Tas june 2023

EMQ 1
SAIDH
NEPHROGENIC DI
WATER INTOXICATION
CENTERAL DI
HABITUAL DRINKING
Nephrology 100 %

1. Patient with polyuria, defect in v2 receptors in the

kidney
Nephrogenic DI
2. Pnt with polyuria and polydipsia and newly
diagnosed with craniopharyngioma
Central DI

3. Pnt with hyponatremia and was treated as

pneumonia
SAIDH

EMQ 2
MIXED RESP AND METABOLIC ALKALOSIS
MIXED RESP AND METABOLIC ACIDOSIS
COMPENSATED CHRONIC RESP ACIDOSIS
COMPENSATED CHRONIC RESP ALKALOSIS
ACUTE RESP ACIDOSIS
ACUTE RESP ALKALOSIS
Respiratory 100%

1. PH 7.15 , PCO2 7.7 , HCO3 17.8 (N:19-24)

Mixed resp and metabolic acidosis
2. PH 7.35 , PCO2 9.2 , HCO3 36
Chronic compensated resp acidosis

3. PH 7.2 , PCO2 9.2 , HCO3 21

Acute resp acidosis

EMQ 3
EXON
INTERON
HAPLOID
ALLELE
GENE
DISPENETERANCE
LOCUS
Genetics 100%

1. part of DNA non-coding separating exons

 Intron
2. the coding part of DNA involved in protein
synthesis
Exon
3. cell contain one copy of chromosomal number.
Haploid

EMQ 4

Tidal volume
Functional residual capacity
Forced vital capacity
Residual volume
Total lung capacity
Forced expiratory volume after one second
Respiratory 100%

1. X = tidal volume
2. S= FRC functional residual capacity
3. Y=FEV1

EMQ 5

IGE
IL6
IL5
IL13
TNF ALPHA
CD20
IGA
C5
Pharma 100%
1. Mepolizumab for treatment of asthma
Interleukin 5
Interleukin 2??
2. Eculizumab for treatment of HUS
C5

3. Adalimumab for ttt of rheumatoid arthritis

Tnf alpha

EMQ 6

1. Lead time bias

2. Long-time bias
3. Spectrum bias
4. Systematic bias
5. Response bias
6. Reporting bias
7. Sampling bias
Sop 100%
Researcher conducting study in adolescents with
epilepsy regarding their ttt of epilepsy and effect on
quality of life

a-The research was advertised by poster on OPD

clinic
Sampling bias

b- Adolescent give response there is no difference the

2 intervention so he doesn't publish the reports
Reporting bias

c-Adolescents requested to study examining health

related quality of life submitted fewer responses at
time point 2 than at time point 1
Attrition bias

EMQ 7
1. LT optic tract
2. RT optic tract
3. optic chiasma
4. LT parietal optic tract
5. Rt parietal optic tract
6. Rt temporal optic tract
7. Lt temporal optic tract
8. optic nerve
Ophthalmology 100%
A-Rt temporal visual field loss, Lt nasal visual field
loss
Lt optic tract lesion

B-Bitemporal hemianopia
Optic chiasma

C- Rt temporal lower
quadrant visual field loss, Lt nasal lower quadrant
visual field loss
Lt parietal optic tract lesion

EMQ 8
BOUNDING PULSE
ELEVATED BP
SINGLE 2ND HEART SOUND
FIXED SPLITTED 2ND HEART SOUND
Cardiology 100%

1. Loud Continuous Murmur at LUSE & Biventricular

enlargement.
Pounding pulse

2. Systolic Murmur LUSE & ECG shows RBBB. Fixed

splitting S2
3. Systolic Murmur radiating to the Back, with left
ventricular hypertrophy.
High blood pressure

EMQ 9
FASCIAL NERVE
ABDUCENS NERVE
VEGUS
TROCHLEAR
OPHTHALMIC BRANCH OF MAXILLARY
MANDIBULAR BRANCH OF MAXILLARY
Neurology 100%

1- Responsible for sensation of anterior 2/3 of the

tongue
Fascial nerve

2- Its injury leads to post surgical stridor

Vegus nerve

3- 1st nerve affected due to iih

Abducent nerve

EMQ 10
Haemorrhagic disease of newborn
Factor 9 defeciency
Factor 7 deficiency
Immune thrombocytopenic purpura
Disseminated intravascular coagulation
Hematology 100%

1. 9 days old neonate born at home NVD, came with

bleeding after circumcision , prolonged PT,
normal PTT, low HB
Haemorrhagic disease of newborn

2. Child at foster care , came with multiple bruising ,

had chicken pox few weeks earlier, plt 18 , hb
normal
ITP

3. Girl came with fever 37.8, lethargic, CRT 3 sec,

poor perfusion pt prolonged, ptt prolonged,
fibrinogen 1 ( 1.5-2) , d dimer > 0.5 ( normal < 0.5)

DIC

BOF

1. During sleep, in normal child, how body responding

to hypoxia:
Respiratory 100%

A.Medulla rasp centre

B.Carotid body chemoreceptor
C.Diaphragmatic Vagal nerve sensation
D.Chest wall receptors
E. Larynx receptors

2. Gallick competence of a girl15 yr old with ALL who

refuses chemo for 40% chance cure. She does not like
to complete her ttt
Ethics 100%

A.Parents want her to proceed:

B.Go with parent wishes
C.Don't ttt according to her wish
D.Seek legal advice
E. Health committee

3. Which is fat soluble vitamin

Nutrition
A.Vitamin A
B.Vitamin B12
C.Vitamin c
D.Vitamin B2
4. Which of the following bacteria attacked by T Cell
mediated immunity
Immunology 100%

A.Mycobacteria
B.Strep. Pneumonia
C.Neisseria
D.Klebsiella
E.Staph aureus

5. Toxic shock syndrome what is the mechanism of

action of toxin :
Infection & immunology 100%

A. activation of B cells
B. activation of T cells
C. activation of Macrophages

6. what commonest among children associated with

HLA B27
MSK 100%
A- oligoarticular Jia
B- polyarticular Jia
C- systemic onset Jia
D- enthesitis related arthritis
E- psoriatic arthritis
7.Morphine mechanism of action
Pharma 100%
A.Conjugation
B.Cytochrome p450
C.Glucuronidation
D.Sulphation

8.Hirschsprung disease pathophysiology:

GIT 100%

A.Cholinergic activity decreases throughout large bowel

B.Absent myenteric and submucosal plexuses in the
large bowel
C.Cholinergic inhibitory activity predominates over
excitatory adrenergic in control of smooth muscle tone
D.innervation is patchy throw out large bowel Control of
smooth muscle is predominantly intrinsic

9. Neonate 3 weeks screening done showed high TSH

then radioisotope show no uptake And absent thyroid
tissue what is the reason of this finding :
neonatology 100 % & endocrine 100%
A.Defect migration of thyroglossal duct
B.Transcription defect of the development of thyroid
gland
C. Defect in binding of free thyroxine to the thyroid TSH
receptor in low ia
 D. Defect iodine transport into thyroid follicle
E.Defect in coupling of tyrosine residue result in
defective thyroglobulin

10. Child 2yrs old with coryzal illness, stridor, barking

cough and no drolling, which organism responsible
for this illness
respiratory 100% & infection 100%

A.Parainfluenza virus
B.Haemophilus influenzae
C.RSV
D.Diphtheria

11. 14 yrs old , runner presented with acute limb pain ,

haemarthrosis, prolonged ptt
HematoLogy 100%

A. Factor 7
B. Factor 9
C.Factor 2
D.Factor 10

12. 7 mths , wheezy chest, dyspnea , O sat 90 after

salbutamol 89
respiratory 100%
 A. Decrease V/Q mismatch
B. Inflammation rather than bronchoconstriction
C.Defective b2 receptors at the Age of 7 months

13. Which causes lt to RT shunt through foramen

ovale after cord clamping
cardiology 100%
A. Pulmonary vasodilatation
B.Increase of systemic resistance
C. Increase Right atrial pressure
D.Placental circulation interruption

14. Girl with hypertension, hyperthermia & dilated

pupils, What is the causative drug ?
Pharma 100%

A.Amphetamine
B.TCA
C.Carbamazepine
D.Oxybutunin

15. Mechanism of action of metformin

Pharma 100%

A.Inhibit the hepatic enzymatic glycogenolysis

B.Bind to enzyme system to Increase glucose uptake by
muscle cell
 C.Increase production of insulin

16. Mechanism of action of methylphenidate in ttt of

ADHD
Pharma 100%

A.Increase dopamine activity

B.Increase noradrenaline uptake
C.Decrease dopamine activity

17. Mechanism of action of carbamazepine

pharma 100%
A.Blockage of voltage gated NA channel
B.Blockage of voltage gated calcium channel
C.Modulation of presynaptic sv2a
D.Inhibit GABA receptor

18. Mechanism of action of phenylephrine

pharma 100%
A.Α1-adrenoceptors agonist
B.B2 agonist
C.Muscarinic agonist

19. Patient with leukemia , on palliative management

with drooling saliva , treated with hyoscine batch,
what is the mechanism of action of hyoscine in this
case:
pharma 100%

A.M1 muscarinic antagonist

B.Non selective muscarinic
C.Block acetyl choline release

20. Mechanism of action of proton pump inhibitor

Inhibition of gastrin secretion
Pharma 100%

A.Bind to h/k atpase and block hcl secretion

B.Block gastrin secretion
C.Activate somatostatin
D.Increase gastric acid secretion

21. Mechanism of action of furosemide

pharma 100%

A.Decreased reabsorption of NA
B.Decrease k reabsorption
C.Inhibition of aldosterone action

22. boy is taking desmopressin for nocturnal enuresis

presented with seizure and his mother reported being
lethargic, having vomiting, abdominal pain has Hx of
collapse
NA 120 low
K: 5.6 high
Glucose : low 2.3
Cortisol: 20 mol ( 100 - 300) low
Urine osmolality 225
Plasma 265
Endocrine 100%

A.Failure of adrenal gland to secret mineralocorticoids

and glucocorticoids
B.Increase ADH
C.Increase desmopressin

23 .Preterm baby was on TPN and extravasation

discovered after 48hr how will you proceed?
Patient safety 100%
A. Inform parents after all investigations are done and
completed
B.Explain promptly and fully clearly what happened
C.Tell parents after legal authority
D. Do everything by yourself without
E.Complete incident report then inform family

24. Neonate with severe hyperammonemia which of

the following enzymes is inherited as an x-linked
recessive condition?
metabolic 100%
A.arginase
 B.Trans carbamoyl synthetase
C.Argininosuccinate synthetase
D.Ornithine transcarbamylase

25. 12-year-old Child with type 2 dm tension headache

and BMI 33 on Exam liver palpable 3cm soft Came for
assessment
LFT:
Bilirubin normal
ALT 265
AST374
ALP Normal
What is the histopathology finding in this child liver
biopsy?
GIT & HEPATOLOGY 100%
A. Lobular disarrange and ballooning and degeneration
of hepatocytes Kupffer cell activation and lymphocyte
predominant lobular and portal inflammations
B. Eosinophilic hyaline intracytoplasmic globules in
periportal hepatocytes and bile duct epithelium
C.Macro vesicular steatosis and mix mild lobular
inflammation and hepatocytes ballooning

26. teenager boy with urethral purulent discharge,

sexually active, has new girlfriend, which of the
following investigation can lead to the diagnosis:
Infection & adolescent 100%
 A.nucleic acid amplification tests from urine catch
sample
B.Mid urine sample
C.Urethral swap for gram stain

27. 2 months girl with thigh haemangioma 1cm that is

increasing in size from the age of 3 weeks till now
bleed when scratch, What is the origin of capillary
haemangioma from the following skin layers:
dermatology 100%
A. hypodermis
B.dermis
C. basal cell layer
D. cornium cell layer

28. Cardiac catheterization:

1 year old
Saturation:
RA 74
LA RV 93
RV 74 PA 74
LV 84
Aorta 84

Pressure:
RA. 7
RV 88/20
LA 6
Lv normal
A. TOF
PA 18/3
Aorta normal

Cardiology 100%

A.VSD with eisenmenger

B.TOF
C. ASD with septum scandium

29. How many half - life cycles needed to eliminate

97% of
drug from circulation?
Pharma 100%
A. 3
B. 4
C. 5
D. 6

30.15 yrs. old child with cystic fibrosis controlled on

his
medication, afebrile ,chest: clear normal air entry
Spirometry done showing the following
69 obstructive or mixed
FEV1:1.36 PREDICTED:2.02 Z SCORE:-3.2
FVC:1.96
PREDICTED 2.02
Z SCORE: -1.62
respiratory 100%

A.predominantly obstructive with no significant

restriction
B.predominantly restrictive with no significant
obstruction
C.combined restriction with mild obstruction
D.restrictive

31.what is the type of insulin in continuous

subcutaneous
insulin infusion pump
diabetes & pharma 100%
A. insulin aspart
B. insulin glargine
C. insulin isophane
D. Insulin determir
E. insulin degludec

32. 6-child with road traffic accident (RTA) , paralyzed ,

respiration OK, CVS HR 120 SPO2 98, responsive only
to pain, left pupil: 2mm reactive, Rt pupil: 5mm
non-reactive
What the underlying cause of this finding
ophthalmology 100%

A.uncal herniation compressing rt 3rd cranial nerve Due

to trauma or angorsim
B. compression on oculomotor nucleUs GoS normal
unilateral dilated pupilwith prosis
C.optic chiasmal compression
D.Unequal
E.tentorial herniation compressing the medulla
oblongata

33. IN UK law there is a list of protected

characteristics in discrimination law which of the
following is a protected cc?
ethics 100%

A. gender
B. political beliefs
C.social class
D.age under 16 yrs. (Who choose this didnot got this q
full mark )
E. refugee status

34. PROM what is the function of antenatal steroid

Dexamethasone in RDS
Respiratory & neonatology 100%

A.maturation of pneumocyte type 2

B.release of prestored surfactants from pneumocytes
type 2
C.Increase in no. of pneumocyte type 2
D. Increase surface tension

35. neonate antenatal US with hydronephrosis after

delivery came with left lumber mass US showed pelvic
2cm and calyceal dilation Proximal ureter 8mm in
diameter, bladder wall no thickness
Neonatology 100% & nephrology 100%
A. Post urethral valve obstruction
B.Backward flow from the bladder
C.stenosis in the proximal ureter at PUJ

36. were to specify disease based on this clinical

manifestation
so arrangement for microarray CGH was done. Which
of the following advantage of the microarray over the
karyotyping:
genetics 100%
A.can detect single gene A.A substitution
 B. can detect unbalanced translocation and inversion
more
C.than karyotyping
D.can detect mosaicism more than karyotyping
E.allow more detection of chromosomal abnormality
F. result with 7 days

37. girl presented with diarrhea followed by puffiness

and oedema, lethargic, petechial rash over her body:
Investigation showed HB low urea and creatinine high
plat low diagnosed with HUS,Which of the following
describe pathophysiology?
nephrology 100%
A.Mechanical distraction of the RBC due to passage in
altered renal vasculature
B.Complement mediated intravascular haemolysis
C.Toxin destruct RBC

38. 14 year come from party drinking alcohol and stay

outside, mother is asking what is responsible for risk
taking behavior in adolescent
adolescent 100%
A.decrease size of prefrontal cortex
B.Decrease size of parietal lobe
C.Maturation of temporal lobe
D.Maturation of limbic area
39. 7-year-old female diagnosed with absence
seizures and had multiple attacks at school, on
attending clinic she had hyperventilation and
twitching around mouth and staring episode
neurology 100%

A.3 per second spikes and waves

B.Unilateral centrotemporal spikes
C. Hypsarrhythmia
D.Symmetrical poly spikes
E.Normal EEG

40. 12 year old after RTA with head contusion child on

mechanical ventilator after discussion between the
medical team and the family about irreversibility of full
return of neuronal function what is in the
following included in the NDDC ( neurological
determination of death criteria)
neurology 100%

A.absent cranial motor Reflexes

B.Chyne stock breathing
C.EEG finding(we don't remember)
D.Asymmetrical pupillary reflex
E.Persistent hypothermia less than 35c
41. complete trochlear nerve injury:
Neurology 100%

A.Superolateral
B.Inferolateral
C. Mydriasis
D.Horizontal diplopia

42. steroid potency increasing pattern

pharma 100% & derma 100%
A.Hydrocortisone. 5%, clobetasole. 05%,clobetasone .
05%
B.Clobetasol. 05%/clobetasone. 05 %/ hydrocortisone
1%
C.Clobetasone. 05%/ betamethasone. 025 /
clobetasole. 05%
D.D.hydrocrtisone. 05%, clobetasone. 05% clobetasol.
05%

43. Neonate 9 day old came with lethargy, poor

feeding, unexplained respiratory alkalosis, what is the
suggestive condition
Neonatology 100%

A.Septicemia
B.Urea cycle defect
C.Organic acidemia
 D.Congenital heart defect

44. Child with hydrocephalus and meningitis, which

extraocular muscle will be affected first:
ophthalmology 100%

A.Lateral rectus
B.Inferior rectus
C.Superior rectus
D.Superior oblique

45. 11yrs BMI 31 , plotted+3 standard deviation score

which is severe obesity which is correct??
nutrition 100%
A.BMI assessment of adiposity percentage.
B.BMIof +3 sds approximate to 98th centile
C.BMI at 50 centile change throughout childhood

46. Which will promote child growth

endocrine 100%
A.Insulin
B.Glucagon
C.Cortisol
D.somatostatin

47. What is responsible for hard callus formation

msk 100%
 A.Osteoblast osteoclast bone remodeling
B.Octeocyte progenitaor activity
C.Haematoma formation
D.Cartilagenous proliferation

48. 2 month old, failure to thrive , came to the gp c /o

slow growth, microcephaly, weight< 0.4th centile,
short forearms , and no family history and fracture
clavicle at birth
genetic 100%

A.Osteogenesis imperfecta
B.Down $
C.Russel silver
D.Achondroplasia
E.Hypochondroplasia

49. Neonate 2 days old found to have CMV igM , what

does it mean , weight normal, has jaundice started
early ?
neonatology 100%
A.Intrauetrine infection
B.Intrapartum infection
C.Transplacental passage
D.Milk born infection
E.Preconceptional maternal infection
50. Neonate born with bradycardia , crying at once ,
HR is 50 Bpm , which test to diagnose?
neonatology 100%
A.ANTI DSDNA
B.ANTI RO
C.ANA
D.RF

51. Baby with jaundice , mother o+ve , baby A+ve,

DCT +ve,which will indicate transplacental passage of
maternal antibodies causing haemolysis?
neonatology 100%
A.Anti A IGG
B.ANTI A IGM
C.ANTI O IGA

52. Mechanism of action of NO in management of

PPHN
pharma 100%

A.Through c-GMP
B.Phosphodiesterase inhibitor
C.Systemic vasodiltation

53. a 6 month old came with head trauma, which will

be most suspecting NAI brain injury?
safe guarding 100%
 A.Skull fracture
B.Long bone fracture
C.Head bruising

54. In study prophylactic intravenous indomethacin to

prevent mortality and morbidity in preterm 19 trails
done with 2872 neonates participating randomly
allocated in to control group( not receiving treatment)
and experimental group( received indomethacin)
Background: duct closure with side effect
Objective to detect effect of the drug on morbidity and
mortality
Result:
Treated pt to not treated pt RR :
1-symptomatic PDA RR 0.44 CI 95% ( 0.38-0.50)
2-PDA surgical ligation of pulmonary trunk RR 0.51 CI
95%
(0.37-0.71)
3-severe intraventricular hemorrhage RR 0.66 CI 95% (
0.53-0.82)
4- mortality rate RR 0.96 CI 95% (0.81-1.12)
What is the conclusion of the study?
sop 100%

A. Mortality rate significantly decreased

B. Neonate should be treated with indomethacin
C. Severe intraventricular hemorrhage significantly
decrease
with treatment
D. Three Way trail with placebo indomethacin and
ibuprofen
Needed

55. What is the most common cause of angelman

syndrome
genetic 100%
A.Maternal deletion 15 q11.3
B.Parental deletion 15q11.3
C.Maternal disomy 15q11
D.Single gene defect

56. Fillagrin gene defect will lead to

dermatology 100%

A.Acne vulgaris
B.Atopic eczema
C.Pemphigus

57. Child with blisters, Layer affected in

staphylococcal scalded skin syndrome
dermatology 100%

A.Stratum corneum
 B.Stratum spinosum
C.Stratum granulosum
D.Stratum basale

58. Child with digeorge syndrome, what is the

embryological defect in pharyngeal arches?
Genetics 100%
A.3rd and 4th
B.5th and 6th
C.4th and 5th
D.4th and 6th

59. Child with chronic granulomatous disease, what is

the defect?
immunology 100%
A.Oxidative burst in neutrophil
B.Congenital neutropenia
C.Leukocyte migration defect
D. Phagocytosis defect

60. What is the direct action of parathyroid hormone?

endocrine 100%

A.Increase ca reabsorption from GIT

B.Increase phosphorus reabsorption from kidney
C.Increase ca excretion through kidneys
D.Activation of one alpha hydroxylase in kidneys
61. Cause of cerebral oedema in DKA?
Diabetes
A.Rapid fall in NA level
B.Rapid full in K level
C.Glucose not lowering
D.Increase in FFA

62. Child on chemotherapy dexamethasone,

doxorubicin and vincristine , developed foot drop,
what you will tell the patient about foot drop?
pharma & palliative 100%

A.Reversible side effect of chemotherapy

B.Irreversible side effect of chemotherapy
C. Complication of the disease

63.Which factor to decrease occurrence of RDS is

significant,(Confidence interval )
Birth wt< 1000 (1.027-1.567)
Antenatal steroid(0.987-1.556)
Température ( -0.7 - 5 )
What is significant ?
sop 100%

A.Birth weight < 1000

B.Antenatal steroids
 C.Temperature

64. Child diagnosed with PDA on ventilator , which will

cause difficult ventilation in this baby?
Neonatology 100%

A.Pphn
B.Prematurity
C.Pulmonary hemorrhage
D.Low systemic blood flow
E. Lt to rt shunt

65. Neonate to mother diagnosed with listeriosis,

which organism u will find on csf examination of the
baby?
neonatology 100% & infection 100%

A.Gram +ve rod

B.Gram -ve bacilli
C.Gram -ve cocci
D.Gram+ve cocci

66. a 6 month old was on a trip to Gambia, came down

with gastroenteritis , vomiting settled, with persistent
diarrhea on refeeding, went to her GP given soya milk
, her diarrhea settled within 48 hrs later, what is the
causative organism?
infection 100%
A.Giardia
B.Salmonella
C.Campylobacter
D.Rota virus
E.Vibrio cholera
Both answers got 100%
67. Teenage girl 4 yrs old her BMI <13.5 , came with
collapse, BP 80/55 , HR 45, what is the cause of her
collapse?
adolescent 100%

A.Hypokalemia
B.Hypocalcemia
C.Long QT
D.hypoglycemia

68. Child with increasing HC, on CT shows dilatation

of 3rd ventricle and severe dilatation of 4th ventricle,
where is the obstruction?
Neurology 100%

A.Magendie and luschka

B.Foramen of monro
C.Aqueduct of sylvius
69. Child with lip swelling and puffiness after eating
peanuts, which test will help you in diagnosing
allergy?
Infection & allergy 100%

A.IGE
B.Mast cell tryptase
C.Eosinophil count
D.histamine

70. We randomly assigned 182 children (6 to 17 years of

age), who had uncontrolled asthma while receiving 100 µg of
fluticasone twice daily, to receive each of three blinded
step-up therapies in random order for 16 weeks: 250 µg of
fluticasone twice daily (ICS step-up), 100 µg of fluticasone
plus 50 µg of a long-acting beta-agonist twice daily (LABA
step-up), or 100 µg of fluticasone twice daily plus 5 or 10 mg
of a leukotriene-receptor antagonist daily (LTRA step-up)..
Which type of study?
sop 100%

A.Parallel group study

B.Cross over study
C.Cohort study
D.Open label study
 ‫تمت بحمد هللا‬
‫وفقنا هللا واياكم‬
‫شكرا لكل من ساهم في اتمام هذا العمل على خير‬
‫جروب يونيو ‪2023‬‬