Imed last rotation apparently

10. When is bronchoscopy indicated for someone with Pneumonia

a) Aspiration

b) Pneumothorax

c) Slowly resolving pneumonia

d) Empyema thoracis

11. A 32-year-old woman presents with two days of fever and headache. On exam, she is febrile.
tachycardic, and has neck stiffness, with no other focal neurologic signs. Which huntar puncture
findings would be most consistent with hacterial meningitis?

a) WBC count 10 with PMN predominance

b) WBC count 300 with PMN predominance

c) WBC count 2000 with PMN predominance

d) WBC count 10 with lymphocytic predominance

12. A 30-year-old male intravenous drug user presents with a two-week history of fever, malaise
and chest pain. On examination he is ill looking, diaphoretic and tachycardic with a pansystolic
murmur in the mitral area. Additionally, he has painful nodules in his fingers and dark streaks
beneath some of his finger nails. He has a normal LCG and full blood count shows WIIC 24x101,
11b 12g/dl, CRP 50 (normal -5). Which of the following is the most common complication of this
condition?

a) Myocarditis

b) Pulmonary embolism

c) Acute renal failure

d) Stroke

13. A 30-year-old woman presents to the clinic complaining of eye pain. Her vision is not
affected On examination she has chemosis, exophthalmos, lid lag, lid retraction and
ophthalmoplegia. She feels well in herself and is apyrexial. Which other clinical feature may she
be expected to have?

a) Heat intolerance

b) Purple striac

c) Weight gain

d) Polydipsia

14. A 50-year-old woman with HIV and poorly-controlled diabetes mellitus presents with a two-
year history of progressive numbness and pins and needles in the feet. They were initially only in
the fect but have now ascended up to the knees and are involving her fingers. On examination
she has reduced reflexes, a glove and stocking sensory loss pattern to pain and temperature,
and reduced vibration sense in the fingers and toes. What is the most likely localization of her
symptoms?

a) Polyradiculopathy

b) Small fiber sensory polyneuropathy

c) Large and small fiber sensory polyneuropathy

d) Mycloradiculopathy

15. A 50-year-old man with a history of surgical removal of a pituitary macroadenoma presents
with symptoms of low mood, fatigue, and brittle hair. A diagnosis of secondary hypothyroidism is

made. Which of the following laboratory findings would you expect to find?

a. Low TSH, high 14

b. Low TS11, low 14

c. High ISH, low 14

d. Low ISII, normal 14

16. Oval macrocytes are noted on a peripheral blood smear of a patient with macrocytic anaemia.
Oval macrocytosis is a typical feature of which of the following? a) Liver disease
h) Hypothyroidism

ca Pernicious Anaemia

Alohobsm

25. A 64-year-old male chronic smoker presents with a history of fling well for the d feels tired,
feverish and has a pridictive cough of green sputum. He ignored this for a ci day's as he often
has a story 100 pack yaking history and to smoke despite recent incresce of breath on exercise.
What is the most appropriat First line diagnostic investigation for this gentleman?

a) Sputum culture

b) Spirometry

c) Chest X-ray

d) C-reactive protein

26. A 65-year-old man with poorly controlled hypertension and diabetes presents with sudden
on bilateral lower limb weakness that happened 5 days ago. He describes that he felt a sudden
se pain in his back then fell to the ground due to leg weakness. On examination of the legs, you
that tone is increased, power is about 3/5. He has hyper-reflexia and up-going toes. He cann
pain and temperature up to the umbilicus, but vibration and proprioception are preserved. H
arms are not affected. He denies any trauma. What is the most likely localization?

a) Hemi-cord syndrome

b) Anterior cord syndrome

c) Posterior cord syndrome

d) Transverse cord syndrome

27. A 56-year-old woman presents with upper abdominal pain that she ascribes to stress. She
recently appointed as manager of a large company. She takes an over-the-counter antacid
temporary benefit. She uses no other medications. One night she awakens with nausea an a
large volume of brownish material. Upon hospitalization, she is found to have an active bleeding
duodenal ulcer. Which of the following statements is true?
a) The most likely etiology is adenocarcinoma of the duodenum b) The etiology of duodenal ulcer
is different in women than in men

c) The likelihood that she harbors Helicobacter pylori is greater than 50%

d) Organisms consistent with 11 pylori are rarely seen on biopsy in patients with duode

28. Which of the following hormones are produced by the thyroid gland?

a) Thyroid releasing hormone

b) Thyroid stimulating hormone

Calcitonin

d) Parathyroid hormone

29. A 45-year-old man presents to the clinic for an evaluation of hypertension. He went fo
medical checkup a week ago and his blood pressure was 160/100mml lg. Two further that week
were 156/98 and 166/96. Which of the following is the most appropriate in

examination in a patient with a new diagnosis of hypertension?

a) Electrocardiogram (ECG)

b) Echocardiogram

c) Fasting blood glucose

d) Urinalysis

40. A patient recently diagnosed with lower limb deep vein thrombosis (DVT) is prescribed a
factor X X antagonist for anticoagulation. All the following drugs are Factor X antagonists,
EXCEPT:

a) Rivaroxaban

b) Dabigatran.

c) Apixaban
d) Fondaparinux

24. A 30-year-old female with type I diabetes mellitus is admitted to the hospital with DKA. She
is started on an insulin infusion and intravenous fluids. Several hours later, her blood glucose
levels have decreased, but she becomes increasingly lethargic and develops a severe headache.
Repeat laboratory tests show a sodium level of 122 mmol/l. (normal 135-145 mmol/L.). What is
the most likely cause of her new symptoms?

a) Hypoglycemia

b) Cerebral edema

c) Hyponatremia due to hyperglycemia

d) Hypokalemia

25. A 64-year-old male chronic

27. Causes of tracheal deviation towards the side of the lung lesion include all of the following
EXCEPT:

a) Pleural effusion

b) Pneumothorax

c) Upper lobe fibrosis

d) Pneumonectomy

Pag

200. Which of the following is not used when assessing the severity of pecunonia ining the (Lin
6) score?

a) Oxygen Saturation

b) Serum Urea

c) Mental state

d) Respiratory Rate
18. A 78-year-old man is brought to the clinic by his family with concems of mensory problems.
They have noticed that in the last 2 years he has become increasingly forgetful. He gets lost in
tus neighborhood, often leaves the tap running and forgets to turn off the stove. He is able to
feed, bathe and dress himself. There are no changes to his personality, and no abnormalities of
movement. Ile has hypertension. Which of the following causes of dementia is most likely in this
patient?

a) Vascular dementia

b) Alzheimer's dementia

c) Dementia with Lewy Hodies

d) Normal pressure hydrocephalus

19. A 50-year-old female presents with a six-month history of carly morning stiffness of her
fingers in both hands. She also reports feeling excessively tired and unintended weight loss. On
examination you note that she has finger deformities at her distal and proximal interphalangeal
joints She denies dry eyes or dry mouth or any other skin changes. What is your most likely
diagnosis in this

patient?
a) Sjogren's syndrome

b) Systemic Lupus Erythematosus

c) Rheumatoid Arthritis

d) Dermatomyositis

20. You have just joined the clinical rotation in the emergency room at UITH A nurse comes to
you with her blood results, hepatitis B surface antibodies- positive, hepatitis It surface antigen
negative. What explanation are you going to give to your Consultant concerning this murs

a) The nurse should be started on antiviral drugs for HBV

b) This means that she was exposed to HRV in the past and cleared it. This can be confirmed by
checking the antibodies to the core antigen

c) This means that the nurse got vaccinated against IIIIV and should be monitored every six
months for HBV infection

d) She must be screened for IIIV since she is infected with HBV

21. A 25-year-old woman presents to the clinie with a three-month history of headaches. The
headache involves her whole head, is worst in the morning and at times wakes her up from sleep
It is worse when she bends over or strains. She has also noticed that she gets double vision at
times. On examination, you notice that she is obese and has bilateral papilledema The rest of her
examination is normal You suspect that she has idiopathic intracranial hypertension (3111).
Which of the following is NOT a feature of 1111? a) Bilateral cranial nerve VI palsies

b) Cerebrospinal fluid opening pressure of greater than 25cm 11.0

c) Pulsatile tinnitus

d) Headache relieved by lying that

22. A 50-year-old man with a history of chronic hypertension presents to the clinic with a 3-
month history of intermittent chest tightness. On examination he is not in respiratory distress
and his blood pressure is 190/105mmllg. Which of the following conditions is NOT an indication
for urgent treatment of hypertension?

a) Acute renal failure

b) Stable angina

c) Hypertensive retinopathy

d) Pulmonary edema

Page

30 A 40-year-old male with HIV and a CDM count of 143, initiated on ART at a local clinic 2
weeks age presents to the ART clinic for a routine review. He has no complaints and examination
reveals no abnormalities. What investigations should be ordered

a) urine LAM

b) Chest X-Ray

c) Senan CrAg
dj All of the above

31 A 20-year-old female with a long-standing history of type 1 diabetes mellitus presents with
nausea, vomiting, and abdominal pain. She has been non-compliant with her medications. On
examination, she appears dehydrated and has a fruity odor on her breath. Her blood glucose
level is 30mmol/L, and arterial blood gas shows a plf of 7:25. Which of the following DOES NOT
OCCUR in the pathophysiology of diabetic ketoacidosis?

a) Reduction in glucagon activity

b) Reduction in insulin activity

2) Increased gluconeogenesis

d) Increased lipolysis

32. A 15-year-old female with longstanding megaloblastic anaemia is found to have folate
deficiency. Folate deficiency can be caused by

a) Jejunal resection

b) Fish Tapeworm infestation

c) fical resection

d) Ascaris lumbricoides infestation

33. Which of the following is the major difference between Community Acquired and I Hospital

Acquired Pneumonia" a) Hospital acquired pneumonia is more severe than community acquired
pneumonia.

b) The CURB-65 scoring system can be used for community acquired pneumonia but not for
hospital acquired pneumonia C) Treatment of hospital acquired pneumonta should include
coverage of drug-resistant

organisms d) Viruses can cause community acquired pneumonia but not hospital acquired
pneumonia.

34. A 70-year-old woman with a history of hypertension and diabetes suddenly collapses and is
brought to the emergency room. Her husband saw her collapse two hours ago. On examination
her blood pressure is 180-100mmg11g. She is awake but not speaking or following commands, sh
does not blink to visual stimulation on the right, but blinks on the left. She moves her arm and les
on the left spontaneously, but there is no movement on the right. Which of the following is an

expected finding in this patient? a) Left homonymous hemianopia.

b) Right hemi-neglect

c) Occlusion of the left internal carotid artery on angiograin

d) Right facial weakness involving the upper and lower face.

35. A 30-year-old woman with HIV and a low CD4 count presents with a history of fever, night
sweats, weight loss and left-sided chest pain. She denies any cough. On examination you note
she has a stony dull percussion note over the left lower zone. Which of the following clinical

examination findings is NOT a characteristic of pleural effusion?

a) Reduced vocal resonance

b) Pleural friction rub

c) Reduced breath sounds

d) Increased tactile fremitus

36. A 65-year-old man with massive splenomegaly has just been diagnosed with chronic myc
leukaemia (CMI). Which one of following statements is NOT true about CML?

a) The BCR oncogene is found on chromosome 22

b) Dasatinib is second generation Tyrosine kinase inhibitor

c) Massive splenomegaly is a common feature

d) The Philadelphia chromosome is present in all patients

201. Which type of heart failure is most commonly associated with chronic hypertension?

a) Systolic heart failure

c) Acute heart failure

d) Congenital heart failure