Practice paper

Q:1. The most acurate way for diagnosing non-erosive reflux disease (NERD) is:
A. GERD Questionnaire
B. Endoscopy
C. Barum swalow X-rays
D . Esophageal impedance-pH monitoring;
E. Erophagnal manometry

Q: 2. the most common metastasis way for breast cancer is

A. Direct infiltration of cancer cells.
B. Thoracic implant.
C. Lymphatic metastasis.
D. Haematogenous transfer.

Q: 3. What are the risk factor of osteoporosis?

A. Low sun exposure
B. Menopause.
C. Corticoid medication.
D. All of above.

Q: 4. A 35 year old woman has had recurrent episode of headache and sweating. Her mother had
renal calculi And died of thyroid cancer. Physical observation revealed a thyroid nodule and
ipsilateral large cervical lymph nodes. Before performing thyroid surgery the woman’s physician
should order
A. Estimation of TSH and TRH level in serum
B. Thyroid scan.
C. Estimation of urinary metanephrines, VMA and catecholamines
D. Estimation of hydroxyl indole acidic acid in urine

Q:5. Which of the following statement about gastrointestinal track, (GI tract ) in adult is correct
A. The whole GI tract is about 5 m long and divided into three parts. The small bowl is the
longest one and its primary function is the absorption of nutrients and minerals in foods.
B. The whole GI tract each 9 m long and divided into three parts, the small bowel is the longest
one and its primary function is the absorption of the nutrients and mineral in food.
C. The whole GI tract is . The small bowel is the longest one. Its primary function is the
absorption of water and minerals in food.
D. The whole GI tract Is about 9 m long and divided into three parts. The large bowl is the longest
one and its primary function is the absorption of the water and minerals in food.
E. The whole GI tract is about 9 m long and divided into two parts. The primary function of the
stomach is the absorption of the nutrient and minerals in food.

Q: 6. Trench mouth is related to ?

A. Lemirre’s ds.
B. Ludwig’s angina
C. Vincent’s angina
D. Oropharyneal candidiasis (thrush)

Q: 7. you find a discrete, whitish polyp that extend through the tympanic membrane in a child
with the history of recurrent otitis media. This most likely present, which of the following?
A. Otitis media with perforation and drainage.
B. Dislocation of the malleus from its insertion in tympanic membrane.
C. A cholesteatoma
D. Tympanosclerosis
E. Excessive cerumen production

Q: 8. which of the following is not complication of severe placenta abruption?

A. Coagulation dysfunction.
B. Hypertension.
C. Ostpartum haemorrhage.
D. Acute renal failure.
E. DIC

Q: 9. The most common acute abdomen is:

A. Acute cholecystitis
B. Gastrointestinal perforation.
C. Acute pancreatitis.
D. Acute appendicitis.

Q: 10. Pre-term labour is defined as the presence of regular Uterine contraction combined with
cervical changes at which gastational week?
A. 40-41 weeks
B. 41-42 weeks
C. 37-40 weeks
D. 20-37 weeks
E. 18 weeks

Q: 11. When should corticosteroids be used to enhance fetal pulmonary maturity?

A. 24-34 weeks gestation
B. 41 weeks gestation
C. 0-12 weeks gestation
D. 39 weeks gestation
E. 40 weeks gestation

Q: 12. which out of the following ASD is most common?

A. Patent foramen ovale
B. Ostium secundum ASD
C. Ostium primum ASD
D. Sinus vinosus ASD

Q: 13. Which of the following is the most important therapeutic major in the treatment of stage
1( confined to the uterus) endometrial cancer?
A. Progestin therapy.
B. Surgical therapy.
C. Chemotherapy.
D. Immuno stimulation therapy.
E. Radiation therapy.

Q: 14. Cough-variant asthma is seen in ?

A. Children.
B. Elderly.
C. Adolescents
C. Adolescents
D. Adults.

Q: 15. the last menstruation period (LMP) is dated from

A. The first day of the last bleeding episode.
B. The first day of the last normal period.
C. The last day of the last normal period.
D. The last day of the last bleeding episode.

Q: 16. which of the following is the fibrin specific plasminogen activator?

A. Alteplase
B. Streptokinase
C. Anistreplase
D. Urokinase

Q: 17. Increased fundal height is seldom associated with

A. Fetal growth restriction ( or IURG)
B. Macrosomia.
C. Polyhydramnios
D. Full bladder.
E. Twins.

Q. 18. Pulse tardus is found in

A. Mitral regurgitation.
B. Mitral stenosis.
C. Aortic regurgitation.
D. Aortic valve stenosis

Q: 19. strangulated obstruction is characterised by abdominal pain

A. Radioactive pain.
B. Intermittent cramping pain.
C. Sustained severe abdomen pain.
D. Persistent dull pain.

Q: 20. Poikilocytosis is related to which feature of RBC

Q: 20. Poikilocytosis is related to which feature of RBC
A. Number.
B. Size.
C. Shape.
D. Colour.

Q: 21. a 15 year old female present to your office with secondary amenorrhea. As a part of your
evaluation, you find that she is pregnant. After informing her of the pregnancy, you continue to
explain that young mothers have a high risk of several pregnancy related complications,
including which of the following?
A. Low birthweight infants.
B. Excessive weight gain.
C. Hypertension.
D. Twin gestation
E. Infant with genetic defects.

Q. 22. Another name of small pelvic is.

A. Pelvic inlet.
B. None of above.
C. Pelvis cavity.
D. Bony birth canal.

Q. 23. Post term gestation are associated with several condition that present diagnostic and
management challenges exclude.
A. Pre-Term baby.
B. Meconium aspiration syndrome.
C. macrosomia or shoulder dystocia
D. Oligohydramnios
E. Post maturity syndrome.

Q. 24. The difference between low intestinal obstruction and high intestinal obstruction is mainly.
A. Abdominal distension.
B. With or without peritonitis.
C. Vomiting.
D. With or without blood.
Q. 25. A nulligravida at 30 gestational week was found, shocked in bed with severe vaginal
bleeding without abdominal pain. What is the most possible diagnose of her?
A. Complete placenta prévia
B. Placenta absorption.
C. Marginal placenta Previa
D. Rupture of uterus.
E. Cervical cancer.

Q. 26. Regular supraventricular tachycardia include all except.

A. Atrioventricular reciprocating tachycardia (AVRT)
B. Atrial tachycardia (AT)
C. Multifocal atrial tachycardia.(MAT)
D. Atrioventricular nodal reentrant tachycardia (AVNRT)

Q. 27. After bilateral adrenalectomy, patient developed gradual loss of vision, with
hyperpigmentation of skin, and headache. Likely cause is
A. Addisonis diseaso
B.Hypopibitarism
C. Nelsonsyndrome
D .Cushing'sdisease

Q. 28. On a routine-screening complete blood count, a 1-year-old is noted to have a microcytic

anemia. A folow-up hemoglobin electrophoresis demonstrates an increased concentration of
hemoglobin A2. The child is most Ikely ot have
• A. Iron deficiency
• B. Chronic systemic illness
• C. B-thalassemia trait
• D. Lead poisoning
E . Sickle cell anemia

Q. 29. Abnormal premature separation of an otherwise normally implanted placenta i s

associated with :
• A .Placental Previa
• B . Uterine Rupture
• C .PlacentaAbruption
D. Preterm Labor
• E .Vasa Previa

Q. 30. Although labor is a continuous process, it is divided into

A . two functional stages
B .five functional stages
c .three functional stages
D . four functional stages

Q. 31. A15-year-old girl with short stature, neck webbing, and sexual infantlism is found to have
coarctation of the aorta. Achromosomal analysis likely would demonstrate which of the
following?
A. Mutation at chromosome 15q21.1*
B . Defect at chromosome 4p 16
C . Trisomy 21
D .Normal chromosome analysis
E .ХО karyotype

Q. 32. Chest hyper resonance in pneumothorax is the best appreciated at.

A. Apex
B. Base of lung.
C. Axillary region
D. Interscapular region

Q. 33. Gastric emptying time varies depending on the type of food, which one is wrong
A. Breast milk 2-3 hours
B. Water 1.5-2 hours
C. Milk.3-4 hours.
D. Premature infant have a fast gastric and are prone to gastric retention.

Q. 34. In a patient of mesothelioma, one often finds

A. Hypoglycaemia.
B. All of the above.
C. An association with asbestosis
D. Haemorrhage plural effusion.

Q. 35. Which of flowing statement about Irritable Bowel Syndrome (IBS) is wrong?
A. No mucopurulent bloody stool
B .Stool sometimes with mucous.
c. Bowel movement 3-Stimes a day.
D. Defecation often interfere with sleep.
E. Abdominal discomfort improved with defecation.

Q. 36. A 10 year old boy has been having epigastric pain for about two years. They occur at night
as well as during a day. Occasionally he vomit after the onset of pain. Occult blood has been
found in his stool. His father also gets frequent non-specific stomachaches. Which of the
following is the most likely diagnose?
A. Functional abdominal pain.
B. Pinworm infestation
C. Mackle diverticulum.
D. Appendicitis.
E. Peptic ulcer.

Q. 37. Which of the following does the early pregnancy have in common?
A. Breast enlargement.
B. Amenorrhea (cease of menses)
C. Abdomen enlargement.
D. Morning sickness.
E. Urinary frequency.

Q. 38. G l o m e r u t o n e p h i t s ( GN ) h a s ( )
• A .Hypoproteinaemia
• B . Hypotension
• C.Hyperlipidemia
• D .Haematuria
• E. Diuresis

Q. 39. Abnormal premature separation of an otherwise normally implanted placenta is associated

with.
A. Uterine rupture.
B. Pre-Term labour.
C. Placenta absorption.
D. Vasa Previa
E. Pleasant Previa

Q. 40. If division of the conceptus occurs within 3 days of fertlization each fetus will be
surrounded by an amnion and chorion. There may be two separate placentas or one "fused"
placenta. The diagnosis
should be
A. Monochorionie Monoamnionio twins
B . Dichorionic Diamnionic twins
c . Conjoined twins
D. Singleton
•E .MonochorionieDiamnionictwins

Q. 41. Most common cause of a high jugular venous pressure is ?

A. Elevated right atrial diastolic pressure
B .Elevatedrightventricularsystolicpressure
C. Elevated right atrial, systolic pressure.
D.Elevated right ventricular diastolic pressure

Q. 42. The most accurate way for diagnosing non-erosive reflux disease (NERD) i s :
A. Bar iums wallowX-rays
B. Esophageal impedance-pH monitoring:
C . Esophageal manometry
D . GERD Questionnaire
E. Endoscopy.

Q. 43. Which of the following is false in Eisenmenger syndrome?

A. Pulmonic stenosis
B. Elevated pulmonary vascular resistance.
C. Intra cardia communication.
D. Cyanosis

Q. 44. The 2nd most common causes of primary liver cancer in the world today are
A. Hepatitis A & Hepatitis B
B. Hepatitis B & hepatitis C
C. Hepatitis C & Acohol
D. Hepatits E & Hepatitis C
E. Hepatitis B & Acohol

Q. 45. Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized
petechiae, more prominent over hte legs. No hepatosplenomegaly or lymph node enlargement is
noted. The
examination is otherwise unremarkable. Laboratory testing shows the patient to have a normal
hemoglobin, hematocrit, and white blood cell (WBC) count and differential. The platelet count
is15.000 muco litre. Which of the following is the most likely diagnosis?
A. Aplasteanenia
B .Thrombotic thrombocytopenic purpura
C. Acute leukemia
D. Idiopathic (immune) thrombocytopenic purpura (ITP)
E. Von Willebrand disease (VWD)

Q. 46. Atrial natriuretic peptide (ANP) is stored in secretory granules within?

A. Sinoatrial node
B. All of the above
C. Atrial myocytes
D. Pulmonary veins

Q. 47. Pistypnea is dyspnea that occurs in which position?

A. Supine
B. Upright
C. Sitting
D. Lateral

Q. 48. In cardiao tamponade, Beck's triad consists of all except ?

A. Pulsusparadowus
B. Hypotension
C . Soft or absent beart sounds
D .JugularvenousdistentionwithaprominentXidescentbutanabsenty descent
Q. 49. A40-year-old woman, G3P1. At 14 weeks, BP is 130/70 m Hg, at 30 weeks, BP 160/95 mm
Hg Urine dip protein 3+, no symptoms. 12 weeks postpartum BP 122/70 mm Hg - Urine dip
protein negative. What is the diagsosis:
A. Pressiampsia
B. Chronic hypertension
C. Eclampsia
D. Gestational hypertension
E. Preeclampsia superimposed on chronio hypertension

Q. 50. Nocturnal dyspnea" is a festure of which of the foliowing ?

A. Chronic bronchitis
B. H e a r t failure
C . Asthma
D. All of the above

Q. 51. Which is wrong about clinical manifestations of acute pentonitis?

A. Muscle tension and rebound tenderness
B. Persistent abdominal pain
C. Hyperative bowel sounds
D. Nausca, vomiting

Q. 52. The main clinical manifestations of acute glomerulonephritis

A. oliguria, edema, hypertension
B. oliguria, edema, hematuria
C. edema, hypertension, hematuria,
D. proteinuria, hypertension
E. hypertension, hematuria, proteinuria,

Q. 53. Which of the following is the most important therapeutic measure in the troatment of
stage 1(confined to the uterus) endometrial cancor?
A. Immunostimulation therapy
B. Radiation therapy
C. Chemotherapy
D. Surgical therapy
E. Progestin therapy
Q. 54. Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized
petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node enlargement is
noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have
a normal hemogiobin, hematocrit, and white blood count and differential. The platelet count is
15,000/uL. The most likely diagnosis is
A. Aplastic anemia
B. von Willebrand disease
C. Idiopathic (immune) thrombocytopenic purpura
D. Thrombotic thrombocytopenic purpura
E. Acute leukemia

Q. 55. Platypnea is dyspnea that occurs in which position?

A. Upright
B. Lateral
C. Sitting
D. Supine

Q. 56. Which of the following is the most typical finding in COPD ?

A. Increase in residual volume/total lung capacity ratio
B. Increase in the residual volume
C. Nonuniform distribution of ventilation
D. Persistent reduction in forced expiratory flow rates

Q. 57. The most typical clinical manifestation of acute appendicitis is:

A. Fever
B. Transferred right lower abdominal pain
C. Paroxysmal right lower abdominal pain
D. Psoas muscle test positive

Q. 58. Henoch-Schártein Purpura has ()

A. APTT long
B. CRP high
c. PT long
D. Joint pain
E. Thrombocytopenia
Q. 59. The main point for identifying primary peritonitis and secondary peritonitis is
A. with or without peritoneal irritation
B. fever
C. whether there is primary disease in the abdominal cavity
D. abdominal distension

Q. 60. For almost a century, which one has been used to prevent and to treat eclamptic
convulsions.
A. Magnesium sulfate
B. Labetalol
C. Methyldopa
D. Beta-adrenergic receptor agonists (Ritodrine)
E. Nifedipine

Q. 61. Strangulatod intestinal obstruction refers to

A. interina citruction caused by intestinal wail tumors
B: Intestinal costruction caused by stoppage of intestinal contents
C. Intestinal costruction without mechanical factors
D. intestinal castruction, win impeded blood supply to the intestinal wail

Q. 62. which of the following is the most common clinical presentation of uterine leiomyoma?
A. Menorrhagia
B. Recurrent abortion -
C. Infertility
D. Ureteral obstruction
E. Pelvic pain

Q. 63. Athough labor is a continuous process, it is divided into

A. two functional stages
B. five functional stages
C. three functional stages
D. four functional stages

Q. 64. Which of the following scope is Not commonly used for small bowel examination ?
A. Capsule endoscope:
B. Double-balloon enteroscope
C. Spiral enteroscope
D. Colonoscope
E. Singie - balloon enteroscope

Q. 65. After bilateral adrenalectomy, patient developed gradual loss of vision, with
hyperpigmentation of sun, and headache. Likely cause is
A. Cushing's disease
B. Addison's disease
C. Hypopiultartsm
D. Nelson syndrome

Q. 66. S1Q3T3 patter is seen in ?

A. Acute dissection of aorta
B. Severe mitral stenosis
C. Right bundle branch block
D. Acute cor pulmonate due to pulmonary embolism

Q. 67. A child can walk well holding on to furniture but is slightly wobbly when walking alone. She
uses a neat pincer grasp to pick up a pellet, and she can release a cube into a cup after it has
been demostrated to her. She tries to bulld a tower of two cubes with vanable success. She is
most Baly at which of the following age?
A. 6 months
B. 2 months
C. 4 months
D. 1year
E. 9 months

Q. 68. Which of the following scope is Not commonly used for small bowel examination ?
A. Single - balloon enteroscope
B. Capsule endoscope.
C. Spiral enteroscope
D. Double- balloon enteroscope
E. Colonoscope

Q. 69. Oliguria refers to a 24-hour urine output of ?

A. <500mL
B. <400mL
C. <300mL
D. <200mL

Q. 70. Which of the following is the typical finding in COPD?

Ans: hyperventilation( barrel chest)
● Wheeze ( reduce breath sound)
● Pursed lip breathing
● Central cyanosis
● Flate diaphragm

Q. 71. Patient, male, 37 years old. Digestive tract ulcers for many years, sudden severe
abdominal pain, abdominal muscle tension, platy abdomen, the most likely diagnosis is
A. Acute pancreatitis
B. spleen rupture
C. Acute cholecystitis
D. Perforation of stomach or duodenum

Q. 72. The most common metastasis way for breast cancer is

A. Hematogenous transfer
B. lymphatic metastasis
C. Direct infiltration of cancer cells
D. Thoracic implant

Q. 73. Once the elderly with mechanical intestinal obstruction, the first consideration should be
given to
A. Tumor
B. Incarcerated hernia.
C. Intestinal obstruction due to adhesions
D. Intestinal obstruction caused by ascaris

Q. 74. Regardless of type of intestinal obstruction. the four common manifestations of intestinal
obstruction
A. Contipation abdominal pain, destension, bowel sounds
B. Voming abdominal pain, hyperactive bowel sounds, distension
C. Constpaion wonding, abdominal pain, distension
D. Abdominal pain, boasi type, vomiting, constipation

Q. 75. A 29 yr-old woman, G1P0, at 8 weeks of gestation. Urine pregnant test+, some spotting,
ultrasound shows normal intrauterine pregnant viable. Cervi closed. What is the diagnosis?
A. Ectopic pregnancy
B. Complete abortion
c. Inevitable abortion
D. Threatened abortion
E: Incomplete abortion

Q. 76. Which of blowing statement about Irritable Bowel Syndrome (IBS) is wrong?
A. Stool sometmes with mucous.
B. Defecation eten interfere with sleep
C. Bowel movement 3-5 times a day.
D. Abdominal discomfort improved with defecation.
E. No mucopurient bloody stool

Q. 77. Which of the following is the most typical finding in COPD ?

A. Nonuniform distribution of ventilation
B. Persistent reduction in forced expiratory flow rates
C. Increase in residual volume/total lung capacity ratio
D. Increase in the residual volume

Q. 78. Which of the following is not the symptoms and sign of the onset of the labor?
A. Nausea and vomiting
B. Rupture of membranes
C. Painful uterine contraction
D. a bloody show
E. Efficient & dilation of the cervix

Q. 79. Which of the following drugs should be avoided in a patient of dilated cardiomyopathy?
A. Beta adrenergic blocker
B. Digitalis
C. Calcium channel blocker
D. Spironolactone
Q. 80. The main treatment after the formation of perianal abscess is
A. Application of antibiotice
B. Hot water bath
C. Early incision and drainage
D. Drug treatment

Q. 81. Kidneys excrete how much H+ ions per day ?

A. About 3000 mmol
B. About 5000 mmol
C. About 4000 mmol
D. About 2000 mmol

Q. 82. In additon to abdominal pain, the main symptom of upper small bowel obstruction is:
A. Frequent vomling
B. Bloodystools
C. Distension
D. The enhaust and defecation are stopped

Q. 83. Postterm gestations are associated with several conditions that present diagnostic and
management challenges exclude:
A. Macrosomia or Shoulder dystocia
B. Postmaturity Syndrome
c. Preterm baby
D. Meconium Aspiration Syndrome
E. Oligohydramnios

Q. 84. Which ultrasound finding each concerning for ovarian malignancy?

A. Smooth border
B. Thin…….Cyst
C. Solid consistency
D. Unilateral
E. Uni……

Q. 85. The most common cause of adhesive intestinal obstruction is.

A. Dysplasia.
B. Abdominal surgery.
C. Meconium peritonitis.
D. Primary peritonitis.

Q. 86. Urinary irritation syndrome

A. Fever.
B. Dysuria
C. Frequent micturition
D. Urgent micturition
E. Pain micturition

Q. 87. Pt. Male 37 year old. Digestive tract ulcer for many years, sudden severe abdominal pain ,
abdominal muscle tension, platy muscle. The mostly diagnose is.
A. Spleen rupture
B. Perforation of stomach and duodenum.
C. Acute pancreatitis.
D. Acute cholecystitis

Q. 88. Most common cause of a high jugular venous pressure is?

A. Bevated right ventricular diastolic pressure
B. Bevated right ventricular systolic pressure
C. Berated right atrial diastolic pressure
D. Elerated right atrial systolic pressure

Q. 89. The most common type of intestinal obstruction is

A. Vascular I leus
B. twisting ileus
c. mechanical intestinal obstruction
D. paralytic ileus

Q. 90. "Stary sky' appearance an immunofluorescence

Ans. endocapillary-mesangial
glomerulonephritis

Q. 91. 98% of ectopic pregnancies are

A. Abdominal pregnancy
B. Orarion pregnancy
C. Cervical pregnancy
D. Heterotople pregnancy
E. Fallopian tube pressancy.

Q. 92. in pheochromocytoma, the urine will contain:

A. VMA
B. None
C. HIAA
D. Both

Q. 93. Term azotemia is used mostly for ?

A. All of the above
B. Postrenal ARF
C. Intrinsic ARF
D. Prerenal ARF

Q. 94. Arthritis
A. Enderness or pain on motion
B. Increased heat in one or more joints;
c. swelling or effusion
D. imitation of range of motion,
E. Tenderness or pain when no motion

Q. 95. Retroperitoneal fibrosis most common presents with

A. Pedal Edema
B. Вack pain
C. Ascites
D. Ureteric obstruction

Q. 96. The earliest symptom of colon cancer is

A persistent abdominal ditcomfort, dull pain, bloating
B. Unexpisined anemia of weight loss
C. Intestinal costruction symptoens
D. Changes in bowel habits and changes in fecal traits

Q. 97. Under which of the situation, there might be seen pathological retraction ring?
A. Polyhydromia
B. Threadened rupture of uterus
C. Twin pregnancy.
D. Placenta Previa
E. Placenta abruption

Q. 98. Once the elderly with mechanical intestinal obstruction, the first consideration should be
given to.
A. Incarcerated hernia
B. Intestinal obstruction caused by ascaris
C. Intestinal obstruction due to adhesion
D. Tumor

Q. 99. Commonest site of intestinal atresia is in the:

A. Jejunum
B. Colon
c. Ileum
D. Duodenum

Q. 100. The last menstrual period(LMP) is dated from:

A. the first day of the last normal period
B. the last day of the last normal period
C. the last day of the last bleeding episode
D. The first day of the last bleeding episode

Q. 101. 35.Under which of situation, there might be seen pathologic retraction ring?
A. threatened rupture of uterus
B, twin pregnancy
C. placenta previa
D. Polyhydromnia

Q. 102. The most common acute abdomen is:

A. Gastrointestinal perforation
B. Acute cholecystitis
C. Acute pancreatitis
D. Acute appendicitis
Q. 103. Which of the following abnormalities is NOT related to dystocia?
A. Presentation, position, or development of the fetus
B. Maternal bony
C. Preeclampsia
D. Expulsive forces

Q. 104. Not a feature of Fallot's tetralogy

A. Overriding of arch of aorta
B. VSD
C. Boot shaped heart
D. Left ventricular hypertrophy

Q. 105. An patient with type I diabetes has a dramatically elevated glycosylated hemoglobin
(hemoglobin A1C) level, indicating poor control of his diabetes over at least the preceding
A. 1 week
B. 2 months
C. 8 h
D. 1 month

Q. 106. Potts shunt is:

V1
A. Right subclavian artery to right pulmonary artery
B. Descending aorta to left pulmonary artery
C. Left subclavian to left pulmonary artery
D. Left ventricular hypertrophy

Q. 107. 51.0n a routine well-child examination, a 1-year-old boy is noted to be pale. He is in the
seventy-fifth percentile for weight and the twenty-fifth percentile for length. Results of physical
examination are otherwise normal. His hematocrit is 24%. Of the following questions, which is
most likely to be helpful in making a diagnosis?
A. Is the child on any medications?
B. Has anyone in the family received a blood transfusion?
C. Did the child receive phototherapy for neonatal jaundice?
D. What is the child's usual daily diet?
Q. 108. A 41-year-old woman is suspected of having intrauterine adhesions because she had had
irregular since a spontaneous abortion 18 months previously.
Which of the following historical or laboratory pieces of information support this diagnosis?
A. monophasic basal body temperature chart.
B. follicle-stimulation hormone level too low to be measurable
C. normal estradiol levels for a reproductive-age woman
D. presence of hot flushes

Q. 109. 50.A 33-year-old woman has a pap smear showing moderately severe cervical dysplasia
(high-grade squamous intrepithelial neoplasia),which of the following is the best next step?
A. conization of the cervix
B. repeat pap smear in 3months
C. radical hysterectomy
D. colposcopic-directed biopsies

Q. 110. Fetal pulmonary surfactant production increase rapidly at which gestational age?
A. More than 35 weeks gestation age
B. 18-20 weeks gestation age
C. 28-32 weeks gestation age
D. 22-24weeks gestation age

Q. 111. Weight loss in excess of () is cause for concern and must be investigated
A. 10%
B. 5%
C. 20%
D. 7%

Q. 112. Cannon waves are seen in

A. TR
B. Complete heart block
C. AF
D. Constrictive pericarditis

Q. 113. Weight loss in excess of () is cause for concern and must be investigated.
A. 10%
B. 5%
C. 20%
D. 7%

Q. 114. Cannon waves are seen in

A. TR
B. Complete heart block
C. AF
D. Constrictive pericarditis

Q. 115. According to 2018 AHA update of Cardiopulmonary Resuscitation and Emergency

Cardiovascular Care, which medication is recommended for ventricular fibrillation /pulseless
ventricular tachycardia:
A. Procainamide
B. Lidocaine
C. Either lidocaine or amiodaroneprocainaride
D. Amiodarone

Q. 116. 96. Drugs contraindicated in acute myocardial infraction

A. Nifedipine
B. Methanol toxicity
C. ACE inhibitors
D. Aspirin

Q. 117. What are characterized in RA?

A. chronic pain
B. All of the above
C. morning stiffness
D. peripherial joints pain

Q. 118. Another name of small pelvis is:

A. none of above
B. bony birth canal
C. pelvis inlet
D. pelvis cavity

Q. 119. Causes of non-pitting edema

A. CLD
B. Renal disease
C. CCF
D. Hypothyroidism

Q. 120. The most important regulator of serum 1,25(OH) vitamin D concentration is

A. serum 25(OH) vitamin D
B. serum magnesium
C. parathyroid hormone
D. serum calcium

Q. 121. The smallest anteroposterior diameter of the pelvic inlet is called:

A. true conjugate
B. diagonal conjugate
C. interspinous diameter
D. obstetric conjugate

Q. 122. A 38-year-old woman with obesity, dermal striae, and hypertension is referred for
endocrinologic evaluation of possible cortisol excess. The woman receives a midnight dose of 1
mg of dexamethasone; a plasma cortisol level drawn at 8 A.M. the next day is 386 nmol/L. At this
point in the evaluation the most appropriate diagnostic maneuver would be
A. abdominal CT scanning
B. measurement of a 24-h urine free cortisol
C. measurement of 24-h 17-
hydroxycorticosteroid excretion in urine
D. CT scanning of the pituitary gland

Q. 123. The main point for identifying primary peritonitis and secondary peritonitis is
A. fever
B. whether there is primary disease in the abdominal cavity
C. abdominal distension
D. with or without peritoneal irritation

Q. 124. A 45-year-old woman is diagnosed with an early cervical cancer,which of the following is
a risk factor for CC?
A. late menopause
B. nulliparity
C. obesity
D. early age of coitus

Q. 125. Drugs used in ventricular arrhythmias due to WPW syndrome

A. Lignocaine
B. Digoxin
C. Amiodarone
D. Verapamil

Q. 126. Deficiency of which of the following vitamin is most commonly seen in short bowel
syndrome with ileal resection?
A. Vitamin K
B. Folic acid
C. Vitamin B1
D. Vitamin B12

Q. 127. A 21-year-old woman presents with left lower quadrant pain. An anterior 7-cm firm
adnexal cyst is palpated. Ultrasound confirms a complex left adnexal mass with solid
components that appear to contain bone and teeth. What percentage of these tumors are
bilateral?
A. Less than 1%
B. Greater than 75%
C. 2 to 3%
D. 10 to 15%

Q. 128. A successful neonatal resuscitation, () is the most important step.

A. medications
B. volume
C. chest compression
D. an adequate ventilation

Q. 129. About primary teeth, which is wrong?

A. 4-10 months begin eruption
B. ‹Zyrs number = age(mons) - (4~6)
C. 7-Byrs exchange
D. completion by 3yrs

Q. 130. Which one is the first vaccine, according to Immunization Program for Children.
A. Attenuated live measles vaccine
B. Hepatitis B immunoglobulin
C. Mycobacterium tuberculosis vaccine(attenuated live tuberculosis liquid)
D. Attenuated live polio vaccine

Q. 131.All are true about pseudomyxoma peritonel except:

A. Appendix is most common site of origin
B. Yellow jelly collection of fluid
C. Associated with ovarian tumors
D. Common in male

Q. 132. A child is brought to your clinic for a routine examine.

She can dress with help, can ride a tricycle, knows her own age, and can speak in short
sentences. She had difficulty in copying a square. The age of this child is most likely
A. 1 year
B. 4 years
C. 2 years
D. 3 years

Q. 133. Acute appendicitis pain is typically characterized by

A. referred pain
B. reflex pain
C. spasmodic pain
D. transferred right lower abdominal pain

Q. 134. 23.After bilateral adrenalectomy, patient developed gradual loss of vision, with
hyperpigmentation of skin, and headache. Likely cause is
A. Hypopituitarism
B. Cushing's disease
C. Addison's disease
D. Nelson syndrome

Q. 135. Once the elderly with mechanical intestinal obstruction, the first consideration should be
given to
A. Incarcerated hernia
B. Intestinal obstruction due to adhesion
C. Tumor
D. Intestinal obstruction caused by ascaris

Q. 136. Red Flags in Developmental Screening and Surveillance, NEGATIVE INDICATORS

(ACTIVITIES THAT THE CHILD CANNOT DO) NOT INCLUDE
A. Hold object placed in hand by 5 mo (corrected for gestation)
B. Run by 2.5 yr
C. Walk by 30 mo (boys) or 2 yr (girls)
D. Sit unsupported by 12 months

Q. 137. please see questions in picture

A. Glipizide
B. Repaglinide
C. Metformin
D. Acarbose

Q. 138. Which is the most common subtype of primary aldosteronism?

A. Unilateral hyperplasia or primary adrenal hyperplasia
B. Bilateral idiopathic hyperaldosteronism
C. Unilateral APAs
D. Familial hyperaldosteronism

Q. 139. Which of following statement about gastrointestinal tract (Gl tract) in adult is NOT true
A. The large intestine is about 1.5 meters and its primary function is the absorption of water and
minerals in food.
b. The small bowel is the longest one and its primary function is the absorption of nutrients and
minerals in food.
c. The whole Gi tract is about 9 meters long and divided into 3 parts.
d. The main function of the stomach is secreting the gastric acid and pepsinogen, and the
absorption of nutrients in food.

Q. 140. Please list Developmental Milestones in the 1st 2 Yr of Life GROSS MOTOR
A. Rolls back to stomach (6.5 MONTH)
Truncal flexion, risk of falls
B. Sits without support (6 MONTH)
Increasing exploration
C. Holds head steady while sitting (3
MONTH) Allows more visual interaction
D. Asymmetric tonic neck reflex gone (4
MONTH) Can inspect hands in midline

Q. 141. The second stage is

A. the period of the delivery of the placenta

B. the period of the delivery of the infant
c. the interval between the onset of labor and full cervical dilation (10cm)
d. approximately 2 hours after delivery of the placenta

Q. 142. 26.A post-op patient presents with peritonitis and massive contamination because of
duodenal leak.
Management of choice is:
a. Duodenostomy + Feeding jejunostomy + Peritoneal lavage
b. Four quadrant peritoneal lavage
C. Total parenteral nutrition
D. Duodenojejunostomy

Q. 143. Gastroesophageal reflux diseases is LEAST likely to result in the development of

A. an esophageal peptic stricture
B. Barrett's esophagus (esophagus lined by columnar epithelium)
C. Pneumonia
D. a lower esophageal ring

Q. 144. All of the following are associated with carcinoid syndrome except:
a. Diarrhea
b. Acute appendicitis
c. Flushing
d. Cyanosis graduation

Q. 145. The typical sign of upper respiratory tract obstruction is:

a. Expiratory stridor accompanied with prolonged expiratory phase
b. Expiratory wheezing accompanied with prolonged expiratory phase
c. Inspiratory wheezing accompanied with shorten inspiratory phase
d. Inspiratory stridor accompanied with prolonged inspiratory phase

Q. 146. Which of the followings is not the complication of severe placenta abruption?
A. hypertension
b. postpartum hemorrhage
c. coagulation dysfunction
d. acute renal failure

Q. 147. 85.What are key physical findings of RA?

a. tenderness in peripheral joints
b. Most common are MCP,PIP and MTP joints
c. All
d. Symmetrical soft tissue swelling

Q. 148. A 55-year-old male insurance agent with a benign past medical history presents to his
primary care physician complaining of indigestion. He notes that
"heartburn" has occurred weekly for about half a year, especially after eating a heavy meal. He
has no risk factors for coronary artery disease. Physical and routine laboratory examinations are
unrevealing. Which of the following is the most appropriate next step?
a. Serology for H. pylori
B. Upper gastrointestinal endoscopy
c. Upper gastrointestinal barium radiography
d. Ambulatory esophageal pH testing

Q. 149. A 54-year-old woman undergoes a laparotomy because of a pelvic mass. At exploratory

laparotomy, a unilateral ovarian neoplasm is discovered that is accompanied by a large omental
metastasis. Frozen section diagnosis confirms metastatic serous cystadenocarcinoma. The most
appropriate intraoperative course of action is
A. Omentectomy and ovarian cystectomy
b. Excision of the omental metastasis and unilateral oophorectomy
c. Omentectomy, total abdominal hysterectomy, and bilateral salpingooophorectomy
d. Excision of the omental metastasis and ovarian cystectomy
Q. 150. Which of the following inhibits growth hormone secretion from the anterior pituitary
gland?
A. Hypoglycemia
B. Arginine
C. Somatostatin
D. Growth hormone - releasing hormone
(GHRH)

Q. 151. Deficiency of which of the following vitamin is most commonly seen in short bowel
syndrome with ileal resection?
A. Vitamin K
B. Folic acid
C. Vitamin B1
D. Vitamin B12

Q. 152. Which of the following abnormalities is NOT related to dystocia?

a. Expulsive forces
b. Maternal bony
c. Presentation, position, or development of the fetus
D. Preeclampsia

Q. 153. A 62 year old woran presents with pain and morning stiffness in PIP 2-4 joints on both
hands for two years. The most appropriate diagnosis would be:
a. SLE
b. Gout
c. OA
d. RA

Q. 154. 37.A post-op patient presents with peritonitis and massive contamination because of
duodenal leak
Management of choice is:
A. Total parenteral nutrition
b. Four quadrant peritoneal lavage
c. Duodenostomy + Feeding jejunostomy + Peritoneal lavage
D. Duodenojejunostomy
Q. 155. 29 yr old woman,G1P0,at 8 wks of gestation, urine pregnant test + , some spotting,
ultrasound show normal intrauterine pregnant,viable, cervix closed. What is the dx?
A. Threatened abortion
B. Incomplete abortion
C. Ectopic pregnancy
D. Complete abortion
E. Inevitable abortion

Q. 156. Causes of non-pitting edema

A. CLD
B. Renal disease
C. CCF
D. Hypothyroidism

Q. 157. A 38-year-old woman with obesity, dermal strae, and hypertension is referred for
endocrinologic evaluation of possible cortisol excess. The woman receives a midnight dose of 1
mg of dexamethasone; a plasma cortisol level drawn at 8 A.M. the next day is 386 nmol/L. At this
point in the evaluation the most appropriate diagnostic maneuver would be
A. abdominal CT scanning
B. measurement of a 24-h urine free cortisol
C. measurement of 24-h 17-
hydroxycorticosteroid excretion in urine
D. CT scanning of the pituitary gland

Q. 158. A 41-year-old woman is suspected of having intrauterine adhesions because she had had
irregular since a spontaneous abortion 18 months previously.
Which of the following historical or laboratory pieces of information support this di nosis?
A. monophasic basal body temperature chart.
B. follicle-stimulation hormone level too low to be measurable
C. normal estradiol levels for a reproductive-age woman
D. presence of hot flushes

Q. 159.A successful neonatal resuscitation, () is the most important step.

A. medications
B. volume
c. chest compression
d. an adequate ventilation

Q. 160. Drugs used in CCF are all except

A. Diuretics
B. Amiodarone
c. Vasodilators
D.

Q. 161. The most important sign of acute appendicitis is:

A. Psoas muscle test positive
b. Right muscle tension
c. Murphy sign posit
d. Right lower abdominal pain and tenderness

Q. 162. What are key physical findings of RA?

A. tenderness in peripheral joints
b. Most common are MCP,PIP and MTP joints
C. All
D. Symmetrical soft tissue swelling

Q. 163. Clinical indicators for adverse prognosis in HIE newborns do not include
A. BE at 1h>15
B. high pitch cry
c. Seizures
d. Apgar score <3 at 5min

Q. 164. Under which of situation, there might be seen pathologic retraction ring?
A. threatened rupture of uterus
B. twin pregnancy
c. placenta previa
d. Polyhydromnia

Q. 165. Please list Developmental Milestones in the 1st 2 Yr of Life GROSS MOTOR
A. Rolls back to stomach (6.5 MONTH)
Truncal flexion, risk of falls
B. Sits without support (6 MONTH
Increasing exploration
C. Holds head steady while sitting (3
MONTH) Allows more visual interaction
D. Asymmetric tonic neck reflex gone (4
MONTH Can inspect hands in midline

Q. 166. Cannon waves are seen in

a. TR
b. Complete heart block
C. AF
D. Constrictive pericarditis

Q. 167. The second stage is

A. the period of the delivery of the placenta
B. the period of the delivery of the infant TESSE
C. the interval between the onset of labor and full cervical dilation (10cm)
D. approximately 2 hours after delivery of the placenta

Q. 168. The main point for identifying primary peritonitis and secondary peritonitis is
a. fever
b. whether there is primary disease in EMER the abdominal cavity
c. abdominal distension
d. with or without peritoneal irritation

Q. 169. Examination of the cerebrospinal fluid of an 8-year• old, mildly febrile child with nuchal
rigidity and intermittent stupor shows the following: white blood cells 100/pL (all lymphocytes),
negative Gram stain, protein 150 mg/dL, and glu
Se 15 mg/dL. The most
likely diagnosis is
a. Stroke
b. Acute bacterial meningitis
c. Tuberculous meningitis
d. Tuberous sclerosis

Q. 170. The main treatment after the formation of perianal abscess is

a. Drug treatment
b. Early incision and drainage
c. Hot water bath
d. Application of antibiotics

Q. 171. An patient with type I diabetes has a dramatically elevated glycosylated hemoglobin
(hemoglobin A1C) level, indicating poor control of his diabetes over at least the preceding
A. 1 week
B. 2 months
C. 8 h
D. 1 month

Q. 172. A 21-year-old woman presents with left lower quadrant pain. An anterior 7-cm firm
adnexal cyst is palpated. Ultrasound confirms a complex left adnexal mass with solid
components that appear to contain bone and teeth. What percentage of these tumors are
bilateral?
A. Less than 1%
B. Greater than 75%
C. 2 to 3%
D. 10 to 15%

Q. 173. Fetal pulmonary surfactant production increase rapidly at which gestational age?
a. More than 35 wee gestation age
B. 18-20 weeks gestation age
C. 28-32 weeks gestation age
d. 22-24weeks gestation age

Q. 174. Patient, male, 37 years old. Digestive tract ulcers for many years, sudden severe
abdominal pain, abdominal muscle tension, platy abdomen, the most likely diagnosis is
a. Acute cholecystiti
b. spleen rupture
c. Acute pancreatitis
d. Perforation of stomach or duodenum

Q. 175. please see questions in picture

A. Such seizures usually occur in association with infections outside the central nervous system
B. Affected children usually are between 2 months and 10 years of age
C. There is usually a mild pleocytosis in the cerebrospinal fluid

D. Such seizures often last more than 15 min

Q. 176. Retroperitoneal fibrosis most commonly presents with:

A. Ureteric obstruction
b. Pedal edema
c. Ascites
d. Back pain

Q. 177. please see in pic

A. Liver biopsy
b. Endoscopic retrograde
cholangiopancreatography(ERCP)
C. Further evaluation for hemolytic jaundice
Sriram
D. Ultrasonography of the abdomen

Q. 178. Which of the following abnormalities is NOT related to dystocia?

a. Presentation, position, or development of the fetus
B. Maternal bony
c. Preeclampsia
D. Expulsive forces

Q. 179.Post-operative hypertension can be due to all except

A. Hypovolemia
B. Fever
C. Pain
D. Hypothermia

Q. 180. The difference between low intestinal obstruction and high intestinal obstruction is
mainly
A, with or without peritonitis
B. abdominal distension
C. with or without blood
Q. 181. a 65-year-old woman is noted to have suspected uterine myoma on physical
examination.Over the course of 1 year,she is noted to have enlargement of her uterus from
approximately 12 weeks' size to 20 weeks' size. Which of the following is the best management?
a. gonadotropin-releasing hormone agonist (GnRH)
B. continued careful observation
c. exploratory laparotomy with hysterectomy
d. monitoring with ultrasound examination

Q. 182. Although labor is a continuous process, it is divided into-

A. four functional stages
B. three functional stages
c. five functional stages
d. two functional stages

Q. 183. The most common cause of adhesive intestinal obstruction is:

a. Primary peritoniti:
B. Meconium peritonitis
c. Abdominal surgery
D. Dysplasia

Q. 184.Weight loss in excess of () is cause for concern and must be investigated.

A. 10%
B. 5%
C, 20%
D. 7%

Q. 185.A 7 years old girl present with fever, productive cough for 7 days. On physical
examination, fixed crackles was heard over both lung bases during deep inspiration.
Routine blood test: WBC 18*109/L, NE 70%, CRP 65mg/l.
The most likely diagnosis is
A. Asthma
b. Viral bronchitis
c. Bacterial bronchitis
d. Bacterial pneumonia

Q. 186. Once the elderly with mechanical intestinal obstruction, the first consideration should be
given to
A. Incarcerated heria
B. Intestinal obstruction due to adhesions
C. Tumor
D. Intestinal obstruction caused by ascaris

Q. 187. After bilateral adrenalectomy, patient developed gradual loss of vision, with
hyperpigmentation of skin, and headache. Likely cause is
a. Hypopituitarism
b. Cushing's disease
c. Addison's disease
d. Nelson syndrome

Q. 188. The smallest anteroposterior diameter of the pelvic inlet is called:

A. true conjugate
B. diagonal conjugate
c. interspinous diameter
d. obstetric conjugate

Q. 189. The most common metastasis for breast cancer is

a. Direct infiltration of cancer cells
b. lymphatic metastasis
c. Hematogenous transfer
D. Thoracic implant

Q. 190. Once the elderly with mechanical intestinal obstruction, the first consideration should be
given to
A. Incarcerated heria
B. Intestinal obstruction due to adhesions
C. Tumor
D. Intestinal obstruction caused by ascaris

Q. 191. Drugs used in ventricular arrhythmias due to WW syndrome

a. Lignocaine
b. Digoxin
C. Amiodarone
D. Verapamil

Q. 192. About primary teeth, which is wrong?

A. 4-10 months begil
eruption
b. <2yrs number = age(mons) - (4~6)
c. 7-8yrs exchange
d. completion by 3yrs

Q. 193.All are true about pseudomyxoma peritonei except:

a. Appendix is most common site of origin
b. Yellow jelly collection of fluid
c. Associated with ovarian tumors
d. Common in male

Q. 194.Red Flags in Developmental Screening and Surveillance, NEGATIVE INDICATORS

(ACTIVITIES THAT THE CHILD CANNOT DO) NOT INCLUDE
A. Hold object placed in hand by 5 mo (corrected for gestation)
B. Run by 2.5 yr
c. Walk by 30 mo (boys) or 2 r (girls)
d. Sit unsupported by 12 months

Q. 195.The most important regulator of serum 1,25(OH) vitamin D concentration is

A. serum 25(OH) vitamin D
B. serum magnesium
C. parathyroid hormone
D. serum calcium

Q. 196. Which of the following statements is not true?

a. Activity amount and energy requirement increases age grows
b. Smaller age, less totai energy requirement
c. Energy for growth is specific for children
d. Energy for basal metabolism of children is more than adults for 10% to15%

Q. 197. Which of the followings is not the complication of severe placenta abruption?
A. hypertension
b. postpartum hemorrhage
c. coagulation dysfunction
d. acute renal failure

Q. 198. Gastroesophageal reflux diseases is LEAST likely to result in the development of

A. an esophageal peptic stricture
B. Barrett's esophagi by columnar epithelium)
C. Pneumonia
D. a lower esophageal ring

Q. 199. Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized
petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node enlargement is
noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have
a normal hemoglobin, hematocrit, and white blood count and differential. The platelet count is
15,000/uL. The most likely diagnosis is
A. acute leukemia
b. Idiopathic (immune) thrombocytopenic purpura
c. von Willebrand disease
d. Aplastic anemia

Q. 200. A 34-year-old woman states that she has had no menses since she had a uterine
curettage and cone biopy of the cervix 1 year previously, Since those surgeries, she complains of
severe,crampy lower abdominal pain"similar to Inbor pain" for 5 days of each month. Her basal
body tem erature chart is biphasic,rising 1 F for 2 weeks of every month. which of the following is
the most likely etiology of secondary amenorrhea?
a. Hypothalamic etiology
b. Cervical condition
c. Pituitary etiology
D. Uterine etiology

Q. 201. Which is Disease modified anti-rheumatic drugs(DMARDs) for treatment of RAA

A. All
в. мтx
c. Aspirin
d. PPI
Q. 202. Strangulated obstruction is characterized by abdominal pain: C
A. Radioactive pain
B. intermittent cramping pain
c. Persistent dull pain
d. Sustained severe abdominal pain

Q. 203.A 33-year-old woman has a pap smear showing moderately severe cervical dysplasia
(high-grade squamous intrepithelial nolasia), which of the following is the best next step?
A. conization of the cervix
B. repeat pap smear in 3months
c. radical hysterectomy
d. colposcopic-directed biopsies

Q. 204. Strangulated intestinal obstruction refers to

A. Intestinal obstruct intestinal wall tumors
caused by
b. Intestinal obstruction caused by stoppage of intestinal contents
c. Intestinal obstruction with impeded biood supply to the intestinal wall
d. Intestinal obstruction without mechanical factors

Q. 205. The most common type of intestinal obstruction is

A. twisting ileus
B. vascular ileus
c. paralytic ileus
d. mechanical intestinal obstruction

Q. 206. The earliest symptom of colon cancer is

a. persistent abdominal discomfort, dull pain, bloating
b. Intestinal obstruction symptoms
c. Changes in bowel habits and changes in fecal traits
D. Unexplained anemia or weight loss

Q. 207. A 54-year-old woman undergoes a laparotomy because of a pelvic mass. At exploratory

laparotomy, a unilateral ovarian neoplasm is discovered that is accompanied by a large omental
metastasis. Frozen section diagnosis confirms metastatic serous cystadenocarcinoma. The ost
appropriate intraoperative course of ac.on is
a. Omentectomy and ovarian cystectomy
b. Excision of the omental metastasis and unilateral oophorectomy
c. Omentectomy, total abdominal hysterectomy, and bilateral salpingooophorectomy
D. Excision of the omental metastasis

Q. 208. Which is the most common subtype of primary aldosteronism?

a. Unilateral hyperplasia or primary adrenal hyperplasia
b. Bilateral idiopathic hyperaldosteronism
c. Unilateral APAS
d. Familial hyperaldosteronism

Q. 209. Which description of anatomical characteristics of respiratory system is wrong?

A. Eustachian tube is broad, straight and short with a horizontal position in infant, otitis media is
a common complication in URTI.
b. The nasal cavity, pharynx, and larynx are relatively narrow and blood supply is rich in infant, so
they are prone to acute upper respiratory tract infection and respiratory tract obstruction
c. Sinus opening is relatively large and is a direct extension of nasal mucosa, so acute rhinitis
often involves the sinuses
D. Immaturity of the respiratory muscles, combined with low chest wall compliance,
maycontribute to ventilation asynchrony and promote respiratory fatigue.

Q. 210. The most common abdominal hernia is

A. Incisional hernia
b. Umbilical hernia
c. femoral hernia
D. Inguinal hernia

Q. 211. Features of TIETZEs syndrome

a. Costochondritis without selling
b. Costochondritis Wal swelling
C. Rheumatoid arthritis
D. Ankylosing spondylitis

Q. 212. Tangier's disease is associated with:

a. High TG
b. High LDL
c. Low HDL
D. High HDL

Q. 213.A post-op patient presents with peritonitis and massive contamination because of
duodenal leak.
Management of choice is:
a. Duodenostomy + Feeding jejunostomy + Peritoneal lavage
b. Four quadrant peritoneal lavage
C. Total parenteral nutrition
D. Duodenojejunostomy

Q. 214. Which of the following inhibits growth hormone secretion from the anterior pituitary
gland?
A. Growth hormone-(GHRH)
easing hormone
B. Somatostatin
c. Arginine
d. Hypoglycemia

Q. 215. A 37-year-old woman is noted to have 6 months amenorrhea, Previously her menses
were monthly, She is not pregnant. Intially progestin therapy does not lead to menstrual
bleeding. Sequential administration of estrogen and progestin alsoDoes not reveal any bleeding.
which of the following is the most likely diagnosis?
A. Ovarian failure
B. Hypothalamic dysfunction
C. Pituitary dysfunction
D. Intrauterine adhesions

Q. 216. The most common acute abdomen is:

a. Gastrointestinal perforation
b. Acute cholecystitis
c. Acute pancreatitis
d. Acute appendicitis

Q. 217. A 30-year-old woman is seen in your clinic during her first pregnancy. She is 26 weeks
pregnant and has had an uncomplicated pregnancy so far. She has no other significant past
medical history. On physical exam she has normal vital signs, including a normal blood pressure.
She is not obese. A 50g oral glucose challenge is given to the patient. One hour later a serum
glucose level of 8.3 mmol/L is obtained. Which of the following statements is col
a. The patient has gestational diabetes mellitus
b. The test is valid only if performed during the morning after an overnight fast
c. The test should be repeated with a
75-g glucose challenge and serum glucose levels measured 1,2, and 3h after the test
D. The test should be repeated and a
02: 5grum glucose level obtained 2 h after the oral glucose challenge

Q. 218.A 62 year old woman presents with pain and morning stiffness in PIP 2-4 joints on both
hands for two years.
The most appropriate diagnosis would be:
a. SLE
b. OA
c. Gout
d. RA

Q. 219. which of the following does the early pregnancy have in common?
A. morning sickness
B. abdomen enlargement
C. amenorrhea (cease of menses)
D. breast enlargement

Q. 220. Deficiency of which of the following vitamin is most commonly seen in short bowel
syndrome with ileal resection?
A. Vitamin K
B, Folic acid
c. Vitamin B1
d. Vitamin B12

Q. 221. Not a feature of Fallot's tetralogy

a. Overriding of arch raorta
b. VSD
C. Boot shaped heart
D. Left ventricular hypertrophy
D. Left ventricular hypertrophy

Q. 222. 0n a routine well-child examination, a 1-year-old boy is noted to be pale. He is in the

seventy-fifth percentile for weight and the twenty-fifth percentile for length.
Results of physical examination are otherwise normal.
His hematocrit is 24%. Of the following questions, which is most likely to be helpful asking a
diagnosis?
a. Is the child on any medications?
b. Has anyone in the family received a blood transfusion?
c. Did the child receive phototherapy for neonatal jaundice?
d. What is the child's usual daily diet?

Q. 223. Which is the most common subtype of primary aldosteronism?

a. Unilateral hyperplasia or primary adrenal hyperplasia
b. Bilateral idiopathic hyperaldosteronism
C. Unilateral APAs
D. Familial hyperaldosteronism

Q. 224. A child is brought to your clinic for a routine examine.

She can dress with help, can ride a tricycle, knows her own age, and can speak in short
sentences. She had difficulty in copying a square. The age of this child is most likely
a. 1 year
b. 4 years
c. 2 years
D. 3 years

Q. 225. hypertonic dysfunctional labor generally can be expected to

A, be associated with rapid cervical dilation
B, cause little pain
C, respond to sedation
D, occur in the active phase of labor

Q. 226. Drugs contraindicated in acute myocardial infraction

A. Nifedipine
B. Methanol toxicity
c. ACE inhibitors
d. Aspirin
Q. 227. In addition to abdominal ain, the main symptom of upper small bowel obstruckon is:
a. The exhaust and defecation are stopped
b. Distension
C, Frequent vomiting
D. Bloody stools

Q. 228. Regardless of type of intestinal obstruction, the four common manifestations of intestinal
obstruction are
a. Constipation, abdominal pain, distension, bowel sounds
b. Constipation, vomiting, abdominal pain, distension
c. Abdominal pain, bowel type, vomiting. constipation
d. Vomiting, abdominal pain, hyperactive bowel sounds, distension

Q. 229. Which is wrong about clinical manifestations of acute peritonitis?

a. Persistent abdominal pain
b. Hyperactive bowel sounds
c. Nausea, vomiting
d. Muscle tension and rebound tenderness

Q. 230. A nulligravida at 30 gestational week, was found shocked in bed with severe ginal
bleeding without abdominal pain, what is the most possible diagnosis of her?
A, complete placenta previa
B. placenta abruption
c. marginal placenta previa
D. rupture of uterus

Q. 231. Please find the right Growth of Skull

A, anterior fontanelleInsed in 1.0-1.5
b. cranial suture closed in 1-2 monsafter birth
c. posterior fontanelle closed in 2-4 weeksafter birth
D, cranial suture closed in 3-4 monsafter ISS birth

Q. 232.A 55-year-old man who has complained of heartburn over the past 10 years undergoes
endoscopy. The endoscopist notes a change in the appearance of the epithelium in the distal
esophagus. Biopsy reveals erosion of the squamous mucosa and local replacement with severe
dysphasia. Which of the following steps should be taken?
a. Resection of the distal esophagus
b. ESD (Endoscopic Submucosal
Dissection)
c. Treatment with PPI (Proton pump inhibitor)
d. Repeat endoscopy and biopsy in 12 months

Q. 233. The difference between low intestinal obstruction and high intestinal obstruction is
mainly
a. with or without peritonitis
b. abdominal distension
c. with or without blood
d. vomiting

Q. 234. Which one is the first vaccine, according to Immunization Program for Children.
A. Attenuated live measles vaccine
B, Hepatitis B immuraglobulin
C. Mycobacterium tuberculosis vaccine(attenuated live tuberculosis liquid)
D. Attenuated live polio vaccine

Q. 235. The typical sign of upper respiratory tract obstruction

Is:
a. Expiratory stridor accompanied with prolonged expiratory phase
b. Expiratory wheezing accompanied with prolonged expiratory phase
c. Inspiratory wheezing accompanied with shorten inspiratory phase
d. Inspiratory stridor accompanied with prolonged inspiratory phase

Q. 236. This is a 55 year old woman who has fatigue. Her past medical history is un
unrenderable. She is taking no medication. No abnormalities detected on physical examination.
The only abnormal detected on routine blood testing is an elevated acium |2.96 mmol/L (11.9 mg/
dL)] and a serum inorganic phosphorus of 0.65 mmol/L (2 mg/dL). An immunoreacted
parathyroid hormone level is undetectable. The m likely etiology for this patient's high serum
calcium is-
A, primary hyperparathyroidism
B. hyperthyroidism
C, hypervitaminosis
D, malignancy

Q. 237. please see questions in picture

a. Glipizide
b. Repaglinide
c. Metformin
D. Acarbose

Q. 238. Which of the following statements concerning the H. pylori infection is correct?
A. Most patients infected with H. pylori will develop an ulcer
b. Both elevation of pH in the stomach and suitable antibiotics are very important in the
treatment of H. pylori.
c. Positive H. pylori antibody in serology means H. pylori infection now
D. All patients with a duodenal ulcer harbor H. pylori.

Q. 239. A 45-year-old woman is diagnosed with an early cervical cancer,which of the following is
a risk factor for CC?
A, late menopause
B, nulliparity
c. obesity
d. early age of coitus

Q. 240. The main cause of death in patients with cancer is

a. Secondary bleeding
b. Extensive metastasis
c. Pain
d. Secondary infection

Q. 241.In pheochromocytoma, the urine will contain:

a. HIAA
b. Both
c. None
D. VMA.

Q. 242. Commonest site of intestinal atresia is in the:

a. Jejunum
b. Colon
c. Ileum
d. Duodenum

Q. 243. The most typical clinical manifestation of acute appendicitis is:

a. Psoas muscle test positive
b. Paroxysmal right lower abdominal pain
c. Fever
d. Transferred right lower abdominal pain

Q. 244.All of the following are a sociated with carcinoid syndrome except

A. Diarrhea
b. Acute appendicitis
c. Flushing
D. Cyanosis

Q. 245. Drugs used in CCF are all except

A. Diuretics
B. Amiodarone
c. Vasodilators
d. Domapmine/Dobutamine

Q. 246. Potts shunt is:

a. Right subclavian artery to right pulmonary artery
b. Descending aorta to left pulmonary artery
c. Left subclavian to left pulmonary artery
d. Left ventricular hypertrophy

Q. 247. According to 2018 AHA update of Cardiopulmonary Resuscitation and Emergency

Cardiovascular Care, which medication is recommended for ventricular fibrillation /pulseless
ventri ar tachycardia:
a. Procainamide
b. Lidocaine
c. Either lidocaine or amiodaroneprocainamide
D. Amiodarone
Q. 248.In a patient of mesothelioma, one often finds
A. Hemorrhagic pleu
effusion
b. An association with asbestosis
c. All of the above
D. Hypoglycemia

Q. 249. Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized
petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node enlargement is
noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have
a normal hemoglobin, hematocrit, and white blood count and differential. The platelet count is
15,000/uL. The most likely diagnosis is
a. acute leukemia
b. Idiopathic (immune) thrombocytopenic purpura
c. von Willebrand disease
d. Aplastic anemia

Q. 250. A 55-year-old male insurance agent with a benign past medical history presents to his
primary care physician complaining of indigestion. He notes that
"heartburn" has occurred weekly for about half a year, especially after eating a heavy meal. He
has no risk factors for coronary artery disease. Physical and routine laboratory examinations at
anrevealing. Which of the following is the most appropriaté next step?
A. Serology for H. pylori
b. Upper gastrointestinal endoscopy I#
c. Upper gastrointestinal barium radiography
d. Ambulatory esophageal pH testing

Q. 251. A 35-years old woman has had recurrent episodes of headache and sweating. Her
mother had renal calculi and died of thyroid cancer. Physical observations revealed a thyroid
nodule and ipsilateral enlarged cervical lymph nodes. Before performing thyroid surgery the
woman's physician should order
A. Estimation of hydioxyl indole acetic acid in urine
B, Estimation of TSH, and TRH levels in serum
c. Estimation of urinary metanephrines, EMa S VMA and catecholamines
d. Thyroid scan
Q. 252.A 34-year-old woman states that she has had no menses since she had a uterine
curettage and cone biopy of the cervix 1 year previously, Since those surgeries, she complains of
severe,crampy lower abdominal pain"similar to Inbor pain" for 5 days of each month. Her basal
body tem erature chart is biphasic,rising 1 F for 2 weeks of every month. which of the following is
the most likely etiology of secondary amenorrhea?
a. Hypothalamic etiology
b. Cervical condition
c. Pituitary etiology
D. Uterine etiology

Q. 253. Strangulated obstruction is characterized by abdominal pain: C

A. Radioactive pain
B, intermittent cramping pain
c. Persistent dull pain
d. Sustained severe abdominal pain

Q. 254.