Medicine exam (4th yaer) M – 16
1/ A 55 year old man works as university professor , presented to the emergency
room with severe chest pain radiated to the left arm & jaw . He has heavy sweating
and vomiting , with no history of similar condition . He smokes 2 cigarettes per day
. On examination : He is in severe pain , restless , and apprehensive Pulse is 60 /
min , Bp is 110/80 Normal 1 and 2 heart sound No raised JVP or Lower limbs
oedema No Basal crepitation. Which one of the following is most essential in
management of this patient
A) Insertion of temporary pacemaker
B) Catheterization of the coronary arteries
C) Large dose statin
D) Analgesia with intravenous morphin
2/ Which one of the following is correct regarding the pathological featur crohn's
disease
A) It affects only large bowel
B) There is eosinophilic infiltration into the mucosa
C) Transmural spread of inflammation leads to lymphedema and bowe thickening
D) Caseating granulomas with multinucleated giant cells
3/ Which one of the following is an extra - intestinal manifestation of crohn's
disease
A) Erythema marginatum
B) Erythema multiforme
C) Erythema nodosum
D) Erythema migrans
4/ Which one of the following is a recognized cause of chronic liver disease
A) Haemochromatosis
B) Hepatitis A
C) Malaria
D) Leishmaniasis
5/ A 45 years farmer from Gezira presented with upper GI bleeding with history
of schistosomeiasis . Which one of the following medications is used to prevent a
further attacks ?
A) Alpha blockers
B) Beta Blockers
C) Calcium channel blockers
D) Methyldopa
6/ A 37 years male presented with history of recurrent diarrhea and bloating
Which one of the following investigations is used to diagnose the cause of
malabsorption in this patient
A) Direct measurement of urinary fat
B) Small bowel.biopsy
C) F. Xylose absorption test
D) Large Bowel Biopsy
7/ Which one of the following is correct regarding celiac disease
A) It is a chronic intestinal malabsorption disorder caused by intolerance to
gluten
B) It is a chronic intestinal malabsorption disorder caused by intolerance to
phenylalanin
C) It is a chronic intestinal malabsorption disorder caused by intolerance to
glucose
D) It is a chronic intestinal malabsorption disorder caused by intolerance to
lactose
8/ Angina pectoris is a recognized symptom in which valvular lesions
A) Mitral regurgitation
B) Tricuspid regurgitation
C) Pulmonary regurgitation
D) Aortic stenosis
9/ Which one of the following is correct regarding irritable bowel syndrome
A) It is an inflammatory disorder
B) It is associated with bloody diarrhea
C) Patients may have mucous in the stool
D) Sigmoidovesical fistula may occur
10/ A 50 years school manager presented to ER complaining of severe epigastric
pain that awakens him from sleep and is improved by drinking milk and worsens with
hunger . What could be the diagnosis
A) Irritable bowl syndrome
B) Gastric ulcer disease
C) Dudenal ulcer disease
D) Acute appendicitis
11/ Which one of the following is correct about proton pump inhibitors
A) Used in treatment of chest pain due to ischemic heart disease
B) Used in treatment of peptic ulcer disease
C) Block the hydrogen / sodium adenosine triphosphatase enzyme system
D) The proton pump is the primary stage in gastric acid secretion
12/ 28 year male presented with productive cough for 3 days . On examination was
febrile , BP 90/60 . Chest examination reveals right middle zone crepitations and
bronchial breathing . What is the radiological diagnosis ?
A) Fibrosis
B) Consolidation
C) Lung mass
D) Pneumothorax
13/ Which of the following is a cause of failure of seizure control in epileptic
patients ?
A) Sleep deprivation
B) Cold weather
C) Change in BP
D) Quiet environment
14/ 35 year old male presented with jerky movement affecting his right side
followed by loss of consciousness , this picture is fitting which type of seizure
A) Grand mal seizures
B) Simple partial seizure
C) Myoclonic seizure
D) Complex partial seizure
15/ 60 year male presented with Rt side weakness and deviation of the mouth to
the left , what's your diagnosis
A) Crossed hemiplegia
B) Brown Sequard syndrome
C) Uncrossed hemiplegia
D) Hemorrhagic stroke
16/ 35 year old heavy vehicle driver , brought to the ER with generalized tonic
clonic seizure , that first occurred at home , lasting for about 35 minutes . then
recurred while he was on his way to the hospital and took around 7 minutes without
regaining of his consciousness between the attacks . Upon arrival to the emergency
room , the patient was still fitting , unconscious , with up rolling eyes and wet
clothe and injured his tongue . What is the diagnosis
A) Hypertensive emergency
B) Status epilepticus
C) Acute subarachnoid hemorrhage
D) Vertigo
17/ An example of paraplegia due to hereditary myopathy is
A) Down syndrome
B) Multiple sclerosis
C) Dermatomyositis
D) Bekker's dystrophy
18/ Which one of the following conditions is considered resistant to falciparum
malaria
A) Pemicious anemia
B) Blood group A
C) Glucose 6 - phosphate dehydrogenase deficiency
D) Iron deficiency anemia
19/ What is the infective stage of leishmaniasis that is sucked by the female sand
fly from human blood
A) Promastigote
B) Trypomastigote
C) Amastigote
D) Epimastigote
20/ Regarding leishmaniasis which one of the following statements is the most
accurate
A) Mefloquine is effective in preventing the disease
B) Large domestic animals such as cattle are principal reservoir
C) Marked enlargement of the heart on x ray is a typical finding
D) Both visceral and cutaneous leishmaniasis are transmitted by the sand fly
21/ What is the main drug for treatment of schistosomiasis
A) Chloroquine
B) Praziquantel
C) Metronidazol
D) Mebendazol
22/ A15 year old boy who is known to be sickler , presented to the ER with severe
pain and swelling in his right hip , diagnosed as osteomyelitis and a swab taken from
the bone for culture . Which of the following organisms is expected to be
cultured?
A) A beta hemolytic streptococci
B) Staph aureus
C) Salmonella
D) Mycobacterium tuberculosis
23/ A 25 year street man presented with 2 weeks of excessive diarrhea and loss
of weight with mild fever and skin rash , giving history of sharing needles in the
last 2 yrs with heroin . What specific test you will do for him after counseling
A) PCR for Corona virus
B) CD4 count
C) Stool analysis
D) ELISA for HIV antibody
24/ A 30 year lady delivered by emergency caesarian section due to fetal distress
and received 2 units of blood , after 3 weeks she was admitted with high grade
fever , abdominal pain and jaundice . What infection most probably this patient has
contracted ?
A) Malaria
B) Hepatitis C virus infection
C) Typhoid fever
D) HIV 98. 35 year
25/ 35 year Sheppard presented to the ER with continuous fever that goes up and
down but does not disappear and associated with abdominal pain and loss of weight .
On examination he was febrile with hepatosplenomegaly . What is the most
probable diagnosis ?
A) Brucellosis
B) Malaria
C) Visceral leishmaniasis
D) Hepatitis B virus infection
26/ What is the pathogenesis for the massive watery diarrhea in Cholera infection
A) Stimulation of gastric acid receptors
B) Paralysis of the smooth muscles in the large bowl
C) Activation of the adenylate cyclase
D) Stimulation of thirst centre
27/ What is the mode for spread of salmonella enterica
A) Blood born disease
B) Via respiratory droplets
C) Via sharing needles
D) Feco oral transmission
28/ Ms. Huda , 28 year old , came complaining of photosensitivity , butterfly rash ,
mouth ulcers , joint pain and fever . She has low hemoglobin and platelets on
complete blood count . What is the most likely diagnosis
A) SLE
B) Rheumatoid arthritis
C) Gouty arthritis
D) Osteoarthritis
29/ 17 year old male presented with generalized body swelling and proteinuria . He
was diagnosed as Minimal change GN , based on renal biopsy . What are the findings
in renal biopsy which will support the diagnosis
A) There is loss of nephron by 100 %
B) There is loss of nephron by 50 %
C) There is loss of nephron by 25 %
D) The renal biopsy was noramal
30/ 45 year old male who was diagnosed as having membranous nephropathy , was
asking about his chances of developing end stage renal disease within 10 years
diagnosis ?
A) No risk for end stage renal disease
B) 30 % risk for end stage renal disease
C) 50 % risk for end stage renal disease
D) 100 % risk for end stage renal disease
31/ 30 year old male presented with hematuria 2 weeks after an onset of an Upper
a Post streptococcal glomerulonephritis Respiratory Tract Infection . What is the
most likely diagnosis
A) post streptococcal GN
B) IgA nephropathy
C) Membranous nephropathy
D) Minimal change disease
32/ Why small changes in pH can produce major disturbances ? Because
A) Most enzymes function only with broad pH ranges
B) Acid - base balance can NOT affect electrolytes
C) Can affect hormones
D) Can NOT affect hormones
33/ A 30 year old man had a blood pressure of 150/100 mmHg . Clinical
Examination was normal . Which one of the following would suggest Secondary
hypertension ?
A) 24 hour urinary protein excretion of 1.6g ( < 0.2 )
B) A Creatinine clearance of 90 mL / min ( 70-140 )
C) Left ventricular hypertrophy criteria on ECG
D) The presence of arteriovenous nipping on fundoscopy
34/ The followings are complications of nephrotic syndrome , with the exception of
A) Acute renal failure
B) Accelerated hypertension
C) Hypocalcaemia
D) Pneumococcal infection
35/ Which of the following features would be expected in acute tubular Necrosis ?
A) Heavy proteinuria on urinalysis
B) Red cell casts on urinalysis Urine plasma osmolality ratio more than 1 : 1
C) Urinary sodium concentration greater than 30 mmol
36/ A 45 year old male presents with a long - standing history of hypertension .
Investigations show a urea of 10.2 mmol / l a Creatinine of 150 micromaol / l (
normal 50-100 ) . Which one of the following would suggest a diagnosis of acute
Glomerulonephritis ?
A) 24 hour urinary protein excretion of 0.8g
B) Dyslipidaemia
C) RBC casts in urinary sediment
D) Shrunken glomeruli on renal biopsy
37/ A 28 year old man presented with hypertension . On examination he had
Palpable kidneys and abdominal ultrasound shows bilaterally enlarged cystic kidneys
. Which condition is most likely to be present in this Patient
A) Nail dystrophy
B) Short stature
C) Polycythaemia
D) Mitral stenosis
38/ 21 years old male student , presented to the emergency room with severe
joints pain . He has past history of similar condition , He has history of recurrent
blood transfusion and past history of jaundice with family History of similar
condition , On Examination . He is pale , Pulse 88 / min , Bp 110/75 ... Investigation ,
Hlb 5gm / dl , Reticulocytes count : 5 % , Peripheral blood picture showed Sickling
of the red blood cells , Which one of the following conditions is expected to find in
abdominal Ultrasound
A) Epigastric mass
B) Increase portal vein diameter
C) Ascites
D) Gallstone
39/ Which one of the following is a recognized cause of vitamin k deficiency ?
A) Renal disease
B) Cardiac disease
C) Liver disease
D) Muscle disease
40/ A 25 year old male with history of previous nose bleeding for which he
received no treatment , he presented to the dental clinic for tooth extraction .
The systemic review was unremarkable with no significant past medical history , he
was not allergic to any medications . On Examination : He looks well , not pale
jaundice or cyanosed . Pulse 5 / min and regular , Bp 120/80 , No other
abnormalities detected in the clinical examination . Unfortunately after the
extraction he started to have extensive bleeding from the site of the operation ,
after applying pressure the dentist send him to the emergency department . The
following results came back after investigations : Increased bleeding time • Slight
increase in PTT Normal PT • Normal platelet count What is the most likely
diagnosis ?
A) Haemophilia A
B) Haemophilia B
C) Desseminated intravascular coagulation
D) Von - wellebrand's disease
41/ 60 year - old woman presents with fever , shortness of breath and right -
sided chest pain . On examination the right side of the chest moves less ; dull to
Percussion and absent breath sound , What is the most likely diagnosis ?
A) Pleural effusionmjy
B) Pulmonary oedema
C) Pneuomothorax
D) Pneumonia
42/ 47 year old female presents to the emergency department with
breathlessness and productive cough . On examination she is cyanosed with finger
clubbing and tachycardia and has bibasilar soft crackles , What is the most likely
diagnosis ?
A) Cystic fibrois
B) Fibrosing alveolitis
C) Pulmonary oedema
D) Pulmonary embolus
43/ A 35 years old male with history of tuberculosis and alcohol abuse ,
presented with cough with purulent sputum for three months , and shortness of
breath , on examination there is finger clubbing , bronchial breathing in the
right upper lung what is the most likely diagnosis ?
A) Pneumonia
B) Bronchial carcinoma
C) Lung abscess
D) Chronic bronchitis
THE ANSWERS
1_B
2_
3_C
4_A
5_B
6_B
7_A
8_D
9_C
10_C
11_B
12_B
13_A
14_C
15_A
16_B
17_D
18_C
19_A
20_D
21_B
22_C
23_D
24_B
25_A
26_C
27_D
28_A
29_D
30_B
31_A
32_A
33_A
34_B
35_D
36_C
37_C
38_D
39_C
40_D
41_
42_B
43_B
