MU MCQs

Table of Contents
Preface ....................................................................................................................................................... 4
Final MCQ 6th year 2019 ............................................................................................................................. 5
Dr. Rami questions : ............................................................................................................................................ 5
Dr. Basil questions: ............................................................................................................................................. 5
Dr. Noha questions : ........................................................................................................................................... 6
Dr. Samah questions : ......................................................................................................................................... 6
Dr. Jeries questions : ........................................................................................................................................... 7
Dr. Mdallal questions : ........................................................................................................................................ 8
Dr. AL3ani questions : ......................................................................................................................................... 8
Final Exam 2019 4th year (Ihsan)
By:Abdelrahman Bdeir, Abdulrahman Alwardat & Abdallah Alazzam ........................................................... 8
DR. Rami – GI : .................................................................................................................................................... 9
DR. Samah – RS : ............................................................................................................................................... 11
DR. Ahmad – NEOHRO : .................................................................................................................................... 13
DR. Mohammed – HEMATOLOGY .................................................................................................................... 14
DR. Nuha – ENDO + INFECTUS : ........................................................................................................................ 16
4th year Final exam 2018
By: Ammar Adaileh & Tareq Abu Lebdah ................................................................................................... 17
GIT & Liver :....................................................................................................................................................... 18
Hematology :..................................................................................................................................................... 19
Infectious : ........................................................................................................................................................ 20
Endocrinology : ................................................................................................................................................. 20
CVS : .................................................................................................................................................................. 21
Rheumatology : ................................................................................................................................................. 22
Nephro & electrolytes :..................................................................................................................................... 23
Pulmonary : ....................................................................................................................................................... 24
4th year Final exam 2017............................................................................................................................ 25
4th year Final exam 2016 .......................................................................................................................... 29
6th year Final exam 2016............................................................................................................................ 36
Final Exam 2013 6th year............................................................................................................................ 42
Final Exam 2012 4th year .......................................................................................................................... 54
Final Exam 2011 4th year .......................................................................................................................... 60
Final Exam 2008 X year ............................................................................................................................. 75
Final exam 2007 6th year ........................................................................................................................... 94
Final Exam past years 2004 - 2007 / Q. of unknown origin ........................................................................ 119
Part 1............................................................................................................................................................... 119
Part 2............................................................................................................................................................... 125
Part3................................................................................................................................................................ 128
Part 4............................................................................................................................................................... 152
Part 5............................................................................................................................................................... 156
Part 6............................................................................................................................................................... 160
Part7 .............................................................................................................................................................. 165
Part 8 ............................................................................................................................................................ 171
Part 9............................................................................................................................................................... 181
Cardiology .............................................................................................................................................. 185
Part 1 (top secret) ........................................................................................................................................... 185
part 2............................................................................................................................................................... 196
Gastroenterology .................................................................................................................................... 266
Haematology .......................................................................................................................................... 274
Rheumatology and bone disease ............................................................................................................. 279
Nephrology ............................................................................................................................................. 287
Respiratory medicine .............................................................................................................................. 420
RS MCQs Dr. Samah 2019 ............................................................................................................................... 420
Preface
The file contains all the questions for the Internal Medicine
department at Mu'tah University from the year 2004 to the
current year.
The file will be updated periodically and modified as

appropriate.
In order to benefit, the file was divided into two parts:
Part one: Contains questions for complete exams.
Part Two: Contains questions related to a specific topic.

Final MCQ 6th year 2019
Head of department : Dr. Rami Dwairi
Dr. Rami questions :
1. Celiac disease is followed up by :

Anti TTG antibody
2. One of the following not a part of child PUGH classification :
Platelet count
3. Diagnosis of Hepatitis E :
Anti Hepatitis E titers
4. Wrong about crohn:
rose thorn ulcer
caseating granuloma
5. Most common route of transmission for hep B worldwide :
vertical
6. Treated hep c follow up by :
viral load
7. All true except :
some thing about treatment of IBD and mentions TPMT enzyme related to
methotrexate ‫ هذا االنزيم لل‬azthioprine
8. wrong about Mx of irritable bowel:
barium follow through for all pt
9. hemochromatosis wrong about it :
congestive ?
Dr. Basil questions:
1. hypokalemia didn’t give :

Sine wave
2. Dyspnea, syncope and chest pain in 70 yo patient and has early diastolic murmur
:
aortic stenosis
aortic dissection
mitral valve prolapse
spontaneous pneumothorax
3. B blocker effect of heart all except :
increases cardiac contractility
4. Factors play role in incrasing oxygen demand in angina pectoris patient except:
ventricular size
5. Emegent drug in ACS except :
digoxin
6. ECG with ST elevation in lead 2, 3,avf :
right Ventricular infarction
7. Eye manifestation in infective endocarditis :
Roth spot
8. cardiac tamponade :
increase in JVP
9. Raised JVP in SLE patient :
constrective pericarditis
Dr. Noha questions :
1. eye complaint and abnormal color perception in HIV pt due to :

Cmv retinitis
2. Chloramphenicol for prevent :
typhoid relapse
3. Pt come with presentation of Addison Dx by :
ACTH stimulation test
4. Pregnant with lower UTi :
Ampicillin
5. Brucella resistant to flouroquinolone due to :
DNA gyrase
6. Pt with HIV on Rx and prophylactic Ab CD4 was 25 If raised to 250 , what to do
:
Stop anti- HIV medication
7. Drug not given in pregnancy :
Doxycyclin
8. Dysuria, frequency , urine analysis shows WBCs , leukocyte esterase on stain
(not culture) no organism was found , diagnosis :
TB , lower UTI
9. Cause of death in malta fever :
infective endocarditis
10. kaposi Sarcoma :
HHSV8
Dr. Samah questions :

1. 80 year old patient in hospital develops pneumonia 3 days after hospitalization ,
what is the treatment :
anti psuodomanous beta lactam +anti pseudo quinolone + vancomycin
2. Patient with mass in chest x ray and hyponatermia :
SIADH with small cell
3. ASA causes metabolic acidosis RS alkalosis ???
4. pt on high dose inhaled steroid and long acting beta agonist for 6 months :
step down for low dose inhaled steroid and keep long acting beta agonist
5. TB drug that cause problem in vision :

ethambutol
6. MDR TB is resistant to :
both isoniazid plus rifampicin irrespective to other drugs
7. lung fibrosis biopsy :
subpleural fibrosis + cystic lesion
8. flial chest is :
2 or more rib fracture in 2 or more places
Dr. Jeries questions :

1. Question indicating Churg-strauss (Eosinophilia and asthma in history) :
P-anca
2. one of the following is not seen in RA :
Bouchard nodules
3. Gottren Rash :
dermatomyositis
4. case scenario and you are asked to how many SLE criteria are present :
5
5. Recurrent abortion , sle , long ptt low platlets :
anti phospholipid
6. All are seen in RA except :
boucherds
7. One of the following involves the DIP :
Psoriasis
8. we use RF for follow up except :
9. antibody not in dermatomyositis :
anti RNP
10. we see it on MRI years before X-ray :
Axial
11. anti centromere :
limited
12. Diffuse urticaria , low complement seen in :
Hypocomplement urticarial vasculitis
13. All cause erythema nodosa except :
TB - OCP - beta hemolytic strep – leukemia , RA
14. Pt with gout ,, what is the goal uric acid level :
<8 <7 <6 <5 <4
Dr. Mdallal questions : ‫كانت صعبة كثير‬

1. Causes glomerulosclerosis :
DM nephropathy
Dr. AL3ani questions :

1. polycythemia RV what is wrong :
It is myelodysplastic
2. Prophylaxis for DVT is needed In all except :
normal vaginl delivary
3. All in DIC except :
increase fibrongen level
4. Disease with decrease clotting factor :
christmas disease (hemophilia b)
5. Wrong about CLL :
Disease of children
6. PT is not elevated in :
intrinsic pathway
Final Exam 2019 4th year (Ihsan)

DR. Rami – GI :
1- Which of the following not side effect of ribavirin?
A. Hemolysis
B. Hirsutism
C. Pruritus
D. nasal congestion
E. Teratogenic in Pregnancy
2-Most common cause of cirrhosis in our region?
A. Viral hepatitis
B. Autoimmune hepatitis
C. Budd–Chiari syndrome
D. Alcohol
E. Wilson’s disease
3-Not used in diagnosis of hepatitis?
A. HBsAg
B. HBV DNA
C. Anti-HBc
D. HBcAg
E. Anti-HBe
4- What Anti-HBs mean?
A. indicates immunity
B. increased severity and infectivity
C. continual viral replication
D. recent HBV infection
5- commonest cause of GI bleeding in the following?
A. GI cancer
B. esophagitis
C. Dieulafoys lesion
D. Mallory Weiss tears
E. Esophageal varices
6- Does not used in long term control of bleeding?
A. Non selective B antagonist
B. TIPS
C. Banding
D. Sclerotherapy ???
7- All the following are components of Child's criteria of liver disease except?
A. Serum albumin
B. Serum bilirubin
C. Ascites
D. varices
E. Hepatic encephalopathy
8-False about risk of rebleeding?
A. Advanced age
B. HR 130 and BP 80/50
C. Absence of liver disease sign
D. Comorbidity
E. Endoscopic diagnosis reveal bleeding
9-Wrong about Crohn’s disease?
A. Caseating granuloma
B. chronic inflammatory condition that may affect any part of the gastrointestinal
tract
C. There are deep ulcers and fissures in the mucosa, producing a cobblestone
appearance
D. the inflammation extends through all layers of the bowel
E. involve multiple areas with relatively normal bowel in between skip lesions
10-All correct about transfusion except?
A. pallor, cold peripheries,
B. systolic BP below 100 mmHg,
C. pulse > 100/min
D. Transfusion with Hb 9 g/dl without bleeding
11-Patient has history of multiple fractures he is known case of celiac disease best
diagnostic imaging for bone ?
Answer: bone densitometry (DXA)
12-Wrong regarding crohn disease management?
Answer: the key enzyme in biological agent is TPMT
Explanation: The key enzyme involved in AZA and 6MP metabolism is
thiopurine methyl transferase (TPMT)
13-All about bleeding correct except?

Answer: All patient with cirrhosis will develop variceal bleeding
Explanation: Approximately 90% of patients with cirrhosis will develop
gastroesophageal varices, over 10 years, but only one third of these will bleed
from them
DR. Samah – RS :
1-Not side effect of B2 agonist :
A. Tachycardia
B. Arrythmias
C. Tremor
D. Hyperkalemia
E. hypokalemia
2-most common clinic presentation of PE ?
A. acute onset dyspnea
B. chest pain
C. cough
D. syncope
E. hemoptysis
3-67 years old male patient complain from chest pain, productive cough and fever,
on examination the patient confused and RR=33, BP=100, on laboratory
investigation blood urea = 9 mmol/L (not mg/dl as in slides so to convert mmol/l to
mg/dl = mmol/l X 18), calculate CURP-65 score?
A. 2
B. 3
C. 4
D. 5
E. 6
4-A medical student while taking the internal medicine exam suffered from
tachypnea and anxiety, in the emergency laboratory investigation Ph=7.52, co2=22
, HCO3=24, which of the fooling is correct ?
A. Acute Metabolic alkalosis
B. Chronic Respiratory alkalosis
C. chronic Metabolic alkalosis
D. Acute Respiratory alkalosis
5-Pateint taking anti TB and warfarin started feeling (arrythmia?) ?

Answer: Increase warfarin dose
Explanation: The Rifampin is hepatic microsomal enzymes inducer so increase
the dose
6-True about pneumothorax?
Answer: Decrease or absent breath sound
7-Fever , myalgia, headache , dry cough, the causative organism is?
Answer: Mycoplasma pneumonia
8-Drug of choice for MRSA?
Answer: vancomycin
9-False about consolidation?
Answer: Decrease tactile vocal fremitus
Explanation : in consolidation increase tactile vocal fremitus
10-Wrong about TB manegiment ?
Answer: anti tb stopped after 4 weeks
Explanation: according to DOTS Strategy is recommended continued anti-TB
drugs to 6 months
11-Wrong regarding to TB ?
answer: microscope used to differentiate between resistance and sensitive bacteria
for anti-TB
explanation: Cultures on L J media used as Sensitivity tests for anti-TB drugs
12-interstitial lung fibrosis ?
Answer: CT ????
13-Not part of hyperventilation syndrome:
Answer: PE
DR. Ahmad – NEOHRO :
1- Patient come with loin pain & fever and costovertebral angle tenderness what’s
your diagnosis :
A. Pyelonephritis
B. kidney stones
C. Nephrotic syndrome
D. Nephritic syndrome
2-Drugs that Cause hyperkalemia except :
A. Salbutamol
B. Insulin
C. ACEI
D. ARBs
E. SPIRONOLACTONE
3 - Pt with ventricular tachycardia and after few days serum creatinine increased
what type of kidney injury :
a. pre-renal
b. renal
c. post renal
4- One of the following doesn't cause secondary nephropathy ?

A. HSP
B. DM
C. congenital glomerulonephritis
D. NSAIDs
E. cryoglobulinemia
5- wrong about AKI
A. Associated with oliguria
B. Uncompensated cases has poor prognosis and high mortality ?
C. May lead to life threatening electrolyte disturbance
6- Not an indication of dialysis:
A. Acidosis not responding to treatment
B. Pulmonary edema not responding to treatment
C. Hyperkalemia not responding to treatment
D. Uremia pericarditis
E. To remove anti hyper tensive drug in renal failure
7- True about FSGN:
A. 90% pediatrics
B. Resistant to steroid
C. Never develop to ESRD
D. is a Nephritic syndrome
E. Low protein in urine
8- Drug cause prerenal uremia:
A. ACE inhibitors
B. Beta blocker
C. Calcium chanel blocker
D. Potassium sparing diuretics
9- Wrong about nephrotic:
Answer: Cause of hyperlipidemia due to decrease loss of LDL and VLDL
10- male came with urethritis and a diplococci bacteria ?

Answer: Neisseria gonorrhea
DR. Mohammed – HEMATOLOGY

1- All of the following “B” symptom of non-Hodgkin lymphoma except :
A. drenching sweat
B. Fever
C. Weight loss
D. itching
2- ITP not affect

A. Pt /Ptt
B. Platelets count
C. Bleeding time
3- All are aquired causes of platelet disorders exept?
A. Bernard soulier syndrome (Autosomal ressisive )
B. ITP
C. TTP
D. Trombocytosis
E. Uremic thrombocytopenia
4- anemia of chronic disease all false except?

A. Low serum ferritin
B. Macrocytic
C. High total iron binding capacity
D. High Fe saturation
E. has high hepcidin
5- 35 year old male complaining from fatigue. He denied hx of melena, trauma ...
cbc shows decrease in Hb, MCV, .. normal RDW ; next step :
A. Occult stool test
B. Iron measurment
C. Hb electrophoresis
D. Lead level
6- Wrong about DIC :

A. thrombocytosis
B. Decrease fibrinogen
C. Burn can cause it
7- Pt have serum ca 14.3 and serum creatinine is 2.3 and on X-Ray have
compression Fracture of vertebrae what is next step :
Answer: Serum immune electrophoresis
8- Drug act on thrombin ?
Answer: Argatroban (direct thrombin inhibitor)
9- 1st choice treatment for ITP ?
Answer: IVIG
10- All true except ?

Answer: Fe deficiency has low RDW
DR. Nuha – ENDO + INFECTUS :
1- first test to diagnose Cushing?
A. Synacthen test
B. Salaiva
C. High dose dexamethasone ?
D. CT brain
2-patient with weight gain what is the most appropriate test ?
A. TSH
B. T3
C. T4
3-diabetic patient type 1 had kussmaul breathing , what most likely happen to him
?
Answer: DKA
4-patient present with perioral numbness & carpopedal spasm what most likely
diagnosis ?
Answer: Hypocalcemia
5-diabetic patient type 1 missed a meal what will happen to him ?
Answer: DM type 1 patient take insulin so missed a meal will cause
hypoglycemia
6- patient present with nausea ,vomiting & Bradycardia + continuous fever for 4
weeks what most likely causative organism ?
answer: Salmonella typhi
7- HIV patient with dry cough bilateral hilar lymphadenopathy + fever ?

Answer: Pneumocystis jiroveci
8- what is the disease that cause malta fever ?

Answer: Brucellosis
9- patient present with eccentric target sign ( ring sign) on MRI , what is the most
likely diagnosis?
Answer: Toxoplasmosis
➢ DR. Cardio :
1- All increase HOCM except ?
A. Valsalva
B. Standing
C. Squatting
D. Exercise
E. Nitrate
2- patient presented to the clinic 5 days post STEMI , he complained of pleuritic
chest pain increased when lying down friction rub , ECG showed diffuse ST-
elevation what is the DX?
A. STEMI
B. Dressler syndrome
C. Myocarditis
D. PE
E. Pneumonia
3- most common cause of death in HTN?
Answer: MI
4- Previous MI patient with increase cholesterol level what is next step ?
Answer: describe statin drug
5- young female with left ankle and knee swelling and hx of sore throat ?
Answer: rheumatic fever
6- female with ECG showed : narrow QRS complex with regular HR of 170bpm
what is next step ?
Answer: IV adenosine
➢ DR. jeries – ROMATOLOGY :
✓ Most of the questions are same to past years questions

GIT & Liver :
1- 69 year old patient with jaundice and mild fatigue only , Direct billirubin is elevated (
more than 80% ) with high Alkaline phosphatase and normal AST ALT, proper
diagnostic tool for this patient :
CT Scan ( suggestion of malignancy )
(there was ERCP as other choice but not the correct answer Approved by dr. waleed)
2- 59 year old patient with upper abdominal and nausea with vomiting , least essential
tool for dx :
CT scan ( Cardiac enzymes , ECG , Amylase , other ?? ).
3- Patient complaining of jaundice and the urine analysis revealing positive bilirubin :
( obstructive jaundice cause ) so it is Dubin–Johnson syndrome
4- Patient diagnosed with crohn's disease complaining of multiple perianal fistulas and
the treatment that given is infliximab which is :
Anti TNF monoclonal antibodies
5- Patient with liver cirrhosis come with tense ascitis and bilateral lower limb edema and
diffuse abdominal pain , ascetic fluid analysis was : 750 wbcs with 90%
polymorophonuclear cells and 3 g/dl albumin , what is treatment and negative gram stain
? Ceftriaxone IV (spontenous bacterial peritonitis
6- 40 years old patient complaining of intermittent dysphagia ( ‫)نسيته ذكروني‬
7- Patient with liver cirrhosis complaining of esophageal varicies and the banding
therapy is given , what drug we should put patient on : Propranolol
8- not risk factor of poor prognosis gi bleeding :

onset of bleeding during hospitlization ????!!! (not sure )
9- 20 year old female diagnosed as Irritable bowel syndrome with pain predominance ,
what is treatment not used for her :
Narcotic analgesia ( the other choices : tricyclic antidepressant , high fiber diet ,
antispasmotic )
10- At liver cirrhosis the level of which substance with low level :
urea ( impairment of urea cycle which occur at liver )
11- true regarding hepatitis D :

infection with that virus should be associated with hepatitis B patient ( there was other
true choice??? that Hep. D and Hep. B coinfection lead to increase chronicity ? )
12- Drug of choice for patient with ulcerative colitis that reach segmoid colon :
Oral 5-ASA ( suppository if it is limited to rectum )
13- Risk factor for Ulcerative colitis to develop malignancy : pancolitis
1- Nerve roots for Biceps reflex : c5 , c6
2- Site of Chemotriger zone for vomiting : Medulla
3- Father with his two sons come to ER at cold weather . They are complained of
dizziness and headache and confusion what is most likely diagnosis :
Mono oxide toxicity
4- yound adult complaint of sudden headache with neck rigidity and without fever , most
likely diagnosis : Subarachnoid hemorrhage (approved by dr, waleed )
Hematology :
1- wrong regarding CLL : It is disease of adults
2- not cause of DIC : essential thrombocytosis
3- True regarding polycythemia vera : ?????
4- True regarding Sickle cell disease : Hand-foot syndrome is associated with swelling
and pain at fingers and toes for children and cause disability ???!!!!
5- Patient with history of treatment of pneumonia ( he took co-triamethaxazole )

complaining of sign and symptoms of anemia with splenomegaly , CBC : Hb: 9 , MCV :
90 , reticulocytes count : 7% what is most likely diagnosis :
G6pd ( co-trimethaxazole is one of the drug which cause hemolytic crisis )
6- PT prolongation doesn't occur at : intrinsic pathway
7- one is coagulation disease : Hemophilia B
.
Infectious :
1- Passive immunization with immunoglobulin as prophylaxis :

Hep. B ( ‫)راجعنا الدكتور فيه و حكى بنرجع ندققه النه فيه كمان تيتناس توكسويد‬
2- IV drug user complaining of scenario of infective endocarditis , blood gram stain

reveals G+ bacteria in cluster , what is treatment of choice :
Vancomycin (approved by dr. waleed )
3- Patient with history of cough and sputum with fever and SOB , xray reveals non
homogeneous opacity at middle lung , after few days complained of Spontaneous
pneumothorax what is most likely organism :
This is scenario of narcotizing pneumonia >> Staph aurues
4- Contraindicated antibiotic at pregnancy : doxycycline
5- Not a drug used for treatment of TB : bismuth
6- Wrong regarding high risk patient with pneumonia : Respiratory rate is 22
7- True regarding catheter induced UTI :

Patient with more than 2 weeks on catheter without changing reveals bacteriuria
8- Egyptian farmer with scenario of mass at junction between bladder and ureter , true
regarding this patient :
He has schistosomiasis ??!!!!
9- true regarding typhoid fever : rose spot comes with fever ???!!
Endocrinology :
1- Wrong about Acromegaly : exophalmous
2- Longest insulin half life : Glargine

3- Thyroid disease without nodule : hashimoto's thyroiditis
4- Not cause of cushing : Adrenal hemorrhage
5- Best diagnostic test for addison's : Synacthen ACTH test ??!!
6- Fasting blood sugar : 120 , postprandial blood sugar : 180 , what is true : impaired
FBS & postprandial blood sugar tolerance
7- DM drug which cause weight loss : ???
8- Elderly came with HF , what drug deteriorate her condition : pioglitazone
9- Wrong regarding treatment of Grave's disease : Methimazole used at pregnancy
10- Wrong regarding SIADH : there is signs of overload in that patient ??! actually there
is no significant signs ??!!!
11- adverse effect ‫او اشي هيك‬for Methimazole: Agranulocytosis
CVS :
1- young complained of repetitive attack of syncope in the morning after he shaves his
beard : ( He pressed on carotid body during shaving ) So it is Carotid body syncope
2- Patient come to clinic due to attack of syncope and doctor approved that his new drug
is the real cause of these attack of syncope , which less likely drug :
Aminoglycoside ( all of them are HTN drugs + procainamide )
3- Anaphylactic shock true :

Stridor (due to edema of laryngeal mucosa) or dry hot skin ??!
4- ECG question ???!!
5- Young female patient with palpitation and regular pulse with 120 Beat per minute ,
Treatment : Adenosine IV ??!!
6- Case of 2nd degree heart block treament of choice : pacemaker ??!!
7- wrong regarding antidote : Calcium gluconate for digoxin toxicity
8- patient with early diastolic murmur at left sternal area with high volume pulse (water
hammer pusle) : Aortic regurgitation
9- One is presentation of hypertrophic cardiomyopathy : sudden death
10- True regarding mitral stenosis : hemoptysis is due to pulmonary hypertension
11- Shifted apex beat to anterior axillary line to 6 or 7th intercostal space indicative of :
Left ventricular dilatation
12- wrong regarding Pulmonary HTN : onset of HTN is above 60 mmHG
13- drug improve mortality rate in HF : Enalapril
14-contraindication for enalapril : bilateral renal artery stenosis
Rheumatology :
1- known Patient of renal failure complaining of monoarthritis (swelling , pain , signs of

inflammation ) with no previous history , after aspiration microscopic picture reveals
intracellular neddle shape crystals , Treatment of choice :
intra-articular corticosteroid ( Voltaren is contraindicated in renal impairment )
2- True regarding SLE :

azathioprine & other immunosupressive drugs decreasing need for long term
corticosteroid
3- Wrong regarding scleroderma : there is vegetation on the heart valves
4- True regarding Rheumatic fever : need secondary prophylaxis of antibiotic to decrease

possibility to recurrent rheumatic fever
5- Antistreptolysin Q ??!!!!
6- common manifestation at ankylosing spondylitis
7- 60 year old patient with headache and tenderness over temporal region and she suffers
from tiredness during mastication and talking , what is the diagnostic test
8- wrong regarding inclusion body myositits : female more than male

9- Not feature of osteoarthritis at xray : ?????!!!
10- signs and symptoms of glomerulnephritis after upper respiratory tract infection, on
histopathology of biopsy what is the finding ( ‫)ذكروني بالكيس‬: IgA nephritis
11- case with hemoptysis and hematuria with proteinase 3 positive (c-ANCA positive ) :
Wegner granulomatosis
12- Case of young patient with monoarthritis at ankle what is true :

* erythema over dorsum of foot suggestive of gout (most like answer )
* Recurrency and 1st metatarsal involvement suggestive of gout (may be the answer )
Nephro & electrolytes :
1- True regarding management of chronic renal failure :

we use calcitriol for treatment of hypocalcemia
2- It's not a cause of hypokalemia : adrenal insufficiency
3- Cause of hypercalcemia at malignancy :

bone involvement ( i think) or PTH secreting tumor ????!!!
4- Hyperkalemia chages on ecg : PR prolongation and QRS widening which one ???!
5- Not normal anion gap acidosis : renal failure
6- Corrected calcium equation : 7 mg/dl
7- Not used for treatment of hyperkalemia : Magnesium sulphate
8- Low co2 , Low Hco3 & ph= 7.1 : metabolic acidosis
9- cause of osteodystrophy at chronic renal failure : ‫؟؟؟؟‬
10- cause of papillary necrosis due to tubulointerstitial disease : elderly using chronic
analgesia
11- wrong regarding type 4 tubular acidosis : hypokalemia
12- wrong regarding type 1 tubular acidosis : ????

Pulmonary :
1- Wrong regarding physical examination findings of Right sided obstruction of main

stem bronchus : bronchial breathing at right side
2- stony dull on percussion , decrease TVF , loss of auscultatory sounds :

Pleural effusion
‫ فيزكال اكزامينشن ؟‬pneumothorax ‫ فيه سؤال‬-3
4- Best diagnostic test for cystic fibrosis : Gene analysis
5- scenario of asthma exacerbation one is true regarding of this patient :

flattening of diaphragm ??!!!
6- one is wrong regarding severe asthma attack :kPa of o2 is more than 10
7- True regarding ARDS : ‫شايفهن كلهن غلط (الويدج برشر دايركتلي ريليتد للبولموناري برشر فأي جواب‬
‫ وال مش صحيح ؟‬،‫ بأكد الثاني‬2‫)من ال‬
8- True regarding sarcoidosis :

increase absorbtion of calcium from intestine ( Vitamin D effect due to hydroxylase
activity of epitheloid activity of granuloma )
1) Most common cause of death in Jordan --->
heart attacks
RTA
STROKE
2) Complete heart block
- anti ssa
3) Treatment for eradication of h pylori
- omeprazole, clarythromycin, amoxicillin
4) Cause of galactorrhea,
primary hypothyroidism
5) Furesamide
- loop diuretic
6) *Av node aw conduction abnromality following MI
- right Coronary artery
7) Deforaxamine
- iron overdose
8) Retinal vasculitis
- behcet*
9) A cause of clubbing
-abscess
10) Most uti bacteria
- e. Coli
11) Metformin
- lactic acidosis
12) Urti with hematuria
- iga nephropathy
13) Elevated Bleeding time and PTT
- von disease
14) Cause of HTN
- coarctation of the aorta
15) Adults AS
- bicuspid aortic valve
16) X-ray negative finding with positive MRI
- none of the above
17) Diabetes except
- first neurological manifestation is muscle weakness
18) UTI with knee joint inflammation-
A,B,D
19) Not a bronchogenic asociated paraneoplastic syndrome
- hypoglycemia
20) Not an inherted thrombophilia
- anti-phospholipid
21) Not hepatitis C mode of transmission
- feco oral
22) *All cause hyperuricemia except ?
- large doses of aspirin
23) *Hodgkin 1a? Which is wrong;
involves 2 nodes
24) Celiac disease
- anti-tissuw transglutaminase antibody
25) Not related to hypertension treatment aw hek eshi
- statin
26) Periphral neuropathy ..
vit b12
27) Positive direct coomb test .
.AIHA
28) early finding in hepatitis b ...
HBsAG
29) electrophoresis...
Thalasemia
30) X-linked..
G6PD
31) All cause hyperurecimea exept ...
Hige dose aspirine
32) Finger clubbing ..
Lung abscess
33) Gallbladder contraction ..
CCK
34) non lymphoid organ..
.liver
35) M.C cause of urinary infection.
.E-coli
36) M.C cause of CAP ...
s.pneumonia
37) Frusamide..
loop of henle
38) Retinal vasculitis..
behcet
39) Celiac ...
Anti-endomysium
40) M.C cause of death in jordan ..
Heart attac
41) M.C cancer in jordan .
.colorectal
42) Rt sternal" ‫"مش ذاكر النص‬
... aortic regurg
43) M.C cause of End stage renal failure.
.DM
44) HLA-B27...
AS
45) inclusion body myositis "all true except" ..
Femal > male
46) DIP involvment ..
.a+c+d "psoriatic/osteo "..../
47) Q"diarrhea"
...‫ نسيته‬salmonela/shigella/uroplasma..."a+b+d"
48) Warfarin..
INR
49) heparin antidote ..
Protamine sulfate
50) Body mass index 27..
overweight
51) Q about sle criteria ..
I think 4
1-Common organism cause Community acquired pneumonia ? >>>>

strep.pnemonia
2-Common organism cause pneumonia. In alcoholic. Pt >>>

klebsiella
3-About Ulcerative colitis exept ??

Deep fissure ulcer
4-About crohn disease exept? ?

. Ceaseation granuloma
5-Inheritance bleeding ??
Vwf
6-Systolic murmur ??
Between s1 and s2
7--Temporal pain wt to do nxt?>>>>>

high dose steroid
8-patechia with no other complain------

ITP
9--how much criteria of SLE is present in this pt?

SLE criteria 4
10--asthma, eosinophilia... wts the diagnosis>

chug strauss
11-gottorn rash>
dermatomyositis
12--inclusion body myositis

most common in men
13--LT upper Q pain radiat to sholder, diagnosis? ?
14--most common sign in eye in RA??
15-1st manifistation of AS??

A+b+C
16-best for diagnosis skeletat involvemey in AS>
MRI??
17-one is wrong about psoriatic arthritis -----

chronic posterior uveitis
18-DM , Correct :
Fasting blood glucose < 126
19-Heparin therapy , wrong ?

Skin necrosis
20-Most common transmission mode in Hep B ?

Vertical or needle stick ???
21-Not used in hep B diagnosis?

HbCAg
22-Not used for H.Pylori eradication success ?

Serology
23-Most common cause of death in hypertensive pts ?

CVA , MI
24-achilles enthesitis seen in :

reactive arthritis ?
24-Triad of portal vein thrombosis + pancytopenia + hemolysis ?

PNH
25-CASE : low platelet count , WBC count 30000 , 50% blast ?

AML , M3 type
26-B12 def anemia ? Wrong ?

Commonly caused due to Diet deficiency
27- radiofemoral delay where ?

Coartication of aorta
28- h.pylori mode of transmession ?

Feco oral
29- one ofe these is not a cause of malabsorption?

Contact dermatitis
30- cause of hypothyroidism ?

Auto imune or iodine def.
31- systolic murmer ?

between s1-s2
32-which of these is not a primary cause of nephrotic syndrome ?

Amylodosis
33-high blood urea is due all of these exept ?

Law urea intake
34-all of these make hyperparathyroidism except ?

pancreatitis
35-a patient come with pain in left upper quadrent for with a history of infectious
mononucliosis what is the diagnosis ?
Splenic rapture
36-Akhilis tendinitis where we find it ?

Reactive artheritis
37-Most common hormone secreted by adenoma

(prolactin)
38-Most common adenoma

(prolactinoma)
39-All are present on ecg for hyperaklemia except

(prominent p wave )
40-All are present in behcet'sdisease except

(behcet's disease ( headache "....pulmonary thrombosis DVT..erythema nodosum
...chronic post uveitis )
41-Patient presents with confusion ;high creatinin and urea ,fever

(HUS" TTP)
42-One of the following are found in renal tubular necrosis

(hyperphosphatemia)
43-On of the following is true regarding to nephrotic syndrome

(increase HDL". decrease LDl ..derease lipoprotein ....glomerular basemt membrane
injury )
44-Signs of CHF include all of the following except :

a) Jugular venous distention
b) S3
c) Inspiratory rales
d) Displaced and sustained apical impulses
e) S4
45In pericarditis the chracterstic EKG changes ;

A:T wave invertion*
B; ST segent depression
C Atrial fibrillation
D;ST segment elevation covex upwards
E; ST segment elevation with cocave downwards
46-the causative organim in rheumatic fever is

A.staph aurus
B. B Haemolytic Streptococcus group A*
C streptococcus viridians
D; E coli
E; virus
47-Patients with aortic stenosis frequently develop:

A. Exertional dyspnea and angina *
B. Wide pulse pressure
C. Systemic embloization
D. Atrial fibrillation
E. Right ventricular hypertrophy
48-Radiofemoral delay present in one of the following condition;

a- in Angina pectoris
b- Coarctation of the aorta*
c-Renal artery stenosis
d-Heart failure
e-COPD
49-In hyperthyroidism Atrial fibrillation is best treated with :

A. Quinidine
B. Digitalis
C. Digitalis and quinidine
D. Pronesty
E. Antithyroid drugs*
50-Ulcerative colitis all true except

(deep ulcer fissure )
51-Chrohn's disease all true except

(caseating granuloma)
52-Most common thyroid cancer

(papillary )
53-Howell jolly body
(hyposplenism )
54-Most common bleeding disorder

(von willenrand disease )
55-Most common cause of thromboembolism

(protein c deficiency)
56-Most common cause of endemic goiter

(iodine deficiency )
57-antibiotic for whipple disease......

ceftriaxone
58-. DKA all except..

No change in anion gap
58-.ECG in hypercalemia
60-.SS In ...
SLE +sjougren "not sure"
61-. Howell jolly body. Target cell ...

Hyposplinism
62-.SE Of rifamicine ...

Hersutism
63-. Most common bleeding disorder...

Vwf
64-.Most common eye finding in RA ??---

sjogren or sicca syndrome???-episcleritis
65-. All about heparin true except??

cause shin necrosis
66--.commonest ca in thyroid..
papillary
67-.Case Cushing... Diagnostic test ??—

24h urine free cortisol
68-. Case .. k7.3 what give ...
Ca gluconate
69-. Community acquired pneumonia . ..

strepto
70-..pneumonia in alcoholic ..??-----

klebsiella
71 HLAB27 ...
SPA
72- SE Of statine
( HmgCoa reductase)??
73-. DM ..
insulin not use firstly for type 2DM
74-. Commonest pituitary Tumar .. prolactinoma / commonest hurmone .. prolactine
75-. Definitions ...

erosion superficial layer
76-.1st manifestations in blood transfusion rejection ...

nausea and vomiting
78-Side effect of statin include followings except

pulmonary fibrosis

. Quinidine
. Digitalis
. Digitalis and quinidine
. Pronesty
. Antithyroid drugs xxx
80- the causative organim in rheumatic fever is ?

A.staph aurus
B. B Haemolytic Streptococcus group A xxxx
D; E coli
E; virus
81- In renovascular hypertension the following statements are true except :

a) Mechanism of hypertension is increased renin levels
b) Etiology is fibromoscular dysplasia or atherosclerosis
c) Onset < 30 years without family history or recent onset >55 years
d) Treatment is usually by ACE-inhibitors if bilateral xxxx
e) Reccurent pulmonary oedema is a clue for diagnosis
82- -Which of these is not found in sarcoidosis ??

Finger clubbing
83-Most common cause of upper GI bleeding>)

E.esophageal varices
84--not of managment of varicies>

ppI
1.Least needed investigation for pulm. Embolism diagnosis :

ABGs 7asab step up ma3 enni mu mjawbe sa77 😬
2.smudge cells seen in :
CLL
3.patient who doesnt need subcut. Heparin :
21 yrs old female after Normal vaginal delievery
4.immediate management in patient coming to ER with hx of nsaid intake and ugib
:
administer 2 units of pRBCs (resuscitate)
5. tumor lysis syndrome causes all but which of the following :
hypercalcemia
6. Anti smooth muscle antibodies highest in
autoimmune hepatitis
7. patient with hx of Barette's esoph .first approach is :
endoscopy with biopsy
8. most common organism causing septic arthritis :
staph aureus
9. Non infectious disease
(legionella)
10. Malar rash and postive ANA
(lupus)
11. AB doesn't cover pseudomonas
(ceftriaxone)
12. Azithromycin
doesn't cover pseudomonal
13. Associated with Raynoud
(systemic sclerosis)
14. Not associated with anemia of chronic disease
(essential HTN)
15. About Graves disease :
decrease iodine uptake ......
16. most common cause 4 cushing other itragenic :
pituitary adenoma
17. Most common cause of FUO
(infections)
18. Indications of thrombolytics
( new onset LBBB)
19. Most common cause of meningitis
(strep pneumonia)
20. Most common cause of pneumonia
(strep)
21. Patient with positive blood dipstick but no RBCs on microscope
(rhabdomyolysis
22. Drug of choice for SVT
( IV adenosine)
23. Diastolic blowing murmur
(aortic regurg)
24. All true about FMF except
(autosomal dominant)
25. Calculate BMI
(25)
26. All are true about DKA except
(high insulin)
27. Irregularly irregular pulse after alcohol
(A fib)
28. Patient with bilateral infiltrates after H1N1
(ARDS)
29. Patient has symptoms of hypothyroid how to confirm
(TSH)
30. Drugs that affect mortality in HF except
(frusemide)
31. Asthma excacerbation
we don't use antibiotics for acute management
32. wrong about COPD answer
(o2 doesn't affect life expectancy )
33. hepatitis A doesn't cause
HCC
34. fulminant hep all except
A
35. wrong about side effects of these drugs :
thiazide/thrombocytosis
36. thiazide not use in
acute liver failure
37. low antibodies in Coeliac >>
IgA
38. aortic dissection
jawabo elHX el charachtaristic pain
39. which indicates a life threatening attack of athma,,
the answer is cyanosis
40. Most common cause of death in HTN
=MI
41. patient with Mutiple Myloma & nephrotic ;
membranoproliferative
42. true about PE :
negative D-dimers can exclude low probablity
43. Most cause cause of gout
decrease renal excretion
44. Kan fe kman gout o renal stones
45. Most common pathophysiology l eshe respiratory k2nu hypoxia>>
VQ mismatch
46. case male with URTI infection and gastroenteritis o sar 3ndu hematuria.. Etc
i guess
IgA nephritis
47. Mechanism of action for aspirin >>
decrease el TA2
48. Mechanism of action for warfarin>>
Vit K ..etc.
49. Not a cause of macrocytic anemia ;
thalassemia b
50. Doesn't cause lymphadenopathy ;
CML , brucellosis ( e5taf el 3olama2 😛 )
51. Manage Asyatole ;
compression
52. Mechanism of action for imatinb >>
tyrosine kinase inhi9
53. Hb 4.6 w retic 3% parvovirus ans.
Hemolytic crisis
‫ الصح‬aplastic crisis pages334
54. 60 yrs old diabetic female with knee pain Septic arthritis kan 3ndha pyrexia
o 3ayfeh 7alha
55. Acromegaly not associated with??!!
Osteomalacia
56. Least associated with ANCA =
giant cell artirites
57. hyperlipidemia o 7atet el level bl mmol k2nu kan 9 unsure emoticon o 3ndu
CVA bs ma 3ndu MI esh el management?!
Simvastatin
58. Right sided headache
Giant cell artiritis
59. 7.51 .. PaCO2 : 24...caculated bicarb 24 ABG
respiratory alkalosis
60. Minimum time to repeat HBA1C
i guess 3 months
61. the measurement used for re-infarction diagnosis :
CK-MB
62. Pt on dialysis o sar 3ndu nausea o blurred vision..
Et Disequilibrium syndrome
63. Wrong about hypokalemia on ECG >>
Delta wave
64. Wrong about ECG of hyperkalemia >>
peaked p wave
65. Adverse effects of chronic use of steroid excep
hyperkalemia
66. hypercalcemia causes except >>
long q-t
67. Female with syncopial attacks o 3ndha murmur radianting to the carotids
>>
aortic stenosis
68. ACS ma mna3ty
digoxin
69. Not side effect of heparin –
skin necrosis.
70. kant SLE o ejat b chest pain o diffuse ST elevation >>
Pericaditis
71. el RA eja b decrease el voltage sa7?! O hypotension o raised JVP
cardiac temponade
72. Which one of cases of UGIB associated with
the worst outcome
75 male with liver cirrhosis and variceal bleeding
73. patient 3endo non hodgkin lymphoma ...shu el renal manifestation elo?
74. he question was about CHADVASc score and the answer was
COPD
75. IV drug user in the 1990s and asked for Hep C test. Which test to do?!
76. pt. with prev. hx of rheumatic heart disease history but with new murmur
what's the cause?
strep. Viridins
77. not a risk factor for osteoporosis?
Obesity
78. all true about influenza except:
high fever
79. heliotrope rash :
dermatomyocitis
80. recurrent miscarriages:
anti-phospholipid syndrome
81. all true about pernicious anemia except:
response to iron treatment
82. case SOB o absar shu 3l CXR kan bat wings .etc Dx is
pulmonary edema
83. wrong about ulcerative colitis >>
Fistulas usually happens or hek she
84. wrong about crohns >>
causes polyps..
85. aldosteronism wrong >>
hyperreninemia
86. adrenal insufficiy wrong >
metablic alkalosis
87. most common cause of MI mortality >> ventricular arrhythmias
Final Exam 2013 6th year
• Head of Department: Dr. Khetam Rfooa’.

• Doctors who wrote the questions:
o Dr. Rami Dwearee (GI + RS)
o Dr. Muhammad Abo Farah (Hematology)
o Drs. Khaleel Sweese and Hussein Amarat (Cardiology)
o Dr. Jereas Al-Daood (Rheumatology)
o Dr. Muhammad Goneemat (Nephrology)
o Dr. Nadeem Jarah (Endocrine)
• Dr. Rami GI lectures ➔ A good number of questions are word by word

statements from his lectures. You need to have learnt them by heart.
1) Wrong about mitral stenosis:

a. Atrial fibrillation is associated with presystolic accentuation of the murmur
b. The later the opening snap, the less severe the stenosis
2) 75 year-old female patient, blood pressure 160/90, best treatment:
a. ACEI
3) 35 year-old woman with BMI of 35 kg/m2 was found to have a blood
pressure of 150/90, the best step in management:
a. ACETI
b. BB
c. CCB
d. ARB
e. Weight reduction
4) Not used in acute left ventricular failure:

a. Disyprimadole
b. Mechanical ventilation
c. Dobutatmine
d. Diuretics
5) Wrong about pseumomembranous colitis:
a. Develops two weeks after treatment with antibiotics
b. Normal rectal mucosa
c. Characterized by profuse bloody diarrhea
d. There can be relapses after treatment with vancomycin
6) Woman with… and RNP antibody +ve, diagnosis is:
a. MCTD
b. Systemic sclerosis
c. Dermatomyositis
7) Management of a patient how have a fever of 3 month duration. Has typical

signs, symptoms, and laboratory findings consistent with SLE. She present to
hospital with hematuria with dysmorphic RBCS. Next step in management:
a. Renal biospys
b. Intravenous methylprednisolone
c. pulse cyclophosphamide
d. IV methylprednisolone + pulse cyclphosmaide
e. Monitoring c3 level
8) Correct about calcium hemostasis :

a. Vitamin D deficiency causes Hypocalcemia + Hypophosphatemia
b. Vitamin D deficiency causes Hypocalcemia + Hyperphosphatemia
c. Hyperparathyroidism causes metabolic acidosis
d. In primary hyperparathyroidism in primary PTH decreases 24 hour urine calcium
e. None of the above
9) JAK2 mutation is found in?

a. CML
b. Polycythemia rubra vera
c. Essential thombocythemia
10) Not a complication of mycoplasma pneumonia:

a. Erythema multiforme
b. Diarrhea and vomiting
c. Thrombocytopenia
d. Leucocytosis
e. Pericarditis
11) Wrong about ulcerative colitis complications:

a. Renal stones and gallstones
b. Malignancy
c. Amyloidosis
d. Ascending cholangitis
12) Wrong about FAP:

a. Unlikely to present with cancer before the age of 40
b. Autosomal recessive
c. Clinically apparent before age 20
d. Associated with osteomas and mucous fibromas
13) History of a man with retrosternal chest pain. ECG reveals ST segment
depression in I and aVL, diagnosis:
a. Posterior MI
b. Inferior MI
c. Lateral MI
14) Not part of child purgh score in liver cirrhosis:

a. Encephalopathy
b. Partial thromboplastin time
c. Ascites
d. Albumin
15) Anti-TB drugs and side effect, correct answer is:

a. streptomycin and renal failure
b. Pyrazinamide and hepatitis
c. Optic neuritis and…
d. Vesitbular neuritis and ethambutol
16) Not a cause of atrial fibrillation:

a. Core pulmonale
b. Alcoholic cardiomyopathy
c. Hypertension
d. Acute rheumatic fever
e. Rheumatic heart diseases
17) All are causes of chronic interstitial nephritis, except:

a. Sickle cell
b. Wilson’s disease
c. NSAIDs
18) RA, patient in pain, he takes indomethacin, next step:

a. Methotrexate
b. Corticosteroid therapy
19) All are causes of upper zone infiltrate, except:

a. RA
b. Ankylosing spondylitis
c. TB
d. Sarcoidosis
20) All cause cavitation in lungs, except:

a. Pneumocystic carini
b. Aspiration pneumonia
c. Invasive Aspergillosis
d. Septic emboli
e. ?
21) Young male, 20 years, fever, weight loss 10 kg, x-ray show anterior
mediastinal mass , diagnosis is:
a. Lymphoma
b. Coccidiomycoma
c. Histoplasmosis
22) All are risk factors for legionella pneumonia, except:

a. Surgery
b. Tobacco use
c. Hospital stay
d. HIV
e. Steroids
23) One is true about COPD:

a. Prophylactic antibiotics reduce the incidence of exacerbations
b. A patient with PaO2 <60 who want to air travel, must have O2 therapy
c. ?
24) A joint deformity that is not present in RA:

a. Heberden
b. Botnunnier
c. Z-deformity
25) A patient who presented with typical signs and symptoms of PMR, next step
in management:
a. Low dose steroids
b. High dose steroids
26) Correct about PAN:

a. Association with hepatitis C
b. Pathology in small and medium arteries at site of bifurcation
c. Associated with leukocytoclastic necrosis
27) Not causes by fungus:

a. Leprosy
28) Defect in C5-C8 predispose to infection with which of the following
organisms:
a. Nisseria meningitides
b. Streptococcus pneumonia
c. Salmonella
d. ????
29) MRSA treated by ➔
Vancomycin
30) Not in management of bronchiectasis:
a. Surgery
b. Postural drainage and CPT
c. Maintenance of normal BP
d. Prophylactic antibiotics
31) Not a complication of HIV:

a. Idiopathic pulmonary fibrosis
b. Lymphoid interstitial pneumonia
32) Wrong about IBS:

a. All need barium enema and meal
b. Patient with diarrhea-prominent disease can be treated by leperulide
33) Not indication for renal biospy ➔

isolated proteinuria and normal shaped RBCs
34) A cause of respiratory failure I:

a. Guillain bare
b. ARDS
c. Kyphosis
d. Foreign body in a major brochus
35) Correct about psoriasis:

a. Can cause sacroilitis
b. Psoriatic arthritis present in 60% of patients
36) Not part of criteria to diagnose Behcet:

a. Arterial aneurysms
b. Uveitis
c. Pethargy test positive
37) Correct about Cushing syndrome:

a. Loss of diurnal variation is a reliable sign for diagnosis
b. ACTH level elevated
38) Correct about hypothyroisim:

a. T4 and T3 can be normal while TSH is the first to be elevated
b. Weight gain is not a sensitive parameter
39) Wrong about hypothyroidism:

a. Antibodies are positive only in 70% of patients with Hashimotoo thyroidits.
40) Not side effects of interferon TT hepatitis B:

a. Irreverislbe hair loss
b. Depression
c. ?
Answer: A (it is a reversible hair loss)
41) Wrong about management of upper GI bleeding:
a. Ligation and sclerotherapy is more effective than medical therapy
b. Most bleeding stop temporarily
c. Somatostatins and terlipressin reduce portal pressure
d. Ballon tamponade after upper GI Endoscopy
42) Not biological agent in ??:

a. IL 6
b. Infliximab
c. Etanrecpt
d.
43) Wrong about hemochromatosis:

a. Has a male predominance
b. Autosomal recessive
c. Congestive cardiomyopathy
d. Patients have gray skin pigmentation from iron deposition
44) Not a cause of thrombocytosis:

a. Iron defeciency anemia
b. Myelodysplasia
c. Pernicious anemia
45) Another marker that is used to diagnose vitamin B12 defeciency:

a. Elevated methylmalonic acid level
b. Decrease methylmalonic acid level
c. Elevated homocysteine level
d. Decrease homocysteine level
46) A typical cause of anemia with normal RDW:

a. Thalssemia
b. Iron defeciency anemia
47) The definitive treatment of B-thalassemia major:
a. BMT (Bone marrow transfusion)
b. Blood transfusion
c. Iron therapy
48) Which leukemia typically is associated with DIC:

a. M1
b. M2
c. M3
d. M4
e. M5
49) Not a typical feature of elevated ICP:
a. Tachycardia and hypotension
b. Morning headache
c. Headahce that increase with straining and bending forward
50) Patient present with Hb of 8… Blood film shows polychromasia. Best next
step in management . patient is on hydoxychloroquine therapy for SLE :
a. IV corticosteroids
b. Plasmapharesis
Ans: A (She has Evan’s syndrome)
51) All are correct about the mortality in ARF, except:
a. Mortality depend on the cause
b. Prognosis is generally good with reversible causes like drugs and blood loss
c. Mortality in complicated ARF reaches 15-30%
52) History: A female with history of long travel, then develops unilateral lower
limb swelling with redness and hotness. She was diagnosed with DVT. She was
started on Unfractionated heparin. 10 days later, she was found to have a platelet
count of 60,000. Next step in management:
a. Stop unfractionated heparin and no longer anticoagulation
b. Stop unfractionated heparin and start low-molecular heparin.
c. Stop unfractionated heparin and start her on leperudine
53) Alcoholic patient was found to have macrocytic anemia, the most likely
cause:
a. Vitmain B12 defeciency
54) 30 year old male patient, presented with chest pain one week after an URTI,
most likely diagnosis:
a. Pericarditis
b. Tension pneumothorax
55) 3 weeks after MI, a patient presented with chest pain. ECG showed elevated
ST segment in anterior chest leads, diagnosis is:
a. Re-infarction
b. Pericarditis
c. Ventricular aneurysm with superimposed VT
Answer: C (Cause of persistent ST segment elevation is ventricular aneurysm)
56) A 22 year old male patient, with central chest pain, radiating to back, he is
found to have murmur on exam. Also, he is 2m tall. Most likely diagnosis:
a. MI
b. Pericarditis
c. Aortic dissection
Answer: C (tall ➔ Marfan syndrome. Plus, he is too young for an MI. Also, chest pain
that radiates to back is characteristic of aortic dissection)
57) Wrong statement about T wave:

a. Can be inverted in all leads in pericarditis
b. Always abnormal if inverted in V2
c. Always abnormal if inverted in V5
d. Can be normally inverted in V1 in 20% of population.
e. Can be found in NSTEMI
58) 45 year-old male patient presents with retrosternal chest pain, radiating to
left arm. Troponin is negative. CK is 320. Next step in management:
a. Reassure and send home
b. Start heparin
c. Start thrombolytics
d. Observation
e. Ask for the CK-MB fraction.
59) Patient with history typical of MI. Found to have ST segment depression in
leads aVF, V2, and V3. Pulmonary capillary wedge pressure is normal. Right
ventricle pressure is 65/20. Right atrial pressure is 25/10. Neck veins are distended.
Diagnosis is:
a. Mitral valve prolapse
b. Right ventricular infarction
c. ?
60) Type II respiratory failure is likely to be present in a patient with the

following ABGs:
a. Hypoxia, Hypercapnia, low pH
61) correct about the exacerbation of COPD:

a. Mechanical ventilation maybe helpful in management if pH is <7.15
b. ?
62) Correct about Turner syndrome:

a. Likely to be diagnosed at birth
b. Typically diagnosed around puberty
c. End up to have a tall stature
63) Wrong or right about diabetic retinopathy???:

a. Hard exudate are the first to appear
b. Hard exudates result from retinal infarction
c. Hard exudate carry worst prognosis than soft exudate
d. None of the above
64) A paitent with typical history and signs and symptoms of dermatomyositis.
What would you do to confirm your diagnosis?
a. Muscle biopsy
b. EMG
c. ENA
d. ?
e. A&B
65) Wrong about hyperpartathyroidism:

a. Most likely cause is parathyroid hyperplasia
b. ?
c. ?
66) Wrong about hypoparathyroidism:

a. Typically associated with metabolic alkalosis
b. Typically associated with metabolic acidosis
c. ?
67) Correct about cluster hedache:

a. Most common form of migraine
b. Some are associated with horner’s syndrome
c. More common in males than females
d. Beta-blcoker are of benefits as prophylaxis
e. Sumatriptan is not effective
Horner syndrome can be caused by any interruption in a set of nerve fibers that start in the part of the brain called
the hypothalamus and travel to the face and eyes.
Sympathetic nerve fiber injuries can result from:
• Injury to one of the main arteries to the brain (carotid artery)

• Injury to nerves at the base of the neck called the brachial plexus
• Migraine or cluster headaches
• Stroke, tumor, or other damage to a part of the brain called the brainstem
• Tumor in the top of the lung
Source: http://www.nlm.nih.gov/medlineplus/ency/article/000708.htm
68) Correct statement about the natural history of multiple sclerosis:

a. Invariably progressive with relapses and remission
Answer: A
69) Correc about hepatits B:

a. HbsAg is positive during the prodrome
b. HbsAg is positive during the acute and chornic phase
c. HbsAg is more likely to be positive in carrier in western countries than eastern
countries
d. HbsAg is invariably present if the patient is jaundices during the acute infection
70) Correct about H. pylori:

a. Gram positive
b. Antral gastritis is the second most common complication
c. Infection is life long unless treated
d. Causes 80% of DU
e. Increase bicarbonate production
71) Wrong about autoimmune hepaitis:

a. Not associated with hepatosplenomegaly or spider naevi
72) About cirrhosis:

a. TIPS increases the incidence of hepatic encephalopathy
b. Protein should be restricted to 40mg/kg/d unless encephalopathy develops
73) Wrong statement:

a. IVA of renal arteries is less likely to cause renal shutdown than IVU
b. IVU is renal arteries is more likely to cause systemic atheroembolism?
c. ?
74) Wrong about the use of US to diagnose kidney problems:

a. Cheap, available quickly.
b. Diasadvantage is that it is highly operator dependent
c. Use of Doppler velocimetry can significantly enhance the information that we can
get from it like restitivy index.
d. In cKD, the kidneys appear small with loss of corticomedullary differentiation
e. ???
75) One is correct about hyperthyroidism
a. high T3, normal T4 and low TSH is well known type
b. viral infection is usually the cause of graves disease
c. toxic MNG is most common in young males
76) Correct about acromegaly:

a. IGF-1 is the gold standard for diagnosis
b. Cardiovascular is main cause of mortality
77) Wrong about viral encephalitis:

a. There is no prodrome before the onset of symptoms
b. EEG typically shows involvement of temporal lobe in herpes simplex
encheplaitis
c. Meningism is present in 70% of patients
d. ???
e. Glucose in CSF has normal value
78) Which lesion would result in right homonymous hemianopia:

a. Left optic tract
b. Optic chiasm
c. Left optic nerve
d. Right optic nerve
e. Right optic tract
79) One of the following can diagnose DM:

a. Fasting blood sugar ≥ 100
b. Random blood sugar ≥ 140
c. Random blood sugar ≥ 200 with typical signs and symptoms
80) Wrong about nephrotic syndrome;

a. More than 2.5 gm is called nephr(i)tic range proteinuria
b. Range from 0.5-1.5 gm is more likely to be glomerular than tubular
c. Rnage >2.5 gm is most likely to be glomerular
d. ?
e. ?
Answer: A? The question could have a spelling mistake of “nephirit range” instaed of
nephrotic range. Don’t statements b & C contradict each other?
81) Not a cause of acute pancreatitis:

a. Measles
b. Hypothermia
c. Azathioprine
d. Corticosteroids
Answer: A (mumps not measles causes acute pancreatitis)
82) During normal inspiration:

a. RA pressure increases
b. SBP increases
c. Splitting of S2 is increased
83) In pericarditis, one is false:

a. T inversion occurs after the J point returns to isoelectric line
b. Elevated troponins imply worse px
84) All the following increase survival in MI except:

a. Heparin
b. Antiplatelets
c. Beta blockers
d. Iv nitroglycerine
85) Pulmonary edema management except:
a. Oxygen
b. Morphine
c. Iv aminophylline
d. Diuretics working on the proximal tubule
86) In primary TB:

a. Patients remains infectious after 2 months of therapy
b. Bilateral hilar lymphadenopathy
c. Caseating lesions in lymph nodes always present
Answer: C (this is the definition of Gohn’s complex???)
87) In Addison’s disease one is true:

a. Nausea and vomiting are early symptoms
.

1-In ASD the second heart sound is best described by the following:
a- Splitted and fixed during respiration
b-Splited and moves with respiration
c-Paradoxical splitting
d-ecrease in the intensity of the second heart sound
e-Increase in the intensity of the heart sound
2-Sytlolic murmur one of the following is true:

a-Murmur occures between S1 and S2
b-Murmur occures after S2
c- Murmur occures before S1
d-Murmur occures between S! and S2 and after S2
e-In aortic stenosis the murmur is not transmitted to the carotid artery
3-Diastolic Murmur are all true except:

a-Occures after the S2
b-It is divided into an early mid and late diastolic murmur
c-In aortic stenosis the murmur is mid diastolic
d-In aortic regurgitation the murmur is called early diastolic blow
e-In atrial fibrillation and mitralstenosis the accentuation of presystolic murmur is not
maintained

b- Coarctation of the aorta
d-Heart failure
e-COPD
A. Quinidine
B. Digitalis
D. Pronesty
E. Antithyroid drugs
6- Patients with aortic stenosis frequently develop:

A. Exertional dyspnea and angina
7-Edema, ascites , enlarged liver and venous pressure of 180mm. of saline suggest:
A. Laennec’s cirrhosis
B. Congestive failure
C. Interior vena caval obstruction
D. Acute glomerulonephritis
E. Cirrhosis of the liver
8- the causative organim in rheumatic fever is

A.staph aurus
B. B Haemolytic Streptococcus group A
D; E coli
E; virus
9-In pericarditis the chracterstic EKG changes ;

A:T wave invertion
10-IN idiopathic hypertrophic sub aortic stenosis (IHSS)

One is true
A; it is a type of dilated cardiomyophy
B; AN important cause of sudden death in athelets
C;Left ventricle is dilated
D; pulse examination is normal in character
E:need nitrate for treatment
11) One of the following is not a cause of pericarditis :

a) TB
b) SLE
c) Lymphoma
d) COPD
e) Uremia
12) In the management of DCM all are true except :

a) Salt and water restriction
b) ACE-inhibitors
c) Diuretics
d) Beta blockers
e) Complete bed rest
13) In hypertrophic CMP one statement is false :

a) Diagnosis is based on hypertrophied non-dilated left ventricle in the absence of
another disease.
b) Small LV cavity , asymmetrical septal hypertrophy ( ASH ) and systolic
anterior motion of the mitral valve leaflet ( SAM ) .
c)50% of cases of familial hypertrophic cardiomyopathy is autosomal dominant
d) Pathophysiologically associated with impaired systolic function.

e) Patients with HCMP usually die because of SCD
14) Pathophysilogical abnormalities in heart failure include all of the following

except :
a) Reduced myocyte shortening and wall motion
b) Sodium retention and circulatory congestion
c) Systemic vasodilation that increase impedence of the LV ejection
d) Structural remodelling and dilation of the LV
e) Renin-Angiotensin-Aldosterone activation
15) Signs of CHF include all of the following except :

b) S3
e) Bradycardia
16) Systems responsible for BP regulation include all of the following except :
a) Heart
b) Blood vessels
c) Kidney
d) Baroreceptors in aortic arch and carotid sinuses
e) Direct CNS control
17) Detrimental effects of HTN include all of the following except :

a) LVH and dyastolic dysfunction
b) Thromboembolic stroke
c) Sclerotic and markedly spastic retinal arteries
d) Aortic dissection
e) Acute renal failure
18) In renovascular hypertension the following statements are true except :

d) Treatment is usually by ACE-inhibitors if bilateral
19) Major manifestations of acute rheumatic fever include all of the following
except :
a) Arthralgia
b) Subcutaneous nodules
c) Cardites
d) Chorea
e) Erythema marginatum
20) In pulmonary hypertension the following statements are true except :

a) Primary pulmonary hypertension likely to begin with spasm of the muscle layer
of pulmonary arteries .
b) Secondary pulmonary hypertension most probably results from disease that
impedes flow of blood through lungs or that causes periods of low oxygen in blood .
c) In some people the bone marrow responds to hypoxemia by red blood cell
production ( polycythemia)
d) Signs and symptoms of right sided heart failure usually dominates the picture in
core pulmonale
e) Medical treatment of pulmonary hypertension is usually effective
21)What is swan neck deformity in RA :

A)Hyper flextion of proximal interphalangal (PIP) and hyper extension of distal
interphalangal (DIP).
B)Hyper extension of PIP and hyper flextion of DIP.
C)Hyper extension of PIP and hyper extension of DIP.
D)Sublaxation of Metacarpophalangal.
E)Non of the above.
22)Which disorder is diagnosed by the presence of calcium pyrophosphate is

synovial fluid:
A)Chondro calcinosis.
B)Gouty arthritis.
C)Psoriatic arthritis.
D)Psoriatic arthritis.
E)O.A
23)A patient present with B-Asthma mono neuritis multiplex-esoino phila.ANCA

positive ; what is the most likely diagnosis :
A)SLE.
B)Wegner granulomatosis.
C)Microscopic polyangiitis.
D)Good pasture.
E)Currg-strass.
24)Which of the statements isn't true according to myositis :

A)Inclusion body myositis take a good prognosis.
B)Helio trope rash is highly specific for dermato myositis.
C)steroid is corner stone for treatment.
D)Statin's can induced myositis.
E)Subcutanous calcification a frequent manifestation in juvenile dermato myositis.
25)A disease modifying anti rheumatic drugs (DMARD) include all f the following
except for :
A)Salazo pyrine.
B)Hydroxychloro quine.
C)Colchicine.
D)Methotrexate
E)leflenamide
26)All of the following are criteria for Behcet disease except for :
A)Mouth ulcer's.
B)Arterial Anuyresm .ِ
C)Hypopyron..
D)Pethergy test.
E)Acne-like lesion
27) All of the following are criteria for SLE

A)Anti RNP.
B)Mouth ulcer's.
C)ANA.
D)Photosensitivity.
E)Leukopenia.
28)One of the following deformities can't be caused by RA:

A)Swan neck deformity.
B)Genu valgua.
C)Elbow flextion.
D)Bouchard nodules.
E)Z deformity of thumb.
29)All of the following are indications for the treatment of Gouty arthritis except
for:
A)Chronic Gouty arthritis.
B)Renal stones.
C)Renal failure.
D)Serum uric acid more than 8mg in men.
E)All of the above.
30)One of the following isn't a characteristic for spondylo arthropathy:

A)Strong association with HLA-B27.
B)Occasional Aortitis.
C)Assocoation with chronic inflammatory bowel disease.
D)Tendency for posterior uveitis.
E)Enthesitis.
31)The_____________ isn't a cause of secondary sjogren:

A)Reactive arthritis.
B)SLE.
C)Scleroderma.
D)RA.
E)Hypothyroctism.
32)Differential diagnosis of sacroiliitis includes all of the following except for:

A)Psoriatic.
B)Behcet disease.
C)Aukylosing spondylitis.
D)Reactive arthritis.
E)Chron disease.
33)Boutonniere deformity is seen in:

A)RA.
B)Psoriatic arthritis.
C)Reactive arthritis.
D)Ostco arthritis.
E)Tenosynovitis of haud.
34)All of the following are ANCA associated vascuilitis except for:

A)Microscopic poly angiitis.
B)Churg-strauss vascuilitis.
C)Kawasaki syndrome.
D)Wegner gramulomatosis.
E)All of the above.
1. Wrong about DM:
A. Goal of HbA1C should be less than 6.8%
2. Wrong about peptic ulcer:

A. Associated with type A personality
B. Duodenal ulcer is associated with increased risk of malignancy???
C. Most common cause of upper GI bleeding
INTRODUCTION — Since the discovery of Helicobacter pylori in the 1980s, much has been learned about this gram-
negative spiral bacteria and its associated disease states. In 1994, the NIH Consensus Conference recognized H. pylori as
a cause of gastric and duodenal ulcers. Later that year, the International Agency for Research on Cancer (IARC) declared
H. pylori to be a group I human carcinogen for gastric adenocarcinoma [1]. There is also evidence that H. pylori infection
is a risk factor for gastric mucosa-associated lymphomas (MALT lymphomas). (See "Clinical presentation and diagnosis
of primary gastrointestinal lymphomas".)
Ans:
- About 55% of UGIB is due to peptic ulcer disease.
 Abstract
 The relation between peptic ulcer and stomach cancer has long been disputed, but there is accumulating
evidence that gastric ulcer disease is positively associated and duodenal ulcerations negatively associated with the risk of
developing stomach cancer.
World J Surg. 2000 Mar;24(3):315-20. Risk of stomach cancer in patients with peptic ulcer disease. Hansson LE.
Department of Surgery, Mora Hospital, S-792 85 Mora, Sweden.
3. Obesity is associated with an increased risk of, except:

A. Cancer
B. Diabetes
C. Hypertension
D. Biliary disease
E. COPD
Answer: E
4. Worldwide, the most common cause of renal failure is?
A. Diabetes
5. Case history: Patient presents to ER with K of 7.9 mmol/L and… the best
initial management:
A. Calcium gluconate
B. Calcium resonium
C.
6. One of the following does not metastasize to the CNS:
A. ALL
Answer: AML is the leukemia that metastasizes to the CNS.

7. Wrong about diagnosis of ALL:
A. Lumbar puncture
8. Worst prognosis in a patient diagnosed with ALL is with the following at the
presentation:
A. Neurological involvement
B. Philadelphia chromosome
C. Male
D. Age
Answer: Increasing age\ Philadelphia chromosome\ WBC >30,000
9. Wrong about iron defeciency anemia:
A. Low TIBC
B. Low retics response
Answer: (A)➔ High TIBC
Corrected reticulocyte count = %reticulocyte X (Patient's Hct/Expected normal Hct of 40)
Our patient's Corrected reticulocyte count is 2.5 x 23 / 40. It is 1.2%.
Less than 2% = hypoproliferative type. This means that her anemia is due to underproduction of red cells by the bone marrow.
10. About blood transfusion:

A. Back and lumbar pain most common sign and earliest sign of incompatible
reaction.
Fever is the most common transfusion reaction
11. A plumber who didn’t improve after taking ranitidine for multiple ulcers he
had. He then developed steatorrohea:
A. Zollinger Ellison syndrome
12. Not a criteria in diagnosing irritable bowel syndreome:

A. Nocturnal diarrhoea
B. Bloating
C. Gastrocolic reflex
Diarrhea — Diarrhea is usually characterized as frequent loose stools of small to moderate volume. Stools generally occur
during waking hours, most often in the morning or after meals. Most bowel movements are preceded by lower abdominal
cramps and urgency even to the point of fecal incontinence and may be followed by a feeling of incomplete evacuation.
Approximately one-half of all patients with IBS complain of mucus discharge with stools [16]. Large volume diarrhea,
bloody stools, nocturnal diarrhea, and greasy stools are NOT associated with IBS and suggest an organic disease. A
subgroup of patients describe an acute viral or bacterial gastroenteritis which then leads to a subsequent disorder
characteristic of diarrhea-predominant IBS, called post-infectious IBS. (See "Pathophysiology of irritable bowel
syndrome".)
13. Most common pituitary problem:

A. Prolactinoma
14. 17 year old african american girl presented to ER with a one week history of
painful lesions on the legs. X-ray showed bilateral hilar masses, diagnosis is:
A. Sarcoidosis
15. Most common cause of death in hypertesnive patients:

A. MI
B. CVA
C. Renal failure
16. A woman who developed dyspnoea over 3 weeks… she presented to ER… X-
ray showed large left pleural effusion, your next step is:
A. Aspiration of fluid to dryness and examination of fluid
B. Only examination of fluid
17. Which is not associated with finger clubbing:

A. Wegner’s granulmoatosus
B. Idiopathic pulmonary fibrosis
C. Bronchiectasis
Clubbing — Clubbing of the digits (figure 3) is common in some pulmonary disorders (idiopathic pulmonary fibrosis,
asbestosis) and rare in others (sarcoidosis, hypersensitivity pneumonitis, pulmonary Langerhans cell histiocytosis). Other
disorders associated with clubbing include cystic fibrosis, pulmonary arteriovenous malformations, cyanotic heart
disease, malignancies of the lung and pleura, and inflammatory bowel disease [24]. When clubbing occurs in the course
of ILD, it is typically a late manifestation and suggests advanced fibrosis of the lung.
Answer: A
NEW TERMINOLOGY — In January 2011, the Boards of Directors of the American College of Rheumatology, the
American Society of Nephrology, and the European League Against Rheumatism recommended that the name Wegener’s
granulomatosis be changed to granulomatosis with polyangiitis (Wegener’s), abbreviated as GPA [1-3]. This change
reflects a plan to gradually shift from honorific eponyms to a disease-descriptive or etiology-based nomenclature. The
parenthetic reference to Wegener’s will be phased out after several years as the new name becomes more widely known.
18. X-ray showed a mass in the lung, you suspect this patient to have non-small
cell lung cancer. What finding would be against this diagnosis:
A. High ADH
Small cell carcinoma is associated with Eaton-Lambert syndrome (spares ocular muscles), SIADH, and other
paraneoplastic syndromes.
Lambert-Eaton syndrome (LES)

lamcb_rt Tct[n
a generalized disorder of neuromuscular transmission caused by a defect in the release of acetylcholine quanta from the
presynaptic nerve terminals; often associated with small cell carcinoma of the lung, particularly in elderly men with a
long history of cigarette smoking. In contrast to myasthenia gravis, weakness tends to affect solely axial muscles, girdle
muscles, and less often the limb muscles; autonomic disturbances, e.g., dry mouth and impotence, are common; the
deep tendon reflexes are unelicitable; on motor conduction studies, responses on initial stimulation are quite low in
amplitude, but they show marked post-tetanic facilitation after a few seconds of exercise. Lambert-Eaton syndrome is
due to loss of voltage-sensitive calcium channels located on the presynaptic motor nerve terminal. See: myasthenic
syndrome. Syn: carcinomatous myopathy, Eaton-Lambert syndrome, Lambert syndrome, myasthenic syndrome.
19. Wrong about polycystic ovarian syndrome:

A. High LH/FSH ratio
B. Acanthosis nigricans
C. Acne
D. Hypertension
Answer: according to Wikipedia, Women with PCOS are at risk for the following: …
acanthosis nigricans
Ehrmann et al1 reported recently that 33.4% of US women with PCOS exhibit symptoms of the metabolic syndrome, such as increased
hyperglycemia, insulin resistance, and dyslipidemia, although this percentage varies depending on the cohort studied. Frequently these
young women exhibit hypertension as well.
Despite the list of characteristics that typically accompany PCOS, the exact mechanism(s) responsible for hypertension in women with
PCOS is controversial. Many of the symptoms associated with PCOS have been shown to also be associated with increases in blood
pressure, such as increases in body mass index and the presence of metabolic syndrome, with its accompanying insulin resistance and
type 2 diabetes.
http://hyper.ahajournals.org/content/49/6/1220.full
20. Wrong about pulmonary hypertension:

A. Meidcal treatment is effective.
B. Bone marrow can respond by producing more RBCs
Outcome — Treatment of pulmonary hypertension improves hemodynamic measures, World Health Organization
(WHO) functional class, and the six-minute walking test distance [69,70]. It also appears to improve survival:
Numerous uncontrolled trials and one controlled trial of epoprostenol therapy have demonstrated improved survival
compared to historical controls [61,71-73]. As an example, one trial demonstrated that survival among patients
receiving epoprostenol was better than historical controls at one year (85 versus 58 percent), three years (63 versus 33
percent), and five years (55 versus 28 percent) [61].
A meta-analysis of 21 randomized trials (3140 patients) found that therapy with a prostanoid, an endothelin receptor
antagonist, or a phosphodiesterase-5 inhibitor improves mortality compared to controls (1.5 versus 3.8 percent, RR
0.57, 95% CI 0.35 - 0.92) [69]. The average duration of the trials was 14 weeks.
21. Defnitive treatement of obstructive sleep apnea:

A. Weight reduction
B. Tracheostomy
C. Continouse positive airaway pressure
• Tracheostomy provides definitive correction because it bypasses the obstruction. It is recommended
for patients with very severe OSA, especially if the patient does not tolerate CPAP or has cor pulmonale.
http://emedicine.medscape.com/article/295807-treatment#showall
22. Wrong about hypertension:

A. Complications start >140/90
Answer: ????
23. A diabetic patient was diagnosed with new hypertension, best management:
A. Thiazide
B. Enalapril
C. Furosmide
Answer: B.
24. Causes of hypercalcemia, except:

A. Cushing
B. Thiazides
Answer: A.
25. All cause hyperkalemia, except:
A. ACEI
B. Furosemide
C. RTA type 4
26. The following drugs improve prognosis of patients with heart failure, except:
A. Metoprolol
B. ACEI
C. Statin
D. Fruosmide
E. Aldosterone antagonist
Although data on diuretic efficacy are limited, a meta-analysis of a few small trials found that diuretics were
associated with reduction in mortality as well as reduced admission for worsening heart failure [25]. (See "Use
of diuretics in patients with heart failure", section on 'Efficacy'.)
Statins — Clinical trials have evaluated the efficacy of statins on mortality in patients with both ischemic and
nonischemic systolic HF. (See "Statin therapy in patients with heart failure".)
Summarized briefly, no benefit from statin therapy has generally been demonstrated in patients with moderate to severe
heart failure due to systolic dysfunction with or without coronary artery disease. Limited data suggest that statins may
benefit patients with diastolic dysfunction.
SUMMARY AND RECOMMENDATIONS — Despite strong evidence of benefit for statins in most subsets of patients
with established cardiovascular disease, two large randomized trials found no benefit from initiating statin therapy in
patients with symptomatic systolic heart failure (ischemic or nonischemic) and a mean left ventricular ejection fraction
≤33 percent. (See 'Statins in systolic HF' above.)
27. True about systolic murmur:

A. Between S1 & S2
28. Patient was diagnosed with polymyositis. Wrong statement is:

A. Good prognosis in inclusion body myositis
B. Myositis associated with calcification in children
Ans: IBM is generally resistant to all therapies and its rate of progression appears to be unaffected by currently available
treatments.
http://www.ninds.nih.gov/disorders/inclusion_body_myositis/inclusion_body_myositis.htm#What_is_the_pr
ognosis
29. Wrong about scleroderma:

A. Pulmonary fibrosis
B. Encephalopathy
Answer: B.
Pulmonary involvement — Pulmonary involvement is seen in more than 70 percent of patients with SSc. The two
principal clinical manifestations are interstitial lung disease (also called fibrosing alveolitis or pulmonary fibrosis) and
pulmonary vascular disease, leading to pulmonary arterial hypertension (table 5). These issues are discussed in detail
separately but will be briefly reviewed here. (See "Clinical manifestations of systemic sclerosis (scleroderma) lung
disease".)
Neuromuscular involvement — Neuromuscular involvement in SSc is discussed in more detail elsewhere. (See
"Neuromuscular manifestations of systemic sclerosis (scleroderma)".) The following is a brief summary of the types of
neurologic and muscle disorders that have been noted in case reports and series:
• Cranial, entrapment, peripheral, cutaneous, autonomic neuropathies

• Myopathy and inflammatory myositis
• Central nervous system involvement, including headache, seizures, stroke, vascular disease, radiculopathy, and
myelopathy
30. In kidney biopsy, linear deposits of IgG were found along basement
membrane, diagnosis is:
A. Good pasture’s syndrome
31. A patient had infectious mononucelosis, 3 weeks later, he developed pain in

the tip of the left scapula and…
A. Pancreatitis
B. Splenic rupture
Ans: B
32. A patient with RUQ pain, fever, chills, rigors, clay colored stool and dark
urine. Diagnosis is:
A. Acute hepatitis
B. Ascending cholangitisi
C. Acute cholecystisi
Ans: A.
CLINICAL MANIFESTATIONS — The classic triad of The incubation period averages 30 days (range 15 to 49
Charcot — fever, right upper quadrant pain, and jaundice — days), after which the illness begins with the abrupt onset
occurs in only 50 to 75 percent of patients with acute of prodromal symptoms including, fatigue, malaise,
cholangitis [8]. Confusion and hypotension can occur in nausea, vomiting, anorexia, fever, and right upper
patients with suppurative cholangitis, producing Reynold's quadrant pain. Within a few days to one week, patients
pentad, which is associated with significant morbidity and note dark urine, acholic stool (light-colored stools lacking
mortality [9]. Hypotension may be the only presenting bilirubin pigment), jaundice, and pruritus. The prodromal
symptom in elderly patients or those on corticosteroids,
symptoms usually diminish when jaundice appears. The
while septic shock in severe cases can lead to multiorgan
most common physical findings are jaundice and
failure.
hepatomegaly. (See 'Clinical evaluation' above.)
33. Best first management in a 22-year-old presenting to the ER with DKA:

A. Insulin + Bicarbonate + Saline
B. Saline + Insulin
C. Insulin
D. Saline
Answer: D.
Fluid replacement — Initial fluid therapy in DKA and HHS is directed toward expansion of the intravascular volume and
restoration of renal perfusion [16]. Adequate rehydration with subsequent correction of the hyperosmolar state may result
in a more robust response to low dose insulin therapy [17,18].
The average fluid loss is 3 to 6 liters in DKA and up to 8 to 10 liters in HHS, due largely to the glucose osmotic diuresis
(table 2) [1,2,8,10]. In addition to inducing water loss, glucosuria results in the loss of approximately 70 meq of sodium
and potassium for each liter of fluid lost. The aim of therapy is to replete the extracellular fluid volume without inducing
cerebral edema due to too rapid reduction in the plasma osmolality. (See 'Cerebral edema' below and "Treatment and
complications of diabetic ketoacidosis in children", section on 'Cerebral edema'.)
Fluid repletion is usually initiated with isotonic saline (0.9 percent sodium chloride). This solution will replace the fluid
deficit, correct the extracellular volume depletion more rapidly than one-half isotonic saline, lower the plasma osmolality
(since it is still hypoosmotic to the patient), and reduce the serum glucose concentration both by dilution and by
increasing urinary losses as renal perfusion is increased [16,19]
Intravenous regular insulin — After an initial infusion of isotonic saline to increase insulin responsiveness by
lowering the plasma osmolality [17,18], the only indication for delaying insulin therapy is a serum potassium
below 3.3 meq/L, since insulin will worsen the hypokalemia by driving potassium into the cells. (See
'Potassium depletion' below.)
34. RF is positive in all of the following, except:

A. Subactue bacterial endocarditis
B. Adult onset steltz
C. Vasculitis
Answer: B.
Rheumatic disorders — Patients may have detectable serum RF in a variety of rheumatic disorders, many of which share
similar features, such as symmetric polyarthritis and constitutional symptoms. These include [36]:
• Rheumatoid arthritis — 26 to 90 percent (see below)

• Sjögren's syndrome — 75 to 95 percent
• Mixed connective tissue disease — 50 to 60 percent
• Mixed cryoglobulinemia (types II and III) — 40 to 100 percent
• Systemic lupus erythematosus — 15 to 35 percent
• Polymyoitis/dermatomyositis — 5 to 10 percent
Nonrheumatic disorders — Nonrheumatic disorders characterized by chronic antigenic stimulation (especially with
circulating immune complexes or polyclonal B lymphocyte activation) commonly induce RF production (table 1).
Included in this group are [36]:
• Indolent or chronic infection, as with SBE or hepatitis B or C virus infection. As an example, studies have
demonstrated that hepatitis C infection, especially when accompanied by cryoglobulinemia, is associated with a positive
RF in 54 to 76 percent of cases [44-47]. RF production typically ceases with resolution of the infection in these disorders.
These molecules may be produced by activated hepatic lymphocytes [48]. (See "Clinical manifestations and diagnosis of
essential mixed cryoglobulinemia".)
• Inflammatory or fibrosing pulmonary disorders, such as sarcoidosis.
• Malignancy.
• Primary biliary cirrhosis
CLASSIFICATION CRITERIA — There is no specific test or combination of tests that can be used to establish
the diagnosis of ASD. As a result, at least seven sets of diagnostic criteria have been proposed [15-21].
Yamaguchi criteria — There are four major Yamaguchi criteria:
• Fever of at least 39ºC lasting at least one week

• Arthralgias or arthritis lasting two weeks or longer
• A nonpruritic macular or maculopapular skin rash that is salmon-colored in appearance and usually found over
the trunk or extremities during febrile episodes
• Leukocytosis (10,000/microL or greater), with at least 80 percent granulocytes
The minor Yamaguchi criteria include:
• Sore throat
• Lymphadenopathy
• Hepatomegaly or splenomegaly
• Abnormal liver function studies, particularly elevations in aspartate and alanine aminotransferase and lactate
dehydrogenase concentrations
• Negative tests for antinuclear antibody and rheumatoid factor
35. Wrong about a patient with liver cirrhosis:

A. Lactulose
B. Warfarin
C. Restrict proteins
D. Restrict diet
E. Restrict salt
Answer: B.
Salt restriction is often necessary, as cirrhosis leads to accumulation of salt (sodium retention). Diuretics may be
necessary to suppress ascites. Diuretic options for inpatient treatment include aldosterone
antagonists (usually spironolactone) and loop diuretics. Aldosterone antagonists are preferred for patients who can
take oral medications and are not in need of an urgent volume reduction, with loop diuretics as additional
therapy.[21]\
http://en.wikipedia.org/wiki/Cirrhosis#Management
36. All predispose to hepatic encephalopathy, except:

A. Hyperkalemia
B. Furosemide
The history may reveal a precipitating cause. These include:
• Hypovolemia
• Gastrointestinal bleeding
• Hypokalemia and/or metabolic alkalosis
• Hypoxia
• Sedatives or tranquilizers
• Hypoglycemia
• Infection (including SBP)
• Rarely, hepatoma and/or vascular occlusion (hepatic vein or portal vein thrombosis)
37. A 35 female predispose with 3 weeks history of bilateral squeezing headache

toward the end of the day, after work. 3-4 times weekly:
A. Tension headache
B. Caffeinse & nictonine withdrawl
C. Migraine
CLINICAL FEATURES — The typical presentation of a TTH attack is that of a mild to moderate intensity, bilateral,
nonthrobbing headache without other associated features. Descriptions of TTH pain are characteristically nondescript:
"dull," "pressure," "head fullness", "head feels large," or, more descriptively, "like a tight cap", "band-like," or a "heavy
weight on my head or shoulders."
38. Blood film shows target cells, Howell Jolly boies, and sideroblasts:
A. Hyposplenism
B. Myelofibrosis
Answer: B.
39. WBCs 25,000, platelets 6,000
40. 26 year old female presented to ER with petechiae, everything else is normal:
A. ITP
B. Septic meningitis
Ans: A?
41. Most common thyroid cancer:

A. Papillary
42. Increase life expectancy in COPD patients:

A. O2 therapy & smoking cessation
43. Megaloblastic anemia, except:

A. Dietary defeciency is common.
44. Most common defeciency in thromboembolism:

A. Protein C
B. Protein S
C. Antrithrombin
INTRODUCTION — Inherited thrombophilia is a genetic tendency to venous thromboembolism. Factor V Leiden is the
most common cause of the syndrome accounting for 40 to 50 percent of cases. The prothrombin gene mutation,
deficiencies in protein S, protein C, and antithrombin account for most of the remaining cases, while rare causes include
the dysfibrinogenemias [1,2]. The total incidence of an inherited thrombophilia in subjects with a deep vein thrombosis
ranges from 24 to 37 percent overall compared with about 10 percent in controls. (See "Overview of the causes of venous
thrombosis", section on 'Inherited thrombophilia'.)
45. Wrong about Coeliac disease:

A. Not associated with increased malignancy
46. While a patient was participating in medical students exam, he developed

hypotension of 50/30, flushing… Treatment is:
A. Corticosteroids
B. Adrenaline
ACUTE MANAGEMENT:
The first and most important therapy in anaphylaxis is epinephrine. There are NO absolute contraindications to
epinephrine in the setting of anaphylaxis.
Airway: Immediate intubation if evidence of impending airway obstruction from angioedema; delay may lead to
complete obstruction; intubation can be difficult and should be performed by the most experienced clinician available;
cricothyrotomy may be necessary
Promptly and simultaneously, give:
IM Epinephrine (1 mg/mL preparation): Give epinephrine 0.3 to 0.5 mg intramuscularly, preferably in the mid-
anterolateral thigh; can repeat every 5 to 15 minutes as needed. If symptoms are not responding to epinephrine injections,
prepare IV epinephrine for infusion (see below).
47. All indicate severity in community acquired pneumonia, except:

A. Mental score 6/10
B. WBC 22,000
C. Age 75 years
CURB-65 score — The British Thoracic Society found a 21-fold increase in mortality in patients who had two or more of
the following findings [24]:
• Blood urea nitrogen greater than 20 mg/dL (7 mmol/L)

• Diastolic blood pressure less than 60 mmHg
• Respiratory rate above 30 per minute
• Confusion of new onset (mini mental score< = 8)
48. Patient was diagnosed with rapidly progressive glomerulosclerosis (RPGS),

best initial managent:
A. Prednisolone
TREATMENT — Untreated RPGN typically progresses to end-stage renal disease over a period of weeks to a few months.
However, patients with fewer crescents may have a more protracted, not so rapidly progressive course [3].
Many of the older studies examining treatment in RPGN with pulse corticosteroids, cyclophosphamide, and
plasmapheresis are difficult to interpret because they were performed at a time before it was possible to distinguish
among the different types of RPGN. Nevertheless, these studies demonstrated that conventional doses of oral
prednisone, given alone or in combination with azathioprine, usually had little beneficial effect [1].
As a result, the therapy of most patients with RPGN involves pulse methylprednisolone followed by daily oral
prednisone, oral or intravenous cyclophosphamide, and, in some settings, plasmapheresis. Early diagnosis with renal
biopsy and serologic testing and early initiation of appropriate therapy is essential to minimize the degree of irreversible
renal injury.
Empiric therapy may be begun with the above modalities in patients with severe disease, particularly if either renal
biopsy or interpretation of the biopsy will be delayed. Empiric initial therapy consists of intravenous pulse
methylprednisolone (500 to 1000 mg/day for three days) and consideration of plasmapheresis, especially if the patient
has hemoptysis. This regimen will not alter the histologic abnormalities observed with a renal biopsy that is performed
soon after initiating empiric therapy.
49. A patient with palpitations and heat intolerance… technocium sacn revealed
uniform increased uptake in the thyroid, diagnosis is:
A. Graves’ disease
50. Best treatement of fibrillation in hyperthyroidism is:

A. Anti-thyroid drugs.
Atrial fibrillation occurs in 10 to 20 percent of patients with hyperthyroidism, and is more common in elderly patients. In
one study, 8 percent of all patients and 15 percent of patients between ages 70 to 79 developed atrial fibrillation within 30
days of the diagnosis of hyperthyroidism [8]. Even subclinical hyperthyroidism is associated with an increased rate of
atrial ectopy and a threefold increased risk of atrial fibrillation (figure 1) [9].
In 60 percent of hyperthyroid patients with atrial fibrillation, the rhythm converts spontaneously to sinus rhythm when the
hyperthyroidism is treated; in one study, all who spontaneously converted did so within four months after becoming
euthyroid [10]. Among those who do not convert spontaneously to sinus rhythm and who undergo successful electrical
cardioversion, the two-year risk of recurrent atrial fibrillation was 59 percent compared with 83 percent of patients whose
atrial fibrillation was not associated with hyperthyroidism [11].
51. Wrong about diagnosis of H. pylori:

A. Stool antigen
B. Breath test
C. Culture
D. Blood ???
E. C13/C14
52. Most common cause of community acquired pneumonia:

A. Strept. Pneumonia
EPIDEMIOLOGY — The overall rate of CAP in adults is approximately 5.16 to 6.11 cases per 1000 persons per year;
the rate of CAP increases with increasing age [2]. There is seasonal variation, with more cases occurring during the
winter months. The rates of pneumonia are higher for men than for women and for black persons compared with
Caucasians. The etiology of CAP varies by geographic region; however, Streptococcus pneumoniae (S. pneumoniae) is
the most common cause of pneumonia worldwide.
53. Most common cause of pneumonia in alcholics:

A. Klebseiella
• Klebsiella pneumonia — K. pneumoniae is responsible for approximately 6 percent of cases of CAP in Asia [17], but is less common
in other regions (table 2). K. pneumoniae must be considered as a cause of severe CAP in patients who have significant underlying
disease, such as COPD, diabetes, and alcohol abuse. In a study of 112 immunocompetent patients with severe CAP, multivariate
analysis found K. pneumoniae was an independent risk factor for mortality [25]. (See "Overview of Klebsiella pneumoniae infection",
section on 'Community-acquired pneumonia'.)
54. Most common cause of spontaneous peritonitis:

A. E. Coli
B. Bacteria isolated from ascitic fluid in 519 patients with spontaneous bacterial peritonitis
Organism Percent of isolates
Escherichia coli 43
Klebsiella pneumoniae 11
Streptococcus pneumoniae 9
Other streptococcal species 19
Enterobacteriaceae 4
Staphylococcus 3
Pseudomonas 1
Miscellaneous* 10
C. *In some regions of the world, such as Korea, Aeromonas hydrophila infection is an important cause of SBP,
particularly in warm weather months. Affected patients commonly also have diarrhea. [Choi, JP, et al. Clin Infect Dis
2008; 47:67.]
D. Data from McHutchison, JG, Runyon, BA. Spontaneous bacterial peritonitis. In: Gastrointestinal and Hepatic
Infections, Surawicz, CM, Owen, RL (Eds), WB Saunders, Philadelphia 1995. p.455.
55. Wrong about DKA:

A. Normal anion gap
56. Causing organism in rheumatic fever :

A. Group A beta-hemolytic streptococci.
57. All are causes of bloody diarrhoea in a traveler:

A. Shistosoma mansoni
58. 6 hours after hamburger, abdominal pain:

A. Staph. Aurerus
B. ?
59. Not a finding in angina:

A. Normal
60. Not a finding in sarcoidosis:

A. Cranial nerve palsy
B. Uveitis
C. Wrong answer
61. About renovascular hypertension:

A. Managemetn is drugs if bilateral
TREATMENT — Once the diagnosis of hemodynamically significant stenosis is established, with both vessels showing
more than a 75 percent stenosis, there are three therapeutic alternatives:
• Medical therapy with antihypertensive drugs

• Percutaneous angioplasty, usually with stent placement
• Surgery
We generally agree with the 2005 American College of Cardiology/American Heart Association (ACC/AHA) guidelines
on peripheral artery disease, which were produced in collaboration with major vascular medicine, vascular surgery, and
interventional radiology societies [4].
Medical therapy for control of hypertension is indicated in all patients with bilateral renal artery stenosis (or unilateral
stenosis in a single viable kidney) [4,6]. Revascularization, usually by percutaneous angioplasty with stenting, may be
considered in patients with persistent hypertension who have one or more of the clinical features that suggest that the
stenosis plays an important role in the elevation in blood pressure (table 1). Surgery is primarily warranted for correction
of complex lesions.
The following discussion will review the antihypertensive response to therapy in patients with bilateral renal artery
stenosis. The use of angioplasty or surgery to preserve renal function in such patients is discussed separately. (See
"Chronic kidney disease associated with atherosclerotic renovascular disease".)
62. All are differential diagnosis of sacroilitis, except:

A. Crohn’s
B. Ankylosing spondylitis
C. Psoriasis
63. Which condition is associated with HLA-B27:

A. Ankylosing spondylitis
64. Wrong about heparin:

A. Half life 90 minutes
B. Skin necrosis
C. Thromobcytopenia
D. Only administered SC and IV
Heparin reversal with protamine — If urgent reversal of heparin effect is required, protamine sulfate can be administered by slow
intravenous infusion (not greater than 20 mg/minute and no more than 50 mg over any 10 minute period). The appropriate dose of
protamine sulfate is dependent upon the dose of heparin given and the elapsed time since the last heparin dose. Full neutralization of
heparin effect is achieved with a dose of 1 mg protamine sulfate/100 units heparin. Because of the relatively short half life of
intravenously administered heparin (approximately 30 to 60 min), the protamine sulfate dose used must be calculated by estimating the
amount of heparin remaining in the plasma at the time that reversal is required.
Skin necrosis — Skin necrosis is a well-described complication of treatment with unfractionated or LMW heparin. Affected patients
develop heparin-dependent antibodies but most do not experience thrombocytopenia. (See "Heparin-induced thrombocytopenia",
section on 'Skin necrosis'.)
Thrombocytopenia — Heparin-induced thrombocytopenia (HIT) is a well-recognized and potentially fatal complication of heparin
therapy, usually occurring within 5 to 10 days after the start of heparin therapy. The pathogenesis, clinical manifestations, diagnosis,
and treatment of HIT are discussed in detail separately. (See "Heparin-induced thrombocytopenia".)
65. Which is not a side effect of statins:

A. Pulmonary fibrosis
B. Headache
Ans: A
66. The following drugs and their side effects are correct, except:
A. Thiazide diuretics: thrombocytosis
B. Enalapril: Dry cough
67. Patient with bronchial asthma, eosinohphilia, and mononeuritis multiplex:

A. Churg strauss
68. Women with multiple tender areas, all investigations are normal:
A. Fibromyalgia
69. Wrong about ECG findings in hyperkalemia:

A. Pronounced P wave
70. About ECF findings in pericarditis, except:

A. ST segment convex upwards
B. ST segment concave downwards
C. Inverted T wave
ECG: initially diffuse elevated ST segments ± depressed PR segment, the elevation in the ST
segment is concave upwards -+ 2-5 days later ST isoelectric with T wave flattening and inversion
• Stage 1, seen in the first hours to days, is characterized by diffuse ST elevation (typically concave up) with
reciprocal ST depression in leads aVR and V1 (figure 1). There is also an atrial current of injury, reflected by
elevation of the PR segment in lead aVR and depression of the PR segment in other limb leads and in the left
chest leads, primarily V5 and V6. Thus, the PR and ST segments typically change in opposite directions. PR
segment deviation, which is highly specific though less sensitive, is frequently overlooked.
Saddle-shaped ST segment
71. True about hypetropihc sub-arotic stenosis:

A. A type of dilated cardiomyopathy
B. Nitrates are used in treatment
C. A cause of death in athletics
Answer: A.
72. 40 pack years smoker. He has cervical spondylosis. FEV1/FVC 97%,

diagnosis is:
A. Restirve pattern
73. Wrong about parathyroid hyperplasia:

A. Can be part of MEN1
B. Can be part of MEN2a
C. Wrong answer
74. Wrong about polycythemia rubra vera:

A. Abnormal findings in ABG
B. Increased platelets, and WBCs
LABORATORY FINDINGS — Laboratory findings in PV include an elevated hemoglobin/hematocrit and red blood cell
mass in virtually all patients, a platelet count >400,000/microL in 60 percent, and a white blood cell count
>12,000/microL in 40 percent. Bone marrow cellularity was increased in 90 percent of patients, and storage iron was
absent from the marrow in 94 percent.
75. Swan neck deformity is characterized by:

A. Hyper-extension of PIP, and hyperflexion of DIP
76. All are criteria to diagnose SLE, except:

A. Anti-RNP
B. Photosensitivity
C. Mouth ulcers
D. Leucopenia
Ans: A (Anti-ANA or Anti-dsDNA or Anti-SM)
77. Most common type of lupus nephritis is:

A. Mesangial glomerulonephritis
B. Focal proliferative glomerulonephritis
C. Diffuse GN
D. Membranous GN
Answer: (C) (type IV)
78. All is part of metabolic syndrme, except:
A. High LDL
B. High triglyceride
C. Low HDL
D. Hypertension
E. DM
Answer: (A)
79. Absence of megakaryocytes in bone marrow is seen in:
A. HIV
B. Aplastic anemia
THE PLURIPOTENT STEM CELL — Following the atomic bombings in World War II, there was great interest in the
effects of radiation. Lethally irradiated mice frequently died as a consequence of neutropenic infections and
thrombocytopenic hemorrhage. Their marrow was found to be "aplastic." That is, the myeloid and erythroid precursors
were absent, as were lymphocytes and megakaryocytes, leaving only fat cells, stromal elements, and blood vessels. Two
striking observations in this model led to the discovery of the pluripotent hematopoietic stem cell, which could
reconstitute all of hematopoiesis and lymphopoiesis:
80. Criteria which is used to diagnose DM is:

A. Glycocylated haemoglobin
B. Fasting plasma glucose ≥ 126 mg/dL.
81. All are indications for transfusion therapy in sickle cell anemia, except:
A. Stroke
B. Pain
C. Pain with occulusive ???
D. ???
Transfusion therapy for individuals with SCD can be categorized as therapeutic or prophylactic. Accepted indications for
transfusion therapy in individuals with SCD include [62,63]:
• Therapeutic — Acute use of transfusions for acute stroke, acute chest syndrome, acute multi-organ failure,
acute symptomatic anemia (eg, onset of heart failure, dyspnea, hypotension, marked fatigue [9]), reticulocytopenia (most
commonly associated with Parvovirus B19 infection, but can occur with any infection), or following hepatic or splenic
sequestration.
• Prophylactic — Use of periodic red cell transfusions for primary or secondary stroke prevention.
82. Patient with pancytopenia, splenic vein thrombosis, and ???. Diagnosis is:
A. Promyelocytic???
83. Osteoporosis, most common site of fracture is:
A. Hip
B. Vertebrae
C. Femur
The answer is not FEMUR ===> Neck of femur ===> So, the the most common location is "Hip"... Right? Because "fracture of
the neck of femure" is a type of hip fracture.
"Hip fractures are classified as intracapsular, which includes femoral head and neck fractures, or extracapsular, which includes
trochanteric, intertrochanteric, and subtrochanteric fractures. The location of the fracture and the amount of angulation and
comminution play integral roles in the overall morbidity of the patient, as does the preexisting physical condition of the individual.
Fractures of the proximal femur are extremely rare in young athletes and are usually caused by high-energy motor vehicle
accidents or significant trauma during athletic activity. Other causes may be an underlying disease process such as Gaucher
disease, fibrous dysplasia, or bone cysts."
http://emedicine.medscape.com/article/87043-overview
From the paper entitled “Which fractures are most attributable to osteoporosis?” : "the fractures rated most likely because of
osteoporosis were the femoral neck, pathologic fractures of the vertebrae, and lumbar and thoracic vertebral
fractures."http://www.sciencedirect.com/science/article/pii/S0895435610002635
Final Exam 2008 X year

11. All the following cause normal anion gap metabolic acidosis, except:
a. Spironolactone
b. Diarrhea
c. Vomiting
d. Acetazolamide
e. Primary hyperparathyroidism
Acid-base balance — High concentrations of PTH inhibit proximal tubular bicarbonate

reabsorption, which tends to cause a mild metabolic acidosis. However, this effect is usually
counterbalanced by the alkali liberated as a result of increases in bone resorption and in tubular
reabsorption of bicarbonate caused by hypercalcemia [85,86]. Thus, metabolic acidosis is
unusual in PHPT unless serum PTH concentrations are very high or the patient has coexistent
renal insufficiency.
Acetazolamid (Carbonic anhydrase inhibitos cause normal anion gap metabolic acidosis)
Spironolactone blocks actions of Aldosterone. Therefore, H is retained. “Other recognized side

effects of spironolactone include diarrhea and hyperchloremic metabolic acidosis, especially in
patients with a prior history of renal insufficiency.3 A few case reports have been published
discussing type 4 renal tubular acidosis (RTA) developed by patients while taking
spironolactone.4,5”
Answer: C (not sure… Because Wikipedia: A less frequent occurrence results from a vomiting
of intestinal contents, including bile acids and HCO3-, which can cause metabolic acidosis.)
C is most probable answer bcz vomiting causes mainly alkalosis
12) All of the following are associated with hypokalemia and alkalosis, except:
a. Bartter syndrome (???) [Yes ➔ Hypokaemia + alkalosis➔ a disorder due to a defect in
active chloride reabsorption in the loop of Henle; characterized by primary juxtaglomerular cell
hyperplasia with secondary hyperaldosteronism, hypokalemic alkalosis, hypercalciuria,
elevated renin or angiotensin levels, normal or low blood pressure, and growth retardation;
edema is absent. Autosomal recessive inheritance, caused by mutation in either the Na-K-2Cl
cotransporter gene (SLC12A1) on chromosome 15q or the K(+) channel gene (KCNJ1) on 11q.
b. Furosemide ➔ Yes
c. Diabetes (If they are talking about DKA➔ Hypokalemia and acidosis, so this should be
the answer?
d. Nasogastric tube suction ➔ Yes (loss through upper GI of K and Hydrogen)
e. Thiazides ➔ Yes
13) All of the following are indications to start hemodialysis, except:

a. Pericarditis
b. Encephalopathy
c. Creatinein – 8 mg/dL
d. Hypercalcemia
e. Hyperkalemia
Answer: C ( hypercalcemia is an indication for dialysis according to up-to-date )
14) All of the following are complications of nephrotic syndrome, except:

a. Hypercholestrolemia
b. Renal vein thrombosis
c. Recurrent infection
d. Polycythemia
e. ARF
Ans: D
15) Concerning the antibiotic resistance, all of the following are true, except:
a. The more antibiotics are continued the more the resistance develop
Ans: A.
16) In a patient with HIV, the worst prognosis is for a patient with:
a. ?
b. ?
c. ?
d. ?
Ans: C (this is the lowest CD4 and highest viral load )
17) HIV is composed of:A single strand of RNA
18) Which of the following is least likely to transmit HIV?
a. Semen
b. Saliva
c. Blood
d. CSF
e. Transplanted organs
Answer: B (saliva_) http://www.cdc.gov/hiv/resources/qa/transmission.htm
19. Which of the following influenza viruses subtypes is expected to cause the (???)
pandemic influenza?
Ans: ????
20. Neuroamindiase projections in the influenza virus act as:

a) Receptors for entry into cells
b) Ezymatic function to release the building virus for the cell
c) Both A + B
d) Cherokinase receptors
e) Receptors for IL-1
The enzyme helps viruses to be released from a host cell. Influenza virus membranes contain
twoglycoproteins: hemagglutinin and neuraminidase. While the hemagglutinin on the surface of
the virion is needed for infection, its presence inhibits release of the particle after budding. Viral
neuraminidase cleaves terminal neuraminic acid (also called sialic acid) residues
from glycan structures on the surface of the infected cell. This promotes the release of progeny
viruses and the spread of the virus from the host cell to uninfected surrounding cells.
Neuraminidase also cleaves sialic acid residues from viral proteins, preventing aggregation of
viruses.
Answer :b
21. Which of the following is true regarding brucella:
a) monotherapy is the standard of care
b) Usually is treated for 3 weeks. ➔ For 6 weeks
c) Intracellular activity is important in the antibiotic (choice) for brucellosis
d) It is a Gram +ve coci ➔ G-ve bacilli
e) Penumonia is a frequent complication ➔ Pneumoniitis is a less common complication
Answer : c
22. Which of the following is the closest measurement of core body temperature:
a) Oral temperature
b) Axillary temperature
c) Rectal temperature
d) Ear temperature
e) Mixed venous temperature
Ans: E (mixed venous termpature)
23. Which of the following is false about acute HIV disease?
a. It occur within 2-6 weeks of infection
b. It is best diagnosed by ELISA ➔ Wrong (However, the standard third generation
enzyme linked immunosorbent assays (ELISAs) used in clinical practice and in blood banks in
the United States do not detect antibodies to HIV until three to seven weeks after infection.)
c. It manifess aa flue-like illness➔ Yes
d. It is associated with high infectoiu state → Patients with primary HIV infection are
highly contagious to others,
e. It occurs in about 70% of patients
24. Which of the following is true about S. aureus?

a. It lacks a coagulase enzyme
b. It rarely causes a nosocomial infection
c. It is a gram negative bacili
d. It is associated with infections in patiens with burns ➔ Correct ➔ Burns provide a
suitable site for bacterial multiplication and are more persistent richer sources of infection than
surgical wounds. Staphylococcus aureus is one of the most frequently isolated pathogens in
both community and hospital practices.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511900/
e. So far, there is no documented resistance to vaoncomycin
25. Which fo the following is true about fever of unknown origin?

In developing countries, infections contribute to majority of cases.
26. A 70-year-old man with 3 months headache, stiffness, low grade fever, jaw
claudication, and amuresiss fugax, his ESR is 100, all of the following statements are true
regarding this condition, except:
a. Increased risk of permenant blindness
b. Tongue claudicaiton
c. Weight loss
d. Drug therapy can only be started after tissue biospy
e. Dramatic response to steroids
Answer: d
27. All of the following are true about vasculitis, except:

a. PAN is associated with hypertension
b. Wegner granulomatosis is associated with +ve C-ANCA
c. Hypersensitivity vasculitis mainly presents with large vessel involvement of the aortic
arch vessls in females younger than 40 years of age.
d. Giant cell arteritis affects mainly people above the age of 50
e. Churg-strus disease occurs in people with history of atopy
Answer: c
28. Which of the following associations is true?

a. Hepatitis a with PAN
b. RF and Riter’s syndroe
c. Giant cell arteritis and blindness
d. RA and addison’s disease
e. TB and reactive arthritis
Answer (C): Giant cell arteritis and blindness.
29. Which of the following is true about septic arthritis?

a. Hematogenous spread is the most common route of infection
b. Joint involvement is typically episodic recurrent polyarticular
c. Almost always occur in normal joints
d. Presence of urate crystals exclude its diagnosis
e. Gram negative bacteria is the leading cause
Answer: A
30. Which statement about rheumatoid arthritis is not correct?
a. The commonest cause of anemia seen in pts with the diseas is due to hemolysis?
b. Synovitis characerisically involves Metarasophalangeal joints
c. RF is of an IGM type
d. Joint effusions occur in the first several months
e. Felty’s disease is more common in seropositive patients
Answer: A (Anemia of chronic disease)
31. Which antibody is rather specific for diffuse scleroderma?
a. Anticentromere AB
b. Anti-myeloperoidase AB (p-ANCA)
c. Anti-Jol AB
d. Antimitochondrial AB
e. Anti-Scl70
Answer: E [Diagnosis is by clinical suspicion, presence of autoantibodies (specifically anti-
centromere and anti-scl70/anti-topoisomerase antibodies) and occasionally by biopsy. Of the
antibodies, 90% have a detectable anti-nuclear antibody. Anti-centromere antibody is more
common in the limited form (80-90%) than in the diffuse form (10%), and anti-scl70 is more
common in the diffuse form (30-40%) and in African-American patients (who are more
susceptible to the systemic form).[19]
In 1980 the American College of Rheumatology agreed upon diagnostic criteria for
scleroderma.[20]
32. All of the following statement about gout are true, except:
a. In adult men the solubility of monosodium urate is 7 mg/dL
b. Women of child-bearing age have lower serum uric acid
c. Initial treatment of acuteattack should include NSAIDs, colchicine, and allopurinol
d. Diuretics should elevate serum uric acid
e. Attacks can be precipitated by acute MI.
Answer: C (allopurinol and colchicine never in acute treatment)
33. One of the following is correct about aldosterone?
a. Increased Na and K reabsorption in the renal collecting duct
b. Causes increase synthesis of Na/K pumps in the principal cells of the renal collecting
duct
c. Is released from the adrenal cortex in response to decreased plasma K
d. Promotes H secretion from the principle cells of the normal collecting duct
e. ?
Answer : B
34. Acute interstitial nephritis might present with any of the following, except:
a. Fever
b. Rash
c. Renal impairment
d. Hypertension
e. Low grade proteinuria
Answer: D (hypertension )
35. All of the following may cause renal papillary necrosis, except:
a. DM b. Analgesic abuse c. Sickle cell anemia d. pyelonephirits e.
hypertension
Answer E: Any condition that involves ischemia can lead to renal papillary necrosis. The four
most significant causes are sickle cell disease or trait, analgesic use, diabetes mellitus, and
severe pyelonephritis.[2]
A mnemonic for the causes of renal papillary necrosis is POSTCARDS: pyelonephritis,
obstruction of the urogenital tract, sickle cell disease, tuberculosis, chronic liver disease,
analgesia/alcohol abuse, renal transplant rejection, diabetes mellitus, and systemic vasculitis.
Often, a patient with renal papillary necrosis will have numerous conditions acting
synergistically to bring about the disease. [3][4]
36. A 40-year-old female presented to clinic because his blood pressure was 160/100.
All the following are appropriate first line investigations, except:
a. K+ level
b. Urine analysis
c. Renal US
d. MRI suprarenals
e. Creatinien level
Answer: D
37. A 20-year-old male presented to you with generalized weakness. Labs showed:
a. DIarrhea
b. Spironolactone
c. Recovery from DKA
d. Thiazide diurectic
e. Amiloride
Ans: D (Thiazide diuretic cause metabolic alkalosis)
38. All of the following are true about pre-renal acute renal failure, except:
a. FeNa<1%
b. BUN/CR ratio is elevated
c. Mostly irreversilbe
d. Most common cause of ARF
e. Urine output imporoves with IV fluid coverage
Answer: C
39. All of the following is true about diabetic nephropathy in IDDM< except:
a. Microalbumnuria is seen within 5 years from onset
b. Usually preceded by retionopathy
c. Thickening of basement membrane is a ??? factor determining progressing of disease
d. It requires kidney transplant
e. More common in diabetic who have siblings with diabetic nephropathy
Answering: D.
40. All the following are true about effect of drugs in causing ARF, except:
a. Furosemise causes toxicity by forming crystals?
b. NSAIDs cause vasoconstriction
c. Aminogrlyicoside cause toxicity to proimal tubules
d. D-penicillamine causes membranous nephropahty
e. Ampicillin cuases acute tubulointerstitial nephritis
Ansewr: A
41. One of the following is least likely feature of hemochromatosis:

a. Fulminant liver failure
b. Psuedogout
c. Diabetes
d. Bronze skin
e. Hepatocellular carcinoma
Answer: A (akeed)
42. All the following are subclinical presentations of celiac disease, except:
a. Mood changes
b. Iron def
c. B12 dfe
d. Unexplained elevation of liver enzymes
e. Recurrent abdominal pain
Ans: C (Mild to moderate anemia is present in 50% of cases. Folate deficiency is common,
often causing macrocytosis. B12 deficiency is rare. Iron deficiency due to malabsorption of iron
and increased loss of desquamated cells is common).
43. All of the following are associated with rapid progression of chronic hepatitis C to
cirrhosis, except:
a. Acquiring the infection at older age
b. Female sex
c. Alcohol use
d. HIV co-infeciton
e. HBV co-infection
Ans: Female sex (akeed)
44. The most common complication after ERCP: answer: b

a. Acute pancreatitis
45. All of the following are initial management strategies in aptients with upper GI
bleeding, except:
a. Somatostatitn
b. Bleeding scan
c. Esophagogastroduodensoscoyp
d. Acid suppressing medicaiton
e. Gastric lavage
Answer: b
46. Wilson’s disease should be considered in all of the following medical scenarios,
except:
a. Abnormal liver enzymes and non-immune hemolytic anemia
b. Exaggerated high bilirubin level and depressed alkaline phosphtaea
c. Decreases serum ceruloplasmis
d. Elderly patient with neuropsychiatric problem
e. Fuliminat liver failure with low uric acid
Answer: D
47. All of the following medications are being used for non-alcohol steatohepatitis
(NASH), except:
a. Betaite
b. Ursodeoxycholic acid
c. ribaverin
d. Vitamin e
e. Beta carotene
Anwer: C (akeed)
48. All of the following medciations are being used in chronic hepatitis B, except:
a. Lamividine
b. Ribavirine
c. Pregyled interferon
d. Adefovel dig
e. Entovavir
Answer: B (akeed)
49. All of the following micro-organisms can cause infectious diarrhea with positive
fecal leucocytes, except:
a. Shigella
b. Yersinia
c. Giardia
d. Campylobacet
e. Salmonella
Answer: c
50. All of the following are protective from colo-rectal cancers, except:
a. Aspirn
b. Folic acd
c. Fier diet
d. calcium
e. moderate use of alcohol
Answer: E.
51. The most common cause of GI bleeding is:

a. Peptic ulcer disease
52. Regarding achalasia, all of the following are tue, except:

a. There is increase of intramural inhibitory signals
53. Regarding Crohn’s disease, all of the following are true, except:
a. The rectum is often spared
b. Fistual fissures and absesscess can occur in patietns with colo-rectal Crohns
c. The disease is limited to the mucosa
d. The mucosa can appear as cobble stone
Answer: C.
54. All of the following are true regarding ulcerative colitis, except:
a. Azathioripne can be sued in treatment
b. Maybe associated with Pyoderma gangreonusum
c. Patients may be P-ANCA positive
d. The rectum is never involved
Answer: D.
55. Regarding IBD, all of the following are rue, except:

a. UC patients usually smokes more than Crohn’s patients (Unlike Crohn's disease,
ulcerative colitis has a lesser prevalence in smokers than non-smokers.)
b. Incidencei s about 7/100,000
c. Jweish affected more often than asians
d. Iliocecal area is frequenly involved in Crohn’s disease
Answe: a
56. The most common cause of portal hypertension is:
a. Liver cirrhosis
57. All of the following are true regarding inflammatory acute diarrhea, except:
a. Can be caused by shigella ➔ Correct
b. There is polymorphonuclear cells in the stool sample
c. There may be blood in the stool sample
d. Usually affects the small bowel in the infected type inflammatory acute diarrhea
Answer: D
58. 5 year-old girl came to ER because of fatigue and shortness of breath. She was
taking amoxacililn for acute otitis medica. Laboratory testing showed Hb 5.5 gm/dL with
normal WBC and platelet count. The smear showed numerous nucleated RBCs and
spherocytes. Both direct and indirect test Coomb’s test were positive. The patient has:
a. Warm autoimmune hemolytic anemia
59. All of the following can cause peptic ulcer, except:

a. Paracetamol
60. All of the following help differentiate between inflammatory and non-
inflammatory arthritis, except:
a. Favorable response to NSAIDS
b. Mornign stiffness for 2 hours
c. Pain improves with continued ambulation
d. Presence of extra-articular features
e. Hottness and rednes of the affected joint
Answer: E.
61. All of the following are features of osteoarthritis, ecept:

a. Morning stiffness for more than an hour
b. Normal ESR
c. Pain in affected joint is increased with ambulation
d. Swelling of the affected joint but without hotness or redness
e. Lack of systemic extra-articular symptoms
Answer: A.
62. All of the following are consistent with the diagnosis of rheumoatoid arthritis,
ecept:
a. Symmetrical involvemtn of the small joints of the hands?
b. Elevated ESR
c. Wan neck deformities in the fingers
d. Nodes of the distal interphalangeal Heberden’s joint
e. Erosive changes othe MCP joints on x-ray
Answer: D (osteoarthritis)
63. A positive rheumatoid factor can be seen in all of the following conditions, ecept:
a. RA
b. TB
c. Hepatitc C
d. Malignancies
e. Combined immune deficiency syndrome → Correct
Answer: B (TB)
64. All of the following are extra-articular features of rheumatoid arthritis, except:
a. Posterior uveitis
b. Cutaneous vasculitis
c. Pulmonary fibrosis
d. Sicca syndrome (secondary sjogren’s)
e. Pericarditis
Answer: A (Eyes: Scleristis, episcleritis, scleromalacia perforans, and Sicca syndrome)
65. All of the following are true for myofibril, except:

a. Each myofibril is made up of a serious of sacromeres
b. The basic unit of contraction is intercalated disc
c. A scromere is bounded by two tran??? Z lines
d. The actin filamne overaly with thicker protein filament called myocin
Answer:B
66. In conductive system of the heart muscle, all of the following are ture, except:
a. Conduction started in SA node. AV node, bundle of His, left and right bundle branch-
purkinjee fibers.
b. Left bundle branch is shorter than right bundle
c. Right bundle supplies right ventricle and left bundle supplied left ventricle and spetum
d. Action potential in the ventricle is rapid and generated by rapid transmembrane K
diffusion.
Answer:D (sodium not K)
67. Cause of syncope include all of the following, except:

a. Arrhythmias, atrial and ventricular.
b. Obstruction to cardiac output like artic stenosi
c. Vasovagal, neurogenic
d. CVA
e. SBE
Answer: E.
68. The least common ause of AF is? Or: The commonest cause of AF?
a. WPW syndrome
b. Mitral valve disease
c. Hypertension
d. Pericarditis
e. Thyrotoxicosis
Most common cause: Mitral valve disease

Least common cause: Either WPW syndrome or pericarditis (The common arrhythmia that
occurs in WPW syndrome is a paroxysmal (intermittent) supraventricular tachycardia (PSVT).
Other arrhythmias that can also occur include atrial fibrillation, atrial flutter and atrioventricular
re-entrant tachycardia (AVRT). Rarely, another arrhythmia called ventricular fibrillation can
develop)
69. Compensatory physiologic changes in HF include which one of the following:
Thyrotoxicosis\ infection and infective endocarditis, poor compliance in therapy, renin

angiotensin system, pregnancy ??? Question not clear ➔ Probably answer is Renin-
angiotensin-system.
70. All of the following are true in atrial fibrillation, except:
a. Presence of A wave in front of QRS in EKG
b. Presence of pulse deficit between apical rate and radial rate ≪< Wrong
c. It’s a type of arrhythmia called irregular irregularly
d. It is treated medically by digoxin and surgicall by Maixe operations?
71. Myocardial ischemia is an imbalance between O2 supply and myocardial demand,

all of the following are true except:
a. Obstruction of coronary arteries by atherosclerosi
b. Coronary artery spasm
c. Anemia
d. Thyrotoxicosis
e. Pericarditis
Answer: E Conditions that may cause myocardial ischemia include Coronary artery disease
(atherosclerosis). Atherosclerosis occurs when plaques made of cholesterol and other cellular
waste products build up on your artery walls and restrict blood flow. Atherosclerosis of the
heart arteries is called coronary artery disease and is the most common cause of myocardial
ischemia.
Blood clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot, which
may lead to sudden, severe myocardial ischemia, resulting in a heart attack.
Coronary artery spasm. A coronary artery spasm is a brief, temporary tightening (contraction)
of the muscles in the artery wall. This can narrow and briefly decrease or even prevent blood
flow to part of the heart muscle. Coronary artery spasms are more common in people with risk
factors for heart disease, such as high cholesterol and high blood pressure, but the spasms can
happen in people who have no risk factors, too. Coronary artery spasms can also occur in
people who have conditions that affect their immune systems, such as lupus.
Severe illnesses. Myocardial ischemia can occur when the metabolic demands of your heart
increase or when blood pressure is very low due to infection, bleeding or other severe illness.
Source: http://www.mayoclinic.com/health/myocardial-ischemia/DS01179/DSECTION=causes
72. In acute MI< all of the following are true, except:
a. Inf MI, St elevation in 1, 2, AVF
b. Anteroseptal MI – ST segment elevation in V1-V2-V3
c. In acute MI, thrombolytic therapy achieve 100% reperfusion arate.
d. Treatment of MI include morphine, coronary vasodilation, aspirin.
e. Cardiac markers in acute MI, serial cardiac enzymes, like CPK, troponin.
Answer: C (reperfusion rate 100%? Fee eshee bel6eb 100%)…
73. Clinical features in infective endocarditis include all of the following, except:
a. Appearnace of new murmur or change in the quantiy of eisting murmur
b. Fever
c. CHF
d. Skin and eye lesions
e. No splenomegaly
Answer: E (A wide variety of diseases are associated with splenomegaly, or enlargement of the
... Such as in subacute bacterial endocarditis or infectious mononucleosis ...
http://emedicine.medscape.com/article/206208-overview)
74. Classification of cardiomyopathy include all of the following, except:

a. Dilated cardiomyopath
b. Hypertrophic-IHSS
c. Restrictive cardiomyopathy
d. Arrythmogenic right ventricle
e. Prolpase mitral valve
Answer: E.
75. In pericarditis, all are true, except:
A. Chest pain increase by deep breating\ b. usually follow URI’\ C. on EKG, ST segment
elevation is conve upwards\ D. pericardial rub can confirm diagnosis\ E. treated with NSIAD or
aspirin
Answer: C (saddle shaped ST segment – convex downwards not upwards)
76. All of the following are causes of secondary hypertension, except:
A. Coarcation of the aorta\ B. Renal artery stenosis\ C. Pheochromocytoma\ D. Female

hormones nad NSAIDS\ E. Increase in arteriolar peripheral resisatnce
Drug-induced hypertension associated with NSAIDs is due to the renal effects of these drugs.
Specifically, NSAIDs cause dose-related increases in sodium and water retention. This effect is
also seen with COX-2 selective agents, such as celecoxib.[11]
Answer: Increase peripheral arteriol resistnace
a. ?
77. Inspiratory arm of the flow-volume loop wil be typically abnormal in which of the
following conditions?
A. Bronchial asthma
B. Vocal cord dysfunction
C. Emphysema
D. Interstitial lung diseae
E. Bronchoiolitis obliterans
Answer: B.
Vocal cord dysfunction involves inappropriate vocal cord motion that produces partial airway
obstruction. Patients may present with respiratory distress that is often mistakenly diagnosed as
asthma. Exercise, psychological conditions, airborne irritants, rhinosinusitis, gastroesophageal reflux
disease, or use of certain medications may trigger vocal cord dysfunction. The differential diagnosis
includes asthma, angioedema, vocal cord tumors, and vocal cord paralysis. Pulmonary function testing
with a flow-volume loop and flexible laryngoscopy are valuable diagnostic tests for confirming vocal
cord dysfunction. Treatment of acute episodes includes reassurance, breathing instruction, and use of a
helium and oxygen mixture (heliox). Long-term management strategies include treatment for symptom
triggers and speech therapy.
http://www.aafp.org/afp/2010/0115/p156.html
78. All of the following associations between conditions and mechanisms of hypoxia
are true, except:
a. COPD and V/Q mismatch (The principal contributor to hypoxemia in COPD patients is
ventilation/perfusion (V/Q) mismatch resulting from progressive airflow limitation)
b. ARDS and pulmonary shunt (edema in patients with ALI/ARDS is impaired gas
exchange with intrapulmonary shunt,)
c. Multiple rib fractures and hypoventilation
d. Hepatopulmonary syndrome and V/Q mismatch (The hepatopulmonary syndrome is
characterized by a defect in arterial oxygenation induced by pulmonary vascular dilatation in
the setting of liver disease1) (Dyspnea and hypoxemia are worse in the upright position (which
is called platypnea and orthodeoxia, respectively)
e. Motor neuron disease and hypoventilation
Answer: C
79. IN patients with sarcoidosis, all of the following are associated with good
prognosis, except:
a. Fever
b. Erythema nodosum
c. Age less than 40 years
d. Black race
e. Presence of polyarthritis
Answer: D.
80. Regarding the pathogenesis of bronchial asthma, one of the following is specific for
the disease:
a. Air flow limitation
b. Airway hyper-responsiveness
c. Inflammation of the mucosa
d. Peak flow variability
e. Brochioalevolar eosinophils
Answer: B.
81. The most common organism responsible for severe community pneumonia needing
ICU care is:
a. Strep. pnuemonia
b. Legionella
c. H. influenza
d. Gram negative bacilli
e. Mycoplasama pneumonia
Answer: Strep. pnuemonia

82. In chronic obstructive pulmonary disease, there is increased risk of respiratory
tract infection with all of the following pathogens, except:
a. Strep/ pneumonia
b. H. influenza
c. Atypical mycobacteria
d. Moraxxela cataralis
e. Legionella pneumonia
Answer: e
83. Actions of PTH include all of the following, except:
a. Increase bone resoption
b. Increase net acid excretion
c. Increased calcium absorption from GI tract
d. Increased calcium reabsorption in the kidney
e. Increased phosphate excretion
Answer: B
effect of serum osmolarity of a patient with the following labs: Na+ 125 mmol/l, glucose
108 mg/dL and BUN of 140 mg/dL is:
Serum osmolarity= 2 x[Na+] + Glucose/18 + Urea/2.8 = 2x15+108/18+140/2.8= 250+ 6 + 50 =
306
84.
85. Actions of PTH include all of the following, except:
a. Increase bone resoption
b. Increase net acid excretion
c. Increased calcium absorption from GI tract
d. Increased calcium reabsorption in the kidney
e. Increased phosphate excretion
Answer: C (this is a function of vitamin D). So, PTH acts indirectly to increase calcium
absorption from GI tract by increasing the synthesis of vitamin D.
86. The effect of serum osmolarity of a patient with the following labs: Na+ 125 mmol/l,
glucose 108 mg/dL and BUN of 140 mg/dL is:
Serum osmolarity= 2 x[Na+] + Glucose/18 + Urea/2.8 = 2x15+108/18+140/2.8= 250+ 6 + 50 =
306
85. Syndrome of inappropriate ADH secretion is characterized by all of the following,

except:
a. Urine osmolarity more than 100
b. Hypoosmolarity of the serum
c. Urine Na+ more than 40
d. Normovolemia and hyperuricemia
Answer: D.
86. All of the following factors increase distal tubular secretion of K+, except:
a. Increased serum K+.
b. Increased tubular flow rate
c. Increased serum H+ concentration
d. Increased tubular Cl- concentration
e. Increased aldosterone → Correct
Answer: D?
87. All of the following electrolyte and acid-base disturbances may be seen in a patient
with diabetic ketoacidosis upon presentation, except:
a. Hyponatremia
b. Normal anion gap metabolic acidosis
c. Hyperkalemia
d. Hyperphosphatemia
e. Increased urea
Answer: B (DKA causes high anion gap metabolic acidosis)
88. All of the following are causes of high turnover bone disease in chronic renal
failure, except:
a. Aluminum toxicity
b. Decreased vitamin D hydroxylation
c. Metabolic acidosis
d. Hyperpohsphatemia
e. Increased parathyroid hormones
Answer: A
89. All of the following are true about chronic myeloid leukemia (CML), except:
a. It is a disease of middle aged which could present with constitutional symptoms
b. The laboratory finding usually show leukocytosis, with left shift and high leucocyte
alkaline phosphatase.
c. It is characterized by specific transloation between chromsomes 9, 22 (Philadelphia
chromosome)
d. Possible treatment for CML include; imtinib ??? and allogenic BMT
e. CML could transfer to AML or ALL
Answer: B (low Luecocyte alkaline phosphatase).
90. All of the following are true about myeloproliferative disorders, except:
a. In polycythemia vera, the serum erythropoietin level is high.
b. In essential thrombocytosis, the bone marrow biospy usually show hypercellular
marrow with increased megakaryocytes
c. Massive splenomegaly in CML and myelofibrosis
d. ?
e. ?
Answer: A.
96. The adrenal glands, one is correct:
a. The zona reticularis is the most important area in the cortex during embryogenesis
b. There is no relation between the adrenal cortex and the adrenal medullar regarding
catecholamine synthesis ➔ Wrong! Cortisol increases catecholamine sysnthesis.
c. Phechromocytoma is associated with high blood pressure and hyperkalemia
d. Atrophy of the glnads is a late sign of autoimmune adrenalitisi
e. Zona fasiculata is the place for adrenal androgen synthesis
Ans:
97. In Cushing syndrome, one is correct:

a. Significant hypokealima is associated with Cushign diseas
b. Easy bruisability is associated only with oral steroid therapy – induced cushign
syndrome
c. Loss of diurnal variation of serum cortiosol is found in cushing syndrome
d. Proimal myopathy is a rare feature of Cushing syndrome
e. Glucose intolerance in Cushing syndrome is related to suppression of insulin release
Ans: C.
98. In Addison disease, one is correct:

a. Hyperpigmention of the gums and skin is secondary to the increased release of prolactin
hormone…
b. Postural dizziness is a common feature in the history of a paitient with Addison disease
c. Normokaleima is the rule unlcess there is recurrent vomiting
d. The ACTH level is normal in the later stage of disease
e. Hemorrhage into the adrenals is the most common cause
Ans: B???
Extra info: Schmitdt syndrome: Primary adrenal insufficiency + Hypothryoidism (and often
type 1 DM).
99. A 17 year old pregnant lady was referred for evaluation of anemia. As a child, she
was hospitalized with pneumonia and visited ER twice with abdominal pain. Two years
ago, she was found anemia and iron was recommended, but intermittently taken. The
examination was unremarkable except for a palpable spleen tip. The Hb was 10 with
ferritin 105 and saturation 18%. The peripheral smear revealed slight hypochrmoasia and
target cells, but no sickle forms. Hb electrophoresis results were HbA 26%, HbF 5%, and
HbS 69%. Which of the following is the most likely diagnosis:
a. ?
b. ?
c. ?
d. ?
e. ?
Answer: B? ➔ B-Thalassemia minor + Sickle cell trait

100. A 65-year-old man with progressive pancytopenia is referred for evaluation. On
examination, there is splenomegaly. Bone marrow aspirate demonstrated no dysplasia but
decreased cellularity. Which diagnosis is most likely:
a. Aplastic anemia
b. Megaloblastic anemia
c. Myelodysplasia
d. Hairy cell leukemia
Answer: D
Final exam 2007 6th year
1. Pulsus paradoxus pulse is felt in ONE of the following.
a- aortic regurgitation
b- aortic stenosis
c- mitral stenosis
d- VSD
e- Cardiac tamponade
2 . A 30-year-old man admitted with right sided hemiplegia.Clinical examination
reveals loss of a wave in JVP with irregular irregular pulse. He has ONE of the
following cardiac rhythm abnormalities.
a- complete heart block
b- atrial fibrillation
c- atrial flutter
d- sinus tachycardia
e- sinus bradycardia
3. Major criteria for Rheumatic fever include all the following Except.
a- carditis
b- Sydenham's chorea
c- Polyarthralgia
d- Erythema marginatum
e- Subcutaneous nodules
4. ONE of the following drugs is LEAST used in treatment of acute sever asthma.
a- nebulized B2 agonist
b- i.v hydrocortisone
c- epinephrine (adrenaline)
d- oxygen
e- i.v . aminophylline
5. Hypoxia (decreased PaO2) and decreased Pa CO2 is found in all the following
Except.
a- left ventricular failure
b- massive pulmonary embolism
c- acute sever asthma
d- acute exacerbation of COPD
e- pneumonia
6. All the following are true following splenectomy Except.
a- thrombocytopenia
b- pneumococcal vaccine should be given
c- annual influenza vaccine should be given
d- long term oral penicillin V 500 mg 12 hourly should be given
e- Howell-Jolly bodies are characteristically seen on blood film.
7. ONE of the following drugs is most appropriate in treatment of pneumocystis
carinii pneumonia.
a- clarithromycin
b- ethambutol
c- azithromycin
d- Trimethoprim-Sulphamethoxazole
e- INH and rifampicine
8. ONE of the following is the mode of action for B-Blockers in controlling

hypertension.
a- decrease cardiac out put.
b- Slow the heart rate
c- Increase cardiac force of contraction
d- Increase cardiac output
e- Decrease plasma volume
9. A healty patient who is HLA-B27 is most likely to develop ONE of the following.
a- psoratic arthritis
b- enteropathic spondylitis
c- gonococcal arthritis
d- Reiters disease
e- ankylosing spondylitis
10. According to Vaughan Williams Classification of antiarrhythmic drugs, which class

would be verapamil belong to?
a- class 1 A
b- class 1 B
c- class 1 C
d- class III
e- class IV
11. Which one of the following is LEAST useful in assessing patient with a poor
prognosis in community-acquired pneumonia?
a- mental confusion
b- urea of 11.4 mmol/l
c- positive C-reactive protein
d- respiratory rate of 35/ min.
e- age 75 years old.
12. All the following are functions of kidney Except.

(a). Excretion of waste products.
(b). production of erythropoietin.
(c). Metabolism of vitamin D
(d). destruction of rennin.
(e). production of prostaglandins.
13. All the following are causes of sterile pyuria Except:

a) Kidney stones
b) Tubulointerstitial disease
c) Papillary necrosis
d) Tuberculosis
e) Acute pyelonephritis
14. ONE of the following is the most frequent cause of death in acute renal failure.
a) Uremia
b) Pulmonary edema
c) Hyperkalemia
d) Infection
e) Hyponatremia
15. A 29-year-old medical student developed a positive PPD (purified protein
derivative) test. She was started on isoniazid (INH) and rifampin
prophylaxis. Three months into her therapy, she began to experience
pins and needles (parasthesia ) in her lower limbs. Administration of which of
the following vitamins might have prevented these symptoms?
A. Niacin
B. Pyridoxine
C. Riboflavin
D. Thiamine
E. Vitamin C
16. Increased bleeding time and PTT is found in ONE of the following.
a- hemophelia A
b- hemophelia B (Xmas disease)
c- Von Willebrand disease
d- treatment with warfarin
e- idiopathic thrombocytopenic purpura
17.All the following may be found in Iron deficiency anemia Except.
a- Red cell distribution width (RDW) is less than 13.
b- microcytic RBC
c- low serum ferritin
d- low serum iron
e- increased TIBC
18.Bilateral hilar lymph nodes enlargement occurs commonly in all the following
Except.
a- pulmonary Tuberculosis
b- chronic myeloid leukemia
c- non-Hodgkins lymphoma
d- Hodgkin lymphoma
e- sarcoidosis
19.All the following may be found in Intravascular hemolysis Except.
a- increased unconjucated bilirubin
b- increased haptoglobin
c- increased methemalbumin
d- reticulosytosis
e- Hemoglobinurea
20.All the following are causes of WORM autoimmune hemolytic anemia Except.
a- SLE
b- chronic lymphocytic leukemia
c- methyldopa
d- infectious mononucleosis
e- non-Hodgkins lymphoma
21. A 72-year-old woman comes to you to control her high blood pressure (180/100)
mmHg.
What is the ONE target blood pressure in the long term for this patient?
a- <160/90
b- <150/90
c- <145/90
d- <130/85
e- <120/70
22. All the following are true about side effects of anti-diabetic agents Except.
a- metformin carries a risk of lactic acidosis.
b- sulphonylurea is used safely pregnancy
c- glitazones may cause prominent fluid retention
d- insulin may cause lipohypertrophy
e- acarbose causes diarrhea
23.Causes of hypoglycemia in diabetes include all the following Except.

a- no daily exercise.
b- unrecognized other endocrine diseases like Addison's disease.
c- missed, delayed or inadequate meal
d- gastroparesis
e- factitious and deliberately induced.
24.Causes of indirect (unconjucated) hyperbilirubinemia include all the following

Except.
a- autoimmune hemolytic anemia
b- thallassemia major
c- G6PD deficiency anemia
d- Dubin-Johnson syndrome
e- Gilbert's syndrome
25.Precipitating factors for hepatic encephalopathy in patient with liver cirrhosis include
all the following Except.
a- occult infection
b- aggressive diuresis
c- gastrointestinal bleeding
d- treatment with oral neomycin
e- excess dietary proteins
26. All the following hepatitis viruses are RNA Except.
a- hepatitis A
b- hepatitis B
c- hepatitis C
d- hepatitis D
e- hepatitis E
27.ONE of the following statements is true about treatment of pulmonary tuberculosis.

a- pyrazinamide may precipitate hyperurecmic gout.
b- INH can cause optic neuritis
c- renal impairment with rifampicine
d- streptomycin is causing reversible damage to vestibular nerve
e- hepatitis is usually caused by ehambutol
28.All the following are found in left sided heart failure Except.
a- bilateral basal creptations
b- third heart sound
c- pulsus alternans
d- raised JVP
e- pulmonary oedema
29. All the following may occur in cardiac tamponade Except.

a- raised jugular venous pressure with sharp rise and y descent.
b- Kussmaul's sign ( rise JVP/ increased neck vein distension during inspiration)
c- pulsus paradoxus
d- visible apex beat.
e- reduced cardiac output.
30. ONE of the following B-Blockers is cardioselective and lipid soluble.

a- atenalol
b- propranolol
c- metoprolol
d- bisoprolol
e- carvidalol
31. All the following are criteria to define sever attack of ulcerative colitis Except.
a- stool frequency > 10 per day with out blood
b- fever > 37.5 C
c- tachycardia >90/min
d- anemia hemoglobin < 10 gram/dl
e- albumin < 30 g/L
32. All the following are true about gout except:

a- Is caused by deposition of monosodium urate monohydrate crystals in the joints.
b- It is an asy,mmetric arthritis.
c- Can be caused by thaiazide diuretics.
d- It is commoner in females than males 4:1.
e- Attack of gout can be triggered by dehydration.
33. A 32-year-old alcoholic with shock due to bleeding oesphageal varices. After
resuscitation.Which ONE of the following is the treatment of choice.
a- intravenous octreotide.
b- intravenous glypressin
c- oesophagial variceal endoscopy ligation
d- Transjugulartranshepatic portocaval shunt (TIPS)
e- oesophagial variceal sclerotherapy
34. A 65-year-old man with liver cirrhosis presented with ascitis,abdominal pain,
tenderness and peripheral edema. A diagnostic tap revealed a neutrophil count of 400
/mm 3(normal < 250).
Which ONE of the following would be of the most immediate benefit ?
a- Fluid restriction and no added salt diet.
b- Intravenous antibiotics.
c- Oral spironolactone.
d- Therapeutic paracentesis
e- Trans-jugular intrahepatic porto-systemic shunt.
35. All the following are recognized complications of Hepatitis C infection Except.
a- diffuse proliferative glomerilonephritis.
b- hepatocellular carcinoma
c- liver cirrhosis
d- chronic hepatitis C infection
e- cryoglobulinemia
36. ONE of the following tests is most suitable in screening patients for celiac disease.
a- Anti-casein antibodies
b- Anti-endomyseal antibodies
c- Anti-gliadin antibodies
d- ESR
e- Aplha feto protein.
37. All the following are true about Bronchiectasis Except.

a- chronic cough with whitish sputum.
b- May be caused by cystic fibrosis
c- Clubbing of fingers
d- Hemoptysis
e- Bronchial dilation and wall thicking is shown by high resolution chest CT scan.
38. All the following are true about sarcoidosis Except.

a- raised serum level of angiotensin converting enzymes
b- Negative tubercline skin test
c- Normochromic normocytic anemia
d- Hypercalcemia
e- Pulmonary caseating granuloma
39. ONE of the following is found only in Grave's disease.

a- atrial fibrillation
b- Pretibial myxoedema
c- heat intolerance
d- Tremor
e- Proximal myopathy
40. Rheumatoid factor is positive in all the following diseases except:
a.- Rheumatoid arthritis
b- dermatomyocytis
c- ankylosying spondylitis
d- dicoid lupus erythematosis
e- mixed connective tissue diseases.
41. 20-year old woman presents with a week history of fever, rigor and productive
rusty cough. The chest X-ray shows left lower lobe consolidation. Which ONE of
the following is most appropriate treatment?
a- clarithramycin
b- gentamycin
c- Cotrimoxazole
d- Benzypenicillin
e- Flucloxacillin
42. ONE of the following is most likely diagnosis for patient with thyroid function test
showing elevated serum T4 and low radioactive iodine uptake.
a- Grave's disease.
b- Hashimoto's thyroiditis.
c- subacute thyroiditis.
d- non-toxic goiter.
e- pregnancy.
43. A-25- year old man presents with urethritis, painful swollen left knee and
conjunctivitis.
ONE of the following is most likely diagnosis.
a- SLE
b- Gonococcal arthritis
c- Gout
d- Reiter's syndrome
e- Ankylosising spondylitis
44. One of the following is true about mangment of diabetes mellitus.

a. the latest guide lines recommended HbA1C to be less than 7%.
b. post prandial blood sugar up to 200 mg/dl is accepted.
c. fasting blood sugar should be less than 100 mg/dl in all patients.
d. LDL-cholesterol up to 120 mg/dl is acceptable in diabetics.
e. blood pressure of 145/95 mm Hg is acceptable in diabetics.
45. One of the following is true about complications of diabetes mellitus.

a. HbA1C is the most studied marker for diabetes mellitus complications.
b. fasting blood sugar dose not attribute to HbA1C level.
c. Erectile dysfunction is solely (only) due to diabetic vasculopathy.
d. hard exudates are more serious than soft exudates in diabetic retiopathy.
e. serum creatinin is the early biochemical marker to change in diabetes nephropathy.
46. All the following are true about calcium metabolism except.
a. calcitonin inhibit bone resorption
b. vit. D3. is hydroxylated in the liver to 25-hydroxycholecalciferol
c-. parathyroid hormone decrease phosphate execretion by the kidneys.
d. parathyroid hormone is increased renal tubular reabsorption of calcium.
e. vit. D deficiency is manifested as low parathyroid hormone level.
47. A 54- year- old male with Child's grade C hepatic encephalopathy presents with
haemetemesis. Which ONE of the following is most appropriate immediate
therapy?
a. i.v desmopressin
b. i.v isosorbide dinitrate
c. i.v. omperazole
d. i.v. propranolol
e. i.v. somatostatin.
48. All the following are risk factors for development of peptic ulcer disease Except.
a. daily use of NSAID
b. gastric infection with H.pylori
c. sever emotional stress.
d. cigarette smoking
e. gastrin-secreting tumors.
49. Which ONE of the following is LEAST associated with hemochromatosis.

a. cardiomyopathy
b.hypogonadism
c. Chorea.
d. diabetes mellitus
e. liver cirrhosis.
50. A29- year-old man presents with symptoms of gastroesophageal reflux. Which ONE
of the following is most useful in assessing the role of surgery.
a. cardiac sphincter manometry.
b. gastric emptying study.
c. intragastric PH monotring off therapy .
d. oesophgeal motility study.
e. oesophgeal PH monotring on therapy
51.All the following are true about hepatitis A ,except.
a. has an incubation period of 2-4 weeks.
b. it is transmitted during vaginal delivery.
c. does not cause chronic hepatitis.
d. may cause hepatosplenomegaly.
e. a vaccine is avalible.
52.A peripheral blood film shows hypersegmented neutrophils.

What is the most likely ONE cause for this ?
a. Iron deficiency anemia
b. myelofibrosis
c. thalassemia major
d. thallasemia minor
e. megaloblastic anemia
53. All the following may be used in treatment of idiopathic thrombocytopenic purpura
Except.
a. oral predinsolone.
b. Fresh frozen plasma
c. splenectomy
d.I.V. immunioglobulin
e. immunosuppresent drug ( cyclophosphamide)
54.A-23- year old woman presents with lethargy, the following blood results are
obtained. Hb 10.4 g/dl, platelet 268x 10 9/L, WBC 6.3X 10 9/L, MCV 65 fl, Hb A2 9% (
NORMAL < 3.5% ),
Which ONE of the following is the most likely diagnosis?
a. B-Thallassemia minor
b. B-Thallassemia major
c. sickle cell anemia
d. hereditary spherocytosis
e. G6PD deficiency
55.A 70-year-old woman is referred to hospital due to evidences of congestive heart

failure. Blood test reveal the following: Hb 7.4 g/dl, MCV 124 fl, platelets 98 x10 9/l,
WBC 3X10 9/L,
All the following investigations are required to reach a diagnosis Except.
a. Schilling test
b. Intrensic factor antibodies
c. antiparitel cell antibodies
d. bone marrow aspiration, looking for megaloblasts
e. C-reactive protein.
56. Splenomegaly may be found in all the following Except.

a. polycythemia rubra vera
b. essential thrombocythemia
c. portal hypertension
d. thalassemia minor.
e. myelofibrosis.
57. A patient with Hodgki's lymphoma, has cervical lymphadenopathy with

splenomegaly. He has no fever,weight loss or drenching sweating.
His clinical staging is ONE of the following.
a. stage I
b.stage II
c.stage III B
d. stage III
e. stage IV B.
58. All the following are true about renal osteodystrophy Except.
a. reduced conversion of 25 (OH)2 D3 to 1-25-(OH) 2 D3
b. increased parathyroid hormone
c.increased intestinal calcium absoprption
d. decreased osteoclastic activity
e. increased reabsorption of calcium from bone.
59. All the following may be found in polycythemia rubra vera Except.
a. elevated WBC
b. elevated platelets
c. splenomegaly
d. elevated serum uric acid
e. high erythropoietin level
60.Coomb's test is positive in ONE of the following.

a. warm autoimmune hemolytic anemia
b. hereditary spherocytosis
c. G6PD deficiency
d.paroxysmal nocturnal hemoglobinuria
e. malaria
61. All the following are true about thalassemia major Except
a. Hb electrophoresis shows mainly increase in Hb A2
b. failure to thrive with short stature
c. sever anemia
d. hepatosplenomegaly
e. treatment is by blood transfusion with iron chelating agent ( desferrioxamine)
62.All the following are true about rheumatoid arthritis except.

a- it is chronic disease, but curable.
b- it is commonly associated with positive rheumatoid factor
c- antimalarial treatment is one of the lines of management.
d- the patients with the disease are liable to infection
e- this disease may affect the patients functionally.
63. All the following are true about uric acid metabolism except.
a- 2/3 of body uric acid pool is dietary in origin
b- 2/3 is from endogenous purine metabolism
c- 2/3 of uric acid is excreted by the kidney
d- serum uric acid is increased in polycythemia rubra vera
e- serum uric acid is increased in eclampsia of pregnancy.
64- All the following are poor prognostic signs in scleroderma except.
a- old age of onset.
b- limited skin involvement.
c- high ESR
d- renal involvement
e- pulmonary hypertension
65. Pathergy test is positive in one of the following diseases.

a- Behcet's syndrome
b- Kawasaki disease
c- erythema multiforme
d- osteoarthritis
e- rheumatoid arthritis
66. All the following are most likely causes of pyrexia of unknown origin Except.
a- occult bacterial infection
b- lymphoma
c- factitious fever
d- viral infection
e- SLE
67. A 50-year old woman has pain in her fingers on exposure to cold, arthralgia, and
difficulty in swallowing solid food.
The most useful One test to make a definitive diagnosis is
a- rheumatoid factor
b- anti-nuclear antibody
c- ECG
d- Blood urea and serum creatinin
e- anti-mitochondrial antibody
68. A 20-yea-old male is complaining of arthritis and eye irritation. He has a history of
burring on urination. On examination, he has Right knee effusion and dermatitis of the
glans penis.
Which of the following is ONE most correct statement about this patient?
a- Nisseria gonorrhoeae is likely to be cultured from the glans penis
b- B- the patient is likely to have positive rheumatoid factor
c- An infectious process of the GI tract may precipitate this disease
d- The anti-nuclear antibody is very likely (highly) to be positive
e- There is strong association with HLA-B8 antigen.
69. A pleural effusion analysis results: ratio of concentration of total protein in pleural
fluid to serum of 0. 38 , latate dehydrogenase LDH level of 125 IU, and ratio of LDH in
pleural fluid to serum of 0. 45.
Which of the following ONE disease is the most likely the cause for this pleural effusion.
a- uremia
b- pulmonary embolism
c- sarcoidosis
d- SLE
e- Congestive heart failure
70. All the following criteria indicate sever asthma Except.

a- silent chest
b- respiratory rate of 20/ min.
c- hypercapnia
d- throracoabdominal respiration
e- confusion
71. A 57-year-old man develops acute shortness of breath shortly after a 20-hour
automobile ride. He has normal physical examination except for tachycardia,ECG:
shows sinus tachycardia, but is otherwise normal.
Which ONE of the following is correct?
a- the patient should admitted to hospital and if there is no contraindication to
anticoagulant, Heparin should be started while waiting for tests.
b- Normal finding on examination of the lower limbs are extremely unusual
c- A definitive diagnosis can be made by history alone
d- Early treatment has little effect on overall mortality
e- The disease can be diagnosed definitely by Chest X-Ray
72. Which ONE of the following Arterial Blood Gases is most likely to be found in a 60-
year-old heavy smoker man, He has chronic bronchitis, peripheral odema and cyanosis?
a- PH 7.50, PO2 75, PCO2 28
b- PH 7.15, PO2 78, PCO2 92
c- PH 7.06, PO2 36, PCO2 95
d- PH 7.06, PO2 108, PCO2 13
e- PH 7.39, PO2 48, PCO2 54
73. A 60-year-old man has an inferior myocardial infarction; his heart rate is 45 /min.
The artery most likely to be involved in this process is:
a- right coronary artery
b- left main artery
c- left anterior descending artery
d- circumflex artery
e- left mammary artery
74. A patient with stable angina on asprine, nitrate and B-Blocker, developed 3 episodes
of sever and long –lasting chest pain each day over the past 3 days.
His ECG and cardiac enzymes are normal.
One of the following is the best treatment
a- admit the patient and start I.V digoxine
b- admit the patient and start I.V heparine
c- admit the patient and start I.V prophylactic streptokinase
d- admit the patient and for observation without changing his medications
e- Discharge the patient with increasing the dose of B-blocker and nitrate
75. ONE of the following drugs reduces myocardial remodeling after acute myocardial
infarction.
a- ACE inhibitors
b- digoxine
c- verapamil
d- furosemide (lasix)
e- hydralazine.
76. Autoimmune thyroditis can be confirmed by ONE of the following.

a- thyroid peroxidase antibody
c- thyroid uptake resin
d- fine needle thyroid aspiration
e- estimation of TSH
77. A70 hypertensive woman patient with mild left hemiparesis and finding of peristant
atrial fibrillation. Optimal treatment with anti-hypertensive drugs would be ONE of the
following
a- close observation
b- permenant pace maker
c- asprin
d- warfarin
e- I.V heparin
78. ONE of the following is used in treatment of hypertensive Emergency

a- I.V atenalol (tenormin)
b- oral captopril
c- sublingual nifedipine
d- continous infusion of sodium nitroprusside
e- oral alpha methyl dopa
79. Which ONE of the following should be immediately given to a patient with
ventricular fibrillation.
a-I.V amiodrone
b-I.V epinephrinr (adrenaline)
c- defibrillation at 200 joules
d- I.Vadenosine
e-I.V verapamil
80. Which ONE of the following drugs would be most appropriately used in treatment of
patient with inferior myocardial infarction and has a heart rate of 40/minute .
a- atropine
b- digoxine
c- propranolol
d- calcium channel blockers
e- heparine
81. All the following are true in Cushing Except

a- ectopic ACTH is association with sever weight gain without electrolytes
disturbances
b- Cushing disease is usually due to pituitary micro-adenoma
c- Salivary cortisol level has low sensitivity and specificity
d- Cushing disease is a major component in MEN-1
E- Ectopic ACTH Cushing is associated with metabolic acidosis and hyperkalemia
82. A 50-year-old female , she is 155 cm tall and weighs100 Kg, her fasting bloods sugar
is 150 mg/100 ml on 2 occasions, she is a symptomatic and no abnormal physical signs
on examination.
The treatment of choice include ONE of the following.
a- observation
b- medical nutrition therapy
c- insulin
d- sulphonylurea
e- biguanides ( metformin) !!!!!!!!!!!!!!
83.Increased rennin and angiotensin II is found in ONE of the following causes of

secondary htpertension.
a- renal artery stenosis
b- Conn's syndrome
c- cushing's syndrome
d- pheochromocytoma
e- acromegaly
84. Hypocalcemia with increased serum phosphate is found in ONE of the following
a- hypoparathyrodism
b- osteomalacia
c- acute pancreatitis
d- chronic renal failure
e- malabsorption
85. All the following may be findings in primary hypoadrenalism (Addison's disease)
Except.
a- hypernitremia with hypokalemia
b- palmer creases skin pigmentatioin
c- impotance and amenorrhoea
d- postural hypotension
e- weight loss
86.All the following are true about nephrotic syndrome Except.

a- dietary sodium restriction is initial treatment.
b- high protein diet (120-150 gram) daily is recommended
c- prolong bed rest should be avoided as thromboembolism is common.
d- Sepsis is the major cause of death
e- hyperlipdemia is responsible for increase risk of ischemic heart disease.
87. Modifiable risk factors for ischemic heart disease include all the following Except.
a- smoking
b- hypertension
c- hyperlipidaemia
d- age
e- diabetes mellitus
88. All the following antibiotics may be used in treatment of H.pylori Except.
a- amoxicillin
b- tetracycline
c- metronodazo;e
d- clarithramycin
e- strepotomycin
89. All the following are found in chronic renal failure Except.
a- hyperkalemia
b- hyperurecemia
c- hypophosphatemia
d- hypocalcemia
e- Low serum erythropitein
90. Treatment of hyperkalemia include all the following Except.

a- i.v calcium gluconate
b- i.v salbutamol
c- i.v soluble insulin and glucouse
d- i.v hydrocortisone
e- hemodialysis
91. After undergoing surgical resection for carcinoma of stomach, a 60-year-old male
develop numbness in the lower limb. Blood film shows macrocytosis and MCV = 120 fl.
The abnormality is most likely due to ONE of the following
a- folic acid
b- Vit. B12 …… (IF)
c- thiamin
d- Vit. K
e- Riboflavin
92. ONE of the following is not a disease –modifing anti-rheumatoid arthritis drug.
a- sulfasalazine
b- NSAIDs
c- methotrexate
d- leflunamide
e- sodium aurothiomalate (Gold)
93. All the following are early complications of acute myocardial infarction Except.
a- cardiogenic shock
b- heart block
c- ventricular fibrillation
d- aneurismal dilatation of infracted area
e- sudden cardiac death
94. ECG shows ST elevation in leads II, III, AVF, indicate infarction in ONE of the
following
a- anteroseptal MI
b- anterolateral MI
c- posterior MI
d- inferior MI
e- subendocardial MI
95. All the following ECG findings are found in hypokalemia Except.
a) Flattened T waves
b) U waves
c) Shortened QT interval
d) ST segment depression
e) Ectopic beats
96. ONE of the following is LEAST common cause of Microscopical hematuria
a-Minimal change disease (lipoid nephrosis)
b-Membranous glomerulonephritis
c-Proliferative glomerulonephritis
d-Membranoproliferative glomerulonephritis
e-Lupus nephritis
97. Causes of nephrotic syndrome include all the following Except.
a) SLE
b) DM
c) Amyloidosis
d) Membranous glomerulionephritis
e) Autosomal-dominant polycystic kidney disease
98. All the following are true regarding the pathogenesis of lupus erythematosis
except.
a- the exact cause is unknown.
b- It is a chronic inflammatory disease.
c- the basic pathological unit is vasculitis
d- it is due to type I hypersensitivity reaction.
e- genetic and environmental factors may play a role in the disease.
99. All the following are causing hypokalemia Except.
a- Conn's syndrome
b- Addison's disease
c- B-agonist (salbutamol) therapy
d- Alkalosis
e- Thiazide diuretics
100. Repeated multiple mouth ulcers are seen in the following conditions EXCEPT:
a- Behcet's disease.
b- Systemic lupus erythematosus.
c- Herpes simplex virus infection.
d- Ankylosing spondylitis.
e- Mental stress.
Final Exam past years 2004 - 2007
Q. of unknown origin
Part 1
1 ) A 22 year old female presents to clinic because of severe generalized muscle
weakness .Her Blood pressure 120/70 mm Hg , pulse 76/min . Physical exam is
normal except for the muscle weakness .
Labs : Na 142 meq/L , K 2.8 meq / L , Cl 94 meq / L , Ca 10 mg / dl , Po4 3.5 mg/dl,
CO2 36 meq/L
Urine ;
Ph : 7 , protein : trace elements , Cl 75 meq / L , glucose : negative , K : 74 meq/L , Na :
55 meq /L
The clinical findings are most consistent with :
A .) Hypokalemic periodic paralysis
B ) Villous adenoma
C ) Primary aldosteronism
D ) Bartter s syndrome xxx
E ) Surreptitious vomiting
2 ) A 20 year old primigravida in her 32 nd week of gestation is admitted to the hospital

because of epigastric pain , nausea & vomiting . physical exam shows Blood pressure
150/105 mm Hg , puffiness of the eyes , + 1 peripheral edema , segmental arteriolar
narrowing but no hemorrhages or exudates of the fundus , cardiovascular exam is normal
Labs :
Hct :40 % ,WBC 7000 / µL , platelets 70 , 000 /µL , BUN 15 mg/dl , Uric acid 8.3 mg/dl
, Cr 1.7 mg/dl , Bilirubin 2.7 mg/dl , ALT 500 U/L , lactate dehydrogenase 500,
Haptoglobin 14 mg / dl , Urine analysis + 2 protein , no RBC .
Peripheral smear shows schistocytes & helmet cells , retic 5 % , fibrin split products 20
mg/dl ( normal < 10 ) .
What is the most likely diagnosis ?
A ) Thrombotic thrombocytopenic purpura
B ) Malignant hypertension
C ) Acute glomerulonephritis
D ) Acute pancreatitis
E ) Fulminant Preeclampsia ( HELLP)
3 ) During a routine physical examination for obtaining health care insurance , a 31 year
old woman is found t have asymptomatic hematuria with 25-30 RBC/HPF in her urine
. Her serum Cr level is 0.9 mg/dl , and her BUN is 12 mg/dl . On questioning , the
patient said that she had a sore hroat within the past month . Physical Exam is
unremarkable & shows no evidence of hypertension or edema . Dipstick analysis
shows only trace proteinuria .
The patient returns for follow up evaluation 2 weeks later , the microscopic hematuria
has resolved .
What is the most appropriate next step you would take to arrive at a diagnosis ?
A ) Order complement , ANA, and ANCA tests
B ) Order a urine test for cytology
C ) Order measurement of Serum IgA level
D ) Repeat urine analysis xxx
E ) Order an intravenous pyelogram
4 ) A 67 year old man with a 4 year history of NIDDM is admitted to the hospital
with DVT in his calf . He is placed at bed rest & given a diet for diabetic patients &
started on heparin therapy . He is treated with his chronic antihypertensive
regimen of Captopril , 25 mg, twice daily
Labs :
Na 138 meq/L, K 4.6 meq/L , HCO3 25 meq/L , Cr 2 mg/dl stable for 2 years ,
5 days later Blood pressure remained stable 135/85 mmHg , but labs became :
glucose 225mg/dl, Na 135 meq/L , k 7 meq/L , HCO3 21 meq/L , Cr 2.4 mg/dl , TTKG
4.
What is the most likely cause of hyperkalemia ?
A ) Acute adrenal hemorrhage
B ) Acute Renal failure
C ) Hyperglycemia
D ) Pulmonary embolus
E ) Hypoaldosteronism xxx
5 ) 30 year old woman , 34 weeks pregnant developed PET , as part of her

treatment was given Mg SO4 , a check on her deep tendon reflexes were decreased
and she started to be confused .
Labs :
BUN : 40 mg/dl , Cr 1.7 mg/dl , Ca 8.3 mg/dl , CO2 23 meq/L , Cl 97 meq/l , K 4.3
meq/l , Na 137 meq/l , Mg 10.5 meq/L
The patient urine output is 30 cc / hour for the last few hours
What is the first step in management of this patient hypermagnesemia :
A ) Placement of a dialysis catheter and initiation of hemodialysis
B ) Administration of furosemide , Iv 100 mg
C ) Administration of 10 % Ca gluconate , Iv , 10-20 ml xxx
D ) Discontinuation of Mg containing antacids followed by observation
E ) Gastric lavage alternating with Kayexalate ( Na polysterene sulfonate ) enemas .
6 ) A 66 year old man with ESRD secondary to hypertension has been receiving
maintenance hemodialysis for 15 years . He is hospitalized for evaluation of neck
and bilateral shoulder pain associated with pain and parasthesias in both hands .
Nerve conduction studies show bilateral median nerve entrapment .
He undergoes a bilateral carpal tunnel release procedure . A skeletal survey shows
numerous periarticular lytic lesions in both humeral heads , the right acetabulum ,
& right scaphoid . Diffuse osteopenia , and subperiosteal erosion of the medial
aspects of the middle phalanges of the hands .
Which of the following procedures is most likely to document the cause of this
patients symptoms ?
A ) MRI of the cervical region and shoulders
B ) An intact parathyroid hormone level test
C ) Congo red staining of the carpal tunnel band or periarticular lytic lesions xxx
D ) A transiliac bone biopsy
E ) A deferoxamine challenge test
7 ) A 19 year old man presents to ER with nausea & vomiting . He has been
attending a wrestling camp for 2 days and had been in good health previously . He
has an oral temperature of 38 ºC , the remainder of his vital signs are normal .
Labs :
Cr 2 mg/dl , Urine analysis : protein + 1 , blood + 3 , microscopic RBC 0-3 / HPF , WBC
0 , casts positive
What is the most appropriate next step :
A ) Prescribe acetaminophen , oral hydration , and abstinence from exercise for the next
3 days
B ) Prescribe Aspirin , oral hydration, & abstinence from exercise for the next 3 days
C ) Admit to hospital & order Iv hydration xxxx
D ) Order a toxic screen for drugs
E ) Order a throat culture and antistreptolysin O titer
8 ) A 33 year old woman presented with Sarcoidosis , her labs showed :
BUN 13 mg/dl ,Na 140 meq/L , K 3.8 meq/L , Cl 105 meq/L , Ca 11.9 mg/dl , PO4 3.5
mg/dl , Cr 1.9 mg/dl , alb 4 g/dl , CO2 23 meq/L .
All the following are likely to be a finding in this patient except :

A ) Increased intestinal Ca absorption
B ) Increased production of 1,25 dihydroxyvitamin D3
C ) Increased levels of PTH xxxx
D ) Hypercalciuria
E ) Increased risk for nephrolithiasis
9 ) A 55 year old male has progressive CRI dueto type II Diabetic Nephropathy &
hypertension . His Cr clearance is 23 ml/min , his serum Cr is 3.1 mg/dl . He has
just returned from an introductory educational session regarding dialysis &
transplant options . He asks your opinion about the best options
Which of the following offers the best prognosis for this patient :
A ) NIPD
B ) Hemodialysis
C )Renal transplant xxxx
D ) Combined renal & pancreas transplant
E ) CCPD
10 ) A 41 year old man has had recurrent Calcium oxalate stones for the past 3
years . A recent 24 hour collection showed the following :
Cr 1.56 g/24 hrs
Ca 380 mg/24 hrs , normal ( < 300 mg/24hrs ) .
Urate 740 mg/24 hrs , normal ( < 750 mg/24 hrs )
Oxalate 38 mg/24 hrs , normal ( < 40 mg/24 hrs )
Citrate 643 mg/24 hrs , normal ( 300-700 mg/24 hrs )
Na 104 meq / 24 hrs
Which of the following would be most effective in reducing his urinary Calcium
excretion ?
A ) Dietary Ca restriction
B ) Cranberry juice
C ) Hydrochlorothiazide xxxx
D ) Furosemide
E ) High fluid intake
11 ) A 28 year old man is found to have microscopic hematuria on an insurance

physical examination . His physical exam is normal .
Urine analysis : no protein , many RBC/HPF , no RBC cast nor dysmorphic RBC .
IVP showed Medullary sponge kidney but no stones .
Appropriate counselling of this patient include which of the following :

A ) Advice him that this disorder is likely to progress to CRF over 10-20 years .
B ) Advice him that this is a benign finding and that although it may be a risk factor for
nephthrolithiasis , it never leads to renal failure xxxx
C ) Advice him that his children should have a genetic testing
D ) Advice him that ACE inhibitor can modify course of disease
E ) He needs cystoscopy to find source of bleeding
12 ) In which of the following clinical situations would an increase in serum Cr

concentration be explained only by reduction in GFR ?
a ) Use of Trimethoprim in a patient with a urinary tract infection
b ) Increased levels of ketoacids in a patient with DKA
c ) Severe extracellular volume cotraction in a patient with diarrhea xxxx
d ) Use of Cimetidine in a patient with a peptic ulcer
e ) Carnitine ingestion for body building
13 ) After 4 years on dialysis , a 42 year old HCV positive black patient received a
living unrelated transplant from his wife . He is treated with Tacrolimus , Sirolimus
& prednisone .Four months post transplant he has high blood sugar ranging 200-
300 mg/dl .He has no family history of diabetes . His BMI is 35 .
His risk factors for past transplant diabetes include all Except :
A ) Tacrolimus therapy
B ) Increased BMI
C ) HCV infection
D ) Sirolimus therapy xxxx
E ) Ethinicity
14 ) All the following are true in regards to corticosteroid withdrawal after kidney
transplant except :
a ) Acute rejection is more likely in blacks
b ) Avoidance of steroids may be more effective than withdrawal
c ) If achieved without acute rejection , it does not affect graft survival x
d ) Results in acute rejection in approximately 30 % of patients
e ) Reduces the need for antihypertensive therapy .
15 ) The use of which one of the following immunosuppressant therapies is not
Associated with hyperlipidemia ?
A ) Tacrolimus
B ) Cyclosporine
C ) Rapamycine
D ) Mycophenolate mofetil xxxx
E ) Prednisone
Part 2
1- the drug that act on cell wall:
vancomysin
2- the most virulant baceria:

strep a b hemolytic
3- patient with hypotention post op u suspect the cauuse to be hypovolemia

one will confirm it in urine:
-urine Na 40
-urine\plasma creatinine ratio 20
- na execretion ratio less than 1
-urine osmolality 350
4- primary survey all must be done exept

-radiogaphs and selecting fractures
-airway patency
-disability
-circulation
elmohem A B C D
5- all antibiotcs affects anerobes exept:

-metronidazole
-chloramphenicole
-clindamycein
-cefalaxin? 2 ‫هو الجواب واحد من‬nd generation cephalosporines
6- not important in prevention of surgical infections during surgery

- dec number of persons in OR
-masks and gloves
-air handeling systems
- taking shower to the surgeon pre op----- had eljwab
7- clean contaminated surgery

- appendicectomy with walled off ?? abscess?
- shot gun injrury --perforated eshe
-cholecistectomy--- azon hai
-
interstial vol = 11 L
9- how many k calory need for adult??

10-30
30-50
50-70
70-90
i think 30-50
10- not avasodailator??

angeotensin
11- most effective method to prevent dvt -

post op mobilization
12- most common herniA IN FEMALE:

indirect
13- ringer lactate
14- peritoneal lavage in trauma patient is not sensitve fer intra peret bleeding
15- men fe bleeding ma b3mal hypovolemic shock?

peritonium-pleura-pericarduim-limbs- pharynx
ana 76et pharynx fe nas b7ko pericardium
16- fe jwab kan mild anexiety in hypovol.shock
17- inhalational injury - msh chest x-ray and ABG
onco
18- radiation not cause lymphocytosis
19- radiationn effect fat necrosis and breast edema
20- mean age for mammogram check up for normal female y3ne :40 yr
30- most common cause of unilat nipple bleeding

intraductal papilloma
31- nipple retraction msh sign for advanced local malig!!!!!! mn dr.jamal
cardio
about varicise vein
32- most common cause for visiting dr
asthesis
33- first symptom..

pian
34- aortic stenosis poor prognosis :

congestive H F
35- trachostomy doesnt incease dead space? not sure
36- not in middle mediastinum ??

schwannoma???
37- dvt complications :

venous ulcer
38- pt with intemit claud & impotence Dx :

leriche synd??
39- tension pneumothorax: false:

collapsed neck veins
40- teratology of fallot not present??

anemia-bleeding tendency- cyanosis-clubbing
ymkin anemia l2no 3ndhom polycythemia
Part3
1. A 50 year old man with no past medical history is found to be in atrial fibrillation
during routine medical examination. He reports no history of palpitation or
dyspnea.Normal physical examination. He refused DC cardioversion. If the patient
remains in chronic Atrial fibrillation.
Which ONE of the following is most suitable treatment to offer?
a- Asprine.**********************
b- warfarin,target INR 2-3.
c- no anticoagulation.
d- warfarin, target INR3-4.
e- warfarin, target INR2-3, for 6 months then Asprin.

e- aortic regurgitation
f- aortic stenosis
g- mitral stenosis
h- VSD
i- Cardiac tamponade.************************
3. A 30-year-old man admitted with right sided hemiplegia.Clinical examination reveals

loss of a wave in JVP.He has ONE of the following cardiac rhythm abnormality.
b- atrial fibrillation************************
c- atrial flutter
##4. All the following occurs usually in 3rd week of Enteric (Typhoid ) fever Except.
a- meningitis
b- lobar pneumonia
c- maculopapular rash (rose spots)*************************
d- oestomyelitis
e- intestinal perforation
##5. All the following are Zoonotic infections Except.

a- rabies
b- brucellosis
c- anthrax
d- toxoplasmosis
e- cholera*******************
f- carditis
g- Sydenham's chorea
h- Polyarthralgia******************
i- Erythema marginatum
j- Subcutaneous nodules

a- Behcet;s syndrome.*********************
b- Kawasaki disease.
c- Erythema multiforme.
d- Osteoarthritis.
e- Rheumatoid arthritis.
f- nebulized B2 agonist
g- i.v hydrocortisone
h- epinephrine (adrenaline)********************
i- oxygen
j- i.v . aminophylline
9. Hypoxia (decreased PaO2) and decreased Pa CO2 is found in all the following Except.
f- left ventricular failure
g- massive pulmonary embolism
h- acute sever asthma
i- acute exacerbation of COPD*****************??????????????
j- pneumonia
##10. All the following are true in osteomalacia Except.

a- may be caused by primary biliary cirrhosis
b- low serum 25-hydroxy vitamin D3
c- normal serum alkaline phosphatase************************
d- pelvic x-ray may show linear areas of low density surrounded by sclerotic borders
(looser's zones)
e- treated by alfacalcidol.
##11. All the following are causes of eosinophilia Except.

a- ascaris infestation
b- malaria********************************
c- bronchial asthma
d- Hodgkin's lymphoma
e- Drug hypersensitivity
##12. All the following are true about Giardia lamblia Except.
a- Is usually acquired by ingestion of food or water contaminated by
trphozoites.*******************************
b- Can cause malabsorption
c- Both cystic and trohozoites can be found in stool
d- Can be effectively treated by metonidazole (flagyel)
e- Cysts are destroyed by boiling.

f- Thrombocytopenia******************************
g- pneumococcal vaccine should be given
h- annual influenza vaccine should be given
i- long term oral penicillin V 500 mg 12 hourly should be given
j- Heizbodies are characteristically seen on blood film.
##14. All the following are true about Amoebic liver abscess Except.
a- it can be treated by metronidazole (flagyel)
b- should be aspirated routinely************************************
c- there may be signs of pleural effusion on right side of chest.
d- Usually affect the right lobe of liver.
e- There is often no history of dysentery.
##15. All the following neoplasm have a known infective etiology Except.
a- Burkitt's lymphoma****************************
b- Hepatocellular carcinoma
c- Gastric lymphoma
d- Nasopharyngeal carcinoma
e- Skin basal cell carcinoma
##16. All the following are findings in Visceral leishmaniasis (Kala azar),Except.
a- pancytopenia
b- hypergammaglobulinaemia
c- lymphadenopathy
d- splenomegaly
e- the drug of choice for treatment is chloroquine.*********************
17. ONE of the following drugs is most appropriate in treatment of pneumocystis carinii.
f- clarithromycin
g- ethambutol
h- azithromycin
i- Trimethoprim-Sulphamethoxazole*************
j- INH and rifampicine
hypertension.
f- decrease cardiac out put.
g- Slow the heart rate****************************
h- Increase cardiac force of contraction
i- Increase cardiac output
j- Decrease plasma volume
19. HLA-B27 is commonly associated with all of the following Except.

a- it may present normaly in general population
b- ankylosing spondilitis
c- polymyositis********************************
d- reactive arthritis
e- Reiter's disease
f- mental confusion
g- urea of 11.4 mmol/l
h- positive C-reactive protein**************************
i- respiratory rate of 35/ min.
j- age 75 years old.
22. Functions of the kidney include all the following Except.

(c). Metabolism of vitamin.
(d). destruction of rennin.*********************
23. ONE of the following ECG changes will NOT be found in patient with
cirrhotic liver and chronic diarrhea who has been taking diuretics
f) Flattened T waves
g) U waves
h) Shortened QT interval********************
i) ST segment depression
j) Ectopic beats

a) Minimal change disease (lipoid nephrosis)
b) Membranous glomerulonephritis***********************
c) Proliferative glomerulonephritis
d) Membranoproliferative glomerulonephritis
e) Lupus nephritis
25. Ultrasound is not useful in defining ONE of the following:

a) Obstructive uropathy
b) Papillary necrosis*****************
c) Renal cysts
d) Renal masses
e) Renal size

f) SLE
g) DM
h) Amyloidosis
i) Membranous glomerulionephritis
j) Autosomal-dominant polycystic kidney disease *******************
27. All the following are associated with large or normal size kidneys Except:
a) Diabetes
b) Amyloid*******************
c) Scleroderma
d) Acute tubular necrosis
e) Chronic pyelonephritis
28. A low complement level is seen in all the following Except:

b) Membranous GN*********************
c) Mesangiocapillary GN
d) Bacterial endocarditis
e) Shunt nephritis
f) Systemic lupus erythematosus

f) Kidney stones
g) Tubulointerstitial disease
h) Papillary necrosis
i) Tuberculosis
j) Acute pyelonephritis********************
30. Hypernatremia in the presence of uncontrolled DM suggests One of the following:

a) Salt overload *********************************
b) Water depletion
c) Hyperlipemia
d) Increased tubular sodium resorption
e) Ketoacidosis
e) Uremia
f) Pulmonary edema
g) Hyperkalemia
h) Infection***********************
e) Hyponatremia
32.. A 29-year-old medical student developed a positive PPD (purified protein

muscle fasciculations and convulsions. Administration of which of
a- Niacin
b- Pyridoxine **************************
c- Riboflavin
d- Thiamine
e- Vitamin C
33. All the following are causes of low Total gas transfer (TLCO) in respiratory function
test Except.
a- pulmonary fibrosis
b- pulmonary oedema
c- emphysema
d- pulmonary emboli
e- asthma************************************
34. A 71-year-old woman with no significant past medical history is investigated for
generalized tiredness. She has recently lost 7 Kg in weight.
The following blood results are obtained.
Hb: 9.8 g/ dl, platelates: 104 x 10 9/ L, WBC: 70 X 10 9/L
Blood film: small mature lymphoctosis, smudge cell seen, no abnormal (blast) cells.

a- chronic myeloid leukemia
b- chronic lymphocytic leukemia***********************
c- acute myeloid leukemia
d- acute lymphoblastic leukemia
e- aplastic anemia
##35. All the following cardiac lesions are associated with high risk of infective
endocarditis Except.
a- VSD
b- combined mitral valve disease
c- aortis stenosis
d- Atrial septal defect********************************
e- Aortic regurgitation
a- hemophelia A
c- Von Willebrand disease*************************

a- Red cell distribution width (RDW) is less than 13.************************
b- microcytic RBC
d- low serum iron
e- increased TIBC
38. Bilateral hilar lymph nodes enlargement occurs in all the following Except.
b- chronic myeloid leukemia*********************
d- Hodgkin lymphoma
e- sarcoidosis

b- increased haptoglobin*****************************
d- reticulosytosis
e- Hemoglobinurea
a- SLE
c- methyldopa
d- infectious mononucleosis***************************+
41. Splenectomy may be an option in treatment of all the following Except.

a- hereditary spherocytosis
b- idiopathic thrombocytopenic purpura
c- worm autoimmune hemolytic anemia
d- hypersplenism***************??????????????????
e- G6PD defecicency
42. Philadelphia chromosome is seen in 90-95 % of patients in ONE of the following.

a- - chronic lymphocytic leukemia
b- chronic myloid leukemia******************************
c- polycythemia rubra vera
d- essential thrombocythemia
e- myelodysplastic syndrome
##43. Life threatening complications of multiple myeloma include all the following
Except.
a- renal impairment
b-hypercalcemia
c- hyperurcemia*********************************
d- hyperviscosity due to high level of paraprotein
e- spinal cord compression.
##44. Metronidazole (Flagel) is used in treatment of all the following Except.

a- acute intestinal amoebiasis.
b- H.pylori infection
c- Giardiasis
d- Enteric fever (typhoid)*************************
e- pseudomenbrnous coloitis.
mmHg.
a- <160/90
b- <150/90
c- <140/90
d- <130/85**********************
e- <120/70
46. A woman, her weight is 82 Kg, height is 1.71 meter.

Which ONE of the following is approximately her Body Mass Index?
a- 28.37*************************
b- 24.50
c- 32.40
d- 34.00
e- 36.00
47. All the following are true about anti-diabetic agents Except.
b- sulphonylurea is used safely pregnancy*******************

a- no daily exercise.*********************
d- gastroparesis
49. All the following drugs are used in treatment of congestive heart failure Except.
a- bisoprolol
b- metaprolol
c- carvidolol
d- spironolactone
e- propranolol**********************
50. Causes of indirect (unconjucated) hyperbilirubinemia include all the following

Except.
d- Dubin-Johnson syndrome*****************************
51. Precipitating factors for hepatic encephalopathy in patient with liver cirrhosis include
a- occult infection
b- Aggressive diuresis
c- Gastrointestinal bleeding
d- Treatment with oral neomycin***************
e- Excess dietary proteins

a- hepatitis A
b- hepatitis B**************************
c- hepatitis C
d- hepatitis D
e- hepatitis E
53. ONE of the following statements is true about treatment of pulmonary tuberculosis.
a- pyrazinamide may precipitate hyperurecmic gout.******************
##54. In patient with coma due to morphine over dose, which ONE of the following
Medications is used to reverse its act.
a- methionine
b- N-acetyl cystine
c- Naloxne********************************
d- Atropine
e- Praladoxine
55. All the following are found in left sided heart failure Except.
c- pulsus alternans
d- raised JVP*******************
e- pulmonary oedema
56. All the following are long term complications of sickle cell anemia Except.
a- pulmonary hypertension
b- leg ulcer
c- neurological complications
d- aplastic crisis
e- splenomegaly.**************
##57. All the following are true about secondary syphilis Except..
a- generalized lymphadenopathy
b- condylomata lata
c- mucosal ulceration (snail track ulcer )
d- generalized itchy skin rash*******************************
e- acute neurological signs.
58. A 35-year-old man with type 1 diabetes mellitus, is evaluated for recent onset
morning hypoglycemia. For the last 10 days his morning blood glucose has ranged from
220 mg/dl-300 mg/dl. He has experienced nightmares recently.
Which of the following is best explanation for his morning hyperglycemia.
a- Diabetic nephropathy
b- Under treatment with insulin
c- Overtreatment with insulin**************???????????????????
d- Diabetic neuropathy
e- Hypothyrodism.
59. All the following can cause high prolactin level Except.
a- prolactinoma
b- acromegaly
c- polycystic ovary syndrome
d- metacopramide
e- hyperthyroidism.**********************
60. Which ONE of the following is contraindicated in treatment of patients with

hypercalcemia of malignancy.
a- thiazide diuretics*****************************
b- loop diuretics
c- infusion of intravenous normal saline
d- bisphoaphonates
e- glucocorticoids

c- pulsus paradoxus
d- visible apex beat.*******************************
62. All the following are correct about non-pharmacological therapy in all hypertensive
patient Except.
a- weight reduction –BMI- should be < 25 Kg/m2*********************
b- low fat and saturated fat diet
c- low sodium diet < 2 gram per day
d- dynamic exercise
e- stop smoking
63. All the following are true regarding the pathogenesis of lupus erythematosis except.
d- it is due to type I hypersensitivity reaction.*************************
a- stool frequency > 10 per day with out blood***************************
b- fever > 37.5 C
e- albumin < 30 g/L
65. Constipation may occur with all the following Except.

a- diabetes mellitus
b- hypercalcemia
c- carcinoid syndrome***********************************
d- porphyria
e- hypothyrodism
66. A-65-year old man presents with 6 months history of diarrhea with pale stool and
weight loss. Relevant lab results show: calcium 1.8 mmol/L (normal 2.12-2.62 mmo/L),
alkaline phosphatase 350 U/L Normal value (45-105) ,
What is the ONE most likely diagnosis?
a- celiac disease
b- Giardia lambila infection
c- Pancreatic carcinoma***********************************
d- Small intestinal bacterial overgrowth
e- Whipple disease.
resuscitation. Which ONE of the following is the treatment of choice.
e- oesophagial variceal sclerotherapy********************************
68.A 65-year-old man with liver cirrhosis presented with ascitis,abdominal pain,
Which ONE of the following would be of the most immediate benefit?
f- Fluid restriction and no added salt diet.
g- Intravenous antibiotics.
h- Oral spironolactone.
i- Therapeutic paracentesis**********************************
j- Trans-jugular porto-systemic shunt.
##69. The presence of fecal leukocytes in a sample of stool or rectal mucus is consistent
with all the following causes of diarrhea Ecxept ONE.
a- campylobacter jejuni.
b- Shigella sonnei
c- Giardia Lambilia**********************************
d- Ulcerative colitis
e- Entamoeba histolytica
a- diffuse proliferative glomerilonephritis.**********************
c- liver cirrhosis
e- cryoglobulinemia
71. All the following statements are associated with Wilson's disease Except.
a- Kayser-Fleischer rings.
b- haemolysis
c- Elevated serum caerloplasmine******************************
d- Renal tubular acidosis
e- Chorea.
b- Anti-endomyseal antibodies******************************
d- Xylose absorption test
e- C-reactive protein.

a- chronic cough with whitish sputum.***********************
d- Hemoptysis

d- Hypercalcemia
e- Pulmonary caseating granuloma*******************************
75. Cardiac risk factors for CNS ischemic stroke are all the followings except:
a- Atrial fibrillation.
b- Supraventricular tachycardia.
c- Myocardial infarction.**************************
d- Left atrial myxoma.
e- Cardiomyopathy.

b- Pretibial myxoedema********************
c- heat intolerance
d- Tremor

a- Conn's syndrome
b- Addison's disease****************************
d- Alkalosis
78. A60-year-old man recently treated for renal tuberculosis, presents with weight loss,
diarrhea, anorexia, and hypotension and is noted to have hyper pigmented buccal mucosa
and hand creases.
ONE of the following is discriminating investigations which is useful in diagnosis.
a- Stool for ova, cysts and parasites.
b- Full blood count.
c- thyroid function test
d- Plasma ACTC and Cortisol*********************************
e- Blood cultures.
79. A20-year-old woman presents with fever, abdominal pain, purpura and focal
neurological signs.
a- idiopathic thrombocytopenic purpura
b- thrombotic thrombocytopenic purpura****************************
c- DIC
d- Henoch-Schonlein purpura
e- Von Willebrand's disease.
80. A -30-year old man has, on heart auscultation, loud first heart sound, rumbling mid
diastolic murmur with opening snap.
a- Pliable (mobile) mitral valve stenosis.*****************************
b- Calcified (immobile) mitral valve stenosis.
c- Mitral valve prolepses.
d- Aortic regurgitation
e- Mitral regurgitation.
81. A-40-year old man post thyroidectomy for medullary thyroid carcinoma presents
with hypertension and complains of attacks of sever headache and palpitations. He is
noted to have glycosuria.
Which ONE of the following is most likely cause of his hypertension.?
a- Cushining syndrome.
b- Primary hyperaldosternosim.
c- Essential hypertension
d- Pheochromocytoma*******************************************
e- Polyarteritis nodosa.
82. A-20-year old woman presents with a week history of fever, rigor and productive
rusty cough. The X-ray shows left lower lobe consolidation.
Which ONE of the following is most appropriate treatment?
f- Clarithramycin*************************************
g- ciprofloxacin
h- Cotrimoxazole
i- Benzypenicillin
j- Flucloxacillin
83. A-60- year-old female with rheumatoid arthritis presents with splenomegaly.Her
CBC shows: WBC 1500/ mm3, platelates 60000/mm3, Hb 8 g/dl. No blast in peripheral
blood film.
Which ONE of the following is most likely diagnosis?
a- Malaria
b- Lymphoma
c- Polycythemia rubra vera
d- Felty's syndrome**********************************************
e- Gaucher's disease.
84. A patient with mild congestive heart failure is treated with high-dose
furosemide and diureses 25 pounds of fluid. A complete blood count (CBC)
taken before the diuresis shows an RBC count of 4 million/mm3; a CBC
taken after diuresis shows a RBC count of 7 million/mm3. Which of the
ONE of the following is the most likely explanation?
a- Cyanotic heart disease
b- Increased erythropoietin
c- Polycythemia vera
d- Relative polycythemia********************???????????????????/
e- Renal cell carcinoma
a- Grave's disease.
c- subacute thyroiditis.**********************************
e- pregnancy.
86. Blood stored in a blood bank tends, with time, to become relatively depleted of
2,3-diphosphoglycerate. What effect does this have on the hemoglobin-oxygen
dissociation curve?
a- Shifts the curve to the left, so that the hemoglobin has a decreased oxygen affinity
**************************************
b- Shifts the curve to the left, so that the hemoglobin has an increased oxygen affinity
c- Shifts the curve to the right, so that the hemoglobin has a decreased oxygen affinity
d- Shifts the curve to the right, so that the hemoglobin has an increased oxygen affinity
e- Does not change the dissociation curve
87. A-25-year woman who takes oral contraceptive pills, recently developed intermittent
left sided headache with photophobia, vomiting. They occur about once a month and last
24-36 hours.
a- tension headache
b- temporal arteritis
c- trigeminal neuralgia
d- migraine********************************
e- Cluster headache.
88.In anaphylactic shock, ONE of the following drugs should be given FIREST.
a- intramuscular epinephrine********************************
b- oral predinsolone
c- oral antihistamine
d- intramuscular antihistamine
e- intravenous atropine.
89. All the following are true regarding the ANA(Antinuclear antibody ) test Except.
a- it is the mainstay test in SLE
b- there are several techniques for making this test.
c- it is highly specific test for SLE.****************************************
d- it may be positive in normal individuals.
e- it is highly sensitive in SLE.
90. All the following are causes of high ESR Except.

a- Anemia
b- polycythemia rubra vera*********************
c- multiple myeloma
d- giant cell arteritis
e- tuberculosis.
91. An elderly man on treatment for irregular heart rate develop ankle oedema for which
he is given a new drug. 2 weeks later he develops complete heart block, nausea and
complains of seeing " yellow".
ONE of the following drug combination is most likely the cause for above complaints.
a- theophylline and erythromycin.
b- Propranolol with verapamil
c- Amiodarone with captopril
d- Digoxin with frusemide (lasixs)******************************
e- ACE inhibitor and atenolol.
92. A 52-year-old man presents to his physician after a community health screening test
reveals a fasting glucose of 170 mg/dL. Physical examination is remarkable for bronze
skin pigmentation, hepatomegaly, splenomegaly, and limitation of motion in the second
and third metacarpophalangeal joints of both hands. The man has no known history of
hemolytic anemia, and takes daily multivitamins without minerals.
Which ONE of the following pigments is most likely present in the
man's liver?
a- Bilirubin
b- Carotene
c- Ferritin ***************************
d- Lipofuscin
e- Melanin
93. A 45-year-old homeless man has a chronic cough, a cavitary lesion of the
lung, and is sputum positive for acid-fast bacilli. Which ONE of the following
is the principle form of defense by which the patient's body fights this
infection?
a- Antibody-mediated phagocytosis
b- Cell-mediated immunity******************
c- IgA-mediated hypersensitivity
d- IgE-mediated hypersensitivity
e- Neutrophil ingestion of bacteria
94. A 54-year-old male with acute lymphocytic leukemia develops a blast crisis. He is
treated with intensive systemic chemotherapy. Following treatment, the patient will be at
increased risk for the development of ONE of the following.
a- bile pigment gallstones
b- cholesterol gallstones
c- cystine kidney stones
d- struvite kidney stones
e- uric acid kidney stones *****************************
95. A 30-year-old pregnant woman complains to her physician of feeling very tired
during her pregnancy. A complete blood count with differential reveals a Hg 10 g/dl,
with hypersegmented neutrophils and large red cells. Deficiency of which ONE of the
following would be most likely to produce these findings?
a- Ascorbic acid
b- Calcium
c- Copper
d- Folate ****************************
e- Iron
96. A 26-year-old man presents to his physician with a chronic cough. The man is a
smoker, and states that he also gets frequent headaches and aches in his legs when he
exercises. Chest x-ray demonstrates notching of his ribs.
Which ONE of the following undiagnosed congenital defects may be
responsible for these findings?
a- Coarctation of the aorta ******************
b- Eisenmenger's syndrome
c- Tetralogy of Fallot
d- Transposition of great vessels
e- Ventricular septal defect
97. All the following statements regarding the uric acid are true Except.
a- two third of the body uric acid pool is dietary in origin. *****************
b- two third is from endogenous purine metabolism.
d-normal serum uric acid level dose not exclude acute gouty arthritis.
e- there are variation in normal values between male and female.
98. A 42-year-old female presents with a recent onset of fatigue, malaise, constipation,
and a 12-pound weight gain. On examination, her thyroid is firm and enlarged. What
ONE laboratory test is most likely to confirm the expected diagnosis?
a- Antithyroid antibodies
b- Serum thyroid-stimulating hormone (TSH) measurement *****************
c- Serum thyroxine (T4) measurement
d- Serum triiodothyronine (T3) measurement
e- T3 resin uptake
99. 5 mL of synovial fluid is aspirated from an inflamed knee joint. The fluid contains
Needle-shaped, strongly negatively birefringent crystals. These crystals most likely to
have ONE of the following compositions?
a- Basic calcium phosphate
b- Calcium oxalate
c- Calcium pyrophosphate dihydrate
d- Cholesterol
e- Monosodium urate ***************************
100. ONE of the following intravenous fluids is colloid.

a- 0.9% sodium chloride intravenous infusion
b- Ringer's solution
c- Ringer's lactate solution
d- Dextran 40 solution************************
e- 5% glucose intravenous infusion.
Part 4
1. 30 year old male has IDDM for the past 15 years , now presenting with lower limb edema .
Cr 2.0 mg/dl , urea 70 mg/dl . 24 hour urine collection 4.0 gm/24 hrs
All the following have a role in the progression of his renal disease except :
a) Degree of Mesangial expansion on kidney biopsy

b) Decrease in intraglomerular pressure
c) Duration since onset of DM
d) Amount of proteinurea
e) Quitting smoking
2. All the following are true about Focal Segmental Sclerosis ( FSGS) except :
a) Familial type has better prognosis
b) Progresses fast in Renal failure
c) Collapsing type is associated with HIV
d) Recurrence after transplant is high
e) Main presentation is Nephrotic syndrome
3. 25 year old female presented to OPD with Bp 160/100 , she stated that her Bp was the same over
the past 2 weeks .
All the following are first line investigations for this patient except :
a) Urine analysis
b) Serum K, Urea ,Cr
c) Lipid profile
d) Fasting blood sugar
e) MRA for renal arteries
4. 35 year old female previously healthy presented to ER c/o generalised weakness , Bp 110/80 .
Irregular irregular pulse
Labs : K 2.5 meq / L , Cl 100 meq /L , Na 135 meq /L
ABG : PH 7.48 , HCO3 30 meq/L , PCO2 40 mm Hg
All the following can be in the differential diagnosis of this case except :
a) Bulimia
b) Barter syndrome
c) Hypercalcemia
d) Primary Hyperaldosteronism
e) Diuretic abuse
5. 20 year old male came to OPD with c/o of passing red urine , which was preceded by URTI the
previous morning .
Upon exam Bp 170/95 otherwise Negative :
All the following can present in the above disease except :
a) More common in males

b) May run in families
c) Mesangial expansion by kidney biopsy
d) Symptoms may recur with future URTI
e) Low complement
6. 25 year old female was admitted to hospital with referred to OPD due to incidental finding of the
following labs & ABG :
PH 7.32 , HCO3 15
Cr 1.0 mg/dl , urea 35 meq/l , Na 135 meq /L , Cl 110 meq/l
All the following may cause the above except :
a) Acetazolamide treatment
b) Fanconi syndrome
c) Treatment with Thiazide
d) Primary hyper parathyroid
e) Diarrhea
7. 70 year old male presented to OPD with Bp 180/80 , he had similar readings over the last month
otherwise asymptomatic . The best management for this patient is :
a) Observation
b) Start on Enalapril 5 mg Q day
c) Start on Nifidipine 20 mg + Thiazide 25 mg
d) Start on Furosemide 40 mg Q day
e) Start on α Methyl Dopa 250 mg 1 x 3
8. 50 year old patient previously healthy presented with hemoptysis & hematurea
Labs : Cr 3.0 mg/dl , Urea 70 mg/dl , PO4 5 mg/dl , Ca 9.2 mg/dl . Hb 13 .Kidney biopsy showed 55 %
crescents with linear deposits on basement membrane by IF . The best management is :
a) Prednisone 20 mg Q day
b) Azathioprine 50 mg Q day + Cyclosporin 1mg/kg/day
c) Plasmapheresis + Methylprednisone IV + Cyclophosmide PO
d) Prednisone 30 mg Q day alternating with Chlorambucil
e) Tacrolimus 1 mg 1x2
9. 40 year old male know to have Nephrotic syndrome for 15 years , now presenting with Cr 8.0 mg/dl ,
Urea 100 mg/dl , All the following are indications to start this patient on dialysis except :
a) Peripheral Neuropathy
b) Anemia
c) Pericarditis
d) Low albumin
e) Bleeding tendency
10. All the following are true about Diabetic Nephropathy except :
a) More likely to occur if patient ha siblings with Nephropathy
b) More severe in black
c) Occurs within 5 years in I DDM
d) It needs 15 years to progress into ESRD after start of overt proteinurea
e) Mostly preceeded by Diabetic Retinopathy
11. 60 year old male known to have Diabetes for 10 years and is on Enalapril 10 mg 1x2 , presented to
ER because all his peripheral extremities became paralised , Labs K 8.0 meq /L , Cr 1.0 mg/dl. Which of the
following should be used first in the management of this patient :
a) NAHCO3 Iv
b) Ventolin nebuliser
c) Glucose + insulin Iv
d) K exalate ( Na polysterene Sulfonate )
e) Ca gluconate Iv
12. 25 year old male presented c/o of polyurea and weakness , Bp 110/70 , Labs : K 3.0 meq/l , PH 7.46
, HCO3 32 . All the following could be part of the dfferential of the above case except :
a) Barter Syndrome
b) Furosemide abuse
c) Hypercalcemia
d) Excessive Licorice ingestion
e) Gittleman syndrome
13. All the following are true for a Diabetic with ESRD except
a) Oral hypoglycaemic agents should be stopped
b) First year post transplant survival is the same as in the general population
c) More prone to hypotension during HD than other patients
d) They have higher Insulin requirements
e) PD is associated with increase in Triglycerides level
14. A 40 year old female known to have Membranous GN came to OPD with 24 hour protein 4 gm/24
hours , Cr 1.0 mg/dl , Urea 40 mg/dl . Her Bp 160/100 , she was started on Enalapril 20 mg 1x1 . The desirable
Bp reading in such a lady should be :
a) 140/90
b) 130/85
c) 120/75
d) 130/80
e) 135/85
15. 20 year old male has a LRD kidney transplant 2 years ago , he is not known to be Diabetic nor
Hypertensive . His medications are Tacrolimus 3 mg 1x2 , prednisone 5mg 1x2 , MMF 1 gm 1x2, Labs : FBS
400 mg/dl , Cr 1.0 mg/dl , Urea 35 mg/dl , Tacrolimus level 12 . The next step in managing his Diabetes other
than start him on treatment and re checking his sugar level is :
a) Stop Prednisone
b) Decrease MMF to 500 mg 1x2
c) Stop Tacrolimus
d) Stop MMF , and increase Tacrolimus
e) Decrease Tacrolimus to 2 mg 1x2
16. Each of the glomerular lesions listed below can cause Nephrotic syndrome . Which of them may be
found in all the following conditions : non – Hodgkins lymphoma , hepatitis B, hepatitis C , and infective
endocarditis ?
a) Focal and segmental glomerulosclerosis
b) Minimal change disease
c) Membranous nephropathy
d) Type I membranoproliferative glomerulonephritis ( with subendothelial deposits )
e) Type II membranoproliferative glomerulonephritis ( dense deposit disease )
17. 83 year old male who has DM , CHF,CRI is admitted to hospital with volume overload & Cr 4.0 mg/dl
( baseline 2.3 mg/dl ) . He was treated by Iv diuretics , post voiding residual was 250 ml after foleys catheter
was inserted . He was discharged 2 days later with Cr 3.0 mg/dl . One week lter he came to OPD , Cr is 3.5
mg/dl , ultrasound shows mild bilateral hydronephrosis . Which of the following would best predict the effect
of the patient bladder outlet problem on kidney function :
a) Serum PSA
b) Serum Cr after several days with foleys catheter
c) Kidney size on U/S
d) Retrograde urography
e) Renal Scan
18. 49 year old female is evaluated in ER after being found lying in the street in a semiconscious state ,
she is known to have hypertension and a history of seizures. Lab : BUN 79 mg/dl , Cr 8.7 mg/dl , Na 138
meq/l , K 4.2 meq/l , Cl 60 meq/l , HO3 54 meq/l . ABG PH 7.43 , PCO2 85 mmHg. Which of the following Acid
Base disorder is most compatible with these lab findings
a) Metabolic Acidosis and Metabolic Alkalosis
b) Metabolic Acidosis and Respiratory Acidosis
c) Metabolic Acidosis and Metabolic Alkalosis and Respiratory Acidosis
d) Metabolic Alkalosis and Respiratory Acidosis
e) Metabolic Acidosis
Part 5
1. Which one of the following arterial blood gas sets on room air is compatable with
completely compensated metabolic acidosis?
A B C D E
PH 7.44 7.38 7.60 7.36 7.56
PaC02 mmHg 26 25 25 95 40
Bicarb. mEq 18 15 24 49 34
B. Excess -4.0 -10 +4 +15 +11
The pH must be normal. Therefore, exclude “E” and “C”. The correction will be respiratory in the form of
“washed-out” CO2 need to be low. Therefore, exclude D. Bicarbonate will be low. The remaining options are A &
B.
2. Lung’s failure type respiratory failure is characterized by which one o the followings :
a. Normal chest X ray .
b. Hypocapnia or normocapnia .
c. Diffusion is the main mechanism of hypoxia .
d. Easy to correct hypoxia .
e. PEEP is contraindicated .
Answer: B (Lung’s type respiratory failure = type 1 respiratory failure).
Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange
functions: oxygenation and carbon dioxide elimination. In practice, it may be classified as either hypoxemic or
hypercapnic.
Hypoxemic respiratory failure (type I) is characterized by an arterial oxygen tension (Pa O2) lower than 60 mm
Hg with a normal or low arterial carbon dioxide tension (Pa CO2). This is the most common form of respiratory
failure, and it can be associated with virtually all acute diseases of the lung, which generally involve fluid filling
or collapse of alveolar units. Some examples of type I respiratory failure are cardiogenic or noncardiogenic
pulmonary edema, pneumonia, and pulmonary hemorrhage.
Hypercapnic respiratory failure (type II) is characterized by a PaCO2 higher than 50 mm Hg. Hypoxemia is
common in patients with hypercapnic respiratory failure who are breathing room air. The pH depends on the
level of bicarbonate, which, in turn, is dependent on the duration of hypercapnia. Common etiologies include
drug overdose, neuromuscular disease, chest wall abnormalities, and severe airway disorders (eg, asthma
and chronic obstructive pulmonary disease [COPD]).
Source: Medscape, http://emedicine.medscape.com/article/167981-overview

3. All of the followings can be caused by sarcoidosis EXCEPT :
a. Stridor .
b. Wheezes .
c. Heart block .
d. Facial nerve weakness
e. Hypercalcemia and Hypocalciuria .
Answer: A.
4. In patients with idiopathic pulmonary fibrosis (usual interstitial pneumonia) all of the
followings are expected patho physiological changes EXCEPT :
a. Low DLCO .
b. Decreased FEV1/FVC .
c. Severe O2 desaturation on exercise.
d. Reduced vital capacity and total lung capacity .
e. Increased pulmonary artery pressure
Answer: B (increased FEV1/FVC ratio).
5. All of the followings may improve obstructive sleep apnea EXCEPT:

a. Dental extraction .
b. Weight Reduction .
c. Decrease alcohol consumption .
d. Nasal CPAP
e. Tracheostomy
Answer: A
6. All of the following statement regarding lung cancer are true EXCEPT :
a. Small cell lung carcinoma metastasis late in the course of the disease
b. Adenocarcinoma usually is a peripheral lung tumor .
c. Adenocarcinoma in some cases is difficult to be differentiated from mesothelioma .
d. Thromboembolic disease can be the first manifestation of the disease.
e. Surgery can be curative for early diagnosed cases .
Answer: “A. Compared to non-small cell lung cancer, small cell lung cancer is just bad disease. The tumor grows
fast and metastasizes early. Small cell is more often associated with paraneoplastic syndromes (e.g., Eaton-
Lambert) and ectopic hormonal syndromes (e.g., SIADH).
7. All of the followings are useful for the assessment of the severity of an attack of
bronchial asthma, EXCEPT :
a. Spirometry .
b. Methacholine test
c. ABG (arterial blood gases)
d. Peak expiratory flow rate
e. Physical examination.
Answer: B. Methacholine tes: methacholine challenge test: a test that involves the inhalation of increasing
concentrations of methacholine, a potent bronchoconstrictor, in patients with possible bronchial hyperreactivity;
usually performed when a diagnosis of asthma or bronchospastic lung disease is not clinically obvious. Source:
Stedman’s.
8. Which one of the following pulmonary function values indicates airflow limitation
a. FEV1 of 60% of predicted .
b. FVC of 60% of predicted .
c. FEV1/FVC of 60% of predicted .
d. DLCO of 60% of predicted.
e. Residual volume of 60% of predicted.
Answer: C. FEV1/FVC of 60%. Total lung capacity (TLC) is used to assess interstitial lung disease. Expiratory flow
rate (FEV1/FVC is used to assess obstructinve lung disease. Airway obstruction is diagnosed when the FEV1/FVC
is <0.7 (70%0). (Source: MedStudy Pulmonology 2013, p. 6)
9. Wide alveolar-arterial Po2 (PA-a O2) gradient can be increased in all of the following
conditions EXCEPT:
a. Morphine overdose .
b. Severe pneumonia .
c. Acute Bronchial Asthma .
d. Acute Pulmonary edema .
e. ARDS (acute respiratory distress syndrome)
Answer: In morphine overdose ➔ Hypoventilation ➔ No washout of alveolar CO2 and replacement with new O2
➔ Both arterial and alveolar O2 are decreased. Therefore, the PAa O2 gradient is decreased.
10. Atopic bronchial asthma is characterized by all of the followings EXCEPT:

a. Positive family history .
b. Positive immediate reaction to skin prik test to allergens.
c. Elevated IgE level .
d. Affects patients after age of 40.
e. Elevated serum eosinophils count.
Answer: D. Onset of asthma early in life.
11. The main mechanism of dyspnea is

a. Hypercapnia.
b. Alkalosis.
c. Increased work of breathing.
d. Increased deoxygenated hemoglobin.
e. Hypoxia .
Answer: A? Hypercapnia ➔ metabolic acidosis?. For hypoxia and deoxygenated hemoglobin, it is true that they
cause dyspnea. But in metabolic acidosis, for example, there is no hypoxia. Nonetheless, there is “dyspnea”.
12. All of the followings are true combination between a risk factor and pathogens causing
pneumonia EXCEPT :
a. Alcoholism and klebsella pneumonia
b. Old age and mycoplasma pneumonia
c. Cigarette smoking and H .infleunza
d. Mechanical ventilation and pseudomonal pneumonia.
e. Abnormal level of consciousness and anaerobic bacteria
Answer: B (Mycoplasma ➔ Young, otherwise healthy patients).

13. This is atypical part of 8 hours polysomnography for a 45 year old male patient
What is the diagnosis of this patient?

a. Narcolepsy.
b. Central apnea
c. Obstructive sleep apnea.
d. Mixed apnea .
e. Hypopnea
Answer: I don’t know and I don’t want to know! Most probably, this is not required from us! Medscape article
about polysmnography: http://emedicine.medscape.com/article/1188764-overview#showall
Part 6
1. All of the following statements regarding acute lower limb ischemia are true
except:
A) Acute lower limb ischemia of thrombotic origin generally has a long history of
intermittent claudication
B) In cases of thrombosis, the embolic source of acute lower limb ischemia is
generally present
C) Treatement of acute lower limb ischemia of embolic origin is embolectomy and
anticoagulation
D) Arteries in acute lower limb ischemia of embolic origin are soft to tender
E) In acute lower limb ischemia of embolic origin , contralateral pulses are
generally present
2. All of the following regarding mediastinal masses are true except:

A) The most common anterior mediastinal mass is a thymic derivative
B) The most common posterior mediastinal mass is a neurogenic tumor
C) The most common middle mediastinal mass is a bronchogenic cyst
D) The majority of mediastinal masses are present in the pediatric population.
E) Most mediastinal masses are benign
3) All of the following regarding thymoma are true except:

A) It is the most common neoplasm of the anterosuperior mediastinum
B) It is the second most common mediastinal mass
C) patient with thymoma are usually symptomatic at presentation
D)Mysathenia is the most common symptom associated with thymoma
E)Thymoma is frequent in the first two decades of life.
4) All of the following regarding mediastinal masses(MM) are true except:

A) Patient swith MM are generally symptom- free
B) The most common clinical feature of MM is fever.
C) Asymptomatic MM are generally regarded as benign
D) Children with MM are more symptomatic than adults
E) MM of the anterior mediastinal are most likely to cause symptoms
5) The most common clinical manifestation of patients with hemodynamically

significant aortoiliac occlusive disease is:
A) Claudication.
B) Sexual dysfunction
C) Absent femoral pulses
D) Limb threatening ischemia
E) Intestinal ischemia
6) Screening for Abdominal aortic aneurysm is usually done by:

A) Computed tomography
B) Angiography
C) Ultrasonography.
D)Magnetic resonance imaging
E) Serial abdominal X-ray
7) Which of the following is regarded as the most important sign for evaluating the
degree of lower limb ischemia?
A) Pulseless
B) Pallor
C) Paralysis.
D) Severe pain
E) Poikilthermia (coldness)
8) Popliteal artery aneurysm is:
A) The rarest peripheral arterial aneurysm
B) Rarely bilateral
C) Occurring predominantly in males.
D) Generally diagnosed before the stage of complications
E) Treated once it is diagnosed
9) Which of the following is notregarded as risk factor for development of
peripheral arterial atherosclerosis?
A)Female sex.
B) Advanced age
C) Hypertension
D)Tobacco use
E)Diabetes mellitus
10) Which of the following is the most frequently reported immediate complication
of subclavian vein catheterization?
A)Pneumothorax.
B)Hemothorax
C) Air embolism
D) Vessel laceration
E)Atrial Fibrillation
11) Which of the following regarding congenital anterior chest wall deformity is
true?
A) Pectus carinatum is the most common type
B) Its etiology is well established
C) A familial tendency is rare
D) Cardiopulmonary derangement constitutes its main operative indication
E) Its repair is recommended around the preschool age.
12) All of the following are accepted treatment options for empyema except:
A) Thoracocentesis
B) Closed tube thoracostomy
C) Thoracotomy + decortication
D) Thoracotomy +lung resction.
E) Open drainage + rib resection
13) Which of the following is the most common clinical manifeatation of major
pulmonary embolism?
A) Tachypnea.
B) Tachycardia
C) Pleural pain
D) Cough
E) Rales
14) A 65-year diabetic and hypertensive patient is complaining of symptomatic
aorto-iliac occlusive disease. Which of the following therapeutic modality is not
applicable on him?
A) Aortofemoral bypass
B) Aortoiliac endarterectomy
C) Extra anatomic by pass
D) Angioplasty/stenting
E) Lumbar sympathectomy.
15) All of the following regarding varicose veins(VV) are true except:
A) Varicose veins are the most common vascular disorders affecting the human
being
B) Leg paraesthesia is the most common late post operative complication.
C) The majority of patients with varicose veins are treated conservartively
D) Large thigh VV should be treated surgically
E) Varicose veins with l sapheno-femoral incompetence should be treated with
sclerotherapy.
16) All of the following are accepted surgical indication for patients with lung
abscess except;
A) Failed medical treatment
B) Serious hemorrhage
C) Suspicion of cancer
D) Unsuccessful drainage
E) An abscess of 3 cm diameter.
18) The total lung capacity is:

A) 2 liters
B) 3 liters
C) 4 liters
D) 5 liters
E) 6 liters.
19) All of the following regarding pneumothorax are true except:

A) Expiratory chest radiograph is not necessary for the routine diagnosis of
pneumothorax
B) A patient with normal PA radiograph,alateral chest or lateral decubitus
radiograph should be performed if clinical suspicion of pneumothorax is high
C) CT scanning is not recommended when differentiating a pneumothorax from
complex bullous lung disease.
D) The clinical history is not a reliable indicator of pneumothorax
E) On a plain chest radiograph, a surgical emphysema may obscure simple
pneumothorax
19) All of the following regarding intercostals tube drainage for pneumothorax are
true except:
A) It is done in cases of unsuccessful simple aspiration or catheter aspiration drainage
B) It is especially recommended in secondary spontaneous pneumthorax
C) A non-bubbling chest tube should not usually be clamped
D) Bubbling chest tube should never be clamped
e) A patient with a non-bubbling and clamped chest tube for pneumothorax can leave the
ward environment.
20) All of the following regarding chest drain suction are true except:
A) Suction to an intercostal tube should not be applied directly after tube insertion
B) Suction to an intercostal tube is recommended in cases of lung failure to re-
expand
C) When applying suction,high volume, low pressure (-10 to –20 cm H2O) suction
systems are recommended
D) Suction to an intercostal tube should can be applied in cases of persistent air leak
E) Patients requiring suction can be managed on outpatient basis.
21) All of the following regarding spontaneous pneumothorax are absolute

indications for operative interventions except:
A) Second ipsilateral pneumothorax
B) First contra lateral pneumothorax
C) Bilateral pneumohoraces
D) First ipsilateral ofpneumothorax in individuals living in remote area.
E) Persistent air leak (>7days)
22) Which of the following is the least cause of iatrogenic pneumothorax?

A) Transthoracic needle aspiration
B) Subclavian vessel puncture
C) Thoracocentesis
D) Pleural biopsy
E) Intercostal nerve block.
23) All of the following are causes of exudative pleural effusion except:
A) Malignancy
B) Trauma
C) Collagen vascular disease
D) Infection
E) Congestive heart failure.
37) The essential factor in the pathogenesis of aortic aneurysm is damage:

A) To the intimal layer
B) To the medial layer.
C) To the adventitial layer
D) To all layers
E) Due to atherosclerosis
Part7
1 ) 35 year old man presented to ER after an episode of Grand mal seizure and by exam he was afebrile , Bp
130/95 and confused .
Labs showed : Cr 1.0 mg/dl , BUN 12mg/dl , Na 140 meq/L , K 4.8 meq /L , Cl 100 meq/L , HCO3 12 meq/L .
ABG : PH 7.25 , PCO2 28 mmHg , HCO3 12 meq/L .
Which of the following is the most appropriate initial treatment for the Metabolic Acidosis :
Observation and repeat ABG in 2 hours
NaHCO3 2 ampoules ( 100 meq ) by Iv push
1 L of 5 % dextrose in H2O & HCO3 3 ampoules ( 150 meq ) infused over 3 hours
Hemodialysis
Fomepizole
2 ) All the following affect short term survival in kidney transplant except :
Delayed Allograft function
HLA antibodies
Acute rejection
Type of Donor kidney
Donor illness
3 ) 25 year old man was found to have microscopic hematuria by chance . Urine analysis showed many RBC
/HPF, no RBC casts , no Dysmorphic RBC
IVP showed Medullary Spomge Kidney , but no stones
The most appropriate counseling for this patient includes which of the following :
Advice him that this disorder is likely to progress to CRF over 10-20 years
Advice him that this is a benign finding , there may be a risk for nephrolithiasis but it never progresses to
Renal failure
Advice him to have his children undergo genetic testing and get treatment early
Advice him that ACE inhibitor can modify course of disease
Advice him that he should be on daily Trimethoprim –Sulfa forever
4 ) All the following are mechanism – drug induced Hyperkalemia except :
Trimethoprim inhibits Na channels
Cyclosporin and Cl shunting
Heparin decreases Aldosterone level
Digoxin inhibits K-ATP ase
NSAID blocks PG stimulated Renin secretion
5 ) 35 year old female is evaluated because of an elevated Bp 160/105 for the past 2-3 months . Her mother
has hypertension and kidney disease , and a maternal aunt is now on hemodialysis
Labs : Cr 0.8 mg/dl , Na 140 meq/ L , K 5.0 meq /L , Cl 102 meq / L , HCO3 25 MEQ / l , Urine Analysis is
negative .Which of the following is most likely to provide information regarding cause of her hypertension .
Captopril Renal Scan
24 hour urine for Vanillyl Mandellic Acid
Renal U/S
Plasma Renin activity & aldosterone level
Plasma PTH
6 ) All the following are Renal changes expected in normal pregnancy except :
Dilation of pelvicaliceal system
Serum HCO3 is 4-5 mmol/L higher than normal
GFR increase by 35-50 %
Serum osmolality decreases by 10 mosmol/L
Renal length increases by 1 cm on U/S
7 ) 50 year old man has history of recurrent kidney stones which were Ca containing stones .
All of the following are risk factors for formation of these stones except :
Hypercalciuria
Hyperoxaluria
Low urine volume
Hypercitrauria
Hyperuricosuria
8 ) All the following can be clinical & lab manifestations of hpokalemia except :
Nephrogenic DI
Tubular vacuolization
Rhabdomyolysis
Decreased Amoniagenesis
Tetany
9 ) According to National kidney foundation guidelines . All the following are acceptable target PTH levels in
CRF as per stage except :
Stage I , PTH 10-65 pg /ml
Stage II 25-50 pg/ml
Stage III 35 -70 pg/ml
Stage IV 70-110 pg/ml
Stage V 150-300 pg/ml
10 ) All the following diuretic site of action combinations are true except :
Indapamide is a Na channel blocker in CD
Ethacrynic acid blocks NaK2CL in TALH
Acetazolamide inhibits CA in PT
Spironolactone inhibit Aldosterone in Principal cell
Mannitol act on both PT & TALH

1. Upper GI bleeding secondary to Dieulafoy is characterized by all of the following
except:
A. Presents as massive and recurrent bleeding

B. Extramural artery present in the Submucosa.
C. Most commonly in the gastric fundus
D. Easily diagnosed and treated by endoscopy
E. High mortality
2. One of the following causes of portal hypertension is caused by Presinusoidal

intrahepatic pathology:
A. Veno-occlusive disease
B. Schistosomiasis
C. Viral hepatitis
D. Alcohol Hepatitis
E. Congestive heart failure
3. All of the following are subclinical presentations of Celiac disease except:
A. Mood changes
B. Iron deficiency
C. B12 deficiency
D. Unexplained elevation of liver enzymes
E. Recurrent abdominal pain
4. All of the following factors are associated with rapid progression of chronic
hepatitis C to cirrhosis except:
A. Acquiring the infection at older age

B. Female sex
C. Alcohol use
D. HIV Co-infection
E. HBV Co-infection
5. The most common complication after Endoscopic retrograde

cholangiopancreatograghy (ERCP) is:
A. Perforation
B. Pancreatitis
C. Cholangitis
D. Bleeding
E. Sepsis
6. All of the following regarding Vibrio Cholera except:

A. Most vibrio cholera infections are Asymptomatic.
B. Antibiotic therapy is effective in decreasing mortality.
C. Transmission by Contaminated Water and Food and very rarely by person-to-person
transmission.
D. Requires large inoculum to get the infection
E. “Rice water” diarrhea is characteristic feature.
7. All of the following are risk factors for Squamous cell carcinoma of the
esophagus except:
A. Zinc Deficiency
B. Low serum Selenium
C. Infection with Human Papilloma virus
D. Chronic Gastroesophageal reflux disease
E. Alcoholism
8. All of the following are accepted initial management strategies in patients with
upper GI bleeding except:
A. Somatostatin
B. Bleeding scan
C. Esophagogastrodeudeoscopy EGD
D. Acid suppressive medication
E. Gastric Lavage
9. Wilson's disease should be considered in all of the following medical scenarios

except:
A. Abnormal liver enzymes and non-immune hemolytic anemia

B. Exaggerated high bilirubin level and depressed serum alkaline phosphatase
C. Decrease serum ceruloplasmin
D. Elderly patients with neuropsychiatric problem
E. Fulminant liver failure with low uric acid
10. All of the following medications are being used for Non Alcohol steatohepatitis
NASH except:
A. Betaine
B. Ursodeoxycholic acid
C. Ribavirin
D. Vitamin E
E. Beta- Carotene
11. In treatment of patients with Spontanous Bacterial peritonitis, all of the following
are true except:
A. Initiate therapy when ascitic fluid Neutophils > 250/mm2
B. Majority sterile at presentation (culture negative)
C. Gentamycin is the drug of choice
D. Treat for at least 5 days
E. 30% of patients are Asymptomatic at presentation and during follow up
12. In regard to hepatitis C and pregnancy, all of the following is true except:
A. The rate of transmission from mother to baby during delivery is around 6%.
B. Transmission is higher in vaginal delivery comparing to cesserian.
C. Higher rate of transmission is seen if the mother is co-infected with HIV
D. Severe hepatitis is rare in infected infants
Breast-feeding is safe
13. All of the following medications are being used in chronic hepatitis B except:
A. Lamivudine
B. Ribavirin
C. Pegylated interferon
D. Adefovir Dipivoxil
E. Entecavir
14. All of the following micro organisms can cause infectious diarrhea with positive
fecal leucocytes except:
A. Shigella
B. Yersinia
C. Giardia
D. Campylobacter
E. Salmonella
15. All of the following are protective from colo-rectal cancer except:
A. Aspirin
B. Folic Acid
C. Fiber Diet
D. Calcium
E. Moderate use of Alcohol
Part 8
Q1. Esophageal lower esophageal sphincter contraction is caused by?

a) protein
b) fat
c) peppermint
d) alcohol
Q2. How much bile is produced by the liver each day?

a) 100-300 ml
b) 300-500 ml
c) 500-1000ml
d) 500-1200 ml
Q3. Which of the following is not a criteria for diagnosing Sphincter of Oddi
Dysfunction
a) CBD diameter more than 12 mm on USG
b) Decrease in CBD pressure after infusion of Cholecystokinin
c) Ampullary pressure more than 40 mm Hg
d) Delayed emptying of contrast from CBD after ERCP
Q4. Most important investigation for Dysphagia in 60 year old is

a) Upper GI Endoscopy
b) CT Thorax
c) Barium Swallow d) MRI
Q5. Maximum potassium concentration is seen in

a) Saliva
b) Gastric Secretion
c) Jejunum
d) Colon
Q6. In Bismuth Strasberg Classification cystic duct stump blow out is

A) Type A
B) Type B
C) Type C
D) Type D
Q7) All segments of liver drain into Right Hepatic Duct except?
A) I
B) III
C) V
D) Viii
Q8) Right Posterior segment duct drains into

a) VI VII
b) V Viii
c) III
d) IV
Q9) Double bubble sign is seen in

a) Pyloric stenosis
b) Esophageal atresia
c) Duodenal Atresia
d) Ileal atresia
Q10) In liver transplantation false is

A. HLA-I is present on endothelium
B. HlA-II present on biliary epithelium
C) chronic rejection syndrome is same as vanishing bile duct syndrome
D).None
Q11. Most common site of carcinoma colo-rectum is

a) Hepatic Flexure
b) Sigmoid colon
c) Anal canal
d) Rectum
Q12. All are premalignant for carcinoma esophagus except

a) Diverticulum
b) Caustic burn
c) Mediastinal fibrosis
d) Human papillloma virus
Q13. Lipoma which undergo malignant degeneration is

a) Retroperitoneal
b) Subserosal
c) subfascial
d) Submucosal
Q14. Most important prognostic factor for carcinoma esophagus is

a) cellular differentiation
b) Depth of esophagus involvement
c) length of esophagus involvement
d) age of the patient
Q15 Contraindication to anterior resection of rectum is

a) Age more than 60
b) poorly differentiated carcinoma
c) Sigmoid lymph nodes
d) single hepatic metastasis
Q 16 Budd chiari Syndrome Most common cause is?

a) Hepatic vein thrombosis due to haematological disorder
b) Membranous IVC Obstruction
c) Congestive Heart failure
d) Veno occlusive Disease
Q17. In Transhiatal Vs Trans thoracic esophagectomy most common complication

associated
with THE is
a) Pulmonary
b) Anastomotic leak
c) Bleeding
d) Injury to recurrent laryngeal nerve
Q18 ) Dye used for early diagnosis of carcinoma while doing endoscopy
a) toluidine blue
b) Methylene Blue
c) Gentian Violet
d) Haematin and Eosin
Q19) Most Severe metabolic demand is seen in

a) 50 % burns
b) Peritonitis
c) Multi organ failure
d) Trauma
Q20. What is the most common complication after esophagectomy

a) Arrythmia
b) Pulmonary Collapse and Consolidation
c) Recurrent laryngeal nerve injury
d) Massive bleeding
Q21 After liver resection earliest proliferation is of which kinds of liver cells occurs?
a) Parenchymal
b) Ductal
c) Canalicular
d) Non parenchymal
Q22. In Hepatocellular carcinoma true is

a) Arterial bruit is seen in 80% cases
b) 2/3rd of patients present with signs of liver disease
c) 5% of patients present with haemoperitoneum
d) none
Q23.Most valuable investigation for preoperative evaluation of extensive corrosive

stricture is
a) Endoscopic ultrasound
b) Barium study
c) CT Thorax
d) Pharyngoscopy
Q24 Tumor Marker for Hepatocellular carcinoma is?
a) alpha feto protein
b) carbohydrate antigen
c)alpha fucosidase
d)HCG
Q25) In high risk population HCC (Hepatocelluar carcinoma ) is best detected by

a) USG
b)CT
c)MRI
d)x-ray
Q26 Which of the following is not true about TME (Total Mesorectal Excision)
a) It improves survival
b) It decreases local recurrence
c) It is associated with with increased blood losss
d) Associated with higher anastomotic leakage as compared to Low Anterior Resection
e) Associated with pelvic sepsis
Q27. About Crohn's disease of colon false is

a) Midline incision is used for surgery
b) Perianal disease in 20% cases present with SI diseases
c) Ileocaecal type is the most common
d) Bypass is preferred over resection
Q28 False about Crohn's disease

a) Perianal presentation can be there
b) Predominant Rectal involvement
c) Deep fissures and fistula is common
d) Transmural involvement occurs
Q29 In Ulcerative Colitis false is

a) Malignancy related to duration of disease not extent
b) Malignancy more common on Right side
c) Cancer is more infiltrative and with poor prognosis
d) 30% malignancies associated with Dysplasia
Q30) In carcinoid tumor of small bowel false is

a) Transmural location
b) 65% arise in ileum and appendix
c) Rectum is rare site
d) Localised disease has 75% 5 year survival
e) Symptoms are due to 5HT
Q31 What is not true regarding Siguira's procedure for Portal Hypertension
a) Transesophageal variceal ligation
b) Splenectomy
c) Vagotomy
d) Pyloroplasty
Q32. True about Hydatid cyst of liver is

a) E. multilocularis is more common than E.Granulosus
b) Extrahepatic 15% in lungs 2% in brain
c) Adult worm infests herbivores
d) Indirect Heamagglutination (IHA) is the most specific serological test
Q33. Peritoneo-Venous shunt is contraindicated in

a) Uncorrectable coagulopathy
b) Spontaneous bacterial peritonitis
c) Hepatic encephalopathy
d) All
Q34. False about cholecystectomy

a) Open cholecystectomy CBD injury rate is 0.1-0.2%
b) In Lap Cholecystectomy complication of CBD injury is double that of open
c) Abnormal GB, CBD, Cystic artery in 1/3 cases
d) Open cholecystectomy is the treatment of choice for cholelithiasis
Q35. Write True or false for the following statements for Extra Hepatic Biliary atresia
a)More in premature babies
b)Jaundice occurs after 1wk
c) surgery should be done after 1year
d) Most common operation is Kasai operation
e) Most common indication for liver transplant in children
f) only intrahepatic tree is involved
Q36. Which is not a type of anal margin tumors

a) Basal cell carcinoma
b) Epidermoid carcinoma
c) Paget's disease
d) Bowen's disease
Q37. False about the pelvic floor is

a) Anorectal ring is formed by Puborectalis and ext sphincter
b) Anorectal ring is 3cm above anal verge.
c) Pelvic Floor is supplied by S2,3,4
d) All are true
Q38 True about radiation proctitis is

a) Sucralfate enema is very effective.
b) Laser Abalation is efective in every case.
c) Local Metronidazole is effective
d) Resection and Anastomoses give best results.
Q39. Recurrence after resection for Ca rectum is related to all except

a) Tumor Grade
b) No. of lymph nodes
c) Lateral Margin Involvement
d) Inexperienced surgeon
e) None of the above
Q40. Contraindication for resection of locally recurent rectal cancer are all except
a) Extrapelvic disease
b)Sciatic pain
c) Bilateral ureteric obstruction
d) S1 or S2 nerve inolvement
e) Circumferential or extensive pelvic side wall involvement
f) None
Q41. False about carcinoma pancreas is
a) Smoking is a risk factor

b) CA19-9 is a good tumor marker
c) Laparoscopy is required for staging
d) Pylorus Preserving Pancreoduodenectomy should not be done.
Q42. In cirrhosis mechanism of portal hypertension is all

except
a) fibrosis
b) Regenerating nodules compress portal vein
c) single blood supply of regenerating liver nodule
d) Dual blood supply of regenerating liver nodule
Q43. In liver laceration if there is uncontrolled bleeding after pringles's maneuver what
is the likely cause
a) arterial bleeding
b) capillary bleed
c) hepatic vein bleed
d) portal vein bleed
Q44. A 3cm non bleeding liver laceration, what is the optimal intraoperative
management
a) suture the laceration
b) Mesh closure of the laceration
c) Peritoneal Toileting and close abdomen
d) Use a binding glue
Q45. Vein of segment I of liver drains into

a) IVC
b) Right Portal vein
c) Left Portal vein
d) Main portal vein
Q46. Mesothelioma of peritoneum is associated with exposure of which of the

following
a) Beryllium
b) Asbestos
c) Zinc
d) Nickel
Q 47. The most common symptom of peritoneal mesothelioma is

a) Abdominal pain
b) Anorexia
c) Nausea
d) weight loss
Q48. Drug of choice in chemotherapy of mesothelioma is

a) Mitomycin
b) 5FU
c) cisplatin
Q 49. Colonic polyps are seen to regress with

a) Azathioprine
b) streptozocin
c) Sulindac
Q 50) True about Caudate lobe Segment

a) Caudate lobe is segment IV
b) Caudate lobe has three parts
c) Caudate lobe duct mainly drains into Right lobe duct
d) Does not Hypertrophy in Budd Chiari syndrome
Q51). Ulcerative Colitis with malignancy

a) has a better prognosis than Ca Colon
b) Is related to disease activity
c) is related to duration of ulcerative colitis
d) Malignancy is more in ano rectal ulcerative colitis
Q52) In ulcerative coilitis with toxic megacolon lowest recurrence is seen in

a) complete proctocolectomy and brook's ileostomy
b) Ileo rectal anastomose
c) koch's pouch
d) Ileo anal pull through procedure
Q53) All are premalignant except
a) Turcot syndrome
b) cowden syndrome
c) Juvenile polyposis coli
d) none
Q54) Colonic polyps are seen to regress with

a) Azathioprine
b) streptozocin
c) Sulindac
Q55) All are precancerous for carcinoma colon except

a. crohn's disease
b. Bile acids
c. Fats
d. carotene
Q56. which of the following statements regarding arterial blood supply of the colon is
incorrect
a) Marginal artery of Drummond is a collateral vessel that connects SMA with IMA
b)Arc of Riolon or meandering mesenteric artery connects proximal SMA with proximal
IMA
c) Right colic artery is the most constant branch of Ileo colic artery
d) Splenic flexure is the area of watershed
Q57. which of the following about blood supply to the liver is incorrect
a)Portal vein provides 75% of total blood flow
b)Hepatic artery provides 75% of total blood flow
c)Portal flow provides 50-70% of total oxygen deman
d)Increase in Hepatic artery flow is autoregulated and increase
in hepatic artery flow decreases portal blood flow
Q58. which of the following regarding bile formation is false

a)Osmolality of bile is mainly by organic solutes
b)Major organic solutes are Bile acids, Bile pigments, cholesterol and phospholipids
c)Approximately 1500 ml bile is secreted per day
d)Bile flow has a linear relation with bile acid secretion
Q59) Which of the following statements regarding the quantitative tests is false
a)Aminopyrine breath test based on clearance by hepatic p450 depends on functional
hepatic mass
b)Aminopyrine breath test is mainly used for prognosis in chronic liver disease but its
not useful for subclinical hepatic dysfunction.
c)Lidocaine and MEGX have some value in transplant population
d)Indocyanine green has a role in predicting prognosis in cirrhosis patients undergoing
resection
e)None of the above
Q60. Most common site for cholangiocarcinoma is

a) Intrahepatic
b) Hepatic duct bifurcation
c) Lower End of CBD (Common Bile Duct)
d) Lower 1/3rd of CBD
Part 9
1. A 4-month-old infant is noted to have a grade 4 holosystolic murmur that is harsh over
the left parasternal border. Results of both the chest radiograph and ECG are normal, and
the child is otherwise asymptomatic. The most likely cause of this murmur is
A. large VSD with 3:1 shunt

B. an ASD secundum defect
C. a small VSD
D. pulmonic stenosis
E. pink tetralogy of Fallot
2. The initial treatment of choice for a symptomatic patient with isolated pulmonic
stenosis is
A. closed surgical blade valvotomy
B. open surgical valvotomy
C. balloon catheter valvuloplasty
D. Blalock-Taussig shunt
E. valve replacement
For the following question one or more of the answers is correct , select :
A. if only 1,2,3 are corret.
B. if if only 1,3 are corret
C. only 2,4 are corret
D. if only 4 is corret
E. all are correct
3. Factors that are thought contribute to maintaining the patency of the ductus arteriousis
are
1.increased pulmonary vesicular resistance secondary to hypoxia.
2. high arterial oxygen tension.
3. prostaglandin.
4. acetylcholine
4. All of the followinq are acyanotic child may have increased pulmonary marking on x-
ray ,except:
A. ASD
B. VSD
C. PDA
D. Endocardial cushing defect
E. Pulmonary stenosis.
5. all are mechanisms of increase risk of infections in minimal lesion nephrotic syndrome
, except:
a.Loss of immunoglobulin
b.Loss of Properdin factor B
c.Decreased perfusion of the spleen
d.Loss of opsonizination factors
e.leukopenia
6. Pneumocystis carinii pneumonia is caused by:

a. protozoa
b. rickettsia
c. virus
d. bacteria
e. none of the above
7. Long term outcome in healthy children who survive staphylococcal pneumonia is

usually:
a. recurrent spontaneous pneumothorax
b. chronic respiratory failure
c. chronic lung abscess and empyema
d. persistent pneumatoceles
e. complete resolution
8. Over a period of a day a 4 month old infant developed tachypnea, chest recession,
widespread wheezes, CXR showed hyperinflation. Which of the following is correct?
a. viral studies would show rhinovirus in 25% of cases
b. the baby has a chance of > 20% of becoming asthmatic later in life
c. steroids will decrease the mortality rate
d. you can assure the family that the critical period of his illness will not last >48hrs
e. adrenaline nebulizer is the state of art in the treatment
9. ITP, one is correct:

a. often follow a viral infection
b. typically has chronic course
c. is characteristically associated with moderate splenomegaly
d. requires splenoectomy in more than 20 % of cases
e. associated with decrease megakaryocytes on bone marrow exam
10. 11 month-old girl presents to your office with fever (39.c) for the last 2 days. 3 hrs
ago she started to to have vomiting and decrease oral intake, she looked tired and ill. Her
exam reveals no focus and moderate to severe dehydration. you suspect UTI
19. Her urine culture is positive at 24 hrs, the most likely organism , is:
a. klebsiella
b. E. coli
c. staph. Aureus
d. proteus
e. enterococcus
11. After treating her infection, what investigation(s) needed?
a. no test are needed
b. renal U /S
c. VCUG
d. DTPA
e. renal U /S & VCUG
12. an 4-year old boy presented with his mother with abnormal posturing of the hands,
the mother stated that his hands turned into a claw shape, first time noticed by his teacher
in the day care center for mental retarded kids. This is his photo you were surprised by
his funny looking and laughing.
In your cardiac exam, you heard a systolic murmur, you conclude that he has at most:
a. VSD
b. subvalvular aortic stenosis
c. supravalvular aortic stenosis
d. ASD
e. critical pulmonary stenosis with right sided aortic arch
Cardiology
Part 1 (top secret)
1.One of the following is the principle symptoms of heart desease :
a- chest pain with deap inspiration
b- nerveousness
c- chest pain on movement ?xxx
d- edema of the lower limbs
e- pain in the right arms
2.The following diseases cause cardiac pain except :

a-Angina
b-MI
c-Percarditic pain
d-Aortic pain
e-Pectus excavatum xxx
3.The best description of

Angina is:
a- pain in both hands
b- pain in the back of the chest
c- interscapular pain
d- retrosternal heaviness xxx
e- Sharp pain comes on movement or breathing
4.In Paroxysmal nocturnal dyspnoea one is true :

a-dyspnoea on exersion
b-comes early at night xxx
c-the patient is despenic at rest
d- cough and frothy sputum is not present e-chest pain is a major symptom
5. In Palpitation all the following are true except :
a- Is the sensation of the heart beating
b- awareness of occasional irregularities
c- missed beats
d- cyanosis may be present xxx
6.Which one of the following is not a cause of sinus tacchardia:

a-Anemia
b-Raised intracranial pressure ####
c-Thyrotoxicosis
d- Phaeochromocytoma
e- Nebulized salbutamol
7.Sytlolic murmur one of the following is true:

a-Murmur occures between S1 and S2 xxx
8.Diastolic Murmur are all true except:

c-In aortic stenosis the murmur is mid diastolic xxx
e-In atrial fibrillation and mitral stenosis the accentuation of presystolic murmur is
maintained
9.All the following are occupational aspect of CV disease except :

a- cold exposure xxx
b- deap sea diving
c- vibrating tools
d- bus driver
e- organic solvents
10.ECG signs of hyperkalemia may include all of the following except :

a) Peaked T wave
b) QRS widening
c) Delta wave ####
d) Prolonged P-R interval
e) Sine wave
11.The murmur of patent ductus arteriosus is one of the following :

a-Pansystolic murmur
b-Pandiastolic murmur
c-Systolic and diastolic xxx
d- mid diastolic with pre systolic accentuation .
a- Austin Flint murmur.
12 .In the majority of individuals the Av-node supplied by:

a Left main stem artery
b Left anterior descending artery
c Circumflex artery
d Right cornary artery ####
e Obtuse marginal artery
13 .Which one of the following is not a cause of sinus tachycardia:

a-Anemia
b-Raised intracranial pressure ####
c-Thyrotoxicosis
d-Phaeochromocytoma
e-Nebulized salbutamol
14.Aortic stenosis in adults is most commonly a result of which of the following?

a-Bicuspid aortic valve disease ####
b-Hypertension
c-Dilated cardiomyopathy
d-Cystic medial necrosis
e-Hyperlipidemia
15.All the following are the symptoms of CV disease except:

a-Chest pain
b-SOB
c-Palpitation
d-Syncopy
e-Cough and expectoration xxx
16.In ASD the second heart sound is best described by the following :
a- Splitted and fixed during respiration xxx
17.Which of the following is LEAST likely to cause hemoptysis?

a-Tuberculosis
b-Acute bronchitis
c-Pulmonary embolism
d-Bronchogenic carcinoma
e-Aortic stenosis ####
18.The leading cause of early death in patients with acute myocardial infarction is
a-Rupture of the myocardial wall
b-Rupture of the septum
c-Rupture of the cordae tendinea leading to acute mitral regurgitation
d-Ventricular arrhythmias ####
e-Ventricular aneurysm
19.The best description of Angina is:
a-pain in both hands
b-pain in the back of the chest
c-interscapular pain
d-retrosternal heaviness xxx
d-Sharp pain comes on movement or breathing
20.The most common cause of death in hypertensive patients is:

a-CVA
b-Renal failure
c-Congestive heart failure
d-Myocardial infarction ####
e-Dissecting aortic aneurysm
c- pulsus alternans
d- raised JVP xxx
e- pulmonary oedema

c- pulsus paradoxus
d- visible apex beat. xxx
e- reduced cardiac output
23.ONE of the following B-Blockers is cardioselective and lipid soluble.

a- atenalol
b- propranolol
c- metoprolol xxx
d- bisoprolol
e- carvidalol
24. In questioning the chest pain the best answer is:

a-Site of the chest pain
b-The character of the chest pain
c- The prespitating condition
d-Releaving Factors
e-All are true xxx
25.Clubbing of the fingers occurs in all the following except :

a-Cyanotic congenital heart disease
b- Bronchial carcinoma
c- intrathoracic suppuration
d- hyperlipedaemia xxx
e- hepatic cirrmhosis
26. Diastolic murmurs occurs in all the following except:

a-mitral stenosis.
b-aortic stenosis xxx
c-tricuspid stenosis
d-aortic regurgitation
e-pulmonary regurgitation.
27.Which of the following measures is least helpful in diagnosing a patient with

suspected pulmonary embolism?
a-Coagulation profile ####
b-Spiral CT of the chest
c-Echocardiogram (ECHO)
d-Electrocardiogram (ECG(
e-Arterial blood gases
28. What is an indication for IVC (Inferior vena cava) or venous filter:
a- +Inability to anticoagulate in a patient with upper extremity DVT due to a vein
catheterization xxx
b- Reccurent PE in a patient already on Warfarin with INR 1.5
c- Bleeding diathesis in a patient with femur fracture
d- A thrombus in the right ventricle
29.In conductive system of the heart muscle, all of the following are ture, except:
a-Conduction started in SA node. AV node, bundle of His, left and right bundle branch-
purkinjee fibers.
b-Left bundle branch is shorter than right bundle
c-Right bundle supplies right ventricle and left bundle supplied left ventricle and spetum
d-Action potential in the ventricle is rapid and generated by rapid transmembrane K
diffusion xxx
30.The following diseases cause cardiac pain except :

a-Angina
b-Myocardial infarct
c-Pericarditic pain
d-Aortic pain
d-Pectus excavatum xxx
31.You are examining a 63-year old man. You hear a blowing diastolic murmur at
the right upper sternal border. What is the probable diagnosis?
a-Mitral stenosis
b-Mitral regurgitation
c-Aortic stenosis
d-Aortic regurgitation ####
e-Tricuspid regurgitation
32.In the majority of individuals the Av-node supplied by:

a Left main stem artery
b Left anterior descending artery
c Circumflex artery
d Right cornary artery ####
e Obtuse marginal arter
33.All the following drugs reduce mortality in patient with congestive heart failure
except:
a Angiotensin receptor blockers
b ACE inhibitors
c B blocker
d Loop diuretic ####
e Spinono lactone
34.Venous thromboembolism prophylaxis with subcutaneous heparin should be

given to all of the following patients, EXCEPT :
A 60-year old woman undergoing total hip arthroplasty
A 45-year old man undergoing hemi-colectomy for colon cancer
A 35-year old man mechanically ventilated for severe pneumonia
A 70-year old man admitted with thrombotic stroke in the ICU
A 21-year woman who had normal vaginal delivery ####
35.Which of the following is LEAST likely to be a side effect of amiodarone?

a-Hyperthyroidism
b-Pulmonary fibrosis
c-Corneal deposits
d-Hypothyroidism
e-Gynecomastia ####
36.You are examining a 63-year old man. You hear a blowing diastolic murmur at
the right upper sternal border. What is the probable diagnosis?
a-Mitral stenosis
b-Mitral regurgitation
c-Aortic stenosis
d-Aortic regurgitation ####
e-Tricuspid regurgitation
37.all the following is true about heart failure except :-

a-patient should avoid high salt food
b-ACEI can be used in treatment
c-sever anemia can causes heart failure
d-right side heart failure causes pulmonary edema xxx
e-hyponatremia can occur
38.Which of the following drugs is most likely to cause prolonged QT interval :

a-Omeperazole
b- Digoxin
c-Clathramycine ####
d-Diazepam
e- Morphine
39.All of the following are risk factors for coronary artery disease EXCEPT:
a Morbid obesity
b Diabetes mellitus
c Elevated HDL ####
d Elevated LDL
e Elevated homocysteine
40.Which one of the following ECG changes is most typical of hyper kalemia:
a-Peaked P wave
b-Presence of U wave
c-Packed T wave ####
d-ST depression
e-Narrowed QRS complex
41.All of the following are recognized to precipitate heart failure EXCEPT

a-High dietary salt intake, such as mansaf
b-Pneumonia
c-Non-steroidal anti-inflammatory drugs (NSAIDs) use
d-Acute cardiac ischemia
e-Increased water intake ####
42.What is wrong about mitral stenosis :

a-Causes a pansystolic murmur xxx
b-Causes a mid-diastolic murmur
c-Most cases are secondary to rheumatic fever.
d-May lead to pulmonary congestion
43. a 50 year old was found to have a heart murmur. On examination his BP in the
right arm is 160/100 and in the right leg 120/80. CXR showed rib notching in the
upper ribs. What’s the likely Diagnosis?
a-Coarctation of the aorta xxx
b-Supravalvular aortic stenosis
44.Which of the following congenital heart diseases causes cyanosis?

a-TOF( Tetralogy of fallot) xxx
b-VSD( ventricular septal defect)
45.All these drugs increase the survival in heart failure except

a-Digoxin
b- loop diuretics xxx
c-ACE inhibitors
d-spironolactone
e-Beta blockers
46.What is the most common arrhythmia in Wolff-Parkinson-White syndrome?

a-atrial ectopics
b-Ventricular tachycardia
c-AV nodal re-entry tachycardia xxx
d-Ventricular fibrillation
47.Which of the following is associated with ST elevation on the ECG?

a-Right ventricular hypertrophy
b-Left ventricular hypertrophy
c-Digoxin effect
d-Subendocardial infarction
e-Early in repolarization after angina attack xxx
48.Which of the following is not a minor Duke’s criteria?

a-Fever
b-Osler nodules
c-Janeway lesions
d- New valve regurgitation xxx
e-Mycotic aneurysm
49.What is false about amiodarone?

a-can cause hypothyroidism
b-can cause hyperthyroidism
c-has a very long half-life
d-potentiates the effect of warfarin
e- Causes irreversible eye lesions xxx
50.Which of the following signs is associated with cardiac tamponade?

a-Pulsus alternans
b-Pulsus paradoxus xxx
c-Pulsus bisferins
d-Pulsus esh ma beddak
51.Which of the following is not a contraindication to stress test?

a-acute pericarditis
b-Unstable angina
c-Uncontrolled hypertension
d- Patient underwent PCI and had a stent xxx
e-Heart failure
part 2



e-In atrial fibrillation and mitral stenosis the accentuation of presystolic murmur is not
maintained
b- Coarctation of the aorta
d-Heart failure
e-COPD

A. Quinidine
B. Digitalis
D. Pronesty
E. Antithyroid drugs
6- Patients with aortic stenosis frequently develop:

A. Exertional dyspnea and angina
7-Edema, ascites , enlarged liver and venous pressure of 180mm. of saline suggest:
A. Laennec’s cirrhosis
B. Congestive failure
C. Interior vena caval obstruction
D. Acute glomerulonephritis
E. Cirrhosis of the liver
8- the causative organim in rheumatic fever is

A.staph aurus
B. B Haemolytic Streptococcus group A
D; E coli
E; virus
9-In pericarditis the chracterstic EKG changes ;
A:T wave invertion
Answer: E (saddle shaped ST segment)
10-IN idiopathic hypertrophic sub aortic stenosis (IHSS)

One is true
A; it is a type of dilated cardiomyophy
B; AN important cause of sudden death in athelets
C;Left ventricle is dilated
D; pulse examination is normal in character
E:need nitrate for treatment
Answer: b
11) One of the following is not a cause of pericarditis :

a) TB
b) SLE
c) Lymphoma
d) COPD
e) Uremia
12) In the management of DCM all are true except :

a) Salt and water restriction
b) ACE-inhibitors
c) Diuretics
d) Beta blockers
e) Complete bed rest
13) In hypertrophic CMP one statement is false :

a) Diagnosis is based on hypertrophied non-dilated left ventricle in the absence of
another disease.
b) Small LV cavity , asymmetrical septal hypertrophy ( ASH ) and systolic anterior motion
of the mitral valve leaflet ( SAM ) .
c)50% of cases of familial hypertrophic cardiomyopathy is autosomal dominant
d) Pathophysiologically associated with impaired systolic function.
e) Patients with HCMP usually die because of SCD
Answer: D ➔ Imparied diastolic function ➔ Imparied filling of the left ventricle!
14) Pathophysilogical abnormalities in heart failure include all of the following except :
a) Reduced myocyte shortening and wall motion
b) Sodium retention and circulatory congestion
c) Systemic vasodilation that increase impedence of the LV ejection
d) Structural remodelling and dilation of the LV
e) Renin-Angiotensin-Aldosterone activation
15) Signs of CHF include all of the following except :

b) S3
e) Bradycardia
16) Systems responsible for BP regulation include all of the following except :
a) Heart
b) Blood vessels
c) Kidney
d) Baroreceptors in aortic arch and carotid sinuses
e) Direct CNS control
17) Detrimental effects of HTN include all of the following except :
a) LVH and dyastolic dysfunction

b) Thromboembolic stroke just thromobotic or hemorrhagic
c) Sclerotic and markedly spastic retinal arteries
d) Aortic dissection
e) Acute renal failure
18) In renovascular hypertension the following statements are true except :

d) Treatment is usually by ACE-inhibitors if bilateral
19) Major manifestations of acute rheumatic fever include all of the following except :
a) Arthralgia )arthritis not arthralgia ..this is minor criteria (

b) Subcutaneous nodules
c) Cardites
d) Chorea
e) Erythema marginatum
20) In pulmonary hypertension the following statements are true except :

a) Primary pulmonary hypertension likely to begin with spasm of the muscle layer
of pulmonary arteries .
b) Secondary pulmonary hypertension most probably results from disease that
impedes flow of blood through lungs or that causes periods of low oxygen in blood .
c) In some people the bone marrow responds to hypoxemia by red blood cell
production ( polycythemia)
d) Signs and symptoms of right sided heart failure usually dominates the picture in
core pulmonale
e) Medical treatment of pulmonary hypertension is usually effective
B)Hyper extension of PIP and hyper flextion of DIP
E)Non of the above.
22)Which disorder is diagnosed by the presence of calcium pyrophosphate is synovial

fluid:
A)Chondro calcinosis
B)Gouty arthritis.
E)O.A

A)SLE.
D)Good pasture.
E)Currg-strass
except for :
A)Salazo pyrine.
C)Colchicine.
D)Methotrexate
E)leflenamide
A)Mouth ulcer's.
B)Arterial Anuyresm .
C)Hypopyron..
D)Pethergy test.
E)Acne-like lesion

A)Anti RNP.
B)Mouth ulcer's.
C)ANA.
D)Photosensitivity.
E)Leukopenia.

B)Genu valgua.
C)Elbow flextion.
D)Bouchard nodules
29)All of the following are indications for the treatment of Gouty arthritis except for:
B)Renal stones.
C)Renal failure.
E)All of the above.

E)Enthesitis.

B)SLE.
C)Scleroderma.
D)RA.
E)Hypothyroctism.

A)Psoriatic.
B)Behcet disease.
E)Chron disease.

A)RA.
D)Ostco arthritis.

E)All of the above.
1- All the following are occupational aspect of CV disease except :

a- cold exposure
b- deap sea diving
c- vibrating tools
d- bus driver
e- organic solvents
2- One of the following is the principle symptoms of heart desease :

b- nerveousness
c- chest pain on movement
3- The following diseases cause cardiac pain except :

a- Angina
b- Myocardial infarct
c- Pericarditic pain
d- Aortic pain
e- Pectus excavatum
4- The best description of Angina is:

a- pain in both hands
b- pain in the back of the chest
c- interscapular pain
d- retrosternal heaviness
e- Sharp pain comes on movement or breathing
5- In Paroxysmal nocturnal dyspnoea one is true :

b-comes early at night
d- cough and frothy sputum is not present
e-chest pain is a major symptom
6- In Palpitation all the following are true except :

a- Is the sensation of the heart beating
b- awareness of occasional irregularities
c- missed beats
d- cyanosis may be present
e- e- occur with excesive caffeine intake or coffee,tea .
7- Clubbing of the fingers occurs in all the following except :

d- hyperlipedaemia
8- On examining the radial pulses, all the following are essential except :
a- rate of the pulses
b- rhythm of the pulses weather is regular or irregular
c- the volume of the pulse
d- the character of the pulse
e- thrill of the pulse
9- Radio-femoral delay is present in one of the following condition :

c- Angina pectoris
d- Coarctation of the aorta
c - Renal artery stenosis
d- Heart failure
e- COPD
10- Estimation of jugular venous pressure is :

a- 9–12 cmH2O
b- 5– 7 cmH2O
c- 15 – 20 cmH2O
d- 0 – 5 cmH2O
e- 20 – 22 cmH2O
11-Dispalcement of apex beat occurs in all the following except:

a-pectus excavatum
b-large plural infusion
c-mitral senosis
d- tension pneumothorax
e- left ventricular hypertrophy.
12- fixed splitting of the second heart sound occurs in one of the following :
a-left bundle branch block
b- Atrial septal defect
c-hypertension
d-aortic stenosis.
e- left ventricular outflow obsruction
13- systolic murmurs occurs in all of the following except:

a-aortic stenosis.
b-pulmonary stenosis.
c-mitral stenosis.
d-mitral regurgitation.
e-aortic regurgitation.
14- In evaluation of a murmur all are true except:
a- timing either systolic or diastolic.
b-duration of the murmur.
c-radiation of the murmur.
d-location of the maximal intensity
e-presence or absence of a click.
15- Diastolic murmurs occurs in all the following except:

a-mitral stenosis.
b-aortic stenosis
16-The murmur of patent ductus arteriosus is one of the following except :

c-Systolic and diastolic
f- Austin Flint murmur.
17- Past history should include :

a- rheumatic fever.
b- diabeties
c- thyrotoxicosis.
d-glomerulonephritis.
e-all of the above.
18- The best description of the physiological cause of a heart murmur are except:
a-turbulant blood flow
b-increase blood flow through a normal valve.
c-increase blood flow through an abnormal valve.
d-occurs in preganancy and athletes
1-Zantholesma is yellowish skin occur in on of the following :
a-Rheumatic heart disease

b-Hyperthyrodism
c-Hyperlipedemia
d-Myocardial infarction
e-Scar after a trauma
2-Hot sweaty hands occur in all the following except:
a-Aortic regurgitation
b-Thyrotoxosis
c-Increase the number of sweat glands
d-Anxiety neurosis
e-Acromegaly
3-RT ventricular heave occur in one of the following:
a- LVEnlargement
b- RT Ventricular Enlargement
c- LA enlargement
d_RA enlargement
e- Aortic enlargement
4-In measuring the blood pressure one of the following is true:
a- The length of the bladder cuff should be double than the width
b- The bladder of the cuff should cover the Brachial artery
c- Systolic blood pressure should be messured only by palpatory method
d-Diastolic blood pressure is the point which the sounds becomes muffled
e-The patient should have an exercise before measuring the blood pressure
5-Heart sounds are generated by one of the following:-
a-Opening of the valve

b-closing of the valve
c-Partially opening of the valve
d-Partially closing of the valve
e-The valve is in the mid position
6- In questioning the chest pain the best answer is:

d-Releaving Factors
e-All are true
7-All the following are the symptoms of CV disease except:
a-Chest pain
b-SOB
c-Palpitation
d-Syncopy
e-Cough and expectoration

b- b-Splited and moves with respiration


maintained

a- aortic regurgitation
b- aortic stenosis
c- mitral stenosis
d- VSD
12 . A 30-year-old man admitted with right sided hemiplegia.Clinical examination

reveals loss of a wave in JVP with irregular irregular pulse. He has ONE of the following
cardiac rhythm abnormalities.
c- atrial flutter
ONE of the following is the mode of action for B-Blockers in controlling hypertension.
a- decrease cardiac out put.
b- Slow the heart rate
c- Increase cardiac force of contraction
d- Increase cardiac output
e- Decrease plasma volume

a- class 1 A
b- class 1 B
c- class 1 C
d- class III
e- class IV
mmHg.What is the ONE target blood pressure in the long term for this patient?
a- <160/90
b- <150/90
c- <145/90
d- <130/85
e- <120/70
c- pulsus alternans
d- raised JVP
e- pulmonary oedema

c- pulsus paradoxus

a- atenalol
b- propranolol
c- metoprolol
d- bisoprolol
e- carvidalol

WBC 3X10 9/L,
a. Schilling test
b- Conn's syndrome
d- pheochromocytoma
e- acromegaly
a- smoking
b- hypertension
c- hyperlipidaemia
d- age
a- the patient should admitted to hospital and if there is no contraindication to
b- Normal finding on examination of the lower limbs are extremely unusual
c- A definitive diagnosis can be made by history alone
d- Early treatment has little effect on overall mortality
e- The disease can be diagnosed definitely by Chest X-Ray
a- right coronary artery
b- left main artery
c- left anterior descending artery
d- circumflex artery
e- left mammary artery
a- admit the patient and start I.V digoxine
b- admit the patient and start I.V heparine
c- admit the patient and start I.V prophylactic streptokinase
d- admit the patient and for observation without changing his medications
e- Discharge the patient with increasing the dose of B-blocker and nitrate
infarction.
a- ACE inhibitors
b- digoxine
c- verapamil
e- hydralazine.
following
c- asprin
d- warfarin
e- I.V heparin

b- oral captopril
a-I.V amiodrone
d- I.Vadenosine
e-I.V verapamil
a- atropine
b- digoxine
c- propranolol
e- heparine
b- heart block
following
a- anteroseptal MI
b- anterolateral MI
c- posterior MI
d- inferior MI
a) Flattened T waves
b) U waves
c) Shortened QT interval
d) ST segment depression
e) Ectopic beats
64. All of the following are true for myofibril, except:

a. Each myofibril is made up of a serious of sacromeres
b. The basic unit of contraction is intercalated disc
c. A scromere is bounded by two tran??? Z lines
d. The actin filamne overaly with thicker protein filament called myocin
Answer:B
65. In conductive system of the heart muscle, all of the following are ture, except:
a. Conduction started in SA node. AV node, bundle of His, left and right bundle
branch-purkinjee fibers.
b. Left bundle branch is shorter than right bundle
c. Right bundle supplies right ventricle and left bundle supplied left ventricle and
spetum
d. Action potential in the ventricle is rapid and generated by rapid transmembrane K
diffusion.
Answer:D (sodium not K)
66. Cause of syncope include all of the following, except:

a. Arrhythmias, atrial and ventricular.
b. Obstruction to cardiac output like artic stenosi
c. Vasovagal, neurogenic
d. CVA
e. SBE
Answer: E.
67. The least common ause of AF is? Or: The commonest cause of AF?
a. WPW syndrome
b. Mitral valve disease
c. Hypertension ‫يمكن‬
d. Pericarditis
e. Thyrotoxicosis
71. Myocardial ischemia is an imbalance between O2 supply and myocardial

demand, all of the following are true except:
a. Obstruction of coronary arteries by atherosclerosi
b. Coronary artery spasm
c. Anemia
d. Thyrotoxicosis
e. Pericarditis
Answer: E Conditions that may cause myocardial ischemia include Coronary artery
disease (atherosclerosis). Atherosclerosis occurs when plaques made of cholesterol and
other cellular waste products build up on your artery walls and restrict blood flow.
Atherosclerosis of the heart arteries is called coronary artery disease and is the most
common cause of myocardial ischemia.
Blood clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot,
which may lead to sudden, severe myocardial ischemia, resulting in a heart attack.
Coronary artery spasm. A coronary artery spasm is a brief, temporary tightening
(contraction) of the muscles in the artery wall. This can narrow and briefly decrease or
even prevent blood flow to part of the heart muscle. Coronary artery spasms are more
common in people with risk factors for heart disease, such as high cholesterol and high
blood pressure, but the spasms can happen in people who have no risk factors, too.
Coronary artery spasms can also occur in people who have conditions that affect their
immune systems, such as lupus.
Severe illnesses. Myocardial ischemia can occur when the metabolic demands of your
heart increase or when blood pressure is very low due to infection, bleeding or other
severe illness. Source: http://www.mayoclinic.com/health/myocardial-
ischemia/DS01179/DSECTION=causes
72. In acute MI< all of the following are true, except:
a. Inf MI, St elevation in 1, 2, AVF
b. Anteroseptal MI – ST segment elevation in V1-V2-V3
c. In acute MI, thrombolytic therapy achieve 100% reperfusion arate.
d. Treatment of MI include morphine, coronary vasodilation, aspirin.
e. Cardiac markers in acute MI, serial cardiac enzymes, like CPK, troponin.
Answer: C (reperfusion rate 100%? Fee eshee bel6eb 100%)…
73. Clinical features in infective endocarditis include all of the following, except:
a. Appearnace of new murmur or change in the quantiy of eisting murmur
b. Fever
c. CHF
d. Skin and eye lesions
e. No splenomegaly
Answer: E (A wide variety of diseases are associated with splenomegaly, or enlargement

of the ... Such as in subacute bacterial endocarditis or infectious mononucleosis ...
http://emedicine.medscape.com/article/206208-overview)
74. Classification of cardiomyopathy include all of the following, except:

a. Dilated cardiomyopath
b. Hypertrophic-IHSS
c. Restrictive cardiomyopathy
d. Arrythmogenic right ventricle
e. Prolpase mitral valve
Answer: E.
1- Irregular irregularity indicate one of the following;

a-multiple premature ventricular contraction
b-mutiple premature atrial contraction
c-atrial fibrillation
d-second degree heart block
e-sinus tachycardia
2- normal heart rate is

a-60-90
b-60-100
c-60-120
d-100-150
e-40-60
3- Organism responsible for rheumatic fever is:

a-streptococcus pyogens
b-mycoplasma
c- streptococcus viridians
d- B heamolytic streptococcus
e-staphylococcus aures
4- Specific EKG changes of acute pericarditis one is true:

a-presence of Q wave
b-atrial fibrillation
c-sinus bradycardia
d-sinus tachycardia
e- elevation of ST segment is concave upwards
5-secondary hypertention include all the following except;

a-renal causes
b- endocrine causes
c-congenital like coarctaion of aorta
d-drugs like NSAID ,contraceptive pill
e. pulmonary hypertention
6-pulmonary hypertntion occurs in the following condition except

a- Chtronic obstructive pulmonary disease( COPD)
b- Mitral stenosis
c- Cyanotic congenital heart disease
d- Subacute bacterial endocarditis
e- Right ventricular failure
7-All the following can cause a Large Cardiomegally on XRay chest except:
a-dilated cardiomyopathy
b-pericardial effusion
c-(HOCM,)hypertrophic obstructive cardiomyopthy
d- multiple myocardial infarction
e-Aortic stenosis and regurgitation
8-contraindication of thrombolytics in MI are the following except:
a- Late MI more than 24 hours after MI
b- Previous surgery before 3months
c- Head trauma before 3 months
d- Elevated ST segment MI
e- Haemorahgic diseases
9- Complication of MI all the following are true except

a- Arrythmic complication
b-mechnical complication
c-Thromboembolic complication
d-papillary muscle rupture
e-Subacute bacterial endocarditis
10-Atrial fibrillation treated by allof the following except:

a- Digoxin
b- cortisone
c- Qunidine sulphate
d- Cordarone
e- B- Blocker
11- normal axis of the heart , one is true :

a-zero to + 90
b- zero to minus 30
c- 90 to180
d-minus30 to180
e-zero to 180
12- signs of Cor pulmonale (RT ventricular failure) all are true except:
a- RT ventricular heave
b- Congested neck vein
c- Tricuspid regurgitation
d- Wheezing chest on examination
e- Pan systolic murmur at the apex transmitted to axilla
13- most specific cause of essential hypertention. One is true

a-increase of peripheral resistance in medium sized arteries and arterioles
b-increase of cardiac output
c-increase of blood volume
d-increase of heart rate
e-polycythemia
14- signs and symptoms of severe aortic stenosis all are true except:
a-angina pectoris
b-syncope
c- heart failure
d- murmur transmitted to the carotid
e-double apical impulse
15-signs of tricuspid regurgitation all are true except:

a-pulsation of enlarged liver
b-pansystolic murmur at the tricuspid area
c-congested neck veins
d- murmur increase by respiration
e-murmur transmitted to axilla
16-in Sytlolic murmurs one of the following is true:

d-Murmur of aortic regurgitation i
e-murmur of mitral stenosis
a-occures after the S2

b-It is divided into an early, mid, and late diastolic murmur
c-the murmur of aortic stenosis
e-In atrial fibrillation and mitral stenosis the accentuation of presystolic murmur is lost
19)All of these statement are true except

a)classification of heat failure include 4 typesA.B.C.D
b)type A include risk factors
c)classification of antiarrythmic drugs include 5 types
d)Amiodorone is type III
e)Amiodorone has an iodine molecule
20-IN idiopathic hypertrophic sub aortic stenosis (IHSS)all are false One is true:
a) it is a type of dilated cardiomyophy
b) AN important cause of sudden death in athelets
c)Left ventricle is dilated
d) pulse examination is normal in character
e)need nitrate for treatment
1) All the following are true in diabetes and CAD except:
a) Mortality from CVD is 2-8 folds higher in people with diabetes than in those without.
b) Thiazolidine are Synthetic legends of Newer transcription factor PPARY
c) Recent meta analysis questioned the cardiac safety of rosiglitazone by decreasing LV
contractility.
d) In recent studies ENHANCED and ACCORD study –mortality has increased in
diabetes in those
with intersively lowering blood glucose.
e)Thiazolidinediones enhances insulin sensitivity in patients with high risk of CV events.
2) Hypertensive patents all are true except:
a) J curve is the paradoxial increase in CV events with a low blood pressure

b) The most major complications of long standing hypertension ,Stroke are thrombotic
rather than haemorrhagic.
c) Beta-blocker is the main drug in treatment of hypertension.
d) In the management of the resistant hypertension the recognition of inappropriate
Aldosterone concentration with raised Aldosterone\Renin ratio in 20% of those patients.
e) The recent recommendation of BP in diabetes and Renal impairment was 120/80 mm
Hg
3) In Aortic stanosis all are true except:
a) The most Common congenital Anomaly is bicuspid Arotic valve which is about 1-2%.
b)US guidelines do not recommend balloon valvoplasty in adults because of high risk of
complications >10%.
c) patients with low cardiac output usually have a small aortic area and small gradient ,
this can be distinguished by doing Dobutamine stimulation.
d)Degenerative Arotic scleosis is distinguished from Arotic Stenosis by valve thickening
and calcification without obstruction of significant gradient.
e) In US guidelines severe stenosis valve area is 1-1.5/cm2 and the mean gradient is 25-
40 mmHg
4) All are true except:
a) Renin-angiotensin aldosterone sympathetic access and natriuratic peptide system

serve to inhibit salt and water retention.
b) B-type natriuratic peptide(BNP is secreated from overloaded left ventrical).
c) The levels of BNP decrease with the degree of LV wall stretch and progression of
decreased EF .
d) Plasma BNP levels is important in diagnostic evaluation of acute dyspnea, as
well as prognostic evaluation of heart failure.
e) In ADHEAR study(acute decompensate heart failure national registry) the
hospital mortality increased by elevate BNP.
5) In Pulmonary arterial hypertension(PAH) the following are true except:
a) Drugs and toxins cocaine, amphetamines, and metamphetamines are very

important in etiology of PAH.
b) Left heart disease like mitral stenosis is an important etiological factor in PAH.
c) Endothelin I antagonist is the treatment of choice in PAH followed by
phosphodiesteraize 5 inhibitors.
d) Incidence of PAH associated with scleroderma and CREST syndrome are present
in almost all cases.
e) Embolic or thrombotic deceases of the lung are associated with PAH due to
hypoxaemia.
6) the degree of obstruction in hypertronic subaortic stenosis is dynamic and depends

upon the contractile state of the left ventricle and changes in preload and afterload.All of
the following increase the intraventricular gradient except:
a) Methoxamine
b) Valsalva maneuver
c) Hemorrhage
d) Rapid heart rate
e) digitalis
7) Cardiac biomarkers all are true except:
a) In acute coronary syndrome there are a high incidence of elevated cTn.

b) Elevated CK.MB after PCI indicate adverse outcome and this has not been the
case with cTn.
c) In TACTICS-TIMI-18 trial individuals with elevated cTn with normal coronary
had an adverse prognosis.
d) In both sexes with elevated BNP or CRP values seemed to benefit from early PCI
even if they have normal cTn.
e) In acute coronary syndrome elevated CRP indicate a poor prognosis.
8) PFO can cause all the following except:

a) paradoxic systemic embolization.
b) PFO maybe a possible cause of migraine headache.
c) Warfarin was better than aspirin in treatment of PFO to prevent Cerebrovascular
accident or TIA .
d) PFO can be detected by TEE using contrast and colour Doppler specially after
Valsalva maneuvers
e) Surgical PFO closure is better than percutanous transcatherter closure for stroke
9) CAD in women are characterized by all the following except:
a) In women HDL cholesterol maintain 10mg/dl higher than in men.

b) Angiographic and intravascular ultrasound studies shows that women have
smaller size coronary arteries than men.
c) Oral post menopausal hormone therapy decrease LDL cholesterol and LPa levels
but increase HDL cholesterol and triglyceride levels.
d) National cholesterol educational program recommend different treatment
guidelines for men and women
e) Elevated LPa levels seems to be more strongly related to CAD events tha to the
severity of CAD in women.

b-Hyperthyrodism
c-Hyperlipedemia
b-Thyrotoxosis
d-Anxiety neurosis
e-Acromegaly
a- LVEnlargement
b- RT Ventricular Enlargement
c- LA enlargement
d_RA enlargement
a- The length of the bladder cuff should be double than the width

b-closing of the valve

d-Releaving Factors
e-All are true
a-Chest pain
b-SOB
c-Palpitation
d-Syncopy
e-Cough and expectoration



maintained

f- cold exposure
g- deap sea diving
h- vibrating tools
i- bus driver
j- organic solvents

b- nerveousness
c- chest pain on movement

f- Angina
g- Myocardial infarct
h- Pericarditic pain
i- Aortic pain
j- Pectus excavatum

f- pain in both hands
g- pain in the back of the chest
h- interscapular pain
i- retrosternal heaviness
j- Sharp pain comes on movement or breathing

b-comes early at night

f- Is the sensation of the heart beating
g- awareness of occasional irregularities
h- missed beats
d- cyanosis may be present
e- occur with excesive caffeine intake or coffee,tea .

d- hyperlipedaemia
f- rate of the pulses
g- rhythm of the pulses weather is regular or irregular
h- the volume of the pulse
i- the character of the pulse
j- thrill of the pulse

e- Angina pectoris
f- Coarctation of the aorta
d- Heart failure
e- COPD

a- 9–12 cmH2O
b- 5– 7 cmH2O
c- 15 – 20 cmH2O
d- 0 – 5 cmH2O
e- 20 – 22 cmH2O

a-pectus excavatum
c-mitral senosis
b- Atrial septal defect
c-hypertension
d-aortic stenosis.

a-aortic stenosis.
c-mitral stenosis.
e-aortic regurgitation.

e-presence or absence of a click.

a-mitral stenosis.
b-aortic stenosis
16-The murmur of patent ductus arteriosus is one of the following :

c-Systolic and diastolic

a- rheumatic fever.
b- diabeties
c- thyrotoxicosis.
e-all of the above.
18- The best description of the physiological cause of a heart murmur is:
c-increase blood flow through an abnormal valve.
e-all of the above.
6- ORGANISM RESPOSIBLE OF SUBACUTE ENDOCARDITIS one is true
a)streptococcus pyogenes
b)B haemolytic streptoccous
c)streptococcus viridians
d)stafyllococcus aures
e)H pylori
7-LAD in EKG ,all are true except

a)in LAD the vector is between 0 and -30
b)maximum deflexion of QRS inlead II isnegative
c)maximum deflexion of QRS in AVF lead is negative
d)maximum deflextion of lead III is negative
e)maximum deflexion 0f lead AVF is positive
8 All are true in mitral regurgitation except:

a) Pansystolic murmur at the apical area
b) Transmitted to axilla
c) The murmur may be short ESM
d) Apex is deviated lattarlly and downwards
e) Is common in dilated cardiomiopathy
9- All are true in Aortic stenosis:

a) Murmur is ejection systolic
b) Transmilled to the carotid
c) Second heart sound is diminished in intensity
d) Presence of sustaind apex
e) Presence of right ventricular heave
10- Examination of ascitis all are true except:

a) Presence of fluid thrill
b) Presence of percussion dullness
c) treatment needs lasix and aldactone
d) Presence of fllapping tremors
e) Ballotment can be present
11- Angina pectoris all are true except
a) Restrosternal chest pain
b) Comes on exertion
c) Releived by rest and Nitroglecrine
d) Last from 5-10 min
e) Pain increase by deep breathing and by movement

b-Hyperthyrodism
c-Hyperlipedemia xxx

b-Thyrotoxosis xxx
d-Anxiety neurosis
e-Acromegaly

a- LVEnlargement
b- RT Ventricular Enlargement xxx
c- LA enlargement
d_RA enlargement

a- The length of the bladder cuff should be double than the width xxx

b-closing of the valve xxx

d-Releaving Factors
e-All are true xxx

a-Chest pain
b-SOB
c-Palpitation
d-Syncopy
e-Cough and expectoration xxx
a- Splitted and fixed during respiration xxx

a-Murmur occures between S1 and S2 xxx


c-In aortic stenosis the murmur is mid diastolic xxx
maintained

e- aortic regurgitation
f- aortic stenosis
g- mitral stenosis
h- VSD
2 . A 30-year-old man admitted with right sided hemiplegia.Clinical examination reveals

loss of a wave in JVP with irregular irregular pulse. He has ONE of the following
cardiac rhythm abnormalities.
c- atrial flutter
k- carditis
l- Sydenham's chorea
m- Polyarthralgia
n- Erythema marginatum
o- Subcutaneous nodules
k- nebulized B2 agonist
l- i.v hydrocortisone
m- epinephrine (adrenaline)
n- oxygen
o- i.v . aminophylline
k- left ventricular failure
l- massive pulmonary embolism
m- acute sever asthma
n- acute exacerbation of COPD
o- pneumonia

k- thrombocytopenia
l- pneumococcal vaccine should be given
m- annual influenza vaccine should be given
n- long term oral penicillin V 500 mg 12 hourly should be given
o- Howell-Jolly bodies are characteristically seen on blood film.
7. ONE of the following drugs is most appropriate in treatment of pneumocystis carinii

pneumonia.
k- clarithromycin
l- ethambutol
m- azithromycin
n- Trimethoprim-Sulphamethoxazole
o- INH and rifampicine
hypertension.
f- decrease cardiac out put.
g- Slow the heart rate
h- Increase cardiac force of contraction
i- Increase cardiac output
j- Decrease plasma volume
d- Reiters disease

f- class 1 A
g- class 1 B
h- class 1 C
i- class III
j- class IV
k- mental confusion
l- urea of 11.4 mmol/l
m- positive C-reactive protein
n- respiratory rate of 35/ min.
o- age 75 years old.


k) Kidney stones
l) Tubulointerstitial disease
m) Papillary necrosis
n) Tuberculosis
o) Acute pyelonephritis
i) Uremia
j) Pulmonary edema
k) Hyperkalemia
l) Infection
e) Hyponatremia
15. A 29-year-old medical student developed a positive PPD (purified protein

pins and needles (parasthesia ) in her lower limbs. Administration of which of
A. Niacin
B. Pyridoxine
C. Riboflavin
D. Thiamine
E. Vitamin C
a- hemophelia A

b- microcytic RBC
d- low serum iron
e- increased TIBC
18.Bilateral hilar lymph nodes enlargement occurs commonly in all the following
Except.
d- Hodgkin lymphoma
e- sarcoidosis

d- reticulosytosis
e- Hemoglobinurea
a- SLE
c- methyldopa
mmHg. What is the ONE target blood pressure in the long term for this patient?
a- <160/90
f- <150/90
g- <145/90
h- <130/85
i- <120/70

d- gastroparesis
24.Causes of indirect (unconjucated) hyperbilirubinemia include all the following

Except.
25.Precipitating factors for hepatic encephalopathy in patient with liver cirrhosis include
a- occult infection

a- hepatitis A
b- hepatitis B
c- hepatitis C
d- hepatitis D
e- hepatitis E

c- pulsus alternans
d- raised JVP
e- pulmonary oedema

c- pulsus paradoxus
a- atenalol
b- propranolol
c- metoprolol
d- bisoprolol
e- carvidalol
b- fever > 37.5 C
e- albumin < 30 g/L

f- Is caused by deposition of monosodium urate monohydrate crystals in the joints.
g- It is an asy,mmetric arthritis.
h- Can be caused by thaiazide diuretics.
i- It is commoner in females than males 4:1.
j- Attack of gout can be triggered by dehydration.
34. A 65-year-old man with liver cirrhosis presented with ascitis,abdominal pain,
k- Fluid restriction and no added salt diet.
l- Intravenous antibiotics.
m- Oral spironolactone.
n- Therapeutic paracentesis
o- Trans-jugular intrahepatic porto-systemic shunt.
a- diffuse proliferative glomerilonephritis.
c- liver cirrhosis
e- cryoglobulinemia
d- ESR

d- Hemoptysis

d- Hypercalcemia

c- heat intolerance
d- Tremor

b- dermatomyocytis
41. 20-year old woman presents with a week history of fever, rigor and productive rusty
cough. The chest X-ray shows left lower lobe consolidation.
k- clarithramycin
l- gentamycin
m- Cotrimoxazole
n- Benzypenicillin
o- Flucloxacillin
a- Grave's disease.
e- pregnancy.
conjunctivitis.
f- SLE
g- Gonococcal arthritis
h- Gout
i- Reiter's syndrome
j- Ankylosising spondylitis


e. serum creatinin is the early biochemical marker to change in diabetes nephropathy.
46. All the following are true about calcium metabolism except.
haemetemesis. Which ONE of the following is most appropriate immediate therapy?
a. i.v desmopressin
c. i.v. omperazole
d. i.v. propranolol

a. cardiomyopathy
b.hypogonadism
c. Chorea.
e. liver cirrhosis.
50. A29- year-old man presents with symptoms of gastroesophageal reflux. Which ONE
of the following is most useful in assessing the role of surgery.


b. myelofibrosis
Except.
c. splenectomy
obtained. Hb 10.4 g/dl, platelet 268x 10 9/L, WBC 6.3X 10 9/L, MCV 65 fl, Hb A2 9% (
NORMAL < 3.5% ),
e. G6PD deficiency
WBC 3X10 9/L,
a. Schilling test

e. myelofibrosis.

a. stage I
b.stage II
c.stage III B
d. stage III
e. stage IV B.
a. elevated WBC
c. splenomegaly

c. G6PD deficiency
e. malaria
11
c. sever anemia

c- high ESR

b- Kawasaki disease
d- osteoarthritis
66. All the following are most likely causes of pyrexia of unknown origin Except.
b- lymphoma
c- factitious fever
d- viral infection
e- SLE
c- ECG
68. A 20-yea-old male is complaining of arthritis and eye irritation. He has a history of
burring on urination. On examination, he has Right knee effusion and dermatitis of the
glans penis.
69. A pleural effusion analysis results: ratio of concentration of total protein in pleural
fluid to serum of 0. 38 , latate dehydrogenase LDH level of 125 IU, and ratio of LDH in
pleural fluid to serum of 0. 45.
f- uremia
g- pulmonary embolism
h- sarcoidosis
i- SLE
j- Congestive heart failure

a- silent chest
c- hypercapnia
e- confusion
f- the patient should admitted to hospital and if there is no contraindication to
g- Normal finding on examination of the lower limbs are extremely unusual
h- A definitive diagnosis can be made by history alone
i- Early treatment has little effect on overall mortality
j- The disease can be diagnosed definitely by Chest X-Ray
72. Which ONE of the following Arterial Blood Gases is most likely to be found in a 60-
year-old heavy smoker man, He has chronic bronchitis, peripheral odema and cyanosis?
a- PH 7.50, PO2 75, PCO2 28
b- PH 7.15, PO2 78, PCO2 92
c- PH 7.06, PO2 36, PCO2 95
d- PH 7.06, PO2 108, PCO2 13
e- PH 7.39, PO2 48, PCO2 54
f- right coronary artery
g- left main artery
h- left anterior descending artery
i- circumflex artery
j- left mammary artery
f- admit the patient and start I.V digoxine
g- admit the patient and start I.V heparine
h- admit the patient and start I.V prophylactic streptokinase
i- admit the patient and for observation without changing his medications
j- Discharge the patient with increasing the dose of B-blocker and nitrate
infarction.
a- ACE inhibitors
b- digoxine
c- verapamil
e- hydralazine.

following
c- asprin
d- warfarin
e- I.V heparin

b- oral captopril
a-I.V amiodrone
d- I.Vadenosine
e-I.V verapamil
a- atropine
b- digoxine
c- propranolol
e- heparine

disturbances
E- Ectopic ACTH Cushing is associated with metabolic acidosis and hyperkalemia
82. A 50-year-old female , she is 155 cm tall and weighs100 Kg, her fasting bloods sugar
is 150 mg/100 ml on 2 occasions, she is a symptomatic and no abnormal physical signs
on examination.
f- observation
g- medical nutrition therapy
h- insulin
i- sulphonylurea
j- biguanides ( metformin) !!!!!!!!!!!!!!

b- Conn's syndrome
d- pheochromocytoma
e- acromegaly
84. Hypocalcemia with increased serum phosphate is found in ONE of the following
b- osteomalacia
e- malabsorption
85. All the following may be findings in primary hypoadrenalism (Addison's disease)
Except.
e- weight loss
a- smoking
b- hypertension
c- hyperlipidaemia
d- age
a- amoxicillin
b- tetracycline
c- metronodazo;e
d- clarithramycin
e- strepotomycin
a- hyperkalemia
b- hyperurecemia
c- hypophosphatemia
d- hypocalcemia

b- i.v salbutamol
e- hemodialysis
91. After undergoing surgical resection for carcinoma of stomach, a 60-year-old male
develop numbness in the lower limb. Blood film shows macrocytosis and MCV = 120 fl.
The abnormality is most likely due to ONE of the following
f- folic acid
g- Vit. B12 …… (IF)
h- thiamin
i- Vit. K
j- Riboflavin
a- sulfasalazine
b- NSAIDs
c- methotrexate
d- leflunamide
b- heart block
following
a- anteroseptal MI
b- anterolateral MI
c- posterior MI
d- inferior MI
f) Flattened T waves
g) U waves
h) Shortened QT interval
i) ST segment depression
j) Ectopic beats

e-Lupus nephritis

k) SLE
l) DM
m) Amyloidosis
n) Membranous glomerulionephritis
o) Autosomal-dominant polycystic kidney disease

a- Conn's syndrome
d- Alkalosis
e- Mental stress.
1. A 50 year old man with no past medical history is found to be in atrial fibrillation
during routine medical examination. He reports no history of palpitation or
dyspnea.Normal physical examination. He refused DC cardioversion. If the patient
remains in chronic Atrial fibrillation.
Which ONE of the following is most suitable treatment to offer?
a- Asprine.**********************
b- warfarin,target INR 2-3.
c- no anticoagulation.
d- warfarin, target INR3-4.
e- warfarin, target INR2-3, for 6 months then Asprin.

i- aortic regurgitation
j- aortic stenosis
k- mitral stenosis
l- VSD
m- Cardiac tamponade.************************
3. A 30-year-old man admitted with right sided hemiplegia.Clinical examination reveals

loss of a wave in JVP.He has ONE of the following cardiac rhythm abnormality.
b- atrial fibrillation************************
c- atrial flutter
##4. All the following occurs usually in 3rd week of Enteric (Typhoid ) fever Except.
f- meningitis
g- lobar pneumonia
h- maculopapular rash (rose spots)*************************
i- oestomyelitis
j- intestinal perforation
##5. All the following are Zoonotic infections Except.

f- rabies
g- brucellosis
h- anthrax
i- toxoplasmosis
j- cholera*******************
p- carditis
q- Sydenham's chorea
r- Polyarthralgia******************
s- Erythema marginatum
t- Subcutaneous nodules

a- Behcet;s syndrome.*********************
b- Kawasaki disease.
c- Erythema multiforme.
d- Osteoarthritis.
e- Rheumatoid arthritis.
p- nebulized B2 agonist
q- i.v hydrocortisone
r- epinephrine (adrenaline)********************
s- oxygen
t- i.v . aminophylline
p- left ventricular failure
q- massive pulmonary embolism
r- acute sever asthma
s- acute exacerbation of COPD*****************??????????????
t- pneumonia
##10. All the following are true in osteomalacia Except.

f- may be caused by primary biliary cirrhosis
g- low serum 25-hydroxy vitamin D3
h- normal serum alkaline phosphatase************************
i- pelvic x-ray may show linear areas of low density surrounded by sclerotic borders
(looser's zones)
j- treated by alfacalcidol.
##11. All the following are causes of eosinophilia Except.

f- ascaris infestation
g- malaria********************************
h- bronchial asthma
i- Hodgkin's lymphoma
j- Drug hypersensitivity
##12. All the following are true about Giardia lamblia Except.
f- Is usually acquired by ingestion of food or water contaminated by
trphozoites.*******************************
g- Can cause malabsorption
h- Both cystic and trohozoites can be found in stool
i- Can be effectively treated by metonidazole (flagyel)
j- Cysts are destroyed by boiling.

k- cold exposure xxx
l- deap sea diving
m- vibrating tools
n- bus driver
o- organic solvents
b- nerveousness
c- chest pain on movement ?xxx

k- Angina
l- Myocardial infarct
m- Pericarditic pain
n- Aortic pain
o- Pectus excavatum xxx

k- pain in both hands
l- pain in the back of the chest
m- interscapular pain
n- retrosternal heaviness xxx
o- Sharp pain comes on movement or breathing

b-comes early at night xxx

i- Is the sensation of the heart beating
j- awareness of occasional irregularities
k- missed beats
d- cyanosis may be present xxx
e- occur with excesive caffeine intake or coffee,tea .

d- hyperlipedaemia xxx
k- rate of the pulses
l- rhythm of the pulses weather is regular or irregular
m- the volume of the pulse xxx
n- the character of the pulse
o- thrill of the pulse

g- Angina pectoris
h- Coarctation of the aorta xxx
d- Heart failure
e- COPD

a- 9–12 cmH2O xxx
b- 5– 7 cmH2O
c- 15 – 20 cmH2O
d- 0 – 5 cmH2O
e- 20 – 22 cmH2O

a-pectus excavatum
c-mitral senosis xxx
b- Atrial septal defect xxx
c-hypertension
d-aortic stenosis.

a-aortic stenosis.
c-mitral stenosis.
e-aortic regurgitation. ?xxx

e-presence or absence of a click. xxx

a-mitral stenosis.
b-aortic stenosis xxx
16-The murmur of patent ductus arteriosus is one of the following except :
c-Systolic and diastolic xxx

a- rheumatic fever.
b- diabeties
c- thyrotoxicosis.
e-all of the above. xxx
18- The best description of the physiological cause of a heart murmur is:
c-increase blood flow through an abnormal valve. xxx
e-all of the above.
Gastroenterology
16.One of the following is the least likelyOne of the following is the least likely
future of Hemochromatosis:
A. Fulminant liver failure
B. Pseudogout
C. Diabetes
D. Bronze skin
E. Hepatocellular carcinoma
17.Upper GI bleeding secondary to Dieulafoy is characterized by all of the following

except:
A. Presents as massive and recurrent bleeding

B. Extramural artery present in the Submucosa.
C. Most commonly in the gastric fundus
D. Easily diagnosed and treated by endoscopy
E. High mortality
18.One of the following causes of portal hypertension is caused by Presinusoidal

intrahepatic pathology:
A. Veno-occlusive disease
B. Schistosomiasis
C. Viral hepatitis
D. Alcohol Hepatitis
E. Congestive heart failure
19.All of the following are subclinical presentations of Celiac disease except:
A. Mood changes
B. Iron deficiency
C. B12 deficiency
D. Unexplained elevation of liver enzymes
E. Recurrent abdominal pain
20.All of the following factors are associated with rapid progression of chronic
hepatitis C to cirrhosis except:
A. Acquiring the infection at older age

B. Female sex
C. Alcohol use
D. HIV Co-infection
E. HBV Co-infection
21.The most common complication after Endoscopic retrograde

cholangiopancreatograghy (ERCP) is:
A. Perforation
B. Pancreatitis
C. Cholangitis
D. Bleeding
E. Sepsis
22.All of the following regarding Vibrio Cholera except:

A. Most vibrio cholera infections are Asymptomatic.
B. Antibiotic therapy is effective in decreasing mortality.
C. Transmission by Contaminated Water and Food and very rarely by person-to-
person transmission.
D. Requires large inoculum to get the infection
E. “Rice water” diarrhea is characteristic feature.
23.All of the following are risk factors for Squamous cell carcinoma of the
esophagus except:
A. Zinc Deficiency
B. Low serum Selenium
C. Infection with Human Papilloma virus
D. Chronic Gastroesophageal reflux disease
E. Alcoholism
24.All of the following are accepted initial management strategies in patients with
upper GI bleeding except:
A. Somatostatin
B. Bleeding scan
C. Esophagogastrodeudeoscopy EGD
D. Acid suppressive medication
E. Gastric Lavage
25.Wilson's disease should be considered in all of the following medical scenarios

except:
A. Abnormal liver enzymes and non-immune hemolytic anemia

B. Exaggerated high bilirubin level and depressed serum alkaline phosphatase
C. Decrease serum ceruloplasmin

D. Elderly patients with neuropsychiatric problem
E. Fulminant liver failure with low uric acid
26.All of the following medications are being used for Non Alcohol steatohepatitis
NASH except:
A. Betaine
B. Ursodeoxycholic acid
C. Ribavirin
D. Vitamin E
E. Beta- Carotene
27.In treatment of patients with Spontanous Bacterial peritonitis, all of the following
are true except:
A. Initiate therapy when ascitic fluid Neutophils > 250/mm2
B. Majority sterile at presentation (culture negative)
C. Gentamycin is the drug of choice
D. Treat for at least 5 days
E. 30% of patients are Asymptomatic at presentation and during follow up
28.In regard to hepatitis C and pregnancy, all of the following is true except:
A. The rate of transmission from mother to baby during delivery is around 6%.
B. Transmission is higher in vaginal delivery comparing to cesserian.
C. Higher rate of transmission is seen if the mother is co-infected with HIV
D. Severe hepatitis is rare in infected infants
Breast-feeding is safe
29.All of the following medications are being used in chronic hepatitis B except:
A. Lamivudine
B. Ribavirin
C. Pegylated interferon
D. Adefovir Dipivoxil
E. Entecavir
30.All of the following micro organisms can cause infectious diarrhea with positive
fecal leucocytes except:
A. Shigella
B. Yersinia
C. Giardia
D. Campylobacter
E. Salmonella
31.All of the following are protective from colo-rectal cancer except:

A. Aspirin
B. Folic Acid
C. Fiber Diet
D. Calcium
E. Moderate use of Alcohol
24 A 65-year-old man with liver cirrhosis presented with ascitis,abdominal pain,

a- Fluid restriction and no added salt diet.
b- Intravenous antibiotics.
c- Oral spironolactone.
d- Therapeutic paracentesis
e- Trans-jugular intrahepatic porto-systemic shunt.
5
a- diffuse proliferative glomerilone0phritis.
c- liver cirrhosis
e- cryoglobulinemia
26 ONE of the following tests is most suitable in screening patients for celiac disease.
d- ESR
haemetemesis. Which ONE of the following is most appropriate immediate therapy?
a. i.v desmopressin
c. i.v. omperazole
d. i.v. propranolol
a- amoxicillin
b- tetracycline
c- metronodazo;e
d- clarithramycin
Strepotomycin -f
38.One of the following is least likely feature of hemochromatosis:
a. Fulminant liver failure
b. Psuedogout
c. Diabetes
d. Bronze skin
e. Hepatocellular carcinoma
Answer: A (akeed)
39.All the following are subclinical presentations of celiac disease, except:
a. Mood changes
b. Iron def
c. B12 dfe
d. Unexplained elevation of liver enzymes
e. Recurrent abdominal pain
Ans: C (Mild to moderate anemia is present in 50% of cases. Folate deficiency is
common, often causing macrocytosis. B12 deficiency is rare. Iron deficiency due to
malabsorption of iron and increased loss of desquamated cells is common).
40.All of the following are associated with rapid progression of chronic hepatitis C
to cirrhosis, except:
a. Acquiring the infection at older age
b. Female sex
c. Alcohol use
d. HIV co-infeciton
e. HBV co-infection
Ans: Female sex (akeed)
41.The most common complication after ERCP: answer: b
45.All of the following are initial management strategies in aptients with upper GI
bleeding, except:
a. Somatostatitn
b. Bleeding scan
c. Esophagogastroduodensoscoyp
d. Acid suppressing medicaiton
e. Gastric lavage
Answer: b
46.Wilson’s disease should be considered in all of the following medical scenarios,
except:
a. Abnormal liver enzymes and non-immune hemolytic anemia
b. Exaggerated high bilirubin level and depressed alkaline phosphtaea
c. Decreases serum ceruloplasmis
d. Elderly patient with neuropsychiatric problem
e. Fuliminat liver failure with low uric acid
Answer: D
47.All of the following medications are being used for non-alcohol steatohepatitis
(NASH), except:
a. Betaite
b. Ursodeoxycholic acid
c. ribaverin
d. Vitamin e
e. Beta carotene
Anwer: C (akeed)
48.All of the following medciations are being used in chronic hepatitis B, except:
a. Lamividine
b. Ribavirine
c. Pregyled interferon
d. Adefovel dig
e. Entovavir
Answer: B (akeed)
49.All of the following micro-organisms can cause infectious diarrhea with positive
fecal leucocytes, except:
a. Shigella
b. Yersinia
c. Giardia
d. Campylobacet
e. Salmonella
Answer: c
50.All of the following are protective from colo-rectal cancers, except:

a. Aspirn
b. Folic acd
c. Fier diet
d. calcium
e. moderate use of alcohol
Answer: E.
51.The most common cause of GI bleeding is:
a. Peptic ulcer disease
52.Regarding achalasia, all of the following are tue, except:
a. There is increase of intramural inhibitory signals
53.Regarding Crohn’s disease, all of the following are true, except:

a. The rectum is often spared
b. Fistual fissures and absesscess can occur in patietns with colo-rectal Crohns
c. The disease is limited to the mucosa
d. The mucosa can appear as cobble stone
Answer: C.
54.All of the following are true regarding ulcerative colitis, except:

a. Azathioripne can be sued in treatment
b. Maybe associated with Pyoderma gangreonusum
c. Patients may be P-ANCA positive
d. The rectum is never involved
Answer: D.
55.Regarding IBD, all of the following are rue, except:

a. UC patients usually smokes more than Crohn’s patients (Unlike Crohn's disease,
ulcerative colitis has a lesser prevalence in smokers than non-smokers.)
b. Incidencei s about 7/100,000
c. Jweish affected more often than asians
d. Iliocecal area is frequenly involved in Crohn’s disease
Answe: a
56. The most common cause of portal hypertension is:

a. Liver cirrhosis
Haematology
a- hemophelia A

b- microcytic RBC
d- low serum iron
e- increased TIBC
8.Bilateral hilar lymph nodes enlargement occurs commonly in all the following Except.
d- Hodgkin lymphoma
e- sarcoidosis

d- reticulosytosis
e- Hemoglobinurea
a- SLE
c- methyldopa

a- thrombocytopenia
b- pneumococcal vaccine should be given
c- annual influenza vaccine should be given
d- long term oral penicillin V 500 mg 12 hourly should be given
e- Howell-Jolly bodies are characteristically seen on blood film.
\

b. myelofibrosis
Except.
c. splenectomy
obtained. Hb 10.4 g/dl, platelet 268x 10 9/L, WBC 6.3X 10 9/L, MCV 65 fl, Hb A2 9%
( NORMAL < 3.5% ),
e. G6PD deficiency

WBC 3X10 9/L,
a. Schilling test

e. myelofibrosis.

a. stage I
b.stage II
c.stage III B
d. stage III
e. stage IV B.
a. elevated WBC
c. splenomegaly

c. G6PD deficiency
e. malaria

a. cardiomyopathy
b.hypogonadism
c. Chorea.
e. liver cirrhosis.
c. sever anemia
Rheumatology and bone disease
B)Hyper extension of PIP and hyper flextion of DIP.
E)Non of the above.
22)Which disorder is diagnosed by the presence of calcium pyrophosphate is synovial

fluid:
A)Chondro calcinosis.
B)Gouty arthritis.
E)O.A

A)SLE.
D)Good pasture.
E)Currg-strass.

except for :
A)Salazo pyrine.
C)Colchicine.
D)Methotrexate
E)leflenamide
A)Mouth ulcer's.
B)Arterial Anuyresm .ِ
C)Hypopyron..
D)Pethergy test.
E)Acne-like lesion

A)Anti RNP.
B)Mouth ulcer's.
C)ANA.
D)Photosensitivity.
E)Leukopenia.

B)Genu valgua.
C)Elbow flextion.
D)Bouchard nodules.
29)All of the following are indications for the treatment of Gouty arthritis except for:
B)Renal stones.
C)Renal failure.
E)All of the above.

E)Enthesitis.

B)SLE.
C)Scleroderma.
D)RA.
E)Hypothyroctism.

A)Psoriatic.
B)Behcet disease.
E)Chron disease.
A)RA.
D)Ostco arthritis.

E)All of the above.
d- Reiters disease

a- Is caused by deposition of monosodium urate monohydrate crystals in the joints.
b- It is an asy,mmetric arthritis.
c- Can be caused by thaiazide diuretics.
d- It is commoner in females than males 4:1.
e- Attack of gout can be triggered by dehydration.
f-
g- 30. Rheumatoid factor is positive in all the following diseases except:
h- a.- Rheumatoid arthritis
i- b- dermatomyocytis
j- c- ankylosying spondylitis
k- d- dicoid lupus erythematosis
l- e- mixed connective tissue diseases.
conjunctivitis.
a- SLE
b- Gonococcal arthritis
c- Gout
d- Reiter's syndrome
e- Ankylosising spondylitis

f- serum uric acid is increased in eclampsia of pregnancy.
c- high ESR

b- Kawasaki disease
d- osteoarthritis
c- ECG
a- sulfasalazine
b- NSAIDs
c- methotrexate
d- leflunamide
e- Mental stress.
26.A 70-year-old man with 3 months headache, stiffness, low grade fever, jaw
claudication, and amuresiss fugax, his ESR is 100, all of the following
statements are true regarding this condition, except:
a. Increased risk of permenant blindness
b. Tongue claudicaiton
c. Weight loss
d. Drug therapy can only be started after tissue biospy
e. Dramatic response to steroids
27.All of the following are true about vasculitis, except:

a. PAN is associated with hypertension
b. Wegner granulomatosis is associated with +ve C-ANCA
c. Hypersensitivity vasculitis mainly presents with large vessel involvement of the
aortic arch vessls in females younger than 40 years of age.
d. Giant cell arteritis affects mainly people above the age of 50
e. Churg-strus disease occurs in people with history of atopy
28.Which of the following associations is true?

a. Hepatitis a with PAN
b. RF and Riter’s syndroe
c. Giant cell arteritis and blindness
d. RA and addison’s disease
e. TB and reactive arthritis
29.Which of the following is true about septic arthritis?

a. Hematogenous spread is the most common route of infection
b. Joint involvement is typically episodic recurrent polyarticular
c. Almost always occur in normal joints
d. Presence of urate crystals exclude its diagnosis
e. Gram negative bacteria is the leading cause
f.
30.Which statement about rheumatoid arthritis is not correct?
a. The commonest cause of anemia seen in pts with the diseas is due to hemolysis?
b. Synovitis characerisically involves Metarasophalangeal joints
c. RF is of an IGM type
d. Joint effusions occur in the first several months
e. Felty’s disease is more common in seropositive patients
31.Which antibody is rather specific for diffuse scleroderma?
a. Anticentromere AB
b. Anti-myeloperoidase AB (p-ANCA)
c. Anti-Jol AB
d. Antimitochondrial AB
e. Anti-Scl70
32.All of the following statement about gout are true, except:

a. In adult men the solubility of monosodium urate is 7 mg/dL
b. Women of child-bearing age have lower serum uric acid
c. Initial treatment of acuteattack should include NSAIDs, colchicine, and
allopurinol
d. Diuretics should elevate serum uric acid
e. Attacks can be precipitated by acute MI.
Answer: C (allopurinol and colchicine never in acute treatment)
Nephrology
1 ) 35 year old man presented to ER after an episode of Grand mal seizure and by exam
he was afebrile , Bp 130/95 and confused .
Labs showed : Cr 1.0 mg/dl , BUN 12mg/dl , Na 140 meq/L , K 4.8 meq /L , Cl 100
meq/L , HCO3 12 meq/L .
Which of the following is the most appropriate initial treatment for the Metabolic
Acidosis :

Hemodialysis
Fomepizole

HLA antibodies
Acute rejection
Donor illness
3 ) 25 year old man was found to have microscopic hematuria by chance . Urine
analysis showed many RBC /HPF, no RBC casts , no Dysmorphic RBC
Advice him that this is a benign finding , there may be a risk for nephrolithiasis
but it never progresses to Renal failure

5 ) 35 year old female is evaluated because of an elevated Bp 160/105 for the past 2-3
months . Her mother has hypertension and kidney disease , and a maternal aunt is now
on hemodialysis
Labs : Cr 0.8 mg/dl , Na 140 meq/ L , K 5.0 meq /L , Cl 102 meq / L , HCO3 25 MEQ /
l , Urine Analysis is negative .
Which of the following is most likely to provide information regarding cause of her
hypertension .

Renal U/S
Plasma PTH

7 ) 50 year old man has history of recurrent kidney stones which were Ca containing
stones .
Hypercalciuria
Hyperoxaluria
Low urine volume
Hypercitrauria
Hyperuricosuria
Nephrogenic DI
Rhabdomyolysis
Tetany
9 ) According to National kidney foundation guidelines . All the following are

acceptable target PTH levels in CRF as per stage except :


4 Year
30 year old male has IDDM for the past 15 years , now presenting with lower limb
edema .
All the following have a role in the progression of his renal disease except :
Degree of Mesangial expansion on kidney biopsy

Decrease in intraglomerular pressure
Duration since onset of DM
Amount of proteinurea
Quitting smoking
All the following are true about Focal Segmental Sclerosis ( FSGS) except :
Familial type has better prognosis

Progresses fast in Renal failure
Collapsing type is associated with HIV
Recurrence after transplant is high
Main presentation is Nephrotic syndrome
25 year old female presented to OPD with Bp 160/100 , she stated that her Bp was the
same over the past 2 weeks .
Urine analysis
Serum K, Urea ,Cr
Lipid profile
Fasting blood sugar
MRA for renal arteries
35 year old female previously healthy presented to ER c/o generalised weakness , Bp

110/80 . Irregular irregular pulse
Bulimia
Barter syndrome
Hypercalcemia
Primary Hyperaldosteronism
Diuretic abuse
20 year old male came to OPD with c/o of passing red urine , which was preceded by
URTI the previous morning .
More common in males

May run in families
Mesangial expansion by kidney biopsy
Symptoms may recur with future URTI
Low complement
25 year old female was admitted to hospital with referred to OPD due to incidental
finding of the following labs & ABG :
PH 7.32 , HCO3 15
Acetazolamide treatment
Fanconi syndrome
Treatment with Thiazide
Primary hyper parathyroid
Diarrhea
6 th year
70 year old male presented to OPD with Bp 180/80 , he had similar readings over the
last month otherwise asymptomatic .
The best management for this patient is :
Observation
Start on Enalapril 5 mg Q day
Start on Nifidipine 20 mg + Thiazide 25 mg
Start on Furosemide 40 mg Q day
Start on α Methyl Dopa 250 mg 1 x 3
50 year old patient previously healthy presented with hemoptysis & hematurea
Labs : Cr 3.0 mg/dl , Urea 70 mg/dl , PO4 5 mg/dl , Ca 9.2 mg/dl . Hb 13 .
Kidney biopsy showed 55 % crescents with linear deposits on basement membrane by
IF
The best management is :
Prednisone 20 mg Q day
Azathioprine 50 mg Q day + Cyclosporin 1mg/kg/day
Plasmapheresis + Methylprednisone IV + Cyclophosmide PO
Prednisone 30 mg Q day alternating with Chlorambucil
Tacrolimus 1 mg 1x2
40 year old male know to have Nephrotic syndrome for 15 years , now presenting with
Cr 8.0 mg/dl , Urea 100 mg/dl
All the following are indications to start this patient on dialysis except :
Peripheral Neuropathy
Anemia
Pericarditis
Low albumin
Bleeding tendency
All the following are true about Diabetic Nephropathy except :
More likely to occur if patient ha siblings with Nephropathy

More severe in black
Occurs within 5 years in I DDM
It needs 15 years to progress into ESRD after start of overt proteinurea
Mostly preceeded by Diabetic Retinopathy
60 year old male known to have Diabetes for 10 years and is on Enalapril 10 mg 1x2 ,
presented to ER because all his peripheral extremities became paralised
Labs K 8.0 meq /L , Cr 1.0 mg/dl
Which of the following should be used first in the management of this patient :
NAHCO3 Iv
Ventolin nebuliser
Glucose + insulin Iv
K exalate ( Na polysterene Sulfonate )
Ca gluconate Iv
25 year old male presented c/o of polyurea and weakness , Bp 110/70 , Labs
K 3.0 meq/l , PH 7.46 , HCO3 32
All the following could be part of the dfferential of the above case except :
Barter Syndrome
Furosemide abuse
Hypercalcemia
Excessive Licorice ingestion
Gittleman syndrome
Resident
All the following are true for a Diabetic with ESRD except
Oral hypoglycaemic agents should be stopped

First year post transplant survival is the same as in the general population
More prone to hypotension during HD than other patients
They have higher Insulin requirements
PD is associated with increase in Triglycerides level
A 40 year old female known to have Membranous GN came to OPD with 24 hour
protein 4 gm/24 hours , Cr 1.0 mg/dl , Urea 40 mg/dl . Her Bp 160/100 , she was started
on Enalapril 20 mg 1x1 .
The desirable Bp reading in such a lady should be :
140/90
130/85
120/75
130/80
135/85
20 year old male has a LRD kidney transplant 2 years ago , he is not known to be
Diabetic nor Hypertensive . His medications are Tacrolimus 3 mg 1x2 , prednisone 5mg
1x2 , MMF 1 gm 1x2
Labs : FBS 400 mg/dl , Cr 1.0 mg/dl , Urea 35 mg/dl , Tacrolimus level 12 .
The next step in managing his Diabetes other than start him on treatment and re
checking his sugar level is :
Stop Prednisone
Decrease MMF to 500 mg 1x2
Stop Tacrolimus
Stop MMF , and increase Tacrolimus
Decrease Tacrolimus to 2 mg 1x2
Each of the glomerular lesions listed below can cause Nephrotic syndrome . Which of
them may be found in all the following conditions : non – Hodgkins lymphoma ,
hepatitis B, hepatitis C , and infective endocarditis ?
Focal and segmental glomerulosclerosis

Minimal change disease
Membranous nephropathy
Type I membranoproliferative glomerulonephritis ( with subendothelial deposits )
Type II membranoproliferative glomerulonephritis ( dense deposit disease )
83 year old male who has DM , CHF,CRI is admitted to hospital with volume overload
& Cr 4.0 mg/dl ( baseline 2.3 mg/dl ) . He was treated by Iv diuretics , post voiding
residual was 250 ml after foleys catheter was inserted . He was discharged 2 days later
with Cr 3.0 mg/dl .
One week lter he came to OPD , Cr is 3.5 mg/dl , ultrasound shows mild bilateral
hydronephrosis .
Which of the following would best predict the effect of the patient bladder outlet
problem on kidney function :
Serum PSA
Serum Cr after several days with foleys catheter
Kidney size on U/S
Retrograde urography
Renal Scan
49 year old female is evaluated in ER after being found lying in the street in a
semiconscious state , she is known to have hypertension and a history of seizures.
Lab : BUN 79 mg/dl , Cr 8.7 mg/dl , Na 138 meq/l , K 4.2 meq/l , Cl 60 meq/l , HO3 54
meq/l . ABG PH 7.43 , PCO2 85 mmHg
Which of the following Acid Base disorder is most compatible with these lab findings
Metabolic Acidosis and Metabolic Alkalosis

Metabolic Acidosis and Respiratory Acidosis
Metabolic Acidosis and Metabolic Alkalosis and Respiratory Acidosis
Metabolic Alkalosis and Respiratory Acidosis
Metabolic Acidosis
v1 ) 35 year old man presented to ER after an episode of Grand mal seizure and by
exam he was afebrile , Bp 130/95 and confused .
Labs showed : Cr 1.0 mg/dl , BUN 12mg/dl , Na 140 meq/L , K 4.8 meq /L , Cl 100
meq/L , HCO3 12 meq/L .
Which of the following is the most appropriate initial treatment for the Metabolic
Acidosis :

Hemodialysis
Fomepizole

HLA antibodies
Acute rejection
Donor illness
3 ) 25 year old man was found to have microscopic hematuria by chance . Urine
analysis showed many RBC /HPF, no RBC casts , no Dysmorphic RBC
Advice him that this is a benign finding , there may be a risk for nephrolithiasis
but it never progresses to Renal failure

5 ) 35 year old female is evaluated because of an elevated Bp 160/105 for the past 2-3
months . Her mother has hypertension and kidney disease , and a maternal aunt is now
on hemodialysis
Labs : Cr 0.8 mg/dl , Na 140 meq/ L , K 5.0 meq /L , Cl 102 meq / L , HCO3 25 MEQ /
l , Urine Analysis is negative .
Which of the following is most likely to provide information regarding cause of her
hypertension .

Renal U/S
Plasma PTH

7 ) 50 year old man has history of recurrent kidney stones which were Ca containing
stones .
Hypercalciuria
Hyperoxaluria
Low urine volume
Hypercitrauria
Hyperuricosuria
Nephrogenic DI
Rhabdomyolysis
Tetany
9 ) According to National kidney foundation guidelines . All the following are

acceptable target PTH levels in CRF as per stage except :


a1-A 64-year-old female is brought to A&E by her family, who are concerned about her
increasing confusion over the past 2 days. On examination she is found to be pyrexial at
38ºC. Blood tests reveal:dssdfsselleds
Hb 9.6 g/dl
Platelets 65 * 109/l
WCC 11.1 * 109/l
Urea 23.1 mmol/l
Creatinine 366 µmol/l
he earaer aeraer asdsadas eerw dssdfsselleds

What is the most likely diagnosis?ia
A.A Wegener's granulomatosisia
B.A Thrombotic thrombocytopenic purpuraia
C.A Haemolytic uraemic syndromeia
D.A Idiopathic thrombocytopenic purpuraia
E.A Rapidly progressive glomerulonephritisia
Next question
HUS or TTP? Neuro signs and purpura point towards TTP
The combination of neurological features, renal failure, pyrexia and thrombocytopaenia

point towards a diagnosis of thrombotic thrombocytopenic purpura
Thrombotic thrombocytopenic purpura

sqweqwesf erwrewfsdfs adasd dhe
Pathogenesis of thrombotic thrombocytopenic purpura (TTP)
• abnormally large and sticky multimers of von Willebrand's factor cause platelets
to clump within vesselshe
• in TTP there is a deficiency of caspase which breakdowns large multimers of von
Willebrand's factorhe
• overlaps with haemolytic uraemic syndrome (HUS)he

Features
• rare, typically adult femaleshe

• feverhe
• fluctuating neuro signs (microemboli)he
• microangiopathic haemolytic anaemiahe
• thrombocytopeniahe
• renal failurehe

Causes
• post-infection e.g. urinary, gastrointestinalhe

• pregnancyhe
• drugs: ciclosporin, oral contraceptive pill, penicillin, clopidogrel, aciclovirhe
• tumourshe
• SLEhe
• HIVhe
_____________________________________________________________________
2-A 25-year-old man has a renal biopsy due to worsening renal function. This reveals
linear IgG deposits along the basement membrane. What is the most likely diagnosis?ia
A.A Systemic lupus erythematousia
B.A IgA nephropathyia
C.A Minimal change diseaseia
D.A Post-streptococcal glomerulonephritisia
E.A Goodpasture's syndromeia
These changes are characteristic of Goodpasture's syndrome
Goodpasture's syndrome
Goodpasture's syndrome is rare condition associated with both pulmonary haemorrhage
and rapidly progressive glomerulonephritis. It is caused by anti-glomerular basement
membrane (anti-GBM) antibodies against type IV collagen. Goodpasture's syndrome is
more common in men (sex ratio 2:1) and has a bimodal age distribution (peaks in 20-30
and 60-70 age bracket). It is associated with HLA DR2
Features
• pulmonary haemorrhage he
• followed by rapidly progressive glomerulonephritishe

Factors which increase likelihood of pulmonary haemorrhage
• young maleshe
• smokinghe
• lower respiratory tract infectionhe
• pulmonary oedemahe
• inhalation of hydrocarbonshe

Investigations
• renal biopsy: linear IgG deposits along basement membranehe

• raised transfer factor secondary to pulmonary haemorrhageshe

Management
• plasma exchangehe
• steroidshe
• cyclophosphamidehe
_____________________________________________________________________
3-Which one of the following is the most common cause of nephrotic syndrome in
children?ia
A.A Minimal change diseaseia
C.A Focal segmental glomerulosclerosisia
D.A Chronic pyelonephritisia
E.A Infantile microcystic diseaseia
Minimal change glomerulonephritis nearly always presents as nephrotic syndrome,

accounting for 75% of cases in children and 25% in adults. The main causes are drugs
(NSAIDs, gold), Hodgkin's lymphoma and thymoma. The majority of cases respond
well to steroids
Glomerulonephritides
Knowing a few key facts is the best way to approach the difficult subject of
glomerulonephritis:
Membranous glomerulonephritis
• presentation: proteinuria / nephrotic syndrome / CRFhe

• cause: infections, rheumatoid drugs, malignancyhe
• 1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop CRFhe

IgA nephropathy - aka Berger's disease, mesangioproliferative GN
• typically young adult with haematuria following an URTIhe

Diffuse proliferative glomerulonephritis
• classical post-streptococcal glomerulonephritis in childhe

• presents as nephritic syndrome / ARFhe

• typically a child with nephrotic syndrome (accounts for 80%)he

• causes: Hodgkin's, NSAIDshe
• good response to steroidshe

Focal segmental glomerulosclerosis
• may be idiopathic or secondary to HIV, heroinhe


Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis
• rapid onset, often presenting as ARFhe

• causes include Goodpasture's, ANCA positive vasculitis, SLEhe

Mesangiocapillary glomerulonephritis (membranoproliferative)
• type 1: cryoglobulinaemia, hepatitis Che

• type 2: partial lipodystrophyhe
_____________________________________________________________________
4-A 5-year-old boy is seen in A&E due to lethargy and pallor. There is no recent history
of diarrhoea. The following results are obtained:
Hb 8.4 g/dl
Platelets 30 * 109/l
Urea 24 mmol/l
araer aeraer asdsadas eerw dssdfsselleds

Urinalysis reveals proteinuria and haematuria. What is the most appropriate
management?ia
A.A IV cyclophosphamideia
B.A Ciprofloxacinia
C.A Oral prednisoloneia
D.A IV methylprednisolone followed by oral prednisoloneia
E.A Plasma exchangeia
There is no role for antibiotics, steroids or immunosuppressants in haemolytic uraemic

syndrome (HUS). Plasma exchange may be indicated, particularly in severe cases of
HUS not associated with diarrhoea
Haemolytic uraemic syndrome

Haemolytic uraemic syndrome is generally seen in young children
Causes
• post-dysentery - classically E coli 0157:H7 ('verotoxigenic',

'enterohaemorrhagic')he
• tumourshe
• pregnancyhe
• ciclosporin, the Pillhe
• systemic lupus erythematoushe
• HIVhe

Management
• treatment is supportive e.g. fluids, blood transfusion and dialysis if requiredhe

• there is no role for antibiotics, despite the preceding diarrhoeal illness in many
patientshe
• the indications for plasma exchange in HUS are complicated. As a general rule
plasma exchange is reserved for severe cases of HUS not associated with
diarrhoeahe
_____________________________________________________________________5-
Which of the following types of renal tubular acidosis is associated with
hyperkalaemia?ia
A.A Type 1 renal tubular acidosisia
B.A Type 2 renal tubular acidosisia
C.A Type 3 renal tubular acidosisia
D.A Type 4 renal tubular acidosisia
E.A Type 5 renal tubular acidosisia
Type 4 renal tubular acidosis is associated with hyperkalaemia
Renal tubular acidosis

All three types of renal tubular acidosis (RTA) are associated with hyperchloraemic
metabolic acidosis (normal anion gap)
Type 1 RTA (distal)
• inability to generate acid urine (secrete H+) in distal tubulehe

• causes hypokalaemiahe
• complications include nephrocalcinosis and renal stoneshe
• causes include idiopathic, RA, SLE, Sjogren'she

Type 2 RTA (proximal)
• decreased HCO3- reabsorption in proximal tubulehe

• complications include osteomalaciahe
• causes include idiopathic, as part of Fanconi syndrome, Wilson's disease,
cystinosis, outdated tetracyclineshe

Type 4 RTA (hyperkalaemic)
• causes hyperkalaemiahe
• causes include hypoaldosteronism, diabeteshe
_____________________________________________________________________6-
A 54-year-old woman with a history membranous glomerulonephritis secondary to
systemic lupus erythematous is admitted to hospital. Her previous stable renal function
has deteriorated rapidly. The following blood tests were obtained:
Na+ 139 mmol/l
K+ 5.8 mmol/l
Urea 44 mmol/l
Albumin 17 g/l
Urinary protein 14 g/24 hours
Urine dipstick protein +++

blood ++

What has likely caused the sudden deterioration in renal function?ia
A.A Exacerbation of SLEia
B.A Renal vein thrombosisia
C.A Bilateral hydronephrosisia
D.A Acute interstitial nephritisia
E.A Analgesic nephropathyia
Nephrotic syndrome predisposes to thrombotic episodes, possibly due to loss of

antithrombin III. These commonly occur in the renal veins and may be bilateral.
Common symptoms include loin pain and haematuria
Nephrotic syndrome: complications

Complications
• increased risk of infection due to urinary immunoglobulin losshe
• increased risk of thromboembolism related to loss of antithrombin III and
plasminogen in the urinehe
• hyperlipidaemiahe
• hypocalcaemia (vitamin D and binding protein lost in urine)he
• acute renal failurehe
_____________________________________________________________________7-
Which one of the following types of glomerulonephritis is most characteristically
associated with partial lipodystrophy?ia
A.A Minimal change diseaseia
B.A Diffuse proliferative glomerulonephritisia
C.A Mesangiocapillary glomerulonephritisia
D.A Membranous glomerulonephritisia
Type 2 mesangiocapillary glomerulonephritis is associated with partial lipodystrophy.

Type 1 is seen in association with hepatitis C and cryoglobulinaemia
glomerulonephritis:











_____________________________________________________________________8-
What is the most common site for extra-renal cysts in a patient with autosomal
dominant polycystic kidney disease (ADPKD)?ia
A.A Pancreasia
B.A Brainia
C.A Liveria
D.A Spleenia
E.A Thyroidia
Most common location of extra-renal cysts in ADPKD is liver
Liver cysts are present in 70% of patients with ADPKD. Around 8% of patients have
berry aneurysms
ADPKD: features
Features
• hypertensionhe
• recurrent UTIshe
• abdominal painhe
• renal stoneshe
• haematuriahe
• CRFhe

Extra-renal manifestations
• liver cysts (70%)he

• berry aneurysms (8%)he
• CVS: mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation,
aortic dissectionhe
• cysts in other organs: pancreas, spleen, thyroidhe
_____________________________________________________________________9-
A 65-year-old female with a 20 year history of rheumatoid arthritis is referred to the
acute medical unit with bilateral leg oedema. The following results are obtained:
aeraer asdsadas eerw dssdfsselleds
Urea 11.2 mmol/l
Albumin 26 g/l
Bilirubin 12 mmol/l
ALP 120 IU/l
Urine protein 6.2 g/24 hours

Which investigation is most likely to lead to the correct diagnosis?ia
A.A CT abdomenia
B.A Plasma magnesiumia
C.A Intravenous urogramia
D.A Rectal biopsyia
E.A Renal angiogramia
This rather odd question fooled most candidates when it appeared. The chronic
inflammatory process (rheumatoid) predisposes to amyloidosis which in turn can cause
nephrotic syndrome. Rectal biopsy is an (infrequent) test done to look for amyloidosis.
Rheumatoid drugs such as gold may cause nephrotic syndrome but none of the other
options point to this as an answer
Amyloidosis: types
AL amyloid
• L for immunoglobulin Light chain fragmenthe

• due to myeloma, Waldenstrom's, MGUShe
• features include: cardiac and neurological involvement, macroglossia, periorbital
eccymoseshe

AA amyloid
• A for precursor serum amyloid A protein, an acute phase reactanthe

• seen in chronic infection/inflammationhe
• e.g. TB, bronchiectasis, rheumatoid arthritishe
• features: renal involvement most common featurehe

Beta-2 microglobulin amyloidosis
• precursor protein is beta-2 microglobulin, part of the major histocompatibility

complexhe
• associated with patients on renal dialysishe
_____________________________________________________________________1
0-Which one of the following types of glomerulonephritis is most characteristically
associated with Goodpasture's syndrome?ia
A.A Diffuse proliferative glomerulonephritisia

B.A Mesangiocapillary glomerulonephritisia
C.A Membranous glomerulonephritisia
D.A Rapidly progressive glomerulonephritisia
E.A Focal segmental glomerulosclerosisia

membrane (anti-GBM) antibodies against type IV collagen
glomerulonephritis:












11-Which one of the following is least recognised as a cause of membranous

glomerulonephritis?ia
A.A Malariaia
B.A Lymphomaia
C.A Hepatitis Bia
D.A Cryoglobulinaemiaia
E.A Goldia
Membranous glomerulonephritis is the commonest type of glomerulonephritis in adults
and is the third most common cause of end-stage renal failure (ESRF). It usually
presents as nephrotic syndrome or proteinuria
Renal biopsy demonstrates:
• sub-epithelial immune complex (mainly IgG and C3) deposition in the

glomerulushe
• electron microscopy: the basement membrane is thickened with sub-epithelial
electron dense depositshe

Causes
• idiopathiche
• infections: hepatitis B, malariahe
• malignancy: lung cancer, lymphoma, leukaemiahe
• drugs: gold, penicillamine, NSAIDshe
• systemic lupus erythematous (class V disease)he

Prognosis - rule of thirds
• one-third: spontaneous remission he

• one-third: remain proteinuriche
• one-third: develop ESRFhe

Management
• immunosuppression: steroids, chlorambucil e.g. Ponticelli regimehe

• BP controlhe
• consider anticoagulationhe
12-Each one of the following is a recognised side-effect of erythropoietin, except:ia
A.A Urticariaia
B.A Hypertensionia
C.A Bone achesia
D.A Long bone fracturesia
E.A Pure red cell aplasiaia
Erythropoietin
Erythropoietin is a haematopoietic growth factor that stimulates the production of
erythrocytes. The main uses of erythropoietin are to treat the anaemia associated with
chronic renal failure and that associated with cytotoxic therapy
Side-effects of erythropoietin
• accelerated hypertension --> encephalopathy, seizures (blood pressure increases

in 25% of patients)he
• bone acheshe
• skin rashes, urticaria, flu-like symptomshe
• pure red cell aplasia (due to antibodies against erythropoietin)he
• raised PCV increases risk of thrombosis (e.g. fistula)he
• iron deficiency 2nd to increased erythropoiesishe
There are a number of reasons why patients may failure to respond to erythropoietin
therapy
• iron deficiencyhe
• inadequate dosehe
• concurrent infection/inflammationhe
• hyperparathyroid bone diseasehe
• aluminium toxicityhe
_____________________________________________________________________1
3-A 10-year-old boy is taken to see the GP by his mother. For the past two days he has
had a sore throat associated with blood in his urine. There is no significant past medical
history. The GP suspects glomerulonephritis and refers the patient to hospital. What
would a renal biopsy most likely show?ia
A.A Proliferation of endothelial cellsia
B.A No changeia
C.A Mesangial hypercellularityia
D.A Basement membrane thickeningia
E.A Capillary wall necrosisia
This boy is likely to have IgA nephropathy. Histological features include mesangial
hypercellularity and positive immunofluorescence for IgA & C3
IgA nephropathy
Basics
• also caused Berger's disease or mesangioproliferative glomerulonephritishe

• commonest cause of glomerulonephritis worldwidehe
• pathogenesis unknown, ?mesangial deposition of IgA immune complexeshe
• histology: mesangial hypercellularity, positive immunofluorescence for IgA &
C3he

Differentiating between IgA nephropathy and post-streptococcal glomerulonephritis
• post-streptococcal glomerulonephritis is associated with low complement

levelshe
• main symptom in post-streptococcal glomerulonephritis is proteinuria (although
haematuria can occur)he
• there is typically an interval between URTI and the onset of renal problems in
post-streptococcal glomerulonephritishe

Presentations
• young male, recurrent episodes of macroscopic haematuriahe

• typically associated with mucosal infections e.g., URTIhe
• nephrotic syndromehe
• renal failurehe

Associated conditions
• alcoholic cirrhosishe
• coeliac disease/dermatitis herpetiformishe

Management
• steroids/immunosuppressants not be shown to be usefulhe

Prognosis
• 25% of patients develop ESRFhe
14-A 73-year-old with a history of alcohol excess is admitted following a fall at home.
On admission the following blood results are obtained:
Urea 3.5 mmol/l
Creatine kinase 180 u/l

Three days later the blood results are as follows:
Urea 14.5
mmol/l
Creatinine 248
µmol/l
Creatine kinase 4,400

u/l
4 Year:
19.30 year old male has IDDM for the past 15 years , now presenting
with lower limb edema .
All the following have a role in the progression of his renal disease except
:
f) Degree of Mesangial expansion on kidney biopsy

g) Decrease in intraglomerular pressure
h) Duration since onset of DM
i) Amount of proteinurea
j) Quitting smoking
20.All the following are true about Focal Segmental Sclerosis ( FSGS)
except :
f) Familial type has better prognosis

g) Progresses fast in Renal failure
h) Collapsing type is associated with HIV
i) Recurrence after transplant is high
j) Main presentation is Nephrotic syndrome
21.25 year old female presented to OPD with Bp 160/100 , she stated
that her Bp was the same over the past 2 weeks .
f) Urine analysis
g) Serum K, Urea ,Cr
h) Lipid profile
i) Fasting blood sugar
j) MRA for renal arteries
22.35 year old female previously healthy presented to ER c/o

generalised weakness , Bp 110/80 . Irregular irregular pulse
f) Bulimia
g) Barter syndrome
h) Hypercalcemia
i) Primary Hyperaldosteronism
j) Diuretic abuse
23.20 year old male came to OPD with c/o of passing red urine , which
was preceded by URTI the previous morning .
f) More common in males

g) May run in families
h) Mesangial expansion by kidney biopsy
i) Symptoms may recur with future URTI
j) Low complement
24.25 year old female was admitted to hospital with referred to OPD
due to incidental finding of the following labs & ABG :
PH 7.32 , HCO3 15
f) Acetazolamide treatment
g) Fanconi syndrome
h) Treatment with Thiazide
i) Primary hyper parathyroid
j) Diarrhea
6 th year:
25.70 year old male presented to OPD with Bp 180/80 , he had similar
readings over the last month otherwise asymptomatic . The best
management for this patient is :
f) Observation
g) Start on Enalapril 5 mg Q day
h) Start on Nifidipine 20 mg + Thiazide 25 mg
i) Start on Furosemide 40 mg Q day
j) Start on α Methyl Dopa 250 mg 1 x 3
26.50 year old patient previously healthy presented with hemoptysis &
hematurea
Labs : Cr 3.0 mg/dl , Urea 70 mg/dl , PO4 5 mg/dl , Ca 9.2 mg/dl . Hb 13 .
Kidney biopsy showed 55 % crescents with linear deposits on basement
membrane by IF . The best management is :
a) Prednisone 20 mg Q day
b) Azathioprine 50 mg Q day + Cyclosporin 1mg/kg/day
c) Plasmapheresis + Methylprednisone IV + Cyclophosmide PO
d) Prednisone 30 mg Q day alternating with Chlorambucil
e) Tacrolimus 1 mg 1x2
27.40 year old male know to have Nephrotic syndrome for 15 years ,
now presenting with Cr 8.0 mg/dl , Urea 100 mg/dl , All the
following are indications to start this patient on dialysis except :
a) Peripheral Neuropathy
b) Anemia
c) Pericarditis
d) Low albumin
e) Bleeding tendency
28.All the following are true about Diabetic Nephropathy except :
f) More likely to occur if patient ha siblings with Nephropathy

g) More severe in black
h) Occurs within 5 years in I DDM
i) It needs 15 years to progress into ESRD after start of overt
proteinurea
j) Mostly preceeded by Diabetic Retinopathy
29.60 year old male known to have Diabetes for 10 years and is on
Enalapril 10 mg 1x2 , presented to ER because all his peripheral
extremities became paralised , Labs K 8.0 meq /L , Cr 1.0 mg/dl.
Which of the following should be used first in the management of
this patient :
a) NAHCO3 Iv
b) Ventolin nebuliser
c) Glucose + insulin Iv
d) K exalate ( Na polysterene Sulfonate )
e) Ca gluconate Iv
30.25 year old male presented c/o of polyurea and weakness , Bp

110/70 , Labs : K 3.0 meq/l , PH 7.46 , HCO3 32 . All the following
could be part of the dfferential of the above case except :
a) Barter Syndrome
b) Furosemide abuse
c) Hypercalcemia
d) Excessive Licorice ingestion
e) Gittleman syndrome
Resident:
31.All the following are true for a Diabetic with ESRD except
a) Oral hypoglycaemic agents should be stopped

b) First year post transplant survival is the same as in the general
population
c) More prone to hypotension during HD than other patients
d) They have higher Insulin requirements
e) PD is associated with increase in Triglycerides level
32.A 40 year old female known to have Membranous GN came to OPD

with 24 hour protein 4 gm/24 hours , Cr 1.0 mg/dl , Urea 40 mg/dl .
Her Bp 160/100 , she was started on Enalapril 20 mg 1x1 . The
desirable Bp reading in such a lady should be :
a) 140/90
b) 130/85
c) 120/75
d) 130/80
e) 135/85
33.20 year old male has a LRD kidney transplant 2 years ago , he is not
known to be Diabetic nor Hypertensive . His medications are
Tacrolimus 3 mg 1x2 , prednisone 5mg 1x2 , MMF 1 gm 1x2, Labs
: FBS 400 mg/dl , Cr 1.0 mg/dl , Urea 35 mg/dl , Tacrolimus level 12
. The next step in managing his Diabetes other than start him on
treatment and re checking his sugar level is :
a) Stop Prednisone
b) Decrease MMF to 500 mg 1x2
c) Stop Tacrolimus
d) Stop MMF , and increase Tacrolimus
e) Decrease Tacrolimus to 2 mg 1x2
34.Each of the glomerular lesions listed below can cause Nephrotic

syndrome . Which of them may be found in all the following
conditions : non – Hodgkins lymphoma , hepatitis B, hepatitis C ,
and infective endocarditis ?
f) Focal and segmental glomerulosclerosis

g) Minimal change disease
h) Membranous nephropathy
i) Type I membranoproliferative glomerulonephritis ( with
subendothelial deposits )
j) Type II membranoproliferative glomerulonephritis ( dense deposit
disease )
35.83 year old male who has DM , CHF,CRI is admitted to hospital

with volume overload & Cr 4.0 mg/dl ( baseline 2.3 mg/dl ) . He was
treated by Iv diuretics , post voiding residual was 250 ml after
foleys catheter was inserted . He was discharged 2 days later with
Cr 3.0 mg/dl . One week lter he came to OPD , Cr is 3.5 mg/dl ,
ultrasound shows mild bilateral hydronephrosis . Which of the
following would best predict the effect of the patient bladder outlet
problem on kidney function :
a) Serum PSA
b) Serum Cr after several days with foleys catheter
c) Kidney size on U/S
d) Retrograde urography
e) Renal Scan
36.49 year old female is evaluated in ER after being found lying in the
street in a semiconscious state , she is known to have hypertension
and a history of seizures. Lab : BUN 79 mg/dl , Cr 8.7 mg/dl , Na
138 meq/l , K 4.2 meq/l , Cl 60 meq/l , HO3 54 meq/l . ABG PH 7.43
, PCO2 85 mmHg. Which of the following Acid Base disorder is
most compatible with these lab findings
f) Metabolic Acidosis and Metabolic Alkalosis

g) Metabolic Acidosis and Respiratory Acidosis
h) Metabolic Acidosis and Metabolic Alkalosis and Respiratory
Acidosis
i) Metabolic Alkalosis and Respiratory Acidosis
j) Metabolic Acidosis
1. Which one of the following is LEAST useful in assessing patient with a

poor prognosis in community-acquired pneumonia?
p- mental confusion
q- urea of 11.4 mmol/l
r- positive C-reactive protein
s- respiratory rate of 35/ min.
t- age 75 years old.


p) Kidney stones
q) Tubulointerstitial disease
r) Papillary necrosis
s) Tuberculosis
t) Acute pyelonephritis
m) Uremia
n) Pulmonary edema
o) Hyperkalemia
p) Infection
e) Hyponatremia
Cause of death in acute renal failure
1. G. Woodrow and
2. J. H. Turney
+Author Affiliations
1. Renal Unit, The General Infirmary at Leeds Great
George Street, Leeds, LSI 3EX, UK
1. Correspondence and offprint requests to: J. H. Turney, Renal Unit, The
General Infirmary at Leeds, Great George Street, Leeds, LSI 3EX, UK.
• Received May 1, 1991.
• Accepted August 12, 1991.
Abstract
The cause of 636 deaths during acute renal failure (ARF) occurring
between 1956 and 1989 were analysed. Deaths due to haemorrhage and to
nonrecovery of renal function have declined but cardiovascular deaths
and withdrawal of active treatment have increased. The causes of death
varied with the clinical situation in which ARF arose. The most important
factor contributing to death was the underlying cause of ARF. 67% deaths
due to sepsis resulted from infection present at the time of development
of ARF. Deaths due to secondary complications have declined, indicating
that the precipitating causes of ARF are the main determinant of overall
mortality
Key words
• acute renal failure
• cause of death
• © 1992 European Dialysis and Transplant Association-European Renal

Association
http://ndt.oxfordjournals.org/content/7/3/230
5. A 29-year-old medical student developed a positive PPD (purified
protein
pins and needles (parasthesia ) in her lower limbs. Administration of which
of
A. Niacin
B. Pyridoxine
C. Riboflavin
D. Thiamine
E. Vitamin C

a- hemophelia A

b- microcytic RBC
d- low serum iron
e- increased TIBC
8.Bilateral hilar lymph nodes enlargement occurs commonly in all the

following Except.
d- Hodgkin lymphoma
e- sarcoidosis

d- reticulosytosis
e- Hemoglobinurea
10.All the following are causes of WORM autoimmune hemolytic anemia

Except.
a- SLE
c- methyldopa

n- aortic regurgitation
o- aortic stenosis
p- mitral stenosis
q- VSD
12 . A 30-year-old man admitted with right sided hemiplegia.Clinical

examination reveals loss of a wave in JVP with irregular irregular pulse. He
has ONE of the following cardiac rhythm abnormalities.
c- atrial flutter
u- carditis
v- Sydenham's chorea
w- Polyarthralgia
x- Erythema marginatum
y- Subcutaneous nodules
14. ONE of the following drugs is LEAST used in treatment of acute sever
asthma.
u- nebulized B2 agonist
v- i.v hydrocortisone
w- epinephrine (adrenaline)
x- oxygen
y- i.v . aminophylline
15. Hypoxia (decreased PaO2) and decreased Pa CO2 is found in all the
following Except.
u- left ventricular failure
v- massive pulmonary embolism
w- acute sever asthma
x- acute exacerbation of COPD
y- pneumonia

f- thrombocytopenia
g- pneumococcal vaccine should be given
h- annual influenza vaccine should be given
i- long term oral penicillin V 500 mg 12 hourly should be given
j- Howell-Jolly bodies are characteristically seen on blood film.
17. ONE of the following drugs is most appropriate in treatment of
pneumocystis carinii pneumonia.
p- clarithromycin
q- ethambutol
r- azithromycin
s- Trimethoprim-Sulphamethoxazole
t- INH and rifampicine
hypertension.
k- decrease cardiac out put.
l- Slow the heart rate
m- Increase cardiac force of contraction
n- Increase cardiac output
o- Decrease plasma volume
19. A healty patient who is HLA-B27 is most likely to develop ONE of the
following.
d- Reiters disease
20. According to Vaughan Williams Classification of antiarrhythmic drugs,

which class would be verapamil belong to?
k- class 1 A
l- class 1 B
m- class 1 C
n- class III
o- class IV
21. All the following are criteria to define sever attack of ulcerative colitis
Except.
b- fever > 37.5 C
e- albumin < 30 g/L

m- Is caused by deposition of monosodium urate monohydrate crystals in
the joints.
n- It is an asy,mmetric arthritis.
o- Can be caused by thaiazide diuretics.
p- It is commoner in females than males 4:1.
q- Attack of gout can be triggered by dehydration.
23. A 32-year-old alcoholic with shock due to bleeding oesphageal varices.

After resuscitation.Which ONE of the following is the treatment of choice.
24 A 65-year-old man with liver cirrhosis presented with ascitis,abdominal

pain, tenderness and peripheral edema. A diagnostic tap revealed a neutrophil
count of 400 /mm 3(normal < 250).
g- Fluid restriction and no added salt diet.
h- Intravenous antibiotics.
i- Oral spironolactone.
j- Therapeutic paracentesis
k- Trans-jugular intrahepatic porto-systemic shunt.
5
25. All the following are recognized complications of Hepatitis C infection

Except.
a- diffuse proliferative glomerilone0phritis.
c- liver cirrhosis
e- cryoglobulinemia
26 ONE of the following tests is most suitable in screening patients for celiac
disease.
d- ESR

d- Hemoptysis
e- Bronchial dilation and wall thicking is shown by high resolution chest CT
scan.

d- Hypercalcemia

c- heat intolerance
d- Tremor

b- dermatomyocytis
6
31. A 72-year-old woman comes to you to control her high blood pressure
(180/100) mmHg.
a- <160/90
j- <150/90
k- <145/90
l- <130/85
m- <120/70

d- gastroparesis
34.Causes of indirect (unconjucated) hyperbilirubinemia include all the

following Except.
Dubin-Johnson syndrome
dacbin joncs[n
[MIM*237500]. an inherited defect in hepatic excretory function

characterized by jaundice with levels of serum bilirubin up to about 6
mg/dL, over half of which is conjugated, and excretion of abnormal
proportions of coproporphyrin I in urine. There is also retention of a
dark pigment in the hepatocytes that is derived either from melanin or
catecholamines, but otherwise liver histology is normal. Oral
cholecystogram fails to visualize the gallbladder, and excretion of test
substances (e.g., bromosulfothalein) by the liver is abnormal. The
basic defect is apparently in canalicular transport. No therapy is
necessary; autosomal recessive inheritance caused by mutation in the
canalicular multispecific organic anion transporter gene (CMOAT) on
10q. Syn: chronic idiopathic jaundice.
35..Precipitating factors for hepatic encephalopathy in patient with liver

cirrhosis include all the following Except.
a- occult infection
36 All the following hepatitis viruses are RNA Except.

a- hepatitis A
b- hepatitis B
c- hepatitis C
d- hepatitis D
e- hepatitis E
7
37.ONE of the following statements is true about treatment of pulmonary
tuberculosis.
First-line
Antimycobacterial ROA Adverse Effects
drugs
I. Isoniazid INH O 1. Peripheral Neuritis –treated by➔ Daily
Pyridoxine (Vitamin B6)
2. Liver Damage➔ Hepatitis
&Hepatotoxicity
3. Optic Neuritis
4. Psychosis
5. Hypersensitivity reactions
# Effect on P-450 ➔ Inhibitor
II. Rifampicin O& Orange-red color of secretions
(Rifampin) PE
1. Nausea & Vomiting
[Should be limited 2. Rash
only when it is very 3. Fever
essential to? 4. Liver Damage➔ Transient disturbance
Avoid Emergence of liver function & Hepatotoxicity
of bacterial 5. Enzyme induction in liver (P-450
Inducer) ➔ decrease effects of drugs
resistance]
metabolized in liver e.g. Warfarin &
OCP
III. Pyrazinamide O 1. Liver Damage➔ May produce liver
toxicity\ hepatitis
2. Hyperuricemia
3. Allergy
4. Sideroblastic anemia
IV. Ethambutol O 1. Optic Neuritis
2. PTs with Renal impairment➔
A. Loss of visual acuity
B. Red-green color blindness
C. Visual field defects
V. Streptomycin IM 1. Ototoxicity
2. Nephrotoxicity
c- pulsus alternans
d- raised JVP
e- pulmonary oedema

b- Kussmaul's sign ( rise JVP/ increased neck vein distension during
inspiration)
c- pulsus paradoxus

a- atenalol
b- propranolol
c- metoprolol
d- bisoprolol
e- carvidalol

b. myelofibrosis
43. All the following may be used in treatment of idiopathic thrombocytopenic

purpura Except.
c. splenectomy
44.A-23- year old woman presents with lethargy, the following blood results
are obtained. Hb 10.4 g/dl, platelet 268x 10 9/L, WBC 6.3X 10 9/L, MCV 65
fl, Hb A2 9% ( NORMAL < 3.5% ),
e. G6PD deficiency
45.A 70-year-old woman is referred to hospital due to evidences of congestive
heart failure. Blood test reveal the following: Hb 7.4 g/dl, MCV 124 fl,
platelets 98 x10 9/l, WBC 3X10 9/L,
a. Schilling test

e. myelofibrosis.

a. stage I
b.stage II
c.stage III B
d. stage III
e. stage IV B.
9
a. elevated WBC
c. splenomegaly

c. G6PD deficiency
e. malaria
51. 20-year old woman presents with a week history of fever, rigor and
productive rusty cough. The chest X-ray shows left lower lobe consolidation.
p- clarithramycin
q- gentamycin
r- Cotrimoxazole
s- Benzypenicillin
t- Flucloxacillin
52. ONE of the following is most likely diagnosis for patient with thyroid
function test showing elevated serum T4 and low radioactive iodine uptake.
a- Grave's disease.
e- pregnancy
conjunctivitis.
g- SLE
h- Gonococcal arthritis
i- Gout
j- Reiter's syndrome
k- Ankylosising spondylitis
10


e. serum creatinin is the early biochemical marker to change in diabetes
nephropathy.
56 All the following are true about calcium metabolism except.

57. A 54- year- old male with Child's grade C hepatic encephalopathy presents
with haemetemesis. Which ONE of the following is most appropriate
immediate therapy?
a. i.v desmopressin
c. i.v. omperazole
d. i.v. propranolol
58. All the following are risk factors for development of peptic ulcer disease
Except.

a. cardiomyopathy
b.hypogonadism
c. Chorea.
e. liver cirrhosis.
11
60. A29- year-old man presents with symptoms of gastroesophageal reflux.
Which ONE of the following is most useful in assessing the role of surgery.
c. sever anemia
e. treatment is by blood transfusion with iron chelating agent (
desferrioxamine)

c- high ESR

b- Kawasaki disease
d- osteoarthritis
12
66. All the following are most likely causes of pyrexia of unknown origin
Except.
b- lymphoma
c- factitious fever
d- viral infection
e- SLE
67. A 50-year old woman has pain in her fingers on exposure to cold,
arthralgia, and difficulty in swallowing solid food.
c- ECG
68. A 20-yea-old male is complaining of arthritis and eye irritation. He has a

history of burring on urination. On examination, he has Right knee effusion
and dermatitis of the glans penis.
69. A pleural effusion analysis results: ratio of concentration of total protein in

pleural fluid to serum of 0. 38 , latate dehydrogenase LDH level of 125 IU,
and ratio of LDH in pleural fluid to serum of 0. 45.
Which of the following ONE disease is the most likely the cause for this
pleural effusion.
k- uremia
l- pulmonary embolism
m- sarcoidosis
n- SLE
o- Congestive heart failure

a- silent chest
c- hypercapnia
e- confusion
13

disturbances
E- Ectopic ACTH Cushing is associated with metabolic acidosis and
hyperkalemia
72. A 50-year-old female , she is 155 cm tall and weighs100 Kg, her fasting
bloods sugar is 150 mg/100 ml on 2 occasions, she is a symptomatic and no
abnormal physical signs on examination.
k- observation
l- medical nutrition therapy
m- insulin
n- sulphonylurea
o- biguanides ( metformin)
73.Increased rennin and angiotensin II is found in ONE of the following

causes of secondary htpertension.
b- Conn's syndrome
d- pheochromocytoma
e- acromegaly
74. Hypocalcemia with increased serum phosphate is found in ONE of the

following
b- osteomalacia
e- malabsorption
75. All the following may be findings in primary hypoadrenalism (Addison's

disease) Except.
e- weight loss
14
77. Modifiable risk factors for ischemic heart disease include all the following
Except.
a- smoking
b- hypertension
c- hyperlipidaemia
d- age
a- amoxicillin
b- tetracycline
c- metronodazo;e
d- clarithramycin
e- strepotomycin
a- hyperkalemia
b- hyperurecemia
c- hypophosphatemia
d- hypocalcemia
b- i.v salbutamol
e- hemodialysis
81. A 57-year-old man develops acute shortness of breath shortly after a 20-
hour automobile ride. He has normal physical examination except for
tachycardia,ECG: shows sinus tachycardia, but is otherwise normal.
k- the patient should admitted to hospital and if there is no
contraindication to anticoagulant, Heparin should be started while
waiting for tests.
l- Normal finding on examination of the lower limbs are extremely
unusual
m- A definitive diagnosis can be made by history alone
n- Early treatment has little effect on overall mortality
o- The disease can be diagnosed definitely by Chest X-Ray
82. Which ONE of the following Arterial Blood Gases is most likely to be
found in a 60-year-old heavy smoker man, He has chronic bronchitis,
peripheral odema and cyanosis?
a- PH 7.50, PO2 75, PCO2 28
b- PH 7.15, PO2 78, PCO2 92
c- PH 7.06, PO2 36, PCO2 95
d- PH 7.06, PO2 108, PCO2 13
e- PH 7.39, PO2 48, PCO2 54
15
83. A 60-year-old man has an inferior myocardial infarction; his heart rate is
45 /min.
k- right coronary artery
l- left main artery
m- left anterior descending artery
n- circumflex artery
o- left mammary artery
84. A patient with stable angina on asprine, nitrate and B-Blocker, developed
3 episodes of sever and long –lasting chest pain each day over the past 3 days.
k- admit the patient and start I.V digoxine
l- admit the patient and start I.V heparine
m- admit the patient and start I.V prophylactic streptokinase
n- admit the patient and for observation without changing his medications
o- Discharge the patient with increasing the dose of B-blocker and nitrate
85. ONE of the following drugs reduces myocardial remodeling after acute
myocardial infarction.
a- ACE inhibitors
b- digoxine
c- verapamil
e- hydralazine.

87. A70 hypertensive woman patient with mild left hemiparesis and finding of
peristant atrial fibrillation. Optimal treatment with anti-hypertensive drugs
would be ONE of the following
c- asprin
d- warfarin
e- I.V heparin
16
b- oral captopril
89. Which ONE of the following should be immediately given to a patient

with ventricular fibrillation.
a-I.V amiodrone
d- I.Vadenosine
e-I.V verapamil
90. Which ONE of the following drugs would be most appropriately used in
treatment of patient with inferior myocardial infarction and has a heart rate of
40/minute .
a- atropine
b- digoxine
c- propranolol
e- heparine
91. After undergoing surgical resection for carcinoma of stomach, a 60-year-

old male develop numbness in the lower limb. Blood film shows macrocytosis
and MCV = 120 fl. The abnormality is most likely due to ONE of the
following
k- folic acid
l- Vit. B12
m- thiamin
n- Vit. K
o- Riboflavin
92. ONE of the following is not a disease –modifing anti-rheumatoid arthritis

drug.
a- sulfasalazine
b- NSAIDs
c- methotrexate
d- leflunamide
93. All the following are early complications of acute myocardial infarction
Except.
b- heart block
17
94. ECG shows ST elevation in leads II, III, AVF, indicate infarction in ONE
of the following
a- anteroseptal MI
b- anterolateral MI
c- posterior MI
d- inferior MI
k) Flattened T waves
l) U waves
m) Shortened QT interval
n) ST segment depression
o) Ectopic beats
96. ONE of the following is LEAST common cause of Microscopical
hematuria
e-Lupus nephritis

p) SLE
q) DM
r) Amyloidosis
s) Membranous glomerulionephritis
t) Autosomal-dominant polycystic kidney disease
98. All the following are true regarding the pathogenesis of lupus
erythematosis except.

a- Conn's syndrome
d- Alkalosis
100. Repeated multiple mouth ulcers are seen in the following conditions
EXCEPT:
e- Mental stress.
Which one of the following would have been most likely to prevent the deterioration in
renal function?ia
A.A Low dose dopamineia
B.A Urinary acidificationia
C.A Intravenous fluidsia
D.A Frusemideia
E.A Mannitolia
Collapse + ARF --> rhabdomyolysis - treat with IV fluids
Intravenous fluids are the most important management step in the prevent of
rhabdomyolysis in such patients
Rhabdomyolysis wesf erwrewfsdfs adasd dhe

Rhabdomyolysis will typically feature in the exam as a patient who has had a fall or
prolonged epileptic seizure and is found to have acute renal failure on admission
Features
• acute renal failure with disproportionately raised creatininehe
• elevated CKhe
• myoglobinuriahe
• hypocalcaemia (myoglobin binds calcium)he
• elevated phosphate (released from myocytes)he

Causes
• seizurehe
• collapse/coma (e.g. elderly patients collapses at home, found 8 hours later)he
• ecstasyhe
• crush injuryhe
• McArdle's syndromehe
• drugs: statinshe

Management
• IV fluids to maintain good urine outputhe

• urinary alkalinization is sometimes usedhe
_____________________________________________________________________1
5-Which one of the following drugs may be safely continued at the same dose in renal
failure?ia
A.A Tetracyclineia
B.A Diclofenacia
C.A Warfarinia
D.A Nitrofurantoinia
E.A Lithiumia
Drugs in renal failure

Questions regarding which drugs to avoid in renal failure are common in the MRCP
Drugs to avoid in renal failure
• antibiotics: tetracycline, nitrofurantoinhe

• NSAIDshe
• lithiumhe
Drugs likely to accumulate in renal failure - need dose adjustment
• most antibiotics including penicillins, cephalosporins, vancomycin,

streptomycinhe
• digoxin, atenololhe
• methotrexatehe
• sulphonylureashe
• frusemidehe

Drugs relatively safe - use in normal dose
• antibiotics: erythromycin, rifampicinhe

• diazepamhe
• warfarinhe
_____________________________________________________________________1
6-Each of the following is a risk factor for renal stone formation, except:ia
A.A Renal tubular acidosisia
B.A Cadmiumia
C.A Hyperparathyroidismia
D.A Dehydrationia
E.A Cystinosisia
Renal stones: risk factors

Risk factors
• dehydrationhe
• hypercalciuria, hyperparathyroidism, hypercalcaemiahe
• cystinuriahe
• high dietary oxalatehe
• renal tubular acidosishe
• medullary sponge kidney, polycystic kidney diseasehe
• beryllium or cadmium exposurehe

Risk factors for urate stones
• gouthe
• ileostomy: loss of bicarbonate and fluid results in acidic urine, causing the
precipitation of uric acidhe

Drug causes
• drugs that promote calcium stones: loop diuretics, steroids, acetazolamide,

theophyllinehe
• thiazides can prevent calcium stones (increase distal tubular calcium
resorption)he
17-Which one of the following causes of glomerulonephritis is associated with normal

complement levels?ia
A.A Post-streptococcal glomerulonephritisia
C.A Subacute bacterial endocarditisia
D.A Goodpasture's syndromeia
E.A Systemic lupus erythematousia

membrane (anti-GBM) antibodies against type IV collagen. Complement levels are
normal
Glomerulonephritis and low complement

Disorders associated with glomerulonephritis and low serum complement levels
• post-streptococcal glomerulonephritishe
• subacute bacterial endocarditishe
• mesangiocapillary glomerulonephritishe
_____________________________________________________________________1
8-Autosomal dominant polycystic kidney disease type 1 is associated with a gene defect
in:ia
A.A Chromosome 4ia

B.A Chromosome 8ia
C.A Chromosome 12ia
D.A Chromosome 16ia
E.A Chromosome 20ia
ADPKD type 1 = chromosome 16 = 85% of cases
ADPKD
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited
cause of kidney disease, affecting 1 in 1,000 Caucasians. Two disease loci have been
identified, PKD1 and PKD2, which code for polycystin-1 and polycystin-2 respectively
he earaer ae
raer asdsadas eerw dssdfsselleds
ADPKD type 1 ADPKD type 2
85% of cases 15% of cases
Chromosome 16 Chromosome 4
Presents with ESRF earlier

The screening investigation for relatives is abdominal ultrasound:
Ultrasound diagnostic criteria (in patients with positive family history)
• two cysts, unilateral or bilateral, if aged < 30 yearshe

• two cysts in both kidneys if aged 30-59 yearshe
• four cysts in both kidneys if aged > 60 yearshe
_____________________________________________________________________1
9-A 27-year-old man is diagnosed with Goodpasture's syndrome. Which one of the
following does not increase the likelihood of a pulmonary haemorrhage?ia
A.A Smokingia
B.A Inhalation of hydrocarbonsia

C.A Male genderia
D.A Dehydrationia
E.A Lower respiratory tract infectionia
Dehydration may decrease the likelihood of a pulmonary haemorrhage. Pulmonary

oedema is associated with an increased risk

Features
• young maleshe
• smokinghe

Investigations

Management
• steroidshe
_____________________________________________________________________2
0-A patient with type 1 diabetes mellitus is reviewed in the nephrology outpatient clinic.
He is known to have stage 1 diabetic nephropathy. Which of the following best
describes his degree of renal involvement?ia
A.A Latent phaseia
B.A Hyperfiltrationia
C.A End-stage renal failureia
D.A Overt nephropathyia
E.A Microalbuminuriaia
For the purposes of the MRCP, increase in the glomerular filtration rate (GFR) is most
characteristic of stage 1 diabetic nephropathy. It is however known that elevation of the
GFR usually persists into stage 2
Diabetic nephropathy: stages

Diabetic nephropathy may be classified as occurring in five stages*:

Stage 1
• hyperfiltration: increase in GFRhe

• may be reversiblehe

Stage 2 (silent or latent phase)
• most patients do not develop microalbuminuria for 10 yearshe

• GFR remains elevatedhe
Stage 3 (incipient nephropathy)
• microalbuminuria (albumin excretion of 30 - 300 mg/day, dipstick negative)he

Stage 4 (overt nephropathy)
• persistent proteinuria (albumin excretion > 300 mg/day, dipstick positive)he

• hypertension is present in most patientshe
• histology shows diffuse glomerulosclerosis and focal glomerulosclerosis
(Kimmelstiel-Wilson nodules)he

Stage 5
• end-stage renal disease, GFR typically < 10ml/minhe

• renal replacement therapy neededhe

The timeline given here is for type 1 diabetics. Patients with type 2 diabetes mellitus
(T2DM) progress through similar stages but in a different timescale - some T2DM
patients may progress quickly to the later stages
_____________________________________________________________________
21-Alport's syndrome is due to a defect in:ia
A.A Type I collagenia
B.A Type II collagenia
C.A Type III collagenia
D.A Type IV collagenia
E.A Type V collagenia
Alport's syndrome
Alport's syndrome is a hereditary condition, usually X-linked dominant but may be
autosomal recessive or dominant. It is due to a defect in the gene which codes for type
IV collagen resulting in an abnormal glomerular-basement membrane (GBM). The
disease is more severe in males with females rarely developing renal failure
A favourite question in the MRCP is an Alport's patient with a failing renal transplant.
This may be caused by the presence of anti-GBM antibodies leading to a Goodpasture's
syndrome like picture
Alport's syndrome usually presents in childhood. The following features may be seen:
• microscopic haematuriahe
• progressive renal failurehe
• bilateral sensorineural deafnesshe
• retinitis pigmentosahe
• lenticonus: protrusion of the lens surface into the anterior chamberhe
_____________________________________________________________________2
2-Which one of the following may be useful in the prevention of calcium renal stones?ia
A.A Pyridoxineia
B.A Allopurinolia
C.A Lithiumia
D.A Ferrous sulphateia
E.A Thiazide diureticsia
Renal stones: management

Calcium stones
• high fluid intakehe

• low animal protein, low salt diet (a low calcium diet has not been shown to be
superior to a normocalcaemic diet)he
• thiazide diuretics (reduce distal tubule calcium resorption)he
• stones < 5 mm will usually pass spontaneouslyhe
• lithotripsy, nephrolithotomy may be requiredhe

Oxalate stones
• cholestyramine reduces urinary oxalate secretionhe

• pyridoxine reduces urinary oxalate secretionhe

Uric acid stones
• allopurinolhe
• urinary alkalinization e.g. oral bicarbonatehe
_____________________________________________________________________2
3-Which one of the following types of glomerulonephritis is associated with fusion of
podocytes on electron microscopy?ia
A.A Membranous glomerulonephritisia
D.A Mesangiocapillary glomerulonephritisia
E.A Minimal change glomerulonephritisia
Minimal change glomerulonephritis

accounting for 75% of cases in children and 25% in adults
Causes
• drugs: NSAIDs, goldhe

• Hodgkin's lymphomahe
• thymomahe

Features
• hypertensionhe
• highly selective proteinuriahe
• renal biopsy: electron microscopy shows fusion of podocytes he

Management
• majority of cases (80%) are steroid responsivehe

• cyclophosphamide is the next step for steroid resistant caseshe
• good prognosishe
24-Fanconi syndrome is associated with each one of the following, except:ia
A.A Hydronephrosisia
B.A Osteomalaciaia
C.A Aminoaciduriaia
D.A Glycosuriaia
E.A Proximal renal tubular acidosisia
Fanconi syndrome
A disorder of renal tubular function
Features
• type 2 (proximal) renal tubular acidosishe

• aminoaciduriahe
• glycosuriahe
• phosphaturiahe
• osteomalaciahe
Causes
• inherited: cystinosis, Wilson's diseasehe

• acquired: renal, Sjogren'she
_____________________________________________________________________
25-A 54-year-old man presents with nephrotic syndrome thought to be secondary to

amyloidosis. A renal biopsy is taken. Which one of the following stains should be
applied to the tissue?i
A.A Rose Bengalia
B.A Pearl's stainia
C.A Congo redia
D.A Periodic acid Schiffia

E.A Cresyl blueia
Amyloidosis
Overview
• amyloidosis is a term which describes the extracellular deposition of an insoluble

fibrillar protein termed amyloidhe
• amyloid is derived from many different precursor proteinshe
• in addition to the fibrillar component, amyloid also contains a non-fibrillary
protein called amyloid-P component, derived from the acute phase protein serum
amyloid Phe
• other non-fibrillary components include apolipoprotein E and heparan sulphate
proteoglycanshe
• the accumulation of amyloid fibrils leads to tissue/organ dysfunctionhe

Classification
• systemic or localizedhe
• further characterised by precursor protein (e.g. AL in myeloma - A for Amyloid,
L for immunoglobulin Light chain fragments)he

Diagnosis
• Congo red staininghe

• serum amyloid precursor (SAP) scanhe
• biopsy of rectal tissuehe
_____________________________________________________________________2
6-Each one of the following is associated with Bartter's syndrome, except:ia
A.A Failure to thriveia
B.A Hypertensionia
C.A Weaknessia
D.A Autosomal recessive inheritanceia
E.A Hypokalaemiaia
Bartter's syndrome is associated with normotension
Bartter's syndrome
Bartter's syndrome is an inherited cause (usually autosomal recessive) of severe
hypokalaemia due to defective chloride absorption at the Na+ K+ 2Cl- cotransporter in
the ascending loop of Henle. It should be noted that is associated with normotension
(unlike other endocrine causes of hypokalaemia such as Conn's, Cushing's and Liddle's
syndrome which are associated with hypertension)
Features
• usually presents in childhood, e.g. failure to thrivehe

• hypokalaemiahe
• normotensionhe
• weaknesshe
_____________________________________________________________________2
7-Which one of the following is least associated with focal segmental
glomerulosclerosis?ia
A.A Alport's syndromeia
B.A Heroinia
C.A Sickle-cell anaemiaia
D.A Sarcoidosisia
E.A HIV infectionia

Causes
• idiopathiche
• secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathyhe
• HIVhe
• heroinhe
• Alport's syndromehe
• sickle-cellhe

Presentations

Focal segmental glomerulosclerosis is noted for having a high recurrence rate in renal
transplants
_____________________________________________________________________
28-A 45-year-old female with nephrotic syndrome develops renal vein thrombosis.
What changes in patients with nephrotic syndrome predispose to the development of
venous thromboembolism?ia
A.A Reduced excretion of protein Sia
B.A Loss of antithrombin IIIia
C.A Reduced excretion of protein Cia
D.A Loss of fibrinogenia
E.A Reduced metabolism of vitamin Kia
Nephrotic syndrome
Triad of
1. Proteinuria (> 3g/24hr) causing
2. Hypoalbuminaemia (< 30g/L) and
3. Oedema
Loss of antithrombin-III, proteins C and S and a associated rise in fibrinogen levels
predispose to thrombosis. Loss of TBG lowers total, but not free thyroxine levels
_____________________________________________________________________
29-Each of the following is a risk factor for renal stone formation, except:ia
A.A Cystinuriaia
B.A Berylliumia
C.A Hypoparathyroidismia
D.A Renal tubular acidosisia

E.A Dehydrationia

Risk factors
• dehydrationhe
• cystinuriahe

• gouthe

Drug causes

theophyllinehe
resorption)he
_____________________________________________________________________3
0-A 45-year-old woman with nephrotic syndrome is noted to have marked loss of
subcutaneous tissue from the face. What is the most likely underlying cause of her renal
disease?ia
A.A Mesangiocapillary glomerulonephritis type IIia
B.A Focal segmental glomerulosclerosisia
C.A Minimal change glomerulonephritisia
D.A Renal vein thrombosisia
E.A Membranous glomerulonephritisia
This patient has partial lipodystrophy which is associated with mesangiocapillary

glomerulonephritis type II
Mesangiocapillary glomerulonephritis
Overview
• aka membranoproliferative glomerulonephritishe

• may present as nephrotic syndrome, haematuria or proteinuriahe
• poor prognosishe

Type 1
• subendothelial immune depositshe

• cause: cryoglobulinaemia, hepatitis Che

Type 2 - 'dense deposit disease'
• intramembranous deposits of electron dense materialhe

• causes: partial lipodystrophy, factor H deficiencyhe
• reduced serum complementhe
• C3b nephritic factor (an antibody against C3bBb) found in 70%he

Type 3
• causes: hepatitis B and Che

Management
• steroids may be effectivehe
_____________________________________________________________________3
1-Which one of the following is not a recognised risk factor for the development of
diabetic nephropathy?ia
A.A Poor glycaemic controlia
B.A Smokingia
C.A Male sexia
D.A Low dietary proteinia
E.A Hypertensionia
Diabetic nephropathy
Basics
• commonest cause of ESRF in western worldhe

• mechanism in type 1 and type 2 diabetes thought to be samehe
• T1DM: 33% of patients by 40 years have diabetic nephropathyhe
• some patients with T1DM seem immune from developing nephropathy, if hasn't
developed by 40 years then low chance of future developmenthe
• approximately 5-10% of patients with T2DM develop ESRFhe

Pathological changes
• basement membrane thickeninghe

• capillary obliterationhe
• mesangial wideninghe

Risk factors for developing diabetic nephropathy
• male sexhe
• poor glycaemic controlhe
• hypertension, hyperlipidaemia, smokerhe
• raised dietary proteinhe
• genetic predisposition (e.g. ACE gene polymorphisms)he
32-What is the most common type of renal stone?ia
A.A Calcium phosphateia
B.A Cystine stonesia
C.A Triple phosphate stonesia
D.A Calcium oxalateia
E.A Xanthine stonesia
Renal stones: imaging

The table below summarises the appearance of different types of renal stone on x-ray
Type Frequency Radiograph

appearance
Calcium oxalate 40% Opaque
Mixed calcium 25% Opaque

oxalate/phosphate stones
Triple phosphate stones 10% Opaque
Calcium phosphate 10% Opaque
Urate stones 5-10% Radio-lucent
Cystine stones 1% Semi-opaque, 'ground-

glass' appearance
Xanthine stones <1% Radio-lucent
_____________________________________________________________________3
3-Which one of the following is least associated with retroperitoneal fibrosis?ia
A.A Riedel's thyroiditisia
B.A Previous radiotherapyia
C.A Inflammatory abdominal aortic aneurysmia
D.A Methysergideia
E.A Sulphonamidesia
Retroperitoneal fibrosis
Lower back pain is the most common presenting feature
Associations
• Riedel's thyroiditishe
• previous radiotherapyhe
• sarcoidosishe
• inflammatory abdominal aortic aneurysmhe
• drugs: methysergidehe
34-Microalbuminuria may be defined as an albumin excretion of:ia
A.A 0.1 - 1 mg/dayia
B.A 30 - 300 mg/dayia
C.A 1 - 10 mg/dayia
D.A 10 - 100 mg/dayia
E.A 3 - 30 mg/dayia
Proteinuria
Microalbuminuria
• defined as an albumin excretion of 30 - 300 mg/dayhe

Albumin:creatinine excretion ratio (ACR)
• used in clinical practice to quantify degree of proteinuriahe

• first morning urine samplehe
• urine albumin (mg) / creatinine (mmol)he
• normal ACR < 2.5he
• microalbuminuric range = 2.5 - 33he
_____________________________________________________________________3
5-What percentage of cardiac output does renal blood flow accounts for:ia
A.A 5%ia
B.A 10%ia
C.A 15%ia
D.A 20-25%ia
E.A 30-35%ia
Renal physiology
Renal blood flow is 20-25% of cardiac output
Renal cortical blood flow > medullary blood flow (i.e. tubular cells more prone to
ischaemia
associated with streptococcal infection in children?ia
A.A Focal segmental glomerulosclerosisia
B.A Diffuse proliferative glomerulonephritisia
D.A Mesangiocapillary glomerulonephritisia
glomerulonephritis:











_____________________________________________________________________3
7-Which one of the following is least recognised as an indication for plasma
exchange?ia
A.A Guillain-Barre syndromeia
B.A Churg-Strauss syndromeia
C.A Myasthenia gravisia
D.A Cerebral malariaia
E.A Goodpasture's syndromeia
Cerebral malaria is not a standard indication for plasma exchange. Exchange

transfusions have been tried but it is generally only justified when peripheral
parasitemia is greater than 10% of circulating erythrocytes. The role of blood
transfusions remains controversial, as they are both expensive and potentially dangerous
in many malaria areas
Plasma exchange
Indications for plasma exchange
• Guillain-Barre syndromehe
• myasthenia gravishe
• Goodpasture's syndromehe
• ANCA positive vasculitis e.g. Wegener's, Churg-Strausshe
• TTP/HUShe
• cryoglobulinaemiahe
• hyperviscosity syndrome e.g. secondary to myelomahe
_____________________________________________________________________3
8-What is the most significant factor leading to the development of anaemia in patients
with chronic kidney disease?ia
A.A Reduced absorption of ironia
B.A Increased erythropoietin resistanceia
C.A Reduced erythropoietin levelsia
D.A Reduced erythropoiesis due to toxic effects of uraemia on bone marrowia
E.A Blood loss due to capillary fragility and poor platelet functionia
Chronic kidney disease: anaemia

Patients with chronic kidney disease (CKD) may develop anaemia due to a variety of
factors, the most significant of which is reduced erythropoietin levels. This is usually a
normochromic normocytic anaemia and becomes apparent when the GFR is less than 35
ml/min (other causes of anaemia should be considered if the GFR is > 60 ml/min).
Anaemia in CKD predisposes to the development of left ventricular hypertrophy -
associated with a three fold increase in mortality in renal patients
Causes of anaemia in renal failure
• reduced erythropoietin levels - the most significant factorhe

• reduced erythropoiesis due to toxic effects of uraemia on bone marrowhe
• reduced absorption of ironhe
• anorexia/nausea due to uraemiahe
• reduced red cell survival (especially in haemodialysis)he
• blood loss due to capillary fragility and poor platelet functionhe
• stress ulceration leading to chronic blood losshe

Management
• the 2006 NICE guidelines suggest a target haemoglobin of 10.5 - 12.5 g/dlhe
• determination and optimisation of iron status should be carried out prior to the
administration of erythropoiesis-stimulating agents (ESA). Many patients,
especially those on haemodialysis, will require IV ironhe
- ESAs such as erythropoietin and darbepoietin should be used in those 'who are
likely to benefit in terms of quality of life and physical function'
_____________________________________________________________________3
A.A Microalbuminuriaia
B.A End-stage renal failureia
C.A Latent phaseia
D.A Hyperfiltrationia
E.A Overt nephropathyia

Stage 1







Stage 5

_____________________________________________________________________4
0-Each one of the following is associated with papillary necrosis, except:ia
A.A Acute pyelonephritisia
B.A Tuberculosisia
C.A Chronic analgesia useia
D.A Syphilisia
E.A Sickle cell diseaseia
Papillary necrosis
Causes
• chronic analgesia usehe

• sickle cell diseasehe
• TBhe
• acute pyelonephritishe
• diabetes mellitushe

Features
• fever, loin pain, haematuriahe

• IVU - papillary necrosis with renal scarring - 'cup & spill'
he___________________________________________________________________41
-Renal cell carcinoma is least associated with which one of the following hormones?ia
A.A Erythropoietinia
B.A Parathyroid hormoneia
C.A Growth hormoneia

D.A ACTHia
E.A Reninia
Renal cell cancer

Overview
• also known as: hypernephromahe

• accounts for 85% of primary renal neoplasmshe
• arises from proximal renal tubular epitheliumhe

Associations
• more common in middle-aged menhe

• smokinghe
• von Hippel-Lindau syndromehe
• autosomal dominant polycystic kidney diseasehe
• tuberose sclerosishe
Features
• classical triad: haematuria, loin pain, abdominal masshe

• pyrexia of unknown originhe
• left varicocele (due to occlusion of left testicular vein)he
• endocrine effects: may secrete EPO (polycythaemia), PTH (hypercalcaemia),
renin, ACTHhe
• 25% have metastases at presentationhe

Management
• radical nephrectomy for confined diseasehe

• in disseminated disease, recent studies have shown a survival advantage for
nephrectomy prior to interferon-alphahe
_____________________________________________________________________4
2-A 6-year-old boy presents is diagnosed as having nephrotic syndrome. A presumptive
diagnosis of minimal change glomerulonephritis is made. What is the most appropriate
treatment?ia
A.A Cyclophosphamideia
B.A Supportive treatment as an inpatientia
C.A Plasma exchangeia
D.A Renal biopsy followed by prednisoloneia
E.A Prednisoloneia
A renal biopsy is only indicated if response to steroids is poor

Causes

• thymomahe

Features
• hypertensionhe

Management

_____________________________________________________________________4
3-What is the best way to differentiate between acute and chronic renal failure?ia
A.A 24 hr creatinineia
B.A Urinary albuminia
C.A Serum creatinineia
D.A Renal ultrasoundia

E.A Serum ureaia
Small kidneys is (usually) a sign of chronic renal failure
Acute vs. chronic renal failure

Best way to differentiate is renal ultrasound - most patients with CRF have bilateral
small kidneys
Exceptions

• diabetic nephropathyhe
• amyloidosishe

Other features suggesting CRF rather than ARF
• hypocalcaemia (due to lack of vitamin D)he
_____________________________________________________________________4
4-Which one of the following features is least likely to be seen in Henoch-Schonlein
purpura?ia
A.A Abdominal painia
B.A Renal failureia
C.A Polyarthritisia
D.A Thrombocytopeniaia
E.A Purpuric rash over buttocksia
Henoch-Schonlein purpura
Henoch-Schonlein purpura (HSP) is an IgA mediated small vessel vasculitis. There is a
degree of overlap with IgA nephropathy (Berger's disease). HSP is usually seen in
children following an infection
Features
• palpable purpuric rash (with localized oedema) over buttocks and extensor
surfaces of arms and legshe
• abdominal painhe
• polyarthritishe
• features of IgA nephropathy may occur e.g. haematuria, renal failurehe
_____________________________________________________________________4
5-Which of the following factors would suggest that a patient has established acute
tubular necrosis rather than pre-renal uraemia?ia
A.A Urine sodium = 10 mmol/Lia
B.A Fractional urea excretion = 20%ia
C.A Increase in urine output following fluid challengeia
D.A Specific gravity = 1025ia
E.A Fractional sodium excretion = 1.5%ia
ATN or prerenal uraemia? In prerenal uraemia think of the kidneys

holding on to sodium to preserve volume
ARF: ATN vs. prerenal uraemia

Prerenal uraemia - kidneys hold on to sodium to preserve volume
Pre-renal Acute tubular

uraemia necrosis
Urine sodium < 20 mmol/L > 30 mmol/L
Fractional sodium < 1% > 1%

excretion*
Fractional urea < 35% >35%

excretion**
Urine:plasma osmolality > 1.5 < 1.1
Urine:plasma urea > 10:1 < 8:1
Specific gravity > 1020 < 1010

Urine 'bland' sediment brown granular casts
Response to fluid Yes No

challenge
*fractional sodium excretion = (urine sodium/plasma sodium) / (urine creatinine/plasma

creatinine) x 100
**fractional urea excretion = (urine urea /blood urea ) / (urine creatinine/plasma
creatinine) x 100
_____________________________________________________________________4
6-Each one of the following is seen in renal osteodystrophy, except:ia
A.A Osteitis fibrosa cysticaia
B.A Primary hyperparathyroidismia
C.A High phosphateia
D.A Low calciumia
E.A Low vitamin Dia
Chronic kidney disease: bone disease

sBasic problems in chronic kidney disease
• low vitamin D (1-alpha hydroxylation normally occurs in the kidneys)he

• high phosphatehe
• low calcium: due to lack of vitamin D, high phosphatehe
• secondary hyperparathyroidism: due to low calcium, high phosphate and low
vitamin Dhe

Several clinical manifestations may result:
Osteitis fibrosa cystica
• aka hyperparathyroid bone diseasehe

Adynamic
• may be due to over treatment with vitamin Dhe

Osteomalacia
• due to low vitamin Dhe

Osteosclerosis
Osteoporosis
47-A 26-year-old man with loin pain and haematuria is found to have autosomal
dominant polycystic kidney disease. A defect in which one of the following genes is
likely to be responsible?ia
A.A Fibrillin-2 geneia
B.A Polycystin geneia
C.A Fibrillin-1 geneia
D.A Von Hippel-Lindau geneia
E.A PKD1 geneia
Most cases of autosomal dominant polycystic kidney disease (ADPKD) are due to a
mutation in the PKD1 gene. The PKD1 gene encodes for a polycystin-1, a large cell-
surface glycoprotein of unknown function
ADPKD


_____________________________________________________________________
48-What is the most likely outcome following the diagnosis of minimal change
nephropathy in a 20-year-old male?
ia
A.A Chronic renal impairment requiring renal replacement therapyia
B.A Persistent proteinuriaia
C.A Full recoveryia
D.A Chronic renal impairment not requiring renal replacement therapyia
E.A Relapsing-remitting courseia

Causes

• thymomahe

Features
• hypertensionhe
Management

_____________________________________________________________________4
9-Each one of the following is a cause of sterile pyuria, except:ia
A.A Renal stonesia
B.A Acute glomerulonephritisia
C.A Renal TBia
D.A Bladder/renal cell canceria
E.A Appendicitisia
Sterile pyuria
Causes
• partially treated UTIhe

• renal TBhe
• appendicitishe
• bladder/renal cell cancerhe
• calculihe
• adult polycystic kidney diseasehe
_____________________________________________________________________5
0-Which of the following types of renal stones are said to have a semi-opaque
appearance on x-ray?ia
A.A Calcium oxalateia
C.A Urate stonesia
D.A Xanthine stonesia

E.A Triple phosphate stonesia
Renal stones on x-ray
• cystine stones: semi-opaque

• urate + xanthine stones: radio-lucent


appearance


glass' appearance
51-A 61-year-old man with a history of hypertension presents with central chest pain.
Acute coronary syndrome is diagnosed and conventional management is given. A few
days later a diagnostic coronary angiogram is performed. The following week a
deteriorating of renal function is noted associated with a purpuric rash on his legs. What
is the most likely diagnosis?ia
A.A Aspirin-induced interstitial nephritisia
B.A Heparin-induced thrombocytopaeniaia
C.A Renal artery stenosisia

D.A Cholesterol embolisationia
E.A Antiphospholipid syndromeia
Cholesterol embolisation is a well-documented complication of coronary angiography
Cholesterol embolisation
Overview
• cholesterol emboli may break off causing renal diseasehe

• seen more commonly in arteriopaths, abdominal aortic aneurysmshe

Features
• eosinophiliahe
• purpurahe
• renal failurehe
• livedo reticularishe
_____________________________________________________________________5
2-Which one of the following statements is true regarding autosomal recessive
polycystic kidney disease?ia
A.A Onset is typically in the third decadeia
B.A Liver involvement is rareia
C.A Is due to a defect on chromosome 16ia
D.A More common than autosomal dominant polycystic kidney diseaseia
E.A May be diagnosed on prenatal ultrasoundia
ARPKD
Autosomal recessive polycystic kidney disease (ARPKD) is much less common than
autosomal dominant disease (ADPKD). It is due to a defect in a gene located on
chromosome 6
Diagnosis may be made on prenatal ultrasound or in early infancy with abdominal

masses and renal failure. End-stage renal failure develops in childhood. Patients also
typically have liver involvement, for example portal and interlobular fibrosis
_____________________________________________________________________5
3-Alport's syndrome is associated with each one of the following, except:ia
A.A Chronic renal failureia
B.A Presentation in childhoodia
C.A Microscopic haematuriaia
D.A Lenticonusia
E.A Anosmiaia
Alport's syndrome
Alport's syndrome is a hereditary condition, usually X-linked dominant but may be
autosomal recessive or dominant. It is due to a defect in the gene which codes for type
IV collagen resulting in an abnormal glomerular-basement membrane (GBM). The
disease is more severe in males with females rarely developing renal failure
A favourite question in the MRCP is an Alport's patient with a failing renal transplant.
This may be caused by the presence of anti-GBM antibodies leading to a Goodpasture's
syndrome like picture
Alport's syndrome usually presents in childhood. The following features may be seen:
• microscopic haematuriahe
• progressive renal failurehe
• bilateral sensorineural deafnesshe
• retinitis pigmentosahe
• lenticonus: protrusion of the lens surface into the anterior chamberhe
_____________________________________________________________________5
4-Each one of the following is a recognised complication of nephrotic syndrome,
except:ia
A.A Hyperlipidaemiaia
B.A Acute renal failureia
C.A Increased risk of infectionia
D.A Hypercalcaemiaia
E.A Increased risk of thromboembolismia

Nephrotic syndrome: complications
Complications
• increased risk of infection due to urinary immunoglobulin losshe

• increased risk of thromboembolism related to loss of antithrombin III and
plasminogen in the urinehe
• hyperlipidaemiahe
• hypocalcaemia (vitamin D and binding protein lost in urine)he
• acute renal failurehe
_____________________________________________________________________5
5-You are asked to review a 75-year-old female on the surgical wards due to
hyperkalaemia. Results are as follows:
Plasma Urine
Na+ (mmol/l) 129 5
K+ (mmol/l) 6.8
Urea (mmol/l) 26 350
Creatinine (µmol/l) 262
Osmolality (mosmol/kg) 296 470

What is the most likely diagnosis?ia
A.A Acute tubular necrosisia
B.A Hyperosmolar non-ketotic comaia
C.A Hydronephrosisia
D.A Prerenal uraemiaia
E.A Pyelonephritisia
The low urine sodium points towards prerenal uraemia, as does the urine:plasma
osmolality and urea ratio


uraemia necrosis

excretion*

excretion**

challenge

creatinine) x 100
creatinine) x 100
_____________________________________________________________________5
A.A Overt nephropathyia
B.A Microalbuminuriaia
C.A Latent phaseia
D.A End-stage renal failureia
E.A Hyperfiltrationia

Stage 1







Stage 5


_____________________________________________________________________5
7-A two-year old boy presents with an abdominal mass. Which of the following is
associated with Wilm's tumour (nephroblastoma)?ia
A.A Deletion on short arm of chromosome 12ia
B.A Tuberose sclerosisia
C.A Beckwith-Wiedemann syndromeia
D.A Autosomal dominant polycystic kidney diseaseia
E.A Autosomal recessive polycystic kidney diseaseia
Beckwith-Wiedemann syndrome is a inherited condition associated with organomegaly,

macroglossia, abdominal wall defects, Wilm's tumour and neonatal hypoglycemia.
Wilm's tumour
Wilm's nephroblastoma
• occurs mostly < 3 years (80% < 5 years); 20% of all childhood malignancieshe

Features
• abdo mass in otherwise well childhe

• also: painless haematuria, abdo pain, anorexia, BP, feverhe
Associations
• Beckwith-Wiedemann syndromehe
• AGR triad of Aniridia, Genitourinary, Retardationhe
• deletion on short arm of chromosome 11he

Management
• USS --> nephrectomy, chemohe

• prognosis: good, 80% cure ratehe
_____________________________________________________________________5
8-A 45-year-old presents to A&E with chest pain. An ECG shows anterior ST elevation
and he is thrombolysed with alteplase. His chest pain settles and he is started on aspirin,
atorvastatin, bisoprolol and ramipril. Three days later his blood results are as
follows:eraer asdsadas eerw dssdfsselleds
Urea 16 mmol/l

What is the most likely cause for the deterioration in renal function?ia
A.A Renal artery stenosisia
B.A NSAID related nephropathyia
C.A Statin nephropathyia
D.A Dressler's syndromeia
E.A Haemorrhage into renal cystia
Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical

kidneys --> renal artery stenosis - do MR angiography
There is likely underlying renal artery stenosis revealed by the addition of an ACE
inhibitor
Renal vascular disease
Renal vascular disease is most commonly due to atherosclerosis (> 95% of patients). It
is associated with risk factors such as smoking and hypertension that cause atheroma
elsewhere in the body. It may present as hypertension, chronic renal failure or 'flash'
pulmonary oedema. In younger patients however fibromuscular dysplasia (FMD) needs
to be considered. FMD is more common in young women and characteristically has a
'string of beads' appearance on angiography. Patients respond well to balloon
angioplasty
Investigation
• MR angiography is now the investigation of choicehe

• CT angiographyhe
• conventional renal angiography is less commonly performed used nowadays, but
may still have a role when planning surgeryhe
_____________________________________________________________________5
9-Which one of the following may be useful in the prevention of oxalate renal stones?ia
A.A Ferrous sulphateia
B.A Thiazide diureticsia
C.A Lithiumia
D.A Pyridoxineia
E.A Allopurinolia
Renal stones: management

Calcium stones
• high fluid intakehe

• low animal protein, low salt diet (a low calcium diet has not been shown to be
superior to a normocalcaemic diet)he
• thiazide diuretics (reduce distal tubule calcium resorption)he
• stones < 5 mm will usually pass spontaneouslyhe
• lithotripsy, nephrolithotomy may be requiredhe
Oxalate stones
• cholestyramine reduces urinary oxalate secretionhe
• pyridoxine reduces urinary oxalate secretionhe

Uric acid stones
• allopurinolhe
• urinary alkalinization e.g. oral bicarbonatehe
_____________________________________________________________________6
0-In Goodpasture's syndrome anti-glomerular basement membrane (anti-GBM)
antibodies are directed against which type of collagen?ia
A.A Type I collagenia
B.A Type II collagenia
C.A Type III collagenia
D.A Type IV collagenia
E.A Type VI collagenia
Features

• young maleshe
• smokinghe
Investigations


Management
• steroidshe
_____________________________________________________________________6
1-A 24-year-old man who has a sister with polycystic kidney diseases asks his GP if he
could be screened for the disease. What is the most appropriate screening test?ia
A.A PKD1 gene testingia
B.A CT abdomenia
C.A Urine microscopyia
D.A Ultrasound abdomenia
E.A Anti-polycystin 1 antibodies levelsia
Ultrasound is the screening test for adult polycystic kidney disease
ADPKD
The screening investigation for relatives is abdominal ultrasound:Ultrasound diagnostic

criteria (in patients with positive family history)

62-Which one of the following is the most common type of SLE associated renal
disease?ia
A.A Class II: mesangial glomerulonephritisia
B.A Class III: focal (and segmental) proliferative glomerulonephritisia
C.A Class IV: diffuse proliferative glomerulonephritisia
D.A Class V: diffuse membranous glomerulonephritisia
E.A Class VI: sclerosing glomerulonephritisia
SLE: renal complications

WHO classification
• class I: normal kidneyhe

• class II: mesangial glomerulonephritishe
• class III: focal (and segmental) proliferative glomerulonephritishe
• class IV: diffuse proliferative glomerulonephritishe
• class V: diffuse membranous glomerulonephritishe
• class VI: sclerosing glomerulonephritishe

Class IV (diffuse proliferative glomerulonephritis) is the most common and severe form
Management
• treat hypertensionhe
• corticosteroids if clinical evidence of diseasehe
• immunosuppressants e.g. azathiopine/cyclophosphamidehe
_____________________________________________________________________6
3-Each one of the following is a recognised side-effect of erythropoietin, except:ia
A.A Hypertensionia
B.A Flu-like symptomsia
C.A Encephalopathyia
D.A Pure red cell aplasiaia
E.A Thrombocytopeniaia
Erythropoietin
Erythropoietin is a haematopoietic growth factor that stimulates the production of
erythrocytes. The main uses of erythropoietin are to treat the anaemia associated with
chronic renal failure and that associated with cytotoxic therapy
Side-effects of erythropoietin
• accelerated hypertension --> encephalopathy, seizures (blood pressure increases

in 25% of patients)he
• bone acheshe
• skin rashes, urticaria, flu-like symptomshe
• pure red cell aplasia (due to antibodies against erythropoietin)he
• raised PCV increases risk of thrombosis (e.g. fistula)he
• iron deficiency 2nd to increased erythropoiesishe

There are a number of reasons why patients may failure to respond to erythropoietin
therapy
• iron deficiencyhe
• inadequate dosehe
• concurrent infection/inflammationhe
• hyperparathyroid bone diseasehe
• aluminium toxicityhe
_____________________________________________________________________6
4-Each one of the following is a feature of renal cell cancer, except:ia
A.A Right-sided varicoceleia
B.A Pyrexia of unknown originia
C.A Loin painia
D.A Haematuriaia
E.A Polycythaemiaia
Renal cell cancer

Overview
• also known as: hypernephromahe

• accounts for 85% of primary renal neoplasmshe
• arises from proximal renal tubular epitheliumhe

Associations
• more common in middle-aged menhe

• smokinghe
• von Hippel-Lindau syndromehe
• tuberose sclerosishe

Features
• classical triad: haematuria, loin pain, abdominal masshe

• pyrexia of unknown originhe
• left varicocele (due to occlusion of left testicular vein)he
• endocrine effects: may secrete EPO (polycythaemia), PTH (hypercalcaemia),
renin, ACTHhe
• 25% have metastases at presentationhe

Management
• radical nephrectomy for confined diseasehe

• in disseminated disease, recent studies have shown a survival advantage for
nephrectomy prior to interferon-alphahe
_____________________________________________________________________6
associated with Wegener's granulomatosis?ia
A.A Mesangiocapillary glomerulonephritisia
B.A Membranous glomerulonephritisia
C.A Rapidly progressive glomerulonephritisia

D.A Focal segmental glomerulosclerosisia
E.A Diffuse proliferative glomerulonephritisia
glomerulonephritis:











_____________________________________________________________________6
6-Each one of the following is typically seen in patients with rhabdomyolysis, except:ia
A.A Elevated ureaia
B.A Hypercalcaemiaia
C.A Elevated serum phosphateia
D.A Elevated creatinine kinaseia
E.A Myoglobinuriaia
Rhabdomyolysis
Rhabdomyolysis will typically feature in the exam as a patient who has had a fall or
prolonged epileptic seizure and is found to have acute renal failure on admission
Features
• acute renal failure with disproportionately raised creatininehe

• elevated CKhe
• myoglobinuriahe
• hypocalcaemia (myoglobin binds calcium)he
• elevated phosphate (released from myocytes)he

Causes
• seizurehe
• collapse/coma (e.g. elderly patients collapses at home, found 8 hours later)he
• ecstasyhe
• crush injuryhe
• McArdle's syndromehe
• drugs: statinshe

Management
• IV fluids to maintain good urine outputhe

• urinary alkalinization is sometimes usedhe
_____________________________________________________________________6
7-A 33-year-old man is admitted with bilateral leg oedema and heavy proteinuria. He
has a history of coeliac disease. What is the likely diagnosis?ia
A.A Diffuse proliferative glomerulonephritisia
D.A Minimal change diseaseia
This man has nephrotic syndrome which is associated with coeliac disease
IgA nephropathy
Basics
• also caused Berger's disease or mesangioproliferative glomerulonephritishe

• commonest cause of glomerulonephritis worldwidehe
• pathogenesis unknown, ?mesangial deposition of IgA immune complexeshe
• histology: mesangial hypercellularity, positive immunofluorescence for IgA &
C3he

Differentiating between IgA nephropathy and post-streptococcal glomerulonephritis
• post-streptococcal glomerulonephritis is associated with low complement

levelshe
• main symptom in post-streptococcal glomerulonephritis is proteinuria (although
haematuria can occur)he
• there is typically an interval between URTI and the onset of renal problems in
post-streptococcal glomerulonephritishe
Presentations
• young male, recurrent episodes of macroscopic haematuriahe

• typically associated with mucosal infections e.g., URTIhe
• renal failurehe

Associated conditions
• alcoholic cirrhosishe
• coeliac disease/dermatitis herpetiformishe
Management
• steroids/immunosuppressants not be shown to be usefulhe

Prognosis
• 25% of patients develop ESRFhe
_____________________________________________________________________6
8-Which one of the following is not a feature of HIV-associated nephropathy?ia
A.A Small kidneysia
B.A Normotensionia
C.A Elevated urea and creatinineia
D.A Proteinuriaia
E.A Focal segmental glomerulosclerosis on renal biopsyia
HIV: renal involvement

Renal involvement in HIV patients may occur as a consequence of treatment or the
virus itself. Protease inhibitors such as indinavir can precipitate intratubular crystal
obstruction
HIV-associated nephropathy (HIVAN) accounts for up to 10% of end-stage renal failure
cases in the United States. Antiretroviral therapy has been shown to alter the course of
the disease. There are five key features of HIVAN:
• massive proteinuriahe
• normal or large kidneyshe
• focal segmental glomerulosclerosis with focal or global capillary collapse on
renal biopsyhe
• elevated urea and creatininehe
• normotensionhe
69-Which one of the following is least recognised as a cause of membranous

A.A Streptococcal infectionia
B.A Penicillamineia
C.A Hepatitis Bia
D.A SLEia
E.A Lymphomaia
Membranous glomerulonephritis is the commonest type of glomerulonephritis in adults
and is the third most common cause of end-stage renal failure (ESRF). It usually
presents as nephrotic syndrome or proteinuria
Renal biopsy demonstrates:
• sub-epithelial immune complex (mainly IgG and C3) deposition in the

glomerulushe
• electron microscopy: the basement membrane is thickened with sub-epithelial
electron dense depositshe

Causes
• idiopathiche
• infections: hepatitis B, malariahe
• malignancy: lung cancer, lymphoma, leukaemiahe
• drugs: gold, penicillamine, NSAIDshe
• systemic lupus erythematous (class V disease)he

Prognosis - rule of thirds
• one-third: spontaneous remission he

• one-third: remain proteinuriche
• one-third: develop ESRFhe

Management
• immunosuppression: steroids, chlorambucil e.g. Ponticelli regimehe

• BP controlhe
• consider anticoagulationhe
70-Which of the following types of renal tubular acidosis is most likely to cause renal
stones?ia

Type 1 RTA (distal)




_____________________________________________________________________7
1-Which one of the following is least associated with minimal change
A.A Hodgkin's lymphomaia
B.A Goodpasture's syndromeia
C.A Thymomaia
D.A Non-steroidal anti-inflammatory drugsia
E.A Gold therapyia
Goodpasture's syndrome is associated with rapidly progressive glomerulonephritis

Causes

• thymomahe

Features
• hypertensionhe

Management

_____________________________________________________________________7
associated with cryoglobulinaemia?ia
A.A Rapidly progressive glomerulonephritisia
D.A IgA nephropathyia
E.A Diffuse proliferative glomerulonephritisia

sKnowing a few key facts is the best way to approach the difficult subject of
glomerulonephritis:












_____________________________________________________________________7
3-Which one of the following is not a risk factor for the development of calcium oxalate
and calcium phosphate renal stones?ia
A.A Bendrofluazideia
B.A Aminophyllineia
C.A Acetazolamideia
D.A Frusemideia
E.A Prednisoloneia
Bendrofluazide may help prevent the formation of calcium based renal stones. It may
however theoretically increase the risk of urate based stones

Risk factors
• dehydrationhe
• cystinuriahe

• gouthe
Drug causes

theophyllinehe
resorption)he
_____________________________________________________________________7
4-The albumin:creatinine excretion ratio (ACR) may be used to quantify the degree of
proteinuria in renal disease. A normal ACR may be defined as:ia
A.A 2.5 - 5ia

B.A < 0.25ia
C.A < 2.5ia
D.A 5 - 50ia
E.A < 25ia
Proteinuria
Microalbuminuria
• defined as an albumin excretion of 30 - 300 mg/dayhe
Albumin:creatinine excretion ratio (ACR)
• used in clinical practice to quantify degree of proteinuriahe

• first morning urine samplehe
• urine albumin (mg) / creatinine (mmol)he
• normal ACR < 2.5he
• microalbuminuric range = 2.5 - 33he
75-Which one of the following causes of glomerulonephritis is associated with low

complement levels?ia
A.A IgA nephropathyia
B.A Membranous glomerulonephritisia
C.A Minimal change diseaseia
D.A Post-streptococcal glomerulonephritisia
E.A Focal segmental glomerulosclerosisia
Glomerulonephritis and low complement

Disorders associated with glomerulonephritis and low serum complement levels
• post-streptococcal glomerulonephritishe
• subacute bacterial endocarditishe
• mesangiocapillary glomerulonephritishe
_____________________________________________________________________
76-Which of the following types of renal stones are radio-lucent?ia
A.A Triple phosphate stonesia
C.A Calcium phosphateia
D.A Xanthine stonesia
E.A Calcium oxalateia
Renal stones on x-ray
• cystine stones: semi-opaque

• urate + xanthine stones: radio-lucent


appearance


glass' appearance

_____________________________________________________________________7
7-Which of the following types of renal tubular acidosis is most likely to cause
osteomalacia?ia

Type 1 RTA (distal)


78-Which one of the following is least recognised as an indication for plasma

exchange?ia
A.A Myasthenia gravisia
B.A Goodpasture's syndromeia
C.A Multiple sclerosisia

D.A Churg-Strauss syndromeia
E.A Cryoglobulinaemiaia
Therapeutic benefit has not been found by controlled trials in patients with multiple
sclerosis
Plasma exchange
Indications for plasma exchange
• Guillain-Barre syndromehe
• myasthenia gravishe
• Goodpasture's syndromehe
• ANCA positive vasculitis e.g. Wegener's, Churg-Strausshe
• TTP/HUShe
• cryoglobulinaemiahe
• hyperviscosity syndrome e.g. secondary to myelomahe
_____________________________________________________________________7
9-Which of the following factors would suggest that a patient has pre-renal uraemia
rather than established acute tubular necrosis?ia
A.A Urine sodium = 70 mmol/Lia
B.A Fractional urea excretion = 20%ia
C.A No response to fluid challengeia
D.A Urine:plasma urea ratio 5:1ia
E.A Specific gravity = 1005ia



uraemia necrosis

excretion*

excretion**

challenge

creatinine) x 100
creatinine) x 100
_____________________________________________________________________8
0-Autosomal dominant polycystic kidney disease type 2 is associated with a gene defect
in:ia
A.A Chromosome 4ia

B.A Chromosome 8ia
C.A Chromosome 12ia
D.A Chromosome 16ia
E.A Chromosome 20ia
ADPKD type 2 = chromosome 4 = 15% of cases
ADPKD


_____________________________________________________________________8
A.A Microalbuminuriaia
B.A End-stage renal failureia

C.A Latent phaseia
D.A Hyperfiltrationia
E.A Overt nephropathyia

Stage 1







Stage 5


_____________________________________________________________________8
2-A 14-year-old boy develops haematuria following an upper respiratory tract infection.
What is the likely diagnosis?ia
A.A IgA nephropathyia
B.A Focal segmental glomerulosclerosisia
C.A Diffuse proliferative glomerulonephritisia
D.A Rapidly progressive glomerulonephritisia
E.A Mesangiocapillary glomerulonephritisia
glomerulonephritis:











_____________________________________________________________________8
3-Which one of the following statements regarding minimal change glomerulonephritis
is incorrect?ia
A.A Has a good prognosisia
B.A The majority of cases are steroid responsiveia
C.A Is a common cause of nephrotic syndromeia
D.A Hypertension is found in approximately 50% of patientsia
E.A Haematuria is rareia
Hypertension and haematuria are rare in minimal change glomerulonephritis

The majority of cases are idiopathic, but in around 10-20% a cause is found:
• drugs: NSAIDs, rifampicinhe

• Hodgkin's lymphoma, thymomahe
• infectious mononucleosishe

Features
• normotension - hypertension is rarehe

Management

Respiratory medicine
RS MCQs Dr. Samah 2019
1. In interstitial lung diseases, lung function tests most often show:
a. Reduced FEV1 and VC xxx
b. Increased total lung capacity (TLC)
c. Airflow obstruction
d. Elevated arterial PCO2.
2. In patients with suspected idiopathic pulmonary fibrosis, the most valuable measure is:
a. Bronchoscopy
b. Sedimentation rate
c. Trial of steroids
d. Open lung biopsy xxx
3."Egg shell" calcification is seen in :

a-Bronchiolitis
b-Silicosis xxx
c-Bronchogenic carcinoma
d-Pulmonary TB
4.Honeycombing of lung in chest radiograph is seen in :

a-pleural effusion
b-Bronchial asthma
c- Bronchial Carcinoma
e-Interstitial lung disease xxx
5.Most common symptom of interstitial Lung disease is:

a-Hemoptysis
b-Progressive dyspnea xxx
c-Substernal discomfort
d-Wheezing
6.Which of the following is one form of "interstitial lung disease".

a-Asthma
b-Bronchiectasis
c-Idiopathic pulmonary fibrosis xxx
d-Pulmonary hypertension
7.the following does not occur with asbestosis

a. Interstitial fibrosis
b. pleural mesothelioma
c. pleural calcification
d. Methhaemoglobinemia xxx
8.which of the following disease coexists with silicosis ?

a. sarcoidosis
b. tuberculosis xxx
c. lymphoma
d. rheumatoid arthritis
9.Which of the following is NOT a common radiological feature of interstitial lung disease:
a- Ground glass pattern
b- Nodular infiltrates
c-Honeycombing
d- Generalized hypertranslucency xxx
10.The main treatment for interstitial lung diseases is:
a- Inhaled steroid
b- Antibiotic
c- Systemic steroid xxx
d- Anticoagulant
11.Which of the following is NOT a feature of idiopathic pulmonary fibrosis?

a- Age of onset greater than 50 years
b- Bilateral apical inspiratory crackles xxx (it is basal not apical)
c- Restrictive pulmonary function test
d- Bilateral basal reticular abnormalities in chest CT
12.Pneumoconiosis is a group of diseases caused by inhalation of:

a- smoke
b- Organic dust
c- Mineral dust xxx
d- Pollens
1) All of the followings are useful for the assessment of the severity of patients with bronchial asthma
except :
a- Spirometry .
b- Methacholine tests
c- ABG (arterial blood gases)
d- Peak expiratory flow rate for variability.
e- Physical examination .
2) Which one of the following pulmonary function values indicates airflow limitation .
a-FEV1 of 60% of predicted .
b-FVC of 60% of predicted .
c-FEV1/FVC of 60% of predicted .
d-DLCO of 60% of predicted .
e- Residual volume of 60% of predicted .
3) All of the followings can be used as a challenge tests for patients with bronchial asthma except ;
a-Methacholine .
b-Histamine .
c-Normal saline .
d-Excersise .
e-Hypertonic saline .
4) Lung’s failure type respiratory failure is characterized by which one o the followings :
a-Normal chest X ray .
b-Hypocapnia or normocapnia .
c-Diffusion is the main mechanism of hypoxia .
d- Easy to correct hypoxia .
e- PEEP is contraindicated .
5) All of the following conditions typically can cause pump failure’s type respiratory failure except :
a-Myasthenia gravis .
b-Multiple rib fractures .
c-Bronchiolitis obliterans .
d-Severe chest pain .
e-Gullien-Barrie syndrome
6- Wide alveolar-arterial Po2 (PA-a O2) gradient can be increased in all of the following conditions
except :
a-Morphine over dose .
b-Severe pneumonia .
c-Acute Bronchial Asthma .
d-Acute Pulmonary edema .
e-ARDS (acute respiratory distress syndrome) .
7)Atopic bronchial asthma is characterized by all of the followings except :

a-Positive family history .
b-Positive immediate reaction to skin prik test to
allergiens.
c-Elevated Ig E level .
d-Affects patients after age of 40 y.
e-Elevated serum eosinophills .
8) – All of the followings are true regarding home monitoring with the PEFR except
a-Usefull in diagnosing asthma
b- Usefull in Identifying environmental triggers of asthma
c- Can detect early signs of deterioration before symptoms change.
d-Long term monitoring is useful for severe brittle asthma .
e- It is less effort dependent than spirometry .
9) The treatment of Bronchial asthma by Anti-inflammatory agents may cause all of the following except:
a-It reduces symptoms .
b-It improves lung function .
C-It decreases BHR (bronchial hyper reactivity).
d-It improves quality of life
e-It may cure the patient from the disease .
10 )Treatment of bronchial asthma by Leukotriene pathway modifiers is more effective in which of

the following conditions ?
a- aspirin and exercise induced asthma .
b-Cough variant asthma .
c-Old age asthmatics .
d- Nocturnal asthma
e-Female asthmatics.
11)The main mechanism of dyspnea is
f. Hypercapnia.
g. alkalosis.
h. Increased work of breathing.
i. Increased deoxygenated Hb .
j. Hypoxia .
12) Noninvasive intermittent positive pressure ventilation (NIIPPV) in acute exacerbations of COPD
patients improves all of the followings except :
a. Blood gases and pH.

b. Airway secreations .
c. In-hospital mortality.
d. The need for invasive mechanical ventilation .
e.The length of hospital stay.
13) One of the following treatment for patients with advanced COPD may improve their survival
a. Exercise and rehabilitation.
b. Nocturnal O2 therapy .
c. Long term O2 therapy (more than 15Hrs) .
d. Prophylactic nebulized antibiotics .
e. Nebulized steroids (budesonide).
14) All of the followings are risk factors for pulmonary tuberculosis except :
a-Close contacts to TB patient
b-Immigration from an endemic area
c-Exposure to under treated cases
-Young adults
-Residence of high incidence location .
15) Regarding pleural effusion caused by TB
a- Fluid analysis Predominated by lymphocytes
b-Fluid positive for AFB stain in less than one third of patients .
c-Negative culture for AFB can’t exclude the disease.
d-Pleural biopsy increases the yield for AFB culture.
e-Usually it is difficult to treat ,and need treatment for 9-12 months .
16)All of the followings are associated with Worse prognosis in sarcoidosis except :
a- Incidious onset
b- Multiple extrathoracic lesion.
c- Blacks..
d- Erythema nodosum.
e- Lupus pernio.
17)All of the followings are true combination between a risk factors and pathgens causing pneumonia
except :
a-Alcoholism and klebsella pneumonia
a- old age and mycoplasma pneumonia
b Cigarette smokers and H .infleunza
c-Mechanical ventilation and pseudomonal pneumonia.
d-Abnormal level of consciousness and anaerobic bacteria
18) This is atypical part of 8 hours polysomnography for a 45 year old male patient .
What is the diagnosis of this patient ?

a-Narcolepsy.
b-Central apnea
c-Obstructive sleep apnea.
d-Mixed apnea .
Hypopnea .
19) ) Next is a typical part of 8 hours polysomnography for a 45 year old male patient .
a-Narcolepsy.
b-Central apnea
d-Mixed apnea .
e-Hypopnea .
20) 19year old man previously healthy presented to the emergency room coughing frish red blood , AFB
stain is negative and the AFB culture is pending , he was given three units of blood after which he remained
thermodynamically stable . a spiral CT scan of the chest using PE protocol showed airspace changes in the
Rt lower lobe ,a bronchoscopy showed large clot in the Rt lower lobe. with no other abnormalities seen
.Which one of the following is the most appropriate next step in the management of this patient ?
a - Start the patient on anticoagulation as therapeutic dose for PE .
b - Start the patent on anti TB treatment.
c - Ask for conventional CT scan.
d - Ask for conventional pulmonary and bronchial angiogram.
e - Sent the patient for Rt lower lobectomy.
21) This is a typical part of 8 hours polysomnography for a 45 year old male patient .

a-Narcolepsy.
b-Central apnea
d-Mixed apnea .
e-Hypopnea
22) All of the followings can be caused by sarcoidosis except :

a- Stridor .
b- Wheezes .
c- Heart block .
d- Facial nerve weakness
e- Hypercalcemia and Hypocalciuria .
23) Which one of the following conditions is an absolute indication for thrombolytic therapy in
patients with PE ?
a- Contraindication for anticoagulation .
b- Large filling defect(s) on spiral CT scan .
c- Hypotention caused by PE .
d- Bilateral PE .
e- presence of ECG changes suggestive of PE .
24) All of the followings are known complications of non invasive ventilation NIV except.
a- Gastric insufflations .
b- Conjunctival Irritation ..
c- Hypotension.
d- Pulmonary edema .
e- Pneumothorax.
25) A 60 year old man , long standing smoker , has progressive dyspnea and prductive cough for the last 2
years .1 week ago had flue like symptoms followed by increase in his symptoms .His best Spirometry taken
2 months ago showed FEV1 1.1 Liter ,FVC 2.2 without changed after inhaled B2 agonist . The ABG taken
10 minuets ago while breathing room air was PH 7.29 , Pa Co2 56 HCO3 32 Po2 35 .
One of the followings is true regarding this patient except :
a- O2 therapy by non rebreathing mask should be started immediately.

b- Hypoventilation is the main mechanism of hypoxia in this patient .
c- CPAP is superior to BiPAP in this patient .
d- After discharge exercise training may improved his survival.
e- After discharge tiotropium is appropriate therapy .
26) A24 year old female patient has 4 days history of fever .chills and left sided chest pain which increased by
inspiration .Chest x ray showed consolidation in the left lower zone with signs of pleural effusion on the same
side .All of the followings are indications for insertion of chest tube and intrapleural thrombolytic therapy
except ;
a- multiloculated fluid by CT scan .

b- LDH of 1500 mg/l
c- Gram stain of the pleural fluid is positive for Gram positive cocci .
d- Fever remained >39 in spite of IV antibiotics .
e- Pleural fluid culture +ve for strep.pneumnia .
27) All of the following statements are true regarding avian influenza except :
a- H5N1 is the killing type.
b- The mortality rate is around 50% .
c- Tamiflu is an effective treatment if given early.
d- Spread from human to human was documented in some cases.
e - R-t PCR is a specific test for the disease .
28) In patients with idiopathic pulmonary fibrosis (usual interstitial pneumonia) all of the followings are
expected physiological changes except :
f. Low DLCO .
g. Decreased FEV1/FVC .
h. Severe O2 desaturation on exercise.
i. Reduced vital capacity and total lung capacity .
j. Increased pulmonary artery pressure .
29)Broncuiolitis obliterans characterized by all of the following conditions except

a- Obstructive changes by spirometry .
b Can complicate bone marrow transplant .
c- Good response to systemic corticosteroid .
d- HRCT scan of the chest typically shows mosaic appearance of air trapping .
e- Transbronchial lung biopsy is in adequate for the diagnosis in most of cases .
30) All of the followings may improve obstructive sleep apnea except :
a- Dental extraction .
b- Weight Reduction .
c- Decrease alcohol consumption .
d- Nasal CPAP
e- Tracheostomy .
31) Nasl CPAP/BiPAP can be used to treate all of the following conditions except :
a- Myasthnia gravis
b- Acute pulmonary edema .
c- Obstructive sleep apnea .
d- Respiratory failure due to severe kyphoscoliosis .
e- Narcolepsy .
32) All of the following statement regarding lung cancer are true except :
f. Smoking is a known risk factor for all types of bronchogenic carcinoma .
g. Adenocarcinoma usually is a peripheral lung tumor .
h. Adenocarcinoma in some cases is difficult to be differentiated from mesothelioma .
i. Thromboembolic disease can be the first manifestation of the disease.
j. Surgery can be curative for early diagnosed cases .
1. Which one of the following is LEAST useful in assessing patient with a poor prognosis in community-
acquired pneumonia?
a- mental confusion
b- urea of 11.4 mmol/l
c- positive C-reactive protein
d- respiratory rate of 35/ min.
e- age 75 years old.
f- 8.Bilateral hilar lymph nodes enlargement occurs commonly in all the following Except.
g- a- pulmonary Tuberculosis
h- b- chronic myeloid leukemia
i- c- non-Hodgkins lymphoma
j- d- Hodgkin lymphoma
k- e- sarcoidosis !! ‫مش أكيد‬
a- nebulized B2 agonist
b- i.v hydrocortisone
c- epinephrine (adrenaline)
d- oxygen
e- i.v . aminophylline
a- left ventricular failure
b- massive pulmonary embolism
c- acute sever asthma
d- acute exacerbation of COPD
e- pneumonia
ONE of the following drugs is most appropriate in treatment of pneumocystis carinii pneumonia.
a- clarithromycin
b- ethambutol
c- azithromycin
d- Trimethoprim-Sulphamethoxazole
e- INH and rifampicine

d- Hemoptysis

d- Hypercalcemia

51. 20-year old woman presents with a week history of fever, rigor and productive rusty cough. The chest X-ray
shows left lower lobe consolidation.
a- clarithramycin
b- gentamycin
c- Cotrimoxazole
d- Benzypenicillin
e- Flucloxacillin
69. A pleural effusion analysis results: ratio of concentration of total protein in pleural fluid to serum of 0. 38 ,
latate dehydrogenase LDH level of 125 IU, and ratio of LDH in pleural fluid to serum of 0. 45.
a- uremia
b- pulmonary embolism
c- sarcoidosis
d- SLE
e- Congestive heart failure

a- silent chest
c- hypercapnia
e- confusion
82. Which ONE of the following Arterial Blood Gases is most likely to be found in a 60-year-old heavy smoker
man, He has chronic bronchitis, peripheral odema and cyanosis?
a- PH 7.50, PO2 75, PCO2 28
b- PH 7.15, PO2 78, PCO2 92
c- PH 7.06, PO2 36, PCO2 95
d- PH 7.06, PO2 108, PCO2 13
f- PH 7.39, PO2 48, PCO2 54
87. All of the following associations between conditions and mechanisms of hypoxia are true, except:
a. COPD and V/Q mismatch (The principal contributor to hypoxemia in COPD patients is
ventilation/perfusion (V/Q) mismatch resulting from progressive airflow limitation)
b. ARDS and pulmonary shunt (edema in patients with ALI/ARDS is impaired gas exchange with
intrapulmonary shunt,)
c. Multiple rib fractures and hypoventilation
d. Hepatopulmonary syndrome and V/Q mismatch (The hepatopulmonary syndrome is characterized by a
defect in arterial oxygenation induced by pulmonary vascular dilatation in the setting of liver disease1)
(Dyspnea and hypoxemia are worse in the upright position (which is called platypnea and orthodeoxia,
respectively)
e. Motor neuron disease and hypoventilation
Answer: C
88. IN patients with sarcoidosis, all of the following are associated with good prognosis, except:
a. Fever
b. Erythema nodosum
c. Age less than 40 years
d. Black race
e. Presence of polyarthritis
Answer: D.
89. Regarding the pathogenesis of bronchial asthma, one of the following is specific for the disease:
a. Air flow limitation
b. Airway hyper-responsiveness
c. Inflammation of the mucosa
d. Peak flow variability
e. Brochioalevolar eosinophils
Answer: B.
90. The most common organism responsible for severe community pneumonia needing ICU care is:
a. Strep. pnuemonia
b. Legionella
c. H. influenza
d. Gram negative bacilli
e. Mycoplasama pneumonia
Answer: Strep. pnuemonia
2. Which one of the following arterial blood gas sets on room air is compatable with
completely compensated metabolic acidosis?
A B C D E
PH 7.44 7.38 7.60 7.36 7.56
PaC02 mmHg 26 25 25 95 40
Bicarb. mEq 18 15 24 49 34
B. Excess -4.0 -10 +4 +15 +11
The pH must be normal. Therefore, exclude “E” and “C”. The correction will be respiratory in the form of
“washed-out” CO2 need to be low. Therefore, exclude D. Bicarbonate will be low. The remaining options are A
& B.
3. Lung’s failure type respiratory failure is characterized by which one o the followings :
f. Normal chest X ray .
g. Hypocapnia or normocapnia .
h. Diffusion is the main mechanism of hypoxia .
i. Easy to correct hypoxia .
j. PEEP is contraindicated .
Answer: B (Lung’s type respiratory failure = type 1 respiratory failure).
Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange
functions: oxygenation and carbon dioxide elimination. In practice, it may be classified as either hypoxemic or
hypercapnic.
Hypoxemic respiratory failure (type I) is characterized by an arterial oxygen tension (Pa O2) lower than 60 mm
Hg with a normal or low arterial carbon dioxide tension (Pa CO2). This is the most common form of respiratory
failure, and it can be associated with virtually all acute diseases of the lung, which generally involve fluid filling
or collapse of alveolar units. Some examples of type I respiratory failure are cardiogenic or noncardiogenic
pulmonary edema, pneumonia, and pulmonary hemorrhage.
Hypercapnic respiratory failure (type II) is characterized by a PaCO2 higher than 50 mm Hg. Hypoxemia is
common in patients with hypercapnic respiratory failure who are breathing room air. The pH depends on the
level of bicarbonate, which, in turn, is dependent on the duration of hypercapnia. Common etiologies include
drug overdose, neuromuscular disease, chest wall abnormalities, and severe airway disorders (eg, asthma
and chronic obstructive pulmonary disease [COPD]).
Source: Medscape, http://emedicine.medscape.com/article/167981-overview
3. All of the followings can be caused by sarcoidosis EXCEPT :

a. Stridor .
b. Wheezes .
c. Heart block .
d. Facial nerve weakness
e. Hypercalcemia and Hypocalciuria .
Answer: A.
4. In patients with idiopathic pulmonary fibrosis (usual interstitial pneumonia) all of the
followings are expected patho physiological changes EXCEPT :
k. Low DLCO .
l. Decreased FEV1/FVC .
m. Severe O2 desaturation on exercise.
n. Reduced vital capacity and total lung capacity .
o. Increased pulmonary artery pressure
Answer: B (increased FEV1/FVC ratio).
5. All of the followings may improve obstructive sleep apnea EXCEPT:
a. Dental extraction .
b. Weight Reduction .
c. Decrease alcohol consumption .
d. Nasal CPAP
e. Tracheostomy
Answer: A
9. All of the following statement regarding lung cancer are true EXCEPT :
k. Small cell lung carcinoma metastasis late in the course of the disease
l. Adenocarcinoma usually is a peripheral lung tumor .
m. Adenocarcinoma in some cases is difficult to be differentiated from mesothelioma .
n. Thromboembolic disease can be the first manifestation of the disease.
o. Surgery can be curative for early diagnosed cases .
Answer: “A. Compared to non-small cell lung cancer, small cell lung cancer is just bad disease. The tumor grows
fast and metastasizes early. Small cell is more often associated with paraneoplastic syndromes (e.g., Eaton-
Lambert) and ectopic hormonal syndromes (e.g., SIADH).
10. All of the followings are useful for the assessment of the severity of an attack of
bronchial asthma, EXCEPT :
a. Spirometry .
b. Methacholine test
c. ABG (arterial blood gases)
d. Peak expiratory flow rate
e. Physical examination.
Answer: B. Methacholine tes: methacholine challenge test: a test that involves the inhalation of increasing
concentrations of methacholine, a potent bronchoconstrictor, in patients with possible bronchial
hyperreactivity; usually performed when a diagnosis of asthma or bronchospastic lung disease is not clinically
obvious. Source: Stedman’s.
11. Which one of the following pulmonary function values indicates airflow limitation
a. FEV1 of 60% of predicted .
b. FVC of 60% of predicted .
c. FEV1/FVC of 60% of predicted .
d. DLCO of 60% of predicted.
e. Residual volume of 60% of predicted.
Answer: C. FEV1/FVC of 60%. Total lung capacity (TLC) is used to assess interstitial lung disease. Expiratory flow
rate (FEV1/FVC is used to assess obstructinve lung disease. Airway obstruction is diagnosed when the FEV1/FVC
is <0.7 (70%0). (Source: MedStudy Pulmonology 2013, p. 6)
9. Wide alveolar-arterial Po2 (PA-a O2) gradient can be increased in all of the following
conditions EXCEPT:
a. Morphine overdose .
b. Severe pneumonia .
c. Acute Bronchial Asthma .
d. Acute Pulmonary edema .
e. ARDS (acute respiratory distress syndrome)
Answer: In morphine overdose ➔ Hypoventilation ➔ No washout of alveolar CO2 and replacement with new
O2 ➔ Both arterial and alveolar O2 are decreased. Therefore, the PAa O2 gradient is decreased.
10. Atopic bronchial asthma is characterized by all of the followings EXCEPT:

a. Positive family history .
b. Positive immediate reaction to skin prik test to allergens.
c. Elevated IgE level .
d. Affects patients after age of 40.
e. Elevated serum eosinophils count.
Answer: D. Onset of asthma early in life.
11. The main mechanism of dyspnea is

k. Hypercapnia.
l. Alkalosis.
m. Increased work of breathing.
n. Increased deoxygenated hemoglobin.
o. Hypoxia .
Answer: A? Hypercapnia ➔ metabolic acidosis?. For hypoxia and deoxygenated hemoglobin, it is true that they
cause dyspnea. But in metabolic acidosis, for example, there is no hypoxia. Nonetheless, there is “dyspnea”.
12. All of the followings are true combination between a risk factor and pathogens causing
pneumonia EXCEPT :
a. Alcoholism and klebsella pneumonia
b. Old age and mycoplasma pneumonia
c. Cigarette smoking and H .infleunza
d. Mechanical ventilation and pseudomonal pneumonia.
e. Abnormal level of consciousness and anaerobic bacteria
Answer: B (Mycoplasma ➔ Young, otherwise healthy patients).
13. This is atypical part of 8 hours polysomnography for a 45 year old male patient
What is the diagnosis of this patient?

a. Narcolepsy.
b. Central apnea
c. Obstructive sleep apnea.
d. Mixed apnea .
e. Hypopnea

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Table of Contents

The file will be updated periodically and modified as

In order to benefit, the file was divided into two parts:

Part one: Contains questions for complete exams.

Part Two: Contains questions related to a specific topic.

Dr. Rami questions :

1. Celiac disease is followed up by :

Dr. Basil questions:

1. hypokalemia didn’t give :

Dr. Noha questions :

1. eye complaint and abnormal color perception in HIV pt due to :

Dr. Samah questions :

5. TB drug that cause problem in vision :

Dr. Jeries questions :

Dr. Mdallal questions : ‫كانت صعبة كثير‬

Dr. AL3ani questions :

Final Exam 2019 4th year (Ihsan)

13-All about bleeding correct except?

5-Pateint taking anti TB and warfarin started feeling (arrythmia?) ?

4- One of the following doesn't cause secondary nephropathy ?

10- male came with urethritis and a diplococci bacteria ?

DR. Mohammed – HEMATOLOGY

2- ITP not affect

4- anemia of chronic disease all false except?

6- Wrong about DIC :

10- All true except ?

7- HIV patient with dry cough bilateral hilar lymphadenopathy + fever ?

8- what is the disease that cause malta fever ?

➢ DR. jeries – ROMATOLOGY :

✓ Most of the questions are same to past years questions

4th year Final exam 2018

6- 40 years old patient complaining of intermittent dysphagia ( ‫)نسيته ذكروني‬

8- not risk factor of poor prognosis gi bleeding :

11- true regarding hepatitis D :

13- Risk factor for Ulcerative colitis to develop malignancy : pancolitis

1- Nerve roots for Biceps reflex : c5 , c6

2- Site of Chemotriger zone for vomiting : Medulla

2- not cause of DIC : essential thrombocytosis

3- True regarding polycythemia vera : ?????

5- Patient with history of treatment of pneumonia ( he took co-triamethaxazole )

6- PT prolongation doesn't occur at : intrinsic pathway

7- one is coagulation disease : Hemophilia B

1- Passive immunization with immunoglobulin as prophylaxis :

2- IV drug user complaining of scenario of infective endocarditis , blood gram stain

4- Contraindicated antibiotic at pregnancy : doxycycline

5- Not a drug used for treatment of TB : bismuth

6- Wrong regarding high risk patient with pneumonia : Respiratory rate is 22

7- True regarding catheter induced UTI :

1- Wrong about Acromegaly : exophalmous

2- Longest insulin half life : Glargine

4- Not cause of cushing : Adrenal hemorrhage

5- Best diagnostic test for addison's : Synacthen ACTH test ??!!

7- DM drug which cause weight loss : ???

8- Elderly came with HF , what drug deteriorate her condition : pioglitazone

9- Wrong regarding treatment of Grave's disease : Methimazole used at pregnancy

11- adverse effect ‫او اشي هيك‬for Methimazole: Agranulocytosis

3- Anaphylactic shock true :

4- ECG question ???!!

6- Case of 2nd degree heart block treament of choice : pacemaker ??!!