اسئلة الباطنية 2016 (2)
1) First improve after IDA treatment :
A) Hemoglobin
B) MCV
C) MCH
D) Ferritin
E) Reticulocyte
2) Rheumatoid arthritis is rarely present with :
A) Joint swelling and tenderness
B) Elevated ESR
C) Elevated CRP
D) Morning stiffness
E) Skin rash and fever
3) Suggestive of Hypercalcemia on ECG :
A) AV block
B) Tall narrow peaked T wave
C) Wide QRS
D) J wave Osborn wave
E) Sinus irritability
4) Guillain barre syndrome is associated with one :
A) Symmetrical ascending paralysis
B) Spasticity
C) Increased DTRs
D) Autosomal recessive inheritance
E) Not affecting the cranial nerves
5) All are true about chronic renal failure except :
A) Hyperkalemia
B) Hyperphosphatemia
C) Hypercalcemia
D) Low HB
E) Metabolic acidosis
6) All are manifestation of diabetic neuropathy except :
A) Infertility
B) Gastroparesis
C) Oculomotor nerve palsy
D) Charcot joint
E) Nocturnal diarrhea
7) The most important medication in treatment of acute bronchial asthma exacerbation :
A) Ipratropium bromide
B) Salbutamol
C) Oxygen
D) IV corticosteroids
E) Salmeterol
8) A 66 years old woman is noted to have asymptomatic atrial fibrillation . Which of the following is the most common complication of her atrial fibrillation :
A) Sudden death
B) Stroke
C) Shock
D) MI
E) Dyspnea
9) Post Streptococcal acute Glomerulonephritis is characterized by all of the following except :
A) Occurs usually within 2_3 weeks of the infection
B) Low plasma levels of C3 , C4
C) HTN
D) RBCs casts in urine sediment
E) Adult have worst prognosis than children
10) Digoxin toxicity can lead to all of the following ECG findings except :
A) Frequent ventricular premature beats
B) ST depression in lateral chest leads V4 , V5 , V6
C) Ventricular tachycardia
D) Complete heart block
E) Prolongation P_R interval
11) Which of the following disease is least likely to be preventable with lifestyle change :
A) Cardiovascular disease
B) Cancer
C) TB
D) COPD
E) Liver cirrhosis
12) A 45 years old man with DM type 2 , have BP 145/90 and 150/96 mmhg on two separate occasions . Which of the following is the best initial therapy :
A) Hydrochlorothiazide
B) ACE_i
C) Beta blockers
D) Hydralazine
E) Spironolactone
13) In spondyloarthropathy , all are true except :
A) HLA B27 is a common association
B) IBD may be underlying disease
C) Psoriasis may be seen
D) Sacroiliitis can be seen on X_Ray
E) More common in females than males
14) All are causes of nephrogenic DI except :
A) Lithium
B) Demeclocycline
C) Thiazide
D) Hypokalemia
E) Hypercalcemia
15) The presence of a thick walled cavitary lung infiltrate on the chest radiograph can be explained by all of the following pathologies except :
A) Wegener Granuloma
B) SCC
C) Lung abscess
D) Mycetoma
E) Pulmonary cyst
16) All of the following can be found in patient with diabetic Ketoacidosis except :
A) PH < 7.35
B) Bicarbonate 15 mmol/L
C) K in serum 6 mmol/L
D) Keton bodies in urine
E) Anion gap 12
17) A 30 years old man has history of bilateral bronchiectasis and recurrent hospitalization for chest infection . During the last admission a sputum culture was done and showed Pseudomonas aeruginosa . He is here today with fever and productive cough of large amount of green sputum , the best antibiotic is :
A) Ceftriaxone
B) Vancomycin
C) Cefotaxime
D) Pipracillin / Tazobactam
E) Amoxicillin / Clavulanic acid
18) In active systematic lupus disease , all of the following are commonly seen except :
A) Proteinuria
B) Thrombocytopenia
C) Arthritis
D) ANA positive
E) Thrombocytosis
19) Splenomegaly can occur in all of the following except :
A) Chronic granulocytic leukemia
B) Chronic malaria
C) Amyloidosis
D) Celiac disease
E) Polycythemia rubra vera
20) Hepatitis B infection is a common and serious problem worldwide , all of the following are true regarding HBV infection except :
A) A positive anti_HBC (IgM) and HBS Ag suggests acute infection
B) When the infection resolves , HBS Ag becomes negative and anti_HBC (IgG) remain positive
C) HBS Ab is a sign of previous infection or immunization
D) Most of acute HBV infection present with jaundice
E) The level of blood HBV DNA is reliable index of active infection
21) In Acromegaly all are true except :
A) Hypotension
B) Impaired glucose tolerance test
C) Erectile dysfunction
D) Elevated IGF_1
E) Bitemporal hemianopia
22) All of the following are suggestive of secondary causes of HTN except :
A) Low plasma renine activity
B) Hypochloremia
C) Urine red blood cells cast
D) Metabolic alkalosis
E) Hypokalemia
23) All of the following environmental hazards , the only non threshold exposure is :
A) Ionizing radiation
B) Noise
C) Heat
D) Lead
E) Carbon monoxide
24) All of the following are true regarding primary Hyperparathyroidism , except :
A) Associated with MEN1 syndrome
B) Osteitis fibrosa cystica
C) Nephrocalcinosis
D) Hyperphosphatemia
E) Short QT interval
25) 65 years old female with primary hypothyroidism , on L_thyroxin replacement 100 mcg / day and clinically euthyroid her lab shows a TSH =2 ( normal 0.45_4.5) with normal T4 and T3 . Which one of the following is true regarding her management :
A) The L_thyroxin does should not be changed
B) The L_thyroxin does should be decreased
C) The L_thyroxin does should be increased
D) The L_thyroxin does should be discontinued
E) Thyroid scan and uptake is needed to determine her thyroid dosage
26) A 45 years old man is admitted with the diagnosis of fulminant active liver failure . With respect to this condition , one is true :
A) Cerebral edema is an unusual cause of death
B) Late administration of of glutathione is unwarranted in paracetamol induced hepatic failure
C) Renal failure rarely occurs in paracetamol induced hepatic encephalopathy
D) High level of bilirubin is an indicator of poor prognosis
E) High level of ALT , AST is a marker for worsening liver failure
27) All of the following are associated with bloody diarrhea except :
A) Cholera
B) Cambylobacter
C) Enteroinvasive E_coli
D) Entamoeba histolytica
E) Shigella
28) The following are recognized causes of hemoptysis except :
A) TB
B) COPD
C) Bronchiectasis
D) Mitral stenosis
E) Good_Pasture syndrome
29) Which of the following drugs can cause deafness and renal impairment :
A) Aminoglycoside
B) Penicillin
C) Tetracycline
D) Quinolones
E) Sulphonoamide
30) Leukemia can be caused by one of the following :
A) Toluene
B) Tetra_Chloromethane
C) Acetone
D) Benzene
E) Ethyl lead
31) A 21 year old male who had recurrent DVT in both legs . All of the following are helpful in diagnosis of Behcets disease except :
A) Recurrent painful oral ulcers
B) Genital ulcers
C) Presence of uveitis
D) History of Erythema nodosum
E) Presence of finger clubbing
32) A 37 years old male patient with WPW syndrome developed wide complex tachycardia at a HR 200 BPM , he appears comfortable and BP 110/70 . The treatment of choice is :
A) Digoxin
B) Metoprolol
C) Procainamide
D) Verapamil
E) Adenosine
33) The effect of obesity on the risk of cardiovascular disease is known to be related to :
A) Gender
B) Family history
C) Body fat distribution
D) Age
E) Cigarette smoking
34) The management of Hyperkalemia include all except :
A) IV calcium gluconate
B) IV ammonium chloride
C) IV glucose and insulin
D) IV sodium bicarbonate
E) IV Furosemide
35) The first clinical manifestation of diabetic nephropathy is :
A) Elevated blood urea
B) Elevated creatinine
C) Urinary casts
D) Microalbuminuria
E) Abundant red blood cells in urine analysis
36) A 38 years old woman is admitted to the hospital with right lower lobe pneumonia and is treated with appropriate antibiotics . After 6 days clinical and radiological signs of right sided pleural effusion develops . A diagnostic pleural tap is performed . Which of the following pleural fluids results indicates the need for pleural spaces drainage :
A) PH of 7.30
B) Pleural to serum LDH ratio 0.6
C) Pleural to serum protein ratio 0.5
D) Differential cell count demonstrating 0 % nitrophils
E) Microscopy showing gram positive cocci
37) A 54 years old man has history of HTN , presented to the hospital with acute pulmonary edema , which of the following is the least likely cause of his condition :
A) Acute MI
B) Hypertensive crisis
C) Diastolic L.V dysfunction
D) Massive PE
E) Mitral regurgitation with rapid atrial fibrillation
38) One of the following can cause restrictive cardiomyopathy :
A) Mitral stenosis
B) TB pericarditis
C) Infective endocarditis
D) PE
E) Amyloidosis
39) All of the following may cause very high ESR except :
A) Active rheumatoid arthritis
B) Giant cell arteritis
C) SCA
D) Carcinomatosis
E) Multiple myeloma
40) Primary health care does not include :
A) Health education
B) Maternal and child health care
C) Sanitary water supply
D) Treatment of endemic disease
E) Provision of high technology instruments
41) Patient with DVT and heparin induced Thrombocytopenia may be treated with any of the following agents except :
A) Danaproid sodium
B) LMWH
C) Recombinant hirudin
D) Danaproid sodium plus warfarin added when platelet count is > 100.000
E) Argatroban
42) All of the following are features of Graves disease except :
A) Graves disease is the most common cause of Thyrotoxicosis
B) Multinodular goiter
C) Pertibeal myxedema
D) Exophthalmos
E) Increase radioactive iodine uptake
43) All of the following can cause renal glucosuria except :
A) Pregnancy
B) Addison disease
C) Cystinosis
D) Lead poisoning
E) Fanconi syndrome
44) You are asked to urgently evaluate a 65 years old female on the floor with acute onest of palpitation , shortness of breath , BP 80/60 mmhg , pulse rate 140_150 BPM and irregular . ECG showed atrial fibrillation , what is the most appropriate management :
A) IV Amiodarone
B) IV digoxin
C) Electrical cardioversion
D) IV beta blockers
E) IV flecainide
45) The leading cause of early death in patient with acute MI is :
A) Rupture of the myocardial wall
B) Rupture of the septum
C) Rupture of the cordae tendinea and acute mitral regurgitation
D) Ventricular arrhythmia
E) Ventricular aneurysm
46) Macrocytic anemia is a typical feature of all of the following except :
A) Folic acid deficiency
B) Hemolytic anemia
C) Alcohol abuse
D) IDA
E) Myelodysplastic syndrome
47) All of the following conditions causes hyperpigmentation except :
A) Primary adrenal insufficiency
B) Nelson syndrome
C) Renal failure
D) Panhypopitutarism
E) Hemochromatosis
48) All of the following causes prolongation of PT except :
A) Antiphospholipid syndrome
B) Vitamin K deficiency
C) Warfarin therapy
D) Factor 7 deficiency
E) Liver disease
49) All of the following are risk factors for gout except :
A) Use of Hydrochlorothiazide
B) Renal impairment
C) Use of alcohol
D) 40 years old male
E) 20 years old female
50) All of the following associated with ulcerative colitis except :
A) Myositis
B) Iritis
C) Pyoderma gangrenosum
D) Venous thromboembolism
E) Sclerosing Cholangitis
51) All of the following are clinical features for Pheochromocytoma except :
A) HTN
B) Palpitation
C) Weight gain
D) Vomiting
E) Sweating
52) All are suggestive of tuberculous meningitis except :
A) Cranial nerve palsies
B) Insidious onest
C) Cough and rhinorrhea
D) Very high CSF protein
E) Extremely low CSF glucose
53) One is true about caustic ingestion :
A) Early endoscopy is indicated
B) Induce vomiting reduce the complication
C) Absent of mouth lesions exclude the esophageal injury
D) Gastric lavage should be done as soon as possible
E) Alkali agents is more harmful than acidotic
54) All of the following are vaccine preventable diseases except :
A) Hepatitis C
B) Genital warts
C) Tetanus
D) Chickenpox
E) Influenza
55) All of the following can cause Erythema nodosum except :
A) Streptococcal infection
B) TB
C) Leprosy
D) Sarcoidosis
E) Amyloidosis
56) A 46 years old man presented with mild bloody diarrhea , which had lasted for 2 weeks . He had lost 2 kg in weight , had occasional lower abdominal cramps , discomfort , painful swelling of his left knee . Most likely diagnosis :
A) Amebiasis
B) Campylobacter infection
C) Crohn disease
D) Gonococcal septicemia
E) Ulcerative colitis
57) Thiazide diuretic can cause all of the following metabolic effects except :
A) Hypercalcemia
B) Hypertriglyceridemia
C) Hyponatremia
D) Metabolic acidosis
E) Hypomagnesemia
58) All of the following clinical signs of toxicity are paired with the affecting drug except :
A) Small pupils and opiates
B) Rhabdomyolsis and Statins
C) Tachycardia and Salbutamol
D) Arrhythmia and tricyclic antidepressants
E) Decreased respiratory rate and salicylates
59) A 35 years old female complaining of intermittent Dysphagia for more than 10 years for both fluids and solids , physical exam _ thin woman with normal findings , esophageal manometry confirmed her diagnosis . What is the best treatment :
A) PPI
B) Smooth muscle relaxants
C) Nissen fundoplication
D) Esophageal ballon dilation
E) Domperidone
60) All are features of Nephritic syndrome except :
A) Proteinuria
B) Hematuria
C) Epithelial casts
D) HTN
E) Oliguria
61) All of the following conditions can cause hyperprolactinemia except :
A) Antipsychotic drugs
B) Primary hypothyroidism
C) Chronic renal failure
D) Dopamine antagonist
E) Contraceptives
62) All of the following cut offs for PPD in the corresponding population and considered positive except :
A) 3 mm in an AIDS patient
B) 10 mm in a house hold contact of TB case
C) 17 mm in healthy person
D) 12 mm in a patient with renal failure
E) 13 mm in a person who repeatedly had negative tests in the past
63) In 15 years old male with 3 years of recurrent fever being evaluated for FMF , all of the following are very commonly seen except :
A) Recurrent attack of abdominal pain
B) Recurrent attack of knee arthritis
C) Recurrent attack of pleuratic chest pain
D) Presence of similar family history
E) Recurrent pericarditis
64) Proximal muscle weakness is commonly seen in all of the following except:
A) Prolonged steroids use
B) Dermatomyositis
C) Thyrotoxicosis
D) Vitamin D deficiency
E) HTN
65) All of the following drugs or produces can improve survival in patient with heart failure except :
A) Digoxin
B) Spironolactone
C) ACE_i
D) ICD _ implantation
E) Carvedilol
66) A 46 years old male with untreated hepatitis c infection , develops persistent Proteinuria . Which one of the following diagnosis is the most likely :
A) Membranous nephropathy
B) FSGS
C) MPGN type 1
D) IgA nephropathy
E) Polyarteritis nodosa
67) Which of the following patients with acute upper GI bleeding does not need urgent upper endoscopy :
A) A 20 years old male presenting with hematemesis and a systolic blood pressure of 85 mmhg .
B) A 31 year old alcoholic man presenting with melana and lethargy .
C) An 86 years old man to the clinic with coffee grounds vomiting and melana with blood pressure 120/80 mmhg .
D) A 37 years old man presenting with melana and in whome the nasogastric tube aspirate shows fresh blood .
E) A 42 years old woman who developed melana 3 days after her admission for pneumonia and heart failure .
68) A 34 years old has six months of weight gain , and three months of DM . On exam she had clinical features of mild Cushing . Which of the following is the best screening test for Cushing :
A) Metyrapone test
B) Serum cortisol
C) Serum ACTH
D) 24 hours urine collection for free cortisol
E) High dose dexamethasone suppression test
69) Which of the following drugs is contraindicated in patients with bronchial asthma :
A) Enalapril
B) Atenolol
C) Adrenaline
D) Verapamil
E) Bendrofluazide
70) A 56 years old man was found to have portal hypertension due to portal vein thrombosis secondary to Polycythemia rubra vera . Which of the following is expected in this patient :
A) Esophageal varices
B) Prolonged PT
C) Prolonged PTT
D) Jaundice
E) Hypoalbuminemia
71) A 29 years old female in noted to have mild jaundice , suspected to have Gilbert syndrome , all are true except :
A) Prevalence 1_2% in the general population
B) Rise bilirubin following prolonged fasting or IV necotinic acid
C) It's inheritance syndrome
D) Jaundice due to defect in bilirubin conjugation due to deficiency of glucuronyl transferase
E) Treatment by enzyme replacement
72) All are true about Dobin Johnson syndrome except :
A) It's benign autosomal recessive disorder
B) Results in an unconjugated hyperbilirubinemia
C) Defect in the cMOAT
D) Defect in hepatic bilirubin excretion
E) Bilirubin is present in urine
73) A 65 years old man with a history of dyspepsia is found to have a gastric MALTOMA on biopsy . The best treatment if it was low grade :
A) Gasterectomy
B) Laser ablation
C) No need for treatment , only follow up
D) Chemotherapy
E) H pylori eradication
74) A 23 years old man develops watery diarrhea 5 days after arriving in U.K . Which one of the following is the most common cause :
A) Salmonella
B) Shigella
C) Campylobacter
D) E coli
E) Bacillus cereus
A) Hemoglobin
B) MCV
C) MCH
D) Ferritin
E) Reticulocyte
2) Rheumatoid arthritis is rarely present with :
A) Joint swelling and tenderness
B) Elevated ESR
C) Elevated CRP
D) Morning stiffness
E) Skin rash and fever
3) Suggestive of Hypercalcemia on ECG :
A) AV block
B) Tall narrow peaked T wave
C) Wide QRS
D) J wave Osborn wave
E) Sinus irritability
4) Guillain barre syndrome is associated with one :
A) Symmetrical ascending paralysis
B) Spasticity
C) Increased DTRs
D) Autosomal recessive inheritance
E) Not affecting the cranial nerves
5) All are true about chronic renal failure except :
A) Hyperkalemia
B) Hyperphosphatemia
C) Hypercalcemia
D) Low HB
E) Metabolic acidosis
6) All are manifestation of diabetic neuropathy except :
A) Infertility
B) Gastroparesis
C) Oculomotor nerve palsy
D) Charcot joint
E) Nocturnal diarrhea
7) The most important medication in treatment of acute bronchial asthma exacerbation :
A) Ipratropium bromide
B) Salbutamol
C) Oxygen
D) IV corticosteroids
E) Salmeterol
8) A 66 years old woman is noted to have asymptomatic atrial fibrillation . Which of the following is the most common complication of her atrial fibrillation :
A) Sudden death
B) Stroke
C) Shock
D) MI
E) Dyspnea
9) Post Streptococcal acute Glomerulonephritis is characterized by all of the following except :
A) Occurs usually within 2_3 weeks of the infection
B) Low plasma levels of C3 , C4
C) HTN
D) RBCs casts in urine sediment
E) Adult have worst prognosis than children
10) Digoxin toxicity can lead to all of the following ECG findings except :
A) Frequent ventricular premature beats
B) ST depression in lateral chest leads V4 , V5 , V6
C) Ventricular tachycardia
D) Complete heart block
E) Prolongation P_R interval
11) Which of the following disease is least likely to be preventable with lifestyle change :
A) Cardiovascular disease
B) Cancer
C) TB
D) COPD
E) Liver cirrhosis
12) A 45 years old man with DM type 2 , have BP 145/90 and 150/96 mmhg on two separate occasions . Which of the following is the best initial therapy :
A) Hydrochlorothiazide
B) ACE_i
C) Beta blockers
D) Hydralazine
E) Spironolactone
13) In spondyloarthropathy , all are true except :
A) HLA B27 is a common association
B) IBD may be underlying disease
C) Psoriasis may be seen
D) Sacroiliitis can be seen on X_Ray
E) More common in females than males
14) All are causes of nephrogenic DI except :
A) Lithium
B) Demeclocycline
C) Thiazide
D) Hypokalemia
E) Hypercalcemia
15) The presence of a thick walled cavitary lung infiltrate on the chest radiograph can be explained by all of the following pathologies except :
A) Wegener Granuloma
B) SCC
C) Lung abscess
D) Mycetoma
E) Pulmonary cyst
16) All of the following can be found in patient with diabetic Ketoacidosis except :
A) PH < 7.35
B) Bicarbonate 15 mmol/L
C) K in serum 6 mmol/L
D) Keton bodies in urine
E) Anion gap 12
17) A 30 years old man has history of bilateral bronchiectasis and recurrent hospitalization for chest infection . During the last admission a sputum culture was done and showed Pseudomonas aeruginosa . He is here today with fever and productive cough of large amount of green sputum , the best antibiotic is :
A) Ceftriaxone
B) Vancomycin
C) Cefotaxime
D) Pipracillin / Tazobactam
E) Amoxicillin / Clavulanic acid
18) In active systematic lupus disease , all of the following are commonly seen except :
A) Proteinuria
B) Thrombocytopenia
C) Arthritis
D) ANA positive
E) Thrombocytosis
19) Splenomegaly can occur in all of the following except :
A) Chronic granulocytic leukemia
B) Chronic malaria
C) Amyloidosis
D) Celiac disease
E) Polycythemia rubra vera
20) Hepatitis B infection is a common and serious problem worldwide , all of the following are true regarding HBV infection except :
A) A positive anti_HBC (IgM) and HBS Ag suggests acute infection
B) When the infection resolves , HBS Ag becomes negative and anti_HBC (IgG) remain positive
C) HBS Ab is a sign of previous infection or immunization
D) Most of acute HBV infection present with jaundice
E) The level of blood HBV DNA is reliable index of active infection
21) In Acromegaly all are true except :
A) Hypotension
B) Impaired glucose tolerance test
C) Erectile dysfunction
D) Elevated IGF_1
E) Bitemporal hemianopia
22) All of the following are suggestive of secondary causes of HTN except :
A) Low plasma renine activity
B) Hypochloremia
C) Urine red blood cells cast
D) Metabolic alkalosis
E) Hypokalemia
23) All of the following environmental hazards , the only non threshold exposure is :
A) Ionizing radiation
B) Noise
C) Heat
D) Lead
E) Carbon monoxide
24) All of the following are true regarding primary Hyperparathyroidism , except :
A) Associated with MEN1 syndrome
B) Osteitis fibrosa cystica
C) Nephrocalcinosis
D) Hyperphosphatemia
E) Short QT interval
25) 65 years old female with primary hypothyroidism , on L_thyroxin replacement 100 mcg / day and clinically euthyroid her lab shows a TSH =2 ( normal 0.45_4.5) with normal T4 and T3 . Which one of the following is true regarding her management :
A) The L_thyroxin does should not be changed
B) The L_thyroxin does should be decreased
C) The L_thyroxin does should be increased
D) The L_thyroxin does should be discontinued
E) Thyroid scan and uptake is needed to determine her thyroid dosage
26) A 45 years old man is admitted with the diagnosis of fulminant active liver failure . With respect to this condition , one is true :
A) Cerebral edema is an unusual cause of death
B) Late administration of of glutathione is unwarranted in paracetamol induced hepatic failure
C) Renal failure rarely occurs in paracetamol induced hepatic encephalopathy
D) High level of bilirubin is an indicator of poor prognosis
E) High level of ALT , AST is a marker for worsening liver failure
27) All of the following are associated with bloody diarrhea except :
A) Cholera
B) Cambylobacter
C) Enteroinvasive E_coli
D) Entamoeba histolytica
E) Shigella
28) The following are recognized causes of hemoptysis except :
A) TB
B) COPD
C) Bronchiectasis
D) Mitral stenosis
E) Good_Pasture syndrome
29) Which of the following drugs can cause deafness and renal impairment :
A) Aminoglycoside
B) Penicillin
C) Tetracycline
D) Quinolones
E) Sulphonoamide
30) Leukemia can be caused by one of the following :
A) Toluene
B) Tetra_Chloromethane
C) Acetone
D) Benzene
E) Ethyl lead
31) A 21 year old male who had recurrent DVT in both legs . All of the following are helpful in diagnosis of Behcets disease except :
A) Recurrent painful oral ulcers
B) Genital ulcers
C) Presence of uveitis
D) History of Erythema nodosum
E) Presence of finger clubbing
32) A 37 years old male patient with WPW syndrome developed wide complex tachycardia at a HR 200 BPM , he appears comfortable and BP 110/70 . The treatment of choice is :
A) Digoxin
B) Metoprolol
C) Procainamide
D) Verapamil
E) Adenosine
33) The effect of obesity on the risk of cardiovascular disease is known to be related to :
A) Gender
B) Family history
C) Body fat distribution
D) Age
E) Cigarette smoking
34) The management of Hyperkalemia include all except :
A) IV calcium gluconate
B) IV ammonium chloride
C) IV glucose and insulin
D) IV sodium bicarbonate
E) IV Furosemide
35) The first clinical manifestation of diabetic nephropathy is :
A) Elevated blood urea
B) Elevated creatinine
C) Urinary casts
D) Microalbuminuria
E) Abundant red blood cells in urine analysis
36) A 38 years old woman is admitted to the hospital with right lower lobe pneumonia and is treated with appropriate antibiotics . After 6 days clinical and radiological signs of right sided pleural effusion develops . A diagnostic pleural tap is performed . Which of the following pleural fluids results indicates the need for pleural spaces drainage :
A) PH of 7.30
B) Pleural to serum LDH ratio 0.6
C) Pleural to serum protein ratio 0.5
D) Differential cell count demonstrating 0 % nitrophils
E) Microscopy showing gram positive cocci
37) A 54 years old man has history of HTN , presented to the hospital with acute pulmonary edema , which of the following is the least likely cause of his condition :
A) Acute MI
B) Hypertensive crisis
C) Diastolic L.V dysfunction
D) Massive PE
E) Mitral regurgitation with rapid atrial fibrillation
38) One of the following can cause restrictive cardiomyopathy :
A) Mitral stenosis
B) TB pericarditis
C) Infective endocarditis
D) PE
E) Amyloidosis
39) All of the following may cause very high ESR except :
A) Active rheumatoid arthritis
B) Giant cell arteritis
C) SCA
D) Carcinomatosis
E) Multiple myeloma
40) Primary health care does not include :
A) Health education
B) Maternal and child health care
C) Sanitary water supply
D) Treatment of endemic disease
E) Provision of high technology instruments
41) Patient with DVT and heparin induced Thrombocytopenia may be treated with any of the following agents except :
A) Danaproid sodium
B) LMWH
C) Recombinant hirudin
D) Danaproid sodium plus warfarin added when platelet count is > 100.000
E) Argatroban
42) All of the following are features of Graves disease except :
A) Graves disease is the most common cause of Thyrotoxicosis
B) Multinodular goiter
C) Pertibeal myxedema
D) Exophthalmos
E) Increase radioactive iodine uptake
43) All of the following can cause renal glucosuria except :
A) Pregnancy
B) Addison disease
C) Cystinosis
D) Lead poisoning
E) Fanconi syndrome
44) You are asked to urgently evaluate a 65 years old female on the floor with acute onest of palpitation , shortness of breath , BP 80/60 mmhg , pulse rate 140_150 BPM and irregular . ECG showed atrial fibrillation , what is the most appropriate management :
A) IV Amiodarone
B) IV digoxin
C) Electrical cardioversion
D) IV beta blockers
E) IV flecainide
45) The leading cause of early death in patient with acute MI is :
A) Rupture of the myocardial wall
B) Rupture of the septum
C) Rupture of the cordae tendinea and acute mitral regurgitation
D) Ventricular arrhythmia
E) Ventricular aneurysm
46) Macrocytic anemia is a typical feature of all of the following except :
A) Folic acid deficiency
B) Hemolytic anemia
C) Alcohol abuse
D) IDA
E) Myelodysplastic syndrome
47) All of the following conditions causes hyperpigmentation except :
A) Primary adrenal insufficiency
B) Nelson syndrome
C) Renal failure
D) Panhypopitutarism
E) Hemochromatosis
48) All of the following causes prolongation of PT except :
A) Antiphospholipid syndrome
B) Vitamin K deficiency
C) Warfarin therapy
D) Factor 7 deficiency
E) Liver disease
49) All of the following are risk factors for gout except :
A) Use of Hydrochlorothiazide
B) Renal impairment
C) Use of alcohol
D) 40 years old male
E) 20 years old female
50) All of the following associated with ulcerative colitis except :
A) Myositis
B) Iritis
C) Pyoderma gangrenosum
D) Venous thromboembolism
E) Sclerosing Cholangitis
51) All of the following are clinical features for Pheochromocytoma except :
A) HTN
B) Palpitation
C) Weight gain
D) Vomiting
E) Sweating
52) All are suggestive of tuberculous meningitis except :
A) Cranial nerve palsies
B) Insidious onest
C) Cough and rhinorrhea
D) Very high CSF protein
E) Extremely low CSF glucose
53) One is true about caustic ingestion :
A) Early endoscopy is indicated
B) Induce vomiting reduce the complication
C) Absent of mouth lesions exclude the esophageal injury
D) Gastric lavage should be done as soon as possible
E) Alkali agents is more harmful than acidotic
54) All of the following are vaccine preventable diseases except :
A) Hepatitis C
B) Genital warts
C) Tetanus
D) Chickenpox
E) Influenza
55) All of the following can cause Erythema nodosum except :
A) Streptococcal infection
B) TB
C) Leprosy
D) Sarcoidosis
E) Amyloidosis
56) A 46 years old man presented with mild bloody diarrhea , which had lasted for 2 weeks . He had lost 2 kg in weight , had occasional lower abdominal cramps , discomfort , painful swelling of his left knee . Most likely diagnosis :
A) Amebiasis
B) Campylobacter infection
C) Crohn disease
D) Gonococcal septicemia
E) Ulcerative colitis
57) Thiazide diuretic can cause all of the following metabolic effects except :
A) Hypercalcemia
B) Hypertriglyceridemia
C) Hyponatremia
D) Metabolic acidosis
E) Hypomagnesemia
58) All of the following clinical signs of toxicity are paired with the affecting drug except :
A) Small pupils and opiates
B) Rhabdomyolsis and Statins
C) Tachycardia and Salbutamol
D) Arrhythmia and tricyclic antidepressants
E) Decreased respiratory rate and salicylates
59) A 35 years old female complaining of intermittent Dysphagia for more than 10 years for both fluids and solids , physical exam _ thin woman with normal findings , esophageal manometry confirmed her diagnosis . What is the best treatment :
A) PPI
B) Smooth muscle relaxants
C) Nissen fundoplication
D) Esophageal ballon dilation
E) Domperidone
60) All are features of Nephritic syndrome except :
A) Proteinuria
B) Hematuria
C) Epithelial casts
D) HTN
E) Oliguria
61) All of the following conditions can cause hyperprolactinemia except :
A) Antipsychotic drugs
B) Primary hypothyroidism
C) Chronic renal failure
D) Dopamine antagonist
E) Contraceptives
62) All of the following cut offs for PPD in the corresponding population and considered positive except :
A) 3 mm in an AIDS patient
B) 10 mm in a house hold contact of TB case
C) 17 mm in healthy person
D) 12 mm in a patient with renal failure
E) 13 mm in a person who repeatedly had negative tests in the past
63) In 15 years old male with 3 years of recurrent fever being evaluated for FMF , all of the following are very commonly seen except :
A) Recurrent attack of abdominal pain
B) Recurrent attack of knee arthritis
C) Recurrent attack of pleuratic chest pain
D) Presence of similar family history
E) Recurrent pericarditis
64) Proximal muscle weakness is commonly seen in all of the following except:
A) Prolonged steroids use
B) Dermatomyositis
C) Thyrotoxicosis
D) Vitamin D deficiency
E) HTN
65) All of the following drugs or produces can improve survival in patient with heart failure except :
A) Digoxin
B) Spironolactone
C) ACE_i
D) ICD _ implantation
E) Carvedilol
66) A 46 years old male with untreated hepatitis c infection , develops persistent Proteinuria . Which one of the following diagnosis is the most likely :
A) Membranous nephropathy
B) FSGS
C) MPGN type 1
D) IgA nephropathy
E) Polyarteritis nodosa
67) Which of the following patients with acute upper GI bleeding does not need urgent upper endoscopy :
A) A 20 years old male presenting with hematemesis and a systolic blood pressure of 85 mmhg .
B) A 31 year old alcoholic man presenting with melana and lethargy .
C) An 86 years old man to the clinic with coffee grounds vomiting and melana with blood pressure 120/80 mmhg .
D) A 37 years old man presenting with melana and in whome the nasogastric tube aspirate shows fresh blood .
E) A 42 years old woman who developed melana 3 days after her admission for pneumonia and heart failure .
68) A 34 years old has six months of weight gain , and three months of DM . On exam she had clinical features of mild Cushing . Which of the following is the best screening test for Cushing :
A) Metyrapone test
B) Serum cortisol
C) Serum ACTH
D) 24 hours urine collection for free cortisol
E) High dose dexamethasone suppression test
69) Which of the following drugs is contraindicated in patients with bronchial asthma :
A) Enalapril
B) Atenolol
C) Adrenaline
D) Verapamil
E) Bendrofluazide
70) A 56 years old man was found to have portal hypertension due to portal vein thrombosis secondary to Polycythemia rubra vera . Which of the following is expected in this patient :
A) Esophageal varices
B) Prolonged PT
C) Prolonged PTT
D) Jaundice
E) Hypoalbuminemia
71) A 29 years old female in noted to have mild jaundice , suspected to have Gilbert syndrome , all are true except :
A) Prevalence 1_2% in the general population
B) Rise bilirubin following prolonged fasting or IV necotinic acid
C) It's inheritance syndrome
D) Jaundice due to defect in bilirubin conjugation due to deficiency of glucuronyl transferase
E) Treatment by enzyme replacement
72) All are true about Dobin Johnson syndrome except :
A) It's benign autosomal recessive disorder
B) Results in an unconjugated hyperbilirubinemia
C) Defect in the cMOAT
D) Defect in hepatic bilirubin excretion
E) Bilirubin is present in urine
73) A 65 years old man with a history of dyspepsia is found to have a gastric MALTOMA on biopsy . The best treatment if it was low grade :
A) Gasterectomy
B) Laser ablation
C) No need for treatment , only follow up
D) Chemotherapy
E) H pylori eradication
74) A 23 years old man develops watery diarrhea 5 days after arriving in U.K . Which one of the following is the most common cause :
A) Salmonella
B) Shigella
C) Campylobacter
D) E coli
E) Bacillus cereus
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