Al Quds University

PALESTINE MEDICAL SCHOOL

AL AZHAR UNIVERSITY

Introduction to Clinical Medicine Final Examination

4th YEAR 2009 / 2010

MEDICINEName:

No.

Answer Sheet

QuestionAnswerQuestionAnswerQuestionAnswerQuestionAnswerQuestionAnswer

121416181

222426282

323436383

424446484

525456585

626466686

727476787

828486888

929496989

1030507090

1131517191

1232527292

1333537393

1434547494

1535557595

1636567696

1737577797

1838587898

1939597999

20406080100

Select only one answer

All of the following conditions can lead to malabsorption of nutrients EXCEPT:

A.Crohn's disease

B.Celiac disease

C.Ulcerative colitis

D.Chronic pancreatitis

E.Resection of terminal ileum

63- In a patient with ascites, which of the following physical examination findings suggests a superior vena cava obstruction instead of intrinsic hepatic cirrhosis?

A. Bulging flanks

B. Collateral venous flow downward toward the umbilicus

C. Everted umbilicus

D. Pulsatile liver

E. Venous hum at the umbilicus

73- A54-year-old woman with rheumatoid arthritis (RA) presents with fatigue and low white

count (white blood cells [WBC] 2500/mL) on routine blood work. She has no active joint symptoms and her RA is controlled on lowdose methotrexate and NSAIDs. On examination, she has chronic joint deformities of her hands and a palpable spleen, which is a new finding. Which of the following is the most likely diagnosis for her low white count?

(A) methotrexate therapy

(B) rheumatoid nodules disrupting bone marrow architecture

(C) Feltys syndrome

(D) normal variation

(E) myelofibrosis5. All of the following valvular heart disease lead to systolic murmur EXCEPT:

A. Aortic regurgitation

B. Aortic stenosis

C. Pulmonary stenosis

D. Ventricular septal defect

E. Mitral regurgitation

7. All of the following valvular heart disease lead to diastolic murmur EXCEPT :

A. Mitral valve stenosis

B. Pulmonary valve regurgitation

C. Tricuspid valve stenosis

D. Aortic valve regurgitation

E. Mitral valve prolapse

9. The commonest cause of hypertension is :

A. Primary hypertension

B. Kidney disease

C. Adrenal disease

D. Coarctation of aorta

E. Thyrotoxicosis

10. Normal blood pressure as classified by JNC 7 is :

A. < 120 / < 80

B. 125/80

C. 130/85

D. 140/90

E.160/100

11. All of the following can cause isolated systolic hypertension EXCEPT

A. Ageing

B. Thyrotoxicosis

C. Anaemia

D. Aortic regurgitation

E. Aortic stenosis

14. All of the following are characteristic of innocent murmur ,Except.

A. Grade I to II murmur in left sterna border.

B. Diastolic murmur

C. No other abnormal sounds or murmurs

D. Normal precordium , apex & first heart sound

E. No evidence of left ventricular hypertrophy

15. In hypertensive emergency . all of the following are true EXCEPT :

A. Associated with end organ damage

B. Usually associated with blood pressure > 210 / 130

C. Require immediate reduction of blood pressure within 1 hour

D. Commonly associated with headache & epistaxis

E. The common reason is secondary hypertension

74- A 32-year-old woman develops symptoms secondary to a dry mouth and dry eyes. She

has enlarged salivary glands. Studies for autoantibodies to Ro (SS-A) are positive. Asalivary gland biopsy reveals lymphocytic infiltration. Which of the following is the most likely diagnosis?

(A) sarcoidosis

(B) primary Sjgrens syndrome

(C) human immunodeficiency virus (HIV) infection

(D) lymphoma

(E) amyloidosis75- A young woman presents with a facial rash, arthralgias, and fatigue. The rash on her face is

erythematous and raised, her heart and lungs are normal, and wrists are swollen and tender

on palpation. She has mild thrombocytopenia (90,000/mL). Which of the following is the most appropriate initial autoantibody test?

(A) anti-double-stranded (ds) deoxyribonucleic acid (DNA)

(B) anti-Sm

(C) anti-Ro or La

(D) ANA

(E) antiphospholipid antibodies (lupus anticoagulant)

77- A 63-year-old man presents with weakness and hemoptysis, but no fever, cough, or sputum.

He has a 60-pack-per-year history of smoking. The chest x-ray (CXR) reveals a lung mass with

mediastinal widening. On examination, there is a blue purple discoloration of the upper eyelids and erythema on his knuckles. He has proximal muscle weakness rated 4+/5, normal reflexes, and sensation. Which of the following is the most likely diagnosis for his muscle weakness?

(A) SLE

(B) scleroderma

(C) dermatomyositis (DM)

(D) polyarteritis

(E) Weber-Christian diseasemore severe stiffness at night and hip pain. The symptoms improve in the morning after doing

some stretching exercises. On physical examination, there is paravertebral muscle and

sacroiliac joint tenderness with limited flexion of the lumbar spine. A2/6 diastolic murmur is also heard at the left sternal border radiating to the apex. Which of the following is the most likely diagnosis for the diastolic murmur?

(A) mitral stenosis

(B) tricuspid stenosis

(C) aortic insufficiency

(D) pulmonic insufficiency

(E) tetralogy of Fallot82- A bad batch of potato salad at a company picnic causes 100 people to develop severe gastroenteritis. A 36-year-old man recovers from the diarrhea, but two weeks later develops arthritis in his right knee and severe Achilles tendinitis. What is the most likely diagnosis?

A. Septic arthritis likely from staphylococcal food poisoning

B. Acute gout caused by dehydration and stress

C. Lyme disease contracted at the picnic

D. Reactive arthritis

E. Osteoarthritis

20-A 33 year old intravenous drug abuser is positive for HIV .She has experienced pain on swallowing .Upper endoscopy reveals a few raised , creamy white plaques and several sharply demarcated small areas of shallow ulceration in the mid to lower oesophagus .Which one of the following is the most likely cause of this proble ?

A- Herpes simplex oesophagitis

B- Cytomegalovirus infection of the oesophagus

C- Barretts oesophagus

D- Oesophageal candidiasis

E- Oesophageal web

27- Which one of the following disorders is MOST likely to be associated with H .pylori infection?A Non ulcer dyspepsia.

B Reflux oesophagitis. C Coeliac disease.

D- Gastric lymphoma.

E Achalasia of the cardia.

42- A 55 year old man presents with a six month history of arthralgia and vasculitic skin rash affectin the lower limbs .Further investiation reveals monoclonal and polyclonal cryoglobulins. This condition is often associated with which one of the following infections ?

A- Hepatitis C virus (HCV )

B- Hepatitis B virus (HBV )

C- Epstein Barr virus (EBV )

D- Parvovirus

E- Cytomegalovirus (CMV )

36 Hepatic encephalopathy can be precipitated by each of the following conditions EXCEPT ?

A Upper gastrointestinal bleeding.

B Hypokalaemia.

C- Constipation.

D- Diuretics.

E High carbohydrate diet.

22- Which one of the following types of arthritis.is the MOST common type of psoriatic arthropathy ?

A Distal interphalangeal (DIP ) joint disease.

B Arthritis mutilans.

C Peripheral symmetric arthropathy.

D Peripheral asymmetric oligoarthropathy.E Psoriatic spondylitis.

The following are causes of nephrotic syndrome except:A.Amyloidosis.B.Henoch- Schonlein purpura.C.Renal vein thrombosis.D.Gold therapyE.Minimal Change Glomerulonephritis

All the following are causes of clubbing of fingers EXCEPT:

A. Idiopathic pulmonary fibrosis.

B. Biliary cirrhosis.

C. Bronchiectasis.

D.Bronchial asthma.

E. Chronic lung abscess.

A 65 years old woman presents with a chronic cough. Which of the following problems might be contributing to this symptom

A. Gastroesophageal reflux.

B. Congestive heart failure.

C. Bronchial asthma.

D. Postnasal drip.

E. All of the above.

The commonest cause of hemoptysis is:

A. Lung cancer.

B. Acute bronchitis.

C. Pulmonary tuberculosis.

D. Pulmonary infarction.

E. Mitral stenosis.

Vitiligo is associated with each of the following disorders EXCEPT :

A Nelsons syndrome. B Alopecia areata.

C Graves disease.

D Addisons disease.

E Diabetes mellitus type I

A 67 year old male presents to the Emergency Room with epigastric pain associated with nausea and vomiting, found to be hypotensive .What is the FIRST investigation to be done ?

A Random blood sugar.

B Abdominal X ray.

C Electrocardiogram(ECG )

D Serum amylase.

E Abdominal Ultrasound.

Treatment of peptic ulcer disease in H. pylori positive patient is

A-Proton pump inhibitor + Clarithromycine + Amoxicillin

B-Misoprotol 200ug /x4.

C-Dual therapy is effective as triple therapy.

D-Proton pump inhibitor alone can eradicate H.pylori.

E-Metronidazole is better than Amoxicillin.

The worst prognosis of aortic stenosis is associated with which of the following signs or symptoms.

A.Angina pectoris

B.Congestive heart failure

C.Palpitation

D.Exertional dyspnea

E.Syncope

2009 Part oneQ.1. A 28-year-old law student comes to your clinic complaining of back pain. He is concerned that he has ankylosing spondylitis. Which of the following symptoms would support that diagnosis?A. Back pain worsening on forward flexion with radiation to the buttocksB. Severe back pain in the eveningC. Morning stiffness for two hours in the back that improves with exerciseD. Diarrhea alternating with constipationE. Acute onset of pain after lifting3--A26-year-old woman develops a red rash over her cheeks and pain, and swelling in both wrists as well as several small joints in her hands. The rash gets worse on sun exposure and involves her cheeks, nose, ears, and chin. Medical evaluation reveals oral ulceration and 3+ proteinuria. Which of the following is the most specific test for diagnosis of this condition?(A) lupus erythematosus (LE) cells(B) antinuclear antibody (ANA)(C) anti-Sm antibody(D) anti-Ro antibody(E) antiphospholipid antibody4-A39-year-old woman complains of developing painful pale fingers on cold exposure for the past 5 years. Recently, she has noticed swollen fingers and tight skin, which limit flexion and extension. She also has new abdominal symptoms that are bothersome. On examination, the skin on the fingers is smooth and shiny with associated edema. The rest of the examination is normal. Which part of the gastrointestinal (GI) tract is most frequently involved in thiscondition?(A) esophagus(B) stomach(C) duodenum(D) ileum(E) colon9- Which of the following is not a feature of systemic lupus erythematosus ? A-Thrombocytopenia.B- Seizures.C-Pericardial friction rub.D-Erosive arthritis.E-Isolated pleural effusion

15- In rheumatoid arthritis, which one of the following is true?A. Association of seropositivity with HLA-DR1.B. Concordance rate of > 60% for identical twins.C. Peak incidence in the third decade.D. Progression from predominantly small peripheral joint disease to involve more proximal, larger joints. E. Sacroiliac joint disease is common.

1. Causes of raised JVP include all of the followings except:A. mediastinal lymphoma B. mediastinal irradiation 2 years previously . C. ST elevation in lead rV4 and chest pain D. Liver Cirrhosis .E. Ebstien anomaly

8. The following are major critera of rheumatic fever EXCEPT :A- Erythema marginatum.B- Prolonged P-R interval in ECGC Fleetin arthritis .D Carditis .E Chorea

13- A 23 year-old male is referred to you after developing reddish brown urine 1 day after playing football. He also notes that for the past two days he has had a sore throat and cough. He has no Past Medical Hx, takes no medications and has a family history of nephrolithiasis. Chemistries reveal a BUN of 16 mg/dL and creatinine of 1.0 mg/dL. ANA is negative and C3 is normal. A 24 hour urine protein excretion is 200 mg and creatinine clearance is 120 cc/m. Microscopic analysis reveals many RBC with some dysmorphic cells. Renal U/S is normal. The most likely diagnosis is:A. Post-streptococcal glomerulonephritisB. Minimal change diseaseC. IgA nephropathyD. NephrolithiasisE. Rhabdomyolysis

15- In the evaluation of a patient with raised urea and creatinine, pre-renal failure is unlikely if there is:K. Decreased pulmonary wedge pressure.L. Postural hypotension.M. Urine osmolality > 500 mosm/1.N. Urine sodium > 20 mmol/l O. Urine to plasma urea ration of > 8.

16- A 19-year-old man presents with malaise,nausea, and decreased urine output. He was previously well, and his physical examinationis normal except for an elevated jugular venous pressure (JVP) and a pericardial rub. His electrolytesreveal acute renal failure (ARF). Whichof the following findings on the urinalysis ismost likely in keeping with acute glomerulonephritis (GN)?(A) proteinuria(B) white blood cell casts(C) granular casts(D) erythrocyte casts(E) hyaline casts

11- A63-year-old woman presents for routine evaluation. She has had diabetes for the past 12 years

with complications of neuropathy and retinopathy. You decide to screen her for renal complications

of diabetes. Which of the following findings is not compatible with diabetic nephropathy?

(A) nephrotic range proteinuria

(B) microalbuminuria

(C) hypertension

(D) red blood cell (RBC) casts in urine

(E) renal tubular acidosis (RTA) type IV

16- A 75 year old female is referred to you because of recent onset of lower extremity edema, and 4+ proteinuria on urinalysis. Further work-up revealed 8 grams/day of proteinuria, creatinine clearance of 72 cc/min, HgbA1C of 6%, normal complement levels, negative HIV and hepatitis. She has had a long history of rheumatoid arthritis and has been treated with NSAIDS and brief courses of prednisone. However, on physical examination there is only mild joint destruction. The most likely cause of her proteinuria is:

A. Minimal change disease

B. Membranous nephropathy

C. Amyloidosis

D. Membranoproliferative glomerulonephritis

E. Focal segmental glomerulosclerosis

17- Cyclosporin, all are seen except:

a) Hirsutism

b) Hypertension

c) Renal failure

d) Bone marrow suppression

e) Tremor

22- Hypocomplementaemia is seen in the following ,EXCEPT

A-Ventriculo-atrial shunt nephritis.

B- Membrano-proliferative glomerulonephritis.

C-Acute post streptococcal nephritis.

D-Henoch Schonlein nephritis.

E-Systemic lupus nephritis

25- Which of the following is the drug of choice for hypertensive encephalopathy?

(A) Sodium nitroprusside.

(B) Nifedipine.

(C) Hydralazine.

(D) Methyldopa.

(E) Propranolol

36- In mitral stenosis all are true except:

a) Formal anticoagulation is indicated in severe stenosis without AF

b) low cardiac output state

c) rarely congenital

d) S3 sound is commonly seen

e) 20 % stays in sinus rhythm despite severe stenosis

37- characteristic Complications of long standing hypertension include all of the followings except:

a) Diastolic heart failure

b) Coronary artery disease.

c) Stroke

d) peripheral vascular disease

e) Systolic heart failure

50 - All these statements about Barretts esophagus are true, except:

a) It is associated with 30- to 40-fold greater risk to develop adenocarcinoma

b) It appears as salmon-pink mucosa on endoscopy

c) It is associated with high risk for esophageal bleeding

d) It represents replacement of the stratified squamous epithelium by columnar epithelium with goblet cells

e) It could be a complication of long-standing reflux esophagitis

51- Hepatitis C infection is characterized by which one of the following:

a) Absence of carrier status

b) Highest incidence of chronic hepatitis among other viral hepatitis

c) No increase risk for hepatocellular carcinoma

d) It can be transmitted by eating contaminated food

54-A 51 year old patient with cirrhosis presents with melaena. Urgent upper GI endoscopy does not reveal varices or peptic ulceration. There is chronic gastric congestion, punctate erythema and gastric erosions.

Which one of the following is most likely source of bleeding?

a) Variceal haemorrhage

b) Rectal polyps

c) Portal hypertensive gastropathy

d) Mallory-weiss syndrome

e) Duodenal ulcer

56- A 47-year-old man has a history of drinking 1 to 2 liters of Alcohol per day for the past 20 years. He has had numerous episodes of nausea and vomiting in the past 5 years. He experiences a bout of prolonged vomiting, followed by massive hematemesis. On physical examination in the emergency room, he has vital signs with T 36.8 C, P 110, RR 22, and BP 80/40 mm Hg. His heart has a regular rate and rhythm with no murmurs and his lungs are clear to auscultation. There is no abdominal tenderness or distension and bowel sounds are present. His stool is negative for occult blood. Which of the following is the most likely diagnosis?

A.Barretts esophagus

B.Esophageal stricture

C.Esophageal lacerations (Mallory Weiss syndrome)

D.Esophageal squamous cell carcinoma

E.Achalasia

57- Which of the following statements about alcoholic liver disease is not true?

A. Alcoholic cirrhosis is often characterized by diffuse fine scarring with small regenerative nodules.

B. The ratio of ALT to AST is often higher than 2

C. Elevated MCV can be seen

D. Concomitant hepatitis C significantly accelerates the development of alcoholic cirrhosis.

E. Serum prothrombin times(PT) may be prolonged, but activated partial thromboplastin times(APTT) are usually not affected.

1-Which of the following would be the first indication of infection in a patient with acute hepatitis B? A. Anti-HBc (antibody to hepatitis B core antigen)B. Clinical symptoms such as fever, jaundice, and abdominal painC. HBeAg (hepatitis B e antigen)D. HBsAg (hepatitis B surface antigen) E. Increased transaminases2-A 32-year-old Asian man presents with diarrhoea after returning from a visit to see his family in Pakistan. He is afebrile and also complains of lower abdominal pain. His stools do not contain blood. What is the most likely diagnosis?1 ) Amoebic dysentery2 ) Campylobacter3 ) Giardiasis 4 ) Salmonella5 ) Shigella

5- H.pylori is best diagnosed by a non invasive test , which one you will do :A- Rapid urease test.B-Urea breath test.C-Ig G antibodies.D-Ig M antibodies.E-Biopsy and pathology.6- Bloody diarrhea can be induced by the following, EXCEPTA-E.histolyticaB-Shingella shigaeC-Giardia lambliaD-Ulcerative colitisE.Cancer rectum

7- The most common presentation of primary biliary cirrhoses is:A. Jaundice.B. Ascites.C. Prurtis.D. Splenomegaly.E. Abdomenal pain.8- 35 yo presents w/ nocturnal wheezing. She does not have h/o asthma & has no known allergies. She awakens at 3AM with coughing, SOB, & bronchspasm. Inhalers & prednisone are not helping. Which is the most appropriate diagnostic study ? A. EGD B. Barium Swallow C. 24-hour ambulatory esophageal pHD. Esophageal manometryE. Gastroduodenoscopy

11- A 58 year old patient complains of dysphagia which is progressive and unrelenting. Initially the patient had difficulty in swallowing solids only but recently also liquids. He has lost weight and complains of anorexia. Select the correct diagnosis for each of the above B. carcinoma of the oesophagusC. AchalasiaD. Diffuse oesophageal spasmE. Cricopharyngeal dysfunctionF. Schatzki ring

4- Select the type of anemia in A 32 year-old man, status post terminal ileum resection of crohn's disease:A. Iron deficiency.B. B12 deficiency.C. Aplastic anemia.D. Hemolytic anemia.E. Thalassemia trait.

62- Which of the following extraintestinal manifestations of inflammatory bowel disease typically worsens with exacerbations of disease activity?

A. Ankylosing spondylitis

B. peripheral joint arthritis

C. Nephrolithiasis

D. Primary sclerosing cholangitis

E. Uveitis

178. A 22-year-old female licensed practical nurse is about to start a new position. Hepatitis B vaccination is required prior to beginning work. The patient refuses to have this done because she believes that she has already received the vaccine.

Which of the following laboratory studies would support prior vaccination for hepatitis B virus:

A. Antibody to hepatitis B surface antigen (anti-HBs).

B. Antibody to hepatitis B e antigen (anti-HBe).

C. IgM antibody to hepatitis B core antigen (IgM anti-HBc).

D. IgG antibody to hepatitis B core antigen (IgG anti-HBc).

E. Hepatitis B surface antigen (HbsAg).

175. A 56-year-old white man has a 15-year history of epigastric discomfort and heartburn. He denies dysphagia and weight loss and currently takes no medications. Physical examination is normal. A once-daily proton pump inhibitor is begun and the patients symptoms resolve rapidly.

Which of the following should be done next:

A. Barium swallow.

B. Upper endoscopy.

C. Ambulatory 24-hour oesophageal pH monitoring.

D. Oesophageal manometry.

E. No diagnostic studies are needed.

1. A 20-year-old lady complains of tiredness, intermittent right upper quadrant abdominal pain. She has one child. On examination, unremarkable, she has two small tattoos, CBC and LFT are normal, anti-hepatitis C virus antibodies are positive.

The following statements are false, EXCEPT:

A. Tattooing is the most likely route of infection.

B. She has chronic hepatitis C infection.

C. Urgent liver biopsy is needed.

D. Anti-viral therapy should be offered immediately.

E. There is a risk that she has transmitted HCV infection to her child.

F. A 63 year old man underwent gastroscopy for investigation of long standing history of heartburn and dyspepsia . Barretts oesophagus was diagnosed .Which one of the follwing statewments about this condition is true ?

A- It is asymptomatic in most cases

B- Aapproximatly 20 % per year progress to adenocarcinoma

C- It has autosomal recessive inheritance

D- Helicobacter pylori eradication therapy is very effective initial treatment

E- The lesion is usually located at the mid point of the oesophagus

2. A 43 year- old woman c/o itching that keeps her up at night. PE is normal except for a liver span 7 cm below R costal margin. Labs show: CBC is WNL. Creat 0.8 T.bili 0.6 ALT 78 Alb 4.2 Alk Phos 450 .Which test would you order next for diagnosis?

A. Serum protein electrophoresisB. Anti-smooth-muscle AbC. Antimitochondrial AbD. Technetium-99m liver-spleen scanE. ERCP

3. The gastroscopy report confirmed the diagnosis of duodenal ulcer in a 40 year old man ,The possibility of Helicobacter pylori infection was raised .Which one of the following tests is considered the gold standard for detection of H. pylori infection ?

A. Rapid urease test

B. Gastric biopsy histopathology

C. Gastric biopsy specimen culture

D. H.pylori IgG antibodies in serum

E. H.pylori IgM antibodies in serum

16- A63-year-old man with a long history of alcoholabuse presents with ascites. He is experiencingmild abdominal discomfort and nausea.Examination reveals tense ascites and generalized tenderness but no rigidity. A diagnostic paracentesis of the fluid is performed. Which of the following ascitic fluid results is most likely to suggest an uncomplicated ascites due to portal hypertension from cirrhosis?(A) hemorrhage(B) protein >25 g/L(C) bilirubin level twice that of serum(D) serum to ascites albumin gradient>1.1 g/dL(E) more than 1000 white cells/mm3

12- The following can be an indicator of acute respiratory failure exceptA- cyanosis .B- tachypnea .C- Paco2 55 mmHg .D- grimacing and nasal flaring .E- Pao2 80 mmHg .

17- On clinical examination of the cardiovascular system during inspiration which one of the following findings is consistent with normal physiology?A. An increased jugular venous pressure.B. A diastolic pulmonary venous flow murmur.C. Increased systemic arterial blood pressure.D. Decreased pulse rate.E. Increased splitting of the second heart sound.6-A 63-year-old woman develops exertional angina and has had two episodes of syncope. Examination shows a systolic ejection murmur with radiation to the carotids and a soft S2. Which of the following is the most likely diagnosis?(A) mitral stenosis(B) mitral insufficiency(C) aortic stenosis(D) aortic insufficiency(E) tricuspid stenosis

9- In a patient with severe uraemia ,the following would indicate chronic renal disease EXCEPT :A-Osteodystrophy.B- Skin pigmentation.C-Neuropathy.D-Small kidneysE- PericarditisMultiple Choice Questions (Chest) - Dr. Walid Daoud

Select ONE best answer for the following:

1- A 58-years old man has a routine chest x-ray. He is asymptomatic. The chest x-ray shows a solitary round lung nodule which on biopsy is metastatic carcinoma. The most common primary tumor is;

(a) carcinoma of the thyroid.

(b) renal cell carcinoma.

(c) carcinoma of the liver,

(d) carcinoma of the bladder,

(e) carcinoma of the adrenal gland,

2- The commonest cause of hemoptysis is:

(a) lung cancer.

(b) pulmonary tuberculosis.

(c) bronchiectasis.

(d) acute bronchitis.

(e) bronchial carcinoid tumor.

3- In lung function tests, small airflow limitation can be diagnosed by:

(a) FEV1.

(b) FEV1/FVC %.

(c) FEF 25-75%.

(d) FVC

(e) RV/TLC

4- The drug of choice in treatment of legionella pneumonia is:

(a) ciprofloxacin.

(b) doxycycline.

(c) erythromycin.

(d) penicillin.

(e) ceftriaxone.

5- Pneumatocele in chest x-ray is typically seen in:

(a) pneumococcal pneumonia.

(b) klebsiella pneumonia.

(c) pulmonary tuberculosis.

(d) pulmonary embolism.

(e) staphylococcal pneumonia.6- Drug-induced lung fibrosis is caused by:

(a) ceforuxime.

(b) colchicine.

(c) bleomycin.

(d) trimethoprim-sulfamethoxazole.

(e) ofloxacin.

7- A spirometer can be used to measure directly:

(a) functional residual capacity.

(b) inspiratory capacity.

(c) residual volume.

(d) total lung capacity.

(e) none of the above.

8- A man breathing at 20 breaths per minute has a minute ventilation of 8000 ml/min

and a dead space of 150 ml. His alveolar ventilation is:

(a) 250 ml/min.

(b) 400 ml/min.

(c) 2500 ml/min.

(d) 3000 ml/min.

(e) 5000 ml/min.

9- Which of the following are associated with Mycoplasma pneumoniae infection:

(a erythema multiforme

(b) Reynaud's phenomenon

(c) hemolytic anemia

(d) bullous myringitis

(e) all of the above.

10- All the following are characteristics of chylous pleural effusion EXCEPT:(a) milky white fluid.

(b) triglyceride level more than 110 mg/dl.

(c) the commonest cause is lymphoma.

(d) rich in lymphocytes.

(e) the fluid clears with addition of ethyl alcohol.

11- All of the following are signs of acute severe asthma EXCEPT:

(a) silent chest.

(b) high Pco2.

(c) altered mental status.

(d) diffuse wheezing.

(e) respiratory rate more than 25 breath / min.

12- Which one of the following medications should be initial therapy for a symptomatic

patient with COPD resulting from tobacco abuse:

(a) theophylline.

(b) ipratropium by inhalation.

(c) prednisone.

(d) salmeterol by inhalation.

(e) spironolactone.

13- The antihypertensive drug of choice in asthmatic patients is:

(a) atenolol.

(b) captopril.

(c) nefidepine.

(d) alpha-methyl dopa.

(e) furisemide.

Answer Key:

1- b 8- e

2- d 9- d

3- c 10- e

4- c 11- d

5- e 12- b

6- c 13- c

1. All the following are vitamin Kdependent coagulation factors exceptA. factor X

B. factor VII

C. protein C

D. protein S

E. factor VIII2. Which of the following statements regarding polycythemia vera is correct?

A. An elevated plasma erythropoietin level is not consistent with diagnosis.

B. Transformation to acute leukemia is common.

C. Thrombocytosis correlates strongly with thrombotic risk.

D. Splenomegaly is rare at presentation

E. Hypocellular bone marrow3. A 68-year-old man seeks evaluation for fatigue, weight loss, and early satiety that have been present for about 4 months. On physical examination, his spleen is markedly enlarged. His hemoglobin is 11.1 g/dL, and hematocrit is 33.7%. The leukocyte and platelet count within normal limits. The white cell count differential is 75% PMNs, 8% myelocytes, 4% metamyelocytes, 8% lymphocytes, 3% monocytes, and 2% eosinophils. The peripheral blood smear shows teardrop cells, nucleated red blood cells, and immature granulocytes.

What is the most likely diagnosis?

A. Chronic idiopathic myelofibrosis

B. Chronic myelogenous leukemia

C. Polycythemia vera

D. Acute lymphoblastic leukemia

E. Microangiopathic hemolytic anemia

4. A 50-year-old female presents to your clinic for evaluation of an elevated platelet count. The latest complete blood count is white blood cells (WBC) 7,000/mm3, hematocrit 34%, and platelets 600,000/mm3.

All the following are common causes of thrombocytosis exceptA.Iron-deficiency anemia

B. Essential thrombocytosis

C. Chronic myeloid leukemia

D. Myelodysplasia

E. Pernicious anemia5. All of the following statements regarding the epidemiology of and risk factors for acute myeloid leukemias are true exceptA. Anticancer drugs such as alkylating agents and topoisomerase II inhibitors are the leading cause of drug-associated myeloid leukemias.

B. Individuals exposed to radiation are at risk for acute myeloid leukemia

C. Paraxismal nocturnal hemoglobinuria is a preleukemic disorder

D. The incidence of acute myeloid leukemia is greatest in individuals 70 mmhg.

D. aortic valve area < 0.8 cm.

E. left ventricular hypertrophy.

4. the most common cause of mitral regurge is : A. Rheumatic heart disease.

B. Ischemic.

C. Congenital ( mitral valve prolapse).

D. Inflammatory.

E. Degenerative.

5. Irregular wide complex tachycardia , include all of the following , except:A.. AF, with LBBB.

B. AF , with RBBB.

C. ventricular tachycardia.

D. AF, with aberrant conduction.

E, AF, with WPWN syndrome.

6. 70 years old male patient , presented to the emergency department, with palpitations, dyspnea, dizziness, BP 60/30 MMHG, his ECG , showed fast atrial fibrillation, the treatment of choice is:

A.. amiodarone IV.

B. verapamil.

C. DC SHOCK A SYNCHRONIZED.

D. DC SHOCK, SYNCHRONIZED.

E. digoxin IV.

7. Acute coronary syndrome, include all of the following , except:A. sudden cardiac death.

B. ST elevation MI.

C. Non ST elevation MI.

D. Stable angina .E. Unstable angina.

8. signs of successful streptokinase therapy, include:A. Relief of chest pain.

B. ST segment regression.

C. Reperfusion arrhythmia.

D. Early peak of cardiac enzymes.

E. All of the above.

9. The most specific cardiac enzyme , is:

A. CK( MB).

B. LDH.

C. TPOPONIN.

D. MYOGLOBIN.

E. AST.

10. IN the management of acute coronary syndrome, all of the following drugs, considered evidence based class A,except: A. aspirin.

B. b. blockers.

C. clopidogrel.

D. ca channel blockers.

E. streptokinase , in ST elevation MI.

11.Unstable angina , include all of the following , except:A. angina de novo.

B. crescendo angina.

C. angina at rest.

D. effort angina.

E. post MI angina.

12.Wich of the following drugs, associated with prolongation of the Q-T interval :A. Gentamycin.

B. Digoxin.

C. Erythromycin.

D. Cefalexin.

E. Isoniazed.13. apex beat , in aortic stenosis , is:A. diffuse, in 5th intercostals space, heave , no sustained.

B. localized, shifted out ward , weak, no sustained.

C. localized, shifted downward, forceful, heave sustained.

D. diffuse. Shifted, downward, no sustained.

E. localized, in 5th intercostal space, sustained.

14.All the following are features of Aortic regurge except:A. Head nodding.

B. Pistol shot.

C. paradoxical pulse

D. Corrigan pulse.

E. Hills sign.

15 . Cardiomyopathies, include the following diseases , except;

A. dilated cardiomyopathy.

B. hypert rophic cardiomyopathy.

C. constrictive cardiomyopathy.

D. Right ventricular dysplasia.

E.. Restrictive cardiomyopathy.

ANSWERS:

1. E

2. E

3. E

4. C

5. C

6. D

7. D

8. E

9. C

10. D

11. D

12. C

13. C

14. C

15. C