Formative 1

A 60-year-old male heavy smoker patient with Long standing type 2 diabetes
mellitus presented to the ER by an acute Epigastric abdominal pain Which one of
the following diagnoses should be considered as the first possibility?
Acute hepatitis.
Peptic ulcer disease.
Acute inferior myocardial infarction.
Diabetic ketoacidosis.
Acute Cholecystitis

Which one of the following is not compatible with the diagnosis of acute
pancreatitis?
Gray Turner’s sign is pathognomonic for pancreatitis
The pain is relieved by leaning forward.
The pain is usually severe but rarely it is painless.
hypertriglyceridemia and hypercalcemia are important risk factors.
The pain is typically radiated to the back.

Which of the following is not considered an etiology for chronic abdominal pain?
Hemolytic crisis in chronic hemolytic anemias.
Inflammatory bowel disease.
Irritable bowel syndrome.
H pylori related peptic ulcer disease.
Diverticular disease of the colon.

A 30-years-old married female patient with Acute severe agonizing right iliac
fossa pain, her pulse is 150 beats per minute, BP 70 / 30 mmHg, severely pale
with cold extremities. Abdominal inspection revealed Cullen’s sign. Which of the
following possibilities is the most likely diagnosis?
Acute pancreatitis.
Ruptured tubal pregnancy.
Perforated peptic ulcer.
Complicated acute appendicitis.
Ruptured aortic aneurysm.

Which one of the following combinations is not correctly matched?

Right hypochondriac pain → amebic liver Abscess.
Left hypochondrial pain → splenic infarction.
Epigastric pain → basal pericarditis.
Suprapubic pain → diabetic ketoacidosis.
Left iliac fossa pain → torsion left ovary.

Which one of the following endocrinopathies is not accompanied by arrhythmia?

Diabetic ketoacidosis.
Pheochromocytoma.
Hypothyroidism.
hyperplolactinemia
Acute adrenal insufficiency.

Which one of the following is not associated with prolonged P-R interval in ECG?
first degree heart block.
Hyperkalemia.
Mobitz type-1 second degree heart block.
Hypermagnesemia.
Wolf-Parkinsonian-White syndrome.

Which one of the following situations is the most indicative for significant
orthostasis?
Patient whose systolic pressure dropped 30 mmHg from recumbent to standing position.
Patient who became sweaty when changed from recumbent to standing position.
Patient whose diastolic pressure dropped 20 mmHg from recumbent to standing position.
Patient who collapsed to the ground attempting to change from recumbent to standing position.
Patient whose heart rate increased 40 BPM from recumbent to standing position.

In the diagnosis of Paroxysmal palpitation, basal ECG is rarely helpful unless

performed during the paroxysm. However, when conducted during the
asymptomatic intervals between the paroxysms, it proves to be highly beneficial
in diagnosing which one of the following paroxysmal palpitations?
Paroxysmal atrial fibrillation.
Paroxysmal atrial tachycardia.
Paroxysmal atrial flutter.
Paroxysmal supraventricular tachycardia.
Wolff Parkinson white syndrome.

In the previous question, which of the following findings in ECG is most

consistent with the diagnosis?
absent P wave with Multiple Fibrillatory “F ” waves.
Narrow Complex regular tachycardia with abnormal "deformed" P wave morphology.
Short PR interval with delta wave.
Narrow Complex regular tachycardia with retrograde p waves and variable RP intervals.

Formative exam 2
1. Which one of the following situations would lead to coma without lateralizing
signs?
a) epidural hematoma.
b) Uncal herniation.
c) Hypertensive encephalopathy.
d) Brain abscess.
e) Basilar artery migraine.

2. Which one of the following signs is not considered a sign of meningeal

irritation?
a) Neck stiffness.
b) Lasègue's sign.
c) Brudzinski's sign.
d) Kernig’s sign.
e) Abadie's sign.

3. Which one of the following signs doesn't truly localize CNS lesions in cases of
coma?
a) Convergent squint.
b) Unequal pupil.
c) Jaw deviation.
d) Tongue deviation.
e) Facial deviation.

4. Which of the following cranial nerve reflexes is not of benefit in the diagnosis
of Coma with lateralization?
a) Pupillary light reflex.
b) Corneal Reflex.
c) Glabellar reflex.
d) Doll’s eye reflex.
e) Gag Reflex.

5. Which of the following workup for a patient with disturbed level of

consciousness, photophobia, neck stiffness associated with fever and
widespread maculopapular skin rash is highly indicated?
a) Lumbar puncture and CSF analysis.
b) Blood culture.
c) CT scan of the brain.
d) fundus examination.
e) toxicological screen.

6. A 67-year-old man develops coma over a few minutes. He is unresponsive on

arrival to the hospital. He has ataxic respirations and pinpoint, reactive pupils.
Oculocephalic reflexes are absent. There is no motor response with painful
stimulation. where is the lesion?
a) Diffuse cerebral lesion.
b) Bilateral cerebellar lesion.
c) Bilateral thalamic lesion.
d) Pontine lesion.
e) Medullary lesion.
7. A 52-year-old man, with poorly controlled hypertension in the past, presents
with increasing headache, confusion, and vomiting. His blood pressure is 230/125
mm Hg, pulse 60/min, respirations 24/min, and there is papilledema. He has no
focal deficits. His creatinine is 2.1 mg/dl and blood urea 79 mg/dl. What is the
most probable diagnosis for his condition?
a) Primary spontaneous intraventricular hemorrhage.
b) Subarachnoid hemorrhage.
c) hypertensive encephalopathy.
d) Sagittal sinus thrombosis.
e) Uremic encephalopathy.

8. A74-year-old woman develops occipital headache, vomiting, and dizziness. She

looks unwell, blood pressure 180/100 mm Hg, pulse 70/min, and respirations
30/min. She is unable to sit or walk because of unsteadiness. Over the next few
hours, she develops a decline in her level of consciousness. What is the most
probable diagnosis for her condition?
a) hypertensive encephalopathy.
b) Cerebellar hemorrhage.
c) Friedreich’s ataxia.
d) Subarachnoid hemorrhage.
e) lobar intracerebral hemorrhage.

9. In a patient with chronic liver disease presented with recent onset of behavioral
changes and disturbed sleep rhythm. Which of the following is the most likely
trigger for that condition?
a) Sleep deprivation.
b) dietary Protein and calories restrictions.
c) GI bleeding.
d) Hypocalcemia.
e) Presence of tense ascites.

10 A diabetic patient on insulin therapy presented to the ER unconscious and is

highly irritable. His RBS was 33 mg/dl with available vascular access. Which of
the following lines of treatment is most effective?
a) Administer 25 gm of 5% glucose infusion over 30 minutes.
b) Giving the patient concentrated sugary solution via oral route.
c) Administer IM 0.5 mg adrenaline.
d) Administer 25 gm of 50% or 25% glucose IV bolus injection.
e) Administer IM glucagon.
Formative exam 3
Which of the following is not used in severity assessment of bronchial asthma?

A. Kussmaul's sign
B. Pulsus paradoxus
C. Silent chest
D. Central cyanosis
E. Drowsiness and confusion

Management of choice in Guillain-Barre syndrome is:

A. Immunoglobulin
B. Cyclophosphamide
C. Corticosteroid
D. Interferon
E. Azathioprin

which one of the following statements regarding tension pneumothorax is

incorrect?*
A. Acute dyspnea of acute onset.
B. Unilateral chest bulge.
C. Dullness on percussion at the side of pneumothorax.
D. Wide bore needle is to be inserted in the second intercostal space.
E. Distant breath sounds on auscultation.

Which of the following is required for the diagnosis of Behçet’s disease?

A. Large-vessel vasculitis
B. Pathergy test
C. Recurrent oral ulceration
D. Recurrent genital ulceration
E. Uveitis

which of the following is not associated with hyperuricemia ?

A. Cardiovascular disease
B. Gouty arthritis
C. Nephrolithiasis
D. Peripheral neuropathy
E. Urate nephropathy

Which type of arthritis is the most common?

A. Osteoarthritis
B. Rheumatoid arthritis
C. Psoriatic arthritis
D. Juvenile idiopathic arthritis
E. septic arthritis
Which of the following can increases toxicity of warfarin?
A. Ampicillin
B. Aspirin
C. Gentamycin
D. L-dopa
E. Probenicid

Which of the following explains interaction between ascorbic acid and iron?
A. Ascorbic acid displaces iron from plasma protein
B. Ascorbic acid decreases iron absorption
C. Ascorbic acid increases iron absorption
D. Ascorbic acid increases iron excretion
E. Ascorbic acid acts as a hepatic microsomal inducer.

Which of the following is an example of chemical antagonism?

A. Gentamycin+Penicillin
B. Cephalosporins+Letium
C. Heparin+Protamine sulfate
D. Insulin+Adrenaline
E. Paracetamol+Ibubrufen

Which of the following explain interaction between probenicid and penicillin?

A. Increase its ionization
B. Inhibit its reabsorption
C. Compete with its active tubular secretion
D. Prevent its efflux from intestine
E. Induce its metabolism