529- 17 years old male presented with severe asthma exacerbation on albuterol and long acting glucocorticoid, hx of admission 2 yrs ago on the exam: respiratory distress and diffuse expiratory wheezing, he Received systemic glucocorticoid and beta-agonist inhaler but no improvement, CXR: hyperinflation, Ph 7.3, What do next?
A- admission to ICU ✅
B- discharge and reassurance
C- discharge and follow up next day
D- Admit to the medical ward

Intubation should not be done in medical ward.

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sickle cell
Malaria
3ed degree heart block
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530- RTA Trauma patient came with open chest wound 2x2 with low air entry, resonance and he is stable
A - 3 sides dressing ✅
B - X-ray
C - chest tube

531- Patient came with bailateral hand joints pain proximal and distal, no morning stiffness, progressing, afebrile
A- RA
B- Hand osteoarthritis ✅
C- Septic arthritis

532- 16 years old female, pubic hair, and breast buds but amenorrhea, which puberty stage ?
A. 1
B. 2
C. 3
D. 4

533- What is used for for staging ?
A. CT
B. US
C. X-R
D. MRI

534- Patient developed DIC after very unpleasant labor, what is the cause ?
A- Uterine rupture
B- Abrubtio placenta✅

535- Patient 35 y.o came to the family clinic after 1 day of membrain rupture and watery dischare, did not mentioned the GA or which week
patient is smoker what to do ?
A- Speculum examination
B- Pelvic digital exam
C- colposcopy

536- Child 12 years old, came with his parents for routine examination we found systolic murmur, patient is completly asymptomatic and physically well
A- Reassurance
B- refere to cariologist

537- Child came with his parents complaining of excessive blinking and ( exact presentation of abscent epilepsy ) but the patient is communicating well with his parents during the episode :
A- Tic disorder ✅
B- petit mal

538- 75 years old male, came with inguinal hernia, iireducible and painful mildly, afebrile, no signs of inflamation :
A- Open repair with mesh
B- Repeai hernia
C- do nothing

539- Breast mass 2x2 with smooth serface and oval in shape, no other details !! :
A- Adenofirbroma
B- Breast abscess

540- Stroke case came after 6 hours asymptomatic now, hemorrage is excluded :
A- Aspirin
B- thrombolytic therapy
C- Aspirin with dipyradimole

541- Child complaining of bloating after eating, sometimes bloody diarrhea, watery diarrhea too, lose of apetite and lose of wieght in 6 weeks
A- Give PPI
B- Refere to surgery
C- Biopsy for something ( but not for anti tissue transglutaminase )
D- Reassurance / conservative

542- Hurschisburg case, what is your initial management ?
A- X-Ray
B-US
C- CT

543- old age patient came with bilateral LL edema, raised JVP and dyspnea, orthopnea ( CHF ) what is next ?
A- Furisemide ✅
B- ACEI
C- Clopidogril

544- 75 years old male, after surgery he was admitted to ICU for days, presented today afebril, decrease level of consciousness, hypotensive
Cardiac Output =2.5 :
A- Septic shock
B- cardiogenic
C- Neurologic
D- hypovolemic

545- infant came to well baby clinic, most urgent is?
superficial sacral dimple
absent femoral pulse ✅
autism

546- Mother came with her child for preschool Vaccination
Which of the following is important Vaccine to give :
RV
OPV ✅
Meningococcal ( MCP4 )
Hib

547- Child with Spinal Muscular Atrophy. The pediatrician deemed he needs intubation. Both parents don’t want intubation as they had a son with the same illness who died. What do you do?

A
Call child protection
B
Search the internet for solutions of similar cases
C
Discuss with hospital ethics committee
D
Ignore both parents and intubate the child as this is an emergency ✅

548- Pt in his 60’s came with flank pain and hematuria, tender mass in lumber region his vital
BP= 160/90
What’s the most diagnostic investigation ?
A-US
B-CT abdomen ✅
C-MRI
D-Radionuclides