1.

Which of the following symptoms is not associated with functional dyspepsia:

a) feeling overly full after a normal meal;

b) mild to severe epigastric pain;

c) black tarry stools;

d) epigastric burning sensations;

2. Dumping syndrome following subtotal gastrectomy has the following symptoms:

a) hiccoughs and diarrhea;

b) fatigue and abdominal pain;

c) constipation and fever;

d) diaphoresis and diarrhea;

3. Which is the most common cause of peptic ulcer disease (PUD) of the following:

a) smoking;

b) NSAID’s;

c) Zollinger-Ellison syndrome;

d) ethanol excess;

4. Peptic ulcers may be caused by all of the following except:

a) emotional stress;

b) eating spicy foods;

c) infection with Helicobacter pylori;

d) gluten intolerance.

5. Which is the most common complication of peptic ulcer disease:

a) perforation;

b) gastric outlet obstruction;

c) penetration;

d) haemorrhage;

6. In a case of hypertrophic pyloric stenosis, the metabolic disturbance is:

a) respiratory alkalosis;

b) metabolic acidosis;

c) metabolic alkalosis with paradoxical aciduria;

d) metabolic alkalosis with alkaline urine;

7. Which of the following drugs is a proton pump inhibitor:

a) ranitidine;

b) sucralfate;

c) misoprostol;

d) omeprazole;

8. Proton pump inhibitors are most effective when they are given:

a) after meals;

b) shortly before meals;

c) along with H2 blockers;

d) along with antacides;

9. Which is not true of H. pylori infection:

a) 80 % of patients with chronic infection H. pylori will develop ulcers;

b) H. pylori is the most common cause of peptic ulcer disease;

c) H. pylori is a risk factor for adenocarcinoma of the stomach;

d) IgG antibody test will remain positive for up to 2 years post eradication limiting its usefulness;

10. Which of the following listed drug is given with bismuth salt in Helicobacter pylori infection:

a) antacids;

b) antibiotics;

c) ACE inhibitor;

d) H2-receptor antagonists;

11. Glycogen is:

a) synthesised in liver, source of energy, forming bile and lipase;

b) disacharide stored in liver, reacts with amonia to form protein;

c) synthesied in blood, stored in liver, and muscle to provide glucose;

d) polysacharide synthesised and stored in liver;

e) synthesised in mucsle.

12. Secretion of cholecystokinin is for:

a) controlling blood pressure;

b) inducing peristalsis;

c) bile functions;

d) release of insulin;

e) decrising peristalsis.

13. Human digestive juice lacks:

a) lactase;

b) cellulase;

c) amylase;

d) sucrose;

14. What type of diet should be provided to the patient sheduled for oral choleycystogram on the
evening before the test:

a) low-protein;

b) high-carbohydrate;

c) fat-free;

d) liquid;

15. Which of the following causes hepatic granuloma:

a) amiodarone;

b) alcohol;

c) cimetidine;

d) metronidazole;

16. All of the following are features of obstructive jaundice except:

a) normal alkaline phosphatase;

b) mildly elevated serum aminotransferases level;

c) clay colour stools;

d) pruritis;

e) elevated mainly conjugated bilirubin level.

17. Which is not a risk factor for gallstones:

a) cystic fibrosis;
b) congestive cardiac failure;

c) familial tendency;

d) diabetes;

18. About 80 % of gallstones are composed of:

a) calcium;

b) bile;

c) bilirubin;

d) hardened cholesterol;

19. Antimitochondrial antibody is typically seen in:

a) hepatic cirrhosis;

b) cardiac cirrhosis;

c) primary sclerosing cholangitis;

d) primary biliary cirrhosis;

e) hemochromatosis.

20. Which is not true of acute pancreatitis:

a) alcohol is the most common cause;

b) pain is usually severe and relieved by sitting forward;

c) Cullen’s sign is blue discolouration around umbilicus secondary to he-

moperitoneum;

d) CT will be abnormal in the vast majority including mild disease.

21. Which of the following drugs is a not pancreatic enzymes:

a) creon;

b) pancitrate;

c) mezim;

d) mesalazine;

22. Pancreatic enzymes are most effective when they are given:

a) after meals;

b) 15 minutes before meals;

c) during meals;
d) during prolonged fasting periods;

23. In irritable bowel syndrome (IBS):

a) mucus may be passed rectally;

b) bloody mucoid diarrhoea is common;

c) treatment options include 5-ASA compounds;

d) symptoms are unrelated to stressful life events;

24. The presence of mucus and pus in the stools suggests:

a) disorder of the colon;

b) intestinal malabsorption;

c) inflammatory colitis;

d) small bowel disease;

25. Symptoms of Crohn’s Disease may include abdominal pain, rectal bleeding, diarrhea, and all of the
following except:

a) anemia;

b) weight loss;

c) joint pain;

d) bradycardia;

26. Regional enteritis (Crohn’s Disease) is characterised by:

a) transmural thickening;

b) diffuse involvement;

c) exacerbations and remissions;

d) severe diarrhoea;

27. Chronic ulcerative colitis usually starts in the:

a) hepatic or splenic flexure;

b) rectosigmoid area;

c) transverse colon;

d) terminal ileum;

28. Which type of diarrhea is caused by increased production and secretion of water and electrolytes
by the intestinal mucosa in to the intestinal lumen:
a) osmotic diarrhea;

b) mixed diarrhea;

c) secretary diarrhea;

d) infection diarrhea;

e) noninfection diarrhea.
29. Microscopic examination of stool in inflammatory diarrhea shows:

a) no fecal leukocytes;

b) mild or no increase in fecal lactoferrin;

c) fecal polymorphonuclear leukocytes;

d) presence of enterotoxin;

30. A patient admitted with dehydration can have the following finding during the assessment:

a) bradycardia;

b) changes in mental status;

c) bilateral crackles in the lungs;

d) elevated blood pressure;

e) oedema.

31. Loperamide is indicated in:

Variants of answer:

a) watery diarrhea;

b) patients with fever and loose stools;

c) dysentery;

d) typhoid fever;

e) salmonellesis.

32. Profuse «rice-water» stools suggest:

a) dysentery;

b) cholera;

c) typhoid;

d) irritable bowel syndrome;

33. Which of the following listed is a risk factor for colorectal cancer:
a) age younger than 40 years;

b) low fat, low protein, high fibre diet;

C) familial polyposis

34. How much nephrons contains approximately each kidney:

a) 10 million;

b) 1 million;

c) 100,000;

d) 10,000;

35. Which of the following is not associated with the role of the kidneys:

a) release of erythropoietin (hormone);

b) release of renin (enzyme);

c) release of vitamin E;

d) activate vitamin D;

36. The primary function of the descending loop of Henle in the kidney is:

a) reabsorption of sodium ions;

b) reabsoption of water by osmosis;

c) secretion of hydrogen ions;

d) secretion of potassium ions;

37. Juxtaglomerular cells combine with what kind cells to form the jux-

tagomerular apparatus in the kidney.

a) macula densa;

b) renal pelvis;

c) nephron;

d) renal sinus;

38. Normal bacterial number of urine:

a) 105 of microorganisms in 1ml of urine;

b) 106 of microorganisms in 1ml of urine;

c) 107 of microorganisms in 1ml of urine;

d) 108 of microorganisms in 1ml of urine;

e) 104 of microorganisms in 1ml of urine.

39. Etiological factors of acute glomerulonephritis:

a) acute bacterial infections;

b) acute viral infections;

c) parasitogenic infections;

d) all above.

40. HyperCholesterolemia is commonly associated with:

a) diabetes mellitus;

b) hypothyroidism;

c) nephrotic syndrome;

d) diabetic nephropathy.

41. Instrumental diagnostics of quickly progressive nephritis:

a) examination of fundus of the eye;

b) ultrasound scanning of kidneys;

c) punctional biopsy of kidneys;

d) scintigraphy of kidneys;

42. A 21-year-old woman presents with hypertension, fatigue, and mi-

croscopic hematuria. A renal biopsy demonstrates glomerulonephritis second-

ary to focal segmental glomerulosclerosis. Which of the following would be

the most appropriate step to take next in the treatment of this patient's disease:

a) renal dialysis;

b) cyclosporine;

c) prednisone;

d) cyclophosphamide;

43. Renal vein thrombosis is most commonly associated with:

a) diabetic nephropathy;

b) membranous glomerulonephritis;

c) minimal change disease;

d) membranoproliferative glomerulonephritis;
44. Pulse-therapy with methylprednisolone must be given:

a) dose 1,000 mg intravenously in drops, once a day (3 days);

b) dose 1,000 mg intravenously, once;

c) dose 50 mg intravenously once a day (2 days);

d) dose 50 mg intravenously twice a day (2 days);

e) dose 10,000 mg intravenously once a day (2 days).

45. Definition of acute interstitial nephritis:

a) nonspecific infectious inflammatory renal disease affecting renal paren-chyma, renal pelves and
calyces;

b) disease conditioned with hypersensitiveness being developed in interstitial tissue of kidneys because
of influence of drugs;

c) acute, diffuse, immune inflammation of renal glomerules being developed after antigenous
influence;

d) diffuse proliferative glomerulonephritis;

46. All the following drugs cause renal failure except:

a) amicacin;

b) amphoterecin B;

c) cefoperazone;

d) gentamicin;

47. Etiologic factors of postrenal acute renal insuffiency:

a) endogenous intoxication;

b) cardiogenous shock;

c) extrarenal obstruction;

d) inflammatory kidney disease;

48. All of the following are associated with polyuria except:

a) diabetes insipidus;

b) diabetes mellitus 1 type;

c) rapidly progressive glomerulonephritis;

d) pyelonephritis;

49. Glomerulal filtration rate in terminal stage of chronic renal insufficiency is:
a) 60–40 ml/min;

b) less than 20 ml/min;

c) 40–20 ml/min;

d) more than 60 ml/min;

e) 70–50 ml/min.

50. Contraindications for transplantation of kidneys in chronic kidney disease:

a) severe exrarenal pathology (tumors, stroke, infarction);

b) single kidney;

c) tuberculous affection of kidneys;

d) chronic hepatitis;

51. A 58-year-old woman had progressive renal failure secondary to polycystic kidney disease and she
await renal transplantation. Which of the following metabolic abnormalities would most likely be
present in this patient:

a) metabolic acidosis;

b) hypokalemia;

c) hypophosphatemia;

d) hypercalcemia;

52. A 35-year-old woman presents to clinic with a history of headaches, weakness, fatigue, and
polyuria. Her blood pressure is 210/94 mm Hg. Laboratory tests reveal the following abnormalities:
arterial pH, 7.48; sodium, 148; potassium, 2.7; HCO3–, 37; plasma renin level is low; urine chloride, 28
mEq/L. Which of the following is the most likely diagnosis:

a) secondary hyperaldosteronism;

b) diuretic abuse;

c) milk-alkali syndrome;

d) primary hyperaldosteronism;

53. A 25-year-old woman presents to clinic with fatigue of 1 week's duration.

She thinks there was blood in her urine on two occasions after excessive exercise.

Physical examination is unremarkable except for some mild muscle tenderness. Urinalysis is positive
for 3+ blood. The blood urea nitrogen level is 18 mg/dl, and the creatinine level is 1.1 mg/dl. What is
the most likely cause of this patient's symptoms:

a) postinfectious glomerulonephritis;
b) myoglobinuria caused by rhabdomyolysis;

c) IgA nephropathy;

d) Wegener granulomatosis;

54. A 56-year-old man presents with bone pain, anemia, hypercalcemia,

and renal insufficiency. Bone marrow biopsy indicates a diagnosis of multiple

myeloma. Which of the following mechanisms does not classically cause renal

damage in patients with multiple myeloma:

a) excessive filtration of Bence-Jones proteins, causing direct tubular cell damage;

b) renal artery thrombosis associated with tubular atrophy;

c) hyperuricemia from urate overproduction or lysis of plasma cells, causing precipitation of urate
crystals;

d) the suppression of humoral immunity, leading to urinary tract

infections that cause chronic tubulointerstitial nephritis;

55. A 36-year-old hypertensive man develops macroscopic hematuria 24 hours after the onset of
pharyngitis. The patient's brother had a history of poststreptococcal glomerulonephritis at age 6
after a streptococcal infection of the throat. What is the most likely explanation for this patient's
hematuria:

a) poststreptococcal glomerulonephritis;

b) glomerulosclerosis;

c) IgA nephropathy;

d) Henoch-Schonlein purpura;

56. Berge’s disease is:

a) neurosensory deafness;

b) diabetic nephropathy;

c) IgА-nephropathy;

d) В12 deficiency anemia;

57. In which disease more than 80 % of patients have the HLA-B27 phenotype:

a) carpel tunnel syndrome;

b) Reiter's syndrome;

c) appendicitis;
d) peptic ulcer disease;

58. Which of the following is a pro-inflammatory cytokine:

a) CRP;

b) Interleukin 4 (IL-4);

c) IL-10;

d) tumour necrosis factor-alpha;

59. IL-1 induces:

a) T lymphocyte activation;

b) delayed wound healing;

c) increased pain perception;

d) decreased PMN release from bone marrow;

60. Rheumatoid factor in rheumatoid arthritis is important because:

a) RA factor is associated with bad prognosis;

b) absent RA factor rules out the diagnosis of rheumatoid arthritis;

c) it is very common in childhood-rheumatoid arthritis;

d) it correlates with disease activity;

61. Rheumatoid arthritis is an autoimmune disease that is characterized by:

a) synovial inflammation and hyperplasia;

b) autoantibody production;

c) cartilage and bone destruction;

d) all above.

62. A 45-year-old female complaints of increasing widespread joint pain which are worse in the
evening after a stressful day at work. She describes puffy hands and feet and a painful neck. Her
concentration is very poor and she has recently suffered from marital problems. Rheumatoid factor
is mildly positive. Examination reveals an increased body mass index and global restriction of
movement due to pain, but no synovitis. Which of the following investigations would be useful in this
case:

a) anti-cyclic citrullinated peptide antibody;

b) ultrasound scan hands and feet;

c) anti-JO-I antibody;

d) erythrocyte sedimentation rate and CRP;

63. A 64 year old male presents with a symmetrical arthritis of both hands with early morning
stiffness. His X-rays of his hands done before clinic show the following: periarticular osteoporosis of
the metacarpeal joints; erosion on the ulnar styloid; symmetrical distribution of disease; reduced
joint space at the carpal bones. What is the most likely diagnosis:

a) ankylosing spondylitis;

b) rheumatoid arthritis;

c) gout;

d) secondary osteoarthritis;

64. Which of the following is a first line drug for patient with rheumatoid arthritis:

a) ibuprofen;

b) methotrexate;

c) glucosamine sulfates;

d) pantoprazole;

65. Which of the following regarding Infliximab is most true:

a) is a monoclonal antibody to the glycoprotein IIb-IIIa receptor

b) is authorized for the treatment of severe ulcerative colitis

c) is licensed for the treatment of Rheumatoid arthritis

d) it prevents relapse of Crohn’s disease in patients who are in remission

66. Osteoarthritis is characterized by all signs except:

a) degradation of articular cartilage and alterations in other joint tissues;

b) joint space narrowing, subchondral sclerosis, subchondral cysts, and peripheral osteophytes;

c) pain on movement, typically occurring when movement is initiated or when the patient begins to
walk;

d) morning stiffness in and around the joints, lasting at least 1 h before maximal improvement;

67. Symptomatic slow-acting drugs for osteoarthritis (SYSADOA) not includes:

a) hyaluronic acid;

b) D-glucosamine sulphate;

c) methotrexate;

d) chondroitin sulphate;

e) diacerein.
68. 45 year old man complains of back pain and multiple joints pain. X-Ray shows bilateral sacroilitis.
Diagnosis could be:

a) rheumatoid arthritis;

b) ankylosing spondylitis;

c) psoriatic arthritis;

d) osteoarthritis;

68. Which of the following drugs is most likely to cause systemic lupus-like syndrome:

a) ibuprofen;

b) procainamide;

c) methotrexate;

d) sulfasalazine;

69. Antiphospholipid syndrome is an autoimmune disorder of acquired hypercoagulability

characterized by all signs except:

a) the association of pregnancy morbidity (foetal loss, premature birth or recurrent embryonic
losses);

b) the association of vascular thromboses (venous, arterial, small vessels);

c) predominantly affecting young males;

d) persistent elevated serum levels of antiphospholipid antibodies (anticardiolipin, lupus anticoagulant

or anti- B2glycoprotein I);

70. Characteristic of mixed connective-tissue disease are all of the following except:

a) hypogammaglobulinemia;

b) membranous glomerulonephritis;

c) polyarthritis;

d) CNS involvement;

71. Patient complaining of finger stiffness and dysphagia. What could be the most probable diagnosis:

a) achalasia;

b) lower esophageal ring;

c) esophageal carcinoma;

d) scleroderma;

72. CREST-syndrome defined by the presence of all symptoms except:

a) cystosis;
b) sclerodactyly;

c) esophageal dysmotility;

d) skin calcification;

73. Characteristic skin manifestations of dermatomyositis are all below except:

a) Gottron's papules;

b) periungual teleangiectasias;

c) a rash on the cheeks and nose, often in the shape of a butterfly;

d) heliotrope rash; mechanic's hand.

74. Diagnostic criteria of polymyositis are all below except:

a) proximal muscle weakness (upper or lower extremity and trunk);

b) destructive arthritis;

c) elevated serum creatine kinase or aldolase level;

d) myogenic changes on electromyography (short-duration, polyphasic mo-

tor unit potentials with spontaneous fibrillation potentials);

75. A 72-year-old man presents with an acutely painful right knee. On examination, he had a
temperature of 37 °C with a hot, swollen right knee. Of relevance amongst his investigations, was his
white cell count which was 12.6 Ч 109/l and a knee X-ray revealed reduced joint space and
calcification of the articular cartilage. Culture of aspirated fluid revealed no growth. What is the most
likely diagnosis:

a) gout;

b) psoriatic monoarthropathy;

c) pseudogout;

d) rheumatoid arthiritis;

76. Principles of treatment gout includes all position except:

a) NSAIDs and colchicine are first-line agents for acute attacks of gout;

b) urate-lowering therapy should be initiated during acute attacks;

c) xanthine oxidase inhibitors are approved for lowering urate levels;

d) uricase agents are approved for lowering urate levels;

77. Cranial symptoms (tenderness, headache), jaw claudication, visual

changes and neurologic changes are all commonly seen in:

a) polymyalgia rheumatic;

b) giant cell arteritis;

c) Takayasu arteritis;

d) Wegener’s granulomatosis;

78. Methotrexate is considered the first-line adjuvant therapy in patients with systemic vasculitis
who do not respond to prednisone. Oral therapy should be initiated at a dosage of:

a) 7.5 mg per week;

b) 7.5 mg per day;

c) 7.0 mg per week;

d) 3,5 to 7 mg per day;

79. Which type diabetes is HLA associated:

a) type I diabetes;

b) type II diabetes;

c) malnutrition related type disease;

d) pregnancy related type diabetes;

80. Which of the following clinical features is associated with type I diabetic mellitus:

a) requirement for oral hypoglycemic agents;

b) presence of islets antibodies;

c) rare ketosis;

d) obesity;

81. One bread unit is contained in:

a) 100 g of boiled beef;

b) 10 ml 40 % glucosae solution;

c) 2 tea spoon of vegetable oil;

d) 1 glass of milk;

82. Oral glucosae tolerant test is not indicate in the following situation:

a) patient’s fasten glicemia 6,4 mmol/l;

b) patient’s bilirubin blood serum level increased;

c) diabetus mellitus type 1 is diagnosed at patient’s relatives;

d) patient’s fasten glicemia 5,9 mmol/l;

83. Of the following listed oral hypoglycaemic agents, which one exerts their primary action by
stimulating the pancreas to secrete insulin:

a) biguanides;

b) alpha glucosidase inhibitors;

c) sulfonylureas;

d) thiazolidinediones;

84. What drug belongs to insulin sencetisers:

a) glibenclamid;

b) monoinsulin;

c) metphormin;

d) α-glucosidase inhibitor;

85. Point criteria of severe hypoglycemia:

a) glycemia 2,8 mmol/l;

b) midriasis;

c) arrhytmias;

d) unconscionessless;

86. Which substances are ketons:

a) alfa-ketoglutaric acid;

b) gamma-aminooiled acid;

c) acetoacetic acid;

d) ketorol;

87. What index is international standart of good controled diabetus mellitus:

a) fructosamine;

b) callicrein;

c) glicohemoglobin;

d) fibronectin;

e) creatinine.
88. What type antibodies is increased it autoimmune thyroiditis:

a) antibodies to receptor TSH;

b) antibodies to thyroidperoxydase (TPO);

c) thyroidblocked antibodies;

d) thyroidstimulated antibodies;

89. Marie symptom is a:

a) exophtalmus;

b) tremor of nasolabial folds;

c) tremor of arm fingers;

d) skin hyperpigmentation;

90. Needle biopsy of solitary thyroid nodule in a young woman with palpable cervical lymph
nodes on the same sides demonstrates amyloid in stroma of lesion. Likely diagnosis is:

a) medullary carcinoma thyroid;

b) follicular carcinoma thyroid;

c) thyroid adenoma;

d) multinodular goiter;

e) amyloidosis.

91. Glucocorticosteroid which is converted to cortisol:

a) prednisolon;

b) hydrocortisone;

c) dexamethason;

d) medrol;

92. Which of the following disorders are characterised by a group of symptoms produced by an excess
of free circulating cortisol from the adrenal cortex:

a) Hashimoto’s disease;

b) Addison’s disease;

c) Grave’s disease;

d) Cushing’s disease;

e) Crohn's disease.
93. What changes of electrolytes are characterized for prime hyperaldosteronism:

a) ↓ Ca; ↓ Na; ↑ K;

b) ↑ Na; ↓ K;

c) ↓ Ca; ↑ Na;

d) ↓ K; ↑ Ca;

94. Which substrates are belonged to somatomedines:

a) metanephrines;

b) growth hormone;

c) normetanephrines;

d) insulin growth factor;

95. What group of drugs are belonged to incretines:

a) insulinsencetisers;

b) secretagogues;

c) α-glucosidase inhibitors;

d) bisphosphonates;

96. The main symptom to different prime and secondary hypocorticism:

a) skin hyperpigmentation;

b) osteopenia of spine;

c) arterial hypertension;

d) hypocalcaemia;

e) hypercalcemia.

97. Diabetus incipidus is characterized by:

a) oliguria;

b) hypoisostenuria;

c) proteinuria;

d) glucosuria;

98. Kussmaul breathing is presented at:

a) hypoglycemic coma;
b) ketoacidotic coma;

c) hyperosmolar coma;

d) hypothyroid coma;

99. Which type endocrinopathy is characterized by hyperglycemia:

a) hypersomatotropism;

b) hypothyroidism;

c) panhypopituitarism;

d) hyperprolactinemia;

e) hyperthyroidism.

100. Which of the following hormone is secreted by posterior pituitary:

a) somatostatin;

b) vasopressin;

c) calcitonin;

d) cortison;

101. All of the following are features of pheochromocytoma except:

a) hypertensive paroxysm;

b) headache;

c) orhtostatic hypotension;

d) proteinuria;

102. Konn’s syndrome is associated with all except:

a) hypertension;

b) hypernatremia;

c) hypokalemia;

d) oedema;

103. Phenylalanine is the precursor of all the following, except:

a) tyrosine;

b) epinephrine;

c) thyroxine;

d) melatonin;
104. All the following drugs a reused in pheochromocytoma except:

a. Prazosin

b. Atenolol

c. Nitroprusside

d. Metyrosine
105. All areclinical featuresof pheochromocytoma,except:

a. Increased hematocrit

b. Orthostatic hypotension

c. Low cortisol level

d. Impaired glucose tolerance

106. A patient with pheochromocytoma would secrete which of the following in a higher
concentration?

a. Norepinephrine

b. Epinephrine

c. Dopamine

d. VMA
107. Which of the following is not found in pheochromocytoma?

a. Episodic hypertension

b. Postural hypotension

c. Increased hematocrit

d. Hypocalcemia

108. Drug of choice for prenatal treatment of CAH due to 21 alpha hydroxylase deficiency:

a. Dexamethasone

b. Betamethasone

c. Prednisolone

d. Hydrocortisone
109. Drug for management of hypertension in Phaeochromocytoma?

a. Phenoxybenzamine

b. Phentolamine

c. Labetalol

d. Esmolol
110. Thebestmarkerto diagnose thyroid relateddisorders is:

a. T3

b. T4

c. TSH

d. Thyroglobulin
111. An adolescent girl presented symmetrical, red, tender swellings in shin and arthralgia. X-ray
reveals hilar and paratracheal lymph node. She is clinicallysuspected to have sarcoidosis. Next step in
the diagnosis is:

a. Mediastinal lymph node biopsy

b. 24 hours urine calcium estimation

c. CT thorax

d. Follow up with 3 monthly CXR

112. Hypothyroidism may be caused by:

a. Lithium

b. Hematochromatosis

c. Scleroderma

d. All of the above

113. Which of the following is not associated with hypothyroidism:

a. Low T3

b. High TSH

c. High Triglycerides

d. Low cholesterol

114. Proptosis is not seen in?

a. Grave's disease

b. Sarcoidosis

c. Pituitary adenoma

d. Myxoedema

115. Thyroid storm isseen in: [NBE Pattern 2014-15]

a. Thyroid surgery
b. Neonatal thyrotoxicosis

c. Peri-operative infection

d. All of the above

116. The most common differential diagnosis ofhyperthyroidism in a young female is:

a. Hysteria

b. Essential tremor

c. Anxiety neurosis

d. Parkinsonism
117. A10-year-old boyhasa fracture of femur. Biochemical evaluation revealed Hb 11. 5 gm/dl and ESR
18 mm 1hour, serum calcium 12.8 Mg/dl, serum phosphorus 2.3 mg/dl, alkaline phosphatase 28 KA
units and blood urea 321mg/dl. Which of the following is the most probable diagnosis in his case?

a. Nutritional rickets

b. Renal rickets

c. Hyperparathyroidism

d. Skeletal dysplasia
118. Which of the following statements about Pseudohypoprathyroidism is true:

a. Caused by 'gain of function' inherited mutation in Gsa subunit

b. Decreased formation of cyclic GMP is observed

c. Decreased formation of Inositol triphosphate is observed

d. Decreased formation of c-AMP is observed

119. Most common cause of hypercalcemic crisis is:

a. Carcinoma breast

b. Parathyroid hyperplasia

c. Parathyroid adenoma
d. Paget's disease

120. Which of the following is not a feature of hypercalcemia:

a. Diarrhoea

b. Polyuria

c. Depression

d. Vomiting
121. Which of the following is not seen in Vitamin D deficiency:
a. Increased alkaline phosphate

b. Decreased phosphate in urine

c. Hypophosphatemia

d. Decreased serum calcium

122. Features of hyperparathyroidism are all except?

a. Solitary adenoma

b. Malignant

c. Thyroid malignancy

d. Parathyroid hyperplasia
123. A middle aged female has a pathological fracture of clavicle, ribs and X-ray shows periosteal
resorption of 2nd and 3rd metatarsals and phalanges. Most probable cause is?

a. Hyper-parathyroidism

b. Hypo-parathyroidism

c. Renal Osteodystrophy

d. Osteomalacia
124. 70 year female is on treatment with Alendronate for severe osteoporosis. Now she complains of
pain in right thigh. What is the next investigation to be performed:

a. DEXAscan

b. X-ray

c. Serum vitamin D levels

d. Serum alkaline phosphate levels

125. Arrow headed finger on X-rayissuggestive of:

a. Acromegaly

b. Hyperparathyroidism

c. Down syndrome

d. Sarcoidosis
126. Tufting of terminal phalanges is seen in:

a. Hypo-parathyroidism

b. Hyperparathyroidism

c. Hyperthyroidism

d. Gallstone
127. Investigation of choice in parathyroid pathology is:

a. CT scan

b. Gallium scan

c. Thallium scan

d. Technetium- 99 sestamibi scan

128. Which of the following is associated with secondary hyperparathyroidism

a. Parathyroid adenoma

b. Marked hypercalcemia

c. Chronic renal failure

d. Parathyroidectomy relieves the symptoms

129. True about primary hyperparathyroidism is:

a. Hypotension

b. Recurrent abortion

c. Neuropsychiatric changes

d. Gallstone
130. Hyperphosphataemia is seen in:

a. CRF

b. Prolonged phosphate intake

c. Pseudo-pseudo-hypoparathyroidism

d. Pseudo-hypoparathyrodism

131. Hypercalcemic crisis is seen in all except:

a. Metastatic carcinoma breast [NBE Pattern 2014-15]

b. Hyperparathyroidism

c. Pancreatitis

d. Hodgkin's lymphoma
132. Low serum alkaline phosphatase is seen with:

a. Hypoparathyroidism

b. Hypophosphatasia

c. Hyperparathyroidism
d. Pseudohypoparathyrodism
134. A 45 year old man,known case of chronic renal failure develops rugger jersy spine. The
probable cause is :
a. Aluminium intoxication
b. Secondary hyperparathyroidism
c. Osteoporosis
d. Osteomalacia

135. Tuftingof the terminal phalanges is seen in :

a. Hypoparathyroidism
b. Hyperparathyroidism
c. Hyperthyroidism
d. Hypothyroidism

136. Low calcium and high phosphate is seen in:

a. Hyperparathyroidism
b. Hypoparathyroidism
c. Hyperthyroidism
d. Hypothyroidism
136(a). A patient presents with low serum calcium, high phosphorus and elevated PTH.
Which of the following investigations is least contributory to establish a diagnosis:
a. Vitamin D levels
b. Serum creatinine levels
c. Cyclic AMP response to PTH
d. Urine myoglobin
137. Hypercalcemia is associated with all except:
a. Hyperparathyroidism
b. Sarcoidosis
c. Milk alkali syndrome
d. Celiac disease

137. Hypercalcemia is seen in all except:

a. Acute pancreatitis
b. Hypervitaminosis D
c. Addison's disease
d. Hyperparathyroidism

138. Hypocalcemia with hyperphosphatemia are seen in:

a. CRF
b. Pseudohypoparathyroidism
c. Vit. D deficiency
d. Magnesium deficiency

139. Alkaline phosphatase is elevated in all, EXCEPT:

a. Rickets
b. Osteomalacia
c. Hypoparathyroidism
d. Hypophosphatemia

140. Osteoporosis may be seen in all except:

a. Hyperparathyroidism
b. Hypoparathyroidism
c. Thyrotoxicosis
d. Heparin administration
141. Osteoporosis is seen in :
a. Thyrotoxicosis
b. Cushing’s disease
c Menopause

d. All of the above

142. Dilutional hyponatremia is seen in?

a. Addison's disease
b. Vincristine
c. Diuretic therapy
d. Craniphyrangioma

143. Allare true regarding ADH action except?

a. Postoperative secretion is more
b. ADH secretion occurs when plasma osmolality is low
c. Acts on DCT
d. Neuro-secretion
144. Which drug is essential in Sheehan's syndrome:
a. Estrogen
b. Cortisone
c. Thyroxin
d. Growth hormone

145. A 28-years old lady has put on weight [10 kg over a I period of 3 years], and has
oligomenorrhoea followed by amenorrhea for 8 months. The blood pressure is 160/100 mm
of Hg.Which of the following is the most 1 appropriate investigation?
a. Thyroid profile
b. Plasma cortisol
c. Plasma testosterone and ultrasound evaluation of pelvis
d. All of the above

146. A patient develops pre breakfast hyperglycaemia. Next step of management is:
a. Start oral hypoglycaemic in morning
b. Monitor overnight blood glucose levels
c. Start a dose of short acting insulin at bedtime
d. Start early morning insulin therapy

148. Purtschner’s retinopathy is seen in all except:

a. Fat embolism
b. Pancreatitis
c. Chest trauma
d. Unilateral carotid artery occlusion

149. Which is not seen in Allgrove syndrome:

a. ACTH excess leading to Cushing syndrome
b. Achalasia
c. Alacrimia
d. Hyperpigmentation
150. Pinna calcification is seen in all except?
a. Gout
b. Onchrnosis
c. Frost bite
d. Addisons disease

151. A patient has amenorrhea with hypothalamic lesion.

The diagnosis is most likely to be?
a. Kallman's syndrome
b. Asherman’s syndrome
c. Stein Leventhal syndrome
d.Sheehanssyndrome

152. Most common tumour of pituitary is:

a. Prolactinoma
b. GH secreting adenoma
c. ACTH secreting adenoma
d. TSH secreting adenoma

153. Polydipsia, polyuria, increased is due to deficiency of:

a. Vasopressin
b. Insulin
c. Decreased ADH
d. Decreased insulin

154. Hypercalcemia is seen in all except:

a. Myxedema
b. Hyperparathyroidism
c. Multiple myeloma
d. CaLung
155. A 29 years old person is known diabetic on oi.ilhypoglycemic agents since 3 years. He
has lost weight and never had DKA. His grandfather is diabetic but his father is
nondiabetic. Which is the likely diagnosi
a. MODY
b. DM typeI
c. DM typeII
d. Pancreatic diabetes

156. Hypoglycemia is a recognized feature of all of the following conditions, except:

a. Uremia
b. Acromegaly
c. Addison’s disease
d. Hepatocellular failure
157. An obese patient presented in casualty in an unconscious state.His blood sugar measured
400mg%, urine tested positive for sugar and ketones; drug most useful in management is:
a. Glibenclamide
b. Troglitazone
c. Insulin
d. Chlorpropamide
158. Endocrinal causes of Carpal Tunnel syndrome include all of the following, except
a. Diabetes Mellitus
b. Hypothyroidism
c. Acromegaly
d. Addison's disease

159. 20-year-old woman presents with bilateral conductive deafness, palpable purpura on the legs
and hemoptysis. Radiographofthe chestshowsa thin-walled cavity in left lower zone.
 Investigations reveal total leukocyte count 1 2,000/mm red cell casts in the urine and
12,000/mm serum creatinine 3 ing/dL. What is the most probable diagnosis?
a. Henoch-Schonlein purpura
b. Polyarteritis nodosa
c. Wegener's granulomatosis
d. Disseminated tuberculosis

160. A patientof chronicLeft lungabscess with generalized edema, hypoproteinemia, hepato-

splenomegaly without renal failure but reduced urine output.Diagnosis is?
a. Amyloidosis
b. Chronic cor-pulmonale with Rt. Heart failure
c. Bronchiectasis
d. Bronchogenic carcinoma

161. Incorrect about Behcet’s syndrome is:

a. There is a strong association with HLA-B7
b. The skin may be hyperactive to minor injury such as venipuncture
c. Inflammatory reaction around large blood vessels
d. Cortiocosteroid therapy is of definite value

162. Keratoderma -Blenorrhagicum is pathognomonic of:

a. Behcet's disease
b. Reiter's disease
c. Lyme's disease
d. Glucagonoma

163. Recurrent oro-genital ulceration with arthritis is

seen in:
a. Behcet's syndrome
b. Gonorrhoea
c. Reiter's syndrome
d. Syphilis

164. Antinuclearantibodies are seen in A/E:

a. Systemic sclerosis
b. Morphea
c. Pemphigus vulgaris
d. SLE
165. Kawasaki's disease has the following features except:
a. Coronary artery aneurysm
b. Conjunctival suffusion
c. Thrombocytopenia
d. Desquamation of the skin of fingers and toes

166. HLA-B*1502 is a genetic marker for:

a. Systemic lupus erythematosus
b. Polyarteritis nodosa
c. Steven Johnson syndrome
d. Seronegative spondy-arthritis syndrome

167. Clinical manifestation of Felty’s syndrome are all except:

a. Rheumatoid arthritis
b. Splenomegaly
c. Neutropenia
d. Nephropathy

168. A patient suffering from lung abscess develops anasarca. The probable reason is:
a. Cor-pulmonale
b. Good Pasture syndrome
c. Pyelonephritis
d. Acute renal failure

169. HLA DRw 52 is associated with:

a. SLE
b. Scleroderma
c. Sjogren
d. Behcet

169. A 16-year-old f presents with non-blanching purpura over the buttocksand lower limbs
along with colicky abdominal pain. Further evaluation revealed deposition of IgA immune
complexes. The most likely diagnosis is:
a. Henoch Shonlein Purpura
b. Kawasaki Disease
c. Wegner’s Granulomatosis
d. Takayasu Disease

170. A 16 year old boy presents to the pediatric emergency unit with seizures. Blood pressure in
the upper extremity measured as 200/140 mm Hg. Femoral pulses were not palpable. The most
likely diagnosis amongst the following is:
a. Takayasu Aorto arteritis
b. Renal parenchymal disease
c. Grandmal seizures
d. Coarctation of Aorta
171. Criterion for prerenal failure:
a. Fractional excretion index > 1
b. Urine sodium concentration > 10 mmol/L
c. Serum BUN : creatinine > 20:1
d. Urine osmolality < 500

172. A 50-year-old patient develops cardiogenic shock following acute myocardial infarction.
His urine output decreases in next few days. He has increased serum urea and creatinine.
Urine analysis reveals no glucose or protein but numerous hyaline casts present. After few
days he develops polyuria and serum creatinine levels fall. Histopathology of renal biopsy
in this patient would reveal:
a. Immune complex
b. Glomerular crescents
c. Patchy tubular necrosis
d. Messangial deposits

173. Chronic hemodialysis in ESRD patient is done?

a. Once per week
b. Twice per week
c. Thrice per week
d. Daily
174. Oliguric phase of ARF is characterized by A/E:
a. Chest pain
b. Acidosis
c. Hypertension
d. Hypokalemia
175. In renal failure, metabolic acidosis is due to?
a. Increased H* production
b. Loss of HCO3
c. Decreased excretion of ammonia
d. Use of diuretics

176. Clinical features of CRF/uraemia appear when renal

function is reduced to:
a. 70%
b. 50%
c. 30%
d. 20%
177. A complication of diuretic phase of acute renal failure is:
a. Convulsion
b. Hyperkalemia
c. Increased sodium excretion in urine
d. acidosis
178. Investigations in a patient of oliguria revealed: Urine osmolality:720 mosm/kg.
Urinarysodium10 mmoI/L.|BUN: creatinine = 20:1. The most likely diagnosis:
a. Prerenal acute renal failure
b. Acute tubular necrosis
c. Acute cortical necrosis
d. Urinary tract obstruction

179. Normal sized to enlarged kidneys in a patient with chronic renal failure is indicative of:
a. Benign Nephrosclerosis
b. Chronic glomerulonephritis
c. Chronic interstitial nephritis
d. Primary amyloidosis

180. Non-oliguric renal failure is commonly seen in:

a. Snakebite
b. Hypovolemic shock
c. Aminoglycoside toxicity
d. Multiple myeloma

181. The differentiating factor between pre-renal and renal azotemia is:
a. Sodium fraction excretion
b. Creatinine clearance
c. Serum creatinine level
d. Urine specific gravity
182. Which of the following is the most specific and sensitive screening test for Renovascular
Hypertension.
a. HRCT
b. CT Angiography
c. Captopril enhanced radionucleatide scan
d. MRI

183. A 25 Year old man develops hemoptysis. A few weeks later he experienced sudden onset of
acute renal failure. His urine examinations showed presence of mild proteinuria, hematuria,
and RBCs casts. Most likely diagonsis:
a. Minimal change disease
b. Good pasture syndrome
c. Diffuse membraneous glomerulonephritis
d. IgA Glomerulonephritis

184. Which ofthe following conditionsareassoiciated with pauci - immune crescenteric

glomerulonephritis:
a. Henoch - Schonlein Nephritis
b. Lupus Nephritis (SLE)
c. Microscopic polyangitis
d. Nephritis in Alport's syndrome

185. Good pasture's syndrome is characterized by all of the following, except:

a. Glomerulonephritis
b. Leucocytoclastic Vasculitis
c. Diffuse alveolar haemorrhage
d. Presence of antibodies to basement membrane
186. Which of the following statements about Hemolytic Uremic Syndrome is least correct:
a. Usually follows Hemorrhagic colitis
b. Often self-limited
c. Fever is usually mild or absent
d. Serotoxin has no role in pathogenesis

187. RBC cast in the microscopic examination of the urine is an indicator of:
a. Acute glomerulonephritis
b. Acute pyelonephritis
c. Chronic glomerulonephritis
d. Nephrotic syndrome

188. Essential feature of nephritic syndrome is:

a. Proteinuria
b. Hypoalbuminaemia
c. Hyperlipidaemia
d. Hematuria
189. True about Post-Streptococcal Glomerulonephritis is:
a. 50% of cases occur after pharyngitis
b. Early treatment of Pharyngitis eliminates the risk of P.S.G.N.
c. Glomerulonephritis, secondary to skin infection, is more common in summer
d. Recurrence is seen

190. A 70-year old male patient presented to the emergency department with pain in
epigastrium and difficulty in breathing for 6 hours. On examination, his heart rate was 56 beats
per minute and the blood pressure was 106/60 mm Hg. Chest examination was normal. The
patient has been taking omeprazole for gastroesophageal reflux disease for last 6 months.
What should be the intial investigation -
a) AnECG
b) Anupper GI endoscopy
c) Urgentultrasoundoftheabdomen
d) An x-raychest
191. Classic "spike and dome" appearance typical for:
a. Membranous nephropathy
b. Diabetic nephropathy

c. Amyloidosis
 d. Focal segmental glomerulosclerosis

192. development of Kimmelstiel-Wilson nodules typical in:

a. Membranous nephropathy
b. Diabetic nephropathy

c. Amyloidosis

d. Focal segmental glomerulosclerosis

193. A light-chain dyscrasia where monoclonal light chains form amyloid fibrils typical in:
a. AL primary amyloid
b. AA amyloid
c. AB amyloid
d. L amyloid
194. a strong linear ribbon-like appearance typical in:
a.Anti-glomerular basement membrane disease
b.Lupus nephritis
c.Henoch-Schönlein purpura
d.IgA nephropathy
195. Which of the following is true regarding GERD?
a. Occurs during transient relaxation of LES
b. Eradication of H pylori infection reduces acid reflux
c. Bicarbonate secreted by gastric mucosa neutralizes the bicorbanat
d. Normal esophageal mucosa on endoscopy excluded
GERD

196. A 48-year-old female presented with history of pain upper abdomen, nausea and decreased
appetite for 4-5 days. She had undergone cholecystectomy 2 years back. Her bilirubin was
10 mg/dl, SCOT 900 IU/L, SGPT 700 IU/L and serum alkaline phosphatase was 280 IU/L.
What is the most likely diagnosis?
a. Acute pancreatitis
b. Acute cholangitis
c. Acute viral hepatitis
d. Posterior penetration of peptic ulcer

197. Prolonged intake of PPI does not cause

a. Hypothyroidism
b. Pelvic fracture
c. Clostridium difficile infection
d. Increased community acquired pneumonia

198. 53 year old man became dizzy while passingstooland noticed fresh blood in stool. Previous
stool examination for routine screening of carcinoma colon was normal. What is the most
likely cause of bleed?
a. Early carcinoma colon
b. Sigmoid diverticulitis
c. Microscopic colitis
d. Dilatation of veins of colon
199. Extraintestinal manifestations of Inflammatory bowel disease include all of the
following, except:
a. Uveitis
b. Sclerosing cholangitis
c. Osteoarthritis
d. Skin nodules
200. Best screening test for Crohn's disease is:
a. A.S.C.A
b. P-ANCA
c. Fecal alpha1anti-trypsin
d. Fecal calprotectin

201. A 39-year-old male patient presented with recurrent episodes of bloody diarrhea for 5 years.
Despite regular treatment with adequate doses of sulfasalazine, he has had several
exacerbations of his disease and required several weeks of steroids for the control of flares.
What should be the next line of treatment for him?
a. Methotrexate
b. Azathioprine
c. Cyclosporine
d. Cyclophosphamide
202. A highly sensitive and specific marker for detecting intestinal inflammation in ulcerative
colitis is?
a. CRP
b. Fecal lactoferrin
c. Fecal calprotectin
d. Leukocytosis

203. All are true about ulcerative colitis except:

a. Smoking may prevent the disease
b. 1:1 male female ratio
c. Presents with bloody diarrhea
d. Highly Associated with infertility

204. Which of the following is the established biological therapy for Crohn's disease?
a. Anti TNF a-antibody
b. IL-1antagonist
c. IL-6 antagonist
d. IL-8 antagonist

205. Best treatment of refractory peri-anal fistula in crohn's disease:

a. Fistulectomy
b. Infliximab
c. Olasalazine
d. Mesalamine

206. Treatment of choice in intractable ulcerative colitis:

a. Mucosal proctectomy + Ileoanal pouch anastomosis
b. Proctectomy
c. Colectomy with ileostomy
d. Ileorectal anastomosis

207. Which of the finding is not a usual feature of Crohn’s disease?

a. Granulomas
b. Pseudopolyps
c. Skip lesion
d. Rightcolon predominance
208. Alpha 1anti-tryspin in stool is indicative of?
a. protein losing enteropathy
b. chroic pancreatitis
c. Acute pancreatitis
d. Whipple disease
209. Jejunal biopsy is diagnostic in:
a. Coeliacsprue
b. Tropical sprue
c. Whipple's disease
d. Radiation enteritis
210. A 30-year-old lady presents with features of malabsorption and iron deficiency anaemia.
Duodenal biopsy shows complete villous atrophy. Probable diagnosis is:
a. Antiendomysial antibodies
b. Anti-goblet cell antibodies
c. Anti-Saccharomyces cerevisae antibodies
d. Antineutrophil cytoplasmic antibodies
211. Gold standard test for diagnosis of Insulinoma is:
a. '72 hour' fast test
b. Plasma Glucose levels < 3 mmol/1
c. Plasma Insulin levels > 6mU/ml
d. C- peptide levels < 50

212. A girl presents with complaints of malena. On examination there are pigmented lesions involving
her mouth and lips. Two of her sisters also had similar complaints. Which of the following is the
most probable diagnosis:
a. Komkhite Canada syndrome
b. Puetz Jagher's syndrome
c. Gardner’s syndrome
d. Turcot's syndrome
213. Normal CRP withelevated ESR seenin?
a. RA
b. SLE
c. Scleroderma
d. Polymyalgia rheumatica

214. Takyasu arteritis mainly affects:

a. Pulmonary artery
b. Celiac artery
c. Subclavian artery
d. SMA
215. A 35-year-old man present with episodes of vomiting, photophobia and unilateral Pulsatile
headache.What is likely cause?
a. Cluster headache
b. Giant cell arteritis
c. Acute congestive glaucoma
d. Tension headache
216. Intravenous immunoglobulin is given in all except?
a. Kawasaki disease
b. Acute ITP
c. Wegener's Granulomatosis
d. Myasthenic Crisis
217. A 30-year-old male patient presents with complaints of weakness in right upper and both lower
limbs for last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side
and 5th finger on left side.On examination, BP was 160/140 mmHg, all peripheral pulses were
 palpable and there was asymmetrical examination showed proteinuria and RBC-10-15/hpf with
no casts. What is the most likely diagnosis?
a. Polyarteritis nodosa
b. Systemic lupus erythematosus
c. Wegner’s granulomatosi
d. Mixed cryoglobulemia
218. Pulse absent in radial artery is seen in?
a. Coarctation of aorta
b. Aortic regurgitation
c. Takayasu's arteritis
d. Dissection of Aorta
219. Cavitating lesion in lung is seen in:
a. Wegner's granulomatosis
b. PAN
c. SLE
d. Goodpasture's syndrome
220. ANCA positive vasculitis include all of the following Except:
a. Wegner's granulomatosis
b. Churgstrauss syndrome
c. Microscopic PAN
d. Good pasture's syndrome
221. C-ANCA is associated with:
a. Wegener's Granulomatosis
b. Microscopic Polyangitis
c. Churg- Strauss Syndrome
d. PolyarteritisNodosa [PAN]
222. p-ANCA is characteristic for:
a. PAN
b. Microscopic polyangitis
c. Wegener’s granulomatosis
d. Henoch-Schonleinpurpura

223. All of the following condition are associated with granulomatous pathology, except:
a. Wegner's Granulomatosis [WG]
b. Takayasu Arteritis [TA]
c. Polyarteritis Nodosa [Classic PAN]
d. Giant Cell Arteritis [GCA]
224. A 24 years old female develops serous otitis media of left ear with cough and occasional
hemoptysis and hematuria and epistaxis for one and half months. Her Hemoglobin is 7 gm.
B.P. > 170/100, ptoreinuria +++, RA positive [+ve] and ANCA positive [+ve], the likely
cause is-
a. Wegener’s granulomatosis
b. Rheumiatoid arthritis
c. Rapidly proliferative glomerulonephritis
d. Good pasteur's syndrome
225. An 17 year old boy presents with digital gangrene in 3rd & 4th fingers for last 2 weeks. On
examination the BP is 170/110 mm of Hg and all peripheral pulses were palpable. Blood &
Urine examination were unremarkable. Antinuclear antibody, Antibody to ds DNA & DNA
& ANCA were negative. Most likely diagnosis is:
a. Henoch-Schonlein purpura
b. Polyarteritis nodosa
c. Wegener’sgranulomatosis
d. Disseminated tuberculosis
227. A patient presents with melaena normal renal function, hypertension and mononeuritis
multiplex. The most probable diagnosis is:
a. Classical polyarteritis nodosa
b. Microscopic polyangiitis
c. Henoch-Schonleinpurpura
d. Buerger's disease
228. Biopsy in PAN shows:
a. Necrotizing arteritis
b. Atrophy arteritis
c. Granulomatous lesion
d. Ring lesion
229. Which of the following is more frequently seen in Churg Strauss Syndrome in comparison
to Wegener's Granulomatosis
a. Renal involvement
b. Lower Respiratory Tract involvement
c. Eye involvement
d. Upper Respiratory Tract involvement
230. An elderly female presents to the emergency department with history of fever, headache and
double vision. Biopsy of temporal artery revealed panarteritis. The most likely diagnosis is
a. Nonspecific Arteritis
b. PolyarteritisNodosa
c. Wegener's Granulomatosis
d. Temporal Arteritis

231. Which of the following is the most frequent presenting symptoms in patients with giant cell
arteritis
a. Headache
b. Jaw claudication
c. Polymyalgin Rheumatica
d. Blindness
232. The investigation of choice for diagnosis of Giant cell Arteritis is
a. Temporal Artery biopsy
b. Colour Doppler of Temporal Artery
c. CT Angiography
d. MRI

232. Bilateral upper limb pulse less disease is?

a. Giant cell Arteritis
b. Polyarteritis Nodosa
c. Aortoarteritis
d. HSP

233. Reversed Coarctation is seen in:

a. Giant cell Arteritis
b. Polyarteritis Nodosa
c. Takayasu Arteritis
d. Kawasaki Disease
234. The treatment of choice for Kawasaki disease is:
a. Cyclosporine
b. Prednisolone
c. Immunoglobulins
d. Methotrexate
235. Which of the following is most commonly involved in Hypersensitivity vasculitis:
a. Capillaries
b. Arterioles
c. Post-capillary venules
d. Medium sized arteries

236. A middle aged female presents with polyarthritis, elevated Rheumatoid factor and ANA
levels. Which of the following features will help in differentiating Rheumatoid arthritis
from SLE
a. Soft tissue swelling in PIP Joint
b. Juxta-articular osteoporosis on X ray
c. Articular erosions on X Ray
d. Elevated ESR
237. Renal arterystenosis may occur inall of the following, except :
a. Atherosclerosis
b. Fibromuscular dysplasia
c. Takayasu's arteritis
d. Polyarteritis nodosa
238. An 18 yr old boy presents with melaena, abdomal pain, numbness of both lower limbs and
right upper limb.O/E: pulse: 88/min, BP: 170/110 mm Hg, and all peripheral pulses
palpabie. Renal function is normal. Urine examination shows proteinuria and RBC with no
casts. What is the most probable diagnosis?
a. Classical PAN
b. Microscopic polyangitis
c. HSP
d. Wegener's granulomatosis
239. Characteristic Cardiac lesion in SLE is:
a. Verrucous endocarditis
b. Valvular incompetence
c. Heart block
d. Myocardial fibrosis
240. A younggirl is admitted with joint pains and butterfly rash and positive urine proteinuria. The best
test for her diagnosis is? Antinuclear antibody
241. A 33-year-old woman has experienced episodes of fatigue, pleural effusion, pericardial
effusion and carpal tunnel syndrome and macrocytic anemia. Best test for diagnosis shall
be:
a. Anti-beta 2 phospholipid antibodies
b. Anti-smith antibody
c. Antinuclear antibody
d. Assay for thyroid hormones

242. Onion skin spleen is seen in:

a. ITP
b. Thalassemia
c. SLE
d. Scleroderma
243. Psychosis in SLE is caused by:
245. Most common presentation of cardiac lupus?
a. Myocarditis
b. Pericarditis
c. Aortic regurgitation
d. Libman sacks endocarditis
246. Bony erosion are seen in the following except:
a. Gout
b. Psoriasis
c. SLE
d. Osteoarthritis
247. Anti-double stranded DNA is highly specific for:
a. Systemic sclerosis
b. S.L.E.
c. Polymyositis
d. Rheumatic sclerosis

248. Best marker for drug induced lupus is :

a. Antihistone antibodies
b. Anti ds DNA
c. ANA
d. Antismith Ab

249. A 23-year old woman has experienced episodes ofmyalgias, pleural effusion, pericarditis and
arthralgias without joint deformity over course of several years. The best laboratory
screening test to diagnose her disease would be:
250. Joint erosions are not a feature of :
a. Rheumatoid arthritis
b. Psoriasis
c. Multicentric reticulo-histiocytosis
d. Systemic lupus erythematosus
251. Deposition of Anti ds DNA Ab in kidney, skin, choroid plexus and joints is seen in:

a. SLE
b. Good pasture syndrome
c. Scleroderma
d. Ranauds disease

252. Autoimmune destruction of platelet is seen in :

a) Reiter disease
b) Rheumatoid arthritis
c) Polyarteritis nodosa
d) SLE

253. In SLE, characteristic kidney lesion is:

254. Bilateral parotid gland enlargement is seen in all of the following except:
a. Sarcoidosis
b. SLE
c. Chronic pancreatitis
d. Sjogern's syndrome

255. Anti-topoisomerase 1 is marker of:

a. Systemic sclerosis
b. Classic polyarteritis nodosa
c. Nephroticsyndrome
d. Rheumatoid arthritis
256. Screening test for sclerodema:
a. Anti-nuclear antibody
b. Ul- Ribonucleoprotein antibody
c. Anti- L.K.M antibody
d. Anti- topoisomerase antibody
257. Recurrentaspiration pneumonia caused by:
a. Dermatomyostis/polymyositis
b. Rheumatoid arthritis
c. Progressive systemic sclerosis
d. Systemic lupus erythrematosus
258. Indication of poor prognosis of systemic sclerosis is:
259. Woman presented with dysphagia and stiff fingers I and leather like skin is diagnosed to
have?
a. Buergers disease
b. Rheumatoid arthritis
c. Sceleroderma
d. Osteoarthrosis
260. A 35 year old lady complains dysphagia, Raynaud's phenomenon, sclerodactyly.
Investigations show antinuclear antibody. The likely diagnosis is :
a. SLE
b. Systemic sclerosis
c. Mixed connective tissue disorder
d. Rheumatoid arthritis
261. An 85-year-old woman presented with bilateral osteoarthritis of the knees. She had no
history of previous gastrointestinal disease. Which of the following is the most appropriate
initial treatment for her?
262. HLA B27 maximum associationis with?
a) Reiter’s disease
b) Ankylosing spondylitis
c) Osteoarthritis
d) Rheumatoid arthritis
263. Arthritis common with uveitisis:
a. Rheumatoid arthritis
b. Still’s disease
c. Ankylosing spondylitis
d. Reiters’s disease
264. Least common siteinvolvedin osteoarthritis is:
a. Hip joint
b. Knee joint
c. Metacarpopharangeal joint
d. Carpometacarpal joint of thumb
265. All are radiological findings of OA except:
266. Reactive arthritis is usually caused by:

a) HLA-B27
b) HLA-B25
c) HLA-DR3
267. HLA-DR4is a marker of: RA ,DM I
268. Type ofanemia seeninRheumatoid arthritis: Normocytic normochromic anemia
269. All are true about pseudogout except?
270. Rheumatoid arthritis commonly affects the: Joints/young females/pip/mcp/wrist
271. Heberdennodes are seenin: Osteoarthritis
272. Caplan's syndrome is seen with: Sjogren syndrome
273. A patient of rheumatoid arthritis develops sudden onset Quadriparesis increased muscle tone of
limbs with exaggerated tendon jerks and worsening of gait. The investigation to be done? X-ray
 ofneck {flexion and extension cervical area
274. Which is the most common site of subcutaneous
nodules in rheumatoid arthritis? Extensor site of neck ,wrist and elbow

275. A young male presents with joint pains and backache with relief of symptoms on
movement/exercise. The most likely diagnosis is? Ankylosing spondolyitis
276. All may be true about Rheumatoid Arthritis except:
277. Which of the following is the most specific test for Rheumatoid Arthritis? Anti ccp Abs test
278. All are true about Berger’s disease except:

279. Recurrent oro-genital ulceration with arthritis is seen in:

a. Bechets syndrome
b. Gonorrhea
c. Syphilis
d. All of the above
280. HLA-B*1502 is a genetic marker for: carbazapine induce [steven johnson syndrome]>toic
epidermal necrolysis
281. The mostcommon cardiacinvolvementin rheumatoid arthritis:
a. Pancarditis
b. Pericarditis
c. Myocarditis
d. Endocarditis
282. True in amyloidosis is all except:
283. A patient suffering from lung abscess develops anasarca. The probable reason is:

284. Kawasaki's disease has the following features except:

285. Plasma urea/creatinine ratio of 20:1 may be seen in: normal

285. The most common neurological disorderseen in CRF patients: peripheral neuropathy
286. Diagnostic feature of CRF is: broadcast/ insulin clearence
287. A 30-year-old male patient came with cough, hemoptysis, fever since 15 days. After a few days
the patient developed hematuria. There were no cause other bleeding manifestations. Most likely
cause is:
288. True statement regarding post streptococcal glomerulonephritis is?
289. Good pasture's syndrome is characterized by all of the following, except:
290. Nephrotic syndrome is the hall mark of the following primary kidney diseases except:
291. Renal vein thrombosis is associated with which underlying disease of kidney: nephrotic
syndrome/ membrenous glomerulonephropathy

292. Painless hematuria is a feature of: malignancy

293. A 30-year-old man presents with generalized edema and hypertension. Urine examination shows
subnephrotic proteinuria (< 2gm) and microscopic hematuria. Serum complement levels are
decreased and he is positive for anti-hepatitis C antibodies. The most likely diagnosis is: PSGN
[post streptocoaal GN]
294. The most likely diagnosis in the case of a patient with multiple pulmonary cavities, hematuria and
red cell casts is: PSGN
295. pH= 7.31 pC02=33 mm Hg and HC03 =16 mEq/dl:
296. pH= 7.55, pC02= 38, HC03 = 33, what is the primary abnormality:
297. Secondary diabetes may be noted in: Pancreatitis/ cystic fibrosis/pancreatic
cancer/hemochromatosis
298. Most common presentation of sick euthyoid state: decrease body
 temperature/bradycardia/hypotension
299. In myxoedema which is not correct:
300/ Excess of calcium intake leads to:

301. A 75 year old lady with fracture neck of femur presents with two days history of altered
sensorium and decreased urinary output. Serum calcium is 15.5 mg/dL, Urea is 140 mg/dL,
Creatinine is 2 mg/dL. All of thefollowing are useful for immediate management
of hypercalcemia, except:
302. Polyuria with low fixed specific gravity urine is seen in? ATN/DI/RF/ intenstinal
nephritis/pyelonephritis
303. The differentiating feature b/w Ectopic ACTH secretion and Cushing syndrome is:
dexamethasone suppresion test

304. A 29 years old person is known diabetic on oral hypoglycemic agents since 3 years. He has lost
weight and never had DKA. His grandfather is diabetic but his father is nondiabetic. Which is
the likely diagnosis? MODY/ type II DM
305. A 40 year old male patient is suffering from type II diabetes mellitus and hypertension. Which of
the following antihypertensive drugs should not be used in such patients:
306. Impaired glucose toleranceonanoral GTT isindicated by; 5.1-6.4%
307. HbAlC level in blood explains: Average amount of glucose attached to hb
308. A 35 year old man presents with vomitings and confusion. On examination Na+ 120 m mol/L, K+
4.2 m mol/L, Uric acid 2 mg/dl. Patient is not edematous. The diagnosis is:
309. Hypoglycemia is a recognized feature of all of the following conditions, except:
310. Kidney biopsies show no changes by light microscopy, few immune deposits (+) may be seen in
the mesangium by I.F. and by E.M. According to the World Health Organization (WHO), lupus
nephritis could be wich classes: class I

311. The light microscopy shows diffuse hypercellularity, membranoproliferative changes,

glomerular tuft necrosis, crescents, and wire loops. IF and EM show extensive deposits (+++) in
all areas (mesangial, subendothelial and subepithelial). According to the World Health
Organization (WHO), lupus nephritis could be wich classes: class IV
312. the focal and segmental proliferation, in this type, light microscopy shows evident segmental
proliferation, necrosis and occasionally hyaline thrombi, IF and EM show more marked deposits
in the mesangium (+++) and to less extent in the subendothelial area (+).According to the World
Health Organization (WHO), lupus nephritis could be wich classes: class III
313. IgA1 with galactose-deficient O-glycans (autoantigen) and anti-glycan autoantibodies
deposit in glomeruli in: Membranoproliterative GN II

314.
 Identify ribbon- ribbon-like appearance will foud in wich disease

314. An 18-year-old marathon runner has been training during the summer. He is brought to
the emergency room disoriented after collapsing on the track. His temperature is 102°F.
A Foley catheter is placed and reveals reddish urine with 3+ blood on dipstick and no
cells seen microscopically. Which of the following is the most likely explanation for his
urine?
315. Which of the following laboratory findings is most consistent with poststreptococcal
glomerulonephritis? Starry sky app/dysmorphic RBCs/ anti DNA

316. A 22-year-old man complains of acute hemoptysis over the past week. He denies smoking or
pulmonary disease. His blood pressure is 130/70 mm Hg, and his physical examination is
normal. His urinalysis also shows microscopic hematuria and red blood cell casts. Which of the
following is the most likely etiology? PSGN
317. A 19-year-old man was seen at the university student health clinic a week ago complaining of
pharyngitis, and now returns because he has noted discoloration of his urine. He is noted to have
elevated blood pressure (178/ 110 mm Hg), and urinalysis reveals red blood cell (RBC) casts,
dysmorphic RBCs, and 1+ proteinuria. Which of the following is the most likely diagnosis?
PSGN

318. Which of the following is the best screening test for early diabetic nephropathy? Urine
albumin:creatinine ratio
319. A 58-year-old man with type 2 diabetes is normotensive, has no known heart disease, and has a
baseline creatinine of 1.8 mg/ dL. H is fasting lipid profile shows triglycerides 205 mg/ dL, total
cholesterol 220 mg/ dL, high-density lipoprotein (H DL) 35 mg/ dL, and LDL 148 mg/ dL.
 What is the most appropriate treatment? statins
320. Which of the following is most likely to be associated with advanced OA? acetaminophen/
NSAIDs
321. A 72-year-old man complains of painful joints in his hips and knees, which you have diagnosed
as osteoarthritis. Which of the following is the best first medication to prescribe for this patient?
322. A 35-year-old obese hotel housekeeper presents with 1 week of lower back pain. Her history and
examination are without “red flag” symptoms and completely normal, except for her weight.
Which of the following is the best next step?
323. A 28-year-old woman from Nigeria presents with a 6-month history of persistent lower lumbar
back pain, associated with a low-grade fever and night sweats. She denies any extremity
weakness or human immunodeficiency virus (H IV ) risk fact ors. H er examinat ion is normal
except for point t enderness over the spinous processes of L4-L5. Which of the following is the
most likely diagnosis? sacroilitis
324. A previously healthy 18-year-old college freshman presents to the student health clinic
complaining of pain on the dorsum of her left wrist and in her right ankle, fever, and a pustular
rash on the extensor surfaces of both her forearms. She has mild swelling and erythema of her
ankle, and pain on passive flexion of her wrist. Less than 1 mL of joint fluid is aspirated from her
ankle, which shows 8000 PMN cells per high-power field (hpf) but no organisms on Gram stain.
Which of the following is the best initial treatment? methotrexate
325. A previously healthy 18-year-old college freshman presents to the student health clinic
complaining of pain on the dorsum of her left wrist and in her right ankle, fever, and a pustular
rash on the extensor surfaces of both her forearms. She has mild swelling and erythema of her
ankle, and pain on passive flexion of her wrist. Less than 1 mL of joint fluid is aspirated from her
ankle, which shows 8000 PMN cells per high-power field (hpf) but no organisms on Gram stain.
Which of the following diagnostic tests is most likely to give the diagnosis for
the case? Anti -ccp abs

326. A 30-year-old man is noted to have an acutely swollen and red knee. Joint aspirate reveals
numerous leukocytes and polymorphonuclear leukocytes, but no organisms on Gram stain.
Analysis shows few negatively birefringent crystals. Which of the following is the best initial
treatment? indomethacin
327. A 72-year-old man develops severe pain and swelling in both knees, shortly after undergoing an
abdominal hernia repair surgery. Physical examination shows warmth and swelling of both knees
with large effusions. Arthrocentesis of the right knee reveals the presence of intracellular and
extracellular weakly positive birefringent crystals in t he synovial fluid. Gram st ain is negative.
Which of the following is the most likely diagnosis? pseudogout
328. A 65-year-old man with a history of chronic hypertension, diabetes mellitus, and degenerative
joint disease presents with acute onset of severe pain of the metatarsophalangeal (MTP) joint and
swelling of the left first toe. Physical examination shows exquisite tenderness of the joint, with
swelling, warmth, and erythema. The patient has no history of trauma or other significant
medical problems. Synovial fluid analysis and aspiration are most likely to show which of the
following? Acute gout
329. A 17-year-old sexually active adolescent boy presents with a 5-day history of fever, chills, and
persistent left ankle pain and swelling. O n physical examination, maculopapular and pustular
skin lesions are noted on the trunk and extremities. He denies any symptoms of genitourinary
tract infection. Synovial fluid analysis is most likely to show which of t he following?
330. A 22-year-old man presents with complaints of low back pain for 3 to 4 months and stiffness of
the lumbar area, which worsen with inactivity. He reports difficulty in getting out of bed in the
morning and may have to roll out sideways, trying not to flex or rotate the spine to minimize
pain. A lumbosacral (LS) spine x-ray film would most likely show which of the following?
Dagger sign
331. A 36-year-old woman was seen by her physician due to pain in her hands, wrists, and knees. She
 is diagnosed with rheumatoid arthritis. Which of the following treatments will reduce joint
inflammation and slow progression of the disease? methotrexate

332. Which of the following patients is most likely to be a candidate for bone mineral density
screening?
333. During which of the following periods in a woman’s life is the most bone mass accumulated?
334. A 60-year-old woman presents with the results of her DEXA scan. She has a T score of – 1.5 SD
at the hip and – 2.5 at the spine. Which of the following is the most accurate interpretation of
these results?
334. You see a 70-year-old woman in your office for a routine checkup, and you order a DEXA scan
for bone mineral density screening. The T score returns as – 2.5 SD in the spine and – 2.6 in the
hip. Which of the following statements is most accurate?
335. Which of the following features is not consistent with the diagnosis of irritable bowel syndrome?
336. A 37-year-old woman is noted to have gallstones on ultrasonography. She is placed on a low-fat
diet. After 3 months she is noted to have severe right upper quadrant pain, fever to 102°F, and
nausea. Which of the following is the most likely diagnosis? cholecystitis
337. A 25-year-old medical student is stuck with a hollow needle during a proce-
dure performed on a patient known to have hepatitis B and C viral infection,
but who is HIV negative. The student’s baseline laboratory studies include
serology: HBsAg negative, anti-HBsAb positive, anti-HBc IgG negative.
Which of the following regarding this medical student’s hepatitis status is
true?
338. A 25-year-old medical student is stuck with a hollow needle during a proce-
dure performed on a patient known to have hepatitis B and C viral infection,
but who is HIV negative. The student’s baseline laboratory studies include
serology: HBsAg negative, anti-HBsAb positive, anti-HBc IgG negative. What postexposure
prophylaxis should the student described in this case? HBIG IV <6 hr of exposure
339. In a suicide attempt, an 18-year-old woman took 4 g of acetaminophen, approximately 8
hours previously. Her acetaminophen level is 30 µg/ mL. Which of the following is the best
next step to be performed for this patient? IV acetylcysteine
340. A 42-year-old overweight but otherwise healthy woman presents with sudden onset of right upper
abdominal colicky pain 45 minutes after a meal of fried chicken. The pain is associated with
nausea and vomiting, and any attempt to eat since then has caused increased pain. Which of the
following is the most likely cause?
341. A 45-year-old man was brought to the emergency room (ER) after vomiting
bright red blood. He has a blood pressure of 88/ 46 mm Hg and heart rate of
120 bpm. Which of the following is the best next step?
342. Which one of the following patients should be promptly referred for endoscopy?

343. A 32-year-old woman has a history of chronic diarrhea and gallstones and
now has rectovaginal fistula. Which of the following is the most likely diag-
nosis?
a) Crohn’s disease
b) Ulcerative colitis
c) SLE
d) Lexative abuse
344. A 45-year-old man with a history of ulcerative colitis is admitted to the hospital with
2 to 3 weeks of right upper quadrant abdominal pain, jaundice, and pruritus. He has no
fever and a normal WBC count. Endoscopic retrograde cholangiopancreatography
(ERCP) shows multifocal strictures of both the intrahepatic and extrahepatic bile ducts
with intervening segments of normal and dilated ducts. Which of the following is the most
likely diagnosis?
 a) Acute spurative cholangitis
b) Cholengiocarcinoma
c) Primary sclerosing cholengitis (psc)
d) Cholidocholithiasis with resultant biliary stricture

345. A 25-year-old man is hospitalized for ulcerative colitis. He has now devel-
oped abdominal distention, fever, and transverse colonic dilation of 7 cm on
x-ray. W hich of the following is the best next step?

a) 5-ASA
b) Steroid
c) Antibiotic and prompt surgical consultation
d) infliximab

346. A 35-year-old woman has chronic crampy abdominal pain and intermittent
constipation and diarrhea, but no weight loss or gastrointestinal bleeding.
Her abdominal pain is usually relieved with defection. Colonoscopy and
upper endoscopy with biopsies are normal, and stool cultures are negative.
Which of the following is the most likely diagnosis?
a. Infectious collitis
b. IBS
c. Crohn’s disease
d. Ulcerative collitis

347. Which of the following clinical features is associated with type I diabetic mellitus:
348. Oral glucosae tolerant test is not indicate in the following situation:

349. In the presence of the patient's weakness, pigmentation of the skin and
mucous membranes, hypotension, nausea, vomiting, first of all you should
consider:

350. Which substances are ketons:

351. Berge’s disease is:
a) neurosensory deafness;

b) diabetic nephropathy;

c) IgА-nephropathy;

d) В12 deficiency anemia;

e) Wegener granulomatosis