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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1.

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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
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
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
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
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

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

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
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 ?!
-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
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 ?!
-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?!
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