Stage 4 paper II 2020-2021 ‫دور اﻟﺜﺎﻧﻲ‬ ‫ﻋﺒﺪﷲ ﻧﺎھﺾ ﺣﺎﻣﺪ‬ 1

1) MOST COMMON JOINT INVOLVED IN SEPTIC ARTHRITIS IS:

a) elbow
b) knee
c) hip
d) shoulder

2) THE FIRST SIGN OF ACUTE COMPARTMENTAL SYNDROME IS:

a) loss of pulse
b) paralysis
c) hypotension
d) severe diffuse pain

3) CHARACTERISTICS OF THE ABDOMINAL PAIN IN ACUTE APPENDICITIS INCLUDE ALL OF THE

FOLLOWING EXCEPT:

a) typically, coughing or sudden movement exacerbates the right iliac fossa pain.
b) The classic visceral-somatic sequence of pain is present in only about half of those patients subsequently
proven to have acute appendicitis
c) Somatic pain followed by visceral pain
d) Periumbilical pain shifted to right lower quadrant

4) THE MOST COMMON EFFECTED ORGAN IN HUMAN BODY BY HYDATIDOSIS IS:

a) Lungs
b) Kidneys
c) Spleen
d) Liver

5) 12-YEAR-OLD BOY PRESENTS WITH A LONG-STANDING HISTORY OF POLYURIA AND

POLYDIPSIA. PROGRESSIVE FATIGUE. DECREASED APPETITE, MORNING NAUSEA AND EMESIS,
WEIGHT LOSS AND IMPAIRED GROWTH VELOCITY, IN ADDITION, HE HAD HAD NO RESPONSE
TO A 6-MONTH COURSE OF IRON THERAPY FOR TREATMENT OF ANEMIA. INITIAL LABORATORY
EVALUATION REVEALS BUN OF 125 MG/DL (43 MMOL/L) AND SERUM CREATININE OF 8.7
MG/DL (765 MCMOL). OTHER EXPECTED LABORATORY FEATURES INCLUDE ALL OF THE
FOLLOWING EXCEPT:

a) Increased anion gap metabolic acidosis

b) Elevated parathyroid hormone level
c) Decreased levels of growth hormone
d) Small, echogenic kidneys on ultrasonography

6) WHAT SPECIFIC SIGN YOU MAY NOTICE IN THE URINE ANALYSES IN THE PATIENT WITH
DIABETES INSIPIDUS:

a) Microscopic hematuria
b) Macroscopic hematuria
c) High proteinuria
d) Low level of specific gravity

7) WHICH OF THE FOLLOWING FRACTURES MOST OFTEN NEEDS PERFECT REDUCTION AND
INTERNAL FIXATION:
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a) Pathological fracture
b) Metaphyseal
c) Diaphyseal fracture
d) Intra-articular fracture

8) A 4-MONTH-OLD BOY IS NOTED TO HAVE POOR GROWTH AT A ROUTINE WELL CHILD VISIT.
RESULTS OF LABORATORY STUDIES INCLUDE SERUM SODIUM 140 MMOL/L. POTASSIUM 3.5
MMOL/L. CHLORIDE 116 MMOL/L AND BICARBONATE 13 MMOL/L. ALL OF THE FOLLOWING
SHOULD BE CONSIDERED IN THE DIFFERENTIAL DIAGNOSIS EXCEPT:

a) Chronic diarrhea
b) Proximal renal tubular acidosis
c) Renal Fanconi syndrome
d) Distal renal tubular acidosis

9) A PREGNANT LADY WITH CARDIOVASCULAR RISK CAME WITH PAIN IN HER CALF MUSCLE WITH
LOCAL RISE IN TEMPERATURE TO THE ANTENATAL CLINIC. WHAT TREATMENT SHOULD BE
STARTED?

a) LMWH
b) Ibuprofen
c) Paracetamol
d) Aspirin

10) PELVIC APPENDICITIS IS CHARACTERIZED BY ALL THE FOLLOWING EXCEPT:

a) There is usually complete absence of abdominal rigidity, nor tenderness over Mc Burney’s point
b) May cause suprapubic discomfort and tenesmus
c) Constipation is the usual bowel habit
d) Tenderness on rectal examination

11) SPONTANEOUS PNEUMOTHORAX CAUSED BY:

a) Rapture apical lung bleb

b) Central venous catheter insertion
c) Stab wound to the chest
d) Foreign body inhalation

12) THE ONSET OF ELEVATION OF CARDIAC TROPONINS IN ACUTE MYOCARDIAL

INFARCTION IS NEARLY:

a) 3-12 hrs.
b) 1-4 hrs.
c) 6-12 hrs.
d) 10-18 hrs.

13) REGARDING ACUTE APPENDICITIS IN ELDERLY. ALL THE FOLLOWING STATEMENTS ARE
TRUE EXCEPT:

a) Gangrene and perforation occur much more frequently

b) The clinical picture may simulate subacute intestinal obstruction
c) The diagnosis is usually easier than in young adults
d) It has a much higher mortality for acute appendicitis in the elderly than in young adult
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14) IN THE CHEST WALL:

a) The intercostal artery lies between the intercostal nerve and vein
b) The intercostal artery is more superficial than the vein
c) The transverses muscle lies between the external and internal intercostals
d) The neurovascular bundle lies between the external and internal intercostals

15) DISPLACES FRACTURE PATELLA NEED REDUCTION AND FIXATION TO RESTORE THE
FUNCTION OF:

a) Gluteus muscles
b) Hamstring muscles
c) Quadriceps muscles
d) Gastrocnemius muscle

16) REGARDING ACUTE APPENDICITIS IN INFANT AND CHILDREN, ALL THE FOLLOWING
STATEMENTS ARE TRUE EXCEPT:

a) The diagnosis is often delayed

b) Diffuse peritonitis is rarely seen due to the function of greater omentum in localizing the infection
c) Anorexia is very important symptom for diagnosis
d) Appendicitis is relatively rare in infants under 36 months of age

17) RENAL COMPLICATIONS IN PATIENTS WITH DIABETES MELLITUS PRESENT WITH

SYMPTOMS OF:

a) Nephrocystosis
b) Increased frequency of renal cancer
c) Frequent urinary infection
d) Nephrolithiasis

18) WHICH ONE IS NOT A COMMON ACTIVITY THAT PRECIPITATING ANGINA?

a) Physical exertion
b) Heavy meals
c) Lying flat
d) Intense emotion

19) OPSI IS MOST COMMON IN SPLENECTOMY DONE FOR:

a) Thalassemia
b) Splenic cyst
c) Splenic abscess
d) Trauma

20) THE BASE OF THE APPENDIX. ALL STATEMENTS ARE TURE EXCEPT:

a) It is found at the confluence of the three taeniae coli of the cecum

b) It is variable in position
c) It is the site of entrance of the appendicular artery
d) Subcecal position is the most common site

21) THE MAJOR ARTERIAL SUPPLY TO THE INTERVENTRICULAR SEPTUM ORIGINATES FROM
THE:
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a) Anterior descending
b) Circumflex artery
c) Marginal artery
d) Posterior descending

22) WHAT IS THE MAIN CAUSE OF CUSHING DISEASE?

a) Hypersecretion of corticotropin
b) Autoimmune adrenalitis
c) Tuberculosis
d) Adrenocortical carcinoma

23) ONE OF THE FOLLOWING IS NOT A COMPLICATION OF ACUTE MI;

a) Calcified aortic valve stenosis

b) Ischemic mitral valve incompetence
c) Cardiogenic shock
d) Mural thrombus

24) NOTED WHICH ASSERTIONS REGARDING THYROID SYNTHESIS ARE CORRECT?

a) Stimulated by corticotropin
b) T4 is derived from T3 on periphery
c) Disturbed following iodine deficiency
d) Thyroid synthesis 80% of T3 and 20% of T4

25) A PATIENT DEVELOPS RENAL FANCONI SYNDROME AFTER RECEIVING IFOSFAMIDE FOR
TREATMENT OF WILMS TUMOR. ALL OF THE FOLLOWING ARE FEATURES OF THIS CONDITION
EXCEPT:

a) Metabolic alkalosis
b) Rickets
c) Phosphaturia
d) Growth retardation

26) SPLENUNCULI:

a) Ruptured spleen
b) Wandering spleen
c) Accessory spleen
d) Diseased spleen

27) COLOSTOMIES ARE DIVIDED ACCORDING TO THE WAY OF FASHIONING INTO:

a) End colostomy
b) Loop colostomy
c) Temporary colostomy
d) Double barrel colostomy

28) A COMMON COMPLICATION OF TIBIAL PLATEAU FRACTURE IS:

a) Knee infection
b) Osteoporosis
c) Limb shortening
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d) Knee stiffness

29) THE FRACTURE THAT CARIES HIGH RISK OF COMPARTMENTAL SYNDROME

a) Scaphoid fracture
b) Supracondylar fracture of femur
c) Surgical neck of humerus fracture
d) Clavicle fracture

30) REGARDING ACUTE APPENDICITIS, ALL THE FOLLOWING STATEMENTS ARE TRUE
EXCEPT:

a) Diarrhea may occur with appendicular perforation

b) Shifting pain
c) Low grade fever
d) Frequent vomiting

31) IN ACUTE OSTEOMYELITIS OF CHILDREN, SHOULD EXCLUDE A MALIGNANT BONE

TUMOR WHICH MAY MIMIC BONE INFECTION IS:

a) Bone metastasis
b) Ewing sarcoma
c) Osteogenic sarcoma
d) Osteoid osteoma

32) THE INTRACAPSULAR FRACTURE NECK OF FEMUR MUST BE TREATED AS EARLY AS

POSSIBLE TO AVOID:

a) Infection
b) Avascular necrosis of femoral head
c) Femoral nerve injury
d) Femoral artery injury

33) THE UNSTABLE FRACTURE PELVIS NEEDS STABILIZATION IN THE CASUALTY BY:

a) Internal fixation
b) Pelvic binder
c) Immobilization
d) External skeletal fixation

34) IN THE PATHOGENESIS OF HYPOTHYROIDISM WHICH OF THE FOLLOWING IS NOT

CURRENT?

a) Peripheral resistance to effect of thyroid hormones

b) Autoimmune process in thyroid gland
c) Inadequate secretion of thyrotropin
d) Decrease in thyroid hormone synthesis

35) PRIMARY HYPOTHYROIDISM DEVELOPS AS A RESULT OF:

a) Thyroid pathology
b) Pathologies of pituitary gland
c) Hypothalamus disorders
d) Loss of thyroid hormones during nephritis
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36) FINGER CLUBBING IS NOT A CLINICAL FINDING IN:

a) Mesothelioma
b) Bronchiectasis
c) Fibrosing alveolitis
d) Bronchial asthma

37) CONCERNING ACROMEGALY, THE FOLLOWING IS NOT CORRECT:

a) Hypersecretion of growth hormone

b) Hypotension is common
c) Increase risk of colorectal carcinoma
d) Impaired glucose tolerance

38) WHICH ONE IS NOT A FEATURE OF UNSTABLE ANGINA:

a) Angina at rest
b) Recent angina
c) Crescendo angina
d) 4 weeks post MI angina

39) NEST STATEMENT IS NOT COMMON IN CLINIC OF HYPOPITUITARISM:

a) Hypocorticism
b) Hirsutism
c) Hypogonadism
d) Hypothyroidism

40) A CLASSICAL EXAMPLE OF CLOSED LOOP OBSTRUCTION IS:

a) Small bowel lymphoma

b) Gastric outlet obstruction
c) Colonic malignant stricture with incompetent ileocecal valve
d) Colonic malignant stricture with competent ileocecal valve

41) THE POSITION OF THE BASE OF THE APPENDIX IS CONSTANT. IT IS MOST COMMONLY:

a) Sub cecal
b) Pre-ileal
c) Pelvic
d) Retrocecal

42) REGARDING THE RIGHT CORONARY ARTERY:

a) Supplies 30% of SA nodes

b) Usually has a posterior interventricular branch
c) Supplies 60% of AV nodes
d) Course through the left auricle and infundibulum

43) WHICH IS THE CORRECT ORDER OF IMPORTANCE IN REDUCING MYOCARDIAL OXYGEN

CONSUMPTION?

a) Blood volume, renal output

b) Blood pressure, antiplatelet agent, heart rate
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c) Antiplatelet agent, left ventricular pressure

d) Heart rate, blood pressure, left ventricular volume

44) A 67-YEAR-OLD MAN HAS DETERIORATING VISION IN HIS LEFT EYE. HE HAS
LONGSTANDING COPD AND IS ON MULTIPLE DRUG THERAPY FOR YEARS. WHAT SINGLE
MEDICATION IS LIKELY TO CAUSE THIS VISUAL DETERIORATING?

a) B2 agonist
b) Diuretic
c) Corticosteroid
d) Theophylline

45) THE MAIN REASON FOR INTRODUCING AN NG TUBE FOR A PATIENT WITH INTESTINAL
OBSTRUCTION:

a) Feeding
b) Differentiating small bowel from large bowel obstruction
c) For decompression proximal to obstruction
d) Lavage

46) CHARACTERISTIC FINDING IN PATIENT WITH PLEURAL EFFUSION IS:

a) Dull percussion notes

b) Expiratory rhonchi
c) Increased tactile fremitus
d) Symmetrical chest expansion

47) SPLENECTOMY IS NOT USEFUL IN:

a) Hereditary spherocytosis
b) Porphyria
c) Thalassemia major
d) Idiopathic thrombocytopenic purpura

48) THE MOST USEFUL INVESTIGATION TO DIAGNOSE OSTEOPOROSIS IS:

a) Serum calcium, phosphorus and vitamin D level

b) DEXA scan
c) Bone radiograph
d) CT scan

49) THE ANTIBIOTIC PROPHYLAXIS MUST BE ADMINISTERED IN ALL PATIENTS WITH:

a) Comminuted fracture
b) Road traffic accident fracture
c) Pathological fracture
d) Compound fracture

50) WHICH OF THE FOLLOWING INSTRUMENT IS USED FOR STERILIZING THE MEDIA AFTER
IS HAS BEEN PREPARED?

a) Incubator
b) Autoclave
c) Inoculum needle
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d) Laminar air flow chamber

51) INCREASED SPLENIC FUNCTION THAT IS MANIFESTED CLINICALLY BY THE DECREASE

IN ONE OR MORE OF THE CIRCULATING BLOOD ELEMENTS IS CALLED:

a) Hyposplenism
b) Hypersplenism
c) Splenorrhexis
d) Splenomegaly

52) WHICH OF THE FOLLOWING DRUGS SHOULD BE AVOIDED AS POSSIBLE IN PATIENT

WITH FRACTURE DUE TO ITS ADVERSE EFFECTS ON FRACTURE HEALING:

a) Third generation cephalosporin

b) Acetaminophen
c) Diclofenac
d) Vitamin D

53) FEATURES OF HYPOTHYROIDISM IN CHILDREN INCLUDE ALL, EXCEPT:

a) Wet skin
b) Retardation of physical and intellectual development
c) Retardation of sexual development
d) Constipation

54) THE MOST COMMON MALIGNANT BONE TUMOR IN CHILDREN:

a) Osteogenic sarcoma
b) Multiple myeloma
c) Chondrosarcoma
d) Metastatic tumors

55) WITH REGARD TO THE CORONARY ARTERIES:

a) There are no arteriolar anastomoses between the left and right

b) Right supplies the posterior descending branch in most patients
c) Right arises from the posterior coronary sinus
d) Left supplies the conducting system in most patients

56) A MAN BROUGHT INTO THE ED AFTER BEING STABBED IN THE CHEST. CHEST IS
BILATERALLY CLEAR WITH MUFFLED HEART SOUNDS. BP IS 60/NIL. PULSE IS 120 BPM. JVP
RAISED. WHAT IS THE MOST LIKELY DIAGNOSIS?

a) Pulmonary embolism
b) Hemothorax
c) Pericardial effusion
d) Cardiac tamponade

57) THE CELLULAR, LAMINATED LAYER OF ECHINOCOCCUS GRANULOSUS CYST WALL IS

THE:

a) Endocyst
b) Broad capsule
c) Pericyst
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d) Ectocyst

58) IN A COMMUNITY ACQUIRED PNEUMONIA THE FOLLOWING INDICATES A POOR

PROGNOSIS:

a) Respiratory rate of 18/min

b) Age of 60 years
c) Confusion
d) Systolic blood pressure of 130 mmHg

59) PATIENT K., SUFFERING FROM DIABETES MELLITUS DURING THE PAST 8 YEARS, IS IN
COMA, THE SKIN IS DRY, KUSSMAUL’S RESPIRATION, ACETONE BREATH IS EVIDENCED. WHAT
TYPE OF COMA IS IT?

a) Hyperosmolar state
b) Lactic acidosis
c) Hypoglycemic coma
d) Ketoacidosis

60) DEVELOPING OF GIGANTISM IS CONDITIONED BY:

a) Overwhelming secretion of GH in adults

b) Overwhelming secretion of somatostatin in adults
c) Overwhelming secretion of GH in adolescence
d) Overwhelming secretion of GH in old age

61) APPROPRIATE TREATMENT OF HYPOTHYROIDISM INCLUDES:

a) Potassium iodide
b) Complex preparations with thyroxine and triiodothyronine
c) Using sodium levothyroxine
d) Using triiodothyronine

62) A FEATURE IN FAVORS OF ACUTE APPENDICITIS OVER MESENTERIC LYMPHADENITIS IS:

a) Deep right iliac fossa tenderness

b) Upper respiratory infections
c) Pain is diffuse and tenderness is not localized/migratory tenderness
d) Cervical lymphadenopathy

63) MACROANGIOPATHY, AS A SYMPTOM OF DIABETES MELLITUS, MOST OFTEN DESTROY

VESSELS OF:

a) Lung
b) Retina
c) Kidneys
d) Leg

64) THE X-RAY CHANGES IN BONE INFECTION USUALLY SEEN AFTER:

a) Two weeks
b) Two hours
c) Two days
d) Two months
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65) FALL ON OUTSRETCHED HAND WITH TENDER SNUFFBOX MAY BE A SING OF:

a) Colle’s fracture
b) Median nerve injury
c) Ulnar styloid fracture
d) Scaphoid fracture

66) MORNING STIFFNESS OF FINGERS MORE THAN ONE HOUR MAY BE A SING OF:

a) Rheumatoid arthritis
b) Septic arthritis
c) Ankylosing spondylitis
d) Osteoarthritis

67) CLINICAL PICTURE OF HYPOTHYROIDISM INCLUDES ALL THE FOLLOWING SYMPTOMS

EXCEPT:

a) Slow speech
b) Drowsiness
c) Weight gain
d) Hyper defecation

68) MEDICAL TREATMENT FOR HYDATID CYST DISEASE IN HUMANS IS CONTRAINDICATED

IN CASE OF:

a) Small cyst
b) Calcified cyst
c) Multiple cyst
d) Peritoneal cyst

69) WHICH ASSERTION IS NOT CORRECT AS REGARDS TO ANGIOPATHY OF LOWER

EXTREMITIES?

a) Developing of foot gangrene

b) Decrease of foot temperature
c) Paresthesia
d) Pain in legs when walking

70) FIBRINOLYTIC THERAPY GIVEN TO PATIENT WITH:

a) Unstable angina
b) NSTEMI
c) Stable angina
d) STEMI

71) WHICH OF THE FOLLOWING ELBOW FRACTURES IS EXTRA ARTICULAR?

a) Fracture of trochlea
b) Capitallum fracture
c) Head of radius fracture
d) Supracondylar fracture

72) REGARDING THE PRESENATION OF ACUTE APPENDICITIS:

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a) If vomiting preceding abdominal pain, acute appendicitis is most likely

b) High grade fever is an important feature for the diagnosis
c) In the majority of patients, anorexia is the first symptom, followed by abdominal pain & then vomiting
d) The sequence of anorexia, abdominal pain and vomiting has no diagnostic significance

73) TO ESTIMATE THYROID FUNCTION, YOU SHOULD ORDER:

a) Determination of 131I uptake

b) Determination of T3 and T4 levels in blood
c) Ultrasonography of thyroid gland
d) Biopsy

74) 3-YEAR-OLD GIRL PRESENTS TO YOUR OFFICE WITH ACUTE ONSET OF LETHARGY AND
PALLOR. THE CHILD’S MOTHER REPORTS THAT THE CHILD HAD BLOODY DIARRHEA FOR 5 DAYS
THAT CLEARED ONE DAY PRIOR TO PRESENTING TO YOUR OFFICE. SHE ALSO NOTES. ON
EXAMINATION, THE PATIENT IS PALE AND LETHARGIC. BLOOD PRESSURE IS 120/80 MMHG.
THE MOST APPROPRIATE NEXT STEP IN DIAGNOSIS WOULD BE:

a) Urinalysis
b) Complete blood cell count and blood film morphology
c) Urine culture
d) X-ray examination of the abdomen

75) IN POSTERIOR HIP DISLOCATION, THE MOST COMMON NERVE LIABLE TO INJURY AND
MUST BE ASSESSED BEFORE JOINT REDUCTION IS:

a) Femoral nerve
b) Sural nerve
c) Sciatic nerve
d) Obturator nerve

76) ALL PATIENTS WITH FALL FROM HEIGHT AND FRACTURE OF CALCANEUM, MUST DO X-
RAY FOR:

a) Femur
b) Knee joint
c) Spine
d) Tibia

77) WHICH ONE IS NOT A FEATURE OF MYCOPLASMA PNEUMONIA:

a) Sudden attacks of severe cough followed by vomiting

b) Cold autoimmune hemolytic anemia is a complication
c) Infections are common in school aged children
d) Erythromycin is a drug of choice

78) A 16-MONTH-OLD CHILD PRESENTS WITH DROOLING, SORE THROAT, CYANOSIS AND
LOSS OF VOICE. HE HAS FEVER WITH A TEMPERATURE OF 38.2 C°. WHAT IS YOUR NEXT STEP
TOWARDS MANAGEMENT?

a) Start antibiotics and nebulizer

b) Finger sweep to remove foreign body
c) Start intravenous fluids and steroids
d) Call anesthesiologist for intubation
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79) OLECRANON FRACTURE OF THE ELBOW USUALLY DISPLACED DUE TO PULL OF WHICH
MUSCLE THAT ATTACHED TO THE OLECRANON:

a) Deltoid muscle
b) Supinator muscle
c) Triceps muscle
d) Bicep’s muscle

80) MEDIAL ELBOW INJURY CAUSING INABILITY TO ADDUCT AND ABDUCT THE FINGERS
INDICATED INJURY TO:

a) Median nerve
b) Musculocutaneous nerve
c) Axillary nerve
d) Ulnar nerve

81) A 75-YEAR-OLD MAN COLLAPSED WHILE WALKING IN HIS GARDEN. HE RECOVERED

FULLY WITHIN 30 MINS WITH BP 110/80 MMHG AND REGULAR PULSE OF 70 BPM. HE HAS A
SYSTOLIC MURMUR ON EXAMINATION. WHAT IS THE DEFINITIVE SINGLE DIAGNOSTIC
INVESTIGATION THAT WILL ASSIST YOU WITH HIS CONDITION?

a) 24h ECG monitoring

b) ECG
c) 24h BP monitoring
d) Echo

82) THE BEST CHOICE OF FLUID REPLACEMENT FOR PATIENTS ADMITTED TO THE ER WITH
INTESTINAL OBSTRUCTION AND ELECTROLYTES DISTURBANCE IS:

a) Human albumin
b) Normal saline 0.9%
c) Glucose saline 0.18%
d) Glucose water 5%

83) FRACTURE SHAFT OF HUMERUS, CARIES RISK OF RADIAL NERVE INJURY WHICH LEADS
TO LOSS OF:

a) Thumb opposition
b) Wrist and finger extension
c) Fingers adduction and abduction
d) Wrist and fingers flexion

84) FOLLOWING INTESTINAL OBSTRUCTION, THE MAIN SYSTEMIC COMPLICATION

RESULTING FROM WATER AND ELECTROLYTE DISTURBANCE IS:

a) Hypovolemia and renal failure

b) Liver failure
c) Sepsis
d) Atelectasis

85) SYMPTOMS OF HYPERTHYROIDISM ARE, EXCEPT:

a) Tachycardia
b) Increased heat production
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c) Weight gain
d) Exophthalmia

86) REGARDING PERICARDIUM:

a) The oblique sinus is bounded anteriorly by the visceral layer of serous pericardium
b) Visceral part supplied by the phrenic nerve
c) Serous pericardium down represents the attachment of central tendon of diaphragm
d) Fibrous pericardium consists of visceral & parietal parts

87) STRANGULATED BOWEL LEADS TO ALL OF THE CARDINAL CLINICAL FEATURES, EXCEPT:

a) Persistence of expansile cough impulse in cases of strangulated external hernia

b) Generalized abdominal tenderness and rigidity
c) Shock resistance to fluid resuscitation
d) Constant severe abdominal pain

88) A CUT WRIST WITH LOSS OF THUMB OPPOSITION (COUNTING) IS A SIGN OF:

a) Radial nerve injury

b) Ulnar nerve injury
c) Musculocutaneous nerve injury
d) Median nerve injury

89) THE TREATMENT OF GRAVE’S DISEASE FIRST OF ALL USUALLY INCLUDE:

a) Carbimazol
b) Antidepressants
c) Narcotic analgesics
d) Diuretics

90) THE COMMON PRESENTATION OF LUMBAR INTERVERTEBRAL DISC PROLAPSE IS:

a) High grade fever and bone pain

b) Foot drop
c) Back pain radiating down the buttock and back of the thigh
d) Retention of urine and constipation

91) THE MOST COMMON SITE OF ACUTE BONE INFECTION IN CHILDREN IS:

a) Bones of the shoulder

b) Bones of the spine
c) Bones of the elbow
d) Bones of the knee

92) 8-YEAR-OLD GIRL, KNOWN CASE OF CKD (CHRONIC KIDNEY DISEASE) WHO HAS
PRESENTED WITH BONE PAIN. HER CALCIUM WAS 2.8 MMOL/L, PHOSPHATE 3.2 MMOL/L,
ALKALINE PHOSPHATASE 860 PG/ML, PTH 760 (35-70 PG/ML), BOTH VITAMIN D METABOLITES
WERE LOW. HAND X RAY (PHOTO). WHICH ONE OF THE FOLLOWING IS THE UNDERLYING
DIAGNOSIS?

a) Hypoparathyroidism
b) Secondary hyperparathyroidism
c) Tertiary hyperparathyroidism
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d) Primary hyperparathyroidism

93) FACTORS THAT PROMOTE APPENDICULAR PERFORATION ARE THE FOLLOWING

EXCEPT:

a) Immunosuppression
b) Extremes of age
c) Diabetes mellitus
d) Absence of fecalith obstruction

94) A 5-YEAR-OLD CHILD WITH HISTORY OF RECURRENT CHEST INFECTION, FINGER

CLUBBING WITH OFFENSIVE STOOL. CHOOSE THE SINGLE MOST LIKELY INVESTIGATION?

a) IgA anti-endomyseal antibody

b) Chest CT
c) Barium meal
d) Sweat test

95) A 50-YEAR-OLD PATIENT IS ADMITTED FOR ELECTIVE HENIORRAPHY. WHICH OF THE

FOLLOWING OPTIONS WILL LEAD TO POSTPONEMENT OF THE OPERATION?

a) SBP 110 mmHg

b) Pain around hernia
c) MI 2 months ago
d) Hgb 12 g/dl

96) IN THE COURSE OF MANAGEMENT OF PATIENT WITH INTESTINAL OBSTRUCTION,

DANGEROUS SINGS ARE:

a) Leucopenia
b) Exaggerated bowel sounds
c) Hypothermia and bradycardia
d) Constant severe pain

97) A 15-YEAR-OLD BOY WITH A 12-YEAR HISTORY OF MICROSCOPIC HEMATURIA IS NOTED

TO HAVE BILATERAL HIGH-FREQUENCY SENSORINEURAL HEARING LOSS, BLOOD PRESSURE OF
140/90 MMHG, SERUM CREATININE OF 1.5 MG/DL (132 µMOL/L), AND URINARY PROTEIN OF
2000 MG/24 HR. THE PATIENT’S MOTHER ALSO HAS MICROSCOPIC HEMATURIA. THE MOST
LIKELY MODS OF INHERITANCE FOR THIS CHILD’S GLOMERULAR DISEASE IS:

a) x-linked dominant
b) autosomal recessive
c) x-linked recessive
d) autosomal dominant
Stage 4 paper II 2020-2021 ‫دور اﻟﺜﺎﻧﻲ‬ ‫ﻋﺒﺪﷲ ﻧﺎھﺾ ﺣﺎﻣﺪ‬ 15

1. b 2. d 3. c
4. d 5. a 6. d
7. d 8. d 9. a
10. c 11. a 12. a
13. c 14. a 15. c
16. b 17. c 18. c
19. a 20. d 21. a
22. a 23. a 24. c
25. a 26. c 27. all true
28. d 29. b 30. a
31. b 32. b 33. b
34. a 35. a 36. d
37. b 38. d 39. b
40. d 41. d 42. b
43. d 44. c 45. c
46. a 47. b 48. b
49. a 50. b 51. b
52. c 53. a 54. a
55. b 56. d 57. d
58. c 59. d 60. c
61. c 62. a 63. d
64. a 65. d 66. a
67. d 68. b 69. c
70. d 71. d 72. c
73. b 74. b 75. c
76. c 77. a 78. d
79. c 80. d 81. d
82. b 83. b 84. a
85. c 86. a 87. a
88. d 89. a 90. c
91. d 92. b 93. d
94. d 95. c 96. c
97. d