4th stage finals - HMU-college of medicine

answers
May 14, 2022

Medicine

Total(120) *cardio() *Git() *Respiaratory() *Endocrine

Single best answers

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6. which of the following clinical features are consistent with acute rheumatic fever based on
Jones criteria

A-12 year old boy presented with fever and leukocytosis

B-12 year old boy presented with carditis associated with migratory polyarthritis and raised ASO
titer

C-12 year old boy presented with arthralgia and raise ESR with rising ASO titer

D-12 year old boy presented with Chorea and erythema marginatum

E-12 year old boy presented with fever,polyarthritis and rising ASO titer

7.A 43-year-old man with history of rheumatic heart disease develops fever and malaise 10 days
after major dental procedure. He has a pan systolic murmur at the apex. Trans esophageal
echocardiography showed large vegetation on the anterior mitral valve leaflet. Blood cultures
are most likely to grow which of the following?

A-Diptheroids

B-Fungi

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C-Staphylococcus aureus

D-Staphylococcus epidermidis

E-streptococcus viridans

8.26 year old man presented with recent dyspnea O/E: Normal S1,Ejection click followed by
diamond ejection systolic murmur mostly heart at the right second intercostal space radiated to
right side of the neck,soft A2.

-Aortic valve stenosis. EMQ

9.collapsing pulse ,,Apex beat at the 6th ICS anterior axilary line,normal S1, Soft A2, eraly
regurgitant diastolic murmur best heard at the left srernal edge,with breath held in expiration.

A.Mitral regurgitation

B-Mitral Stenosis

C-Aortic valve stenosis

D-Patent ductus artereosus

E-Aortic regurgitation

10.16 -year-old male presented with palpitation.On examination there is wide fixed spliting of
the second heart sound. What is the most likely diagnosis?

-Arterial septal defect EMQ

11.malor rush Openinig snap, low pitched rumbling mid diastolic murmur at the apex,loud S1.

-mitral stenosis EMQ

12.Soft S1,Pan systolic murmur at the apex radiate to the axilla

A-Mitral regurgitation

B-Mitral Stenosis

C-Aortic valve stenosis

D-Persistant ductus arteriosus

E-Aortic regurgitation

13.16 year old female presented with exertional dyspnea and growth retardation. O/continous
murmur at the left second intercoastal space

-persistent ductus arteriosus EMQ

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14.regarding ECG heart block which one is true ?!

-2nd-degree heart blockMobitz 1 progressive prolongation of PR interval \

15. true regarding miliary TB

-spleen may be palpable

16.a case of ulcerative colitis , with features of jaundice, beaded biliary duct…etc and diagnosed
with MRCP

-primary sclerosing cholangitis

17.a case ,of 400ml of hemoptysis ,hypotensive ,anemic …etc a management ?!

-admit resuscitate and check vital signs and call pulmonologist or cardiologist

18.which one doesn’t cause cavitation ?!

-Influenza

19. Case of bronchogenic pneumonia after viral infection most probable cause

-staph aureus EMQ

20. Case of pneumonia feature …..etc, he has parrots ?! Cause

-chlamydia psittaci. EMQ

21.a HIV case ,he ,cough ,sob ?! Cause

-22-year-old woman complains of dizziness and feeling light-headed. She works in an office and
most frequently experiences this when standing up to visit the toilet. She has never fainted. The
patient has lost 5 kg, but attributes this to eating more healthily. She has noticed a recent scar
on the back of her hand which has started to turn very dark. The most appropriate investigation
is?!

A. Short Synacthen test

B. Low-dose dexamethasone test

C. Cortisol measurement

D. Urinary free cortisol measurement

E. Abdominal ultrasound (US) scan

23. Which of the following do not occur in sinoatrial disease? → VT

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24.a case(8 hours hematamesis …etc ): an investigation not done in UBGI bleeding(not useful)?!

-Fecal occult blood

25. A Case with mild to moderate epigastric pain ,,,,all investigations were normal including
endoscopy ,LFT,CBC,US…….etc diagnosis ?!

-Functional dyspepsia EMQ

26. Case sudden epigastric pain relief with leaning forward ….etc

-acute pancreatitis EMQ

27. A case with epigastric pain diabetic smoker hypertensive ,radiated to

shoulder ,,sweaty ,diagnosis ?!

-Acute myocardial infarction EMQ

28. Not true regarding the indication of surgery in Bronchiectasis ?!

-Surgery is only indicated in a few cases where bronchiectasis is bilateral

29.true regarding lung abscess ?!

-clubbing occurs in one third

30.which one is not an alarm feature in UBGI bleeding ?!

-Epigastric pain after meal

31.patient presents with acute jaundice. ALT = 1000 IU. Which of the following conditions would
NOT lead to this?

Acute HAV infection

Acute HBV infection

Acute hepatic ischemia

Acetaminophen overdose

Non-alcoholic fatty liver

32.distended neck ,ascites , leg edema …..etc ?!

-right-side heart failure

33.which one of the following is right regarding asthma ?!

-FEV1/FVC < 0.7, FEV1 improve > 15% (400 mL) after glucocorticoid trial

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34.is not a feature of Turner syndrome ?!

-tall stature

35.Which of the following causes the growth to fall off the centile lines before puberty?

-constitutional short stature

36.which one of them cause chronic liver hepatitis ?!

-HBV,HCV,HDV

37.for screening and detection of infection of hepatitis B in school …..which of These

investigations are best ?!

-Hbs Ab HBs Ag HBc Ab

38.best management all cases of diarrhea…..etc ?!

-rehydration

39.a case of dentist ,he is ur colic , how do advise him for vaccination against HBV?!

-please vaccinate , because its effective against the majority of cases

40.which one is right right regarding enteric fever ?!

-Intestinal perforation

41.difference between parasalmonella typhi and salmonella typhi?!

-paratyphi causes more intestinal (manifestations)complications than typhi

42.make the complication of haemolytic uraemic syndrome (HUS) more likely?!

-use of antibiotics

43.a case distend abdomen , flatulence ,clubbing ,going to WC ,cant flush it with water …..etc ?!

Celiac disease EMQ

44. Case :lymph enlargements in neck and axilla ?!

-wipple. EMQ

45.a case :Alcoholic, steatorrhea?!

-chronic pancreatitis. EMQ

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46.a case with prolonged productive cough ……all features of cystic ?!

-cystic fibrosis. EMQ

47.a case of left side plueritic Chest pain (with rigor fever chills ….etc ?!

-Lung abscess

48.a case of hemoptysis ,night sweats ,fever ,SOB….etc ?!

-pulmonary TB

49.a male came to hospital complaint that his wife is snoring at night ,which on them confirm
the osbtractive sleep apnea ?!

-Day time sleepiness

50.a case of hypogoandism and decreased FSH,LH with anosmia …etc ?!

-Kallman syndrome

51.a case of FEC1/FVC is 0.79 (FEV1 51% predicted, FVC 61% predicted) …..etc ? !

-idiopathic pulmonary fibrosis

52.which of the following mechanisms of hypoxemia will inevitably lead to elevated PaCO2

-hypoventialtion

53.a case : 40 years old ,30pack year ,complaining SOB….etc

-chronic bronchitis

54. in obstructive lung diseases?!

FEV1/FVC decreased

55.a case : hemoptysis ,fever ,sob ,from a country(endemic for TB) best investigation ?!

-Sputum analysis EMQ

56.a case came back from London ,he developed SoB , best investigation?!

-CTPA. EMQ

57.to differentiate between type I and type II respiratory failure?!

ABG analysis

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58.which one of the following is not uses in the treatment of Dka?!

-Sodium bicarbonate

59.wWhich of the following is useless test for DKA?

-Serum calcium

60. A case 67 years with uncontrolled hypertension ,Chet’s pain radiating to back ….we should
exclude before discharging ?!

-aorting dissection

61. A case of jaundice …….etc with SAAG is 2.1 ,diagnosis ?!

-portal hypertension

62.which one these is false regarding PUD ?!

-H.Pylori is responsible foe about 90% cases of gastric ulcer

63. Case : for detecting H.pylori infection

-stool antigen test

64.A 42-year-old woman presents with visual disturbances. She reports having double vision
which was intermittent initially but has now become much more frequent. In addition, she
becomes breathless very easily and experiences palpitations. On examination, raised, painless
lesions are observed on the front of her shins and finger clubbing. The most likely diagnosis is:

A. De Quervain’s thyroiditis

B. Thyroid storm

Painful neck Usually comatose and feverish

C. Phaeochromocytoma

D. Graves’ disease

E. Plummer’s disease

65.similar case , with palpitation ,weight loss,starring eyes ,lid lag …etc

-Graves’ disease. EMQ

66.a 60 years old case with ischemic heart disease and HTN ….etc best initial antianginal Drug .?!

-metoprolol

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67.A 60 year old with

70.shepherded , fever ,arthralgia ….etc ?!

-brucellosis

71. A 30 year male with recently diagnosed with hypertension,which one of the following is not
first line agent. That can be used ?!

-metoprolol

72. Case of sever headache after RTA , pappilodema ,vision impairment,hypertensive after
Checking by the staff ,180/120…etc ?!best treatment

-paracetamol bottle 1000mg plus chlorthalidone iV….etc

73.

74.which one of the following is not risk factor for DVT

-female sex

75.which one the following cant cause erectile dysfunction ?!

-DVT

76.which one is true regarding intermittent claudication?!

-Thickened nail w loss of hair….etc

77.irregular beat,pulse 130….etc ?!

-atrial fibrillation

78.which one the following is the primary hyperparathyroidism of hypocalcemia …etc ?!

-renal Calculi

79.a cases : neck lump in lady , with no symptoms fastidious from thyroid disease …. Peas
shape ..ect ?! Best investigation of choice

-US of thyroid

80.which one of the following can be used to differentiate betweeen exogenous thyroid
Hormone and thyrotoxicsois ?!

-isotope scan

81. Best investigation of choice for deep vein thrombosis ?!

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-Doppler study

82. Case with unilateral calf pain and swelling after surgery …etc

-DVT. EMQ

83.post vaginal delivery in the third day she develop SOB ….ect

-pulmonary embolism

84. Case : Dilated superficial veins , before 6 months he got non pitting leg swelling ?!

-postthrombotic syndrome (another answer: superficial thrombophlebitis)

85.which of the following is true about SBP?!

-Ciprofloxacin as prophylaxis

86.which pathogen does not cause colonic diarrhea in HIV patient

-cryptosporidiosis

87. Case with SVT and hypotensive ….ect management ?!

-synchronized DC

88. posterior MI on ECG ?!

-ST depression in V1-V3 and tall R wave septal leads

89. Which one is true regarding taking liver biopsy

-prothrombin time < 4 seconds prolonged

90. which virus causes colonic diarrhea?!

CMV (or adenovirus- not sure)

91.In ARDS which of the following true?

a) Cardiomegaly on CXR

b) PCWP is normal

c) There is Left ventricular dysfunction

d) Very good response to O2 therapy

e) Pleural Effusion on CXR

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92.personal development …..Set personal and professional goals?!

-based on exciting ideas

93.SWOT analysis used to assess?!

-current situation

94.which one of the following is right regarding cough variant asthma (wrong question)

-4 of the the were right answers

95. A case female 3days post delivery(following abortion) developed T=38.5,RR=26,delirious -

Sepsis. EMQ

96. Similar case but T=40 ,tachypnic , fluid given but still hypotensive , dobutamine given also
but still unstable BP 100/60…..ect

-septic shock with adrenal insufficiency

97…………….taqreban similar ,but PT prolonged INR prolonged ,features of DIC mentioned so ?!

(there was no mentiong of giving fluid nor vasopressors hence can’t say it is a shock)

-Sepsis with DIC

98.best for detecting liver function test ?!

-Albumin & prothrombin

99.thin 60 old male with asthma ,hypertensive ,developed GERD ….ETC the cause ?!

A.asthma B.hypertsion C.old age D.thin. E.vasodilators

100. A 60 old year msn with 2 days of chest pain radiated to his left shoulder ,BP 90/70 ,what the
best next step ?!

-emergency PCI

101. A 70 year old woman with history of fracture and back ache ……ect ?!

-Vitamin D deficiency by malnutrition (not sure maybe lack of sunlight)

102. Case with hypokalemia and hypertension …etc?!

-conn syndrome. EMQ

103. Case with palpitations and stress ……..catecholamine in urine ?!

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-pheochromocytoma EMQ

104.a patient with BP;220/130?!

-malignant hypertension

105.best prognosis with lung transplantation ?!

-cystic fibrosis

106.a case with recently diagnosed DM 2 , creatinine 2.1…..ect best drug ?!

-pioglitazone

107. A case with bleeding power rectum,but all investigations are negative ,ex:DRE …ect ?!

-screening by colonoscopy

108.similar case a lady(45years) her brother just diagnosed with colon cancer ,she is
scared ,which one of them needed ?!

-colonoscopy + fecal occult blood

109. A case with thyroid tenderness,ear elevated …..ect

-sub acute thyroiditis EMQ

110. Case weight gain , constipaton …antiTPO positive …...ect?!

-hashimoto thyroditis. EMQ

111.a 60 year old with central chest pain increased with resistance against wind, relieved by rest
…..ect

-typical chest pain

112. Case 60 year smoker diabetic hypertensive presented with chest pain best next step ?!

CT coronary angiography

113. Case with pneumothorax tracheal shifted to the left ….ect ?!

-insert a chest tube in right side EMQ

114. Case with air in living less than 2cm,, soB , looks in pain ?!

- percutaneous needle aspiration

115. which of the following is not a life-threatening feature of asthma?!

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A.bradycardia.

B.inable to complete one sentence in one breath

C.silent chest D. Spo2=92%

116. Case with previous MI , 70 year old , target for lowering LDL?!

-Rosuvastatin 40 mg the goal is LDL<70

117. Case : child 8 years with jaundice ,history of blood transfusion ,HB 8mg/dl ,bilirubin is
4 ,mostly indirect bilirubin,reticulocyte is 5……..etc diagnosis ?!

-Sickle cell anemia

118. (two question were about chronic bronchitis) the case was about classical features of COPD
(heavy smoker…..)? → chronic bronchitis

119. Level of hypoglycemia in DM → <70 mg/dl

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