Q119. A 78 year’s retired teacher was admitted for a hernioplasty procedure. After the operation he became agitate and confused.
What is the most appropriate management?

Q120. A 45-year-old woman has a 2-cm breast cancer tumor removed by lumpectomy, and the breast is irradiated. The cancer is negative for estrogen receptors and positive for progesterone receptors. Three of 14 nodes removed from the axilla are positive for cancer.
What is the next best step in management?

Q121. Patient Chronic smoker with 30 cigarettes per day, got hoarseness of voice.
The most likely diagnosis is:

Q122. Patient with normal pressure hydrocephalus. CT brain picture distended ventricles.
What is initial treatment?

Q123. A 77-years-old male presents with history of enuresis and change in behavior. Exam: waddling gait.
What is the most likely diagnosis?

Q124. A 74-year-old woman, who has been followed for the past 25 years for chronic obstructive pulmonary disease (COPD) comes to the emergency department complaining of 48 hours of temperatures to 38.6 C (101.4 F) and worsening shortness of breath. She has a chronic productive cough, which has become more copious. On physical examination, she has rhonchi and increased fremitus in the posterior mid-lung field. A Gram’s stain reveals many epithelial cells and multiple gram-positive and gram-negative organisms; no neutrophils are seen.
Which of the following is the most likely organism causing the symptoms?

Q125. A 10-month-old boy weighing 3 kg has polyuria, polydipsia and delayed motor milestones. His blood pressure is normal. Blood tests reveal: creatinine 80 mmol/l, sodium 128 mmol/l, chloride 90 mmol/l, potassium 3.0 mmol/l, calcium 2.7 mmol/l, bicarbonate 26 mmol/l and pH 7.46. Ultrasonography shows medullary nephrocalcinosis.
What is the most likely diagnosis?

Q126. After starting Antidepressant drug, if patient is not improving then when you decide to stop drugs?

Q127. 20-year-old patient with a red lesion on her face. She said this from birth.
What is your management?

Q128. A 20-year-old boy is hit by a car while riding his bicycle. He presents to the ED with severe groin pain after falling on the central bar of the bike. Physical examination reveals blood at the urethral meatus and a high-riding prostate.
What is the most appropriate next step in the management of this patient?

Q129. What is the best initial investigation in a postmenopausal woman with a breast lump?

Q130. A 11-year-old boy comes with decreased appetite and abdominal pain around his umbilicus. His parents think he doesn’t want to go to school, and while in math class he begins to have sharp pain in his right lower abdomen. He is rushed to the ED and laboratory analysis shows a WBC of 12,500.
What is the most likely diagnosis?

Q131. Which of the following is the main difference between saphenous vein grafts and internal mammary artery grafts?

Q132. An 82-year-old man has woken up with incoherent speech and difficulty in finding the right words. Exam: good comprehension.
Which anatomical site is most likely to be affected?

Q133. A patient with Type-1diabetes has a fundus showing micro-aneurysm and hard exudate.
What is the single diagnosis?

Q134. A 73-year-old woman has lymphadenopathy and splenomegaly. She feels well but has had recurrent chest infections recently.
Choose the single most likely blood film findings?

Q135. lady presents with hot flashes and other symptoms of menopause.
What is the treatment option?

Q136. A pregnant lady comes at 37 weeks with 3+ proteinuria, confusion and Blood pressure 170/110 mmhg.
What is the best step in her management?

Q137. An elderly man comes to the emergency department with fever, headache, a stiff neck, and photophobia. He is HIV positive with < 50 CD4 cells and a history of pneumocystis pneumonia. His head CT is normal. CSF shows 2,500 white cells that are all neutrophils; Gram stain is normal.
What is the best initial therapy?