سراج
@SirajBank
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An UpToDate-based online SMLE Qbank 📚📝
Joined June 2022
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Subdural hematoma, Epidural hematoma, and Subarachnoid hemorrhage in CT Brain
0
17
76
A pediatric patient was diagnosed in the emergency department with acetaminophen toxicity due to tablet ingestion 1 day ago. He has abdominal pain and tenderness with elevated liver enzymes. In which stage of acetaminophen toxicity is the patient classified?
Stage 1
151
Stage 2
569
Stage 3
261
Stage 4
39
4
12
46
A pregnant lady known case of asthma gave birth via C-section then developed post-partum hemorrhage (PPH) secondary to uterine atony. She was started on IV fluids and the doctor decided to administer a medication to stop the bleeding. Which of the following medications should be
Carboprost
298
Oxytocin
326
Misoprostol
336
Methylergonovine
209
6
8
38
D ✅
A case of acute cholangitis secondary to choledocholithiasis.
Most patients with choledocholithiasis are symptomatic, although occasional patients are asymptomatic. Symptoms associated with choledocholithiasis include right upper quadrant or epigastric pain, nausea, and
0
12
29
A baby with has a noisy breathing and wheezing that improves when the baby is in prone position and increases when supine. Which of the following is the most likely diagnosis?
Croup
293
Tracheomalacia
258
Laryngomalacia
474
Asthma
136
2
6
27
A 70-year-old male was admitted to the ICU due to intracranial hemorrhage. Seven days later, he developed ground coffee vomitus. Which of the following is the most likely diagnosis?
Stress gastritis
744
H. pylori gastritis
171
Dyspepsia
63
Variceal hemorrhage
525
6
4
24
A 3-year-old girl is known to have Turner syndrome. Which of the following is the most common congenital heart anomaly found in Turner syndrome?
Coarctation of aorta
700
Bicuspid aortic valve
303
Tetralogy of Fallot
400
Mitral valve prolapse
184
7
2
24
Which of the following carries the highest risk of endometrial cancer?
Age
462
PCOS
883
Smoking
503
Weigh
197
4
5
21
A patient who was involved in a motor
vehicle accident was brought to the ER with chest pain and shortness of breath. On exam, there is decreased air entry on the right side and the right lung is hyper-resonant on percussion. Which of the following is the most likely diagnosis?
Right hemothorax
108
Rt tension pneumothorax
529
Rt open pneumothorax
127
Right pleural effusion
61
1
1
22
A febrile female patient presents with right upper quadrant pain for 12 hours. Physical examination revealed jaundice and laboratory findings are positive for high bilirubin. An ultrasound revealed a non-thickened gallbladder wall with multiple stones. The CBD is 1 cm dilated.
Acute cholecystitis
278
Non-obstructive jaundice
62
Acute pancreatitis
32
Ascending cholangitis
303
2
4
22
A female patient presented with signs and symptoms of small bowel obstruction. On examination, an irreducible mass medial to the pubic tubercle was palpated. What is your provisional diagnosis?
Incisional hernia
66
Inguinal hernia
508
Femoral hernia
282
Obturator hernia
85
3
3
18
A 3-month-old boy presented to the ER with a history of paroxysmal episodes of cough followed by whoopi sounds at the end of each episode. It is associated with perioral cyanosis and post-tussive vomiting. There is no history of diarrhea. This illness has been preceded by a runny
Chlamydia trachomatis
25
Mycoplasma pneumonia
73
Pertussis
669
Adenovirus pneumonia
69
4
4
19
A 10-day-old baby presents with a green color vomiting for 1 week with a distended abdomen. He has loose stool formation. Per-rectal examination: when the doctor removed his finger a gush of stool passed out. What is the diagnosis?
Umbilical hernia
14
Pyloric stenosis
66
Hirschsprung's disease
316
Meconium aspiration
46
5
1
18
A 22-year-old woman with a history of anxiety visits the dentist for routine dental care. In the waiting room, she begins to complain to the receptionist that she feels extremely dizzy and weak and that her vision is blurring. The receptionist realizes she is having a panic
Lower cerebral blood flow
399
Oxygen toxicity
122
Carotid artery occlusion
50
Reduced respiratory rate
147
2
4
18
A young female suddenly developed jaundice and fatigue. She has high ALP and high bilirubin. No splenomegaly or hepatomegaly. US is unremarkable. MRCP: multiple foci of stricture and dilatation. Which of the following is the appropriate next step in management?
Liver biopsy
230
Antinuclear antibody
232
Repeat US
66
Colonoscopy
109
5
1
17
Which of the following investigations is part of the initial assessment in a perforated peptic ulcer?
Supine abdominal X-ray
178
Abdominal ultrasound
398
Erect chest X-ray
452
Lateral chest X-ray
41
3
4
17
A young patient did a pap smear in screening and showed a high-grade squamous intraepithelial lesion (HSIL). The biopsy showed carcinoma in situ. She wants to conserve her fertility. Which of the following is the best treatment for her?
Endometrial ablation
103
Hysterectomy
56
Cold knife conization
116
Loop excision (LEEP)
204
2
2
16
A patient presented to the primary care
clinic complaining of unilateral knee pain that increases with movement and is relieved with rest. The patient's pain is getting progressively worse. Which of the following is used for diagnosis?
Bilateral knee X-ray
309
Arthroscopy of the knee
64
MRI of the knee
123
Joint aspiration
121
2
2
15
What is the treatment of Wilson's disease?
D-penicillamine
952
Steroids
282
Methotrexate
269
NSAIDs
104
2
1
15
A 27-year-old female with placenta previa had severe bleeding. What is the most likely outcome post-delivery?
Galactorrhea
116
Diabetes
52
Absent menstrual cycles
266
Cushing syndrome
111
2
5
15
A 16-year-old female presents to the clinic with a chief complaint of never having had a menstrual period. She had never had a pelvic exam. Physical examination reveals the following: BP 110/70, Pulse 72, Weight 60 kg, Height 72. The patient appears at her stated age. Axillary
Hypothalamic amenorrhea
41
Prolactin adenonoma
32
Turner syndrome
274
Androgen insensitivity
198
3
5
15
A female patient in her early pregnancy is taking valporic acid. What possible fetal side effects that could happen?
Neural tube defects
485
Polyhydramnios
57
Oligohydramnios
71
Non-immune hydrops
44
2
4
13
An elderly patient’s chest radiograph showed a small lung nodule (<8 mm), he is asymptomatic, not a smoker, has no family history of cancer, and has no constitutional symptoms. What is the appropriate next step in management?
Radiotherapy
21
Biopsy
166
Follow-up with CT scan
387
Chemotherapy
11
1
2
10
What is the appropriate management of hypoxic ischemic encephalopathy?
Therapeutic hypokalemia
86
Therapeutic hyperthermia
98
Therapeutic hypothermia
284
Therapeutic hypervolemia
145
3
0
13
A pregnant lady presents to the clinic with multiple follicles around the areola of the nipple that are smooth, round, and painless. What is the most likely diagnosis?
Breast cyst
119
Montgomery's tubercles
308
Lactiferous ducts
250
Breast cancer
52
1
3
13
Which of the following carries the highest risk of endometrial cancer?
Age
239
PCOS
606
Smoking
302
Weight
124
3
1
12
A febrile patient has a lesion on the lateral side of his leg with red streaks. Which of the following is the appropriate antibiotic to give?
Erythromycin
100
Cephalexin
82
Penicillin
115
Ceftriaxone
183
2
1
13
A man sustained a motor vehicle accident. His right knee underwent a forceful collision with the dashboard. His right foot is pale and pulseless. A radiographic image shows a comminuted distal femoral fracture with a posterior knee dislocation. Which vessel was likely injured?
Posterior tibial artery
79
Superficial fibular
11
Popliteal artery
209
Anterior tibial artery
45
1
2
12
A patient came from India complaining of a headache for 1 week that increased in severity within the last 2 days, and there was intermittent fever and neck pain. Investigations: CSF was done and showed low glucose, ↑ WBC count with lymphocyte dominant 75%, neutrophils 25%, ↑
2
2
13
A man fell while running a marathon and came to the emergency department with darkening of his urine. His urine dipstick test was positive for blood. Urine microscopy showed no RBCs. Which of the following is the most likely diagnosis?
PSGN
29
Hemorrhagic cyst
38
Rhabdomyolysis
403
IgA nephropathy
56
3
1
12
A patient fell from one story
height with direct trauma to the head. He was brought to the ER with hemotympanum. Neurological examination was normal. Ear examination revealed a ruptured tympanic membrane with intact external auditory canal. What is the most likely bone fractured?
Maxillary
43
Basal skull
118
Mandibular
48
Mastoid
137
3
4
11
A baby was brought by his mother due to abdominal distention and a bad-smelling vomit. History is positive for delayed passage of meconium. Rectal exam showed an empty rectum. A CXR is shown below. The doctors started to decompress his stomach. What is the definitive treatment?
Conservative management
83
Leveling colostomy
122
Total colectomy
61
Pneumatic enema
115
2
1
11
A female patient required excessive
curettage after heavy bleeding. Later, she came with amenorrhea. Which layer of the endometrium is affected?
Basilar zone
134
Functional zone
156
Spongy
44
Compact
18
1
1
11
In extradural hematoma, which artery is affected?
Anterior cerebral artery
70
Posterior cerebral artery
57
Middle cerebral artery
151
Middle meningeal artery
271
2
2
11
A patient sustained trauma to the axilla and the lateral chest wall with fractures in the 4th & 5th ribs. While performing the physical examination, a suction sound was sourced from the lacerated wound on the fractured ribs. What is the appropriate next step in management?
Analgesia
35
Three-side dressing
143
Chest tube
194
Intubation
51
2
3
10
An 11-month-old child was brought by his parents due to a 1-day history of fresh blood in stool associated with foul smell and dark brown stool. On examination, the child was pale. Which of the following is the best diagnostic tool for his condition?
Radioisotope scan
88
Barium meal
46
Barium enema
148
US abdomen
177
3
2
11
An 8-year-old girl ingested 2 packs of paracetamol after a fight with her mother. She was brought to the emergency department after 24 hours of ingestion complaining of right upper quadrant pain. In which stage of acetaminophen toxicity is she now?
Stage 1
67
Stage 2
251
Stage 3
155
Stage 4
45
2
1
11
A 55-year-old man known to have hypertension comes for a follow-up. The patient was diagnosed with hypertension 3 months ago after an episode of transient vision loss in his right eye. He has occasional headaches and general fatigue. His current medications include aspirin,
Primary hyperaldostronism
107
Thiazide side effect
87
Unilateral RAS
31
Malignant hypertension
52
2
2
10
A female patient is afraid of automobiles. She starts to feel anxious when she sees a car. Which of the best describes the diagnosis?
Generilezed phobia
33
Specific phobia
304
Panic attack
68
Motorphobia
193
1
2
10
A researcher wants to examine the effectiveness of a drug. He does so by
combining multiple research papers to
reach a conclusion. What type of study is the researcher trying to do?
Meta-analysis
264
Cohort study
49
Case-control study
34
Cross-sectional
50
1
4
8
A female patient has failed lifestyle
modification (LSM) to reduce her weight. She is diabetic and hypertensive. Height: 173 cm, Weight: 126 kg. Which of the following is the most appropriate intervention?
Continue LSM
42
Weight loss medications
103
Bariatric surgery
171
Metformin
213
4
0
9
An 8-year-old healthy male presented with a 2-month history of abdominal pain with 2 episodes of bloody stool. A proctoscope was done and showed numerous polyps covering the linings and multiple biopsies were taken. What is the most likely diagnosis?
Ulcerative Colitis
108
FAP
205
HPV polyp
56
Diverticulosis coli
54
1
2
8
A child who was playing in the garden developed increased salivation, tearing, diarrhea, and sweating. What can explain his symptoms?
Organophosphate toxicity
72
Anti-cholinergic toxicity
20
Muscarinic drug toxicity
26
Carbon monoxide toxicity
9
1
2
8
Which of the following represents cervical insufficiency based on transvaginal US?
Cervical length <5 mm
55
Cervical length <10 mm
67
Cervical length <25 mm
111
Cervical length <35 mm
15
1
1
8
الحمدلله تمكنا في بنك سراج من مساعدة طلاب وأطباء امتياز وأطباء عموميين من أكثر من ١٠ دول حول العالم! ✨🌍
0
2
8
A child ingested a round coin and started to have drooling. In the emergency department, the child was fine with no signs or symptoms of obstruction. An X-ray was done and showed that the coin was in the stomach. Which of the following is the appropriate next step in management?
Immediate endoscopy
127
Discharge and check stool
255
Observe and make him fast
62
Laparotomy
39
3
1
8
A 13-year-old male presented with his parents complaining that he loves to set things on fire. They noticed this behavior 6 months ago, and they also noticed that he extends his arm at a 45-degree angle from time to time. On examination, he looks well and quiet. No other
BPD
33
Schizophrenia
45
Pyromania
192
Mimic syndrome
59
2
3
8
A female patient known case of CHF on medical therapy developed fatigue and yellow vision. She had an ECG in the emergency department (shown below). What is the diagnosis?
1
2
8
A-12-year-old was found to have Klebsiella pneumoniae with a colony count of 100000 from a mid-urine sample. There were no signs and symptoms of UTI. What is the next appropriate step?
Give empirical antibiotic
245
No need to treat
135
Admit to ICU
48
Treat as acute UTI
122
2
1
8
What is the diagnosis?
Tuberculous meningitis
193
Neisseria meningitidis
61
Herpes meningitis
48
Bacterial meningitis
112
1
1
9
سعداء بإعلان دمج فريقي عمل بنك سراج و Qbank في منصة واحدة وتحت سقف واحد؛ وذلك لتحقيق الاستفادة القصوى للمستخدمين والتدرب على حل الأسئلة بطريقة تفاعلية وممتعة 🩵💜🌟
1
1
8
A ✅
UTD: Stress ulcerations are common in intensive care unit (ICU) patients, some of which can cause hemorrhage. As a consequence, many critically ill patients require prophylaxis for primary prevention of bleeding from stress ulceration or treatment for stress ulcer-related
0
4
8
A 6-year-old child came for pre-sport
assessment. On examination, he had a fixed wide split second heart sound and a second-degree ejection systolic murmur at the upper left sternal border. ECG is normal. Which of the following is the most appropriate next step in management?
Cardiac referral
149
ICU admission
20
Cardiac stress test
108
Reassurance
59
2
4
8
Which of the following is the best site for diagnostic thoracentesis in relation to the midaxillary line?
*B/W = between.
2nd intercostal space
97
5th intercostal space
198
B/W 8th and 10th ribs
116
B/W 10th and 12th ribs
23
2
3
9
A patient received rubella vaccine and the doctor told her to avoid getting pregnant for at least 2 months, but she did get pregnant after 1 month. What is the most common possible complication?
Abortion in 1st trimester
89
Fetal death 3rd trimester
26
Fetal malformations
253
Not affected
69
3
2
7
A female patient presented with signs and symptoms of small bowel obstruction and an irreducible mass lateral and inferior to the pubic tubercle. What is your provisional diagnosis?
Direct inguinal hernia
66
Indirect inguinal hernia
123
Femoral hernia
340
Obturator hernia
38
3
2
8
A 49-year-old male who is a heavy smoker for 30 years came for lung cancer screening. Which of the following is the appropriate test to use?
Sputum cytology
41
Low dose CT
216
Chest X-ray
137
Bronchoscopy
76
1
1
7
An old lady has a uterine fundal mass. She was later diagnosed with cancer and was booked for surgery.
Which lymph node should be resected with the mass?
External iliac lymph node
35
Deep inguinal lymph node
87
Internal iliac lymph node
86
Para-aortic lymph node
120
2
1
7
A 23-year-old married lady was prescribed azithromycin for her chlamydial pelvic infection. She has recently started contraception to avoid getting pregnant. Which of the following contraceptive methods will be affected by azithromycin?
Barrier
30
IUCD
66
POP
60
COCP
99
1
3
7
At which age can we give peanuts and eggs to babies to prevent the risk of becoming allergic?
24 months
185
18 months
205
14 months
103
10 months
278
2
2
6
A female patient is complaining of feeling of heaviness in her lower abdomen and irregular menstrual cycles associated with heavy bleeding. She was diagnosed with uterine fibroids. What type of fibroids does she have?
Intramural
116
Subserosal
51
Submucosal
182
Cervical
66
2
0
7
A male smoker had an appendectomy in the past. His brother has Crohn's disease. What is the most important risk factor for the development of Crohn's disease?
Male gender
30
Smoking
93
Family history
218
History of appendectomy
29
2
0
6
كان هناك سوء فهم بيننا وبين الإخوة في Qbank، وهذا لم يكن إلا سوء فهم وتم حله. بعد اجتماع الفريقين قررنا جمع محتوى البنكين وفريق العمل في مكان واحد، وهذا تأكيدًّا منا على حسن النية والمشاركة العمل للخروج بأكبر فائدة ممكنة 💙💜
0
1
7
A female was diagnosed with a subserosal fibroid. She has not completed her family yet. Which of the following is the best next step in management?
Laparoscopic myomectomy
156
Hysteroscopic myomectomy
59
Open hysterectomy
24
Conservative management
181
1
1
6
An elderly was admitted to the ICU due to acute myocardial infarction. Then he developed pneumonia and was put on tazocin. Shortly after, the patient complained of RUQ pain and tenderness. Which of the following is the next appropriate step?
Convert abx to meropenem
93
Emergency cholecystectomy
41
ERCP drainage
75
Cholecystostomy drainage
72
0
2
6
A 62-year-old patient known case of diabetes mellitus presented to the emergency department complaining of cough, shortness of breath, and fever. Chest examination revealed crackles and a small pleural effusion. A diagnosis of pneumonia was made. Which of the following is a poor
1
2
7
A patient turns out to be erratic. For the past 4 months, he said that people on TV know what people are thinking about, and in the last 2 months, he claimed that he has a special power that no one has. Which of the following is the most likely diagnosis?
Unipolar
5
Schizophrenia
46
Brief psychotic disorder
28
Bipolar
11
1
1
6
A patient had a skull base fracture with jugular foramen injury. Which of the following consequences will be seen?
Loss of eye abduction
96
Loss of mastication
108
Loss of zygoma sensation
61
Vocal cord paralysis
121
1
2
5
@IhabFathiSulima
UTD: In IgA vasculitis (Henoch-Schönlein purpura), a tetrad of clinical manifestations is seen:
● Palpable purpura with neither thrombocytopenia nor coagulopathy
● Arthritis/arthralgia
● Abdominal pain
● Kidney disease
0
1
6
لا تفوتوا خصم المجموعات.. خصم حتى 30% على جميع الاشتراكات 😍💙
اشترك مع زملائك لحل أكبر عدد من الأسئلة. كل ما تحتاجه لاختبار SMLE بين يديك في مكان واحد🥇
0
3
6
B ✅
Hernias location (high yield):
- Inguinal hernia = Superomedial to the pubic tubercle
- Femoral hernia = Inferolateral to the pubic tubercle
Inguinal hernia:
- Direct = Medial to the inferior epigastric artery
- Indirect = Lateral to the inferior epigastric artery
0
1
6
Which of the following reduces mortality rate in esophageal varices?
IV ceftriaxone
165
Oral ceftriaxone
67
IV vancomycin
95
Oral vancomycin
49
4
1
4
A 14-year-old girl presented to the emergency department with heliotrope rash around the eyes and cutaneous lesions over the metacarpal aspect of both hands. Physical examination revealed symmetrical proximal lower limbs weakness and truncal instability. What is the diagnosis?
Mitochondrial myopathy
25
Juvenile dermatomyositis
220
Juvenile rheumatoid arthr
55
SLE
63
2
4
5
A baby was brought by his parent to the pediatric clinic for follow-up. His growth chart is shown below. Which of the following is depicted in his growth chart?
1
0
6
A patient came to the mental health clinic for assessment. He speaks rapidly and jumps between topics. Which of the following describes his condition?
Flight of ideas
223
Loosening of association
48
Though insertion
8
Thought broadcasting
11
2
4
6
A ✅
Painless rectal bleeding in an asymptomatic child makes the diagnosis of Meckel’s diverticulum more likely.
UTD: suspicion for Meckel's diverticulum as a source for lower gastrointestinal bleeding should be increased for:
● Children, particularly those less than 10 years
0
0
6
D ✅
Syndrome of the jugular foramen (Vernet's syndrome). This syndrome is characterized by loss of taste in the posterior third of the tongue (ninth cranial nerve), paralysis of the vocal cords and palate (tenth cranial nerve), and weakness of the trapezius and
0
2
5
A 39-year-old primigravida has a history of deep vein thrombosis (DVT). Which of the following is the appropriate management?
Aspirin
64
Warfarin
61
Enoxaparin
102
No need for prophylaxis
25
3
1
6
What is the initial assessment in perforated peptic ulcer?
Lateral chest x-ray
36
Ultrasound
109
Supine abdominal x-ray
101
Erect chest x-ray
299
1
1
5
📊 يمكنكم الإطلاع على أقل درجة تم الترشح عليها للبورد السعودي لعام 2023م عبر زيارة الرابط التالي:
0
2
5
A 12-year-old boy sustained a supracondylar fracture and distal radial pulse was absent. His arm is warm and pink in color. Which of the following is the appropriate next step in management?
Reduction+K-wire fixation
115
Intramedullary nail
16
Surgical exploration
85
Open reduction
90
0
2
4
A ✅
UTD: Analogs of prostaglandin F2-alpha (eg, carboprost) can cause bronchoconstriction and should not be used for termination of pregnancy, cervical ripening, induction of labor, or control of uterine hemorrhage.
Treatment of postpartum hemorrhage (in order):
1) Oxytocin
2)
0
1
5
تجربة أحد مشتركي بنك سراج للأسئلة بعد صدور نتائج الاختبار لشهر ديسمبر 😍👏🏻
ألف مبروك 🤩
0
0
4
C ✅
Compared with a chest radiograph, CT provides better resolution of tumor extent, tumor location, and the presence or absence of mediastinal adenopathy. CT gives excellent morphologic characterization of peripheral and especially centrally located lung mass.
If there is
0
1
4