SMLE 2019

DECEMBER
LEFTOVER OF 1ST WK

Glory Team

Please don't hesitate to contact us if you have any correction, comments or

suggestions.

Teamglory2020@gmail.com

Medicine: 2-5
Surgery: 6-11
OB/GYN: 12-15
Pediatric: 16-18
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Medicine:
Pt take medication for h pylori 14 day course after how many days examine for
eradication:
A. 1 week
B. 2 week
C. 3 week
D. 4 week
Answer is: D

Patient has a sudden cyanotic episode while a family picnic he was previously
healthy, Ex cough, chest x-ray showed trachea shifted to left, what could be the
reason of shifting?
A. Right middle lobe pneumonia
B. Right lung consolidation
C. Right lung collapse
Answer is right lung hyperinflation

What indicate a lymphoma:

A. Hepatosplenomegaly
B. LN more than 1 cm
Answer is: fever
B symptoms of NHL are :
●Fever – Temperature >38°C (>100.4°F)
●Weight loss – Unexplained loss of >10 percent of body weight over the past six
months
●Sweats – The presence of drenching night sweats

Case with + cryptococcal ( HIV ) what the appropriate how to reach the diagnosis:
Answer is :
-​definitive diagnosis of cryptococcal meningitis is culture from CSF but if suspect HIV
infection its better to to CRag if LP can't be obtained
-​For indian ink is used for rapid test while waiting for confirmatory test

Patient came with hyponatremia serum osmo, , urine osmo normal dx?
A. Addison
B. Cons
C. SIADH
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D. Cushing
Answer is
If serum osmolarity low with hyponatremia >SIADH
If low serum osmolarity with high urine osmolarity with high sodium >DI

Case with H.pylori, asking about which drug cause black stool ?
Answer is bismuth

Which drug decrease the effect of ACEI?

Answer is Omeprazole

sever vomiting acid-base disturbance :

Answer is metabolic acidosis

What is the most common cancer to screen in elderly asymptomatic pt:

A. Colon
B. Bladder
C. Thyroid
Answer is A

What’s the most important thing when selecting a cancer screening test?
A. sensitivity
B. Specificity

🤷🏻
(No PPV in the choices.. went with sensitivity cuz we can deal with false positives no
problem but we can’t get undiagnosed cancer patients ​♀)
Answer is:A

A 10 y/o child presenting to the ERA with lethargy, irritability and altered level of
consciousness. He has no past medical hx. Lab findings (given) revealed marked
hyperglycemia and +3 ketonuria. What is the next most appropriate step in
management?
A. IV insulin
B. IV dextrose
C. IV normal saline
Answer is: C
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A 57 year old man has just gone PCI without stent placement for
evaluation of unstable angina. He has been placed on nitroglycerin, BB,
and aspirin, but still feels chest pain with activity. Lipid profile was
provided (and all were on the upper limit of normal, but not elevated).
What would you add to this man’s medications?
A. Diltiazem
B. Atorvastatin
C. Nifedipine
D. Furosemide
Answer is:B
History of CAD is indication for statin

A woman presents with SOB after paint inhalation. She is cyanosed, tachycardic,
tachypnea and has O2 saturation is 85%. What is your next most appropriate
step​?
A. high flow nasal cannula
B. Intubate and mechanically ventilate
C. IV aminophylline
Answer is:A

Rapidly progressive GN pathophysiology ?

A. Bowman capsule dilation
B. Crescent formation
Answer is A

Young patient with bloody diarrhea and abdominal pain i don't remember the rest,
what is the diagnosis ?
Answer is ulcerative colitis

Positive 13C- urea breath test:

Answer is Helicopter pylori

Patient on lisinopril 20 and aspirin and other drugs now he is having TB what to
do:
A. decrease the dose of lisinopril
B. stop refampicin
Answer is increase does of warfarin
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Patient with HTN and HF, on lisinoplril, thiazide, atorvastatin Now his BP is 4
144/98, creatinin clearance is low and develop LL edema Which medication will
change?
A. No change
B. Stop lisinopril
C. Change thiazide to frusemide
D. Add BB
Answer is B

Patient on TPN, developed weakness and convulsion what is the cause of these
symptoms?
A. Hypokalemia
B. Hypomagnesemia
Answer is hypophosphatemia

Pt is asthmatic and now diagnosed htn what drug ci?

A. Ace
B. Bb
Answer is A

Long scenario about increse prolactin which radiological site for this?
A. Kidney
B. Brain
C. Abdomen
D. Bone
Answer is B

40 years old smoker from along time Come with sob and cupping of fingers what
is the Diagnosis?
A. Copd
B. bronchogenic carcinoma
Answer is B
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Surgery:
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A case of cholangitis, Next appropriate step?
A. IV fluid
B. IV abx
Answer is :A

Patient with trauma and exposure of Nerve and muscle,Mx?

A. Depridemnt with 1ry closure
B. Depridement with 2ry closure
C. Depridement with delayed skin graft
Answer is:C
A case of normal thyroid with lymph node showing follicular, What is the Dx?
A. Ectopic
B. thyroid lymphoma
C. papillary ca
D. follicular ca
Answer is:C

Patient k/c of liver cirrhosis, came to the Er complaining of sever pain for 6
days , what the mangment?
A. Expl laparotomy
B. Diagnostic laparotomy
C. Observe
D. Abx
Answer is : D
Pain ,fever and PMN >250 > SBP > ABX

GIST in body of stomach asking about the surgical treatment ?

A. WLE
B. Gastrectomy
Answer is :
Less than 2 cm > observe
More than 2cm > WLE

GIST in posterior wall of stomach, surgical treatment?

Answer is ​Less than 2 cm > observe
More than 2cm > WLE
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40 years old guy, received a blood transfusion postoperative after few minutes he
developed pain at site of transfusion, fever and chest tightness, dx:
A. Hemolytic
B. Febrile non-hemolytic
C. Allergic
D. Bacterial contamination
Answer is A

Pt do right inguinal hernia came after 2 months with dicrease size of the rt testes
what is the cause:
A. Stenosis of the inguinal ring
B. Migration of mesh downward
Answer is : Pampiniform Plexus thrombosis
It seems ischemic orchitis
PFP =varicocele
Artery = atrophy

what the initial management in elderly female patient c/o low back pain after
cough, x-ray showed fracture vertebra:
A. admission for vertebroplasty
B. iv zoledronate
C. iv paracetamol
Answer is:
If patient having pain : go for IV paracetamol
If no pain only compression fracture: go for iv zoledronate

A case of subphrenic abscess..(no size no imaging); how would you manage?

A. chest physiotherapy
B. Drainage
Answer is :B

A 25 year old man and a known case of Crohn’s disease presents with acute
abdominal pain and distention + bloody diarrhea from the past two days, Imaging
reveals distended transverse colon with loss of haustraition. What is the most
appropriate management?
A. total colectomy with end ileostomy
B. Proctectomy w/ smth
C. Conservative management
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Answer is
Toxic megacolon :
if stable > start with IV steroid for 3 days if no response we do colectomy with end
ileostomy
If unstable > colectomy with end ileostomy

A 30 y/o man presents to your clinic and looks weak, dehydrated, pale, thin, and
emaciated. He complains of anal itching and discomfort from the past few
months. On examination, you find an anal mass that is 2 cm away from the anal
verge, cauliflower-like and friable. What is your most likely diagnosis?
A. anal cancer
B. Rectal cancer
C. Condyloma accuminatae
Answer is:C

A woman underwent surgery for something (I forgot). 2 days later she developed
right lower limb swelling, redness and pain. Further investigations reveal DVT
reaching up to the femoral bifurcation. What is the most appropriate
management?
A. enoxaparin
B. Heparin
C. Warfarin
Answer is:A

A 47 y/o man after MVA an hour ago. He had a head injury was conscious. After
resuscitation and stabilization, you need to transfer to another hospital because
of lack of resources in your center. The other hospital is 40 mins far. X- ray
imaging reveals fractures of 2-5 left ribs, but there’s no pneumothorax. What will
u do?
A. intubate
B. call the other hospital to inform the surgeon on call
C. chest tube insertion
D. DPL
Answer is D

A 70 y/o man comes to your clinic complaining of a swelling that developed in the
right lower quadrant after he picked up a heavy object. The swelling is
non-reducible, non-tender, not red and there’s negative cough impulse. What is
your most likely diagnosis?
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A. Ventral hernia (the only hernia in the options)
B. Appendiceal mass
Answer is
Could be rectus sheath hematoma but should be painful

A young man who underwent open hernia repair a few weeks ago presents with a
swelling at the site of the procedure; positive cough impulse.What is your
management?
A. open repair
B. Lap with mesh
Answer is :B
If the primary repair was open > secondary is laparoscopy ...vice versa

A man is brought to the ER with a thigh stab wound that is bleeding profusely. He
is unconscious. What is your initial step?
A. apply tourniquet
B. Intubate
Answer is:B
Unconscious >intubate

A man presents to the ER after being stabbed in the right lower quadrant. He is
vitally stable and asymptomatic other than pain at the site of the stab wound. On
inspection you find that there is penetration of abdominal fascia. What is the next
best step?
A. CT-abdomen
B. Diagnostic laparoscopy
C. Laparotomy
D. Exploration
Answer is :B
Facial penetration is indication for diagnostic laparoscopy
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A woman presents 2 weeks after recovering from acute pancreatitis with

non-specific abdominal pain. On imaging there is a subhepatic collection.
Your management would be:
A. ERCP
B. percutaneous drainage
Answer is:B

A patient presents with GIST (mentioned in the q): 3x4 mass in the pylorus of
stomach. No invasion, mets or signs of malignant/spreading disease. What’s the
most appropriate management?
A. Wedge resection
B. Gastrectomy
C. Chemoradiation
(No infliximab in the options)
Answer is:A

Unilateral nodule that was found to be medullary thyroid cancer.Will you do:
A. Hemithyroidectomy
B. subtotal thyroidectomy
C. complete thyroidectomy
D. radiotherapy
Answer is:C

Signs of perforation after ERCP where is the site of perforation:

A. Duodenal
B. Gastric
Answer is A

A woman at 20 weeks gestation presents with a 2 hour hx of right upper quadrant

pain. On imaging you find that she has cholelithiasis. What is your management?
A. open cholecystectomy
B. Laparoscopic cholecystectomy
C. Conservative management
(There was no option to delay or observe; it was all active management)
Answer is:
If one attack >observe
If recurrent attacks > laparoscopic cholecystectomy
Female pt have history of leg swelling 6 day ago what is the important to ask
about?
A. Trauma
B. Ocp
No smoking in choices
Answer is B
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OB/GYN:
Early deceleration on ctg what is the cause
A. Cord
B. Placenta
C. Head
Answer is:C

variable deceleration on ctg what is the cause

A. Cord
B. Placenta
C. Head
Answer is:A

Pic of female urethral caruncle, what is dx?

A. Urethral caruncle
B. Bartholin cyst
C. Abscess
D. Furuncle
Answer is:A

Character of benign ovarian cyst?

A. Solid
B. Hypoechoic
C. Bilateral
D. Multilocular with thick separation
Answer is :B
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40 years old female come complaining of pain with menstruation and severe
bleeding her menstruation is regular diagnosis?
Answer is : adenomyosis

Pregnant women history of dm and hypertension ga 23 but fundal height is 25

which cause polyhydro pathophysiology of it?
A. because of estradiol
B. Lactogen
C. progesteron
Answer is: human placental lactogen

Diabetic pt delivered 4.8 kg baby with SVD, on examination > absent moro reflex
in the right side. What is the cause ?
A. Hypoglycemia
B. Erb’s palsy
Answer is B

patient during CS developed hemorrhage from upper abdomen , what is the

cause:
A. Liver hemangioma
B. Stress ulcer
Answer is A
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If a mother got exposed to some infection during pregnancy, and has 13

developed IgG antibodies against it, what kind of immunity will the baby be
born with?
A. passive natural
B. Passive active
C. Artificial active
D. Artificial natural
Answer is:A

A 25 y/o married woman presents with a 2 hour hx of sudden sharp right lower
quadrant pain. There is rebound tenderness. Pregnancy test is negative. (That’s
all the information the question provided). What is the most likely diagnosis?
A. ovarian torsion
B. PID
(No appendicitis or ectopic pregnancy in choices)
Answer is: A

An unscheduled pregnant 34 y/o comes to ER with vaginal bleeding On physical

exam you see her tummy is 34 inches But the rest of her is asymptomatic and she
is doing well. What’s the most appropriate thing you’ll do?
A. Lab tests
B. Ultrasound
C. Admit to ward
D. Pelvic exam
Answer is:A

​ 4 y/o lady 20 weeks gestation presented to the antenatal clinic. She is

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completely asymptomatic and has no concerns.BP is 150/95. Everything else is
normal. How would you manage this patient?
A. nifedipine
B. Methyldopa
C. (A beta blocker)
Answer is: B

A 24 y/o at 7 weeks gestation presented with lower limb swelling.

BP 150/95 Rest of everything is normal. What would you give to the patient?
A. furosemide
Answer is: ​methyldopa

gestational age 13 weak and need management according to picture:

Answer is:
If stable > observe
If unstable > D/C
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36 weeks pregnant presented with constant abdominal pain, progressive, O/E

tense abdomen, tender, uterus corresponds to 34 weeks of gestation, Cervix
closed
A. Abruptio placenta
B. Placenta previa
C. Vasa previa
Answer is A

Female in 60 or 50 with no history of breast cancer when to do screening:

A. every year
B. every 2 years
C. every 3 years
Answer is B

Dx?
A. Mother anemia
B. Baby anemia
Answer is B
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Pedia:
Regarding the Saudi immunization provided to the preschool age which disease
is prevented:
Answer is :incomplete

Patient came with fever, tonsils covered with white membrane and
lymphadenopathy, what is the most complication:
A. Pneumonia
B. Scarlet fever
C. Glomerulonephritis
Answer is: B

Same pic, what is the ttx:

A. Abx
B. Antiviral
C. Steroid
D. chemical
Answer is :abx
Case of impetigo

An 8 y/ boy is inattentive in school and the teachers keep complaining that he has
multiple staring episodes whereby he doesn’t know what’s going on, and then he
comes back to normal.EKG (typical of absence seizures What is your
management?
A. ethosuximide
Answer is: A
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Who had the highest risk to fabricate child illness:
A. Father
B. Mother
C. Housemaid
D. Step mother
Answer is:B

A girl with ear pain on examination there is bulging tympanic membrane

diagnosis?
Answer is ​Acute otitis media

A 15 month old presents with fever, lethargy, FTT and has a rash on his thighs
and buttocks. On examination he has neck stiffness, and on CSF analysis he had
turbid CSF. Mother says his 8 y/o brother was in close contact with him. What
would you give to the 8 year old boy?
A. rifampicin
B. Admit to ward
Answer is :A

A child came back from a visit to Africa with his family and is lethargic and
presenting with facial and generalized body weakness. He is irritable and has
mild neck stiffness. Lymphadenopathy wasn’t mentioned. His CSF is turbid.
A. EBV
B. CMV
C. Poliovirus
Answer is:A

What’s organ is mostly affected in mumps in a 4 year old boy (exactly like this)?
A. parotid
B. Testes
Answer is:A

The doctor explains the vaccination process and benefits of vaccination. Towards
the end he says “do you understand what I am saying?”. By the last phrase, what
is the doctor doing?
A. safety netting
B. Verbal mirroring
C. Checking understanding
Answer: C
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A 10 y/o presents to the ER 30 mins after accidentally ingesting bleach. He is
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vitally stable and has been placed NPO, and fluids started. What is the most
appropriate management?
A. dilute the bleach with water
B. NG draining of gastric contents
C. Induce emesis
D. Close observation
Answer is:D

A baby being treated for eczema develops a red rash over his lesions. The new
rash looks like grape-like clusters and you are suspecting a superimposed
infection. What is your most likely diagnosis?
A. streptococcal
B. Coxsackievirus
C. Herpes simplex
Answer is: staph auroas

A 5 week old baby presented with complete heart block. What is the condition the
mother suffered during her pregnancy that could have caused her baby to be
born with this?
A. rubella
B. SLE
Answer is :B

Vaccination of 12 months:
Answer is
OPV ,MMR,PCV ,MCV

A 5 month old is brought to the well baby clinic and the mother is concerned
because he didn’t pass his development milestones when the nurse checked him.
What developmental milestone are you looking for to reassure the mother?
A. waves goodbye
B. Pincer grasp
C. Reaches for objects
D. Sit unsupported
Answer is: D
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Ethics:

A 65 y/o man presents to the ER with Charcot’s knee. After initial management he is
admitted under the surgery ward. The surgeons inform him that he needs amputation but
he refused. What is your action?
A. ask the patient to sign DAMA
B. Refer to another hospital
Answer is :A

A 40 y/o man comes to the counseling clinic after diagnosis of bronchogenic

cancer, and you tell him that he needs to stop smoking. He is ignorant and
completely refuses. What will you tell him?
A. We need to speak to your family about this
B. We will do everything to help you stop smoking
C. We will stop seeing you if you don’t quit
D. Smoking is harmful and you’ll die.
Answer is

Pic:

Answer is: Schizocytes

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Dx? ​Depends on the symptoms could be plural effusion or hemothorx