51 years old female presented with 3 months history of hand joint pain

and early morning stiffness with progressive pain , she concern about
future hand deformity the doctor prescribed methotrexate to treat her
condition .
1. why the doctor prescribe methotrexate once per week ?
2. If patient has no response to methotrexate so we will use
Etanercept , why we should perform tuberculin test before give it ?
3. what pathogenic mechanism of rheumatoid arthritis ?
4. a. identify two types of cartilage tissues .
b. what type of articular cartilage ?

5. At the graph above determine Vd for each drug .

6. If D for each drug is 1.5 mg which drug has more Vd (Cp for
meloxicam is 7.5 mg and for diclofenac 0.75 mg ) .
7. determine the half life for each drug .
38 year old female , presented with Fever, loin pain ,painful micturition ,
she is been on metformin + glibenclamide , her blood glucose level 580
mg/dl .

1. what most appropriate insulin regimen for her ?

2. what difference between metformin and glibenclamide regarding
mechanism of action?
3. What is the investigation to measure how good she controls her
blood glucose in the last three months ?
4. what is the Cause of polyuria in this patient?
5. A study about association of smoking and DM , The researcher

take patients have early diagnosis with DM ( 230 ) , and non

DM ( 455 ) , and they asked about history of smoking : 64 of DM

patients are smoker and ( forget the number ) of non DM is non

smoker.

1. what Type of study ?

2. is there any association between smoking and DM ?

6. mention 4 factors that make diabetic patients more susceptible to

infection ?
15 years old boy come to neurology department presented with difficulty

walking with loss of autonomic sphincter control , normal mental status ,

upper limb examination normal , lower limb revealed hyperreflexia and

hypertonia and spastic rigidity grade 2-3 loss of sensation from the level

of umbilicus and down, meningeal signs are negative.

1. What is the clinical name used to describe weakness of lower limb ?

2. Which part of nervous system involved ?

3. What signs of lower motor exam indicate for ?

4. Will patient come with urinary incontinence or fluid retention ?

5. on cystometry , mention 2 findings that found through filling phase

of bladder ?

6. mention type of autonomic receptor that is found in urinary bladder

& urethral sphincter and mention one antagonist for each one .

7. List 4 physician behaviors adhering to high ethical and moral

standards .
you have a call that one person fall out from the scaffold he has head
injury in lateral side of skull.

1. What is the type of this imaging technique ?

2. What is the abnormality you see ?
3. What is the diagnosis ?
4. What is the pterion and what are the bones forming it?
5. Which artery is most likely to be injuried from damage to pterion ?
6. Is this extradural or subdural the space of this artery ?
7. Why it is necessary to tell the patients about the bad news?
mention 2 causes .
61 year woman is suffered from Right knee joint for three months ago

with limitation of movement. There is GIT upset . She taken NSAID for

the pain.On Examination , there are local tenderness and swelling ,

Axillary temperature is normal .

1. Assess pain score for this patient .

2. Differentiate between analgesic & NSAID with one example for

each one .

3. Which ligament does prevent femur moving backward on tibia ?

4. Which ligament does prevent femur abducting on the tibia ?

5. Why does she have gastric upset?

6. How we can prevent development of gastric upset for patient with

joint pain ?

7. According to medical excellence ethics , the doctor decided to

make hip replacement for her but she refused. What medical ethics

behind : 1) his decision . 2) her refuse .

8. mention radial nerve branches around the arm .

26 year female taking progesteron-only pills, presented to ER with
abdominal pain and fainting, on examination there was high WBC with
positive pregnancy test .

1. What hormone forms the bases of pregnancy test? from where it's
secreted ?
2. On ultrasound there was swelling in fallopian tube with fluid in the
pelvic cavity, an ectopic pregnancy was suspected, at what
gestational age does gestational sac become visible in normal
intrauterine pregnancy ?
3. What is the effect of progesteron on fallopian tube to cause
ectopic pregnancy ?
4. name the structure in the photo of fallopian tube :
1-black arrow .
2-green arrow .
5. Mention two cardiovascular changes that indicates ruptured

ectopic pregnancy .

6. statistical looking for relation between OCP and Breast cancer..

took two groups .. one with breast cancer and one normal .. name

the study type .

7. Culdocentesis was performed to acertain the presense of blood in

pelvic cavity, what structure(s) does the needle through ?

Ghada is 30 years of age presented to ED after a vehicle accident. She
has multiple fractures and cyanosed peripheries, her pulsed were 140
bpm barely palpable and here blood pressure is unrecordable her
biochomestry were ( units in mmol/l and reference ranges were provided
in the case):-

Na 138 ,K 6 , Cl 90 , Hco3 14 , Glucose 6 , Urea 8 , Creatinine 90

her PH was 7,1 and pCO2 4,4 .

1. what his acid base status .. what is the cause ?

2. record anion gap, what dose it tell you ?

3. what is the cause of patient's hyperkalemia ?

4. in certain circumstances amino acid are metabolized to to produce

amonia and carbon compounds

1- mention 2 causes of amino acid catabolism?

2- mention 2 substances that transports ammonia to liver .

5. After a period she developed a mild hypercalcemia and also a mild

hypercholesterolemia

1- does she have a true hypercalcemia ?

2- classify her hypercholesterolemia .

 1. Describe the Origin of vertebral artery and its course at the neck .
2. what is the Most age sensitive component of intelligence of this
man .
3. G>A mutation causes parkinson , mention four molecular tests to
detect this mutation .
4. A- the foramen from which the vagus nerve passes to the neck ?

B- if he had voice harsh, what nerve is affected ?

6 years old child with tetralogy of fallot , hyperactive , difficult in

speech .

1. mention piaget stage of this child .

2. Enumerate 4 siocioeconomic factors can affect the health .

3. Describe his journey from novice to expert?

4. He has swelling in inguinal area change with crying when sleep ,

What this condition? And what are common two the types of it ?

5. He has cyanosis in lips and finger What this condition called ?

6. How we can build trusting between parent and medical staff ?

40 years old male come with injury from explosive vehicle , he has
perforated viscera and hemorrhage , the doctor apply a tourniquet around
his thigh , after one day the doctor check his leg and surprised that the
leg has necrosis and should be amputated and the use of tourniquet was
medical error .

1. To which category of medical errors this error is classified ?

2. When you discover this error , depend on your medical ethics
what should you do ?
3. Two healthy parents with son has sickle cell anemia .
A- why or how they are healthy but has son with sickle cell anemia ?
B- What is the probability that this patient has sickle cell anemia ?
4. Study that compare new drug with other traditional ,
A- What is the type of this study ?
B- Patient doesn’t know the new drug but the physician know it

what is the type of bias here ( what called ) ?

5. What are the boundaries of (foramen of Winslow)?

6. What are the boundaries of (popliteal fossa)?
7. To increase the preload of the blood on the patient's heart what
type of fluid we you should give him?
8. What other investigation should do rather than the vital signs and
urine test?
1. Child was born with two lines of cell in number of chromosomes
(mosaicism), this is occurred due to:
 non disjunction in the meiosis of sperm .
 non disjunction in the meiosis of egg .
 non disjunction in the first mitosis of zygote .
 non disjunction in the early mitosis of zygote .
2. In fetus , the HBF is differ from the hemoglobin of adult by change
the affinity to BPG and O2 :
 decrease , increase .
 increase , decrease .
 increase , increase .
 decrease , decrease .
3. Protein synthesis occur in:
 Ribosome .
 Peroxisome .
 Microfilament .
 mitochondria .

1. A pathway step of carbohydrates metabolism that is stimulated hy

insulin in muscle but not in liver :
 glycolysis .
 gluconeogenesis .
 glycogenolysis .
 glycogen synthesis.
 glucose transport .
2. Galactosaemia is genetic error of metabolism associated with :
 inability to transport galactose into cells.
 inability to digest lactose.
 deficiency of galactokinase.
 deficiency of UDP-glucose : galactose 1- phosphate uridyle
transferase.
 deficiency of UDP-glucose.
3. Marasmus is the deficiency in :
 Essential amino acids .
 Essential fatty acids .
 Calories .
 Zinc .

1. Study about the cervical carcinoma in which the the patients

matched for age and gender with healthy people ...what is the term
best describe this study :
 Cohort .
 Case control .
 Clinical trial .
 Case series .
2. Study about dysmenorrhea , researchers take students from school
have dysmenorrhea and compare with normal to know
risk factors about it , there were more than risk factors was taking
from them responsible for dysmenorrhea.
What type of study :
 prospective cohort .
 Historical cohort .
 Cross section .
 RCT .
 Case control .
3. A group of researchers investigate the relationship between alcohol
and esophageal cancer, smoking is known to cause esophageal
cancer, alcoholics are more likely to smoke , smoking
here is regarded as:
 Strong association.
 one to one relationship.
 confounding.
 Bias .
4. Researchers investigates clindamycin casual relationship with
diarrhea , this relationship is
said to be significant when :
 p<5 .
 p<0.5 .
 p<0.05 .
 p< 0.1 .
 p> 0.5 .
5. Researcher want to make study on dysmenorrhea . Interviewed
with student to collect information about their dysmenorrhea by
using questionnaire ...what is the term best
describe this study :
 Case control .
 Case series .
 Experiment .
 Randomized trial .

1. Which one of these structures pass anterior to flexor retinaculum:

 flexor digitorum superficialis tendons .
 median nerve .
 flexor pollicis longus tendon .
 ulnar nerve .
 anterior interosseous nerve .
2. All of the following are from proximal row of carpal bone except:
 Lunate.
 Scaphoid.
 Pisiform.
 Triqetrum.
 Trapezium.
3. All rotator cuff muscles except :
 Supraspinatus .
 infraspinatus .
 Teres minor .
 Subscapularis .
 Teres major .
4. patient’s thumb can’t oppose little finger, what nerve injurried :
 Median nerve .
 ulnar nerve .
 Anterior interosseous nerve .
 posterior interosseous nerve .
5. 65 years old woman has mastectomy operation. At her review
appointment and on examination she has winged scapula .
Which nerve is affected :
 Long thoracic nerve .
 Accessory nerve .
 medial pectoral nerve .
 lateral pectoral nerve .

1. Patient with a mural thrombus attach to akinetic left ventricle apex

, thrombus will go to :
 Brain .
 Upper limb .
 intestine .
2. 45 Female has DM , BMI 34 , hypertension , obesity and his
father died from MI , now test revealed that she has atherosclerosis
,the following factors contribute to her condition except :
 Family history .
 DM .
 sedentary lifestyle .
 Hypertension .
 High BMI .

1. Patient has Heart failure with mild chest pain with slightly
limitation of daily activity, but S.O.B, palpation and dyspnea on
exercise , what NYHA level :
 NYHA 1.
 NYHA 2.
 NYHA 3.
 NYHA 4.
2. ECG show ST elevation , what is the artery affected ?
 left circumflex artery .
 left anertior descending .
 RCA .
 left coronary artery main trunk .
3. What is the most appropriate treatment of this patient?
 Aspirin , heparin .
 Aspirin , heparin , clopedogril, nitrate, O2 .
 Heparin , O2 .
1. A child admitted to the emergency room to do ENT surgery, about
concrete operational features :
 Abstract thinking .
 classifying by a single form .
 conservation .
 object permanent .
2. Women with multiple sclerosis and mobility problems. The doctor
talk to her about coping strategies. Give an example of problem -
focused coping strategy ?
 Accept help with household tasks..
 focus on the aspects of her life.
 join a support group for emotional problems.
 Take up a new hobby as distraction.
 Talk to family about her problems.
3. A young child is hospitalized and his parents are able to stay at
hospital for several nights in a room. What pattern of behavior
observed in children separated from their careers?
 anxiety - disturbance – adjustment .
 avoidance -.....- disorganized .
 insecurity -withdrawal –recovery .
 protest -despair – detachment .
 proxin seek - contact maintaining – attachment .
4. A patient is diagnosed with terminal cancer, in SPIKES model of
breaking bad news, what specific principle does the letter "P"
relate to?
 Check the patients' perception about what they already know.
 Ensure privacy when breaking bad news.
 prepare the patient with a warning shot.
 prepare the setting for breaking bad news.
 provide as much information as possible....
1. patients presented with fibrosing alveolitis fibrosis which of these
most effect on Pao2 ...
 Oxygen-blood mismatch .
 Hypoventilation .
 Oxygen volume .
 Diffusion of oxygen .
2. The surfactant is produced by :
 Alveolar macrophage .
 Type I cells .
 Type II cells .

1. 45 years old man with epigastric pain, pain relieved by eating,

OTC antacids and by H2 blockers, Diagnosis is confirmed by :
 urea breath test .
 serum gastrin level .
 barium meal examination .
 upper endoscopy .
 upper endoscopy with biopsy.
2. The modulation of the muscular external in the large intestine form
as:
 taenia coli .
 vill .
3. The formation of Sacrococcygeal teratoma is derived from :
 Trophoblast .
 Neural tube defect .
 Mesoderm .
 Neural crest cell .
 primitive streak .
1. The part of innate immunity that destroy pyogenic bacteria such as
Staph.Aureus :
 Eosinophils .
 Nk cells .
 macrophage .
 Neutrophils .
2. Toxigenic condition caused by staphylococcal aureus :
 osteomyelitis .
 git distress .
 staphylococcal scalded skin syndrome .
 impetigo .

3. Indicate on the picture the bacterial structure used to evade

phagocytosis :

1. How Sociology in medicine change in recently years ?

2. Factors in-depended poverty .
3. Sociologist has important role in medicine for .
4. question about poverty .
1. Regarding infratemporal fossa which one is correct ?
 It contain pterygopalatine ganglion
 It's bounded posteriorly by styloid process and carotid
sheath.
 It contain the major part of parotid gland.
 It lies inferior to posterior cranial fossa.
2. The most common pathophysiology of sinusitis :
 occlusion of osteomeatal tract .
 Cold air .

1. Woman present with 5 cm dilation what is the stage of her labour?

 Late stage of first stage .
 Third stage of labour .
 During the active phase of first stage .
2. In pregnancy with gestational diabetes , regarding fatty acid and
carbohydrate metabolism :
 increase in free fatty acid and increase in ketone bodies .
 increase in fatty acid and decrease in ketone bodies .
 decrease in fatty acid and increase in ketone bodies .
 decrease fatty acid and decrease in ketone bodies .
 All decrease .
Case 1: A 6 years old child, came to GP clinic with petechiae, fever for 1
day, he has no family history of bleeding , he suffered from UTI in the
previous days. blood test results are : Hb: 13, WBC 9.3 with normal
differential percentages, Platelet 8, reticulocyte count 2% (uncorrected)
,clotting test reveals normal PT, APTT, and fibrinogen.
1. Where is the defect?
 Blood vessels .
 Platelet .
 Clotting factors .
 Bone marrow .
 Fibrinolytic system .
2. What is the diagnosis?
 Hemolytic anemia .
 Inherited thrombocytopenic purpura .
 Acquired thrombocytopenic purpura .
 Vascular structural abnormalities .
 Bone marrow impairment .
Case 2 : A 9 years old child, come to the GP, he has jaundice, dark
urine, lethargy, he suffered from UTI in the past days, the blood tests
results are: Hb 9, WBC 17.3 (with 80% neutrophil ), platelet 9,
reticulocyte count 22% ( uncorrected) , blood film shows normocytic
normochromic anaemia, neutrophil leukocytosis, large pletelet cells.
Negative indirect coomb's test.
1. Where is the site of hemolysis ?
 Intravascular .
 Extravascular .
 Liver disease .
 Spleen .
2. What the test will you order in the next step ?
 Hemoglobin gel electrophoresis .
 Enzyme assay .
 Bone marrow biopsy.
 Membrane test .
3. What is the type of abnormality in RBC?
 Membranopathy.
 Enzymopathy.
 Hemoglopinopathy.
 Bone marrow impairment.

1. Recorded EEG from the patient after 90 min from his sleep , which
first wave will be dominant :
 Alpha .
 Beta .
 Theta .
 Delta .

2. Astrocytes play important role in all of the following except :

 Participate in blood brain barrier formation .
 storage of lactate .
 maintain extracellular K+ level .
 remove excess glutamate .
 Phagocytosis .
3. Which of this nerve is fully crossed ?
 Oculmotor .
 Trochlear .
 Optic .
 abducens .
4. 70 years old man come with bradykinesia , one side coarse tremor
and cog wheel rigidity the defect in :
 Corpus striatum .
 Substantia Nigra .
 Thalamus .
 Cortex .
 Medulla .
5. A reversible dementia Caused by :
 Alzheimer disease .
 Cerebellar disease .
 Pick’s disease .
 Multi-infarct dementia .
 Hypothyroidism .
6. What is the part of the inner ear sense the angular acceleration
(rotational acceleration ) :
 Semicircular canals .
 Utricle .Resposible for linear acceleration in horizontal plane ( right & left ) .
 Saccule . Resposible for linear acceleration in Vertical plane (Up & Down ) .
 Spiral organ .
 Cochlea .

7. Which of these arteries is not branch from internal carotid artery ?

 Anterior cerebral .
 Anterior communicating .
 Posterior communicating .
 Choroidal artery .
 Opthalmic artery .
8. Inability to identify daily object and and name it , this condition is
called :
 agnosia .
 prosognosia .
 amnesia .
 insomnia .
9. walk If you want to walk, this is must occur:
 increase excitatory pathway .
 decrease excitatory pathway .
 decrease descending inhibitory pathway .
 increase descending inhibitory pathway .