‫الجماهيرية العربية الليبية الشعبية اإلشتراكية العظمى‬

‫جامعة الفاتح للعلوم الطبية‬

‫كلية الطب‬
‫قسم الباطنة‬

‫إمتحان الدور التكميلي لمادة الباطنة‬

‫‪The Reset Examination in Medicine‬‬

‫اإلمتحان الكتابي النهائي‬

‫الورقة األولى‬
‫الثالثاء ‪27/4/2010‬‬
‫***‬
‫‪The Final Written Exam‬‬
‫‪Paper - I‬‬
‫‪Tuesday 27/4/2010‬‬

‫الوقت المخصص ساعتان ونصف‬

‫‪TIME ALLOWED 2½ HOURS‬‬

‫مالحظات بشأن ورقة األسئلة‪:‬‬

‫يتكون اإلمتحان من خمسة وأربعين سؤاالً موزعة على ‪12‬صفحة‪.‬‬ ‫‪.1‬‬
‫تتكون ورقة األسئلة من قسمين‪:‬‬ ‫‪.2‬‬
‫القسم (أ) ‪ 25‬سؤال سيرة حالة (‪)Case Scenario‬‬ ‫‪.1‬‬
‫القسم (ب) ‪ 20‬سؤال تفسير بيانات (‪)Data Interpretation‬‬ ‫‪.2‬‬

‫مالحظات بشأن ورقة اإلجابة‪:‬‬

‫تأكد من كتابة إسمك ورقم جلوسك‪ i‬أوال‪.‬‬ ‫‪.1‬‬
‫يجب تظليل رقم الجلوس في الخانة المعدة لذلك بدقة‪.‬‬ ‫‪.2‬‬
‫إستخدم‪ i‬قلم الرصاص في التظليل‪.‬‬ ‫‪.3‬‬
‫أجب عن كل األسئلة‬ ‫‪.4‬‬
‫إختر إجابة واحدة فقط لكل سؤال‬ ‫‪.5‬‬
‫يعطى صفر لكل إجابة خاطئة‪.‬‬ ‫‪.6‬‬
 Section (A): Case Scenarios

1- A 66 year old man, who is a known case of type 2 diabetes mellitus for 18 years, presented
with a sudden onset of dyspnea that awaked him from sleep. When arrived at emergency
room he was anxious, dyspnic, with cyanosed lips and extremities, his pulse is regular at a
rate of 112/min, respiratory rate of 34/min, blood pressure of 160/100mmHg. Chest
examination revealed bi-basal crepitations.
You should consider all of the following treatment options for his case, EXCEPT:
a) i.v. Morphine.
b) Oxygen in a concentration of 60%
c) i.v. Frusemide.
d) i.v. Atenolol
e) i.v.glyceryl trinitrate

2- A 23 year old female presented with a 3 days history of chest pain and shortness of breath
which is worse on inspiration, coughing and lying flat and relieved by sitting. Physical
examination revealed a thin female in no obvious distress. Blood pressure was 130/80 and
pulse was 80. Lungs were clear and cardiovascular examination revealed a friction rub
heard best at the left lower sternal border.
All of the following statements regarding this patient’s case are true, EXCEPT:
a) History of a recent upper respiratory tract infection is relevant.
b) Serum markers of inflammation are expected to be raised.
c) Absence of pericardial effusion excludes your diagnosis.
d) Usually it is a self-limiting condition, and symptoms are controlled by non-steroidal anti-
inflammatory drugs.
e) Chronic constrictive pericarditis is a potential complication.

3- A 39 year old man, known hypertensive on irregular treatment, presented to the emergency
room with history of blurring of vision and headache for the past 7 hours. On examination,
he looks unwell, pulse is regular at a rate of 88/min, Blood pressure is 270/150mmHg.
All of the following are true statements regarding this patient’s case, EXCEPT:
a) Cocaine drug abuse may contribute to his condition.
b) He should be managed in an intensive care unit with immediate treatment of his high
blood pressure.
c) Fundoscopy is expected to reveal papilledema, hemorrhage and exudates.
d) If his serum potassium is high, this suggests Conn’s disease is the likely underlying cause.
e) Sudden drop of his blood pressure may cause an ischemic stroke.

4- A 30 year old female, known case of bronchial asthma, she failed to respond adequately to
budesonide 400µg /day and salbutamol inhaler.
The next step in the management of this patient would be:
a) Doubling the dosage of inhaled corticosteroids
b) Addition of a long-acting b-agonist
c) Addition of a leukotriene antagonist
d) Addition of theophylline
e) Addition of systemic corticosteroids

Page 1 of 12
5- A 16-year-old male patient, previously healthy, came to the emergency department with
complaints of shortness of breath and chest pain which started one day ago. The shortness
of breath was mild in severity, made worse by exertion and relieved with rest, associated
with left sided chest pain, sharp in nature. He denied any similar symptoms in the past. He
did drink alcohol, denied drug abuse and there was no history of trauma.
On examination; Blood pressure was 112/70 mm/Hg, pulse rate of 90/min, afebrile and
respiratory rate of 23/min. Chest examination revealed a trachea in midline with a hyper
resonance on percussion of the left side of the chest, auscultation showed no breath sounds
on the left side with no crepitations or wheeze. His cardiac and abdominal examinations
were unremarkable. Oxygen saturation was 90% at room air.
All of the following are true regarding this case, EXCEPT:
a) About 90% of cases are smokers or were smokers.
b) This condition most commonly affects men between 20–40 years of age
c) Some individuals have a genetic predisposition to it.
d) A CT scan of the chest is the best initial radiological assessment tool in this case.
e) A Chest tube has to be placed and connected to underwater seal.

6- A 30 year old female patient with history of Caesarean section 20 days ago, presented with
a sudden onset of right sided chest pain and hemoptysis. She gives a history for being
treated for DVT twice with anticoagulants the last was a year ago. On examination she is
cyanosed, tachypnic, her oxygen saturation is 82%, pulse 120/min-regular, blood pressure
120/80mmHg, chest examination is unremarkable, she has left lower limb edema.
All of the following are true regarding her condition, EXCEPT:
a) Chest X-ray is expected to be normal.
b) D-dimer <500ng/ml excludes pulmonary thromboembolism.
c) Doppler U/S to the lower limbs is advisable.
d) Accentuated pulmonary component of the second sound is expected.
e) Arterial blood gases usually show type 1 respiratory failure.

7- A 31 year old woman presented with a 3 year history of chronic diarrhea, tiredness and
weight loss. On examination, she was underweight and has gaseous abdominal distension.
Upper gastro-intestinal endoscopy and a duodenal biopsy was performed, the biopsy report
shows flattened villi.
All of the following statements are true, EXCEPT:
a) Patient is advised to include rice in her diet.
b) Serum antigliadin antibodies are expected to be detectable.
c) Most patients need a course of steroids to induce remission.
d) The anemia is most likely due to folate or iron deficiency.
e) There is an association with the development of lymphoma

8. A 33 year old man, previously healthy, presented with 7 days history of yellow eyes
followed in 4 days by poor concentration and confusion. On examination, he is confused,
has yellow sclera. Flapping tremors were seen on extended hands and fetor hepaticus is
present. Abdominal examination was unremarkable.
Which of the following statements is TRUE regarding this case?
a) Cerebral edema is an unusual cause of death.
b) Renal failure rarely occurs if this condition is paracetamol induced.
c) INR measurement is not a sensitive index liver function in this case.
d) This patient may be a candidate for liver transplantation.
e) Prognosis is generally good.
Page 2 of 12
9- A 44 year old woman presents to the outpatient clinic complaining of tiredness, loss of
appetite and weight loss of 6 kg over the past 4 months. She has diarrhea that is associated
with abdominal pain, there is no blood in the stool. On examination, she is underweight,
pale with angular stomatitis, she has mild tenderness in the right iliac fossa. Her Hgb is 7.1
g/dl, MCV 61 fl, WBC 7.8 x 109/l, platelets 560 x 109/l, ESR 91 mm/1st Hr.
All of the following statements regarding this patient’s condition are true, EXCEPT:
a) The presence of fistula in-ano and perirectal abscesses are of diagnostic significance.
b) Colonoscopy is contraindicated in this patient.
c) Elevation of CRP concentration is helpful in monitoring disease activity.
d) MRI scan is helpful in diagnosing perineal involvement.
e) Development of colonic cancer is a known complication.
10- A 52 year old man, previously healthy, presented with fatigability, headaches, pruritus
following a warm bath and recurrent attacks of epistaxis over the last 8 months. He never
smoked and has no history of any significant illness in himself or in his family. On
examination; the patient looks plethoric, afebrile with a pulse of 88/min, blood pressure of
120/80 mmHg. Abdominal examination revealed a palpable spleen. Investigations reveal;
Hgb 19g/dl. WBC 14.3 x 109/l, Platelets 500 x 109/l
The following statements are true regarding this case, EXCEPT:
a) Hyperuricaemia is may be a finding in this patient.
b) Venesection gives prompt relief of symptoms.
c) Aspirin is used to reduce the risk of thrombosis.
d) Splenectomy is the treatment of choice.
e) Peptic ulceration may be associated with this disease.
11- A 22 year old female, previously healthy, presented with sore throat, menorrhagia and
bruises over the skin which developed over the past week. On examination, she is pale,
temperature 38oC, regular pulse of 108/min, blood pressure 120/70 mmHg, she has
generalized lymph node enlargement, her spleen is palpable and there are multiple bruises
over the skin. Throat is congested and chest and cardiac examinations were unremarkable.
Investigations show; Hgb 8.8 g/dl, WBC 18 x 109/l, Platelets 54 x 109/l, peripheral blood film
examination shows 24% lymphoblasts.
Based on the given data the diagnosis of this patient is compatible with:
a) Acute myelogenous leukemia
b) Chronic lymphocytic leukemia
c) Acute lymphoblastic leukemia
d) Myelofibrosis.
e) Infectious mononucleosis.
12- A 32 year old female, previously healthy, presented with a 2 month history of fatigue,
exertional dyspnea and palpitation which worsened in the last week so that she gets dyspnic
even after walking few steps out of bed. On examination, she is pale, regular pulse of
96/min, blood pressure 120/60mmHg. Chest, Cardiac and abdominal examination were
unremarkable. Hgb 5.6 g/dl, MCV 60fl (N80-100), MCH 16 pg (N26-34), WBC 7.3x10 9/l,
Platelets 218 x 109/l.
All of the following statements are true, EXCEPT:
a) A history of NSAID intake is of significance.
b) You expect a low serum ferritin and high iron binding capacity.
c) Packed Red Cell transfusion is indicated in this patient.
d) Parentral iron leads to faster improvement in hemoglobin level than oral iron.
e) Vitamin C helps improve absorption of iron from animal sources.
Page 3 of 12
13- A 40 year old woman is referred to you because of lethargy, cold intolerance, constipation,
dry skin and weight gain. Physical examination shows mildly enlarged thyroid, enlarged
tongue and slow reflexes.
Which test best confirms the clinical impression of primary hypothyroidism?
a) Measurement of serum T4
b) Measurement of serum T3
c) Measurement of serum TSH
d) Measurement of serum thyroglobulin.
e) Test for antithyroidal antibodies.

14- A 38 year old male presented with a six month history of weight loss, increased skin
pigmentation, dizziness upon standing and episodic severe colicky abdominal pain.
Investigations revealed; Hgb 12 g/dl, MCV 84 fl, Urea 32 mg/dl, Sodium 125 mmol/l,
Potassium 6.1 mmol/l, random blood sugar 54mg/dl.
Which of the following is the most appropriate next investigation?
a) Glucocorticoid suppression test.
b) MRI of the pituitary gland
c) Insulin level
d) Short ACTH stimulation test.
e) Renin-Aldosterone ratio.

15- A 24 year old female, diagnosed 5 years ago with type 1 diabetes mellitus. She is on
morning dose of NPH insulin of 26U/day. She lost 15 kg of her weight and she is non-
compliant to her treatment and follow-up. She attended the diabetic clinic for a pre-
employment check up. Her fasting blood sugar was 220mg/dl, and random 6 pm blood
sugar was 118mg/dl.
All of the following statements are true, EXCEPT:
a) Presence of swelling at injection site is consistent with lipodystrophy.
b) Hemoglobin A1C is expected to be > 7%
c) Increasing the morning dose of insulin is advisable.
d) Adverse fetal outcome is expected if tight blood sugar control is not adopted during
pregnancy.
e) Regular screening for retinopathy by fundal photography is recommended

16- A 58 year old man presents with 7 month history of involuntary shaking movements of his
left hand. On examination, there was a coarse slow resting tremor of the hands with no
intentional component, muscle tone in limbs was increased throughout the whole range of
movement and his face was masked.
Which of the following statements is TRUE?
a) The blink reflex is expected to be exaggerated.
b) Up going planters is typical finding in this case.
c) CT Brain is needed to confirm the diagnosis.
d) Levodopa should be initiated as soon as the diagnosis is suspected.
e) Benzhexol is an excellent option in old people with hypokinesia.

Page 4 of 12
17- A 28 year old male presented with a sudden onset of generalized tonic clonic convulsions
that lasted for 5 minutes and followed by headache, tongue biting and urinary
incontinence. He had a similar attack 4 months ago. There is no history of trauma. On
examination; he is mildly confused, with a regular pulse of 68/min and a blood pressure of
120/70mmHg and no fever. His neurological examination was unremarkable.
All of the following statements are true, EXCEPT:
a) A history of visual aura is of clinical significance.
b) Fundal examination is mandatory.
c) The EEG may help to establish the diagnosis.
d) Anticonvulsant therapy is not indicated at this stage.
e) When started, anticonvulsant therapy may be withdrawn after complete control of
seizures for 2-4 years.

18- A 58 year old female who is a known case of rheumatoid arthritis for 15 years presented
with severe pain in the right knee for 2 days. On examination; the right knee was swollen,
hot, erythematous and tender.
Which of the following statements is TRUE regarding this patient’s case?
a) Aspiration of the synovial fluid must be performed.
b) Anti-nuclear antibodies are of diagnostic value.
c) Physiotherapy is indicated.
d) Treatment with anti-TNF blockers is of benefit.
e) X-Ray of the right knee is the investigation of choice.

19- A 31 year old man, he has a long lasting history of intravenous drug abuse, presented with
a one week history of dry cough and fever. On examination, he was unwell, temperature of
40oC, pulse 112/min, blood pressure 120/70 mmHg. He has generalized lymph node
enlargement. Chest auscultation reveals bilateral fine basal crepitations. Cardiac,
abdominal and neurological examinations were unremarkable. CBC: WBC 1.2 x 10 9/l, Hgb
11g/dl, Platelets 261 x 109/l. Chest X ray shows diffuse interstitial infiltrate. Urea,
creatinine, electrolytes, blood sugar and liver function were within normal.
All of the following are true regarding this case, EXCEPT:
a) A CD4 lymphocyte count is expected to be low.
b) Bronchoscopy and bronchial lavage are helpful.
c) Pneumocystis jiroveci (Pneumocystis carinii) is the most likely cause of his chest signs.
d) Respiratory failure is a recognized complication.
e) Intravenous ceftriaxone is the treatment of choice.

20- A 61 year-old retired man who is a known case of type 2 diabetes mellitus for 30 years on
insulin therapy. Presented with few months history of tiredness and breathlessness. On
examination, he is pale, Blood pressure 170/100 mmHg, Abdominal and Chest
examinations were unremarkable. Investigations show: Hgb 8 g/dl, with normal MCV and
MCH, WBC 8 x 109/l, Platelets 238 x 109/l, fasting blood sugar 148 mg/dl, Urea 210 mg/dl
(N 10-40), creatinine 3.4 mg/dl (N<1.2), Na 134 mmol/l, K 4.9 mmol/l, Serum Calcium 7
mg/dl (N 8.5-10.5).
All of the following are true regarding this patient management, EXCEPT:
a) Administration of recombinant erythropoietin is indicated.
b) Target blood pressure control in this patient should be < 130/80 mmHg.
c) Muscle cramps are common in such patients.
d) Calcium carbonate is recommended if acidosis is present in this patient.
e) Insulin requirements are expected to increase in this patient.
Page 5 of 12
21- A 44 year old man was admitted for treatment of lobar pneumonia. Immediately after commencing
antibiotic treatment he developed a severe facial swelling, stridor and shortness of breath. On
examination he looks seriously ill, with profuse sweating and facial flushing, his pulse was weak and
his blood pressure is 80/50 mmHg.
What is your most appropriate immediate management of this patient?
a) i.v. normal saline.
b) i.v. plasma.
c) i.m adrenaline.
d) i.v. hydrocortisone.
e) i.v. penicillin

22- A 32 year old male patient presented with patches of hair loss over the scalp for 3 weeks duration.
On examination the patches were round with normal appearing skin. There are “exclamation
mark” hairs at the edge of the patches.
All of the following statements about this case are true, EXCEPT:
a) Involvement of the eye brows and eye lashes is not expected.
b) Nail pitting may be seen.
c) It is associated with autoimmune disorders.
d) The condition may be recurrent.
e) Intralesional steroids are used.

23- A 28 year old male presented to dermatology clinic with a 4 week history of itchy lesions over the
wrists. On examination, there were multiple flat topped purplish papules over the inner surface of
both wrists and ankles.
All of the following regarding this case are true, EXCEPT:
a) Köbner phenomenon is expected to be seen in this case.
b) Wickham’s striae over the papules are characteristic.
c) Annular lesions are common on the penis.
d) The nails are usually affected.
e) Local corticosteroids may help improve itching.

24- A 19 year old medical student was brought by his father to the psychiatric casualty because of
sudden onset of bizarre behavior and talking to people while no one is beside him. His father said
that his son is socially withdrawn, has insomnia and reports that he hears some voices ordering him
to injure his brother. The patient also believes that his intelligent ideas have been stolen from his
mind by a superpower. The father was confident that his son is not abusing any drugs.
The most likely diagnosis of this condition is:
a) Bipolar disorder.
b) Hysteria.
c) Obsessive compulsive neurosis.
d) Schizophrenia.
e) Panic disorder.

25- A 33 year old woman was admitted to psychiatric hospital after a suicidal attempt. She has a
history of previous trials of suicide 2 times before. She expressed sense of hopelessness, feeling
guilty of doing wrong and she was tearful and not interested to talk to her doctor. She was slow
speaker and her movements were retarded.
All of the following statements are true regarding this patient, EXCEPT:
a) Hypothyroidism should be excluded.
b) Antidepressant therapy should be commenced.
c) Sympathetic psychotherapy is needed.
d) Lithium carbonate will help improve her depressed mood.
e) Her condition indicates admission to psychiatry ward.

Page 6 of 12
 Section (B): Data Interpretation
26- A 66 year old man who was admitted to coronary care unit because of myocardial
infarction 7 hours ago. Suddenly the patient became unresponsive, pulseless and his ECG
monitor shows the following trace:

The NEXT step in the management of this patient would be:

a) i.v. lignocaine.
b) i.v. adrenaline.
c) Start cardiac massage.
d) i.v. atropine.
e) Insertion of intra-aortic balloon pump.

27- This is an ECG of a 69 year old man who suffers from diabetes and hyperlipidaemia.

Which abnormality does this ECG show?

a) Left ventricular hypertrophy.
b) Right ventricular hypertrophy.
c) Left bundle branch block pattern.
d) Right bundle branch block pattern.
e) Acute anterior myocardial infarction.

Page 7 of 12
28- This ECG is taken from an elderly patient who is complaining of palpitation.

Which of the following diseases you will look for in this patient?
a) Renal Failure.
b) Lung Cancer.
c) Thyrotoxicosis.
d) Hypothyroidism.
e) Subdural Hematoma.

29- A 44 year old lady presenting with exertional dyspnea. Her Respiratory function tests
shows:
FEV1 Low
VC Low
FEV1/VC Normal
This respiratory function test report is compatible with all of the following, EXCEPT:
a) Pulmonary fibrosis.
b) Left ventricular failure.
c) Chronic bronchitis.
d) Pleural effusion.
e) Sarcoidosis.

30- A 43 year old man, his arterial blood gas analysis shows:
 pH 7.12
 PaO2 112 mmHg
 PaCO2 22 mmHg
 HCO3 9 mmol/l
All of the following can cause this abnormality, EXCEPT:
a) Morphine overdose.
b) Diabetic ketoacidosis.
c) Salicylate poisoning.
d) Acute renal failure.
e) Diarrhea.

Page 8 of 12
31- A 33 year old woman recovering from acute gastritis. Her ABG analysis shows:
 pH 7.43
 PaO2 102 mmHg
 PaCO2 46mmHg
 HCO3 32 mmHg
This arterial blood gas abnormality is compatible with:
a) Mixed metabolic alkalosis and respiratory acidosis.
b) Compensated Metabolic acidosis
c) Compensated Respiratory alkalosis
d) Respiratory Acidosis
e) Compensated Metabolic Alkalosis

32- This is a liver profile of a 44 year old lady

 Total bilirubin 7.2 mg/dl (N 0.1-1.2)
 Indirect bilirubin 1.2 mg/dl (N 0.1-0.5)
 AST 98 units/l (N0-35)
 ALT 100 units/l (N7-50)
 Alkaline phosphatase 1107 units/l (N 41-133)
These features are compatible with which of the following diseases?
a) Acute viral hepatitis
b) Liver cirrhosis
c) Multiple gall bladder stones.
d) Chronic lymphocytic leukemia
e) Gilbert syndrome

33- A hepatitis profile of a 27 year old man was performed and shown below:
 HBSAg Negative
 HBeAg Negative
 Anti HBC Negative
 Anti HBS Positive
 Hepatitis C Ab Negative
These findings are compatible with which of the following?
a) A patient with acute viral B hepatitis
b) A patient with post infection of more than one year with hepatitis B.
c) Treated hepatitis C infection
d) Immunization for hepatitis B without previous infection
e) Previous infection with hepatitis B virus.

34- This is a complete blood count of a 85 year old female

 Hgb 5.6 g/dl
 MCV 122 fl
 WBC 2.2 x 109/l
 Platelets 66 x 109/l
This CBC is compatible with the diagnosis of;
a) Thalassemia Major
b) Vitamin B12 deficiency.
c) Chronic lower gastrointestinal bleeding
d) Chronic lead poisoning.
e) Hyperthyroidism.
Page 9 of 12
35- A 44 year old woman presented with epistaxis, her CBC shows:
 Hgb 12.4 g/dl
 WBC 8.1 x 109/l
 Platelets 24 x 109/l
All of the following may be used in the management of this case, EXCEPT:
a) Platelet transfusion.
b) Prednisolone.
c) Rituximab.
d) Chlorambucil
e) High dose immunoglobulin.

36- A 56 year old man has the following laboratory results

 Urea 108 mg/dl
 Creatinine 2.2 mg/dl
 Na 130 mmol/l
 K 3.1 mmol/l
These laboratory findings are compatible with a patient who has:
a) Lung cancer on cisplatin treatment.
b) Inappropriate secretion of antidiuretic hormone.
c) Addison’s disease.
d) Pure water loss complicated by dehydration.
e) Anuric acute renal failure.

37- In assessing a 70 year old male patient with polyuria, polydypsia, constipation and
lethargey, the following analysis was performed:
 Serum Calcium 15 mg/dl (N 8.5 – 10.5)
 Serum phosphorus 2.2 mg/dl (N2.5 – 4.5)
 Alkaline phosphatase 400 units/l (N 41-133)
 Serum albumin normal
All of the following statements are true, EXCEPT:
a) A chest X-Ray could help reach the diagnosis.
b) ECG may show short QT interval.
c) Bisphosphonates are treatment options.
d) Proper hydration is essential in management of these patients.
e) Glucocorticoids should be avoided in these cases.

38- A urine routine examination was performed for a 40 year old lady, it shows;
 pH Alkaline
 WBCs 28/hpf (N <5)
 RBCs 0/hpf (N <3)
 Nitrites Positive (N Negative)
 Casts Negative
 Bacteria 6/hpf (N 0)
This is compatible with which one of the following conditions?
a) Urinary tract infection.
b) Renal stones.
c) Uncontrolled diabetes.
d) Glomerulonephritis.
e) Renal tubular acidosis.
Page 10 of 12
39- A 16 year old female, presented with an acute attack of bone aches and chest pain. Her
brother has a similar condition. Haemoglobin electrophoresis shows:
 Hb A 0% (N97-99)
 Hb A2 2% (N1-2)
 Hb F 10% (N <1)
 Hb S 88% (N= 0)
Based on these findings you will diagnose this patient as having:
a) β-thalassemia major
b) Autoimmune hemolytic anemia
c) Sickle cell anemia
d) Sickle cell trait.
e) α-thalassaemia

40- This is a CSF result from a patient presented with fever and neck stiffness:
 Cell count 500 x 106/l (N 0-4)
 Cell type Lymphocytes
 Glucose 70mg/dl (FBS 100mg/dl)
 Protein 0.4 g/l (N ≤ 0.45 )
 Gram Stain Negative
This CSF picture is compatible with:
a) A normal CSF examination
b) Viral meningitis
c) Bacterial meningitis
d) Tuberculous meningitis
e) Fungal meningitis

41- A pleural fluid was aspirated from a 61 year old man who presented with dypsnea and
haemoptysis, the analysis of the pleural fluid was as follows:
 Appearance serous
 Pleural fluid protein:serum protein ratio 0.66
 Pleural fluid LDH 700 u/l
 Serum LDH 350 U/l (N 208-460)
 Predominant cells in fluid lymphocytes
Which of the following conditions explains best the above mentioned findings?
a) Tuberculosis
b) Obstruction of thoracic duct.
c) Cardiac failure
d) Pulmonary infarction.
e) Acute pancreatitis.

42- A thyroid function test of a 31 year old lady shows:

 T4 2mcg/dl (N 5-11)
 TSH 0.1 mcU/ml (N 0.4-6)
These findings are compatible with:
a) Primary hyperthyroidism
b) Secondary hyperthyroidism
c) Primary hypothyroidism
d) Secondary hypothyroidism
e) Sick euthyroid.
Page 11 of 12
43- A 52 year old lady, known diabetic on oral hypoglycemic drugs, presented for regular
follow up, her investigations show:
 FBS 118 mg/dl (N70-110)
 HbA1C 5.7% ( N <7%)
 Urine routine exam Positive for microproteinuria
 Serum Creatinine 1.3 mg/dl (N <1.2)
 Serum K 3.8 mmol/l
Which of the following you will suggest in this patient’s management?
a) Change to insulin.
b) Add ACE inhibitors.
c) Add thiazide diuretics.
d) Add Calcium channel blockers.
e) Add Potassium Chloride tablets.

44- The following is a laboratory tests from a patient who presented with fever, phayngitis and
splenomegaly.
 Antiviral capsid (VCA) IgM antibodies Positive
 Anti-EBNA (EBV nuclear antigen) Negative
 EBV early antigen antibodies Positive
 Paul Bunnell test Positive
These findings suggest the diagnosis of:
a) Cytomegalovirus infection
b) Herpes zoster infection
c) Infectious mononucleosis
d) Yellow fever
e) Chickenpox

45- A 48 year old lady who presented with fatigue and exertional dyspnea was under
investigation, her laboratory investigations show:
 Hgb 8.8 g/dl
 Direct Bilirubin 2.3 mg/dl
 AST 22 Units/l
 ALT 24 units/l
 LDH 1000 U/l (N 208-460)
 Serum haptoglobin low
 Direct Coomb’s test positive
All of the following conditions can cause this picture, EXCEPT:
a) Lymphoma
b) Lung cancer
c) Systemic lupus erythematosus
d) Congenital spherocytosis
e) Treatment with methyldopa

*‫ لكم بالتوفيق والنجاح‬i‫*إنتهى اإلمتحان مع تمنياتنا‬

Page 12 of 12