1-Cardiology 1-

Cardiology
1- Which of the following is the earliest ECG finding in acute AMI?
Hyper-acute T-wave.
2- The first cardiac enzyme rises & a peak in M.I. is:
Myoglobin.
3- The most important cardiac enzyme in M.I is:
Troponin.
4- First therapeutic measure in M.I. is :
Aspirin.
5- Which drug doesn't improve outcome NSTEM.
Nitrate.
6- Pt. with typical chest pain since 3-hrs with ECG of M.I. Came to Your hospital (A) which Just
Cath. And There is hospital (B) with well-trained and experience lab. Cath. about 45-min. fro
(A), Choose the best answer:
Start thrombolytic then Transfer to hospital (B).
7- 60y/o man present at 4 a.m. with chest pain, he is taking CCB ➥ HTN, antacids➥hiatal her
used Viagra In previous evening, BP 160/90 mmHg, HR 80, RR 16, which of the follow
medication Is contraindicated
Nitroglycerine.
8- All of the following is true in cardiogenic shock Except:
Dopamine -------» hypertension with reflex✄ bradycardia to Protect
heart.
9- In Spinal shock; one is FALSE:
Tachycardia.
10- In old age patient with hypovolemic shock, the tachycardia is not
occur due to:
Decrease Sensitivity to catecholamine.
11- in Hypovolemic shock patient, C.V. line better inserted in:
Subclavian vein.
12- Pt. with Lt. Pneumothorax after stab wound in Lt. Supraclavicular a
tube inserted
In Lt. Side of chest, which location is preferred for insertion of central
catheter?
Right internal jugular.
13- Cardiac tamponed (BECKS TRIADE) which is FALSE: (Echo -------» diastolic c
ventricle)
✄tachycardia (DNV, hypotension & muffled H.S.)
14- A known case treated from Hodgkin lymphoma (mediastinal mass) with radiotherapy not
on Regular Follow up,
Presented with gradual pain, difficulty of swallowing and SOB, CNV There is facial
swelling and redness,
What is the Dx?
SVC obstruction.
15- Child exited to ride bicycle and suddenly collapsed and develop VT, there is F/H of
sudden death of his uncle
16 y/o, what is the cause:
Congenital long QT.
16-* (ECG show atrial flutter) the drug of choice is:
Diltiazem.
17- Feature suggest SVT more than VT IS:
QRS duration less than 0.14 mm.
18- What the rhythm expected VT IS resolved:
QT less 0.52 mm.
19- What is the drug that can cause VT in severe QT Prolongation?
Quinidine.
20- What is the Initial feature of CHF?
Excertional dyspnea.
21- Patient with B.A. & heart attack, which drug is contraindicated:
Adenosine. (& timolol)
22- Which of the following drugs can be least used In Acute CHF
Digoxin.
23- pt. with digoxin toxicity which drug is contraindicated:
Calcium.
24-* (*ECG show wide complex tachycardia) 56 Y/O man c/o palpitation. He feels weak but
denies chest pain & SOB, P/H of HTN, BP 114/68, P. 150, RR 20 & O2 sat 97%RA, what is
the most appropriate initial treatment?
IV procainamide.
25-* (*ECG show Mobitz type 2)
type 2 (Mobitz 2): PRI remains unchanged prior to the P wave which suddenly fails to conduct to the

ventricles
26-* (*ECG show CHB) 78 Y/O women present with fatigue, dizziness, Lightheadedness
and waking
For Past several days. No chest pain or SOB. There are no recent medicatio
BP148/78, P. 48,
RR 16, T 37. IV access & blood sample is obtained & ECG is performed .what is the
Place on cardiac monitor, place external pacing pads on patient, and
admit in CCU.
27-* (*x-ray) ST elevation in L1, avl, V 3, 4, 5&6
Anterolateral MI.
28-* (*x-ray) the most accurate signs of aortic dissection in CXR is (--» sudde
maximum intensity at onset):
Calcium sign.
29-* (*x-ray show Widening of the mediastinum) 25 y/o involved in HSMVC has the s
radiograph,
What is the most immediate appropriate course of action? (Least sensitive in
CXR)?
Order CT scan chest.
30- Most accurate investigation for aortic dissection:
Aortography.
31- Drugs used in the treatment of thoracic aortic dissection?
β- Blockers + Nitroprusside.
32-* (*x-ray of PE) - Oligemia -westernmark’s (earliest) - elevated diaphragm -small
pl. eff. -H.H.
(Pleural- Based wedge infarct) rare, the Dx is:
P.E.
33- What is the Role of d-dimer in PE?
Normal D-dimer level may allow the exclusion of PE.
34-* (ECG with sinus tachycardia)
PE
In a patient with peripheral vascular disease, the principal source of distal emboli --35
: Is
.Heart
y male with history of HF and AF with central abdominal pain, occult blood in stool, by CT 70--36

»----abdomen
MVO (mesenteric vein occlusion
37-* (ECG torsade de pointes), best treatment is:
Magnesium sulfate.
38- PT. present with Frothy sputum, the first investigation is.
ECG
39- Which of the following statements regarding CXR finding in acute pulmonary
embolism is Correct?
Normal CXR in the setting of dyspnea and hypoxemia is strongly
suggestive of P.E.
40- Patient present since 3 days dyspnea then chest pain with both L.L. e
Dx is:
L.L. DVT with P.E.
41- The diagnosis of DVT is:
 Duplex U/S.
42- Which of the following statements regarding diaphragmatic injury is Co
CXR is most often abnormal but nondignostic. (Need surgical repair)
43- All of the following are Risky factor of thrombosis Except:
Diabetes mellitus.
44-Patient with CRF & peaked T-wave in ECG and A. pulmonary edema, which drug is
contraindication is:
Sodium Bicarb.
45- Least cause of pleural effusion.
Mycoplasma pneumonia.
46- In Ejection systolic murmur, one of the following is true:
Aortic Stenosis.
47- 14 Y/O female C/O Rt. leg pain while playing in school, BP in both arms > than in
lower leg, what is Dx:
Coarctation of Aortic.
48-* (*x-ray show cardiomegaly & notched ribs the pt. has bounding pulse) the most
accurate diagnosis is:
Coarctation of aorta.
49- 7 week-old full term male brought by his foster mother 45M. Earlier, he had Become
unresponsive While
Feeding then became cyanotic. The episode Lasted 30-60 s. but the infant remained pale &
M. And
Refused to feed, cardiac exam. Reveals a pulse 160, harsh pan systolic ejection murmur at
border second and single heart sound, the ECG shows RVH, O2 sat 84%. What is the
diagnosis?
Fallot tetralogy.
50-* (picture of CHF) “3 months” pt. with irritable, poor feeding, profus
tachypnea,
pale, HR 28,CXR large heart with Alveolar infiltration what is the
treatment:
.Diuretic .Digoxin.

51- Acute rheumatic fever is caused by:

Group A β-hemolytic streptococci (GABS).
52- Major criteria of Rheumatic fever disease include all of the Following
Except:
Fever.
53- Which of the following conditions is associated with migratory
arthritis?
Rheumatic Fever.
54- What is the most common causative organism of pericarditis & prosth
disease?
Staph. Aureus.
55- Which is wrong in pericarditis ECG?
 PR elevation. (PR depressions)
56- Regarding the treatment of pericarditis is:
Bed rest & NSAIDs.
57- Which organism is the most common organism cause native Valve bacterial
infective endocarditis is:
Strept. Viridans.
58- Electrical alternanas is virtually pathogenic in:
Pericardial effusion with tamponade.
59- CPR theory, all of the following is true Except:
Abdominal pump.
60- The Most common rhythm finding after DC shock is:
VF.
61-* (ECG shows : right ventricular hypertrophy) Dx?

62- What make heart returning to normal?

- Dopamine - Fluid - Lasix

63- First line of treatment of Inf. MI is:

IVF
64- Absolute contraindication of thrombolysis is:
 Any previous history of hemorrhagic stroke, ischemic stroke within 3 months.
 History of stroke, dementia, or central nervous system damage within 1 year
 Head trauma within 3 weeks or brain surgery within 6 months
 Known intracranial neoplasm
 Suspected aortic dissection
 Internal bleeding within 6 weeks
 Active bleeding or known bleeding disorder
 Traumatic cardiopulmonary resuscitation within 3 weeks
65-TIMI score
2-TRAUMA2-
TRAUMA
66- Pt. with head trauma, the initial manifestation of increase ICP is:

67- The first line for treatment of ↗ ICP is:

Headache

Manitol.
68- drug C/I in CT with contrast in child with increase ICP
Ketamine

⊂ High altitude cerebral edema (herniation) ⊃:

69- which of the following treatment is least beneficial in terms of Brain resuscitation life supp

Corticosteroids
70- Patient with head trauma has deep lacerated wound in the scalp, BP 90/60, P. 110 with dec
OC
Since the injury, He was unconscious briefly, but soon awake and returned to normal, over
next
Hours he became confused and then in deep coma (after 10. m ----» lucid interval ----» rap
decline)
Which of the following injury pattern you ?
EDH
71- which of the following for Indication of CT brain with contrast ?
70 Y/O man with history of falling and hitting his head 2 weeks ago, now shows signs of incr
72- Patient with head injury under warfarin therapy, what you will give him:
Vitamin K.
73- Which of the following locations are consisted with an accidental injury (not Traumatic) with
bruises?
Forehead.
74- Which of the following # is most likely to be caused by Non -accidental trauma (child
abuse) in 2-Y/O boy?
Metaphyseal corner # of the distal tibia after falling out of bed.
75- The most serious # or injury in cervical spines is:
Atlanto-occipital dislocation (AOD).
76- Which of the following of cervical injury most commonly associated with Neurological defec
Bilateral facet dislocation.
77- Which of the following of C-spine # considered stable ?
Unilateral facet dislocation.
78- What is the most common spinal injury in children younger than 8 years ?
Spinal cord injury without radiologic abnormality.
79- 16 Y/O experiencing neck pain when he speared another player with his helmet, Par
immobilized
His neck on scene. He is neurologically intact. Which C-spine is most likely?
Jefferson fracture (C1#).
80- C1, C2 Spinal # is MOST COMMON IN:
Recreation injury. HORSE RIDE
81- the Most unstable of flexion cervical injury:
Flexion tear drop
82- Most unstable of extensor cervical injury:
Hangman’s #
83- what is The best position to see the C7-T1 junction in X-ray is:
Swimmer's view (transaxillary).
84- Isolated # of first rib:
Is often easier to visualize on the AP cervical spine radiograph than on CXR.
85- in case of Cervical spine injury:
G.S. consultation, dermatome UL, Dermatome full.
86- All of the following are consistent with spinal shock Except:
Resistance to Trendelenberg position and IVF bolus with crystalloids.
87- IN SPINAL SHOCK WHAT IS THE CONSTATNT FINDING?

↘ ↗
FLACCID PARALYSIS
88- what is 1ST physiological response to shock ?
- Tissue O2 consumption - venous exchange - ADH
89- *35 Y/O man falling down a flight of stairs (after forced hyperextension). He appears Int
C/O Inability
to Move His arms or hands with numbness of his R. Arm; O/E reveals marked weakness of b
Mild Weakness Of legs. And Patchy sensory deficits of Rt. arm and inner thighs. What is th
Dx?
Central cord syndrome. Loss of pain and temperature; Motor loss (arms > legs)
90- pt. present with motor deficit in one limb (Ipsilateral weakness and loss of proprioception and
vibration)
& sensory deficit in another limb. (Contralateral pain and temperature loss)
Brown squared syndrome. Ipsilateral loss of position/vibration/ motor; contralateral loss of pain/ temperature
91- How you are protect the airway with GCS < 8 ?
Intubation.
92- *The best treatment for Patient with facial injury with labored sound is (or severe
maxillo-facial #):
Cricothyrotomy.
93- Traumatic pt. with agonal respiration SBP 60 mmhg, bleeding from R. Ear & nasal bone is
freely mobile
(Midface # is C/I of nasal intubation):
Cricothyrotomy.
The most valuable radiographic study in the initial evaluation of a patient with a potential -94
Midface fracture is
- Waters view.
95- pt. present with complete obstruction of larynx (or trachea), Palpable SBP 70, with Cough
blood & mucus:
Cricothyrotomy.
96- if there is unilateral decrease air entry after ventilation, what you will do:
Check position of ETT.
97- baby come to ER Toxic & lethargic with tachypnea then develop apnea, what is the
management :
ETT.
98- Non-surgical airway management, all of the following true Except:
Retrograde intubation.
99 *4 Y/O boy of average size requires prompt intubation for blunt head trauma.
Which of the following uncuffed EET sizesis most appropriate?
5 mm.
100- Which of the following drugs is ineffective when administered through ETT:
Isoproterenol (or bertelium.)
101- In polytrauma patient with hypovolemia the Initial resuscitation of fluid is better to use:
2.5 cm length + 7 mm diameter.
102- The most important examination in eye trauma is:
Visual acuity.
103- The most common part involved in orbital # is:
The orbital floor.
104- The least stable orbital #:
Zygomatic fracture
105- patient C/O double vision after blow of left eye, the most suggestive blowout # is:
Pain, Sensory loss or numbness over the check, nasal side & zygoma.
106- What is the most common site of # involving the mandible?
The angle.
107- Penetrating injury of platysma in the anterior triangle of the neck above clavicle with
palpable carotid pulse,
No hematoma with normal cervix:
Exploration under G.A. with written consent.
Which of the following is true regarding neck trauma -108
Zone III injuries are most amenable to surgical exploratio
:pt. stabbed in base of Lt. side the neck ,BP 90/40 & DNV, you should do -109
Check chest and tracheal shift.
110- Patient involved in RTA with chest trauma brought to ER with severely dyspnea, in
Decrease air entry
On the right side, what is the management ?
Chest decompression.
111- *67 y/o female falling down, come to ED with cyanosis, dyspnea, hypotension, heart sound heard, no a
side, which is Correct :
Immediate tube thoracotomy ( chest tube) is the preferred and Definitive treatment of choi
112 Pt. present with blunt chest trauma, and give 1000 (500) ml of blood once ICD inserted
ml/h
After 3 hours, CXR level no fluid level And the patient is clinically stable what after that yo
Admission and Observation.
113- In hemothorax if Initial chest tube output is1500 ml of blood once and later Chest tube
output is 300 ml/hour:
Thoracotomy.
114-Chest tube used in pneumothorax, tube thoracotomy drained when its % equal :
)30% (.% 20-29
115- Case of chronic bronchitis (COPD) came with pneumothorax, the management is:
Chest tube.
116- penetrating (Stab) wound with cardio-pulmonary arrest (no signs of life), the
management is:
Immediate Thoracotomy.
117- 19 Y/O man sustain a stab wound to epigastrium. BP Unobtainable and Narrow-complex
rate
Of 140 there is no spontaneous respirations, ETT is performed and produces good bil
sounds.
Which of the following is the appropriate immediate management step?
 Thoracotomy in E.R.
118- Patient with epigastric stab wound (with chest tube, the Pt. develop Hypotensive sho
unstable,
What is the line of management?
Pericardiocentesis
119- Which of the following cases is the suitable for ED auto transfusion?
Blunt traumatic hemothorax.
120-* (CXR showing moderate pleural eff.) the treatment is .
thoracocentesis
121- * (X ray show Hydrothorax or hemothorax) female patient taking chemotherapy for breast cancer
what is the treatment:
Chest tube

122- Which of the following N. is most likely to be damaged during emergency thoracotom
tamponade?
Left phrenic nerve.
123- Differentiation between pneumothorax and hemothorax by:
Hyper-resonant. DJV.
124- DD of pneumothorax & pericardial tamponade:
B.S.
125- Blood volume is sufficient to create hemodynamically compromise in acute pericardial tam
200 ml.
126- (*x-ray show wide mediastinum, deviation of esophagus to Right. (NGT) 1-2 cm most common & specific for
TAR)
Thoracic Aortic Rupture
127- In approximately what percentage of pt. is laparotomy required for Anterior Abdomin
wound?
30%.
128- (*x-ray showed fluid level in the left side of the chest, NGT recoil to the left side) The Man

Laparotomy. Misplaced Vibrator Bullet in the Rectum

129 (*x-ray of bullet in rectum & RIF, Gunshot enter from gluteal region to be seen in the abdomen) If there is
Colonic injury
what you'll do?
Laparotomy.
130- Pt. presents with melena, BP 90/60mmHg, pulse 160/m., What Is the percentage of blood
20-30%.
131- The most common organ affected in blunt abdominal trauma is :
Spleen.
132- The two most often injured organs in blunt abdominal trauma is:
Spleen & liver.
133 What is the radiological sign of Hollow viscous perforation (which indicate for urgent laparotomy ?
 Free Air under diaphragm.
134- All of the following can cause air under diaphragm Except:
Rupture of Bladder.
135- The commonly associated injuries with pelvic # is:
Urethral injury.
136- 23 Y/O man was the unrestrained driver in MV crash. O/E Blood is noted at urethral meatu
And there is perineal ecchymosis. Which of the following is the next management step ?
Retrograde urethrogram
137- indication for inserting of folly's catheter in unstable pt. with abdominal trauma,
Except:
To follow urethral bleeding.
138- Why you insert folly's cath. in traumatic patient ?
To assess renal function.
139- Testicular salvage is accomplished by diagnosis & treatment within:
6 hours.
140- pt. c/o enlarged L.N. of inguinal region with hematuria and back pain since one week,
what is the cause is: or
65y/o with hard painless scrotal Swelling with history of completing course of antibiotic for epididymitis
since 2 weeks develops sudden hematuria and back pain, what is the cause?
Cancer.
141- pt. with cut deep wound below the inguinal ligament with bleeding, the best initial
management is:
Gloved finger compression with bandage
142- After blunt abdominal trauma, if there is blood in the NGT what is the next step:
DPL is indicated
143- pt. brought to ER with anterior Abdominal Stab wound, the DPL reveal 10 ml of gross
Blood
What is the next appropriate step?
Exploratory laparotomy
144- DPL will be diagnostic if:
>500 WBC/mm3
145- Patient with blunt abdominal trauma there is frank hematuria, what investigation is you
the will do:
IVP.
146- 35 Y/O woman involved in HSUA reveals hematuria and IVP Is obtained 30 M. After contr
Lt. Kidney
Appears normal but Rt. kidney is not visualized. What is the most appropriate next
management step?
Renal arteriogram.
147- child C/O Groin swelling with pain and tender of tests ,what's Dx?
Torsion tests.
148- Unstable child brought to ER with mild abdominal pain, the line of treatment is:
Fluid resuscitation then operation.
149- The most important determination factor of clinical resuscitation is:
Return of the normal vital signs.
150- Old patient with picture of appendicitis, all of the following true Except:
Localized Rebound > tenderness.
151- Signs of appendicitis include all of the following Except:
Temperature > 38 C.
:Most patients with appendicitis have -152
.Nausea and vomiting, but not diarrhea
153- Appendicitis in pregnant female with rigid abdomen, BP 60/40 mmhg, the best
treatment is :
G.S. consultation + fluids + antibiotics.
154- What is the grade of Ranson criteria for diagnosis of A. pancreatitis for pt. WBC 14000, glucose is
normal, lipase elevated….
2, 3, 5, 7
155- Which of the following statements is true regarding Acute Appendicitis Late in
pregnancy?
It may be present in the RUQ pain.
156- All of the following is true of Appendicitis in female Except:
Appendicitis more common in pregnancy.
157- 7 months pregnant woman involved in RTA, the pt. is conscious, stable clinically; FHS is 1
What you will do as the trauma to her abdomen:
Observation of FHS for 4 - 6 hours and discharge if stable.
158- alcoholic Patient C/O abdominal pain, weight loss, jaundice, and There is muscle weaknes
Mild tender mass & guarding, the most useful investigation is:
Abdominal CT. U.S.
159- Pt. having epigastric pain radiate to the back increase with lying and decrease when
standing, fever, tachycardia. ( typical picture of with A. pancreatitis), what is the next
diagnostic step?
Serum amylase and lipase
160- pt. with jaundice with inlise gall bladder, cancer head of pancreas what is cause?
Cholylithisis
161- in cystic duct obstruction:
.direct bilirubin .urobiline . Both . None of above
162- Patient involved in RTA, with severe muscle injury, U/A reveal ++ Hem. What is your diagn
Rhabidomyolysis.
163- pt. C/O fever, vomiting, UA show WBCs 15-20 , RBCS 50-100 , bacterial positive IVP ➥
uretrovesical stone,
what your management.
Antibiotic and analgesia
164- what is the Electrolyte abnormalities in Rhabidomyolysis:
Hypercalcemia.
165- Which of the following is treatment for paraphimosis in Except:
Circumcision
166- 55 Y/O female with # of RT. tibia with pop of both LL, P/H OF A .F. what is the most important
investigation?
- LL duplex - ECHO - ECG
167- Patient come to ER complaining of pain and blood with defecation :
Anal fissure.
168- 18-y/o man with gunshot to ant. Aspect of the proximal thigh, O/E reveals; the leg is p
distal
pulses are not palpable . Expanding hematoma is noted in femoral triangle; wha
management step?
Vascular surgery consultation.
169- Gunshot in the thigh, with hematoma, with weak pulse in the leg, the patient can't move h
Which of the following line of treatment Except:
Exploration in OR.
170- 35 Y/O woman come to ER with gunshot wound to right leg V/S are stable. There is an ent
in Rt.
Popliteal fossa but no exit wound. There are palpable Pulses distally and sensory & mo
intact.
What imaging study is required?
Arteriogram
171- what is the Effect of acute injury on body level:
Increase Glucagon.
172- Which of the following is the most reliable clinical test for thoracic outlet syndrome(TOS)?
 Elevated arm stress test (EAST) .
173- (*x-ray) Trauma with clavicle #) what is the treatment:
Bandage (Arm sling) + analgesics.
174-*(X RAY left shoulder) what is the Dx ?

Acromio clavicular dislocation 3rd degree.

175- (*x-ray of supracondylar humerus) Neurological complication of mid-shaft humerus #
accompanied with:
Radial nerve injury with wrist drop.
176- the Presence of fat pad sign on radiographic examination of elbow represents:
Intracapsular blood/fluid.
177- the sure sign of arterial injury is:
Absence of pulse.
178- Patient after RTA, has hand edema and pain, the first sign of C.S. is:
.Paresthesia .Pain with passive extension.
179- The best treatment of compartment syndrome is:
Fasciotomy.
180- 30-years old man with unstable comminuted pelvic #, BP 90/palp. , Pulse 120, RR 24,
What is the most immediate appropriate next step?
Application of pelvic binding apparatus.
181- Lighting injury, all of the following is true Except:
A.C. is worse than D.C .Lighting is D.C. (Direct current) .Arrhythmia of lighting is VF .Injury usually dispersed
182- All of the following are muscle of cuff rotators (waist cuff) Except:
Rhomboids muscle.
183- Sensory supply of the dorsum of the thumb:
C6 Radial.
184- what are urgent Indication of knee aspiration (arthrocentesis) of the following :
Child with fever + knee swelling + limping due to falling down.
185- (x-ray tibia & ankle ) 2 Y/O PT. C/O limping, what is the Dx?
toddlers #.
186- Patient with bleeding LL #, most accurate initial action :
Protection of airway abnormalities before dealing with LL #
187- 20 Y/0 woman sustained injury while running despite pain, she was able to walk for S
then able
To walk 4 steps in E.R. Radiographs are not indicated if the examination reveals abs
tenderness
Along posterior edge of distal 6-cm and tips of both malleoli. OTAWA RULE
188- Patient present with ankle sprain with swelling, and normal X- ray, what is the next step:
B.K. cast for two weeks.
189- 9 y/o boy ankle inversion with swelling and pain , x-ray is normal what your Dx ?
Suspect SALTER HARRIS # grade 1
190- The most common Injury associated with major vascular (arterial) injury:
Knee dislocation.
191- Traumatic injury to the thumb causing hematoma, the management is:
Finger splint.
192- Treatment of subungual hematoma with pain:
Trephination distal to the lunula.
193- Treatment of Paronychia:
Incision and drainage.
194- Confirmation of ankle dislocation on X-ray is:
Bohler angle < 25 degree.
195- Child with biting electrical source:
Admission Even if the patient stable
196- What is the most common cause of death in acute phase of high energy electrical injury?
Cardiac arrest.
197- Child involved in his home fire, there is erythema, and blisters, what is the diagnosis?
2nd degree burn.
198- The difference between 2nd and 3rd degree of burn:
No sensation in the 3rd degree burn.
199- Prehospital care of burn would include all of the following) Except:
Placement of ice on the burn to decrease the pain
200- Burned patient with visible blisters, charring of skin & SC, thrombosed vessels:
Fourth degree.
201- 43 y/o laborer arrives with tar burn on his hands & forearm he is correctly associated as
6% TBSA second
Degree burn, what is the best agent to use for removal of the tar.
Neosporin ointment.
202- the Tissue damage of bullet injury:
Correlates with velocity.
203- Transection of peripheral nerve, regeneration of the nerve; one is true:
1 mm/day.
204- Monteggia #:
# proximal ulna. Dislocation radial head – elbow.

3- pulmonary 3- pulmonary

206- Early Feature of inadequate ventilation:

Tachypnea. (Major inadequate ventilation is tachycardia)
207- Signs of inadequate ventilation:
Hypoxia
208- What is the Cause of acidosis in near drowning?
Hypoxia.
209- 6 months baby with laryngeal airway obstruction Caused by F.B., he
was cyanosed but coughing, the answer is:
Back slaps, chest thrust.
210- in Partial (Simple) airway obstruction with wheezes due to F.B.:
Observation.
211- What is the Etiology of dyspnea non- traumatic pt.:
Pleural effusion
212- pt 58y o ℅ hemoptysis 3weeks 1st blood tinged sputum then frank
blood the most
important investigation :
Chest CT
213- Treatment of bacterial Diphtheria is:
Erythromycin.
214- Most common organism ↔ treatment in Patchy pneumonia:
C- Mycoplasma atypical ↔ Erythromycin.
215- What is the most common cause of pneumonia in elderly?
S. pneumoniae .
216- Alcoholic pt. presents with fever, chills, and productive cough, CXR
shows lobar
pneumonia. the Causes of bacterial pneumonia are:
Klebsiella pneumoniae
217- What is microbiology of aspiration pneumonia?
G -ve bacilli.
;Corticosteroids have major role in ttt of -218
.ARDS
219- The complication of aspiration pneumonia:
ARDS.
220- What is wrong In Aspiration pneumonia?
Antibiotics + steroids.
221- Pneumonia with hematuria is caused by:
Legionella pneumophilia.
222- Legionella pneumophilia causes:
Hypovolemia.
223- (X- ray show Hydro thorax or hemothorax) female patient taking
chemotherapy for breast
cancer, what is the management:
Chest tube.
224- Side effects of anti-T.B. drugs include all of the following Except:
Pyrazinamide (PZA) --------» Renal failure.
225- Which of the following is correct treatment for acute COPD
exacerbation?
Aerosolized β2-agonist remains the first line agents.
226- Mechanism of action of Albuterol:
 Increases adenylate cyclase.
227- End stage of COPD -----»:
Low K.
228- What is the treatment of COPD patient?
NIPPV.
229- How to assist B.A.:
- Spirometry - peak expiratory flow rate (PEFR)
230- What is the drug to be given for induction of 30 Y/O with status
asthmaticus?
Lorazepam
231- Mechanism of action of steroids in bronchial asthma Except:
Contraction of Smooth muscle.
232- Patient presents with sever bronchial asthma which of the following
drug, not
Recommended giving:
Sodium gluconate.
233- 80 y/o pt. C/O with tachypnea fever hypoxia, and confusion, what is
the management?
ETT& IPPV.
234- Which of the following statements regarding Methemoglobinemia is
correct?
Cyanosis does not improve with supplemental oxygen.
235- Inhalation injury --------» COHb. 30, ABG: pH 7.3, O2 67% what to do?
No need for intubation & mechanical ventilation.

B. p. ↘ 10 during inspiration & ↗ 10 during expiration.

236- What is the Definition of Pulsus paradoxus?

237- the most common cause of HIV patient with severe respiratory distre
Infection with PCP.
238- Which of the following infections in HIV pt. requires respiratory prec
prevent exposure of
Health care workers?
Mycobacterium T.B.
?which of the following cause normal anion gap acidosis -239
isopropyl alcohol
:Normal anion gap acidosis will develop in -240
Chronic diarrhea
241- Normal anion gap acidosis will develop in:
Chronic diarrhea
242- All of the following are normal anion gap Except:
Chronic Diarrhea
243- Central cyanosis occurs in all of the following Except:
 .RTA .CO-Hb .Hypoxia. .TOF . Met-
hemoglobin.
244- Treatment of Fireman comes to ER after 2 hours C/O headache,
nausea and confusion is:
HBO.
245- pt. with CO level above 30% will be treated with:
HBO
246- In CO poisoning:
Give HBO if pregnant women with COHb > 10%.
247- Half-life of CO poisoning in 100% O2, at 1 atmosphere is:
. 60 m .80m . 23 m . 40 m . 240 m
248- Which is true with CO poisoning?
Can cause death
249- All of the following are true about flumazenil Except:
Half-life 3-4 hours.
250- Oxygen dissociation curve:
Affinity of Hb to oxygen. (R. means leave O2, while L. accept O2)
251- Acidosis shifts the oxygen dissociation curve to:
Right shift.
252- Legionella p204-Acidosis shifts the O2 dissociation curve to:
Right shift.
253- Which of the following shift the O2 dissociation curve to the right?
Hypoxia
254- All of the following cause right shift of O2 dissociation curve Except:
- Newborn - PCO2.
255- CO poisoning causes:
Shift O2 curve to the left.
256- In Alaska; "the most common" route of heat loss:
Radiation.

4-GIT
Gastroenterology
258- Child ingested a coin with little distress, what is the common site of obstruction of this co
Upper esophagus.
259- Indication for admission of hepatitis is:
Hepatic Encephalopathy.
260- Hepatic pt. develops Hepatic encephalopathy, what is precipitating factor ?
Infection
261- Hepatic pt. got fever, increase Wbcs, the best treatment is:
Clindamycin
262- In hepatic encephalopathy all is true Except:
Hyper-reflexia.
263- All of the following can cause erection Except:
Hepatic failure.
264- Which of the following is most common cause of significant GIB?
Peptic ulcer.
265- Alcoholic patient with Boorhave’s syndrome, one is False?
Conservative treatment.
266- Which of the following statements regarding Mallory Weiss syndrome is true?
Bleeding stop spontaneously in the majority of cases.
267- Which of the following antibiotics is useful in the treatment of Clostridium deficil (enteroc
Metronidazole.
268- Previously healthy 26-Y/O man who returned home 3-days earlier from brief vacatio
presents
With A chief complaint of frequent LBM, he is a febrile and -ve stool exam. For blood & feca
What is the most likely etiologic agent?
Entrotoxigenic E.coli.
269- Patient with SCA comes with fever (temp. 39c), abdominal pain, diarrhea, Neck pain, head
CSF analysis shows no growth, protein 50, glucose? No WBCs, the most common organism
Salmonella.
270- Moderate intestinal obstruction of SCA patient, all of the following Can be given Except:
Packed RBCs. (Search for infection)
271- Absolute indication of blood transfusion is:
Hb < 7.
272- 16-Y/O boy known severe hemophilia-A present with headache after falling from bicycl
head,
he is amnestic and slurred speech, what is the next management step:
Factor VIII replacement 50 U/kg.
273- Every unit/kg of factor VIII % increase of plasma level by:
0.02 U/mL (2%).
274- Head injury with hemophilia-B, the dose of factor IX:
50 u/Kg. (Mild 10, moderate 20, severe 40:60 u/kg)
275- Regarding FFP, which of the following is true?
give 1 unit FFP after each 5 unit of PRBCs.
276- All of the following are complications of massive blood transfusion Except:
hypocalcemia.
277- How to assess platelet function:
Bleeding time.
278- (picture with abd. X-ray) toxic pt. with colonic distension, fever:
Toxic megacolon
 5-INFECTIONS 5- -INFECTIONS
279- Platelet transfusion given as Prophylaxis treatment for leukemia patient for:
.infection 20.000 . 50000 . Platelet . Petichae

280- Which of the following is indication for admission of patient with UTI and fever is:
Age > 6 month
281- Malaria is transmitted by:
The female insect of Anopheles mosquito.
282- Lyme disease is caused by:
Borgellia burgorferi
283- Organisms transmitted by cat bite:
Bartonelle honseia.
284- The skin disease associated with AIDS, all of the following except Except:
Tinia corporis.
285- The most common finding in patients with Behçet's syndrome is recurrent, painful genital
ulcers however the hallmark finding for this disease is
Hypopyon uveitis Green sclera Bullous conjunctivitis Optic neuritis and a “blueberry” spot on the retina
A child came to the ER with purities due to playing with cats, the treatment is -286
. Antihistamine . Adrenaline
287- CBC changes in snake bite:
Increase WBCs & decrease Platelets.
288- Patient came to ER complaining of Grey ulcer (CANDIDA) in mucosa (mouth), the best treat
Nystatin . Acyclovir . Amoxicillin. . Anti-fungal . Neomycin-
?Woman C/O bil. wheezy chest & HTN after ant sting , what is the treatment -289
adrenaline IM
290- Patient had lacerated neck wound 2-weeks back now there is spasm of muscle of the nec
cause:
Not given anti-tetanus.
291- pt. present with Picture of Tetanus and full tetanus immunization with dirty wound,
possible cause?
Didn't take immunoglobulin.
292- Child with dog bites in endemic area of rabies, and immunized up to date:
Pt. Wake up (not immunized against rabies) find bat in room, scratches him and
escapes.
Administer Anti-rabies vaccine & anti-rabies Immunoglobulin.
293- If pt. tetanus prone wound & partially immunized:
Give tetanus antitoxoid & HATI.
294- 28-y/o woman collapsed 5-min. after eating shrimp. She has generalized urticarial rash, sh
Marked respiratory distress, and has swelling of her lips and tongue. BP 70/40, p 120 and
What is the appropriate initial dose of epinephrine?
Epinephrine 1 ml/10KG of 1:10,000 solution IV (2ml 1:10,000 IV----20 kg if shock, laryn
respiratory failure)
295- What is the dose of Epinephrine which can be given through ETT for pt. weight 5kg?
2 to 2.5 x IV dose. (Dilute up to 10 ml with normal saline)
296- what is the Dose of epinephrine in infant ?
0.01MG\KG 1:10000
297- After controlling airway for hereditary angioedema, you must give?
- FFF - Adrenaline -Antihistaminic - Corticosteroid
298- Diagnostic criteria for KAWASAKI is:
Unilateral cervical adenopathy.
299- 41 Y/O woman presents with two large painless fleshy flat moist pearly grey pale lesio
 side of
Her anus she is otherwise asymptomatic what is the most likely diagnosis?
Secondary syphilis
300- Which of the following is associated with secondary syphilis?
Skin lesion Infection
301- Old female with fever dcl aggregation Rigidity ----»:
Neuroleptic malignant syndrome
302- Treatment of neck spasm (dystonic reaction) is:
Benzodiazine

6- RENAL & electrolytes

303- The most common cause of ARF is:
Hypovolemia.
304- Pre-renal cause of ARF diagnosed if:
BUN / Crea > 20.
305- 53 Y/O man presents with 3-days history of weakness, malaise, peripheral edema and decrease U
2.6 mg/dl,
Sodium 150, urine creatinine 111mg/dl, urine sodium 18 mEq/dl. Which of most cause of P
Prerenal Azotemia.
306- in acute tubular necrosis (ATN), which is correct ?
Urine sodium is > 40 mEq/dl
307- 20 Y/O man presents with left shoulder pain, dizziness, fatigue and orthostatic shoulder.
O/E Reveals no
erythema, sswelling, warmth, or pain with range of motion. One week earlier he had
been evaluated by his
Physician For sorethroat, which has now resolved? What is the most likely diagnosis?
Spontaneous splenic rupture.
308- What is Metabolic changes of shock?
Hyperkalemia.
309- Which of the following agents counteracts cardiac effect of severe hyperkalemia?
Calcium gluconate IV.
310- What is the treatment of hyperkalemia with renal failure?
Ca2+ + glucose & insulin + dialysis.
311- Patient with a history of kidney problem presents with Extreme weakness and difficulty
staying awake.
His family reports he has not left the house for 2-weeks and has stopped taking
medications. V/S are:
BP 70/50, P 40, RR 20, O2 SAT 92% on RA, IV access is established, and the rhythm strip
is obtained
What is the best initial therapy?
Calcium chloride 10 ml IV + sodium bicarbonate 1 amp IV.
312- Renal failure patient with hyperkalemia (K 6.9), which drug is contraindicated?
Succinylcholine. & Mg2+.
313- Hyperkalemia pt. with RF, Ca2+ should given for following conditions Except:
Digoxin toxicity
314- If there is Hyperkalemia (hypercalcemia) with Hyponatremia, the Dx. is:
Addison crisis.
315- Which of the following statements regarding adrenal crises is correct?
The Most common cause is abrupt steroid withdrawal
316- Which of the following abnormalities is least to be seen in patient with myxedema coma?
Hypernatremia.
317- What is the Treatment of hypernatremia?
D5%water.
318- What is the Treatment of hypercalcemia after fluid?
Furosemide.
319- What is the metabolic change in Rhabdomyolysis:
. Hypocalcaemia . Hyponatremia
320- What is the Mechanism of action of propylthiouracil?
Prevent synthesis of thyroid hormone.
321- What is the best treatment to prevent the release of thyroid hormone in thyroid storm?
Iodide.
322- Differentiation between thyroid storm and thyrotoxicosis:
AMS and hypotension.
323- The most useful test in Hyperthyroidism and Thyroid storm:
TSH
324- DKA correlate with confusion (coma), How to assess decrease mental status in DKA?
Osmolalrity.
325- The difference between HONK & DKA hyperglycemia:
HONC often occurs in pts who do not have a history of D. & occurs within days whil
within hours.
326- In status epilepticus one is False:
Use of Lidocaine injection.
327- All of the following cause uric acid Except:
Allopurinol.
328- (ECG changes of Hypokalemia) 50 Y/O woman C/O severe weakness for past 2 D. She took
furosemide for peripheral
Edema and ibuprofen for arthritis, which of the following treatment is most likely to
improve these symptoms:
Potassium replacement
329- (*ECG changes) Hyperkalemia:
Tall tented T-wave.
 7-pediatric7-pediat
330- Patient with lymphoma c/o fever, BP 90/60 mmHg, pulse 110/m, what you'll give for fever?

331- 2 years old patient with fever 38.5 ℃, which the drug is the C/I?
Aspirin.

Aspirin.
332- 24-month child with leg cellulitis, what is the most common causative organism is:
Strept (group A β-hemolytic streptococci)
333- Which of the following is the most common cause of death in children with acute leukemia
Infection
334- 2 y/o boy develop LOC, cyanosed with limping, then Return fully conscious and crying, wh
Breath holding spell.
335- Infant 2 weeks, c/o dyspnea , poor feeding , drowsy, what is the ideal investigation?
- ECHO - EEG&ECHO - CT
336- What is Worst thing ingested by baby?
??????
337- 3 Days Baby came with bilious (green) vomiting, with abdominal pain and distension; he wa
With normal pregnancy, choose the best answer:
Malrotation Volvulus.
338- (X- RAY ----» gastric dilatation) Newborn 3-days old with gastric dilatation & vomiting:
Duodenal atresia. (Atresia presents within 48 hours of birth with.)
339- 8 month old baby presented with history of recurrent crying with on & off jelly stool, the
diagnosis is:
Intussusceptions
340- What is the most common stock in infant?
Hypovolemic shock
341- The most likely site of organism in infant < 2 months is:
Blood.
342- Child 5- Kg with severe dehydration, the rate of resuscitated of NS & 2nd bolus fluid
given is:
20 mL/Kg .
343- What is the fluid of choice for treatment of Child with vomiting, severe dehydration , Na is
168, no UOP?
20 mL/Kg of 0.9% NS
344- Infant 6-Kg with severe dehydration, he received 120 ml of D5-1/4 NS but not improved
appropriate treatment is:
120 ml D5-NS.
345- Baby with dehydration, sunken eye, depressed fontanel, NA 170, what is the fluid for
resuscitation?
-1\2 SALINE -SALINE3 -% SALINE -D5
346- What is the peak of age of febrile convulsion?
3-years.
347- Which of the following is the most appropriate antibiotic for febrile 5 weeks old present
with fever?
Amoxicillin 50 mg/kg & Cefotaxime 50 mg/ kg IV.
348- 3 yrs child came with stridor, (Leaning forward) drooling of saliva rapid onset of
respiratory distress, muffled
Voice, looks very Ill, High grade fever 39.4, this best describes which of the following?
Epiglottitis..
349- Toxic ill appearing 9-months with fever, and drooling, neck stiffness, head slightly hy
Muffled sound
&stridor, swelling, Mouth opens widely cannot tolerate PO often has a neck mass, normal
Retropharyngeal abscess
350- To differentiate Epiglottitis from croup on lateral neck film?
Thickened aryepiglotic fold. .stapler sign in Epiglottitis
351- 20 month baby has been pulling his lt. ear, O/E show Non-moving red plugging of tympani
Rectal temperature 39.2 C, the most appropriate management is:
Oral antibiotics.
352- Child with history of renal transplantation & leukemia or lymphoma on chemotherapy, 3
days back came with
Vesico-lobular lesion behind ear, temperature 39 c, all of the following Treatment is true
Except:
Acyclovir.
353- Child with diarrhea, and vomiting was given antiemetic and experience extra-pyramidal
manifestation
(Spasm of neck, face shifted to R. side), what is the appropriate management?
Diphenhydramine.
354- In the delivery room, meconium is noted in the amniotic fluid,
Which of the following is appropriate treatment If the liquor stained with meconium:
Once the head of the fetus delivered, do suction of the mouth & hypopharynx.
355- 10 days infant, lethargic depressed fontanel what is the most important investigation?
TSH.
356- One is true for Physical abuse for children:
The abuser often a parent or cohabitant of a parent.
?Child abuse, what is the injury makes you sure about it -357
SDH after fall from bed
359- what is the management of CHF in neonates/children?
Furosemide.

8OPHTHALMOL
OGY
.
360-What is the Cause of mono-ocular diplopia?
 Lens opacity.
361-What of the following is not a complication of orbital cellulitis?
Conjunctival inflammation.
362- pt c/o eye trauma there is photophobia ,watery secretion, ➘ vision acuity, what is the
diagnosis?
conjunctivitis with rupture globe.
363- the causes of Painless Central progressive rapid loss of vision:
Central retinal vein occlusion (CRVO). Papillitis ------- early central loss of vision unilateral and painful
364- Closed angle glaucoma can leading to:
Shallow ant. Chamber
365- (X-ray picture of hyphema) the management is:
cover the eye
366- 70 Y/O pt. male setting in dark room for long time C/O headache, severe pain, he diagnosed a
closed angle glaucoma,
What is the mechanism of glaucoma?
CILLIARY BLOCK
367- What agent is commonly used to constrict the pupil once the IOP has been reduced?
Pilocarpine. (Used to constrict the pupil once the IOP has been reduced) commonly used to constrict the pupil once
the IOP has been reduced
PT c/o boring pain of Lt. eye ,mid-point pupil & fixed hazy cornea , what is the most -368
important test is
.fundus Examination
369- 47-Eye pain, photophobia, steamy cornea, what you will see by slit lamp?
corneal abrasion (or ulcer).
The most common finding in patients with Behçet's syndrome is recurrent, painful genital -370
aphthous ulcers
However the hallmark finding for this disease is
Hypopyon uveitis.
380- patient c/o headache around the eye , relieved by sleep& ➚ in the morning?
MUSCLE TENSION( due to tension headache )
381-Types of nystigmus in peripheral vertigo is?
?????

9-ENT9-ENT
382- what is The first line of treatment of epistaxis is:
Nasal Compression for 10 minutes.
383- Which of the following factors associated with acute epistaxis necessitates hospital admis
Posterior nasal pack.
384- Epistaxis (sever) on examination you are gray swelling on the nares ttt is
incision &drainage
385- pt c/o from nasal bleeding, when you try to put silver nitrate you found gray mass , what you do?
nasal pack with thrombin
386- Nasal trauma in young female with bluish-purple swelling of the nasal Septum of nose, the
treatment is:
Incision & Drainage.
Epestaxis (sever ) on examination you are gray sweeling on the nares ttt is -387
incision &drainage
388- what is The most common cause of acute otitis externa :
Pseudomonas aeruginosa
389- Which of the following organisms most commonly causes acute otitis media in 2 Y/O child
Streptococcus Pneumoniae.
390- In Bell's palsy one is true:
Hyperacusis & loss of taste in the anterior 2/3 of the half tongue.
391- What is the management for Hematoma at the ear pinna?
Incision, drainage & compression.
392- what is the Treatment of traumatic injury of ear is:
Debridement & evacuation.
392- pt. with insect in RT. ear you put Lidocaine drops and control the movement, many attempts failed
to remove it, but the patient became agitated and nervous ?
- ENT consultation - Paraffin drops - Procedural sedation and remove it