378- 27 Y.O with history of confusion for 2 days and seizure for 5 hours. He is not oriented to time, place and person. He has history of unprotected sex for 6 years. Serum cryptococcal antigen positive, what is the most appropriate next step?
A. HIV serology.
B. SF Toxoplasmosis testing.
C. CSF Syphilis serology.
D. Herpes simplex testing

379- 25-year-old female known case of epilepsy came with generalized tonic clonic seizure for 35 minutes and started on 20 mg IV lorazepam but did not respond, what are you going to give her next?
A- IV Phenytoin
B- IV Phenobarbital
C- IV Steroid
D- IV Fentanyl

380- Case for baby have before eczema and lesions described in Q ( Honeycrusted on mouth )
What the organism cause it ?
A- S.aures
B- Streptoo. Group A
C- Varicella
D- Coxsaki A virus

Osteoarthritis.

381- 70-year-old male K/C of HTN with progressive decline in cognitive state, MRI showed Periventricular white matter Hyperintensities, what is the diagnosis?
A- Vascular dementia
B- Alzheimer disease

نفس هذا بس مغيرين قايلين
Gradually decline in cognitive state

382- Case about child with UTI
What makes you suspect UTI?
A. fever.
B. leukocyte
C. nitrite

383- sjogren syndrome which type of RTA: + Labs: Shows low K Normal Na
A. RTA l
B. RTA II
C. RTA II
D. RTA IV

384- 43YO male known case of hepatitis B infection presented with fever and confusion, examination reveled disorientation, asteraxis and positive shifting dulness
Ascetic fluid analysis:
SAAG= 1.2
Neutrophils= 350 or 320
Culture bending
What is the most appropriate treatment?
A- IV diuretics and metronidazole
B- Lactulose enema and IV Ceftriaxone
C- High ascetic fluid aspiration and propranolol

385- male had type 1 DM and his family best time to start celiac screening. Which of the following is the best advice?
A. Screen at diagnosis then every 5 years.
B. Screen at diagnosis then every 2 years.
C. Screen annually. later o n every 3 tears.
D. No need for screening.

386- 69 yo recommended vaccine
A. Pneumococcal
B. meningococcal

387- Patient on TPN, what’s a common metablic abnormality?
A- Hypokalemia
B- Hypocalcemia
C- Hypophosphatemia

388- 24y/o male presented after
chemotherapy for the treatment of colorectal cancer what electrolytes
abnormality would you suspect?
A- hypokalemia
B- hypocalcemia
C- hyponatremia
D- hypomagnesemia

389- 17year old female, medically free, gymnast in her class, developed
breasts later and never menstruated, on examination she is tanner stage 5
but no menstruation, diagnosis?
A. hypothalamic hypogonadism
B. imperforate hymen
C. gonadal agenesis
D. testicular feminization