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Collection of June SMLE Questions From :

• SMLE-B
• ASMA
• FAIR
• Others
..
..

Note /
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• If there is any issue or wrong answer pls contact with me
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 1.60 pt complain of productive cough and dysnea and fever on

examinatiom crepetation and bilateral middle lobe consolidation and high
reticulcyte and rwbc cold aggultation test what is diagnose
A- Streptococcus pneumo
B- Atypical phenomonia
C- Heart failure

2.50 years old man with chest pain radiating to the neck with exercise.
ECG is normal. Best modality to rule out ischemia:
A. Cardiac CT
B.ECHO
C.Creatine Kinase Enzyme
D.Stress ECHO

3.A 30 years old female medically free presented with jaundice for 2
weeks , no flapping tremors or stigmata of chronic liver. AST 1400, ALT
1300, GGT 70 total bilirubin 60. What is the best next step ?
A- Discharge with follow up
B- Admit and start IV dextrose
C- Order PT And INR
D- Refer her to liver transplant

4.A case highly suspicious of pyloric stenosis what is the diagnostic test ?
A- X- ray
B- Ultrasound
C-Endoscopy

5.Which is consistent with rheumatic heart disease ?

A- Mitral stenosis
B- Mitral regurgitation

6.Child came with 10 cm neck swelling that is soft and bogy how you will
manage ?
A. surgery
B.sclerotheraby
C.chemotherapy
D.radiation

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 7.Old patient long history of leg claudication *for 2 months* , present with
leg pain and ABI <0.3 and , *CTA show artery occlusion more than 3 cm*
what to do?
A- amputation
B- thrombolysis
C- embelctomy
D-enoxaparin

8.A patient with recent rectal surgery comes to you with absent pulses up
to the femoral area. How will you manage such a case?
A- enoxaparin
B- heparin
C- warfarin
D- IVC filter

9.Patient did lap chole due to cholelithiasis 7 days ago and today she came
with vague abdominal pain. On US there is fluid around the gallbladder
and the CBD is 9 mm. What is the most likely diagnosis or cause?
Labs
Mildly high WBC
Direct bilirubin Mildly high nearly double the normal
Total bilirubin Mildly highnearly double the normal
A. CBD injury
B. Retained stone in CBD
C. Sub-hepatic collection
D.slipped clipped

10.Pt with symptoms and signs of tuberculosis what is the sputum

screening method ?
1. thin film
2. Thick film
3 )Ziehl–Neelsen stain

11.7 y child with s/s meningi s Csf culture gram posi ve diplo cocci
Treatment? :
Ceftriaxon and vancomycin‫؟‬
Ampicillin and vancomycin
Ceftriaxon and rifampicin
Something and gentamycin

12.15 y Child rushed to ER suspected meningi s . Doctor decided to do

lumbar puncture From where you get the consent? :
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 Mother and father consent

Child only
Child assert and parents consent
No need to get consent because it is emergency

13.Mode of transmission of tb:

Air born
Contact
Droplets

14.Case of epilepsy presented with cough and a lot of sputum cxr (they
provided CXR picture) show rt upper lobe cavity with air uid level Culture of
sputum show aerobes and unaerobes Cause or mechanism that led to
development of this condi on :
Aspiration
Infection from chest wall
Via blood stream

3 to 4 of cases on hydatidifotm mole and choriocarcinoma

Moderate asthma management

15.Case of Dka started management with iv uid what else:

fixed dose of iv insulin
sc insulin
Sliding scale
Long acting antidiabetics

16.Case of newly diagnosed gout (they gave signs and symptoms and
tests)what drug is contraindicated at this stage?
NSAID
Colchicine
Allopurinol
Dexamethazone

17.Child with fever and whi sh tonsils what is most common complica ons?
Scarlet fever
Glomerulonephritis
Meningitis
Pneumonia

Treatment of kawasaki disease

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 Immunization schedule of 2 months old baby

18.Milestone of baby can x his head but can not sit without support
3 months
5 months
7 months
No 4 months

ECG and senario OF pericarditis

Picture of H Mole (snow storm apoearance)

Picture of urethral carbuncle (i think )with senario of old lady developed

this leasion and it was painful and bleeds easily to touch

Scenario of trichomoiasis an asking about treatment

19.Child developed conjunc vi s then developed signs and symptoms of

pneumonia most common organism
chlamydis trachomatis

20.Case of pregnant 16 weeks developed right side abdominal pain (did not
specify upper or lower). Temp 73.8 Most common cause
gastritis
pancreatitis
cholecystitis
appendicitis

21.Case of anaemia signs and symptoms and gave blood results and ask
what is the cause
IDA
Hemolytic anemia
Thalssaemia

22.Pt with medial leg ulcer what is the high risk?

A. Dm
B. Htn
C.Age
D. Buerger's disease

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 23.Parent's brought their child to the hospital for inability to move his arm X-
ray showed a fracture at both distal ulna and radial bone. The child looks
healthy and dressed well, and has good hygiene they recall that 2 days ago
the mom. dropped a plate on the child's arm and no ced he couldn't move
his arm and a er 2nd day the child couldn't move his arm they didn't no ce
any bruising so they thought it's just a strain. Which of the following is
indica ve of child abuse?
A. Type of fracture
B. Delayed presentation
C. Consistent story of the parents
D. the appearance of the baby

24.10 week GA pregnant lady with u witch drugs contraindica ons?

1-nitrofurantoin
2-ciprofloxacin

25.Drug not used in Mediterranean fever??

Aspirin or
amoxicillins

26.Incase of preterm baby when to give hepa s B vaccine?

A. Immediately after delivery
B. Wait till baby weight is 1.5kg

27.Pa ent known hypertensive on lisinopril and amlodipine, recently

diagnosed as TB What you will do
1.discountinue lisinopril
2.discontinue amlodipine
3- increase lisinopril

28.Parent come with their child male who have recurrent chest infec on and
they have another boy who died from one a ack of chest infec on , he has 2
sisters and healthy ?
A. X-linkedagammaglobulinemia
B. Ataxia telangiectasis
C. Chronic granulomatatosis disease
D. Hyper IgE syndrome

29.56 years with uterine cancer,what the most appropriate t At this age
-laparoscopic hysterectomy
-abdominal hysterectomy

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 -myomectomy
-_follow up

30.Pa ent treated with an bio cs for salpingi s but not e ec ve what is the
most causa ve organism?
A) N. gonorrhea
B) C. Trachomatis

31.pregnant lady with UTI which of the following drug is contraindicated?

A. nitrofurantoin
B. ciprofloxacin
C. amoxicillin
D. Ceftriaxone

32.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

33.Pt with a penetrated neck in zone 1 and is bleeding, what is the best
management?
A. open and primary repair
B. Endovascular
C. open and ligation

All Qs above is con. Of June.

34.Baby Preterm diliver (didn't specify CS or SVD). 4 hours later complaining

from SOB , Tachypnea, Tachycardia with grun ng
1- Hyaline membrane disease
2- pulmonary "something"
3- Meconium Aspiration syndrome
4- Transient Tachypnea of the New born

35.a pa ent diagnosed with paranoid schizophrenia based on the presence of

+ve and -ve symptoms. What’s the treatment?
A. clozapine
B. chlorpromazine
C. fluphenazine

36.Pa ent with sudden severe epigastric pain for 8h associated with vomi ng
and nausea, on examina on epigastric tenderness,,,labs only given elevated
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 amylase. What is most helpful to determine the disease severity or some
thing like thing:?
A.Procalcitonin
B.ESR
C.CRP
D.Alt

37.scenarios about a child 2 years old with SOB and Expiratory wheeze and
other respiratory symptoms he had a viral illness 2 days ago
A. Respiratory monitoring for hypoxia
B. Inhaled epinephrine and steroids
C. Intubation and antibiotics
D. SABA

38.Child with sore throat and coryza 2 days ago came with di culty swallow
food what is the inves ga on u will oder?
A. Chest x ray
B. Ct scan
C. Lateral neck x ray
D. Echo

39.Child came in the early morning complaining if barking cough and

inspiratory s dor he labelled as a case of croup and receive mx but no
improvement what is tje important inves ga on u should do?
A. Lateral neck x ray
B. Direct visualization by larynscope
C. Chest inspiratory and expiratory x ray
D. Anteror and posterior chext xray

40.56 years old pa ent had an upper Gl bleeding due to esophageal varices
and was given IV uid. Which of the following should be given to reduce
mortality?
A. Vasopressin
B. Octreotide
C. Nadolol
D. Ceftriaxone

41.70 years old woman, sexually ac ve, hysterectomy done before, and she
complains of prolapse and enlarged vaginal opening, what is the appropriate
procedure?
A. sacrospinous fixation
B. Ant and post colpoperineorrhaphy
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 C. Manchester repair (Fothergill operation)

42.-Male pa ent complains of episode of hematemesis. normal past medical

history Labs show mild anemia ,All over labs are normal except elevated urea
level in blood?
A-Mallory Weiss syndrome
B-erosive gastritis
C-PUD

43.A 39-week pregnant pa ent, history of caesarean sec on, due to breech
presenta ons, now she is in labor, with regular contrac ons 4 every 5 min,
cervix fully dilated, full e acement, sta on +3, What is your management?
A. Ventouse delivery
B. caesarian section
C. examine her after 2 hours

44.Primigravid come with labor for 4h Dilated 5 cm, e aced 80%, sta on +1
a er 5h there is no change in cervix, and contrac on occur every 3 min. and
stay for 60 sec. What to do?
A. Instrument use
B. C/S
C. IV oxytocin
D. Wait for 2h

45.A woman was bathing her child and no ced a mass in his ank, which of
the following invx is most appropriate?
A. Abdominal radiography (XRAY)
B. Abdominal CT
C. Abdominal MRI
D. Abdominal radiography and ultrasonography

46.vaccines 1 y
Opv
pcv
Varicell
MmR

47.Immunosuppresed child, C/I Vaccine

Varicella

48.Recurrent infec ons + Eczema + family history

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 Wescot Aldridh

49.CAP treatment
Flurocinolon
Azitro

50.Child 9m, when is Vaccine C/I .

Exposure to infectio
moderate to sever infection

51.Recombinant in uenza, Which group

pregnancy women

52.Want to get pregnant in Winter, which Vaccine

In uenza

53.Female took 1st dose Hpv vaccine , Came a er 3m , what to do

Give 2nd dose

54.Veterinarian ,Cns symptoms + right sacroiliac joint pain , next ..

Anti tubuglutinin antibodie
sacroiliac X-ray

55.HCV , Common type in KSA ? 4

11 Chronic HBV , elevated enzymes , what to do ... Screen for delta .. Or

interpheron alpha ?

12 Pseudocyst scenario 5w after Acute pancreatitis ... Surgical drainage .. Or

endoscopic drainage ... Or percutaneous ?

13 Bowel Obstruction 5 years after hernia repair , C/I ... Propofol ... Or
ketamine ?

14 Thump print sign in elderly +scenario , do .... Exploratory Laparotomy ✓

15 Subserosa Fibroid, tt ... Myomectomy ✓

16 Scenario of appendicitis , next ... Us ✓

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 17 Before bariatric surgery , what do ... Upper Endoscopy .. Or Us ?

18 After bariatric surgery , what expect ... Cystocele ✓

19 Pitting edema in leg, then PE , tt ... UF heparin .. Warfarin .. Aspirin ..

Clopidogril

20 Spider Nevus in thigh , before Surgery .. duplex

21 Scenario of Saddle PE with hypotension, tt .. altiplas ✓

22 After Major pelvic surgery for ovary cancer 24 h , sob & intubation ... PE ..
Or Atelectasis ?

23 Nodule 2x2 cm in thyroid , Asymptomatic , what next ... TSH ?

24 Child 3y, Painless bleeding , Hb 9 , investigation ... Isotop scan ?

25 Pelvic fracture , retroperitoneal urethra injury , next ... Suprapubic

cystostomy ✓

26 Fall , bloody discharge from ear , external intact , what fx ... Basal skull .. Or
mastoid or mandible ?

27 Pic of open fracture , tt .. surgical debridement and intramedullary xation ✓

28 Scenario of surgery for appendix , u removed it but was normal , wt to do ..

tell pt it's the procedure ✓

29 Rta , muf ed heart sounds ... Tamponade ✓

30 Rta , sever back pain , wt to maintain while neuro consultation .... Restrain
pt spine ✓

31 Newborn, hernia tt ... Herniotomy Or observe

32 Child, tender in a point in scrotum + edematous, red scrotum ... Testicular

appendix torsion ✓

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 33 Post delivery and episiotomy, came with foul discharge the rst doctor say
UTI , when go to another , it was a stula , wt the mistake ... The doctor fail to
follow safety protocol in OR ✓

34 Reducible hemorhoids , tt .. angio or heordectomy or medical tt or ligation ?

35 Child , blood sometimes with stool , doctor say it's preventable cause dx ..
heomrhoids or anal ssure or intussusception or familial polyp ?

36 Coin ingestion , x-ray , in the stomach tt ... Discharge and follow defecation
it with few days ✓ or admit and NPO for 24 h

37 45 healthy ,no hx , ask for colon ca screening ... At 50 years and every 5 yrs
✓

38 Another similar Q , same answer ✓

39 Polyhedramions , cause ... Anencephaly ✓

40 Scalp wound 6 h ago ... Debridement &2ry closure Or debridement & 1ry
closure ?

41 Pt want to go to another doctor in another hosiptal .... Give a report & refer
✓

42 Worsen stridor when supine , improve when pron .. Laryngomalasia ✓, how

to dx ... Rigid laryngoscopy Or exible laryngoscopy ✓

43 Child 12y , pneumonia , common cause ... Sterp. Pneuomo

44 Woman lobar Pneumonia , tt All oral .. amicillin , vanco , azitro ?

45 Pregnant , fever ank pain rigor , tt .. IV Abx ✓

46 Elderly woman , spotting every many days , investigation .... Endometrial

biobsy ✓

47 Many neuro symptoms , eye and extremities invest .... Brain & spine Mri ✓
48 Meningitis , labs wbc : lymphocytes .. TB ✓

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 49 Meningitis , empirical tt .. Vanco +Ceftriaxone ✓

50 Dm , burn sensation in extremities ,tt .... Amitriptyline Or B12

51 Female 16 y , chronic diarrhea , sometimes bloody , paraumbilical pain post

prandial Dx ... Crohn ✓

52 Child , weight loss , atrophy of buttox , most appropriate invest .... Duodenal
biobsy , anti endomysial ?

53 Celiac , uncomlianet , how to asses ..tissue antitransglutaminas ✓

54 Common Leukemia in child .... ALL ✓

55 After chemo , neutropinia tt ... Iv Abx , Cultures (blood , urine ... ) ✓

56 Convulsion , Na 114 tt ... Hypertonic saline ✓

57 Pic & scenario of IDA , TT .. Iron ✓

58 Pic & Scenario of endometriosis dx ... endometriosis ✓

59 Endometriosis , took nsaids , no improve tt ... Laparoscopy ✓

60 Pain , agitation 10days before period , subside on 3rd day Dx .. Pre

menstraution tension Syndrome ✓

61 Safest antidepress in child .. Floxetine ✓

62 Scenario of sob and retraction in preterm + Cxr ... Rds ?

63 Hx of TOF , came with sob + hepatomegally + bilateral in ltration in lungs ,

tt .. diuretics ✓

64 Child , heliotrope rash , nodules in phalanges .... Juvenile Dermatomyositis

✓

65 Long scenario , but there swollen tender knee joint , invest ... Arthrocentesis
✓
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 66 Urti , after 3 weeks knee joint swollen and tender , Dx .... Septic arthritis ✓ (
no reactive in choices )

67 Pregnant during labor , bleeding , transfusion 4 units of blood , still low hb ,

plt= 60 tt .... Cryoprecipitate ✓

68 PPh , common cause .... Uterine atony ✓

69 Surgeon , change results to make his research better .... Falsi cation ✓

70 Resting tremors , reduced arm swing , where is the lesion .... Substantia
nigra ✓

71 Elderly , Multiple fall , no fractures , wt to do ... Improve lightening ✓

72 Sle, or RA medications including methotrixat , in remission , LFT hi , do ..

stop metho ✓

73 Child can hold his head , sit supported to his father hand , wt age ... 4
months ✓

74 Face/ or leg edema in child , proteinuria dx .... Nephrotic ✓

75 Chest pain upon activity for 2 weeks , relieved with rest .... Equivalent
angina ✓

76 Inferior Mi , after a period , came deteriorated , cuz .... Right heart infarction
✓

77 Elevated st in 2 , 3 avf , appropriate mx ... ?

78 Elderly , no hx of hypertension , takes nsaids for joint pain , Bp : 16/10 ,

dx .. nsaids induced htn ✓

79 Dm , diagnosed Htn wt to start ... Ace ✓

80 Newly diagnosed Dm , wt to start ... Metformin ✓

81 Wiff positive , white discharge + picture .... Bacterial Vaginosis ✓

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 82 Htn , smoking , not controlled wt to control htn ... Low salt✓ , low fat ,low
carbo , low protin

83 Post urti , weeks , murmur , nodule , joint pain , wt help in dx ..... Aso titer ✓

84 Woman with tonic clonic, uncontrolled ,want to conceive .... Review

medications ✓

85 Man TIA, 4 H ago came to ER ... Ct ✓ or MRI

86 Child 8y enuresis , wt muscle ... Detrusor ✓

87 Incontinence ( forgot which type) in urinary , tt .. kegal or oxybutinin or both

??

88 Pe , which contraceptive ... IUD ✓

89 Placenta previa , 30 w , now stop bleeding wt do ... Expectant management

✓

90 Placenta abruption , wt to save her life - low hb .. rapid response team Or

trans 2 plasma (not blood)

91 Infant spitting after feeding , no weight loss , nothing else .... Reassure ✓

92 Pulmonary htn , how to asses chronic thromboempollic .... V/Q scan ✓

93 SLE , anemia reticulo = 7 , ferritin 500 type .. Hemolytic Or chronic

94 DM 1 , Child on insulin , developing hypoglycemia, what's called ...

Honeymoon syn.✓

95 Pregnant , bleeding , vaginal E. , Suspicious lesion in cervix , next ...

Colposcopy Or biobsy?

96 Amenorrhea , nipple discharge , Tsh hi , wt cause .... Hypothyroidism ✓

97 Amenorrhea , prolactinemia , wt invest ... MRI brain ✓

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 98 Female , 27 y last Pap squamous 3 y ago , now do .. pap Or Colposcopy Or

HPV ?

99 Pt , for operation , he was informed to stop warfarin , but he didn't , doctor

postponed surgery , wt is called ... Wrong prescription Or medical neglect Or
Ness miss ?

100 Newborn , seizure and neuro symptoms , Csf : negative ....Hypoxic

ischemic encephalopathy ✓

101 Pt on quinine for malari , doctor prescribe digoxin , pt deteriorated , how to

prevent .... Computerized drug prescription ✓

102 Woman ,with multiple injuries from husband , wt do .... Inform authorities
✓

103 Peanut ingestion, child , common site .... Right main bronchus ✓

104 Epigastric pain radiate to back , pulsatile ... AAA ✓

105 Screening for asymptomatic UTI in pregnancy .... 12th w ✓

106 Case of anti phospholipid Syn. , Ttt ....

107 Indication of cervix cerculage .. < 25 mm ✓

108 Menorrhagia , hx of myomectomy dx ... Adenomyosis ✓

109 Effective way to stop smoking in pregnant ... Behavioural therapy ✓

110 Pneumonia with hemoptysis occasionally wt cause ... Mycoplasma , tb ,

malginancy ? 111 PROM , after a few days fever dx ... Chorioamnionitis ✓

112 Risk factor for oesophageal CA ... Barret ✓ Or smokin

113 CKD , low hb , invest ... Erythropoietin ✓

114 Asthma exacerbation , on alubetrol , wt give .... ICS ✓

115 Child , fungal lesion in mouth , tt ... Nystatin Or Itroconazole ?

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 116 Sob , pleural effusion , analysis: interferon gama Dx ... TB pleural effusion
✓

117 Lobar Pneumonia + pleural effusion tt .. ampicilline + genta +

thoracocentesis ✓

118 Pregnant 26w , uti tt .... Nitrofurantoin ✓

119 Lactating woman , pain + small mass around areola, inverted

nipple ....Ductal ectasia ✓

120 Dementia , white matter hyperdensity dx ... Vascular dementia ✓

121 Hbv ag. + , HBc ab+ ,HBs ab- ... Chronic infection ✓

122 Placenta abruption, risk factor ... Smoking✓

123 Amenorrhea , hx of d&c , wt layer injured ... Basalis ✓

124 Thin tall man , on a ight , sudden SOB , Pneumothorax tt .... Chest tube ✓

125 Retro sternal pain increase at night , unpleasant taste .... Oesophagitis ✓

126 Female ,42y came for screening wt do .. bilateral mammography ✓

127 SCD ,hands and feet pain , in ltration in both lungs ... Acute Chest
Syndrome ✓

128 Gonorrhea in male , invest ... Urinary analysis ,Or blood culture ... ?

129 Endocarditis , 1month post prosthetic valve , organism .... Staph epidermis,
Or areus ?

130 Vaginal discharge with agellate cells .... Trichomoniasis ✓

131 Pregnant forgot LMP , what the accurate way to detect gestation age ...
Femur length Or head circumference Or (no crown-rump length im choices) ..?

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 132 Tonsilitis , given ampicilline ,3 days later, macopapular rash , dx ...

Mononeucoliosis ✓

133 Child diarrhea and vomiting , wt kind of shock .... Hypovolemic ✓

134 Pt , low Bp , tachycardia how improve ... Iv n saline ✓ Or dupamine

135 Case underwent salpingogram for infertility with occlusion in one tubes ...
IVF ✓

136 Child, diarrhea, bloody occasionally with tenesmus ..... Amebiasis ✓

137 Congenital malformation in newborn 23w need resuscitation, mother

(doctor) said no ... Respect her wish ✓

138 Child 7 y, short stature, bone age is delayed wt to do ....

139 Child 6 m, skin lesions on face and scalp then extensors , erythematous
base , tt ... ?

140 Child walks with furniture, wt age ... 10m✓

141 Woman, menopause, LMP a year ago, wt will change .... Testosterone,
estradiol, FSH ?

56.Pt do sigmoidoscopy result with circumferen al ulcera ng lesion what to

do next?
Colonoscop
Ct abdomi

57.Known crhons disease present with abdominal tenderness inves ga on

show mass 16 ×13 what is management
a.percutaneous drainage

58.Pt with acute limp pain and a ec on in his movement and also sensa on
is a ected and ecg show atrial febrila on what to do next ?
hepari
ct angiograph
arteriigraph

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 59.How con rm diagnosis of tracheomalacia?

Broncoscopy
uroscopy of x ra

60.Delivered recently failed to lactate due to nipple retracted released by

pressure us show dilata on in one duct 3cm
breastcys
ductectasi

61.betheda4 management?

62.Lung node meassure 8mm asymptoma c what to do

A) Follow up
B) CT scan
C) biopsy
D)review previous x-ray

63.pa ent with 8 hours post-opera on, urine output is 50 cc, what to do
next?
A. dialysis
B. catheter
C. uid and electrolytes imbalance
D. follow up

64.54 years old male HTN, TIA, A b on warfarin. 6 months without A b

a ack. ECG: S.R, What to do regarding warfarin?
A. con nue the same dose
B. Decrease dose
C. Stop warfarin
D. Add ASA

Pic of:
1- knee osteoarthri s
2- inferior wall MI
3- st eleva on in inferior leave with st depression what the the next step
4- ctg (I think normal ctg)

65.Pa ent of hyda form mole, evacua on done. Moun ng HCG over 1
month, not decreasing. Next step
1- observe
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 2- do another evacua on
3- refer to oncology for methotrexate
4- I forgot

knee osteoarthri s

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 66.Pa ent post MI found to be

Bradycardic
1- 1st degree
2- 2nd degree
3- 3rd degree
4- 4th degree

What is the next step.

1- RT sided ECG
2 -CT Angio

67.35y.o man presented with fever, rigors & weight loss for 10 days. He
underwent Mitral valve replacement by prosthe c valve 1 month ago, Echo
showed a small vegeta on. Vitals: Blood pressure 90/70 mmHg, HR 100/
min, Temp 38.7°C. Caus ve organisim is ?
A. Coxiella burnetli
B. Staphylococcus aureus
C. Streptococcus viridans
D. Staphylococcus epidermidis

68.man has HTN and his family father and 2 sister have HTN, medically free
before, O/E and invesX all with normal limits, his bmi 27 and his blood
pressure is 160/100, high crea nine And high blood urea nitrogen level.
what is the appropriate management?
- ACEI
- alpha blocker
-BB
-CCB

69.known case of RA controlled on HQ 400mg and Prednisone 15mg Well

controlled for period (forget ) All labs include LFT (N ) EXCEPT (high FBG and
HbA1c ) - What's your next ac on :
A- taper Steroid and start MTX
B- taper steroid and start Ibuprofen
C- con nue same Mx

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