. ·. .·.

' .. : . ,
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Jntcmal M.cd. Part I December 20 1

1. A 52 year old woman presents . with left Join pain. Past history inciuded
hypertension and, progress-ive cognitive decline. On examination she was
pyrexial, had livedoreticularis and a blood pressure of 180/100 mm.Bg.
Examination of the abdomen revealed no masses but there was tenderness
in.the left flank. ·
Investigations revealed:
12.9 g/dL .
wblte cell count 8. 7 x
Platelet count 83 x 109/L
Serum creatinine 106 fJ.molJL, (60-100 JJ:moi(L)
Urine dipstick anfilysis: blood+++, protein+ 0

Which one of the following tests is the most likely to be positive?

A. Anticardiolipin antibody 0

B. Antiglomerular basement membrane antibody ·

C. antibody
D. Antineutrophil cytoplasn:;Uc antibody
E. Anti-streptolysin 0 antibody

2. A ·60 year old man presents with right foot drop, left foot and left hand .
numbness, fever, malaise, weight loss, polymyalgia and polyarthralgia of
approximately one month duration. On examination, he appears unwell,
a temperature of 38.5°C and blood pressure of 180/100 mmHg.
· investigations reveal:
haemoglobin 8.0 gldL (13-18)
erythrocyte sedimentation rate 100 momlbro
·serum creatinine 180 11moi/L (60-100)
urine analysjs blood++
urine microscopy: white cells and red cell casts
Which one of the following is the most likely diagnosis?
A. Antiphospholipid syndrome
B. Giant cell arteritis
C. Paraneoplastic syndrome
D.OPOEMS syndrome
E. Polyarteritis nodosa

'W hich of the following antiepileptic drugs is the most_ap_propriate drug for
the treatment of absence (petit mal) epilepsy?
A. Phenytoins
B. Ethosuximide
-C. Phenobarbital
D. Carbamazepine
E. Lorazepam

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December 20 II
1 _ (J/\ 2> '2.. Cf0 ':1
Internal Mcd. Part I
w · k's Korsakoff psychosis
4. . A1l of the follolving are true ernie
EXCEPT:
A. Paraparesis ·
B. Confabulation ·
C. Disorientation
D. Bilateral 6th nerve palsy
E.. Ataxia
.,
: · . . ·. f t eatment of muJtip.le myeloma,
5. All of the following are clear mdJcatwns or r · .
EXCEPT:
A. Anemia ·
B. Hyper:calcemia .
C. Roleux formation in the peripheral blood
D. Coinpression fracture of vertebral spine ·.
E. Extramedullary plasmacytoma

6. All of The followings true in membolic

EXCEPT:
·A. It can follow acetazolamide ingestion
B. Can be caused by ureterosigmoidostomy
C. A high Anion Gap
D. May associate renal tubular acidosis
E. May be caused by Potassium-sparing diuretics

7. All · of the Iollol\·ing features are characteristic for allergic

bronchopulmonary aspergillosis; EXCEPT:
A. Pulmonary infiltrates with eosinophilia
B. Parenchymal invasion with aspergillus organisms.
C. Expectoration of rubbery brownish plugs of sputum
D. Proximal bronchiectasis
E... Type! mediated reaction

8. Which of following is. likely to be a neoplasm ofT-lymphoc te linea e?

A. Chroruc lymphocytic leukaemia · y g
B. Follicular lymphoma
C. Burkitts lymphoma •
D. Mycosis Fungoides
E. Small lymphocytic lymphoma

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 !ntern·aJ Med. Part 1
December 20 11
9. A 22- years old feruale with. h.15 t . · .
·
exercise, presented to the ER with ory of lhtermitt t b
en w eezing in .rcsponse to
wheezy chest. .. . acute SOB (Shortness Of Breath) and
This attack occurred during a .
·this point is? · .. - -·--- n. aerobics class. The most effective drug at
A. Inhaled Salbutamol - -
B. N aminophyllloe-· . < .- -· -··- -- --·----
C: Inhaled cromolyn sodium
D. IV hydrocortisone
E. Inhaled beclomethasone

10. A 20-year-old female with severe pu1monary artery stenosis (Transvalvular

peak gradient 80 mm Hg) which of the following statements is false?
A. Cardiomegaly on chest X-ray
B. Right axis deviation on ECG
C. Absent (a) waves on M
D. Ejection systolic murmur heard at left second ICS (Inter Costal Space) by
auscultation
E. Soft and delayed P2

11. The likely complications of ASD· (Atrial Septal Defect) i.il adults
,.include all of the followings, EXCEPT: ·
· ' A. Cerebral abscess
B. Infective Endocarditis
C. Paradoxical Emboli
D. Atrial arrhythmias
E. Right sided heart failure
. . lik 1 to prevent acute flares of
12. Which of the following appr9aches IS most e y
gout while initiating allopurinol therapy? .
A. Avoidance of alcohol
Dietary modification
C. ·use of colchicine
D. Vitamin C
e used throughout .
13· All of the for RA may b
medications
Pregnancy, EXCEPT: •
A. Hydroxychloroquine
B. Bisphosphonates .
C. Azathioprine ·
D. ·

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December 20 1l
Internal Med. Pail 1
· · . . s ared in osteoarthritis (OA)?
14. Which of the following joints are typically· p
A. Ankle joints. ·
B. Cervical
C. Distal mterphalyngeal joints.
D. Hip joints.
15. woman with family history of autosomal dominant
kidney disease suddenly develops severe headache, vomJtmg., and
stupor. Which of the foilowing diagnostic consideratiOns most wornsome
in this patient.? ·
.•
A. Ba,silar artery dissection
B. from vessels
C. ·Ruptured arteriovenous malformation
D. Ruptured intracranial aneurysm
E. Superior sagittal sinus thrombosis

16. A 45-year-old woman is evaluated for 3 2-year history of right-sided tremor

at rest, bradykinesia, and mild rigidity. She bas noted ·menstrual
irregularities. This patient should be tested for which of the following
endocrine comorbidities?
A. hypcrccrt:solism
B. hypoparathyroidism
C. hypoprolactinemia
D. hypothyroidism
E. polycystic ovary disease
,,..,
.....
17. Winging of the sc2pula results from a lesion affectin .
A. Dorsal scapular nerve. g. '
, I ,,
. "":.
B. Long thoracic ·nerve.
C. Suprascapular nerve.
D. Upper brachial plexus.
"":··
E.·Phrenic nerve.

18. A 54-year-old man presents with sudd .

noted to have a mitral regurQitant en onset of nght hemiparesis. He is
39 ·9oc· Bl ood cultures re.turn
o murmur on ex . .
p •t·
.
ammahon and 1s febrile to
. OSI
CT scan lS remarkable for a 2.5 X 3 0 IVe for st t .
rep ococcal specJes. His head
lobe. Transthoracic ecbocardiogr d. em hemorrhage in the left frontal
Wb' h f
lc o the following is the am most .
emonst t ·
ra es mitral ·
valve vegetations.
cerebral hemorrhage in this patient? hkely mechanism responsible for
A. Hemorrhagic transfonnation of is . . . .
B. Immune complex deposit' . chemic Infarction
C. Rupture of mycotic aneurylon m cerebral arterioles
D S . . sm
. epsls-mduced thromboc o .
E. Septic endaneritis yt pema

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19. Which of. ?the following

•
is tb
e most con
· ·
metastasJs. liD on presentin g 5
A. Fecal incontinence . yrnptom of npln,d
B. Numbness
C. Pain · - ·- - -
D. Urinary retention
....
E. Weakness
-
20. A 46.-year-old woman was admitted t 0 th . .
myalgias, night sweats, weight loss . he hospital feeling u.nwcJJ with
diarrhea. The patient bad a _ ' era) parasthesia, flushing, a.nd
3 year 1story of asth ·h · · ·•
rhinitis, ·and one brief episod f . . rna, c rome smus1hs,
. . e . o urhcana on her left arm 18 month s
prevJOusly, which had resolved spontaneously H
• h 1 d lb t 1 . · er me d'Jcatwn· · ·
cons1sted of
m a e sa . u amo as reqmred.
On admission she was afebrile with purpuric rash on the lateral aspect of
her ankles. Th.ere· was no cardiovascular, respiratory or abdominal
abnorma,lity. She was noted to have two splinter hemorrhages, and
hematuria and proteinuria on urinalysis.
Her blood ·work revealed the following: total WBC 38,000, 29.4%
Eosinophils, Hemoglobin and·platelets were normal, ANA and ANCA both
.were negative.
.·' .Her chest radiograph was within normal limits. Bone marrow examination
showed increased number of eosinophils only.
What is tpe most likely diagnosis?
A. Wegener's Granulomatosis
B. Churg-Strauss syndrome
C. Idiopathic hypereosinophilia syn9.fome
D. Lymphoma ..
E. Drug-induced hypersensitivity vasculitis
· . k history of generalized joint
21. A man presents wtth 6-wee h on his legs: He also complains
fatigue associated WJt . h a PersiStent. ras past history .was of d'1a bet es
·o·r, dryness of his mouth an d eyes . Ilis on 1ynages with diet • aIone, an d of a
hich be ma d I
mellitus diagnosed 3 years ago, w. b' h he sustained a rupture sp een,
g O Jn W IC .
motorcycle accident 15 years a
. · lly · f 'oint movement but
whJch was removed
0 · d • swe ' 10
11
°
• g .or UmitatJOnti n JThere was a purp 1e
n examination he ha no. h ral joints on palpa · on the left · shin
there was tenderness of perJPW:bs and a small u in both feet in
rnlscd rash on his )ower 1. d decreased sensa o
N . f revea e
eurological exarnma 1° 0 . d reatinine at 198 umoi/L,
st?cking rrnal cBC, raJs.e. cbin 15 umoi/L, ANA was
H.ts investigations revealed 234 UfL, h titer. His urine dipsticl<
AST. 135 U/L ALT 123 UfL, positive 10 big
11 ' • f tor was
egative but rbeumatotd + .
3
showed blood 2+ and protem ·
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 December 2011
1r.temal Med. Part I

The most likely is: ..

A. Sjogren's syndrome with vasculitis
B. SLE with vasculitis .
c. Diabetic complicationS-
D. Rheumatoid arthritis . .
E. with hepatitis C infection

22. Which of the following is myositis specific autoantibodies :

A. Anti-Ro, (SS/A) . .
B. Anti LA, (S_S/B)
c. Ariti-Jo-1
E. Anticentomere

23. A 23-y·ear-old woman is pregnant with her first child.

She undergoes screening ultrasonography at five months gestation and the
fetus is determined to have an abnormally low heart rate, altho.u gh it
appears to be otherwise normal.
Serologic screening of the mother is most likely to reveal which of the
following autoantibodies? ·
._A. .A..nti-Ro
-B. Anticentromere
C. Antidoub1e-stranded DNA
D. Anti-Jo-1
E. Anti-Mil

24. Hypoxemia that is corrected 'th 02 .

RXCEPT: Wl therapy mcludes all of the following
ALar
. ge pu1mcnary arteno-venous
· -
malfi .
B. Acute pneumonia. onnat10n.
G._Pulmonary hemorrhage.
D. Pulmonary thromboembo1isr.l.
E. Acute asthma.

25. Common causes of solit:lry 1

EXCEPT.J. _ • ung nodule include all of the followings
A. Single
B. carcinoma.
C. Wegener's granuloma
D. Tuberculoma · ·
E. Lung

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December 2011
internal Med. Part I

· . h t common organism causing

30. \Vbich of the·following pathogens 15 t e mos ·
catheter associated infection? ·
A. Staphyiococcus species
B. Pseudomonas aeroginosa
C. Candida albicans - - - -·- ..
D. Escherichia coli
. ...:. ..- - ·- ··· ··. -··-·· · · ··
A SO year is episode and
. dizziness. Her BP is 85/55 mmHg, CVP 18 mmHg,
· pressure· 7013".. mmHool PC\VP 8 mmHcrbl cardiac output 3.0 L/mm, .
and
heart rate 115 per minute. .
\Vhich of the best expl:lins patient's condition?
A. Hypovolemic shock
B. Cardiogenic shock
C. Recurrent pulmonary embolism
- D. Cardiac tamponade

32. The initial treatment in a patient with serum potassium of 6.4 mEq/L
with electrocardiogram changes is:
A. Kayexalate enema.
B. Kayexalate enema and orally
C. Calcium carbonate IV
D. Calcium gluconate and bicarbunate IV

33. A 65 year old man has been in the ICU for 3 days being t_reated with
nitroprusside and labetalol for severe HTN (Hypertension). He has chronic
renal insufficiency. He bas gradually worsening mental status followed by a
seizure. He also has severe lactic acidosis with mixed venous oxygen
sa.turation of 83%. \Vhich of the following is the most likely explanation of
the patient's condition?
A. Act;te on top of chronic renal faiiure
B. Cyanide toxicity
C. Labetalol toxicity
D. Sepsis

34. A 50 yea.rs old man known to be hypertensiVe for a round 7 i'e!lrs presented
with polyuria and •
His current treatment is valsaru.n and. atenolol.
His physical examination disclosed no abnormal sign.
Laboratory studies: · .
Normal creatinine, and plasma glucose.
Normal thyroid function tests. .
. Calcium 12 mg (3mmol/L)
Phosphorus 1.8 mg/dL
of the following invesingation is most for the diaonosis of
th1s conditiOn. ·

=--7-·:: ··- . . - -=-- ..

- ·----=:....:.___
_
__;..-- -
_...._..
. · .· •.. .:-::. - .:..• ....:· = -
--'-'-- - - ..

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· ..· ·. wterriaJ Mcd. Part 1

..

A. Parathyroid hormone level.

B. I, 25 Dihydroxy vitamin D level
C. Calcitonin level. ·
D. 25 Hydroxy vitamin D level
E. Parathyroid honnone

35. Elderly woman with previous .thyroidectomy, she stops oral

intentionally. She spent the previous night ·in a vacation thus she had been
exposed to a very cold climate. She was found to be poorly arou8ah1e with a
temperature of 32oc and pulse rate of 55 beats per minute, normal
neurological examination apart from slow rela'xation of the ankle jerJr..
Intravenous saline and passive re-warming are started. The appropriate
next step_is:
A. Start intravenous thyroxine.
B. Nothing to be done waiting the results of thyroid function tepts.
C. Illtravenous thyroxine, and broad spectrum
antibiotics. ·
. D. Oral thyroxine, intravenous hydrocortisone, and board sr,ctrum
· antibiotics. ·

36. .A JO-years-old. women with Cushing syndrome. biochemical workup

···; sfiow:
. Morning serum cortisol 40 Jlg/dL (5-25 .
After 8 tng overnight de.xametbazone, serum co:.tJSol 4.5 pg!dL.
Pituitary l\1RI shows a microadenoma (8 mm dtameter). ·
The most appropriate next step is:
A. Ketoconazole. · · 1
B. Radiation therapy for the pituitary gland followed by ketoconazo e.
C. Pituitary adenomectomy.
D. Bilateral adrenalectomy.

37. ,A 50-years-oid man presented WJ'th classical symptoms and signs of

acromegaly
· · fh' tientis·
The best initial step in the workup. 0 . t IS pa honnone JeveJ.
A. Insulin induced hypoglycemJa t<? measure gro
B. _Pifl:!itary MR1 .
C. Lateral skull x-ray with sella cone VJeW. (IGF l)
D. Measurement of insulin-like growth factor • ·

Q
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December 201 1
-· Jntelllal Med. Part I . .. •
· . . f weight, palpitatiOn and
'th gOlter, 1oss o
, ld le presented Wl d b'Iateral exophthalmos . and
38. A 50 year;) o ma . . ation reveale. . 1 . .
. Physic-Jl examm .
. sweatmg 1 aze · 't ·
. limitation of the left latera g h gland-disclosed brm .
Auscultation of the enlarged t y -
Laboratory results: f e 0.81. 1.78 n_g/J!ll) . .... .
Free T4 4 nglmi • u_n_d. e·t·e·.c.table.
... · h rmone IS .
Thyroid .o . t ent is not acceptable:
One of the followmg lines of trea. m . .
. A. Radioiodine thyroid ablatwn.
B. Neomercazofe.
C. PropranOlol.
D. Steroid.
in a 30-year-old man who had bilateral
39 Hormone replacement tb erapy . h. h f th
. adrenalectomy for b'lJ at era I Phaeochroniocytoma
. · mcludes w lC one o e
following:
A. Gluc6corticoids only. .
B. Mineralocorticoids only. . . .
c. Combination of glucocorticoids and mineralocort1c_mds.
D. Catecholamines.
E. Sex steroids.

40. S. Typhi was isolated from the blood of a patient with 2 weeks history of
fever. Wnich antibiotic should not be used in the treatment even if the
microorganism -is fully sensitive in Yitro testing?
A. Co-trimoxozole ·
B. Ciprofloxacin
C. Ofloxacin
D. Gentamicin
E. Ceftriaxon

41 A ti t · h . ·
.: .. en gout on 300mg allopunnol developed swelling of his left big
toe With pam.&_ tenderness. The best approach is : . ..
A. Colchicme 1.2 mg .
B. 9olchicine &prednisolone .
C. of
allopurinol & the use colchicine·
D. & adding Naproxine
E. CombmatiOnof colchicine & Aspirin_

42. A 48 year old man with a: ast m . . .

presents to the ED compl:iin' history for hepatitis C and cirrhosis
BP is 118175 mm Hg, onset abdominal pain and chiils. ·
101F rectally per minute; RR 16 breaths per
ts abdomen is distended and d;ffan oxygen saturation 97% on room 'air.
paracentesis a d ' I usely tend y ·
. n retrieve !-liter of cl d . er, ou decide to perform a
ou Y flmd. · · .

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December 201 1
Lnbornto11' ann lysis of the flul'd 1 .:
slows a neutroph'l
Wh IcI1 of t11c following ·is them t . I count of 550 cells/mm3.
A. Mctionjdazo']c os appropnate choice of treatment?
B. Vancomycin
C. Sulfamethoxazolc/trimethopri
D. Neomycin and Iactulose . _ ----- - ·-- -·-- .. -
E. Ccfotaxime

43. A-68 yenr

. . mnn presents to the·ED with abd omma · . ·J·pam,
. • ·fever ·
nnd dmrrhca for the past 2 days His vitals are HR 95 b t ·
· 30/85 H · · • • ea s per mmute,
BP l mm g, _RR .18 breaths per minute, and temperature 38.3 C.
He has tenderness to palpation in the left lower quadrant 'th 'Id
. •
dIStcntwn d I ' WI IDI
nn vo unt!lry gti!lrding. His stool is guaiac positive. Which of the
following is thc .most likely diagnosis?
A. Appendicitis
B. Crohn's disease·
C. Diverticulitis ·
D. Colonic pseudo obstruction syndrome
E.

44. A 60 year .old .man with n history of alcohol abuse presents to the ED with
heruatemesis for 1 day. He denies abdominal or chest pain. On physical
exam, his eyes appear reddened and he admits to drinldng heaYily in !he
preceded night, after which be vomited SC\'eral times. Vital signs are HR.
115 bc:tts. per minute, BP 130/85 mm Hg, RR 18 breaths per minute, and
tcmpcr.tture 37.2C. Chest radiograph is unrcm.nrknble. Lab results reveal,
hemoglobin 14 gm/dL, hematocrit 40%. Endoscopy confirms the diagnosis,
which is most likely?.
A. Esophageal varices
B. Osephageal perforation
C. Curling ulcer
D. Perforated gastric ulcer
-.. E: Mallory-Weiss tear

45, A 38 year old ·mnn with advanced CHF remains symptomatic spite of
diuretic therapy. You arc adding a second and perhaps even a
third agent to llis regimen. • · .
Which of the following pharmacologic ngents used m the management. of
heart fnifurc lacl<s mortality benefit and does not prevent maladaptive
ventricular
A. ACE inhibitors
B. SJjironoJactone
C. Beta bloCkers
D. Digoxin
E. Angiotensin receptor blockers (ARBs)

II

-----
- .. - ---···· -
... ...
- .-----
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46. A 66 year o :m:n . ..-_ - .. b t • otbe r ?rise un remarka b le. · ru! CD of
ua min ati?n to a ccount i.o r the52 findings?
tbe foJI(J?/Jng con<;J Jtions 15 • ·
A. Pancre-atic cano:r
B. C?..nv;r - -- - - - - - - -- - - -
C. Prinuri oiiiZr; c1.-Tnor - .
D. Autoimmune h--.nolytk ... _ ·- ==--==- · · .---- --·
E.. Viral hepatitis·:- · · · - ·

47. A 55 year :IJ Jd man

. JS .• itt e d fo11owing an anteri or myocardial
· aum • . infarction.
h .
·r.-nich of th e following dru gs is leas t likely to reduce mortahty m t e 1ong-
term?
A. Ator;astztin
B. Atenolol
C. Ramipril
D. Aspirin
E. 1sosorbide mononitrate

48. A 26 year old female is admitted to hospital with palpitations. EGG shows a
'shortened PR interval and wide QRS complexes associated with a slurred
upstroke seen in lead IT. What
condition?
is
the definitive management of this

- . A. pathway atlation
B. Lifelong aspirin
C. AVnode ablation
D. Lifelong amiodaronc·
E. Pcnnancnt pacemaker

49. A 33 ye.ar old woman has congestive heart failure, premature ventricuJ::Ir
contractions, and repeated episodes of vcn tricular tachycardia. Her blood ··
pressure is norm al and there arc no murmurs. Her heart is markedly
enlarged. Coronary angiography shows no abnormalities. Which of the
following is the most likely diagnosis? ·
·"A: Acute rheumatic fever
B. Congenital fibroelastosis
C. Constrictive pericarditis
D. Myocardial infarction
E. Primary

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 December 201 I ·

50. A 48 old W?ll)an ·wi:h a 4-year history of rheUmatoid arthritis develops

fever, fatigue WJth exertJOn and anorexia of 5 weeks duration. Six ·months
ago, infusion therapy with infliximab was added to patient's regimen of
methotrexate and most ·recent dose was administered 4
weeks ago. On physical is 38 oc, pulse rate is
90/min,. bl.ood pressure is 100/60 mmHg;
pulmonary examination reve·als diffrise·crackJes bilaterally, on abdominal
examination, there is evidence·of hepatosplenomegaly.
Laboratory Hb 8.7g/dL WBC 10.500 ceUs/mm3, ESR 90 mmlh.
What is the most cause of patient's presentation?
A. Cornmunity:.acquired pneumonia
B. Miliary tuberculosis
C. Atypical mycobacterial infection
D. HistopJasmosis
E.

-1 One of· the followin·g drugs is considered an acceptable' _alternative

·anticoagulant for with heparin induced thrombocytopema:
A. Enoxaprin. ·
B. Aspirin . .
C. Tirofiban.
: D. -warfarin.
E.Arg?troban.

52. Which of the follo!fing statements regarding infective endocarditis is

correct? . ifestation of renal involvement is
A. The most frequent symptomatic man
nephrifJC syn drome..· ·
. . streptococcus faecahs.
B The commonest orgamsm IS •
. h' d to thrombocytoperua
C. Petec te are ue . · SO% of cases. ·
D. Anti-nuclear factor IS present m · · cultured from. the
. .. . h no orgarusm 15
·-. .. E. Tne prognosis IS worse w en · ·. . ·
ell carcinoma of lung
53. A 62 year old man is foun
.
d t °
. fior b aemoptysis.
.
have squamous c I .
·Which one of the fol .owmg wo
uld
after being investigated .. ? .
, · ·
be a contraindication to .surgJC al resectiOn·
. · ·
A. Einger clubbing . .
B. Hypercalcaemia · . · ·t
C. Hypertrophic pulmonary 05 e.o ·. -.
D. Pleural effusion · · . · · ··
· ·
E. Superior' vena o 5tru ctwn
b .

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 Internal Med. Part I
Decem be; 20 11
54 A IS · :
. - year old boy presents 'th . . . .
likely to be the cause of h' WI l pe:Ianal Jtchmg . The worm that is n.o
Js comp am 1s· .., re
A. Ankylostoma duodenale · ·
b. Taenia sagiata
C. Enterobius vermicularis . ··---: -·- ·---·
D. Ascaris · ·- - ·-...
E: StrongyJojdes stercoralis · · - ' t .
_._ ----· ··-- ..
55
· trWh.ich .. is not adviced in the management of de·J·. ·
emans · JrJum
A. Lorazepam
B. Halopericfol
C. Olanzapine
.. D. Phenyoin

56. Leukem·o jd is differentiated from leukemia by the presence of:

A. Elevated LAP score · ·
B. Splenomegaly
C. Lymphadenopathy
D. Anemia
E. Thrombocytosis

may precipitated by al1 the foHowing conditions

EXCEPT: ·
A. Spontaneous baCterial peritorutis ·
Diuretic therapy
C. GastroinfestionaJ bleeding
D. Hypokalemia
E. Infusion pf branched-chain amino acids

58. A 40 year old previously healthy fem.ale who was admitted tc the hospital
with severe Arterial blood gases showed; pH 7.48: PC02
_ mmHg; Pa02 60 mmHg; HC03 is 23 mmol/L. The acid-base disorder 10
... this patient is:· ·
· A. Acute respiratory alkalosis
B. Chronic compensated respiratory alkalosis
C. ·Metabolic acidosis
•
D. Metabolic alkalosis and respiratory alkalosis ·
E. Respiratory alkalosis and metabolic acidosis ·

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 ... - -.. , _.,. __ _ ... .

Internal Mcd. Part I

S9. A 45 year old man· for evaJu· tl

history is significant for recent dental of jaondke. His
fold increase in enzymes (AST and • yfvcr func tion tcs tJ reveal a 10-
The best (est to I). ou suspect acute btpatifu B.
A. HBsAg _ .... -- . - - - . J - - ....

HBeAg
C. HBV .. - - - ·..:. . .:. .·
· D. IgM anti-HBc
E. IgM anti-HBs

60.' In a wEPomTan all of the following are components of the Metabolic Syndrome
EXC :
A. Fasting plasma glucose of 115 mgldl
B. Serum triglyceride level of 160 mgldl
C Waist of92 em
D. Serum LDL of 170 mg/dl
E. Blood pressure of 153/85 miDHg

61. Which of the following patients should be evaluated for Wilson's disease?
A. A patient with heart failure; hepatomegaly and knee pains
B. A teenager with acute liver failure
.. • C. A 68-year-old with liver cirrhos.is
D. A patient with cho!estasis, ulcerative colitis, and high urinary
copper
E. A patient with chronic unconjugated mild hyperbilirubinemia

62. All of the following are considered bad prognostic factors hi Gl bleeding
EXCEPT: .
A. Old age.
B. Onset of bleeding after hospitalization
C. Coexisting Diabetes
D. Variceal bleeding
E. Coexisting chronic renal ·failure

l. All of the following are true for typhoid fever EXCEPT:

A. Incubation period of. 3 to 60 days
B. Prolonged persistent feVer
C. Early diarrhea in adults·
D. Relative bradycardia . .
E. 3-5% of patients become asymptomatic earners

·· ·-
I
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 December 2011
lnter.1al Med. Part 1

. . . . I of the following, EXCEPT:

64. Vitamin Bl2 deictency 1S caused by al
A. Croh..Tl's disease
B. Gastrectomy
c.- Haemolytic anaemias__. - - - -
D. Vegetarian diet
E. Blind loop syn_dro_me___ --- ----:-:- ----· --- ----- ·
. . . . sivel from her arm. Her mother
65. A 16 year old has been exc;s sy towards bleeding.
and. grand!Dother also have a htstory o ea
Her Blood results show: ISO OOO PT 14 APTT SS sec, thrombin
Hb 13g/dl, WBC ·9.000, platelets , · '. . · ' inutes (Normal:<8
time 18 (Normal:14-22 minutesh bleedmg tllDe 14 m
minutes).
What is the most likely diagnosis?
A. ·Hemophilia A
-B. Hemophilia B
C. Warfarin effect
D. Von Wil\ebrand's disease
· E. Autoimmune thrombocytopenia

66. A 27 old .woman complains of unilflteral throbbing headaches .for 11

._
months. Each time she bas heada-ches, she also complains of umlateral
weakness of the arm which resolves spontaneously when the headaches
improve. CT head was normal What is the most likely diagnosis?
A. Clu.stt!r headache
B. lv'Jgrainc
C. Tension headache
D. Somatoform
E. Cavernous sins thrombosis -

67. A 34 year old woman develops jaundice and pruritis during her
of pregnancy. She has 3 children, and during each pregnancy she
-:--developed similar episodes of jaundice .Each time, the jaundice resolved
after parturition. What is the most likely cause of oatient's recurrent
jaundice? •
A. Acute fatty liver of pregnancy
B. HELLP syndrome' ·
C. Intrahepatic cholestasis of pregnancy
D. Grilbert's syndiome
E. Recurrent ·hepatitis.A b.y: subsequent pregnancy.

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. ·. .
. ..
..... . . : . .: .·.. · ' · ····· ·· . . ·: ·:
....: . :\ .:·..
' ; ·I• .', : ·. • .

December 2011

68. Most deaths in individuals are due

following? to .which one of the
A. stroke
B. renal failure
C. congestive heart failure
D. Ischemic heart ---- ··-- .. ·-·--··
E. di.ssecting aneurysm
& • : • • · ..--.:..... .. _.: •

69. Primary prophylaxis to prevent acute infection in susceptible patients is

. recommended for HIV patients EXCEPT: :
A. Pneumocystis JirDVeci pneumonia.
B. Disseminated Mycobacterium avium complex.
C. Mucocutaneous candidiasis. ·
D. Malaria for persons traveling to areas where malaria is
E. T.oxoplasma gondii encephalitis.

70. Which of the following statements regarding hepatitis B serologic testing is

true?
A. The finding ofHBsAg fn serum is usually indicative of acute HBV
infection.
B. When consideririg hepatitis B vaccination, serologic testing should
. assess for the presence of anti-HBc or anti-HBs in addition to HBsAg
. .. _ C. Chronic HBV infection can be coniinned by the of anti
HBc for at least 6 months. .
D. The presence of anti-HBe i.h serum indicates hlgh levels of viral
replication.

11. A eports an 'unprovoked bite.' from a neighborhood dog. The dog

runner r . tb . . d · h 1h
was captured by Jocal au onties, an It appears eat y.
What is the appropriate a.ctwns. · . . .
d observe the dog for 10 days for signs suggestive of rabies.
A. Confime an . fth b'
·B. Begin prophylax.ts o e . Itten person.
c.. Immediately the dog.
D. No further action IS needed

12 benvy smoker presented to the E/R because of dyspnea

·A 60 year old man, The ABG on room air was PH 7.28. PaC02 60, HC03"
and colored sputum. d'ent is 30 mmHg •
26, Pa02 35, about this patient are true EXCEPT:
5
All of the followt?g h 5 bypoventilation
A. The pat!entth:s bypoventilation and V/Q mismatch
B. The pnt1en ded . . .
C• B 'PAP is rccommen . . ..
1 shoUld be g1ven InttJally by non-rebreathing mask ·
D. 02 · dicated.
E. AntibioticS are m

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 December 2011
.Internal Med. Part l

· . d t A&E via ambulance after

73. A well 25-year-old man P.rese?te loasting one minute. His wife
. . l' ed tonic clomc seiZure . 1 h d
e!penencmg a IZ d that he had never prevtous y a a
witnessed the ep1sode and r:porte td but bad had none for
seizure. He _mos ays · ·
the past three days. · . 't'ally confused and dis
. . . 't l . s were normal. He was tm 1 .
On exammahon, Vl a s1gn . _ . . .. ·· - 11 of the ep1sode.
orientated but recovered one with no tion and both cardiac
There were no focal deficits on
and respiratory examinations were n?rmal.
The most appropriate course of action would be: . further
A. Administer intravenous phenytoin and lorazepam to prevent .
seizureS. · .
B. Advise the patient against driving and·arrange outpatient to follow-up
to underlying for the seizure. .
c;. ArrS?ge for an urgent :MRI _scan as there is no explanat10n for the
seizure. .
D. Commence anticonvu1sant treatment and advise the patient against
driving. . · . .
E. Treat the patient with thia..'lline and berrzodiazepines as this is likely to
be an alcohol withdrawal seizure.

A 44 ye3r old male pn:sented with left hypochondriac heaviness, low grade
fever at night and easy · fatigability of 3 months duration. He had ··
unremarkable medical history, His clinical examination revealed a thin
man in no distress. He was slightly pale, not jaundiced and had no
lymphadenopthy and no skin rash. His vital . signs · were ·normal.
Abdominal examination moderate splenomegaly. HiS blood
counts revealed a Hemoglobin of 10 gm/dl, WBC count. of 3.2x109fL
(neutrophils 55°/o, lymphocytes 37°/o, monocytes 6°/o, myelocytes 2°/o), and
the platelet count was 110xl09fL.
The LEAST likely cause for his presentation is:
.. ... A. Follicular lymphoma. ·
B. Myelofibrosis.
C. Splenic marginal zone ·
D. Clrronic phase C1fL,. . ·. .
E. Disseminated TB.

75. A 13 year old boy was r r · d f · · · · . ·

following tooth e t f e or evaluation of prolonged bleeding
after circumcisio: r:c history revealed mild bleeding
problem. His t a ac of short lived epistaxis,no history of joint
His clinical revealed. an older similar problem.
normal blood counts The . initial work up showed
minutes (normal 5-9 1111• u tlng count. His bleeding time was .9.5
. nu es) 1s p rti h
seconds (control 28-44 se con ds and h'a a1 .t rornboplastine
. time was 53
. . .. . . ts·. prothrombine·
. ·. '
time was 17 seconds

- ... - . . ... . - . - In

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 /nttmal Med. Part 1 ·
December 20 l J

(control 13 seconds).One of. the f 0 II · .·

problem: ' owmg conditions is compatible with his
A. Hemophilia A.
B. Von Willebrand's disease.
C. Hypofibrinogenemia.
D. Factor Xlli deficiency.
E. Factor Xl deficiency.

76. CNS chemotherapy± radio.therapy is usually indicated for one

of the foiJowmg conditions: · · .
A. Stage N B Hodgkin's disease.
B. Stage C chronic lymphatic leukemia.
C. Acute lymphoblastic leukemia.
D. Cb!onic myeloid leukemia in acceleration.
E. Acute myeloid leukemia . .

77. A 60 year old lady had been diagnosed as having pernicious anemia 10 days
ago and she was started on vitamin Bl2 injections 1 mglday i.m, she had
received 8 dose.! till n·ow. His pretreatment hemogl_obin was 7 gni./dl and she
is feeling better and you are intending to evalu;lte her response to treatment.
The best indicator of her response to treatment at this point is:
·/ A. Rise in hemoglobin > 2gmldl above her pretreatrrient level.
B. Feeling of well being.
C. Development of leucocytosis.
D. Development of reticulocytosis.
E. Development of hypokalemia.

18. A 72-year-old woman with a history of hypertension and asthma has a

laceration of her Jeft ankle sutured in the emergency department. One week
later, she to the emergency department because of pain and
discharge from the suture site. On physical examinat.ion, she is afebrile. The
-J_eft ankle shows purulent drainage from the previous suture site and
d.ehf!cence of the wound over the Iate.ral malleolus. There is no evidence of
exposed bone. .
Whfeh of the fo1Jowing stu.dies wi11 be most sensitive and specific for
establishing a diagnosis in this patient?
A. Triple-phase bone scan
B. GaiJiwri scan
C. Plain x-ray of the left ankle .
D. Conventional bone radiograph
E.MRJ

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 December 2011
Internal Med. Part I
.
79. An SO--year-old m:m is evaluated routine :xamin:!tion .. has a history
of hypertension and was diagnosed w1th chrome osteoa.rth.ntls 20 years ago,
_Medications are 'atenolol, 50 mgld, and hydrochlorothiazide, 25 mg/d. One
year ago, he began ibuprofen, 250 mg four times daily. .
_ On physical examination,pulse-rate -is-<lO/min-and ·blood -pressure-is ·180/90 _
mm Hg without orthostatic changes. There is trace peripheral edema ·
Laboratory Studies . -· - - -· - .. .. .. .... _ ·....:..__:_..._
- Blood'urea nitrogen 40 mg/dL (14.28 mmol/L) ----c
1.5 mg/dL (132.63 Jlmol/L)
Sodium 134 meq/L (134 mmol/L)
Potassium 4.9 meq/L (4.9 ·. -
Wb!ch of the fo1lowing treatment strategies is indicated for this patient?
A. Increase the atenolol dose ·
B. Increase the hydrochlorothiazide dose
C. Add lisinopril
D.' Discontinue ibuprofen

80. All of the following are a_ssociated with increased risk obstructi . -.I
apnea syndrome EXCEPT! . ve s eep
A. Large Tongue
B. Large chin
_. . C. Large uvula
D. Obesity
E. Male sex

81. A 30 year old female who has a a .. .

on effort The heart exa . .P st of fever: C/o dyspnea
mmation revealed st
presystolic murmur open. . accentuated 1 heart . sound .
. the followings are lr:egularly irregular pulse. All of
A. PUlse deficit res wuh this condition EXCEPT:
B. Absent "a" wave
C. Hemoptysis .
- .D. Skin redness on her face
E: Slow rising pulse

82. In the family pedigree, the symbol •

A. Affected male. means: .
B. Affected female
C. Propsitus.
D. Dead
E. stillbirth

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 Internal Med. Part 1
December 2011

83. A 56 year .old inale patient presented with chest pain of 2 hours. Which of
details ·in taking history mostly in favor of myo.cardial
mfarct1on rather than
A. Central location ·o r the pain
B. Radiatiop to the left shoulder . __
C. Nausea and sweating durffig the
D. Compressing nature of the pain
E. Duration of the pain for 45 minutes

84. AU of the foll{)wing are common manifestations of Sarcoidosis EXCEPT:

A..Erythema Nodosum
B. Pleural effusion
C. Liver granulomas
_D. Right paratracheallymphadenopathy
- E. Non deforming artluitis

85. An 83-year-old man presents with sudden onset paraplegia. _

3
Complete blood count shows: white blood cell 7900/mm , hemoglobin. 11
g!dl, MCV 103 fl and platelets 178 ·OOO/mm 3• Blood film shows increased
background staining and rouleax formation. Radiography of the spine
shows lytic lesions but no yertebral collapse. :MRI imaging shows cord
.. ..compression by soft tissue mass.
·· The Optimal treatment for this condition at this stage is:
A. higb dose corticosteroids and urgent radiotherapy
B. Corticosteroids only
C. Corticosteroids and surgical decompression
D. Urgent chemotherapy ·
E. High dose Corticosteroid plus chemotherapy

'
{: 86. Surgery is usualJy considered a first line therapy
1 hypothalamic tumors EXCEPT:
. for the following pifuitary-

·A. Non functioning pituitary adenoma

B. Crainopharyngioma·
C. Cushing dis.ease
D. Prolactinoma
E. Acromegally

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 ... . . , .... LUIJ
1
lntcml\1Mcd.
d i have asymptomatic thyroid nodule, Which
87. A 50 year of ngc foun -o rding the t of this conditions or .
following statements . rcga . . Js not
,
correct: ce o.f asymptomatic thyroid nodule has been increasm·g.
A. the preva 1en . . 111
rcccnLycars - ..--- -· . . · -- ·- - - .
·B ·Microcalcifications, and intranodular on UltrasoUnd ..._
· cvaluat10n
· 111.
· d'1ca tc l--1;'gl--e'" ric ' .r'1Lthvrotd
1
. .· -
cancer.
· ·.. · ·· · • .
c. Aspiration Biopsy reserved for hypoecho1ce nodules> 2_0
em in size·on ultrasound. ·
D. The risk of thyroid cancer in' thyroid is similar to
symptomatic thyroid nodules · ·
E. Asymptomatic nodules are more common in females.

88. A patient with fever for three was found to have a blood culture
positive for Staphylococcus aurcus, your management would include which
of the following measures:
A. Doing an ecbocardiogram
B. Fundoscopic eye examination .
C. Observation for 48 hours before starting antioiotics
D. Chest CT looking for septic embo!i ·
E. Start gentamicin IV ·

· A. 70 year old man 15· b · . · . . .

he has a b . treated w1th vancomycin for the last two weekS,
ase 1Jnc creatmme of 1 gldL N h'
increases to m . · ow after one week of therapy
201!1gfL his most recent vancomycin trough ll
Which of the followin · ·.
A Th fi g ls .true about this patient·
. e rrst step should b t . .
B. Start hcmodialy . e s oppmg the vancomycin.
• SIS
C. Add gent2micin to his r . .
D. Decrease the .
ED vancomycm d h
· o an urgent klein ose to alf the original dose
ey ultrasound
90: -All tb f . . .
e allowing d' . .
effect EXCEP auretics mat h . 51'de
'- . f_: . c appropriately with the associated
A. ThJaztdes/ thromb . .
B. TriarntereneJh °CYtosis ·
C. Spironola t yPerkalemia
D. High dos cuonelgyflecomastia
E. Ethacry .e urosernideJ deafn
ntc acid!h ess
YPonatremia

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I

, , t;l Pmtlllnr:niiJ·WJ,vr. ; 11
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U, WldCJilc,d 9J<:i CtJJJJpJr:lj . ___
.... 1

c 2. A 7.2 'yc tl)' Hld ill II/I wltJ, H 2 Wt d at lJJrtttJry rJ!' IJJJ:tttr:tl unklt:
SWtlJlhiv, IIIJd llllld mlldc JHtlll, JJc lnttl JJrJ p:tt;t mt dlc:IJ JJir, tory Yla ;
, tnltfng iw tucdkutfou, Jle worl<r!d :t r. JJ,J}J :wfilti tM1t, :wcJ nt1tlu;r .rnoktiJ .
i'N'I't:utlo)luJ 011 e.r.:tJuln:lllcm, I1INIJ/ood Yl:t f} 110/55
IHIIIJ,lg, nnd hr: JllltJug ttlem:t (t) mltJ- <:;IIf. Jllt1 cl1tr: t :wd aiHJwium were
nor·;unl, 11«: hMI Nllllllllympll uodt .'1 JHtlp:dJlt: Ill .
f II ( fg:1 t fO 11.'1!
Serum soclhou 14J muwl/J, (JJ7 .. 144 wmoi!L), pot:.,u:ium 4.1
mmoi/L
(.15 " tf,!) fJJIJIOI/.L), .'iCI"IIll! CI'C:ItJufnc J()J JLIIIOJ!JJ (60 -11() r;crum
nlhurnlu 14·tl/L (J'l- 49 t!fl.), prottl11 4+; blood 2 +
Whnt fuvc.o;tfgz•tlon l.'l lflccly to he IIJt}:lt tu1cful'!
A. Antl-nc;lltropldl cyroplllmnlc :mtibody
JJ . Antlnucle:u nntibody ·
, .\r... J
C. Bnrr vinm ncrology
D. Proteitl
E. Serum cryoglobulitr:l

93. A 1·1 )ICtiJ' old wouwu NCJUIIS from pneumonia and ft1 admitted to
the lutcauJvc cnrc uuft hccuusc of hypotcmfor1, she fa started on antibiotics,
nnd hca· hloo(J prc.'I!IIJI'C h SIIJlportcd wJth norm:d s:tllnc.
D".'ipltc till.'! sire rorunhJ:t oHt:urlc :111cl ATU", Her urluaJysb shows
h "IJJC·f!l'flllllllll' c!l.'lt.'l JIJJd I'Jtc urine :;odium 13 56 mElJIL. WhlclJ oftbc
foiJowlnt{ b the lllccly cuu,qc of her AH11?
"A. Nophrotoxlc · ·.
J),Ac11to hlfocflou:J glomerulonephritis ''
. ACUI<l lllhlllnr nccro:jf.'l (A'J'N)
D. uapllroporhy
b. iuboll• ·
,,
9·1. A J? )IC!tl' old wonwn In her· wcel! of r:cytntlon (G2!)1) with 11 seizure.
Sh<' Jws hoc·u hcmJtJry lllltl docs uot timolw cll{:tr.ctlcN, drlnJc ulcohol, or,1uc
Illicit cJJ·ugs, SJu: J)pcm poorly cqmpll:111t lr1 her prcnat:tl .
. eximllnntloil ;rave 1Jis ft IJlootl of 150195 mm Hg. 'fhc
fncc: t1ncf huu'cl.'t nppent· cdciwJtous. ·Oth cr· tiJIIn the bc!ng
fHlstlctnl, o11, lll!lli·oloplci racH·muJ. · · .
r·c. Wlll.'l JH:oirfJJurhl., Tile the I.! ·
'' hl<:h of tit«! follo\\'•hru llWNt ·· ; · ·,. .
- ' '. , " ..

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-- December 201\

,\, }\FLU'
n. Prccdnl\11 :111\
c. U s\:1. . .
b . \3:-;sc.nti:l\ hYI c\'lcl::!l()ll - - - - - -- - - - -- --
$C\'l.\ll'C . -.. . t"
--· -- ·-· --- · •'thntrnumntc
---- -----------· It\ }i'Sl'D on nn open. ·-
95 A 5·1 yc:\r olu womnn . . consulta tion d y '¥bich of
fr:tdurc 'of the 'u h •rformrd the n;
reduction :utd intcnu\l fh.utlon ltlo h' lwoiclccl for tlns pnttcnt.
ollowii\p 11\cUIC!\tiOUS (. .
tl\C r • I
A. Acet:nnmop ' en ·
D. Morphine sulf:1tc
c. Meperidine
D. Hydromorphonc
E. Oxycodonc
l · ·r the most
96. In .tS years old female to hnvc Rhcum:ltoid art tn ts,
confirm:ltot-y test i!-t: ·
A. EhweatcdESR
B. Elcvcatcd titer of CI\P
c. Positive nnti-CCP
D. Positive Rhcrnntoid Foetor.
E. Low semm compkment

I
. . d"ctor of diabf;tic
97. Which _one of the following _is the tnost mtportant pre l
ueph ropatl1y?
A. SmorJng
B. Proteinuria
C. Duration of diabetes
D. Family history of diabetic ncphropath>'
E. Diabetic proliferative retinopathy

98. Episodic gross hematuria is not!\ feature of:

'.. , A: Cyclophosphamide therapy
B. Analgesic nephropathy
C. IgA nephropathy
D. Sickle cell disease
E. Minimal change disease.

99. What is the best for treatment of pnticnt with Post-streptococcal

nephritis? ·
A.·Short course of corticosteroids to limit the nephritis.
B. Confinnatory renal biopsy, followed by corti asteroid treatment.
C. Begin penicillin to limit the proteinuria nnd shorten the clinical course.
D. Supportive therapies to control cdc:.mn) nnd begin penicillin to prevent
new cases in the community.

24
--=:.-:....:.:·.- ---- ----- ..
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- ,· . . ' . -.'.: .
. .. ' ..
. .• - - - - -. · ·• • • .·

Internal Med. Part I December 201 1

100. In type 1 renal tubular acidosis, all are true EXCEPT:

A. Incomplete fonns with normal serum bicarbonate are well docume.nted
·B. May cause osteomalacia in adults · ·--· ... ·
C. Nephrocalcinosis is .seen
D. H)'pokalemia is p'resent-With-n6hnal ariit1ttgap111eiaooT1c acidosis--- .--
E. _Ability to form alkaline urine in the contest of systemic acidosis is the
hallmark of the disease

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