A healthy 40 year old man presents for a tuberculosis screen. He is asymptomatic with a normal Chest XR, and his last PPD 5 years ago was negative. Today, his PPD is positive. What is the treatment?
A- Isoniazid for 6 months
B- Isoniazid, Rifampin, Ethambutol and Pyrazinamide
C- Reassurance
D- Rifampicin and isoniazid for 3 months
Another similar question: Nurse during checkup for contract renewal was asymptomatic and normal except PPD of 12mm. What's the management?
A. No need
B. isoniazid 300 mg for 3 months
C. Isoniazid 300 mg for 6 monthes
D. rifampin, isonizid, another drug for 9 months or 6 months
Abdulrahman: The correct answer is isoniazid for 6 months (answered by Umm Al-Qura). Here are 3 ways of managing latent TB:
1. Isoniazid+B6 for 9 months
2. Rifampin for 4 months
3. Isoniazid + Rifampin 3 months
In the first question, Both A and D are correct. I think there was some mistake when writing the recalled choices (mistaken the period or did not write the frequency). If not, I would go for D since INH is not recommended to be given without vitamin B6.
A- Isoniazid for 6 months
B- Isoniazid, Rifampin, Ethambutol and Pyrazinamide
C- Reassurance
D- Rifampicin and isoniazid for 3 months
Another similar question: Nurse during checkup for contract renewal was asymptomatic and normal except PPD of 12mm. What's the management?
A. No need
B. isoniazid 300 mg for 3 months
C. Isoniazid 300 mg for 6 monthes
D. rifampin, isonizid, another drug for 9 months or 6 months
Abdulrahman: The correct answer is isoniazid for 6 months (answered by Umm Al-Qura). Here are 3 ways of managing latent TB:
1. Isoniazid+B6 for 9 months
2. Rifampin for 4 months
3. Isoniazid + Rifampin 3 months
In the first question, Both A and D are correct. I think there was some mistake when writing the recalled choices (mistaken the period or did not write the frequency). If not, I would go for D since INH is not recommended to be given without vitamin B6.
Man test positive to HIV on routine screening and begs you not to tell anyone
A. Infor his boss
B. Report the case
C. Inform wife
D. Can't remember the last
Abdulrahman: This is an old ethical question. The answer is B with 100% certainty. HIV is a reportable disease, so you have to report it. You have to tell the husband to tell his wife, and arrange a meeting with both of them afterwards, but you have to report the case nonetheless.
A. Infor his boss
B. Report the case
C. Inform wife
D. Can't remember the last
Abdulrahman: This is an old ethical question. The answer is B with 100% certainty. HIV is a reportable disease, so you have to report it. You have to tell the husband to tell his wife, and arrange a meeting with both of them afterwards, but you have to report the case nonetheless.
Long scenario female pregnant of baby with down syndrome, how to diagnose?
A- high inhibin, high HCG, low estriol, low AFP
B- Low inhibin, high HCG, High estriol, low AFP
C- high inhibin, low HCG, low estriol, high AFP
Abdulrahman: The correct answer is A.
A- high inhibin, high HCG, low estriol, low AFP
B- Low inhibin, high HCG, High estriol, low AFP
C- high inhibin, low HCG, low estriol, high AFP
Abdulrahman: The correct answer is A.
Patient fall from hight next step ?
A- Check pulse
Better recall: Patient fall down from 3m GCS normal vitally normal
only complaining of sever bilateral heel pain. What is of the following is most appropriate next :
A- Check pulse
B- Bilateral x ray
C- Pain management
D- Stint
Abdulrahman: The correct answer is A. You have to check the pulses as part of the ACLS protocol (Circulation).
A- Check pulse
Better recall: Patient fall down from 3m GCS normal vitally normal
only complaining of sever bilateral heel pain. What is of the following is most appropriate next :
A- Check pulse
B- Bilateral x ray
C- Pain management
D- Stint
Abdulrahman: The correct answer is A. You have to check the pulses as part of the ACLS protocol (Circulation).
Pt post some cholangio intervention few hours later he devolps chills and rigor only no fever mentioned
TWBs was 9 normal till 10
RR 18
HR 90
Bp 115/88
Temp :38 degree exactly
What is the most likely diagnosis:
A) sepsis
B) SIRS
C) bactermia
D) septic shock
Abdulrahman: The answer is SIRS since it almost fulfills the criteria and it can occur after procedures. It is the only plausible answer between these choices.
- No mentioning of suspected or confirmed infection (WBCs are normal and the question does not mention that the procedure was contaminated, dirty, or any complications that happened afterwards)
- No evidence of bacteremia (requires cultural diagnosis)
- Septic shock (patient is hemodynamically stable).
TWBs was 9 normal till 10
RR 18
HR 90
Bp 115/88
Temp :38 degree exactly
What is the most likely diagnosis:
A) sepsis
B) SIRS
C) bactermia
D) septic shock
Abdulrahman: The answer is SIRS since it almost fulfills the criteria and it can occur after procedures. It is the only plausible answer between these choices.
- No mentioning of suspected or confirmed infection (WBCs are normal and the question does not mention that the procedure was contaminated, dirty, or any complications that happened afterwards)
- No evidence of bacteremia (requires cultural diagnosis)
- Septic shock (patient is hemodynamically stable).
Lady, with bruises and fracture bc her husband beat her, what to do?
A- educate about violence
B- inform authorities
C- talk to the husband
Abdulrahman: The answer is B. It’s not the time to educate her about violence and you can’t talk to the husband before informing the authorities.
A- educate about violence
B- inform authorities
C- talk to the husband
Abdulrahman: The answer is B. It’s not the time to educate her about violence and you can’t talk to the husband before informing the authorities.
Case about COPD what is the long term TX?
A- ICS + LABA
B- SABA + LABA + chest therapy
C- Phsophodiesterase inhibitor + LABA
Better recall: Management for COPD mMRC 2 (Modified Medical Research Council)?
A. Combined Salmetrol + fluticasone
B. Phosphodiesterase-4 (PDE₄) inhibitors + Salmetrol + fluticasone
C. Albutarol as needed + Salmetrol+ pulmonary rehabilitation
D. Albutarol as needed + fluticasone
Abdulrahman: The answer is C in the second recall (SABA + LABA + pulmonary rehabilitation)
A- ICS + LABA
B- SABA + LABA + chest therapy
C- Phsophodiesterase inhibitor + LABA
Better recall: Management for COPD mMRC 2 (Modified Medical Research Council)?
A. Combined Salmetrol + fluticasone
B. Phosphodiesterase-4 (PDE₄) inhibitors + Salmetrol + fluticasone
C. Albutarol as needed + Salmetrol+ pulmonary rehabilitation
D. Albutarol as needed + fluticasone
Abdulrahman: The answer is C in the second recall (SABA + LABA + pulmonary rehabilitation)
31 year-old female was following up for the last 5 year with women health, last year negative and this year, negative Pap smear and negative HPV Test, next time to do Pap smear:
A- 6 months
B- 1 year
C- 2 years
D- 3years
Abdulrahman: The correct answer between these choices is D. But remember:
- Every 3 years: pap smear alone.
- Every 5 years: Pap smear + HPV testing.
A- 6 months
B- 1 year
C- 2 years
D- 3years
Abdulrahman: The correct answer between these choices is D. But remember:
- Every 3 years: pap smear alone.
- Every 5 years: Pap smear + HPV testing.
pediatric pat k/c of Asthma since age 2 years he is now asymptomatic with rare uses of albuterol inhalers, he came for counseling, he had contact sport participation, what is best question to ask to know his response:
A- "Are keeping up with your freinds?"
B- "How frequent do use inhaler?"
C-"presence night symptoms (cough)"
Another recall: 16-year-old male, known case of asthma since 2 years, he uses albuterol inhaler rarely came for counseling. He plays sports. What is the best question to ask to know his response?
A. Are you keeping with your friends?
B. How frequent do you use the inhaler?
C. Are you coughing during the day?
D. Are you coughing while eating?
(There were no night symptoms in the question).
Abdulrahman: Abdulrahman: The answer is A since he rarely uses inhalers and is asymptomatic. You want to see how it affects his daily life.
Another recall (different age): 6 yo child k/c of bronchial asthma He is known player in a school team. Presented with acute exacerbation. Which of the following helps in letting you know recurrence of the exacerbation?
A. Asking how frequent he use the inhaler
B. Are you keeping up with your teammates?
C. Cough during eating
D. Cough during the day
Abdulrahman: The answer here should be the occurrence of asthma symptoms at night. SINA guidelines here differ with children aged 4-12. They are not asked how frequent they use their inhalers during the day.
A- "Are keeping up with your freinds?"
B- "How frequent do use inhaler?"
C-"presence night symptoms (cough)"
Another recall: 16-year-old male, known case of asthma since 2 years, he uses albuterol inhaler rarely came for counseling. He plays sports. What is the best question to ask to know his response?
A. Are you keeping with your friends?
B. How frequent do you use the inhaler?
C. Are you coughing during the day?
D. Are you coughing while eating?
(There were no night symptoms in the question).
Abdulrahman: Abdulrahman: The answer is A since he rarely uses inhalers and is asymptomatic. You want to see how it affects his daily life.
Another recall (different age): 6 yo child k/c of bronchial asthma He is known player in a school team. Presented with acute exacerbation. Which of the following helps in letting you know recurrence of the exacerbation?
A. Asking how frequent he use the inhaler
B. Are you keeping up with your teammates?
C. Cough during eating
D. Cough during the day
Abdulrahman: The answer here should be the occurrence of asthma symptoms at night. SINA guidelines here differ with children aged 4-12. They are not asked how frequent they use their inhalers during the day.
14 years old Female has severe abdominal pain and mode changes 1 day before the menstrual cycle which prevents her from going to school and daily activities, recently she is on NSAID with some improvement and now she can go to her school and do her daily activities, but she is unsatisfied and requesting more analgesia, what you will give?
A- Diazepam
B- Advice for life style modification
C- Oral estrogen
D- Hysterectomy
Abdulrahman: The answer is B. After giving her NSAIDs, she improved to the point where she can go back to school and do her daily activities. Therefore, there is no need for further medications to be given. I hope no one answers D in the exam…..
A- Diazepam
B- Advice for life style modification
C- Oral estrogen
D- Hysterectomy
Abdulrahman: The answer is B. After giving her NSAIDs, she improved to the point where she can go back to school and do her daily activities. Therefore, there is no need for further medications to be given. I hope no one answers D in the exam…..
Old pt want to go for hajj he didn't take any Prevention meningococcal vaccine what the best method of prophylaxis antibiotic
A- rifamcine bid for 5 day
B- Cefra for 6 days
C- Azthromycin for 3 days
Abdulrahman: The answer is either ciprofloxacin (one dose) or rifampicin BID for two days (for doses). This is the official MOH Hajj guidelines:
A- rifamcine bid for 5 day
B- Cefra for 6 days
C- Azthromycin for 3 days
Abdulrahman: The answer is either ciprofloxacin (one dose) or rifampicin BID for two days (for doses). This is the official MOH Hajj guidelines: