1700 , before two days it was 1500 . You demonstrate a tubal mass 15 mm and empty uterus.

What is the most appropriate step in this case?

A 30 year old woman has a colposcopy due to a finding of high grade squamous intra epithelial lesion ( HSIL) on PAP smear, the colposcopy report stated that the exam was unsatisfactory and the cervical biopsy revealed CIN 1 cervical intraepithelial neoplasia). Which of the following is the next therapeutic step?

Which of the following correct about Copper IUD ( Intrauterine device)?

How you will determine the stage in women with ovarian cancer?

A 42 year old woman with history of irregular menstruation, in the past 2 terminations of pregnancy. She is smoker. Which of the following
is the correct devise for her?

A 62 years old women had a endometrial biopsy due to vaginal bleeding. Biopsy result was endometrioid adenocarcinoma FIGO grade 3 .

What is the most appropriate treatment?

65 years old female, smoker and hypertensive, complains about exertional dyspnea and peripheral edema. Physical examination is normal including normal point of maximal impulse. On Echo study Ejection fraction of 60%, enlarged left atrium and moderate-severe pulmonary hypertension. What is the most common etiology for her condition?

55 years old male suffers from heart failure with reduced ejection fraction. He is treated with Enalapril and Spironolactone and yet still symptomatic. Echo study revealed 25% ejection fraction. Which drug you recommend to add to his regimen?

65 years old woman suffers from dyspepsia. gastroscopy shows wide and hypertrophic stomach folds as well as deep ulcers. Biopsy shows lymphocytic infiltration of MALT lymphoma. What is the treatment for this patient condition?

50 years old female comes to medical attention due to urinary symptoms and fever. Two days later urinary culture are positive for E. coli ESBL.  Which of the following is an appropriate therapy?

85 years old male with diffuse large B cell lymphoma comes to medical attention due to high spiking fever for the past two days. Blood cultures are drawn and treatment with ceftriaxone is started. Three days later he is still having spiking fevers, and blood cultures are positive for gram positive rods. What is the best next step?

A young asymptomatic cirrhotic patient with HBV DNA of 3000, liver enzymes 30-40 (normal levels). What is your recommendation regarding her cirrhosis treatment?

62 years old woman suffers from pain in her shoulders and right arm for the past two weeks. In the past month she suffers also from headache and fever up to 38. In her examination: non-palpable right sided temporal pulse, normal pulse in the left side. Lab: Hb 10, ESR 94. What is the initial treatment for this patient if we confirm the diagnosis?

10- 60 years old male complaints about dyspnea and chest pain for the past week. He has small cell lung carcinoma and undergoes Chemo therapy for the past two months. His blood pressure is 60/30 and heart rate 113, room air saturation 88% and his physical exam revealed remarkable JVP. An emergent bedside Echo study is performed.

What is the best therapy for his condition?

75 years old female suffers from stage 1 Chronic lymphoid leukemia complaints about dyspnea for the past month. On physical exam she has jaundice and her spleen is enlarged. Blood tests revealed Hemoglobin level of 5 mg/dL with normal WBC and platelets level, high LDH and low Haptoglobin. Blood smear show mild spherocytosis. Which of the following will confirm the diagnosis?

What is the most important prognostic factor in Acute myeloid leukemia?

Which of following is and indication for Chronic resynchronization therapy- CRT in Heart failure patient?

68 years old patient with diarrhoea and abdominal pain for several months. He undergone gastroscopy: esophagitis and several ulcers in the stomach, colonoscopy was normal, abdominal CT shows a mass attached to the second part of the duodenum. What test is expected to be high in the blood tests?

55 years old patient with Ulcerative Colitis since several years has high cholestatic enzymes for the past two years. Lab shows: AST and ALT around 50, ALP GGT around 300, AMA is negative. What is the best next step?

60 years alcoholic male presents with signs of heart failure. Echo study was performed and revealed and ejection fraction of 20%. He is started on beta blockers, ACE-I and furosemide. A month later he is asymptomatic but his ejection fraction is still 20%. He stopped drinking alcohol at diagnosis. What is the best next step?

50 years old woman comes to medical attention due to fever for the past two weeks. She had mitral valve replacement surgery two months ago. A blood cultures are withdrawn and she is suspected to have infective endocarditis. Echo study revealed a 10 mm vegetation on the prosthetic mitral valve. Which of following is the most likely pathogen for her condition?

67 years old man hospitalized with unstable angina and underwent PCI, he takes Beta-blockers, ACE-I, Aspirin and Clopidogrel. 5 days after his hospitalization his Creatinine raised from a base of 1.1 to 3 mg\dL, urine dipstick without protein or leukocytes, renal ultrasound is normal. What explains his condition?

Patient with end stage renal failure [stage 5], congestive heart failure, takes furosemide 120 mg daily was hospitalized due to worsening legs oedema. Furosemide dosage is elevated but without clinical response. He starts to suffer also from dyspnoea and massive weight gain. What is the best step in this patient management?

45 years old unconscious patient, does not respond to pain. On lab he has Hyponatremia of 112, potassium is Normal. His friend tells you that the patient took a pill of MDMA [ecstasy] several hours before admission. What is the treatment for this patient condition?

60 years old smoker and hypertensive male comes to the emergency room due to stabbing chest pain in midsternal area radiating to the back. Vital signs: blood pressure of 160/90 and heart rate of 120. Physical exam: diaphoretic and pale, weak pulses in legs and his left arm. His ECG looks normal. What is the next best step to diagnose this man condition?

83 years old patient comes to the emergency room due to hypokalaemia of 2.5 mg/dL.

In which situation you expect this patient potassium level in the urine to be low?

45 years old male comes to the emergency department due to chest pain. ECG reveal ST elevation myocardial infarction in lateral wall. He undergoes and emergent PCI and drug eluting stent is placed in his left circumflex artery. After two days of observation you plan to discharge him home today. Which of the following statement is correct regarding his medication regimen?

80 years old bedridden patient comes to hospital due to confusion. In lab test Sodium 160, and Potassium of 5. His blood pressure 120/80.  What is the best step in this patient management?

72 years old patient with asthma is treated with SABA, ICS in low dose. Recently she suffers from dyspnoea which interrupts her daily activity and awaken her twice a week at night. How should you manage this patient?

30 years old female comes to medical attention due to low consciousness. Medical history reveal that she gave birth to a child several months ago. On the ER her temperature is 39, and on lab: Hb 7 mg/dL, Thrombocytes 80000, Creatinine level 2 mg/dL. Direct coombs test is negative.  Blood smear is shown below. What is the best treatment strategy for this patient?

What is true regarding infectious lung abscess?

70 years old males diagnosed with new onset hypertension. On exam: Blood pressure 160/100, heart rate 55. On Lab: Sodium 142, Potassium 5. What is the best therapy for this patient?

55 years old male comes to consult due to fever, cough with sputum and dyspnea. He tells you that he has been on a cruise trip a week ago. On chest x-ray you diagnose pneumonia with CRUB-65 score of 0. You start treatment with Amoxicillin yet the patient still has symptoms after three days. You order a second chest x-ray which shows the same findings. On lab: mild leukocytosis and Sodium level of 128 mg/dL. What is the next best step?

27 years old male comes to medical consult due to gum bleeding for the past week. You perform a CBC which reveal 15% peripheral blast cells with promyelocytes. Bone marrow aspiration is performed and the patient is positive for t [15,17]. What is the cornerstone for his therapy?

70 years old female comes to medical attention due to palpitation for the past three days. Blood pressure 120/80, heart rate 100. Her ECG strip is shown below. She is known to be hypertensive and had TIA event several years ago.

What is best therapy for this patient?

A 65 years old man with dyspnoea performed pulmonary function tests:

TLC 160%             RV 180%

FEV 1.0 30%         FVC 60%

DLCO 60%

What is this patient most likely diagnosis?

45 years old female who underwent colon resection due to cancer removal several days ago, suddenly suffers from dyspnoea, tachycardia, and low blood pressure 80\40, her CXR is normal. What is the next step?

80 years old patient recently diagnosed with high grade lymphoma comes to medical attention due to palpitation. She tells you that she started therapy with R-CHOP. Labs: Creatinine 2 mg/dL, Potassium 6 mg/dL, Phosphor 8 mg/dL, Uric acid 12 mg/dL, Calcium 6 mg/dL and LDH 3000 [Normal range 120-360]. What is the diagnosis for her condition?

20 years old male was treated for the past two weeks with Penicillin for syphilis. Now he complaints about multiple diarrheal episodes. On lab: 20000 WBCs. Assuming you confirm the suspected condition, what is the best initial therapy?

20 years old man presents with fever and severe thigh pain. On exam you notice a scabby bite with red swollen and tender thigh. After a while he deteriorated, a spiking fever of 40, with blood pressure of 60/30 and severe tachycardia. What is the cornerstone for his treatment?

30 years old male comes to medical attention due to fever and seizures. After drawing blood cultures, starting intravenous antibiotic therapy and performing head CT test you decide to perform lumbar puncture. On LP: WBC 500, mainly neutrophils, glucose 30 mg/dL, Protein 200 mg/dL and high opening pressure. What is the diagnosis for this patient?

50 years old woman suffers from pneumonia. She is being treated with antibiotics for the past 5 days, but without any improvement. Repeat CXR reveal pleural effusion, a pleural fluid aspiration was performed: Milky fluid with glucose 20 and pH 6.9 was tapped.

What is the best next step in managing this patient?

Which of the following improve prognosis in a patient with COPD and emphysema in the upper lung fields?

Which of the following is a screening test for Cushing syndrome?

75 years old woman is 6 weeks pregnant. In her blood tests: TSH 7 [High], free T4 17 [Normal]. She is totally asymptomatic. What should you do for her lab findings?

78 years old woman who had Parathyroidectomy one week ago comes to medical attention with generalized weakness and tetany. What would you expect to be seen in her physical examination ?

39 years old patient suffers from ankylosing spondylitis. He takes NSAIDS on regular basis but still symptomatic. He is started on Adalimumab (Biological therapy). Two weeks later he develops rash, arthritis, myalgia and positive ANA test. Anti-histone test also is positive. What is the best step in this patient management?

Which antigen is specific to systemic lupus erythematous?

55 years old woman arrives to emergency room with severe confusion. Her blood pressure 220\120, pulse 90, temperature 37. In physical examination she has tense hands skin and ulcers in her fingers, small and fish-like mouth opening with telangiectasias on the face. Lab shows: Potassium 4, Urea 50, Creatinine 2.5. What is the best treatment for this patient?

82 years old patient with Squamous Cell Carcinoma of the lungs, arrives with weakness and fatigue, and signs of dehydration. He has calcium level of 14 mg/dL. What other findings on blood tests you expect for this patient?

Which of the following are the most likely physical examination finding in a patient with emphysema?

A patient is treated for UTI. Two days later he develops renal failure, hypokalemia and hypomagnesemia. Assuming that the following are secondary to his antibiotic therapy, which antibiotic he is treated with?

Which of the following is the first step in the treatment of diabetic ketoacidosis?

55 years old man with dyspnoea worsening in the last month as well as headache and facial swelling, and prominent veins in his chest wall, he has an elevated JVP in the left side. He is known to be a heavy smoker, and he reports losing 20 kg over the past 6 months. What could explain his symptoms?

23 years old type I Diabetes Miletus patient comes to medical therapy due to nausea and vomiting. On admission an acetone smell from her mouth, she is in moderately dyspnoeic and her abdomen is tender. On lab Glucose 450 mg/dL, potassium 2.5 mg/dL, pH 7.1, Bicarbonate 10 meq. What is the best next step in her management?

Which of the following is NOT a side effect of furosemide?

Which of the following is NOT a cause of secondary hypertension?

60 years old male comes to medical attention due to hemiplegia that started 2 hours before admission. After a quick diagnosis you diagnose ischemic stroke on head CT. On lab thrombocytopenia 55000, Creatinine 3 mg/dL, AST 300 mg/dL. On ECG new onset atrial fibrillation. Which of the following is contraindication for thrombolysis therapy in

this patient?

32 years old female develops DVT in her right leg two weeks after delivery. Lab workup a month later reveal positive B2 Glycoprotien antibodies and positive Lupus anticoagulant and Anticardiolipin. Which of the following is the best management in this patient?

Which of the following is NOT a sign for severe aortic stenosis?

A 65 years old patient comes to medical attention due to high grade fever. On admission his blood pressure is 60/30 and his fever 39.5. You start IV fluids and IV antibiotics and he is stabilized. On lab: WBC 20,000 Hb 10 mg/dL and thrombocytopenia 85000, PT 30 seconds PTT 45 seconds [both prolonged] and fibrinogen 80 mg/dL (Low). On smear- several schistocytes. Which of the following is NOT part of this patient therapy?

A 55-year-old man is seen due to palpitation. Examination is notable for a blood pressure of 112/68 mmHg and heart rate of 180 beats/min. ECG is attached. With carotid sinus massage, the heart rate

transiently drops to 130 beats/min, but then returns to 180 beats/min. Which of the following is the most

appropriate next step in management?

Which of the following is NOT an appropriate treatment for osteoporosis?

The most common cause of a pleural effusion is:

57 years old patient with cirrhosis secondary to non-alcoholic steatohepatitis, was discovered to have oesophageal varices in screening test. There is no symptoms or history of variceal bleeding.

What is your recommendation for this patient?

A 4 days infant has not yet transferred meconium. What is most likely to be found in anamnesis or tests?

5 years old boy with fever for 6 days. In addition, chapped lips, peeling at the tips of the fingers, enlarged cervical lymph
node 2 cm, redness in both eyes, and a rash in the limbs. What is the treatment?

A 7 year old, generally healthy, was admitted to the emergency room due to the rash shown in the photo that
appeared in the last few days. He looks well, Laboratory test platletes , wbc , hemoglobin normal.

Which of the following is an indication for steroid treatment?

A few hours age newborn looks cyanotic and suffer from respiratory distress. Physical examination shows tachypnea , loud
S2 with no murmurs, room air saturation is 65 %. After connecting him to 100 % oxygen mask the measured saturation
increases to 68 %. What is he most likely diagnosis ?

A child born to African immigrant parents, presented with neck stiffness and strabismus and 3 weeks of high fever. His
blood glucose 95 mg/ dL . CSF glucose 10 , protein 1200 ,WBC 95 with 80 % lymphocytes. Which of the following is most
likely pathogen for this child condition?

A 3 months old infant was first exposed to cow&# 39 ;s milk.Till now he has been breastfeeding only. One day later he is
admitted to ER due to bloody stools. The child looks well, What is your recommendation?

A two years old child arrives to ER due to high fever and cough. In his examination he is pale, pulse 160 , BP 70 40 , slow
capillary filling, enlarged and sensitive spleen. About six months ago he suffered a similar event treated with a blood
transfusion. In lab: Hb 7 , reticulocytes 4 % [High]. His blood smear is attached. Which of the following could
prevent this situation in the future?

A 6 year old girl, hospitalized due to a prolonged fever of 12 days, is accompanied by findings in the attached picture. After
IVIG treatment, no improvement was observed. What is the recommended treatment now?

A boy suffers from eczema without improvement under steroid and anti histamines therapy. Known for hospitalizations
due to pneumonia. In blood tests: small platelets and thrombocytopenia 17,000 . Leukocytes and hemoglobin are
normal. What is the definitive treatment?

Which of the following conditions is absolute contraindication to a diagnostic lumbar puncture?

A newborn infant born from a mother with polyhydramnios presents with excessive salivation along with coughing and
choking with the first oral feeding. An x ray of the abdomen shows gas in the stomach and a nasogastric tube
coiled in the esophagus. Which of the folloewing is most likley assosiated with the diagnosis ?

you was called to test a one day old newborn, due to a rash, in his test a temperature of 36.5 degrees, a pulse of 80 per

minute, 40 breaths per minute, which of the following tests will confirm the reasonable diagnosis?

A 12 years old has a history of atopic dermatitis at the age of one years old. Now he has difficulty swallowing solids but can
swallow fluids. He also reports frequent epigastric pain and recurrent non bloody vomiting.

Which is the first step treatment?

Two years old boy is admitted to the emergency room due to multiple vomiting, respiratory distress accompanied by fever up
to 40 . At his admission pulse 150 , respiratory rate 45 , and saturation 98 %. At lab mildly elevated WBC and CRP extremely
high, sodium 128 , potassium 4 . A chest photograph was attached. What is the most common pathogen for his condition?

The state laboratory calls your office telling you that a newborn infant, now 8 days old, has an elevated TSH and low T 4
on his newborn screen. If this condition is left untreated the infant is likely to demonstrate which of the following in the first
few months of life?

10 years old boy whose parents did not perform any geneticpre pregnancy tests, suffer from metabolic disturbances. In
physical exam: Large protruding ears. What else is characteristic of this syndrome?

16 years old girl suffer from occasional headaches. The headaches are bilateral and squeezing and lasts several hours.
They occur once a month. On social history you learn that she missed few weeks of school but continues to meet with friends.
She has no significant medical history. She denies weight loss, nausea, vomiting. Her physical examination is normal. Her
mother suffers from headache attacks too. What is the most probable diagnosis?

A 14 year old boy was examined at the clinic forgynecomastia ( see picture ). In his test a tall boy with small
testicles, in laboratory an increased FSH, what test is required for further diagnosis?

Which of the following is most associated with increased risk of asthma persistence in adulthood?

A 5 months old boy whose diet is based on goats ’ milk only and has not yet started solid
food. In lab: anemia with MCV 95 , reticulocytes 1 %. What is the appropriate treatment?

A child suffers from polydipsia and polyuria for the past several weeks. After fasting during the night, in morning tests:
blood sodium 151 , osmolarity in urine 100. What is the most likely diagnosis?

A 3 weeks old male infant is eating poorly, has repeated emesis, and has not regained his birth weight. On physical
examination he appears dehydrated and is noted to have increased pigmentation of skin creases and genitalia. In addition
to measuring electrolytes, assay of which of the following hormones would be most informative?

What is the treatment of Q 73

A two years old infant develops severe urticaria two minutes after exposure to Bamba . He has also facial swelling and
respiratory difficulty. His GCS 15 , with hypotension and 91 % saturation. Wheezing is heard on auscultation to the lungs.
What is the initial treatment required for this condition?

A one week old baby, healthy so far and well breastfed, comes with recurrent vomiting. The mother brought a jar of
vomit with blood spilled in the milk. The mother has cracked nipple. During his stay at the ER he breastfeeds without vomiting.

How should the investigation be continued?

A 2 years old boy has been awakening at night a lot and is restless in recent days. While replacement of his diaper his
mother notices white worms in the anus. What is true about the disease?

Which of the following vaccines is not performed for six months old child vaccinated under the Israeli plan?

Witch of the following can be a complication and cause of mortality in cystic fibrosis?

A boy who swallowed a battery a day ago comes to the ER.

The battery is seen on x ray it in the middle esophagus, what’s the treatment?