NLE 2021

Abu Huraira reported Allah's Messenger (may peace be upon him) as saying: When there comes the month of Ramadan, the gates of mercy are opened, and the gates of Hell are locked and the devils are chained,
:6:Number:2361

A 28-year-old gravida 2, para 1 woman at 34 weeks of
gestation presents with vaginal bleeding. She describes the
passage of bright red blood that soaks through several
sanitary pads over the past few hours. She denies trauma,
passage of other fluids, uterine contractions, or pain. She
denies the use of illicit drugs, to***co, or alcohol. Fetal
heart rate is normal (130 to140 beats/min).
Which of the following is the most likely diagnosis?
A. Abruptio placentae
B. Placenta accreta
C. Placenta previa
D. Uterine rupture
E. Vasa previa

Which of the following is used
to help confirm the diagnosis
of Sjogren's syndrome?
A. Schirmer test
B. Muscle biopsy
C. Electromyogram (EMG)
D. Schober test
E. Trendelenburg test

A 40-year-old man comes to the clinic with increasing
shortness of breath. He says it is worse with exercise and when
lying down to sleep. Blood pressure is 130/60 mm Hg. An early
diastolic murmur is heard at the left sternal border with the
patient leaning forward.
Which of the following left heart physiologic changes is most
likely in this patient?
A. Decreased end-diastolic volume with ventricular wall
thickening
B. Increased atrial pressure with low end-diastolic volume
C. Increased end-systolic volume with decreased stroke volume
D. Increased stroke volume and end-diastolic volume
E. Increased stroke volume with decreased flow through the aortic valve

A 12-year-old male presents to your clinic
complaining of his head "feeling itchy." He
says he wore his friend's hat a few days
prior and since then has had progressive
scalp pruritus. On physical exam you notice
excoriations on the scalp and yellowish-
white flakes. Which of the following is the
most likely causative organism?
A. Pediculus capitis
B. Pediculus humanus
C. Trichophyton verrucosum
D. Microsporum audouinii
E. Malassezia yeast

A 64-year-old male came in an ER with
epigastric pain, vomiting containing coffee
ground substance and melena for 1 day.
Which of the following is the most appropriate
treatment option?

A.Antacids
B. H2 receptor antagonist.
C. Proton pump inhibitors
D. Misoprostol.

A 60yo man presents with dysphagia and pain
on swallowing both solids and liquids. A
barlummeal shows gross dilatation of the
esophagus with a smooth narrowing at the
lower end of the esophagus. What Is the
SINGLE most likely cause of dysphagia?

A.Achalasia
B.Myasthenia gravis
C.Esophageal carcinoma
D .Esophageal web
E.Systemic sclerosis

Q. A young man about to leave for his freshman year of
college visits his physician in order to ensure that his
immunizations are up-to-date. Because he is living in a college
dormitory, his physician gives him a vaccine that prevents
meningococcal disease. What type of vaccine did this patient
likely receive?
(A) Live, attenuated
(B) Killed, inactivated
(C) Toxoid
(D) Conjugated polysaccharide
(E) Killed, attenuated

Q49-year-old man complains of no symptoms, but on a
routine complete blood count (CBC) has a white blood cell
count of 40,000 per uL. A peripheral blood smear
demonstrates leukocytosis with myeloid cells present at
various stages of differentiation, with more mature cells
present at a greater percentage than less mature cells (Figure
A). What is the likely diagnosis?
(A) Acute Lymphoblastic Leukemia (ALL)
(B) Acute Myelogenous Leukemia (AML)
(C) Chronic Lymphocytic Leukemia (CLL)
(D) Chronic Myelogenous Leukemia (CML)
(E) Acute Promyelocytic Leukemia (APL or APML)

A 65-year-old man with a history of chronic kidney disease
and peripheral vascular disease is hospitalized after
developing thromboembolic disease in his left leg
accompanied by dry gangrene. On the third hospital day, he
reports muscle weakness and feels generally unwell.
Laboratory tests show an elevated serum lactic acid, and his
arterial pH is 7.27. Creatinine is 3.8 mg/dL. An ECG in this
patient is most likely to show which of the following?
(A) Peaked T waves
(B) QT prolongation
(C) ST depression
(D) T wave inversion
(E) U waves