Feb-telegram2019 correct by new group

A 69-year-old man is treated for chest infection. He has been on a stable dose of warfarin
for the last six months as a treatment for atrial fibrillation, with INR recordings between
2-2.5. However, his most recent INR was 5.
Which one of the following drugs that has recently been started is likely to be responsible
for the increased INR.
1- Clarithromycin ✅
2- Co-dydramol
3- Digoxin
4- Rifampicin
5- Temazepam

A 30-year-old man presented with a history of transient loss of consciousness and

palpitation. His ECG showed ventricular tachycardia.
Which one of the following treatments should be avoided?
1- Adenosine
2- Amiodarone
3- DC cardioversion
4- Flecainide
5- Verapamil ✅

A 28-year-old man who is known to have Hypertrophic Cardiomyopathy has an out of

hospital cardiac arrest and is successfully resuscitated.
What is the most appropriate mode of treatment?
1- Alcohol Septal Ablation
2- Amiodarone
3- Beta Blocker
4- Implantable Defibrillator ✅
5- Myomectomy

A 51-year-old businessman complains of dyspnoea on exertion. He recently returned

from a business trip to the USA. He has distant heart sounds on auscultation of the chest.
A chest radiograph reveals that there is a thin rim of calcification surrounding the cardiac
outline.
Which of the following conditions is most likely responsible for these findings?
1- Uraemia
2- Tuberculosis ✅
3- Group B coxsackie virus
4- Sarcoidosis
A 69-year-old woman admitted for a surgical procedure is noted to have a soft systolic
murmur at the left sternal edge. Her ECG and chest X-ray were normal and transthoracic
echocardiography revealed a small posterior pericardial effusion with normal valves.
Which of the following would be the most appropriate next step in this patient's
management?
1- A diagnostic Pericardial aspiration
2- mammography
3- purified Protein derivative test for tuberculosis
4- reassurance ✅
5- right heart catheterization

A 28-year-old man who had had tuberculosis of the mediastinal lymph nodes diagnosed
two weeks previously and who had been started on chemotherapy with rifampicin,
isoniazid and pyrazinamide was admitted because of the increasing dyspnoea and stridor.
Chest X-ray showed compression of both main bronchi by carinal lymph node
enlargement.
What is the next step in management?
1- Start prednisolone ✅
2- Mediastinoscopy and biopsy
3- Refer for stent insertion/tracheostomy
4- Refer for urgent CT scan of the mediastinum
5- The addition of ethambutol

A 28-year-old man had been treated for pulmonary tuberculosis with rifampicin,
isoniazid, pyrazinamide and ethambutol for four weeks. Pre-treatment liver function tests
were normal but his most recent investigations revealed:
serum total bilirubin 98 micromol/l (0-18)
serum alanine aminotransferase 620u/l (5-45)
serum aspartate aminotransferase 450 u/l (5-45)
serum alkaline phosphatase 720 u/l (40-110)

Which one of the following is the most appropriate next step?

1- Stop all treatment ✅
2- Stop ethambutol
3- Stop isoniazid
4- Stop pyrazinamide
5- Stop rifampicin

A 35-year-old woman, known to have cystic 􀂡brosis, presented with

cough, foul smelling muco-purulent
sputum and shortness of breath.
Which of the following is the most likely diagnosis?
A. Atelectasis
B. Bronchiectasis ✅
C. Lung abscess
D. Pneumonia
A 48-year-old man presents to the physician with episodic productive
cough of yellow sputum for the last two years. He denied any fever or chest
pain. Examination shows digital clubbing.
Which of the following is the most likely diagnosis?
A. Asthma
B. Bronchiectasis ✅
C. Sarcoidosis
D. Tuberculosis

A 60 year old man presents with a chronic cough with greenish foulsmelling
sputum. On examination, you note crackles and decreased air
entry. What is the likely diagnosis?
A. Bronchiectasis ✅
B. Bronchiolitis
C. Pleural effusion
D. Pneumonia

A 80 year old patient presents with facial swelling when waking up. It
decreases during the day, but increases when he raises his hands. He has a
100 pack year history. What is the diagnosis?
A. Bronchiectasis
B. COPD
C. Lung cancer ✅
D. TB

A70 year old malehas long-standing bronchiectasis. What else beside

medical treatment can bene􀂡t this patient?
A. Chest physiotherapy ✅
B. High-dose oxygen therapy
C. Rigorous exercise
D. Smoking cessation

A 48-year-old man presents to the physician with episodic productive

cough of yellow sputum for the last two years. He denied any fever or chest
pain. Examination shows digital clubbing.
Which of the following is the most likely diagnosis?
A. Asthma
B. Bronchiectasis ✅
C. Sarcoidosis
D. Tuberculosis

Which of the following conditions is associated with clubbing?

A. Asthma
B. Bronchiectasis ✅
C. Pneumonia
D. Pulmonary tuberculosis
A 40 year old female has asthma, on inhaled low-dose corticosteroids. Despite
medication compliance, she is still symptomatic with dyspnoea on exercising and
night-time cough. What should the next step be? A. Add high-dose inhaled
corticosteroids B. Add long-acting beta agonist ✅ C. Add omalizumab D. Add oral
corticosteroids

Which of the following decreases the inammation in asthma? A. Beclomethasone

diproprionate B. Montelukast ✅C. Salmeterol D. Theophylline

40 year old female presents with an acute asthma exacerbation in the ER.
Nebulised SABA is provided. What should be given next? A. IV SABA B.
Nebulisedipratropium ✅ C. Oral corticosteroids D. Theophylline

A 40 year old female has asthma, on inhaled low-dose corticosteroids. Despite

medication compliance, she is still symptomatic with dyspnoea on exercising and
night-time cough. What should the next step be? A. Add medium-dose inhaled
corticosteroids B. Add long-acting beta agonist ✅ C. Add omalizumab D. Add oral
corticosteroids

Which of the following decreases the inammation in asthma? A. Beclomethasone

diproprionate B.Monteleukast ✅ C. Salmeterol D. Theophylline
A healthy 40 year old man presents for a tuberculosis screen. He is asymptomatic
with a normal Chest XR, and his last PPD 5 years ago was negative. Today, his
PPD is positive. What is the treatment? A. Isoniazid for 6 months B. Isoniazid,
rifampin, ethambutol and pyrazinamide C. Reassurance D. Rifampicin andisoniazid
for 3 months ✅
Which of the following is the most common cause of chronic cough? A. Asthma
B. Gastroesophageal Reux Disease C. Pneumonia D. Upper airway cough syndrome
✅
A 16-year-old male presents with acute severe asthma. On examination his peripheral
pulse volume fell during inspiration.
Which one of the following is the most likely explanation for this clinical sign?
1- The cardiac effect of high dose beta agonist bronchodilator drugs
2- A falling heart rate on inspiration
3- Myocardial depression due to hypoxia
4- Peripheral vasodilatation
5- Reduced left atrial filling pressure on inspiration ✅
Massive pneumothorax after long air travel, ttt???chest tube ✅
Which ONE of the following is a contraindication to thrombolysis?
1- age over 75 years
2- the presence of atrial fibrillation
3- asthma
4- pregnancy ✅
5- background diabetic retinopathy
Regarding the genetics of bronchial asthma
1- Mendelian recessive inheritance
2- Leukotriene concentrations are influenced by genetic factors
3- Similar concordance in monozygotic and dizygotic twins
4- Genetic linkage is to a single chromosome 13
5- There is a contribution from HLA alleles ✅
An elderly man with a history of asthma, congestive heart failure, and peptic ulcer
disease is admitted with bronchospasm and rapid atrial fibrillation. He recieves frequent
nebulised salbutamol and IV digoxin loading, his regular medications are continued. 24
hours after admission his serum potassium is noted to be 2.8 mmol/l.
Which of his medications is most likely to have caused this abnormality.
1- Digoxin
2- ACE inhibitor
3- Salbutamol ✅
4- Ranitidine
5- Spironolactone
A 20 year old male presents for a tuberculosis screening test. He has no risk
factors for exposure and is otherwise well. What is the minimum wheal required
for a positive test? A. 10mm B. 15mm ✅ C. 20mm D. 5mm
. A 40 year old patient presents for a health screen. He is asymptomatic. Chest X
ray shows a unilateral calcied nodule on the upper zone of his lung. What is the
likely diagnosis? A. Adenoma B. Granuloma C. Hamartoma D. SCC ✅
Which of the following is the most common cause of hereditary breast
and ovarian cancers?
A. Alpha-fetoprotein
B. BRCA mutation ✅
C. CDH1
D. p53 mutation

-
-Pregnent has abruptio placente what is the acid base balance of fetus
Asphyxia ✅ .. Res acidosis.. Metabolic acidosis

-
A 21-year-old woman presents to the gynecology clinic with a mass in
the left breast. She discovered this mass while showering. Her last
menstrual period was 10 days ago. There is no family history of breast
cancer. On physical exam, you palpate a 3 cm, 􀂡rm, non-tender mass in the
upper lateral quadrant of the left breast. The mass is smooth, wellcircumscribed,
and mobile. There are no skin changes, nipple discharge, or
axillary lymphadenopathy. Which of the following is the most likely
diagnosis in this woman?
A. Fibroadenoma ✅
B. Fibrocystic change
C. Intraducal papailoma
D. Lobular carcinoma in situ

A woman with a history of breast cancer. Which of the following is

medically contraindicated for this woman?
A. Condoms
B. Copper containing intrauterine device
C. Laparoscopic tubal ligation
D. Progestin-only contraceptive pills ✅

A 47-year-old female comes to the hospital to follow up for breast

cancer diagnosed before 4 days, What is the most common site of breast
cancer?
A. lower inner quadrant
B. lower outer quadrant
C. upper inner quadrant
D. upper outer quadrant ✅

24 year beautiful girl , She presents to his doctor with concer about
breast cancer , she has history of family member die from breast cancer ,
She ask about risk factor , which of the following true about The incidence
of breast cancer :
A. Has declined since the 1940s
B. Increases with increasing age ✅
C. Is related to coffee intake
D. Is related to dietary fat intake
E. Is related to vitamin C intake

Lady with a mass in left upper quadrant of the breast, aspiration was
yellow 􀂡uid without masses, this mass completely disappears with
aspiration, what is the diagnosis?
A. Phyllod
B. breast cancer
C. 􀂡broadenoma
D. 􀂡brocystic disease ✅
Which of the following association with Trousseau,s sign?
A. Pancreatic cancer ✅
B. SCC
C. breast cancer
D. gastric cancer

. 24 year beautiful girl , She presents to his doctor with concer about breast
cancer , she has history of family member die from breast cancer , She ask about
risk factor , which of the following true about The incidence of breast cancer : A.
Has declined since the 1940s B. Increases with increasing age ✅ C. Is related to
coffee intake D. Is related to dietary fat intake E. Is related to vitamin C intake

Patient with past history of hodgikon lymphoma . But cured completely .Presented
with back pain . Examination and evaluation show paraspinus Edema and uid
collection, -ve burecella titer and tuberclin test ,what the cause ? A. breast cancer
B. burecellosis C. recurrent hodgikon lymphoma ✅ D. typhiod fever

which of the following associated with Bilateral breast cancer: A. Ductal

carcinoma B. Lobular carcinoma ✅ C. Mucinus carcinoma D. Paget disease

6. Tamoxifen for breast cancer patient, she has metrorrhagia, US showed thick
endometrium, what is side effect of this drug ? A. decrease risk of DVT B.
decrease risk of pitituary adenoma C. increase risk Endometrial cancer ✅ D.
increase risk of uterus tumor

Patient with breast cancer, she having bleeding from breast with redness ,on
routine check 2x3 cm then became 3x6cm.What do you suspect? A. bad prognosis
B. inammatory process C. malignant cancerous change D. metastasis precess

The nearest big-city hospital is a 6-hour drive. Given

your attention to your first priority, you would now:
a. call the ambulance for immediate transport to
another hospital that “knows how to look after this
thing”
b. admit the patient to the coronary care unit for
observation
c. administer streptokinase or alteplase IV
immediately ✅
d. administer heparin IV immediately
e. none of the above
*note:Absolute contraindications to thrombolytic therapy
include:
• Any prior intracranial hemorrhage
• Known structural cerebral vascular lesion (e.g.,
arteriovenous malformation)
• Known malignant intracranial neoplasm (primary
or metastatic)
• Ischemic stroke within 3 months EXCEPT acute
ischemic stroke within 4.5 hours
• Suspected aortic dissection
• Active bleeding or bleeding diathesis (excluding
menses)
• Significant closed-head or facial trauma within 3
months
• Intracranial or intraspinal surgery within 2 months
• Severe uncontrolled hypertension (unresponsive to
emergency therapy)
• For streptokinase, prior treatment within the previous
6 months

Which of the following is the most common cause of communityacquired

pneumonia?
A. Haemophilus inffuenzae
B. Pneumocystis pneumonia
C. Streptococcus pneumoniae ✅
D. Streptococcus pyogenes

A 80 year old who has been in the ICU for 4 days has developed
pneuomnia. What is the most likely organism?
A. Mycoplasma pneumoniae
B. Neisesria meningitidis
C. Pseudomonas aerogenas
D. Strep pneumoniae ✅

A 70 year old patient iscomplaining of face 􀂡ushing and head heaviness

in the morning
that's relieved during the day. He has been smoking for 30 year.s CXR
shows bilateral hilar masses. What is the diagnosis?
A. COPD
B. Hodgkin's lymphoma
C. Lung cancer ✅
D. TB
In what week of gestation do alveoli form?
A. 12 weeks
B. 16 weeks
C. 24 weeks
D. 28 weeks ✅

A 30 year old femaleis admitted for pulmonary embolism. She has a

history of 3 miscarriages. Herlupus anticoagulant test is positive. What is
the diangosis?
A. Antiphospholipid syndrome ✅
B. Factor V Leiden
C. Hemophilia A

A 36-year-old woman is diagnosed with tuberculosis three months ago,

now she complains of numbness, tingling of extremities and ataxia. Her
symptoms started after the anti-tubercular therapy.
What is the most appropriate next step in management?
A. Folic acid supplement
B. Iron supplement
C. Niacin supplement
D. Pyridoxine supplement ✅

Patient has a pleuritic chest pain on the left side. Physical

examinationreveals a pleuritic fruction rub. What is the next step?
A. 21lead ecg
B. CT Thorax
C. Chest x-ray ✅
D. Echo refer to cardio

A 55 yo man with history of chronic cough associated with production of

daily mucopurulent sputum production came with hemoptysis, foul smelling
sputum, and fever. Examination revealed crackles and rhonchi. What is the
most likely diagnosis?
A. Asthma
B. Bronchiectasis ✅
C. Lung cancer
D. Tuberculosis

Which clinical sign is associated with pulmonary hypertension?

A. Central cyanosis
B. Lower limb edema and ascites
C. Pulmonary edema
D. Stroke ✅
A 45-year-old woman presents to the emergency room with pleuritic chest pain,
hemoptysis and shortness of breath for the last three hours. Her temperature is
37.9 C, blood pressure is 120/70 mmHg, pulse is 137/min and respirations are
28/min. Her oxygen saturation is 86% on room air.Which of the following is the
most likely diagnosis? A. Ashtma B. Myocardial infarction C. Pulmonary edema D.
Pulmonary embolism ✅

3. A middle-aged man present to the doctor with blurred vision and eye pain. He
was recently diagnosed with tuberculosis. What is the cause of his symptoms? A.
Ethambutol ✅ B. Isoniazid C. Pyrazinamide D. Rifampin

3. A middle-aged man present to the doctor with red urine. He was recently
diagnosed with tuberculosis. What is the cause of his symptoms? A. Ethambutol B.
Isoniazid C. Pyrazinamide D. Rifampin ✅

3. A middle-aged man present to the doctor with signs of gout . He was recently
diagnosed with tuberculosis. What is the cause of his symptoms? A. Ethambutol B.
Isoniazid C. Pyrazinamide ✅ D. Rifampin

20 year old man presenting for a tuberculosis screen had a positive PPD. What
should the next step be? A. Chest CT B. Chest XR ✅C. Repeat PPD D. Sputum
smear

A 44 year old male has a chest x-ray done for insurance purposes. His health has
always been ne and he does not take any medications, he does not have any
allergies, nor does he smoke. He last saw a doctor several years ago, but has
never had a chest x-ray before. The radiologist has marked an arrow at what
appears to be a “tear shaped” body of the upper lobe parenchyma. The work up
for a malignancy has proven negative, all the labs are normal and the physical
exam is unremarkable. Based on your anatomical knowledge and history, this most
likely represents: A. Apical pneumothorax B. Azygos lobe ✅ C. Consolidated
pneumonia D. Pancoast tumor E. Tuberculosis

A patient with tuberculosis develops bright orange-red urine and calls his physician
in a panic because he is afraid he is bleeding into the urine. The patient has no
other urinary tract symptoms. Which of the following medications is most likely to
produce this side effect? A. Ethambutol B. Isoniazid C. Pyridoxine D. Rifampin ✅ E.
Streptomycin

. What is Cheyne Stokes breathing? A. Cyclic waxing and waning ventilation with
apnoea, gradually giving way to hyperpneic breathing. ✅ B. Increased rate and
depth of breathing over a prolonged period of time C. Only being able to breathe
comfortably while upright D. Persistent hyperventilation
A50 year old male prsents with chronic retrosternal pain, cough and a
metallic taste in the mouth. What is the most likely diagnosis?
A. Acrodermatitis
B. Angina
C. GERD ✅
D. Gastritis

A patient with lung cancer has a low serum PTH and high Calcium .What
is this caused by?
A. Hyperparathyroidism
B. Hypoparathyroidism
C. PTH-related peptide ✅
D. SIADH

A 40 year old female has asthma, on inhaled low-dose corticosteroids.

Despite medication compliance, she is still symptomatic with dyspnoea on
exercising and night-time cough. What should the next step be?
A. Add high-dose inhaled corticosteroids
B. Add long-acting beta agonist ✅
C. Add omalizumab
D. Add oral corticosteroids

On a routine CXR, you note a suspicious single hilar mass. The patient
has a 100 pack year hitstory, but is asymptomatic. What is the likely
diagnosis?
A. Adenocarcinoma
B. Lymph node
C. Small cell lung cancer
D. Squamous cellcancer ✅

What is the treatment of bronchiolitis?

A. Antibiotics
B. Bronchodilators
C. Intranasal glucocorticoids
D. Supportive care and onitoring ✅

Anelderly pt presented to ER due to decreased level of consciousness

and lethargy.
PCO2 is50 mmhg pH is 7.2 andHCO3 is 40. What does she have?
A. Metabolic acidosis without compensation
B. Metabolicacidosis with compensation
C. Respiratory acidosis with compensation ✅
D. Respiratory acidosis without compensation
A 25-year-old man presents to his primary care physician complaining
of wheezing and breathlessness during exercise.
Which of the following is the most appropriate next step in management?
A. Beta-adrenergic agonists before exercise ✅
B. Montelukast
C. Oxygen
D. Theophylline

39. A 45 year old female andnon-smokeris found to have a lung nodule on

CT. It appears to be composed of calcium and fat.
A. Adenocarcinoma
B. Hamartoma ✅
C. Mystheoma
D. Squamous cell carcinoma

A 45-year-old woman presents to the emergency room with pleuritic

chest pain, hemoptysis and shortness of breath for the last three hours.
Her temperature is 37.9 C, blood pressure is 120/70 mmHg, pulse is
137/min and respirations are 28/min. Her oxygen saturation is 86% on room
air.
Which of the following is the most likely diagnosis?
A. Ashtma
B. Myocardial infarction
C. Pulmonary edema
D. Pulmonary embolism ✅

What is most common manifestation of pulmonary disease in HIV

infected patients ?
A. Asthma
B. Bronchiectasis
C. Carcinoma
D. Pneumonia ✅

What is the most common type of cancer in the middle of the

oesophagus? Scc ✅

Which of the followingdrugs can reduce the production of mucous in

COPD?
A. Albuterol
B. Formeterol
C. Ipratropium Br ✅
D. Montelukast
A 40 year old factory worker inhales 3 nanogram of cotton in a factory.
Where will the cotton eventually end up?
A. Engulfed by alveolar macrophages
B. Pass without any damage
C. Trapped in mucocilliary system without reaching alveoli
D. Trappedin distal airway leading to 􀂡brosis ✅

What is th most common cause of acute bronchiolitis?

A. Adenovirus
B. In􀂡uenza
C. Parain􀂡uenza
D. RSV ✅

Which of the following is an appropriate initial treatment for pulmonary

tuberculosis ?
A. INH
B. INH plus rifampin
C. INH, rifampin, and ethambutol
D. INH, rifampin, ethambutol, and pyrazinamide ✅
E. INH, rifampin, ethambutol, and streptomycin

A 62-year-old man presents to the physician with cough for the last 7
months. He also complained of hemoptysis, weight loss and constipation.
He is a chronic smoker with a 40-year history. Laboratory tests reveal
hypercalcemia. Chest x-ray shows hilar mass in the right lung.
Which of the following is the most likely diagnosis?
A. Adenocarcinoma
B. Small cell carcinoma
C. Squamous cell carcinoma ✅
D. Tuberculosis

A 20 year old presents with asthma exacerbation. Which of the

following drugsacts more by decreasing the mucous secretion than
bronchodilation?
A. Beta agonist
B. Ipratropium Br ✅
C. Leukotriene antagonist
D. Oral corticosteroids

52. A 40 year old patient presents with cough during exercise. What
medication could you give her before exercise?
A. Formeterol
B. Inhaled oxygen
C. Inhaled salbutamol ✅
Which of the following is the most common cause of pulmonary
embolism?
A. Antiphospholipid syndrome
B. Deep vein thrombosis ✅
C. Nephrotic syndrome
D. Obesity

A 3 year old boy presents for TB screening. His father has pulmonary
TB. His PPD is 10mm. What does this indicate?
A. Strong postive ✅
B. Strongnegative
C. Weak positive
D. Weaknegative

A 30 year old female has recently given birth. She presents with a
sudden onset of shortness of breath.What would you expect to see in the xray
A. Cardiomegaly ✅
B. Increase in mediastinal width
C. Lobar in􀂡ltrate
D. Pleural effusion

According to the new classi􀂡cation of lung cancer, which of the

following is considered a carcinoma in-situ?
A. Adenocarcinoma less than 10mm
B. Adenocarcinoma less than 2 cm. ✅
C. Atypical hyperplasia
D. Hamartoma

A 68 year old male with adenocarcioma of the lung presents with

blurring of the vision. On examination, you note ptosis and miosis. What is
the diagnosis?
A. Gustave's syndrome
B. Horner's syndrome ✅
C. Hyponatraemia
D. Invasionof CNIII

A 69-year-old man is treated for chest infection. He has been on a stable dose of warfarin
for the last six months as a treatment for atrial fibrillation, with INR recordings between
2-2.5. However, his most recent INR was 5.
Which one of the following drugs that has recently been started is likely to be responsible
for the increased INR.
1- Clarithromycin ✅
2- Co-dydramol
3- Digoxin
4- Rifampicin
5- Temazepam
A 30-year-old man presented with a history of transient loss of consciousness and
palpitation. His ECG showed ventricular tachycardia.
Which one of the following treatments should be avoided?
1- Adenosine
2- Amiodarone
3- DC cardioversion
4- Flecainide
5- Verapamil ✅

A 28-year-old man who is known to have Hypertrophic Cardiomyopathy has an out of

hospital cardiac arrest and is successfully resuscitated.
What is the most appropriate mode of treatment?
1- Alcohol Septal Ablation
2- Amiodarone
3- Beta Blocker
4- Implantable Defibrillator ✅
5- Myomectomy

-Amebic liver abcess management:

Metronidazole ✅
-Eccinococus liver abcess management:combination. Drainage has been accomplished
either surgically and metronidazole ✅
-Pyloric stenosis management:
Surgery: pyloremyotomy
If baby have dehydration must be treated
✅
-Crecendo acrecendo murmur cause:
AS ✅
-Meningitis treatment in elderly:
Ceftrixone ✅
-Tb infection control:
1. Administrative measures
2. Environmental controls
3. Use of respiratory protective equipment
4. All of the above ✅

patient 38-year-old lady diagnose as papillary breast cancer after the

resulting biopsy, what is the most likely characteristic of this cancer?
Communally bloody nipple discharge ✅
which of the following investigation should be done for early detection
of bilateral breast cancer?
A. FNA
B. biopsy
C. mammogram ✅
D. tumor marker

patient 38-year-old lady diagnose as papillary breast cancer after the

resulting biopsy, what is the most likely characteristic of this cancer?
A. breast like orange
B. retraction of the nipple ✅
C. well-de􀂡ned margin with many small projections
D. yellow bloody nippl

Patient with breast cancer, she having bleeding from breast with redness ,on
routine check 2x3 cm then became 3x6cm.What do you suspect?
A. bad prognosis ✅
B. inammatory process
C. malignant cancerous change
D. metastasis precess

In patient post mastectomy, they do for her reconstruction from the rectus muscle.
what is the vessels maybe injured or effected?
A. Inferior epigastric artery ✅
B. Superior epigastric artery
C. intercostal artery
D. internal thoracic artery

- The most correct statement regarding thrombolytic

therapy in acute myocardial infarction (AMI) is:
a. patients younger than 65 years benefit more than
elderly victims of MI
b. no benefits have been realized when therapy has
been instituted after 6 hours of onset of chest pain
c. thrombolytic therapy has improved the prognosis
of patients with prior coronary artery bypass grafting
(CABG)
d. patients with non–Q-wave MI have benefited
as well as patients who sustain Q-wave MIs with
thrombolytic therapy
e. a 50% reduction in mortality has been realized
when therapy is administered within 3 hours of
onset of chest pain ✅
Which of the following statements regarding the use
of heparin in patients with AMI is (are) true?
a. heparin therapy is used almost routinely with
thrombolytic therapy during the acute phase of MI
treatment, provided certain criteria are met
b. heparin is recommended whenever there is echocardiographic
evidence of left ventricular thrombi
c. heparin should be administered (unless contraindicated)
to all patients with acute anterior wall MI
d. heparin is contraindicated in patients with uncontrolled
hypertension
e. all of the above ✅

Which of the following is (are) a contraindication(s) to

the use of thrombolytic therapy in patients with AMI?
a. active gastrointestinal bleeding
b. recent surgery (2 weeks postoperative)
c. history of cerebrovascular accident
d. suspected aortic dissection
e. all of the above ✅

8. Which of the following statements regarding patients

admitted to the coronary care unit after presumed MI
is (are) true?
a. patients with suspected MIs should have the left
ventricular ejection fraction measured before leaving
the hospital
b. patients should have an exercise tolerance test on
the fourth or fifth hospital day
c. patients should have an exercise stress test performed
4 to 6 weeks after hospitalization
d. a and c ✅
e. none of the above

9. Which of the following is (are) a significant feature(s)

of the pathophysiologic process of MI?
a. endothelial cell wall damage
b. coronary atherosclerosis
c. thromboxane A2 production
d. all of the above ✅
e. a and b
10. Which of the following is (are) true concerning aspirin
in the treatment of AMI?
a. aspirin may serve as a substitute for streptokinase
or t-PA
b. aspirin may serve as a substitute for heparin
c. aspirin may serve as a substitute for beta blockade
d. all of the above
e. none of the above ✅
11. Which of the following statements regarding thrombolytic
therapy is (are) false?
a. thrombolytic therapy limits myocardial necrosis
b. thrombolytic therapy preserves left ventricular
function
c. thrombolytic therapy reduces mortality
d. all of the above
e. none of the above ✅

12. Which of the following is true regarding primary

angioplasty in the treatment of acute ST-segment
elevated MI?
a. primary angioplasty is not a substitute for thrombolytic
therapy
b. its universal adoption is likely to be limited by
geography ✅
c. it can be performed in hospitals that do not perform
CABG surgery
d. stent placement worsens outcomes
e. operator variables are insignificant
13. Which of the following statements concerning dysrhythmias
and dysrhythmic drugs in patients who
have sustained an MI is (are) true?
a. premature ventricular contractions are common
and should be treated with lidocaine
b. sustained runs of ventricular tachycardia frequently
progress to ventricular fibrillation (VF)
c. prophylactic lidocaine is recommended to prevent
dysrhythmias in all patients who have sustained an MI
d. none of the above ✅
e. all of the above
14. One of the major patient concerns after an MI is the
risk of a second or subsequent attack. In which of the
following circumstances is the risk of reinfarction or
mortality after MI significantly increased?
a. left ventricular ejection fraction of less than 40%
b. exercise-induced ischemia
c. non–Q-wave infarction (subendocardial infarction)
d. a and b
e. all of the above ✅
15. Which of the following medications has (have) been
shown to be of benefit in some patients who have had
an MI?
a. beta blockers
b. Coumadin
c. aspirin
d. a and c
e. all of the above ✅
16. Which of the following statements concerning rehabilitation
of the patient after an MI is (are) true?
a. sexual intercourse should not resume for at least 3
months
b. patients who have sustained an MI should not
work for at least 4 months
c. patients who have sustained an MI gradually may
increase activity during 6 to 8 weeks ✅
d. no significant psychological distress regarding the
MI has been shown to occur in the patient’s spouse
or significant other
e. all of the above
17. The best single confirmatory investigation for AMI is:
a. the ECG
b. the height of ST-segment elevation in the affected
area (in millimeters) plus the depth of ST-segment
depression in the reciprocally affected leads (in
millimeters)
c. the creatine kinase isoenzyme MB fraction
d. the presence of dysfunctional heart muscle as
demonstrated by echocardiography
e. cardiac troponin levels ✅
18. Sudden death as a result of MI is almost always the
result of:
a. third-degree heart block resulting from infarction
of the atrioventricular node
b. ventricular tachycardia
c. ventricular fibrillation ✅
d. ventricular standstill
e. none of the above
19. Which of the following statements regarding shock
and its treatment in AMI is (are) true?
a. the patient with AMI may develop shock secondary
to hypovolemic hypotension
b. the patient with AMI may develop shock secondary
to persistent hypotension and a poor cardiac
index
c. both forms of shock respond well to treatment
with intravenous fluids (lactated Ringer or normal
saline solution)
d. a and b ✅
e. all of the above
20. Coronary reperfusion with thrombolytic agents has
been shown to be of benefit when it is commenced
within which of the following maximum number of
hours from the onset of pain?
a. 4
b. 6
c. 12 ✅
d. 24
e. 48
21. In this clinical case, there is a key finding on physical
examination of the patient’s abdomen that should be
further assessed by:
a. abdominal ultrasonography ✅
b. intravenous pyelography
c. digital subtraction angiography
d. computed tomography (CT)
e. magnetic resonance imaging (MRI)

Pt with clear symptom of cushing syndrome and give diagnosis on sinario

Investigation show
ACTH low
Cortisol at 8 am normal level ( after given oral dexamethasone 1 mg at night ) wt
investigation to do ?
Brain MRI
CT for adrenal gland ✅
Child had symptom of hypoglycemia and lab show low glucose ask about ttt?
Bolus of 2 ml/kg of D12.5%
Bolus of 10 ml/kg of D10% ✅
Bolus of 2 ml/kg of D 10%

A male patient who is a smoker, developed haemoptysis and shortness

of breath on exertion. Investigations shows a high serum calcium and a
solitary central lung nodule. What is the most likely diagnosis?
A. Adenocarcinoma
B. Hamartoma
C. Small cell cancer ✅
D. Squamous Cell Carcinoma

Which of the following is associated with oral candidiasis?

A. Aspirin
B. Decongestants
C. Epinephrine
D. Inhaled corticosteroids ✅

What will be high in the lumbar puncture of a patient with mycoplasma

pneumonia?
A. Glucose
B. Protein ✅
C. RBC
D. WBC

A 40 year old male has been diagnosed with lung cancer. He and
hisfamily have never smoked, and has no family history of lung cancer. He
works in electricity generation. What is the cause?
A. Asbestos
B. Inhaled coal dust
C. Passive smoking
D. Radon gas ✅

What type of cancer is most commonly found in the distal oesophagus?

A. Adenocarcinoma ✅
B. Metastatic cancer
C. Small cell carcinoma
D. Squamous cell carcinoma

postmenopausal symptom how to reach diagnosis ?

FSH ✅

female after delivered present with unable to breast fed her baby and no milk at all wt z
diagnosis?
Asherman syndrome ✅
 Pt with clear symptom of cushing syndrome and give diagnosis on sinario
Investigation show
ACTH low
Cortisol at 8 am normal level ( after given oral dexamethasone 1 mg at night ) wt
investigation to do ?
Brain MRI
CT for adrenal gland ✅

female after delivered present with unable to breast fed her baby and no milk at all wt z
diagnosis?
Sheehan syndrome ✅

pt diagnosed acromegaly and started ttt with octreotide what the investigation of choice
in the future ?
Echo
Ct abdomen ✅
‫الباقي متزكره ما‬

Child had symptom of hypoglycemia and lab show low glucose ask about ttt?
Bolus of 2 ml/kg of D12.5%
Bolus of 10 ml/kg of D10%
Bolus of 2 ml/kg of D 10% ✅

14/2/2019 Symptom of cough and shortness of breath after exercise what z high
diagnostic value to reach diagnosis?
CXR
PEFR
Methacoline test FEV1 decrease to more than 20 %
Increase to 5% after albuterol inhalor ✅

Which of the following organismsis a common cause of ventilatorassociated

pneumonia?
A. Legionella
B. Mycoplasma pneumoniae
C. Pseudomonas aeruginosa ✅
D. Strep pneumoniae

What skin manifestation is associated with cystic brosis?

A. Acrodermatitis enteropathica ✅
What breathing pattern is observed after a stroke?
A. Cheyne–Stokes respiration ✅
B. Hyperventilation
C. Kussmaul respiration
D. OSA

Which of the following isthe most specic test for tuberculosis?

A. AFB culture ✅
B. CT scan
C. Chest radiograph
D. PPD

A 19-year- old female presents to the physician with malar rash, arthritis,
proteinuria, thrombocytopenia, positive ANA, and anti- dsDNA. Which of the
follwing is the most likely diagnosis?
A. Behcet's disease
B. Reactive arthritis
C. Sjogren syndrome
D. Systemic lupus erythematosus ✅

What cells give rise to lungadenocarcinoma?

A. Bronchial epithelium
B. Neuroendocrine cells ✅
C. Squamouscells
D. WBCs

A 50 year old adult man has a postive PPD skin test. He is

asymptomatic. What should the next step be?
A. Chest XR ✅
B. Isoniazid for 9 months
C. Isonizid and rifampin for 3 months
D. Lung biopsy

A 30 years old female dancer with breast mass that disappeared by

aspiration, What is your suspect?
A. cystic ✅
B. duct ectesia
C. 􀂡broadenoma
D. phylloid

which of the following investigation should be done for early detection

of bilateral breast cancer?
A. FNA
B. biopsy
C. mammogram ✅
D. tumor marker
A 37-year old women presented to the doctor with intermittent bloody
nipple discharge from the left breast. On examination there is no palpable
mass. Which of the following is the most likely diagnosis?
A. Fibroadenoma
B. Fibrocystic changes
C. Intraductal papilloma ✅
D. Mastitis

A 32- year- old female presented to her physician with feel small lump
in her right breast , On Examination and investigation normal, what is the
best asdvise can tell her to do self-breast exam every?
A. 1 week
B. 2 month
C. 3 month
D. month ✅

A 36-year-old woman complains of a 3-month history of bloody

discharge from the nipple. At examination, a small nodule is found, deep to
the areola. Careful palpation of the nipple-areolar complex results in blood
arrears at the 3 O’clock position. Mammogram 􀂡ndings are normal. What is
the likeliest diagnosis?
A. Breast cyst
B. Carcinoma in situ
C. Intraductal carcinoma
D. Intraductal papilloma ✅

a patient lady noticed lump for three months the mass freely mobile no
discharge not related to menstrual, what is the diagnosis?
A. cystic
B. duct ectesia
C. ductal papilloma
D. 􀂡broadenoma ✅

.Which of the following is the best treatment for a lung abscess?

A. Ciprooxacin
B. Clindamycin ✅
C. Macrolides
D. Piperacillin
Female work as an actress, present with mass that increases before
menses, after taking FNA the result is yellow stain with no re􀂡lling again
what is the diagnosis?
A. 􀂡brocystic breast disease ✅
B. follicular cancer
C. intraductal papilloma
D. phyllodes tumor

Patient with bloody stained nipple discharge, you’re suspecting

intraductal papilloma. What’s the next step?
A. Excision ✅
B. FNA
C. Mammogram
D. discharge culture

A 40-year-old lady presented with bloody nipple discharge. Breast

examination showed normal skin and no areolar fullness. There were no
palpable axillary lymph nodes. Which of the following is the most likely
diagnosis?
A. Breast abscess
B. Fibroadenoma
C. Fibrocystic disease
D. Galactocele
E. Intraductal papilloma ✅

patient presents to the hospital with bloody nipple discharge, what is

the most likely cause?
A. Intraductal papilloma ✅
B. ductal
C. lobular carcinoma in situ
D. papillary

After intraductal papilloma, unilateral bloody nipple discharge from

one duct ori􀂡ce is most commonly caused by which of the following
pathologic conditions ?
A. In􀂡ammatory carcinoma
B. Intraductal carcinoma ✅
C. Paget's disease of the nipple
D. Subareolar mastitis
patient noticed lump for three the mass freely mobile, no discharge
not related to menstrual , what is the diagnosis ?
A. cystic
B. duct ectesia
C. ductal papilloma
D. 􀂡broadenoma ✅

Child with history of eczema in knee and flexure elbow. With maximum cortisone dose.
An eczema extending. What to do?
Chemotherapy ✅