DHA 6/7/17

1.Female came with complain of bilateral breast nodularity associated with menstrual cycle,
on examination one subareoalr dominant 3 cm mobile noted among bilateral nodularity. What
should you do?

A FNAC
B. observe after menstrual cycle

2 The most common symptom of emphysema is:

A cough

b. dyspnea

c. cyanosis

3. 36 year old female diagnose epilepsy at 29 years of age, haven been taking phenytoin
since then and has been seizure free since. She now complains of abnormal facial hair
grwth and wants to discontinue phenytoin. Her EEG on phenytoin is normal.

a. She should continue phenytoin

b. It is reasonable to consider stopping phenytoin
c. Switch to another anticonvulsant

4. Young female on phenytoin for epislepsy. She wants to conceive now and asks your
advice. Which of the following is associated with risk of birth defects ?
a. Maternal fits
b. Fetal fits
c. The use of anticonvulsants

5. . Greatest risk for DVT is which of the following?

A Open knee surgery

B fly for 4 hours

C maternal history of DVT

6. Patients with uncontrolled diabetes comes to you with a non healing ulcer of the foot.
Despite antibiotics. On examination pulses are strong. What would your next action be?
a. Mid foot amputation
b. Surgical debridement
c. Another course of antibiotics
d. Hyperbaric oxygen
 7. Patient newly diagnosed depression and started on SSRI now comes to your clinic all
energetic and tells you a detail plan about his suicide. What would you do?

a. Switch to other antidepressant

b. Admit him to hospital

8. Patient known case of Diabetes poorly controlled preneted with sudden onset of right foot
pain. On examination of foot, it is cold, pale but slightly tender. Oher examinationreveals ,
peripheral pulses weak , cold skin,shiny, loss of hair, DVT right leg. What is the most likely
diagnosis?

A. Ischemia
B. Thrombophlebitis
C. Phlebothrombosis
D. Cellulitis

9 . Which of the following is at a risk of serious bronchial asthma?

a. Bp = 150/ 90 HR = 100 RR = 15
b. BP = 160/90 HR = 90 RR = 18
c. BP = 120/ 80 HR = 110 RR = 18
d. BP = 120/80 HR= 120 RR = 30

10. Pregnant lady exposed to her nephew who has rubella. Her titer shows she is immune
susceptible. What would you do?

a. Oral acyclovir
b. Vaccinate her
c. Immunoglobulin
d. Repeat serology next week

11..15 year old has a brother with type 1 DM, what is the risk of his developing DM at 20 years of
age?

a. 1%

b 4%

c 6%

d 10%
12. (long scenario) Female newly diagnosed as DM few months ago and started on sulfonylurea
and guven American 2000 calorie chart now presents for routine visit to the clinic. Her labs are as
follows

CBC = normal

UCE and electrolytes = Normal

BMI = 30

Lipid profile = raised LDL, LOW HDL AND RAISED TOTAL CHOLESTROL

Fbs = HIGH

HBA1C also raised

What should the next action be?

1 needs weight reduction only

2. only DM and lipid need to be controlled

3 benefit of American diet chart

4. multidisciplinary ation needed to control the issues. (something like that)

13. child brought by his parents with fever , malaise, poor feeding, history of Bilateral earache.

Labs show decreased Hb, increased TLC and fever. CT attached ( shows biconvex ring enhancing lesion

in front lobe )

a. Meningitis
b. Epidural abscess
14. 3 year old boy brough by his father with abdominal pain and swelling of the face, eyelids and
upper lip. He says these episodes have occurredseveral times and his brother also had same
condition. On examination, non pitting edema is noted on the back of hands. O/E

HR RR TEMP normal

BP = 100/60

What is the possible complication of this condition?

A . anaphylactic shock

c. Airway obstruction
d. Sepsis
e. Renal failure

14. 13 YEAR OLD girl brought by her mother to the clinic with complain of pain and swelling in
knee after running or jumping. She gave a history of recent growth spurt. On examination, the girl
is found to be obese and swelling is noted in the knee. X ray attached:

WHATS THE most likely diagnosis?

A. Patellar fracture
B. Osgood sclatter disease

15. A patient with Pneumocystitis pneumonia. What to do

a. screen for HIV

15. adolescent female, found to have BMI greate than 95th percentile on her routince visit.
What is the most appropriate action?
 a. avoid discussion about weight.

b. decrease colorie intake

c. interdisciplinary plan something

d. tell her she is larger than most people her age.

16. 47 year old patient presented with recuurent peptic ulcer type symtptoms not relieved by
repeated PPI treatment . what would you advise?

A, take NSAID for pain

B endoscopy is indicated

C take pancreatase when pain starts

17. A boy presents with pterygium extending towards cornea. What is the feared
complication?

A may cause vision impairment

B systemic involvement

C premalignant?

18. Patient presented with recurrent epigastric pain (peptic ulcer symptoms) not relieved by
over the counter antiacids. Whats your next action?

H2 blocker

PPI

Antacids

19
mechanism of action of glipizide:

A/ decrease insulin resistance

b/ increase insulin release from pancreas

20. pt diagnosed with CRF..what is annually investigation he should do?

A/peripheral edema
B/oliguria
C/routine blood test

21. a baby can feed himself, ride a tricycle. Whats the age?

1. 2 years

2 . 3 years

3. 4 years

22. A child can climb and descend stairs one foot at a time, scribble and draw a circle.

a. 1-2 years

b. 5-6 years

c. 3-4 years

23.. which pain killer is suitable for which secondary condition?

a. cardiac, tramadol

b. renal , epinephrine

c. amitriptyline, neuropathic

24. Very long case of 20 years of Ulcerative colitis, with friable mucosa seen on examination.
Biopsy shows carcinoma in situ. Plan of action?

a. left hemicolectomy with colostomy

b total colectomy with ileostomy

25. Signs of codeine intoxication :

a. Tremors and anxiety

b. CNS excitement and insomnia

c. Respiratory depression and hypotension

d. Tachycardia and anxiety

26. Obese patient with DM and HTN, your advice regarding losing weight:

a. Decrease carbohydrate intake during day time

b. Decrease carbohydrate and increase fat intake

c. Decrease 500calories for every pound weight loss per week

d. Decrease caloric intake to 800 kcal/day

27. A man presents with signs of asthma. In office setting, you decide to perform his pulomonary
function test after giving albuterol. His FEV1 is 85%. What do you expect to find?

A. NO improvement

B decrease in FEV1 to 72%

c. increase in FEV1 to 97%

28. First line of defence in the skin

a mucous membranes

b collagenous cell.

c keratinocytes

d areolar connective tissue

29. Psoriasis picture, scaly pink lesion on extensor surfaces

A) avoid trauma

B) avoid sun

C) bath daily

30. Lady with back pain radiating to both buttocks. Started after lifting heavy box. No other
sensory or motor dysfunction. Some lower back stiffness noted

: A) avoid bed rest

B) Lumbar traction

C) Massage

d) cold compresses

31: Pt always think there is alien in his back yard when he is out from home, even though he
knows its not possible, he's always thinking about the idea brought by this aliens. pt came to you
fear that he is going to be "insane" what is his condition

A) Obsessions
B) Compulsions

C) Hallucinations

D) Delusions

32: 3 year old child brought by parents, he is obese.. What advice:

A) Decrease milk intake

B) increase protein

C) total fat per day less than 60% of total daily calories

D) fat less than 30% of total daily calories

33. Saudi Paediatrics society suggest breast feeding for :

A) 4 month

B) 6-12

C) 13-18

D) 19 - 25

34. Old man presented by his children, they suspect his cognitive function is impaired.. what can
you tell them about trying to improve his condition.. (Dementia advice)

A) Daily exercise will help

B) Brain exercise will help prevent dementia

C) New measure of conducting his daily activities will now be required

35. Old lady, know HTN, DM, presented with epigastric pain radiating to the back, and heart burn
for past 2 months, not relieved by antacids (Ranitidine)..otherwise she
looks health, no abdominal tenderness ,

ECG shows sinus tachycardia ( I guess)

vitals BP 150/90

A) Aortic Dissection

B) Perforated peptic ulcer

C) MI

36. Pt e hypertension on atenolol 50 Mg, presented with shiny skin leg weak dorsalis pedis

Bp 140/90 rest vitals normal

A. stop atenolol and start amlodipine

B. educe atenolol to 25 mg and add captopril 25
c. add hydrochorothizide 25 mg plus reduce atenolol to 25 mg
d. reduce dose to 25mg

37. typical senario of closed angle glucoma acute ask for treatment

A. timolol eye drop+ iv acetazolamide

B .Timolol eye drop and refer

C. iv acetazolamide+ pILOCARPINE 0.4%

38. regarding celiac disease, which can be taken safely?

a. oat
b. barley
c. rice
d. wheat

39. a diabetic patient on long acting insulin before dinner and morning. He compains of waking up
at 3 am with sweating and palpitations. His RBS recording shows episode of hypoglycemia at 3-5
am but morning FBS is high. What is your plan of action?

A. decrease long acting insulin dose at night

b. give long acting insulin at midnight instead of before dinner

c. increase pre dinner long acting insulin dose

40. a child with ear pain and conductive hearing loss,

a. Otitis media
b. Otitis externa
c. Otosclerosis
d.
41. Female with facial pain but no rhinorrhea. Diagnosis of sinusitis made suspected Haemophilus
influenza. What would be your management?

A. Antiviral, topical steroids, topical decongestants

B. Topical decongestant, broad spectrum antibiotic
C. Topical steroid, antibiotic,anti-inflammatory

41. Adult female complained of tingling in hip area, later developed a vesicular rash limited to one
dermatome

a. steroids

b. antibiotics

c. acyclovir

42 : Female with uncontrolled DM presented with foul discharge from nose and black crusting
seen on inferior turbinate. What is the likely diagnosis?

a. Mucor mycosis

43. patient complained of difficulty in breathing from one nostril. On examination,a pale
edematous mass is seen in middle turbinate. What will be your treatment?

a Topical antibiotic

b. Topical decongestant
c. Topical steroid
d. Topical antihistamine

44. A patient with single hypopigmented and hypoaesthetic lesion on forearm and thickened
palpable ulnar nerve. What is the most likely diagnois?

A. leprosy

b. tubercolusis

c. fungal infection
45. A boy presented with right eye swelling and chemosis, there is some lid edema and flu like
symptoms. An enlarged pre-auricular node is noted on examination. What is the most likely
etiology

A. Bacterial

2. viral

3. fungal

45. A study was conducted comparing 1000 women with neonates with congential heart defects
compared to 5000 women with no congential heart defects. Out of those with congenital heart
defets, 20 had history of Gestational DM while 50 from the other group had similar history. Which
of the following is most suitable equation?

A. OR = 2.0

B. OR = 0.2

C. RR = 2.0

D. RR = 0.2

46. Community medicine question asking to calculate strength of association

Exposed patients = 2.0

Unexposed patients = 3.0

A. 0.7
B. 1266

47. Female presented with swelling in the axilla, other wise normal. On examination, 5 CM Warm,
tender fluctuant swelling noted in the axilla. What is the management?

A. I&D UNDER GA

B I&D UNDER LA

C. antiobiotics

48. Treatment of non inflammatory acne?

a. retinoic acid

b. acetic acid
c. iso triretinoin

49. Adult female presented with anorexia, jaundice pruritis. On examination, hepatomegaly noted
alongwith icteric sclera. Labs

Direct BILI = 23

Total bilirubin = 32

Alkaline phosphatase = 1000

AST = 45

ALT = 35

Which investigation is of high diagnostic value?

A. Liver biopsy
B. ERCP
C. Abdominal US
D. Abdominal CT

50. A very very long scenario of young female presenting with abdominal pain, fever, dark urine,
no visceromegaly on examination.

Vital examination fever, tachycardia

Cbc ; raised TLC, mild decrease HB

Urinanalysis - > 10 WBC, >10 RBC

What is the most likely diagnosis?

A. Acute glomerulonehpritis
B. Acute pyelonephritis

51. Hypertensive male with pain starting in interscapular region, radiating to jaw and down the
spine. Right sided pulses normal, left sided decreased. Signs on Horner’s ( left sided ptosis, and
miosis and right sided face sweating ) . BP high. Tachycardia.

Which in the most important first line investigation?

A. Ct brain with contrast

B. CT abdomen with contrast
C. Transthoracic ECHO

52. woman presents at 38 weeks with regular uterine contractions and twin gestation. Which of
the following is the most dangerous (for twin A) that the obstetrician should keep in mind?

A transverse – CEPHALIC
b. breech- cephalic

c. cephalic breech

53. patient prescribed with SSRI. What should he be informed about?

A. it needs continuous monitoring

b. takes 3-4 weeks to achieve full effect

54. SSRI takes how long to achieve effect?

a. 1 week

b.2 weeks

c.3-4 weeks

55. In which dementia would you find neurofibrillary tangles, amyloid deposits, senile plaques IN
CORTICAL MATTER?

a. Alzheimers

B. lewy body dementia

c. multiinfarct dementia

56. A long scenario with picture of Sickle cell anemia, boy presented with pain in hands and feet,
he looks lethargic , dehydrated with sunken eyes. ( confusing one)

HB = 8.5

Tlc = raised

What is the best management for this patient?

A. Antibiotics
B. Packed red cell transfusion
C. Hemoglobin electrophoresis.

57. Yound boy asthmatic presention with shortness of breath. At home, he took albuterol inhaler
but no improvement noted. He is short of breath, unable to complete sentences and bilateral
wheezing noted.

SpO2 = 91%
What is the next best management?

A. Oral prednisolone
B. Iv hydrocotisone
C. Long ACTING BETA AGONIST

58. A 7 year old boy diagnosed with asthma. You prescribed him inhaled steroid inhaler for control
of his symptoms. What POSSIBLE side effect would you warn the parents about?

A. Growth retardation

b. CATARACT

C . INFECTION

59. Female with recurrent UTI. What can be a possible cause?

a. back to font wiping

B. use of sanitary napkins

60.
A 17 year old patient presents to the ER with a history of Right Iliac Fossa pain, anorexia, vomiting
and nausea. The temperature is 38.3C. On investigation the TLC is 12000/cu.mm. The most likely
diagnosis is
A. Acute appendicitis
B. Acute salpingitis
C. Mesenteric lymphadenitis
D. Iliopsoas abscess

61. Why is SSRI preferred over other antidepressants?

A its cost effective

b. needs less monitoring
c.well tolerated and better side effect profile

62 Female woke up with sudden onset of headache sharp, then loss of consciousness. CT
attached shows suc arachnoid hemorrhage.

A. Meningitis
B. Stroke
C. Sub arachnoid hemorrhage

63. young sexually active female presented with deep abdominal pain and nausea, fever with
chills starting one day back. On examination, abdominal tenderness noted with no visceromegaly
but she is febrile. She is otherwise stable and tolerating orally. Diagnosis of PID made.

Vitals TEMP = 38.5

What is the best management?

A. Admit and intravenous antibiotics

 B. Outpatient antibiotics

64. Regarding medical management of influenza

a. Given once 3-5 days after diagnosis

b. Shorten the duration of symptoms by 2-3 days
c. Should be started within 72 hours to be effective

65. adult patient with history of fever, sore throat . Now presented with SOB and intermittent sharp
chest pain. ECG attached ( almost like this )

ASKIng for diagnosis.

A. Pericarditis
B. Pericardial effusion
C. Pulmonary embolism

66. same scenario of lymphangitis as repeated in past papers

67

.
What is the best management?

A. Topical steroids
B. Topical antibiotics
C. Cryosurgery

68. Drug of choice for treatment of mania in liver disease?

A. lithium

b. ssri

c. risperidone

69. a man comes to your clinic, keeps looking to your left. When inquired, he tells that his mother
is Stading there and no one else can see her but she comes and goes. His family told that his
mother has been dead for a long time.

A. AUDITORY HALLUCINATION

B. VISUAL HALLUCINATION

C. PSYCHOTIC DISORDER

70. patient with polyuria, polydispsia. WATER DEPRIVATion test shows increased serum
osmolality but no rise in urine osmolality, desmopressin given but still no effect. Whats the
diagnosis?

A. nephrogenic diabetes insipidus

b. central diabetes insipidus

71. 32 year old Female diagnosed with PCOS long ago. Took progesterone for withdrawal bleeding
for a long time. She stopped taking progesterone 5 years ago. What is she at increased risk for?

a. endometrial cancer

b. hip fracture

72 Picture of ganglion, mass moves with finger movement.

A. GANGLION
B. Lipoma

73 Type 1 DM, presented with signs of DKA

a. Insulin mismanagement
b. Diet mismanagement

74 Adolescent noted to have breast bud development and slight glandular tissue. Slightly pubic
and axillary hair deveopement present as well

A tanner stage 1
B tanner stage 2

C tanner stage 3

D tanner stage 4

75. patient presented with complain of palpitations, inability to sleep, excessive sweating. Throid
profile shows hyperthyroidism. On palpation, firm rubbery non- tender thyroid gland nogted.
Thyoperoxidase antibodies positive. Whats the diagnosis?

A. reidel thyroiditis

b. graves disease

c hashimotos thyroiditis

76. PATIENS with mixed first and second degree burns of face and neck. Whats the management?

a. silver sulfaziazine and IV fluids

b. silver sulfadiazine and admit to hospital

77. Female 3 months after delivery complains of fecal incontinence and vaginal flatus. Whats the
diagnosis

a. partial perineal tear

b. rectovaginal fistula

c. hemorrhoid

78. 3 year old child with history of 10 stools and 1 vomit in 1 day. He appears dehydrated.
Tolerating oral liquids.

Labs given which were normal

A. Iv fluids
B. Oral rehydration theapy
C. Iv fluids followed by oral rehydration

79. female with multiple sexual partnets came with complain of foul smelling vaginal discharge
for 6 months. On preliminary vaginal examination, shallow ulder is seen on posterior lip of
ectocervix. What is the best initial investigation?

A cervical biopsy

c. Pap smear
d. colposcopy
80. Most appropriate screening for aortic aneurysm:

A. abdominal CT

B. abdominal US

c. ECHO

81. female with bilateral breast nodularity related to menstrual cycle, what advice would you give?
Takes an ccasional cup of tea and eats chocolates compulsively mid cycle. Whats your advice?

A. avoiding caffeine and chocolates may decrease the symptoms

B. OCP will improve the nodularity and symptoms

82. Regarding inguinal hernia:

A. comes out from a defect in the abdominal wall

B through the internal ring, canal and then external ring ( something like that)

83. female adolescent likes to eat fst food, what should she include in her diet

A. calcium and folic acid

b. vitamin D and calcium

c. folic acid and vitamin C