Medicine 4th year 25-05-2016

" ‫" مش كل االجابات صح‬

1- Heinz bodies in red blood cells in hemolytic anemia is present in:
Select one:

a. Glucose 6 phosphate dehydrogenase deficiency

b. Post splenectomy

c. Cold agglutinin disease

d. Paroxysmal nocturnal haemoglobinuria

e. Clostridium welchii septicaemia

2- A 60-year-old man has developed symptoms of shortness of breath and was referred into
hospital. On examination, he had a hyperdynamic pulse, prominent carotid pulsations and a
displaced apex beat. He had a grade 3 early diastolic murmur in the lower left sternal edge.
What is the likely diagnosis?
Select one:

a. Mitral regurgitation

b. Atrial septal defect

c. Mitral stenosis

d. Aortic stenosis

e. Aortic regurgitation

3- During auscultation of the heart you discover a wide fixed splitting of the second heart sound.
In which of the following conditions does this occur?
Select one:

a. Aortic stenosis

b. Constrictive pericarditis

c. Right Bundle Branch Block

d. An uncomplicated ASD

e. Fallot's tetralogy

4- Which of the following is not a feature of hypokalaemia on an ECG?

Select one:

a. Flattened t wave

b. Prolonged QT

c. ST depression

d. Delta wave
e. U wave

5- A 25-year-old man developed bilateral loin pain and frank hematuria. His symptoms had started
24 hours after developing a sore throat. His blood pressure was 138/88 mmHg. Urinalysis was
positive for blood (4+) and protein (2+).What is the most likely diagnosis?
Select one:

a. Nephrolithiasis

b. Post-streptococcal glomerulonephritis

c. Septicaemia

d. Microscopic polyangiitis

e. IgA nephropathy

6- Which of the following hematological disorders is inherited as an autosomal recessive

condition?
Select one:

a. Glucose-6-phosphate dehydrogenase deficiency

b. Protein C deficiency

c. Antithrombin III deficiency

d. Pyruvate kinase deficiency

e. Acute intermittent porphyria

7- A 56-year-old woman is recently diagnosed with small cell carcinoma of the lung. Which of the
following non-metastatic manifestations is she most likely to develop?
Select one:

a. Eaton-Lambert syndrome

b. Myasthenia gravis

c. Hypertrophic pulmonary osteoarthropathy (HPOA)

d. Erythema gyratum repens

e. Ectopic PTH-related peptide secretion

8- Which of the following statements is true of sickle cell disease?

Select one:

a. There is often an inability to concentrate urine

b. The spleen is frequently enlarged

c. Symptoms of anemia are usually limiting when Hb equals 8 g/dl

d. Oral iron supplements are required

e. A painful shoulder joint will respond to intra-articular corticosteroid injection

 9- A 28-year-old law student comes to your office complaining of back pain. He has been reading
information on the Internet and is concerned that he has ankylosing spondylitis. Which of the
following symptoms would support that diagnosis?
Select one:

a. Severe back pain in the evening

b. Morning stiffness for two hours in the back that improves with exercise

c. Diarrhea alternating with constipation

d. Back pain worsening on forward flexion with radiation to the buttocks

e. Acute onset of pain after lifting

10- A 34-year-old woman develops a red rash over her cheeks, frequent oral ulcers, and pain and
swelling in both wrists as well as in several small joints in her hands. Medical evaluation
reveals a positive ANA, and 3+ proteinuria. Which of the following organ involvement will
determine her prognosis?
Select one:

a. Cardiopulmonary pathology

b. Renal pathology

c. Thrombotic events

d. Musculoskeletal pathology

e. Skin changes

11- Regarding pulmonary emboli, which statement is correct?

Select one:

a. a paO2>80 excludes a pulmonary embolism

b. a normal CXR excludes a pulmonary embolism

c. a normal A-a gradient excludes a pulmonary embolism

d. anticoagulation reduces mortality from pulmonary embolism significantly

e. all of them are correct

12- Bloody diarrhea can be induced by the following, EXCEPT:

Select one:

a. Ulcerative colitis

b. Giardia lamblia

c. Shingella shigae

d. E.histolytica

e. Cancer rectum
 13- A 45- year-old man comes to the physician due to several months of easy fatigability and
exertional dyspnea. The patient had a subtotal gastrectomy for a nonhealing gastric ulcer 5
years ago. He takes daily iron supplementation. Blood pressure is 120/70 mm Hg, pulse is
80/min, and respirations are 16/min. Physical examination shows a shiny tongue and pale
palmar creases. No lymphadenopathy, hepatomegaly, or splenomegaly is present. Laboratory
results are as follows: Hemoglobin 7 .8 g / dL Leukocy1es 3 ,800 cells/IJL Bilirubin, total 2 .3 mg
/ dL Bilirubin, direct 0.4 mg / dL Alkal ine phosphatase 20 U /L Aspartate aminotransferase 12 U
/L Alanine aminotransferase 24 U /L Lactate dehydrogenase, serum 190 U /L Stool tests for
occult blood are repeatedly negative. This patient's condition involves which of the following
pathophysiologic mechanisms?
Select one:

a. Impaired glutathione synthesis

b. Impaired DNA synthesis

c. Immune -related red blood cell injury

d. Impaired globin chain synthesis

e. Mechanical red blood cell injury

14- A 30 year old man had a blood pressure of 150/100 mmHg. Clinical examination was normal.
Which one of the following would suggest secondary hypertension?
Select one:

a. A Creatinine clearance of 90 mL/min

b. The presence of arteriovenous nipping on fundoscopy

c. Left ventricular hypertrophy criteria on the ECG

d. 24 hour urinary protein excretion of 1.6g

15- Which may cause acute renal failure in patients with nephrotic syndrome?
Select one:

a. Lipid-lowering agents

b. Dietary protein restriction

c. Loop diuretics

d. ACE inhibitors

16- Prerenal azotemia is associated with:

Select one:

a. High fractional excretion of sodium

b. Use of angiotensin-converting enzyme (ACE) inhibitors in unilateral renal artery stenosis

c. Evolution to acute tubular necrosis if untreated

d. Granular casts in the urine

 17- A 56-year-old man has a history of hypertension, but is otherwise healthy. Because of new-
onset peripheral edema over the last 6 months, you check labs and find a normal creatinine.
His dipstick, however, is 4+ for protein, and a subsequent 24-hr urine collection documents 3.5
g of protein per 24 hours. Ultrasound of the kidneys is unremarkable. Which one of the
following features would also be expected?
Select one:

a. >3+ hematuria

b. Hypercholesterolemia

c. Normal serum albumin

d. Absence of albuminuria

18- All of the following are features of RTA Type 1 (Renal Tubular Acidosis ) except :
Select one:

a. Hyperkalaemia

b. Urine PH>5.5

c. Renal stones

d. Plasma HCO3<10 mml/l

e. Growth Failure

19- Which of the following best describes the mechanism of action of pioglitazone and
rosiglitazone in treating diabetes mellitus?
Select one:

a. Increased absorption of glucose by the intestine

b. Increased secretion of insulin by the pancreas

c. Decreased production of glucose by the liver

d. Increased sensitivity of peripheral tissues to insulin

20- When type 2 diabetic patient is diagnosed, he had this disease before diagnosis by an average
of:
Select one:

a. 3 years

b. 7 years

c. 10 years

d. 15 years

e. 0 years
 21- A 28-year-old woman presents to your office with a tender neck. She gave birth to her first child
approximately 11 months ago. She describes having a sore throat, nasal congestion, and
rhinorrhea last week. She self-medicated with antihistamines and initially improved. She then
developed a fever and severe neck pain radiating to the left ear. On exam, you are able to
palpate an enlarged thyroid that is exquisitely tender to touch. Initial labs reveal a white blood
cell (WBC) count of 7000/mm3 and a thyroid-stimulating hormone (TSH) of less than 0.01 mU/L.
The most likely diagnosis is:
Select one:

a. Acute bacterial thyroiditis

b Subacute thyroiditis

c. Silent (postpartum) thyroiditis

d. Hashimoto thyroiditis

e. Acute onset of Graves disease

22- Your patient presents with acute abdomen, he has history of dull abdominal pain for several
years mainly when hungry. His CXR is shown below. What do you think?
" ‫" كان في صورة اشعة القولون واالمعاء طالعة فوق الديافرام‬
Select one:

a. This is normal variant, reassure the patient

b. You would like to start antibiotics for possible pneumonia

c. This is an emergency; you need to call the surgery team

d. Chest tube has to be inserted at the right side for pneumothorax drainage

23- In which of the following situations in PFT least useful?

Select one:

a. Evaluating the probability of getting a pulmonary disease

b. Weaning from mechanical ventilation

c. Documenting the progression of pulmonary disease

d. Exercise evaluation.

24- A patient has the following ABG's on room air. pH 7.21, PaCO2 67, PaO2 49, HCO3 26, SaO2 76,
Hb 10.1, his cardiac output is normal Which of the following is true regarding PaO2?

Select one:

a. None of them

b. Is reduced

c. Adequate.

d. The ABG's should be repeated because this low PaO2 is not compatible with life.
 25- 80 year old male patient with H/O hypertension, on beta blocker, presented with presyncope.
His ECG is shown You think:
" ‫" بتذكر االي سي جي كان معطيني برادي كارديا وزي كانو في فيرست ديجري بلوك‬
Select one:

a. He needs urgent coronary angiography

b. the patient has MI pattern on this strip

c. Beta blocker may induce this ECG pattern.

d. CXR should be the initial test, this strip can be ignored

26- A 36-year-old man who is known to have bronchiectasis has a chronic cough. A sputum
sample is sent from the clinic. What organism is most likely to be isolated?
Select one:

a. Klebsiella spp.

b. Pseudomonas aeruginosa

c. Streptococcus pneumoniae

d. Haemophilus influenza

e. Moraxella

27- Which of the following is the commonest cause of traveler’s diarrhea?

Select one:

a. Giardia Lamblia

b. E. Coli

c. Entamoeba Histolytica

d. Shigella Flexneri

e. Yersinia enterocolitica

28- A 35 year old woman with alcoholic cirrhosis is admitted with deteriorating encephalopathy
and abdominal discomfort. An ascitic tap revealed a polymorphonuclear cell count of 350 cells
per mm3. Which of the following is the most appropriate therapy?
Select one:

a. Intravenous cefotaxime

b. Intravenous metronidazole

c. Oral norfloxacin

d. Intravenous amoxicilli

e. Oral neomycin
 29- Which of the following conditions is most likely to be associated with thrombocytopenia?
Select one:

a. Pernicious anaemia

b. Hereditary haemorrhagic telangiectasia

c. Haemophilia A

d. Uraemia

e. Porphyria

30- A 54 year old man presents with central crushing chest pain. Examination is normal. 12-lead
ECG shows ST segment elevation in leads II, III, aVF and ST depression in V1, V2 and V3.
Which coronary artery is occluded?
Select one:

a. Circumflex

b. Left Main Ste

c. Left Anterior Descending

d. Right Coronary Artery

e. Obtuse Marginal

31- Which of the following is a characteristic feature of familial hypercholesterolaemia?

Select one:

a. elevated chylomicrons

b. hypertriglyceridaemia

c. increased expression of LDL receptors

d. Autosomal dominant inheritance

32- Which of the following is true concerning a hepatitis E infection?

Select one:

a. It is a recognized cause of chronic liver disease

b. It does not result in a carrier state

c. It can be transmitted with hepatitis B

d. CT scan of the liver with contrast shows diagnostic appearances

e. The incidence of chronic liver disease is reduced by administration of alpha interferon

 33- Where is B type natriuretic peptide secreted from?
Select one:

a. Renal mesangium

b. Ventricles

c. Left atrium

d. Right atrium

e. Carotid body

34- Water excretion in the kidneys is influenced by:

Select one:

a. Vasopressin

b. Proximal tubule

c. Integrity of collecting ducts

d. Distal tubule

e. Ascending limb of loop of Henle

35- Which of the following is true of radioactive iodine (131I) therapy?

Select one:

a. Causes a deterioration in ophthalmopathy in patients with Graves disease

b. Is associated with an increased risk of thyroid lymphoma

c. Causes hypothyroidism in 90% of treated patients within 3 months

d. Is associated with a subsequently increased risk of infertility

e. Is the preferred treatment in amiodarone induced thyrotoxicosis

36- The finding of antithyroid microsomal and antithyroglobulin antibodies suggests what
diagnosis?

Select one:

a. Graves disease

b. Hashimotos thyroiditis.

c. Celiac Disease

d. Reidels thyroiditis

e. Secondary hypothyroidism
 37- Which of the following clinical or chest x-ray finding are consistent with a tension
pneumothorax?

Select one:

a. Dullness to percussion on the affected side.

b. Increased radiolucency on the affected side.

c. Bronchial breath sounds on the affected side

d. Mediastinal shift towards the site of the pneumothorax

38- Spleen enlargement is invariably seen in which of the following?

Select one:

a. Idiopathic thrombocytopaenic purpura

b. Myeloproliferative disorders

c. Acute myeloid leukaemia

d. Polycythaemia rubra vera

e. Myelosclerosis

39- A 65-year-old man, with a history of smoking, presents with chronic cough, haemoptysis and
weight loss. His Chest X-Ray shows a cavitating lesion. What is the likely diagnosis?
Select one:

a. Alveolar cell carcinoma

b. Adenocarcinoma

c. Squamous cell carcinoma

d. Small cell carcinoma

e. Large cell carcinoma

40- A 27 year old man presents with fever, urethritis and arthralgia. He is found to have a swollen
ankle with a pustular rash on the dorsal aspect of his foot. What is the most likely diagnosis?
Select one:

a. Reiter's syndrome

b. Staphylococcal arthritis

c. Lyme disease

d. Tuberculous arthritis

e. Gonococcal sepsis
 41- What is true regarding vasculitis?
Select one:

a. Classical polyarteritis nodosa affects medium arteries

b. Behçet's disease affects veins precapillary

c. Wegeners granulomatosis mainly affects medium-large blood vessels

d. Takayasus arteritis affects small-medium blood vessels

e. Churg-Strauss syndrome mainly affects medium-large blood vessels

42- Which of the following statements regarding systemic lupus erythematosis (SLE) is correct?
Select one:

a. When evidence of mild nephritis is present, a renal biopsy is unnecessary

b. There is a female preponderance of 8:1.

c. When disease is active the levels of complements C3 and C4 are raised

d. There is neurological involvement in about 10% of cases

e. First manifestation of the disease may be idiopathic thrombocytopenia purpura

43- What is the most likely outcome of minimal change nephropathy at 16 year of age?
Select one:

a. Persistent hypertension

b. Full renal recovery

c. Persistent proteinuria

d. A tendency to relapse

e. Permanent renal impairment

44- Cough lasting for more than 12 weeks is called:

Select one:

a. Paroxysmal.

b. Nocturnal.

c. Acute.

d. Chronic.

45- Primary Pulmonary tuberculosis:

Select one:

a. Commonly leads to military TB

b. Leads always to pleural effusion

c. May be totally asymptomatic

d. Is highly infective
e. Usually produces cavitations

46- A 60 year old gentleman with known alcohol excess presents with epigastric pain radiating to
his back. This has occurred several times. He also describes steatorrhoea and weight loss.
What is the most likely diagnosis?
Select one:

a. Alcoholic Liver Disease

b. Chronic pancreatitis

c. Acute pancreatitis

d. Gastritis

e. Coeliac disease

47- 45 year old male patient, presents with fever, cough and fatigue. His physical exam according
to the below shown CXR would reveal:
" \: ‫" ناسي كيف كانت الصورة‬
Select one:

a. Dullness at both lung bases.

b. Tympanic resonance over the right upper lobe.

c. Bronchial breathing sound at the right upper lobe

d. No abnormal sounds are expected

48- How do you calculate the anion gap?

Select one:

a. ((Na+) + (K+)) - ((Cl-) + (H+))

b. ((Na+) + (K+)) + ((Cl-) + (HCO3-))

c. (Na+) minus ((Cl-) + (HCO3-)

d. ((Na+) + (K+) + (H+)) - ((Cl-) + (HCO3-))

e. ((Na+) + (Cl-)) - ((K+) + (HCO3-))

49- A 23-year-old woman presents with seizures, hypertension, a rash, a raised ESR,
thrombocytopenia, a normal CRP and a creatinine of 4 mg / dl. What is the most likely
diagnosis?
Select one:

a. Hashimoto’s disease

b. Multiple Myeloma

c. Staphylococcal septicemia

d. Systemic lupus erythematosus

e. Sickle cell disease

 50- A teenage boy presents to the emergency room with complaints of sharp pain and trouble
breathing. You find that the patient has cyanosis, tachypnea, tracheal deviation to the right,
decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds
on the left. This is consistent with:
Select one:

a. Acute bronchitis

b. Acute pneumonia

c. An asthmatic attack

d. Spontaneous pneumothorax

e. Massive pulmonary embolism

51- A 72- year-old man presents to your office complaining of severe fatigue. He says that five
months ago he was able to climb four flights of stairs without shortness of breath, but now he
has to rest after two. His appetite has decreased, but he denies any abdominal discomfort or
black stool. Physical examination reveals firm, enlarged cervical, inguinal and supraclavicular
lymph nodes. A soft systolic murmur is heard along the left sternal border. Abdomen is soft
and non-tender. His liver span is 10 cm and the spleen is palpated 4 cm below the left costal
margin. His blood hemoglobin level is 7 .1 mg / dl. Which of the following is the most likely
cause of this patient's anemia?
Select one:

a. Folate deficiency

b. Red blood cell membrane defect

c. Iron deficiency

d. Bone marrow infiltration

e. Glucose-6-phosphate dehydrogenase deficiency

52- A patient presents with proteinuria, hematuria, hypertension, and peripheral edema. Urinalysis
shows red blood cells (RBCs) and RBC casts. Blood work shows normal electrolytes; blood
urea nitrogen and creatinine are elevated at 66 mg/dL and 4.1 mg/dL, respectively. Serum
complement is low. Which one of the following is a possible etiology for this patient’s
presentation?
Select one:

a. Microscopic polyangiitis

b. Goodpasture syndrome

c. Thrombotic thrombocytopenic purpura (TTP)

d. Poststreptococcal glomerulonephritis

53- A young farmer presented with these acutely painful lesions on his lower legs. Not long
afterwards his friends noticed he had an unusual facial appearance. In that he could not smile,
close his left eye or wrinkle his forehead on the left. What are the painful lesions on his lower
legs?
Select one:

a. Chronic plaque psoriasis

b. Erythema marginatum

c. Erythema multiforme

d. Erythema nodosum

e. Necrobiosis Diabeticorum

54- Hypocalcemia can be associated with all of the followings except:

Select one:

a. Can cause prolonged qt interval in ekg

b. Can be caused by sepsis

c. Can cause siezures

d. In hypoparathyroidism phosphate level is usually low

e. Can be elicited by trousseau

55- Which of the following statements regarding metformin therapy is not correct?
Select one:

a. Lactic acidosis is a rare complication

b. It reduces insulin resistance

c. It should not be used in patients above age 80 years

d. It can be used with in patients with significant renal insufficiency if creatinine levels are monitored closely

56- A 58-year-old school teacher presents to your clinic to establish care. In taking vital signs, you
feel the patient’s radial pulse. The pulse pressure is diminished, and the pulse feels weak and
small. The upstroke feels a little slow, and the peak is prolonged. You immediately suspect that
this patient may have which of the following diagnoses?
Select one:

a. Severe aortic stenosis

b. Hypertrophic cardiomyopathy

c. Premature atrial contractions

d. Constrictive pericarditis

e. Aortic regurgitation

57- An 18-year-old patient presents with recurrent severe and invasive Neisserial infection, HIV is
negative and there is no family history available because she is adopted The congenital
immunodeficiency syndrome leading to repeated meningococcal infection is:
Select one:

a. Chediak-Higashi syndrome
b. Early component (C1-4) complement deficiency

c. Common variable immunodeficiency

d. Chronic granulomatous disease

e. Late component (C5-9, MAC) complement deficiency

58- What is true regarding vasculitis?

Select one:

a. Behçet's disease affects veins precapillary

b. Classical polyarteritis nodosa affects medium arteries

c. Wegeners granulomatosis mainly affects medium-large blood vessels

d. Churg-Strauss syndrome mainly affects medium-large blood vessels

e. Takayasus arteritis affects small-medium blood vessels

59- Which of the following scenarios illustrates the most appropriate first-line selection of
antihypertensive agent?
Select one:

a. A 35-year-old woman, pregnant with her first child, is prescribed lisinopril

b. A 72-year-old man with gout is prescribed a diuretic

c. A -year-old woman with a history of chronic obstructive pulmonary disease (COPD) is prescribed
Propranolol

d. A 32-year-old with chronic migraines is prescribed metoprolol

60- As Causes of a collapsing pulse one of the following is false:

Select one:

a. Fever

b. Aortic regurgitation

c. Bradycardia

d. Thyrotoxicosis

e. Patent ductus arteriosus

61- You have been treating a 75-year-old man for hypertension for the last 20 years. He frequently
misses medication doses, and his blood pressure is rarely well controlled. In the office today,
his blood pressure is 165/90. He states that he feels well. Which of the following would you
expect on his physical exam?
Select one:

a. S4 gallop and a left ventricular heave

b. Basilar crackles in the lung fields

c. S3 gallop and a left ventricular heave

d. S4 gallop and a right ventricular heave

e. Papilledema

62- Clinical features of mitral stenosis include one of the followings:

Select one:

a. Displaced apex beat

b. Corrigan's sign

c. Atrial fibrillation

d. Ejection systolic murmur with opening snap

e. De Musset's sign

63- The most important technique when progressing from one auscultory site on the thorax to
another is:
Select one:

a. Side-to-side comparison

b. Interspace-by-interspace comparison

c. Top-to-bottom compariso

d. Posterior-to-anterior comparison

64- Causes of polyuria, all of the followings are true, except:

Select one:

a. Hyperglycemia

b. Early stage of chronic renal failure

c. Excessive fluid intake

d. Heavy smoking

e. Tubulointerstitial diseases

65- A 69-year-old man comes to the office complaining of fatigue, and weight loss for 3 months. He
also reports having frequent headaches, which are new for him. There are no other
constitutional symptoms of fever, chills or night sweats. He does have chronic lower back pain
but lately he has noticed pain in his shoulder, and hip as well. The muscle and joint symptoms
are worse in the morning, and the stiffness lasts for 1 hour. His jaw also hurts when he is
chewing food. Head and neck examination is normal; there is no lymphadenopathy and
fundoscopy is normal. Range of motion in the shoulders and hips is reduced because of
discomfort but there is no active inflammation. Which of the following is the most feared
complication in patients with this condition?
Select one:

a. Cortical stroke

b. Limb claudication
c. Blindness

d. Renal infarction

e. Aortic aneurysm

66- Clubbing is commonly associated with of the following, EXCEPT?

Select one:

a. COPD

b. Asbestosis

c. congenital heart disease

d. idiopathic pulmonary fibrosis

e. Bronchiectasis

67- An otherwise healthy 45-year-old man presents with severe melena and moderate abdominal
cramping since this morning. A barium enema 1 year ago was normal. On examination, his
blood pressure is 120/78 mm Hg and pulse is 100 beats/min while lying down; when standing,
the blood pressure is 105/76 mm Hg and pulse is 136 beats/min. His hematocrit is 34%. What is
the most likely cause of bleeding?
Select one:

a. Duodenal ulcer

b. Vascular ectasia (watermelon stomach)

c. Inflammatory bowel disease

d. Diverticular bleed

e. Mallory-Weiss tear

68- All of the following are causes of diarrhea except :

Select one:

a. Chronic pancreatitis

b. Carcinoid syndrome

c. Hyperthyroidism

d. Hyperparathyroidism

e. Diabetes mellitus

69- Cushing syndrome can present with all the following except:
Select one:

a. Hypokalemia

b. Hirsutism

c. Thick oily skin

d. Low ACTH
e. High ACTH

70- A 52-year-old civil engineer presents to the office for a checkup. He is doing well except that he
has noticed increasing shortness of breath with physical exertion, so he has cut down on his
recreational activities. On auscultation of the heart, you hear a blowing, medium-pitched
pansystolic murmur at the apex. It radiates to the left axilla and does not change with
inspiration. This murmur is most likely:
Select one:

a. Tricuspid regurgitation

b. Ventricular septal defect

c. Mitral regurgitation

d. Mitral stenosis

e. Aortic stenosis

71- Kussmaul’s sign (an increase in the jugular venous pressure during inspiration) is evident in all
of the followings, except:
Select one:

a. Pulmonary embolism

b. Constrictive pericarditis

c. Right ventricular infarction

d. Tricuspid regurgitation

72- Upper gastrointestinal bleeding refers to bleeding that occurs proximal to the :
Select one:

a. Splenic flexure

b. Ligament of Treitz

c. Hepatic flexure

d. Ileocaecal valve

e. Gastro-oesophageal junction

73- A 27-year-old woman with a 3-year history of nephrotic syndrome is found to have a serum
calcium of 7.8 mg/dL (normal range 8.6-10.2) (2.0 mmol/L (normal range 2.2–2.6 mmol/L)).
Serum creatinine is 1.0 mg/dL (88.4 μmol/L), phosphorus is 2.6 mg/dL (normal 2.5-4.5) (0.8
mmol/L (normal 0.8–1.5)). She reports no paresthesias or muscle cramps. Physical exam shows
2+ pitting pretibial edema but no Trousseau or Chvostek sign. Which of the following is the
most useful next test to determine the etiology of her low serum calcium?
Select one:

a. Serum 25-hydroxyvitamin D

b. Serum 1,25-dihydroxyvitamin D

c. Serum parathyroid hormone level

d. Serum magnesium

e. Serum albumin

74- A 52- year-old nursing home worker comes to the physician with a 4-week history of
nonproductive cough and night-time sweating. She has unintentionally lost 2 .2 kg (5 lb} over
the last month. Her medical history is significant for untreated hepatitis C and left-sided
mastectomy for breast cancer 5 years ago. She tested negative for HIV 6 months ago. The
patient takes no medications but smokes 1 pack of cigarettes daily and drinks 2 beers every
weekend. She emigrated from central Africa 2 years ago. Chest x-ray shows a right upper-lobe
cavity with a surrounding infiltrate. Which of the following is the most important epidemiologic
clue to the etiology of this patient's disease?
Select one:

a. Hepatitis C diagnosis

b. Smoking history

c. Emigration from an endemic area

d. Previous breast cancer

e. Nursing home occupation

75- In a patient with liver cirrhosis which one of the listed features is characteristic of portal
hypertension?
Select one:

a. Hepatomegaly

b. Gynecomastia

c. Spider telangiectasia

d. Jaundice

e. Esophageal varices

76- Which of the following is the most appropriate treatment for primary minimal change disease of the
kidney?
Select one:

a. Prednisone 40 mg and 100 mg oral cyclophosphamide for six months

b. Prednisone 60 mg orally each day for four to six weeks

c. Cyclophosphamide 750 mg IV monthly for six months

d. No need therapy

e. An ACE-inhibitor alone
 77- A 30 year old man present with recurrent episodes of chest pain and exertional pre-syncope
.There is a family history of sudden cardiac death .Resting ECG showed LVH , which one of the
following is the most likely diagnosis ?
Select one:

a. Supravalvular aortic stenosis

b. Hypertrophic cadiomyopathy

c. Ischemic heart diseas

d. Dilated cadiomyopathy

e. Pulmonary embolic disease

78- A 32 year old female presents with 5 months of pain and swelling in hands, progressive
weakness, difficult to get up from chair, hold hairdryer, walk up stairs due to weakness.
Physical examination: puffy hands with scaly, darkened fingers. Bibasilar crackles, proximal
weakness upper and lower limbs. Laboratory results: CBC normal. Creatinine normal. ESR 24.
CK 4250 U/L. ANA 1:160. What is the diagnosis?

Select one:

a. SLE

b. Polymyositis

c. Polymyalgia rheumatica

d. Scleroderma

e. MCTD

79- A 63-year-old man develops pain and swelling in his knee. It appears warm, red, and swollen
with decreased range of movement. A diagnostic aspiration is performed. Which of the
following will most likely distinguish pseudogout from gout?
Select one:

a. Acute onset

b. Positive birefringent crystals

c. Involvement of large joints

d. Involvement of single joints

e. Association with diabetes

80- A 42-year-old woman with no significant past medical history presents to your office for a
physical. She has not seen a physician in over 10 years. Her only complaint is fatigue. Her
family history is notable for colon cancer in her mother. Her review of systems is negative for
menorrhagia. Findings on examination are unremarkable. Lab values are as follows:
Hemoglobin (Hgb): 11.2 g/dL Hematocrit: 33.4% Red blood cell (RBC) count: 5.2 106/μL Mean
corpuscular volume (MCV): 70 fL RDW: 12.5% Platelet count: 188,000/μL Serum iron: 100 μg/dL
(reference range 50-170 μg/dL) TIBC: 275 μg/dL (reference range 250-370 μg/dL) Saturation:
 30% (reference range15-50%) Ferritin: 150 μg/L (reference range 15-150 μg/L). Which of the
following tests is most likely to aid in the diagnosis of this patient’s anemia?
Select one:

a. Colonoscopy

b. Prescribe iron tablets for 6 weeks and repeat the blood count

c. Serum transferrin receptor level

d. Hgb electrophoresis

e. Upper endoscopy

81- A 40 year old man has recurrent episodes of bloody diarrhea and lower abdominal cramping.
Histological evaluation of a biopsy from flexible sigmoidoscopy reveals acute inflammation
without architectural distortion consistent with ulcerative colitis. Which of the following
conditions is associated with the condition?
Select one:

a. Gallstones

b. Sclerosing cholangitis

c. Erythema nodosum

d. Vitamin B12 deficiency

e. Renal calculi

82- A 67 year old patient with long history of chronic large amount of sputum production, his CXR
is likely to show:
Select one:

a. Left sided tension pneumothorax

b. Hyperinflated lungs with tram like changes and cysts

c. Cardiomegaly.

d. Bilateral pleural effusions.

83- A 63-year-old man is worried that he has Rheumatoid Arthritis because his RF serology is
positive in a low titer. He has pain in his left hand and right knee, which usually bother him in
the evening. He has not noticed any inflammation or swelling and there is no history of
morning stiffness. On examination, there are no active joints. Which of the following
statements regarding the presence of RF is correct?
Select one:

a. is positive in almost 100% of “classical” RA

b. is always abnormal

c. is positive in 10–20% of people over age 65

d. is seen only in RA

e. is frequently present in osteoarthritis

 84- In herpes simplex encephalitis which of the following statements is correct?
Select one:

a. Temporal lobe involvement is common

b. Fits are uncommon

c. Brain MRI is characteristically normal

d. Viral identification by PCR on cerebrospinal fluid is non-specific

e. Cold sores or genital herpes are usually present

85- A75-year-old woman has abrupt onset of soreness, and severe stiffness of the shoulders and
upper thighs with low grade fever. Physical examination is entirely normal, but ESR is over 100
mm/h. Which of the following is the most likely diagnosis?
Select one:

a. Osteoarthritis

b. Dermatomyositis (DM)

c. Midline granuloma

d. Sarcoidosis

e. Polymyalgia rheumatica (PMR)

86- Regarding lung volumes which is true?

Select one:

a. Inspiratory Reserve = TV + Residual Volume

b. Vital Capacity is about 5L in a 70 kg male

c. Total Lung Capacity = Vital Capacity + Tidal Volume

d. none of them

e. Tidal Volume = 1L in a 70kg male

87- A 39-year-old woman complains of developing painful pale fingers on cold exposure for the
past 5 years. Recently, she has noticed swollen fingers and tight skin, which limit flexion and
extension. She also has new abdominal symptoms that are bothersome. On examination: the
skin on the fingers is smooth and shiny with associated edema. The rest of the examination is
normal. Which part of the gastrointestinal (GI) tract is most frequently involved in this
condition?
Select one:

a. Stomach

b. Ileum

c. Esophagus

d. Duodenum

e. Colon
 88- Which of the list below is not a cause of an exudative pleural effusion?
Select one:

a. pancreatitis

b. Malignancy

c. TB

d. viral pneumonia

e. Nephrotic syndrome

89- A 32-year-old man presents with 4 days of fever, pleuritic chest pain, and cough. Past medical
history is notable for daily injection of heroin and significant daily alcohol intake. On physical
examination the patient is febrile (temperature 38.6º C) with a pulse of 100 beats/min and a
blood pressure of 120/72 mm Hg. Cardiac exam is notable for a systolic murmur at the right
lower sternal border. A chest x-ray (CXR) shows multiple cavitary lesions throughout the lungs.
Which of the following diagnosis is most likely in this patient?
Select one:

a. Aspiration pneumonia

b. Streptococcus pneumonia

c. Mycobacterial tuberculosis infection

d. Bacterial endocarditis

90- Which is an accurate statement concerning diabetic nephropathy?

Select one:

a. It is almost always associated with retinopathy in type 1 diabetes

b. Most patients with type 2 diabetes will develop this problem

c. Routine dipstick urine should be performed to screen for early disease

d. ACE inhibition is only indicated for patients with hypertension

91- Hemoptysis can be caused by all the following except:

Select one:

a. Lung cancer.

b. Tuberculosis.

c. Pneumonia.

d. Asthma.

92- Which of the following is a characteristic feature that points to a glomerular cause of
hematuria?
Select one:

a. Blood clot formation

b. Hematuria noted at the onset of micturition (initial hematuria)

c. Isomorphic (same size and shape) microscopic examination of the urine

d. Red blood cell casts on microscopic examination of the urine

93- A 44-year-old man says that he has had some hepatitis vaccines in the past but does not recall
what he had. The presence of which of the following antibody tests (IgG) indicate probable
immunity to hepatitis B?
Select one:

a. Anti-HBs

b. Anti-Hbe

c. Anti-HDV]

d. Anti-HBc

94- A patient has the following ABG's on room air. pH 7.21, PaCO2 67, PaO2 49, HCO3 26, SaO2 76,
Hb 10.1, his cardiac output is normal. The oxygen carrying capacity is:
Select one:

a. Reduced.

b. Normal.

c. Increased.

d. Cannot be calculated

95- You perform a thoracentesis on a 44-year-old woman who presented with dyspnea and was
noted to have a moderate right-sided pleural effusion. On analysis, the pleural fluid shows a
protein of 3.4 g/dL and lactate dehydrogenase (LDH) of 179 U/L (her serum protein is 6.0 g/dL
and LDH is 220 U/L). Which of the following is a possible cause of this effusion?
Select one:

a. constrictive pericarditis

b. cirrhosis

c. nephrotic syndrome

d. lupus pleuritis

96- Chronic renal failure features include all of the following except:
Select one:

a. Hypocalcemia

b. Hyperphosphatemia

c. Anemia

d. Asymmetric kidney size

 97- A patient has the following ABG's on room air. pH 7.21, PaCO2 67, PaO2 49, HCO3 26, SaO2 76,
Hb 10.1, his cardiac output is normal. This acid-base imbalance can be solely explained by:
Select one:

a. Lactic acidosis

b. Anxiety.

c. COPD.

d. A combination of the above should exist to explain this finding.

98- A 36-year-old man presents with fatigue and pallor. He is found to have a hematocrit of 23%.
His reticulocyte index is 4. You suspect a hemolytic anemia. Which of the following lab
abnormalities is associated with hemolytic anemia?
Select one:

a. A low reticulocyte count

b. An elevated red blood cell count

c. The presence of hemosiderin in the urine

d. An elevated haptoglobin level

99- A 39-year-old woman with a history of asthma presents to her primary care physician with
difficulty walking. Her exam is notable for diffuse expiratory wheezing and difficulty with
dorsiflexion of her left ankle. Which of the following diseases is the best explanation for her
current presentation?
Select one:

a. allergic bronchopulmonary aspergillosis

b. acute eosinophilic pneumonia

c. hypereosinophilic syndrome

d. allergic angiitis and granulomatosis

100- A patient presents with an area of dullness to percussion and breath sounds that are
decreased to absent, suggesting the following diagnosis:

Select one:

a. COPD (emphysema)

b. Pleural effusion

c. Pneumothorax

d. Asthma