1. Patient on sulfonylureas urea since 1year..diabetes not controlled.

Answer metformin
2. . G2p1 GDM 32 weeks comes to ANC, previous pregnancy was demise what to do.
Options.Deliver, induce at 36th week.
3. .psoriasis how to control. Answer. Avoid trauma.
4. . Lady ecg shown. Epigastric pain. Answer aortic dissection.
5. . Patient 64 asymptomatic. Iop high with cupping . What is the patho. Answer trabecular block.
6. Patient on metformin and sulfonylureas still not controlled. Answer add one more agent
7. . Patient lost wife answer bereavement.
8. . Patient having seasonal depression. What is risk factor. Answer living in high altitude .
9. . Risk factor for osteoporosis . Age
10. patient has hypothyroidism has hypertension and on psych drug for depression.creatinine was
high. Which drug to re evaluate . Answer fluoxitene.

11. Lady gave birth. Day 2 postpartum. High fever. Right breast mass .superficial tender nodule.
CBC: normal.WBC high. Neutrophils high..band cells 1 percent. Answer breast abscess.
12. .ecg. SVT
13. . 61 year old hypertension copd and gouty. What drug to start. answer CCB
14. Psych with normal ecg. Psych referral
15. . Asthma. Diagnosis spirometry
16. Lady has polyp aunty also has the same . When to repeat colonoscopy. 6 m or 1 year
17. .pt presents with left lower quadrant pain .mass. febrile dx acute diverticulosis or crohn's
18. Infectious mononucleosis ...treatment acetaminophen and rest
19. Kid with rash sore throat fever hepatosplenomealy ..EBV
20. Fever 1 day after rash.. varicella zoster virus.
21. Vaginal itching + vesicular lesion like rose on water + tender lesion 

Dx: herpes simplex virus / post herpetic lesion /chancroid ulcer
22. Gestation 10 weeks G3 P0 A2 had previous miscarriage and wasn't evaluated . currently came
to ANC with her BP uncontrolled , Proteinuria and edema 

Mx : Terminate pregnancy / hemodialysis /bedrest
23. CT scan pic with midline shift and radio opaque lesion . she was brought in by her mom for
febrile convulsions. she had headache vomiting since 2 weeks . 6 th cranial nerve palsy and
papiledema seen .

Dx: Medulloblastoma / astrocytoma/brain abscess
24. Acute proptosis with no change in vision . orbital edema with redness 

dx : Orbital cellulitis / neuroblastoma
25. Pregnant lady comes with diminished fatal movements . Her lab results : 

Platelets : low ; PT and APTT : increased ; fibrinogen low . what is the cause of the fatal death 

reason : DIC / Amniotic fluid embolism
26. 45 year old multigravida , has a history of DVT . Her previous pregnancy was unremarkable .
she wants to know about the usage of OCP because her husband wont use condoms .

Advice : with her history you ca suggest tubal ligation /OCP doesn't cause any health risk /
IUD has no effect on her health / she is least likely to get pregnant
27. Pt. had food from restaurant . After a week or so he ended up having abdominal pain , vomiting
and ( hepatomegaly ? and rash over abdomen Dx : Enteric fever
28. Pt came to ER with dilated pupil and congestion an water eye with pain and decreased vision 

what would you do : Instil pilocarpine and refer him to ophthalmologist
29. Pt’s work environment is dusty and caused redness and watery eyes . no mucoid discharge .
what to give :olopatadine
30. on examination , the pt has a lump on nasal side below his lower eye lid. his nano lacrimal duct
is red .Before referring him to an ophthalmologist , what to do : Give systemic antibiotics
31. Anemia of chronic disease ; lab: High iron and High TIBC
32. Pt has glossitis and hyperhsegmented neutrophils , and pale RBC . His Hg is low, MCV high .

Schilling test is positive . what to give :Hydroxocobalamin /iron /calcium
33. Pt had UTI . 7 year old boy . he was prescribed antibiotics . followed by that he had orange
urine and he was jaundiced and pale . reason : Drug induced hemolysis
34. kenyan guy presents with cough and weight loss . He had oral lesions white color on his
tongue . His Hx stated he had several transfusion . cause of this : Human immunodeficiency
virus
35. HIV pt presents with red oral lesions (kaposi sarcoma pic ) rx : radio/chemo therapy /
antibiotics/steroids
36. DM pt presents with Abdominal striae , central obesity , skin thickening (scenario of bushings
disease ) . How to investigate : 24 hr urine cortisol level / morning cortisol level/ morning
ACTH level
37. PIC of ambiguous genetalia .U/S shows female gonads (no male gonads )

Dx: Female pseudohermaphrodite
38. 15 year old , breast developed and pubic hair developed . No menarche dx: primary
amenorrhea
39. Girl with menstruation that is heavy and starts with spotting and then heavy bleeds . Rest of the
examination is normal . What to do : Check for pregnancy if it is negative , just re assure
her that her cycle is normal
40. Glomerulonephritis pic ( RBC cast and edema ) what to do next : Refer to nephro/ renal U/S
41. Pic of cholecystitis (RUQ pain on and off , currently it is severe ) . Investigation : U/S
42. Child with microcytic hypo chromic anaemia with palpable spleen and liver enlargement . Liver
enzyme raised and X-ray - cardiomegaly . 

cause of it : Thalessemia / chronic liver damage / more investigations need
43. Cause of death in young athlete - Hypertrophic cardiomyopathy / aortic stenosis
44. Hypertension pt needed life style modification - Brisk walk 30 mins 3 times a week / 1.5 km
walk 4 times a week
45. Family had hypercholestrolemia . the family brings the kid for cholesterol check up . his BMI is
32 . why should his cholesterol be checked ? because his BMI is 32/ His family insisted ?
46. lady with hip pain . her BMI is 33 . she wants further management : ask her to reduce BMI /
give her topical pain killer / ask her to avoid exercise
47. Pt had DM . later he was found to have hypertension , currently his renal function test is
abnormal : high creatinine. how could you know the renal disease is due to DM ? 

he had diabetic retinopathy / his BP is refractory
48. BP normal and controlled . when to do the next BP check : after 6 months
49. cholesterol is normal . How often should cholesterol be checked : 1 time in a year
50. FBS how frequently should it be checked : Twice a year
51. Pt was coughing . Ended up having pneumothorax . On examination he was hypotensive .
what would you do : chest tube drainage / pneumonectomy
52. Pt had sore throat before and had the sequel of rheumatic fever . Currently he is planning to
visit the dentist for dental procedure . what prophylaxis should be give : 2 g of amoxicillin 1
hour prior to procedure
53. 3.5 kg new born how would you expect his growth : 7 kg in 6 months and 10 kg in 1 year / 5
kg in 6 and 8 kg 1 yr / 7 kg in 6 month and 12 kg in 1 year
54. Heart rate in an infant less than 1 year : 90-130 /120-160/80-120
55. Child with sore throat . Came with rinne test :-ve and weber : lateralisation to affected ear . Dx :
Otitis media / cholesteatoma
56. Pregnant lady with diffuse thyroid swelling . What should be done : Fine needle cytology /
iodine ablation /anti -thyroid drugs
57. Papillary thyroid cancer : Rx : surgical resection
58. Case about an old man who is forgetful . His lab - abc , WBc : normal .Brain imaging :Normal .|
what to do : get new methods to do daily activity
59. Lady prescribed phenytoin . she has side effects of : hirsutism . she wants to stop the
mediation .what would you advice: If she is 10 year symptom free , you can stop
medication / continue phenytoin irrespectively /change to new anticonvulsants /stop after 6
months
60. Post partum ( 2 weeks ) she has low mood and feels guilty and she is sleepy . What to do ?

Behaviour therapy / escatilopram
61. Depressed pt has been on SSRI for 3 months . she feels her symptoms have reduced and she
feels better and she is happy . she wants to stop her medication . what would you advice her
 about medicine duration from today ?

continue : 3 more months / 6 months / 9 months
62. An athlete , who is buff and muscular. he has acne . what would you check in him : Anabolic
steroids
63. What is the prior indication for mantoux test prior to BCG vaccination 

do for all > 5 years / do for all more than 6 years and have a family history of TB / baby who
has not got BCG vaccine
64. Pt had a baby with anencephaly . what is the chance of her next pregnancy getting affected ?
2%/8%
65. Post splenectomy what vaccine should be given ? pneumococcus / cryptoformans
66. 40 year old Saudi man comes to your clinic what should he be checked for : obesity +hytn
+DM /obesity +hytn +dylipidemia
67. Pt got flu and meningococcus vaccine last year . she wants to travel to Hajj . she also got her
Tetaus vaccine 6 years ago. what vaccine should she get ?(DONT REMEMBER THE
OPTIONS )
68. Benzodiazepine overdose . Treatment : Flumazenil / naltrexone
69. Acetaminophen toxicity came within 45 mins to ER what to do ? Gastric lavage with activated
charcoal
70. salicylate over dose . the levels are high . he came to ER 6 hours after ingestion what to be
done ? hemodialysis / urine alkalisation / activated charcoal
71. Pt with carotid artery stenosis . asymptomatic . his uncle died due to this condition and he was
also asymptomatic . How to check the progress ?

do u/s check every 5 years / CT once (DON’T REMEMBER OTHER OPTIONS )
72. Singer had colectomy for coon cancer stage 2 . what does this mean ?

spread to 3-4 Lymphnodes / spread to 1 Lymph node / spread to adjacent structure
73. Reason for admission of a child Failure to thrive :

immunotherapy / recent illness /family-child interaction regarding feeding habits
74. Nasal bleeding / mild epistaxis . how to manage it : Pinch nose inferiorly and lean head
forward
75. Lady with urine incontinence and she has tried pelvic floor tightening and it does help . what to
do ? anti cholinergic drug / mid urethral sling ?
76. pt states she wets her self with urine without knowledge , she isn't aware of her voiding . it
happens at day and night and not due to stress. what kind of incontinence is this ?

stress incontinence/ reflex incontinence/overflow incontinence
77. Pt is worried about cholesterolemia/ dylipidemia . what should he avoid in his diet ?

organ meat/ avocado/ egg whites / chicken
78. How to protect from malaria ? vector eradication and protect from vector bites/ count vector
bites
79. Pt has recurrent attacks of ketotic breath and this is due to :mismanagement of insulin dose
80. Old lady has attained menopause and she has got breast cancer . what basis should the
chemo therapy work on ? GnRH analogue or antagonist / aromatase inhibitor ?
81. Mechanism of sulfonyl urea : Increase in insulin secretion
82. Pregnant lady with cystitis, one of the following drugs contraindicated in her case:
fluroquinlones
83. Man feels he hears toaster , fridge telling him the food is poisoned . what is this ?

visual hallucination / auditory hallucination/ delusion
84. Female her height is 10th percentile of population, what u will tell her about when spinal length
completed, after menarche? 24 months
85. Clear scenario of keratitis. On examination there is dendritic ulcer: Herpes simplex keratitis
86. pt with glaucoma and cupping of optic disk . what advice do you give : control IOP will
reverse the changes
87. Earlier sign of puberty in male is: testicular size increases