Cardiology

1. Old patient presented with abdominal pain, back pain, pulsatile abdomen, what is
the step to confirm diagnosis?
a) Abdominal US
b) Abdominal CT
c) Abdominal MRI
 This is a case of aortic aneurysm, initial investigation US, confirmed by CT

2. How to diagnose DVT:

a) Contrast venography
b) Duplex US

3. Drug that will delay need of surgery in AR:

a) Digoxin
b) Verapamil
c) Nifedipine
d) Enalpril

 Nifedipine is the best evidence-based treatment in this indication. ACE inhibitors are particularly
useful for hypertensive patients with AR. beta-Adrenoceptor antagonists (beta-blockers) may be
indicated to slow the rate of aortic dilatation and delay the need for surgery in patients with AR
associated with aortic root disease. Furthermore, they may improve cardiac performance by
reducing cardiac volume and LV mass in patients with impaired LV function after AVR for AR.

4. Secondary prevention is:

a) Detection of asymptomatic diabetic patient

 Secondary prevention generally consists of the identification and interdiction of diseases that
are present in the body, but that have not progressed to the point of causing signs, symptoms,
and dys-function

5. Anticoagulation prescribe for

a) one month
b) 6 months
c) 6 weeks
d) one year

 The likely answer is B, but we should pay attention to the patient hemodynamic status and
specifically the bleeding potential.

6. Patient with left bundle branch block will go for dental procedure , regarding
endocarditis prophylaxis:
a) No need
b) Before procedure
c) After the procedure

7. When to give aspirin and clopidogrel?

a) Patient with history of previous MI
b) Acute MI
c) History of previous ischemic stroke
d) History of peripheral artery disease
e) after cardiac capt

 In acute coronary syndrome, Clopidogrel is given 300 mg initially then 75 mg once daily; Aspirin
75-325 mg once daily should be given concurrently.
8. In patients with hypertension and diabetes, which antihypertensive agent you want to
add first?
a) β-blockers
b) ACE inhibitor
c) α-blocker
d) Calcium channel blocker

 Diuretics (inexpensive and particularly effective in African-Americans) and β-blockers (beneficial

for patients with CAD) have been shown to reduce mortality in uncomplicated hypertension. They
are first-line agents unless a co morbid condition requires another medication. (see table)

Population Treatment
Diabetes with
Proteinuria ACEIs.
CHF β-blockers, ACEIs, diuretics (including spironolactone).
Isolated systolic Diuretics preferred; long-acting dihydropyridine calcium channel
hypertension blockers.
MI β-blockers without intrinsic sympathomimetic activity, ACEIs.
Osteoporosis Thiazide diuretics.
BPH α-antagonists.

9. ECG finding of acute pericarditis?

a) ST segment elevation in all leads
b) Low-voltage, diffuse ST-segment elevation.

10. 59 years old presented with new onset supraventicular tachycardia with palpitation,
no Hx of SOB or chest pain ,chest examination normal ,oxygen saturation in room air =
98%, no peripheral edema Others normal, the best initial investigation:
a) ECG stress test
b) Pulmonary arteriography
c) CT scan
d) TSH

11. The mechanism of action of Aspirin:

a) Inhibit cycloxgenase
b) Inhibit phospholipase A2
c) Inhibit phospholipid D
12. known case of chronic atrial fibrillation on the warfarin 5 mg came for follow up you
find INR 7 but no signs of bleeding you advice is:
a) Decrease dose to 2.5 mg
b) Stop the dose & repeat INR next day
c) Stop warfarin
d) Continue same and repeat INR
IN
R ACTION
>10 Stop warfarin. Contact patient for examination. MONITOR INR
7- Stop warfarin for 2 days; decrease weekly dosage by 25% or by 1 mg/d for next week (7
10 mg total)
4.5- Decrease weekly dosage by 15% or by 1 mg/d for 5 days of next week (5 mg total)repeat
7 monitor INR
3- Decrease weekly dosage by 10% or by 1 mg/d for 3 days of next week (3 mg total); repeat
4.5 monitor INR
2-3 No change.
1.5-
2 Increase weekly dosage by 10% or by 1 mg/d for 3 days of next week (3 mg total);
<1.
5 Increase weekly dose by 15% or by 1 mg/d for 5 days of next week (5 mg total);

13. Patient is a known case of CAD the best exercise:

a) Isotonic exercise
b) Isometric exercise
c) Anaerobic exercise
d) Yoga
 anaerobic exercise (endurance) : isotonic like running >>> rise HR more than BP to improve
cardiac function
 Weight bearing exercise (isometric): isometric like weight lifting, may build muscle strength,
bone density >>>
cause spike rise in BP and is bad for CAD pts.
 stretching exercise : for prevent cramp , stiffness and back pain

14. A known case of treated Hodgkin lymphoma (mediastinal mass) with radiotherapy
Not on regular follow up presented with gradual painless difficulty in swallowing and
SOB , There is facial swelling and redness Dx
a) SVC obstruction
b) IVC obstruction
c) Thoracic aortic aneurysm
d) Abdominal aortic aneurism

15. Complication of Sleep apnea is :

a) CHF
 sleep apnea : Hypoxic pulmonary vasoconstriction PAH Cor Pulmonale CHF
 Complication of sleep apnea: sleep apnea increases health risks such as cardiovascular
disease, high blood pressure, stroke, diabetes, clinical depression, weight gain and obesity.
The most serious consequence of untreated obstructive sleep apnea is to the heart. In
severe and prolonged cases, there are increases in pulmonary pressures that are
transmitted to the right side of the heart. This can result in a severe form of congestive
heart failure (cor pulmonale)

16. Which is not found in coarctation of the aorta:

a) upper limb hypertension
b) diastolic murmur heard all over perecordium
c) skeletal deformity on chest x-ray
 all are found in coarcitation
17. Which of the following medication if taken need to take the patient immediately to
the hospital:
a) Penicillin
b) Diphenhydramine
c) OCPs
d) Quinine or quinidine
 Quinidine is antiarrhythmic medication.

18. What is true about alpha blocker:

a) Causes hypertension.
b) Worsen benign prostatic hyperplasia.
c) Cause tachycardia
 alpha blocker: cause orthostatic hypotension and tachycardia

19. Which of the following drugs increase the survival in a patient with heart failure :
a) Beta blocker.
b) ACE inhibitors
c) Digoxin
d) Nitrites.

 New updated information. As ACE inhibitors inhibit aldosterone which if present in high
concentrations causes modification of the cardiac myocytes in the long term.

20. Elderly patient presented by SOB, rales in auscultation, high JVP, +2 lower limb
edema ,what is the main pathophysiology?
a) Left ventricular dilatation.
b) Right ventricular dilatation.
c) Aortic regurgitation.
d) Tricuspid regurgitation.

 Difficult question. Here we have both symptoms of Left ventricular failure (SOB, Rales) & right
ventricular failure (High JVP & LL edema). So, more commonly left ventricular failure leads to
right ventricular failure due to overload and not vice versa. So the most correct is Left
ventricular dilatation.

229. 60 years old patient presented by recurrent venous thrombosis including superior
venous thrombosis , this patient most likely has:
a) SLE
b) Nephrotic syndrome
c) Blood group O
d) Antiphospholipid syndrome

230. IV drug abuser was presented by fever, arthralgia and conjunctival hemorrhage, what
is the diagnosis?
a) Bacterial endocarditis

231. Which the following is the commonest complication of patient with chronic atrial
fibrillation?
a) Sudden death
b) Cerebrovascular accidents “due to multiple atrial thrombi”

232. Which of the following is the recommended diet to prevent IHD?

a) Decrease the intake of meat and dairy
b) Decrease the meat and bread
c) Increase the intake of fruit and vegetables

25. iArterial injury is characterized by

a) Dark in color and steady
b) Dark in color and spurting
c) Bright red and steady
 d) Bright red and spurting

26. Patient has fatigue while walking last night. He is on Atorvastatin for 8 months,
Ciprofloxacin, Dialtizem and alphaco, the cause of this fatigue is:
a) Dialtizem and Atrovastatin
b) Atorvastatin and Ciprofloxacin
c) Atorvastatin and Alphaco
 Statins cause myopathy, quinolones cause tendonitis

27. Obese lady with essential hypertension, lab work showed high NA, high K, what is the
reason of hypertension?
a) Obesity
b) High Na intake
c) High K intake
 More than 85% of essential HTN with BMI >25

28. All of the following are risk factors for heart disease except:
a) High HDL
b) Male
c) Obesity

29. True about systolic hypertension

a) could be caused by mitral regurg
b) More serious than diastolic hypertension
c) Systolic > 140 and diastolic < 90

30. Patient with continuous Murmur:

a) PDA
b) Coarctation of Aorta

31. Patient has high Blood Pressure on multiple visits, so he was diagnosed with
hypertension, what is the Pathophysiology?
a) Increase peripheral resistance
b) increased salt and water retention

32. Prophylaxis of arrhythmia post MI:

a) Quinidine
b) Quinine
c) Lidocaine
d) procinamide
 If beta blocker present choose it

33. Best single way to reduce high blood pressure is :

a) Smoke cessation
b) Decrease lipid level
c) Reduce weight
36. An old patient presents with history dizziness & falling down 1 day ago
accompanied by history of Epigastric discomfort. He has very high tachycardia
“around 130-140” and BP 100/60. What is the diagnosis?
a) Peptic ulcer
b) GERD
c) Leaking aortic aneurysm

37. Patient with orthostatic hypotension. What's the mechanism:

a) Decrease intravascular volume
b) Decrease intracellular volume
c) Decrease interstitial volume

38. Which of the following anti hypertensive is contraindicated for an uncontrolled

diabetic patient?
a) Hydrochlorothiazide
b) Losartan
c) hydralszine
d) spironolactone

39. 69 years old non diabetic with mild hypertension and no history of Coronary heart
disease, the best drug in treatment is:
a) Thiazide
b) ACEI
c) ARB
d) CCB

40. Which of the following decrease mortality after MI?

a) Metoprolol
b) Nitroglycerine
c) Thiazide
d) Morphine

41. Case of sudden death in athlete is:

a) Hypertrophic obstructive cardiomyopathy (HOCM)

42. Male patient with HTN on medication, well controlled, the patient is using garlic
water and he is convinced that it is the reason for BP control, what you'll do as his
physician:
a) Tell him to continue using it
b) To stop the medication and continue using it
c) Tell him that he is ignorant
d) To stop using garlic water

43. Patient with rheumatic fever after untreated strep infection after many years
presented with Mitral regurge, the cause of massive regurg is dilatation of:
a) Right atrium
b) Right ventricle
c) Left atrium
d) Left ventricle

44. Regarding MI all true except:

a) Unstable angina, longer duration of pain and can occur even at rest.
b) Stable angina, shorter duration and occur with excretion
c) There should be Q wave in MI
d) Even if there is very painful unstable angina the cardiac enzymes will be normal

45. Asystole in adult

 a) Adrenalin
b) Atropine
 asystol has only 2 durgs epinephrine & vasopressine

46. After doing CPR on child and the showing asystole:

A. Atropine
B. Adrenaline
C. Lidocane

47. Classic Scenario of stroke on diabetic and hypertensive patient. What is the
pathophysiology of stroke:

A. Atherosclerosis
B. Aneurism

48. Middle aged patient with an a cyanotic congenital heart disease the X-ray show
ventricle enlargement and pulmonary hypertension
A. VSD
B. ASD
C. Trancus arteriosus
D. Pulmonary stenosis

49. Middle age a cyanotic male with CXR showing increase lung marking & enlarged
pulmonary artery shadow, what is the most likely diagnosis?
A. VSD
B. Aorta coarctation
C. Pulmonary stenosis
D. ASD
E. Truncus arteriosus
50. Most common cause of secondary hypertension in female adolescent is:
a) Cushing syndrome
b) Hyperthyroidism
c) Renal disease
d) Essential HTN
e) Polycystic ovary disease

51. Most common cause of intra cerebral hemorrhage:

a) Ruptured aneurysm
b) Hypertension
c) Trauma

52. Cause of syncope in aortic stenosis

a) Systemic hypotension

53. Medical student had RTA systolic pressure is 70 mmhg, what you will do next in
management:
a) IV fluid therapy
b) ECG
c) Abdominal U/S

54. 25y female with bradicardia and palpitation. ECG normal except HR130 and apical
puls is 210 .past history of full ttt ovarian teratoma, so your advice is
a) Struma ovarii should be consider
b) Vagal stimulate should be done
c) Referred to cardiology

55. 55 years old complain of dyspnea, PND with past history of mitral valve disease
diagnosis is
a) Left side heart faliure
b) Right side heart faliure
c) pnemothrax
d) PE
186. The symptoms suggestive of left side HF

56. What is the first sign of Left Side Heart Failure?

a) Orthopnea
b) Dyspnea on exertion
c) Pedal edema
d) PND
e) Chest pain
 Fluid build up in the lungs is the firest sign of LSHF

57. Middle aged male s involved in RTA, his RR is 30/min, heart sounds is muffled & the
JVP is elevated, BP: 80/40 & a bruise over the sternum, what is the diagnosis?
a) Pericardiac Tamponade
b) Pneumothorax
c) pulmonary contusion
d) Hemothorax
58. Oral anticoagulants :
a) can be given to pregnant during 1st trimester
b) Can be reversed within 6 hours
c) Are enhanced by barbiturates
d) Cannot cross blood brain barrier
e) None of the above

59. The following are features of rheumatic heart disease except:

a) Restless involuntary abnormal movement
b) Rashes over trunk and extremities
c) Short P-R interval on ECG
d) Migratory arthritis

60. Premature ventricular contracture (PVC), all are true except:-

a) Use antiarrhythmic post MI improve prognosis “this is not totally true, as class 1
increase mortality”
b) Use of antiarrythmic type 1 increase mortality

61. One of the following is NOT useful in patient with atrial fibrillation and Stroke:
a) Aspirin and AF
b) Warfarin and AF
c) Valvular heart disease can lead to CVA in young patient
d) AF in elderly is predisposing factor

62. Shoulder pain most commonly due to:

a) Infraspinatus muscle injury
b) Referred pain due to cardiac ischemia
c) In acute cholecystitis
d) Bursitis
 The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator
cuff

63. ECG stress test is indicated in the following except:
a) Routine (yearly) test in asymptomatic patients
b) In high risk jobs
c) 40 year old patient before starting exercise program

64. Most serious symptom of CO poisoning is:

a) Hypotension
b) Arrhythmia
c) Cyanosis
d) Seizure

65. 35 years old male has SOB, orthopnea, PND, nocturia and lower limbs edema. What’s
the most common cause of this condition in this patient:
a) Valvular heart diease
b) UTI
c) Coronary artery disease
d) Chronic HTN

66. 5 days after MI, the patient developed SOB and crackles in both lungs. Most likely
cause is:
a) Pulmonary embolism
b) Acute mitral regurgitation

67. 70 years old male came with history of leg pain after walking, improved after
resting, he notice loss of hair in the shaft of his leg and become shiny;
a) Chronic limb ischemia
 b) DVT

68. Patient comes to the ER with weak rapid pulse, what is your next step?
a) Give him 2 breaths
b) Do CPR (2 breaths / 30 compressions)
c) Waite until team of resuscitation group comes
 I think resuscitation team is the best answer, If pulse is positive don't give CPR

69. DM with controlled blood sugar and his BP was 138/89 mmHg what will be your next
step :
a) Nothing
b) Add ACE inhibitor
70. ECG shows ST elevation in the following leads V1, 2, 3, 4 & reciprocal changes in
leads aVF & 2, what is the diagnosis?
a) Lateral MI
b) Anterior MI
c) Posterior MI

71. Which of the following medications is considered as HMG-CoA reductase inhibitor?

a) Simvastatin
b) Fibrate
 Simvastsin is a hypolipidemic drug used to control elevated cholesterol ‘hypercholesterolemia’

72. DVT for a lady best management?

a) Bed rest, warfarin and heparin

73. 50 years old patient, diagnosed with hypertension, he is used to drink one glass of
wine every day, he is also used to get high Na and high K intake, his BMI is 30kg/m,
what is the strongest risk factor for having hypertension in this patient?
a) wine
b) High Na intake
c) high K intake
d) BMI=30

74. Patient wants to do dental procedure, he was diagnosed to have mitral valve prolapse
clinically by cardiologist, he had never done echo before, what is appropriate action?
a) Do echo
b) No need for prophelaxis
c) Give ampicillin
d) Give amoxicillin calvulinic

75. Old patient with HTN & BPH treatment is:

a) Beta-blocker
b) Phentolamine
c) Zedosin

76. Sign of severe Hypokalemia is:

A. P-wave absence
B. Peak T-wave
C. Wide QRS complex
D. Seizure

77. Patient with AMI and multiple PVC , is your treatment for this arrhythmia :
a) Amiadrone
b) No treatment

78. Causes of secondry hyperlipidemia all except:-

a) Hypertension
b) Nephrotic syndrome
 c) Hypothyroidism
d) Obesity

79. 70 years old lady on …….., feels dizzy on standing, resolves after 10-15
minutes on sitting, decrease on standing, most likely she is having :
a) Orthostatic hypotension

80. The effectiveness of ventilation during CPR measured by:-

a) Chest rise
b) Pulse oximetry
c) Pulse acceleration

81. Cardiac syncope:

a) Gradual onset
b) Fast recovery
c) Neurological sequence after
82. Young patient with HTN came complaining of high blood pressure and red, tender,
swollen big left toe, tender swollen foot and tender whole left leg. Diagnosis is:
a) Cellulitis
b) Vasculitis
c) Gout Arthritis

83. Patient with hypertrophic subaortic stenosis referred from dentist before doing dental
procedure what is true
a) 50 % risk of endocarditis up to my knowledge
b) 12 % risk of endo carditis
c) No need for prophylaxis
d) post procedure antibiotic is enough

84. Female, narrow QRS, contraindication of Adenosine:

a) LHF
b) Mitral
c) Renal

85. 31 years old autopsy show bulky vegetions on aortic and mitral valves, what is the
diagnosis?
a) Infective endocarditis
b) Rh endocarditis

86. Patient on Digoxin drug, started to visualize bright lights and other signs of visual
disturbances. What caused this?
a) Digoxin toxicity

87. How does the heart get more blood?

a) Increasing blood pressure
b) Increasing heart rate
c) Increasing SV

88. The best way of treating patient with BP= 130-139/80-85:

a) Wight reduction and physical activity
b) Exercise alone is not enough

89. Family history of CAD eaten fruit 4 veget 4 bread 8 meat 3 diary 4 what to do
a) Decrease meat and dairy

90. Premature ventricular contraction is due to:

a) Decrease O2 requirement by the heart
b) Decrease blood supply to the heart
c) Decrease O2 delivery to the heart
91. Male patient who is a known case of hypercholesterolemia, BMI: 31, his
investigations show high total cholesterol, high LDL & high TG, of these investigations
what is the most important risk factor for developing coronary artery disease?
a) Elevated LDL
b) Elevated HDL
c) Low HDL
d) Elevated cholesterol
e) Elevated triglyceride level

92. Patient was brought by his son. He was pulseless and ECG showed ventricular
tachycardia, BP 80/, what is your action?
a) 3 set shock
b) One D/C shock (cardioversion)
c) Amiodaron
d) CPR
 Pulsless VT treated by unsynchronized shock (not cardioversion) and CPR.
 The first thing to be given is the shock, then CPR then drugs (epinephrine & amiodaron)

93. One of the following is a characteristic of syncope (vasovagal attack):

a) Rapid recover
b) Abrupt onset
c) When turn neck to side
d) Bradycardia
e) Neurological deficit

94. Which of the following indicate inferior wall MI (Inferior chest leads) in ECG?
a) II, III, AVF
b) V1,V2,V3
c) V2, V3, V4
d) I, V6
e) I, aVL, VI

95. Patient who is a known case of posterior MI presented with syncope. Examination
showed canon (a) wave with tachycardia, unreadable BP & wide QRS complexes on
ECG. The diagnosis is:
a) Atrioventricular reentrant nodal tachycardia
b) Ventricular tachycardia
c) Pre-existing AV block
d) Anterograde AV block
e) Bundle branch block

96. Warfarin is given to all the following except:

a) Young male with Atrial fibrillation & mitral stenosis
b) Male with AF & cardiomyopathy
c) Male with AF & prosthetic heart valve
d) Elderly male with normal heart

97. Angina with decrease ST 1-2 cm < 5 min what is the diagnosis?
a) Ischemia- heart block

98. 15 years old male patient complaining of joint pain & fever for 1 week , difficulty
swallowing, liver 1 cm below costal and pancystolic murmur
a) RHD
b) Infected endocarditis

99. What will increase heart blood flow when increase load on heart?
a) Dilation of coronary
b) Constrict of aorta
c) Increase HR
d) Increase venous retain
100.Pregnant, with history of DVT 4 years back, what will you give her?
a) Aspirin
b) Clopidogrel
c) LMW heparin

101.Patient come with precordeal pain, ECG ST segment elevation, patient given
aspirin and nitrate, but no relieve of pain what next step you will do?
a) Give morphine IV

102.Most common cause of chronic hypertension:

a) DM
b) Hypertension
c) Interstitial renal disease
 kidney disease is the most common cause of secondary HTN

103.All are true about the best position in hearing the

murmurs, EXCEPT: a) Supine: venous hum
b) Sitting: AR
c) Sitting: pericardial rub
d) supine: innocent outflow obstruction
e) Left lateral in: MS

105.What is the most risk of antihypertensive drugs on

elderly patient? a) Hypotension
b) Hypokalemia
c) CNS side
effect

106.About ventricular fibrillation:

a) Can only be treated with synchronized defibrillation
b) The waves are similar in shape, size and pattern
c) Course VF indicates new VF and can be treated with……

107.60 years old male presented with history of 2 hours chest pain, ECG showed ST
elevation on V1-V4 with multiple PVC & ventricular tachycardia. The management
is:
a) Digoxin
b) Lidocane
c) Plavix & morphine
d) Amiodarone


108.Female patient with moderate AS had syncope in the gym while she was doing
exercise, if the syncope was due to AS, what is the cause?
a) systemic hypo-tension
b) cardiac arrhythmia

109.Which of the following is the least likely to cause infective endocarditis:

a) ASD
b) VSD
c) Tetralogy of Fallot
d) PDA
 50% of all endocarditis occurs on normal valves
 Predisposing cardiac lesions:
1) Aortic / mitral valve disease
2) IV drug users in tricuspid valves
3) Coarctation
4) PDA
5) VSD ( Fallot's Tetradincluded )
6) Prosthetic valves
 110. Patient presented in ER with Low BP, distended Jugular veins, muffled heart
sounds and bruises over sterna area, what is the diagnosis?
a) Cardiac tamponade
111.35 years old woman presented with exertional dyspnea. Precordial examination
revealed loud S1 and rumbling mid diastolic murmur at apex. Possible
complications of this condition can be all the following
EXCEPT:
a) Atrial fibrillation
b) Systemic embolization
c) Left ventricular failure
d) Pulmonary edema
e) Pulmonary hypertension

112.S3 occur in all of the following

EXCEPT:
113.a) Tricuspid regurgitations.
b) Young
athelete. c) LV
failure.
d) Mitral stenosis.

113.Treatment of chronic atrial fibrillation

all, EXCEPT: a) Cardioversion
b) Digoxin
c)
warfarin

115.The following are features of rheumatic

fever, Except: a) Restless, involuntary abnormal
movements.
b) Subcutaneous nodules.
c) Rashes over trunk and
extremities. d) Short PR
interval on ECG.
e) Migratory arthritis

 Clinical features: Sudden onset of fever, joint pain, malaise and loss of appetite. Diagnosis also
relies on the presence of two or more major criteria or one major plus two or more minor criteria
Revised Ducket jones criteria Major criteria are carditis, polyarthritis, chorea, erythema
marginatum and subcutaneous nodules.
Minor criteria are fever, arthralgia, previous rheumatic fever, raised ESR/c-
reactive protein. Leukocytosis and prolonged PR interval on ECG.

116.What is the cause of death in

Ludwig angina? a) Dysrythmia
b) Asphyxia
c) pneumonia
d) wall
rupture
 sudden asphixyation is the most common cause of death in ludwig angina,
 It is potentially life-threatening cellulitis or connective tissue infection, of the floor of the mouth,
usually occurring in adults with concomitant dental infections and if left untreated, may obstruct
the airways, necessitating tracheotomy.

117.Nitroglycerine cause all of the

following, EXCEPT: a) Increase coronary
blood flow
b) Methemoglobinemia
c) Venous pooling of blood.
 d) Efficient for 5 min. if taken
sublingual. e) Lowers arterial blood
pressure.

119.Sinus tachycardia and atrial flutter, how to

differentiate? a) Temporal artery message
b) Carotid artery
message c) Adenosine
IV

120.Young patient came to ER with dyspnea and productive tinged blood frothy sputum,
he is known case of rheumatic heart disease, AF and his cheeks has dusky rash, what
is the diagnosis?
a) Mitral stenosis
b) CHF
c) Endocarditis

121.Patient with sudden cardiac arrest the ECG showed no electrical activities with
oscillation of QRS with different shapes. The underlying process is
a) Atrial dysfunction
b) Ventricular dysfunction
c) Toxic ingestion
d) Metabolic cause

122.Best treatment for female with migraine and HTN

a) Propranolol

123.Patient 20 year old come with palpitations ECG show narrow QRS complexes and
pulse is 300 bpm what is the true?
a) Amiodarone should included in the management

124.How coronary artery disease causes MI?

a) Narrowing of the blood vessel

125.Calcium channel blocker as nifedipine, verapamil and diltiazem are extremely useful
in all of the following applications except:
a) Prinzmetal’s angina pectoralis
b) Hypertension
c) Atrial tachycardia
d) Ventricular tachycardia
e) Effort angina pectoralis
126.Old man who had stable angina the following is
correct except: a) angina will last less than 10 min
b) occur on exertion
c) No enzymes will be elevated
d) Will be associated with loss of consciousness

127.70 years old male was brought to the ER with sudden onset of pain in his left lower
limb. The pain was severe with numbness. He had acute myocardial infarction 2 weeks
previously and was discharged 24 hours prior to his presentation. The left leg was cold
and pale, right leg was normal. The most likely diagnosis is:
a) Acute arterial thrombosis
b) Acute arterial embolus
c) Deep venous thrombosis
d) Ruptures disc at L4-5 with radiating pain
e) Dissecting thoraco-abdominal

128.Coarctation of aorta is commonly associated with which of the following syndrome:

a) Down
b) Turner
c) Pataue
d) Edward
e) Holt-Orain

129.Before an operation to a child we found him having continues murmur in his right
sternal area what is the next step of management?
a) Postpone and reevaluate the patient again

130.Each of the following murmur will be elicited by the change of position except:
a) Innocent murmur by sitting

131.Patient post MI with hemiparisis and drowsy what is the first to do :

a) Heparin

132.Patient known case of coronary artery disease, present with a symptoms of it, to
diagnose that patient has MI or not, by first ECG & cardiac enzyme
a) Exercise stress test
b) Coronary angiography
c) Exercise

133.Patient present with carotid artery obstruction by 80%, treatment by

a) Carotid endarterectomy
b) surgical bypass
 If more than 70 % go to surgery

134.Old male come with CHF & pulmonary edema, what is the
best initial therapy a) Digoxin
b)
Furosemide
c)
Debutamine
135.except: a) Nausea and vomiting.
b) Peaked T-waves.
c) Widened QRS
complex. d) Positive
Chvostek sign. e)
Cardiac arrest in
diastole.
 Hyperkalemia is characterized by tall peaked T-waves, wide QRS complex, and cardiac
arrest if untreated, chvostek sign is a sign of hypocalcemia (taping over facial nerve causes
facial muscles to twitch).

136.10 years old had an episode of rheumatic fever without any defect to the heart. The
patient need to take the antibiotic prophylaxis for how long:
a) 5 months
b) 6 years
c) 15 years

137.The antibiotic prophylaxis for

endocarditis is: a) 2 g amoxicillin 1 h
before procedure
b) 1 g amoxicillin after procedure
c) 2 g clindamycine 1 h before
procedure d) 1 g clindamycine after
procedure

138.Patient with hypercholesterolemia, he

should avoid: a) Organ meat
b) Avocado
c) Chicken
d) white
egg

139.Difference between unstable and stable angina :

a) Necrosis of heart muscle
b) Appears to be independent of activity “pathophysiology of the atherosclerosis”

140. Drug contraindication hypertrophic obstructive cardiomyopathy

a) Digoxin
b) One of b-blocker
c) Alpha blocker

141.Fick method in determining cardiac output

a) BP
b) O2 saturation in blood
142.Man who has had MI you will follow the
next enzyme a) CPK
b)
ALP
c)
AST
d) Amylase

143.Patient with congestive heart failure, which medication will decreas his mortality?
a) Furosemide
b) Digoxin
c) ACEIs decrease the mortality

144.Regarding murmur of mitral stenosis

a) Holosystolic
b) Mid systolic
c) Mid-diastolic rumbling murmur

145.What is the correct about unstable angina :

a) Same drug that use in stable angina
b) Should be treated seriously as it might lead to MI
 Note: Fifty percent of people with unstable angina will have evidence of myocardial necrosis
based on elevated cardiac serum markers such as Creatine kinase isoenzyme (CK)-MB and
troponin T or I, and thus have a diagnosis of non-ST elevation myocardial infarction
146. Patient with history of AF + MI, what the best prevention for stroke is?
a) Warfarin
b) Surgery procedure
c) Shunt

147.Which most common condition associated with endocarditis?

a) VSD
b) ASD
c) PDA
d) TOF

148.Patient on Lisinopril complaining of cough, what's a drug that has the same action
without the side effect?
a) Losartan

149.RBBB:
a) LONG S wave in lead 1and V6 & LONG R in VI
b) LONG S wave in lead V1 & LONG R in V6

150.Drug used in treatment of CHF which decrease the mortality

a) B blocker
b) Verapamil
c) Nitrates
d) Digoxin

151.Patient known case of stable angina for 2 years, came c/o palpitation , Holtis
monitor showed 1.2mm ST depression for 1 to 2 minutes in 5-10 minutes wt your Dx
a) Myocardial ischemia
b) Sinus erythema
c) Normal variant

152.Patient presented to ER with substernal chest pain, 3 month ago patient had complete
physical examination, and was normal, ECG normal, only high LDL in which he started
low fat diet and medication for it. What is the factor the doctor will take into
considerations as a risk factor?
a) Previous normal physical examination.
b) Previous normal ECG.
c) Previous LDL level.
d) Current LDL level.
e) Current symptom.

153.Carpenter 72 years old loss one of his family (death due to heart attack) came to you
to do some investigation he well and fit. He denied any history of chest pain or SOB.
O/E everything is normal except mid systolic ejection murmur at left sternal area
without radiation to carotid, what is your diagnosis?
a) aortic stenosis
b) aortic sclerosis
c) Flow murmur
d) Hypertrophic Subaortic Stenosis

154.Patient came with chest pain radiate to jaw increase with exercise, decrease with rest,
what is the diagnosis?
a) Unstable angina
b) Stable angina
c) Prenzmetal angina

155.Patient with sudden SOB had posterior inferior MI, what is the cause?
a) Pulmonary embolism
b) Acute MR
c) Acute AS
 d) Arrhythmia

156.Increase survival rate in heart faliure

a) Enalpril
b) Isosordil
c) Furosemide
d) Spironolactone

157.Cause of LBBB Bundle branch block

a) Aortic stenosis  (cause LBBB)
b) Pulmonary stenosis  (cause RBBB)
c) Mitral
d) Cardiomyopathy  (cause LBBB)
 Causes of LBBB are:
1) Aortic stenosis
2) Dilated cardiomyopathy
3) Acute myocardial infarction
4) Extensive coronary artery disease
5) Primary disease of the cardiac electrical conduction system
6) Long standing hypertension leading to aortic root dilatation and subsequent aortic
regurgitation
 Causes of RBBB are:
1) Coronary artery disease
2) Myocarditis
3) ASD, VSD and Valvular heart disease
4) COPD & pulmonary embolus.
158.surgery. And he is sensitive for penicillin. What you will give him
a) IV vancomycin plus IV gentamicin
b) oral tetracycline
c) no need to give

159.Patient had rheumatic episode in the past, He developed mitral stenosis with orifice
less than(…mm) (sever stenosis) This will lead to
a) Left atrial hypertrophy and dilatation
b) Left atrial dilatation and decreased pulmonary wedge pressure
c) Right atrial hypertrophy and decreased pulmonary wedge pressure
d) Right atrial hypertrophy and chamber constriction

160.Elderly patient presented by SOB, rales in auscultation, orthopnea, PND, exertion

dyspnea، what is the main pathophysiology
a) Left ventricular dilatation
b) Right ventricular dilatation
c) Aortic regurgitation.
d) Tricuspid regurgitation

161.Patient with BP of 180/140, you want to lower the Diastolic (which is true ) :
a) 110-100 in 12 hours
b) 110-100 in 1-2 days
c) 90-80 in 12 hrs
d) 90-80 in 1-2 days

162.Unstable angina:
a) Least grade II and new onset less than 2 months ago.
b) Usually there is an evidence of myocardial ischemia.
c) Same treatment as stable angina.
d) Discharge when the chest pain subsides.

163.Patient post-MI 5 weeks, complaining of chest pain, fever and arthralagia:

a) Dressler's syndrome
b) Meigs syndrome
c) Costochondritis
d) MI
e) PE
 Dressler's syndrome is a secondary form of pericarditis that occurs in the setting of injury to
the heart or the pericardium

164.Patient with chest pain x-ray revealed pleural effusion, high

protein & high HDL: a) TB
b) CHF
c)
Hypothyroidism
d)
Hypoprotienemia

165.Drug used in systolic dysfunction heart failure:

a) Nifidepine
b) Deltiazm
c) ACEI
d) B-blocker

166.Elderly patient known case of AF came with abdominal pain and bloody stool,
What is the diagnosis
167. a) Ischemic mesentery

168.Patient having chest pain radiating to the back, decrease blood pressure in left arm
and absent left femoral pulse with left sided pleural effusion on CXR, left ventricular
hypertrophy on ECG, most proper investigation is:
a) aortic angiogram
 b) amylase level
c) CBC
d) Echo

168.60 years old patient has only HTN best drug to start with:
a) ACEI
b) ARB
c) Diuretics
d) Beta blocker
e) Alpha blocker

169.Patient after 2 months post MI cannot sleep what to give him?

a) Zolpidem
b) diazepam

170.Obese, HTN, cardiac patient with hyperlipidemia, sedentary life style and unhealthy
food, What are the 3 most correctable risk factor?
a) HTN, obesity, low HDL
b) High TAG, unhealthy food, sedentary life
c) High cholesterol, unhealthy food, sedentary life
d) High cholesterol, HTN, obesity
 Note: High cholesterol, unhealthy food & sedentary life are modifiable risk factors.

171.15 years old with palpitation and fatigue. Investigation showed right
ventricular hypertrophy, right ventricular overload and right branch block, what
is the diagnosis?
a) ASD
b) VSD
c) Cortication of aorta

172.Patient with HTN on diuretic he developed painful big toe what kind of
a) Hyderocholrathiazid “I think”
b) Furosemide

 Bothe are correct “Hyperuricemia is a relatively common finding in patients treated with a
loop or thiazide diuretic and may, over a period of time, lead to gouty arthritis”

173.What best explain coronary artery

disease? a) No atherosclerosis
b) Fatty deposition with widening of
artery c) Atherosclerosis with
widening of artery

174.Old patient, she have MI and complicated with ventricular tachycardia, then
from that time receive Buspirone. She came with fatigue, normotensive & pulse
was 65, what investigation must to be done?
a) Thyroid function
b) Liver and thyroid
175.Patient has atrial fibrillation
(AF) risk: a) CVA
b) MI

176.Case of pericarditis
a) Pain in chest increase with movement
b) Best investigation is ECG
c) Best investigation is Cardiac enzyme

 N.B. pericarditis patient present with substernal pleuritc chest pain that aggravated by lying
down and relieved by leaning forward.

177.Patient complain MI on treatment after 5 day patient have short of breath +

crepitation on both lung a) pulmonary embolism
 b)
pneumonia
c) MR
d) AR

178.High pitch diastolic murmur

a) MS
b) MR
c) MVP

179.Patient come to ER with AF, BP 80/60 what it the management?

a) synchronized CD
b) Digoxin

180.Long scenario of MI, what is the inappropriate management?

a) IV ca++ channel blocker
b) nitrate
c) Iv morphine
d) Beta blocker

181.Patient presented with chest pain for 2 hours With anterolaterl lead shows ST
elevation, providing not PCI in the hospital Management
a) Streptokinase ,nitroglysrin, ASA & beta blocker
b) Nitroglysren ,ASA ,heparin beta blocker
c) Nitroglysren ,ASA,beta blocker
d) Alteplase , Nitroglysren , ,heparin betablocker

182.Which of the following is a MINOR criteria for rheumatic fever?

a) Arthritis
b) Erytherma marginutum
c) Chorea
d) Fever

183.Patient diagnosed to have aortic stenosis, he is a teacher, while he was in the class
he fainted, what is the cause?
a) Cardiac syncope
b) Hypotension
c) Neurogenic syncope
184.Patient case of CHF, loved to eat outdoor 2-3 time weekly
u advice him: a) Eat without any salt
b) Eat 4 gm salt
c) Low fat, high protein
 N.B. one of the precipitants of CHF in HF patient is high salt diet therefore salt restriction is most
probable.

185.Picture of JVP graph to diagnose. Patient had low volume pulse, low resting BP, no
murmur, pedal edema. a) Constrictive pericarditis
b) Tricuspid regurg
c) Tricuspid
stenosis
d) Pulmonary hypertension

186.46 years old male came to ER with abdominal pain but not that sever. He is
hyperlipidemia, smoking, HTN, not follow his medication very well, vitally stable, O/E
tall obese patient, mid line abdomen tenderness , DX
a) Marfan's syndrome
b) aortic aneurism
 N.B. AAA characterized by pulsatile epigastric mass.
 Picture doesn't go with marfan's syndrome

187.Old patient with tachycardia pulse 150

otherwise normal a) TSH
b) Stress ECG

188.One non-pharmacological is the most appropriate in

hypertension a) Weight loss
b) Decrease alcohol
c) Stop smoking

189.Female patient Known case of rheumatic heart disease, diastolic murmur,

complains of aphasia and hemiplegia, what will you does to find the etiology of this
stroke?
a) MR angiography
b) Non-contrast CT
c) ECHO
d) ECG
e) Carotid Doppler

190.Normal child, he want to walking, he have brother dead after walking, what of the
following must be excluded before walking?
a) PDA
b) VSD
c) hypertrophic cardiomyopathy

191.One of the following is component of TOF?

a) ASD
b) VSD
c) Left ventricular hypertrophy
d) Aortic stenosis
e) Tricuspid stenosis
192.Patient came with anterior MI + premature ventricular ectopy that indicate pulmonary
edema, give Digoxin + diuretics + after-load reducer, what add?
a) Amiodarone.
b) Propranolol

193.Patient with rheumatic vulvular disease, mitral orifice is 1cm what is the action to
compensate that?
 a) Dilatation in the atrium with chamber hypertrophy
b) Dilatation in the ventricle with chamber hypertrophy
c) Atrium dilatation with decrease pressure of contraction
d) Ventricle dilatation with decrease pressure of contraction

194.Very long scenario about mitral stenosis, the surface area of the valve I think
was 0.7cm2, what is the treatment?
a) Medical treatment
b) Percutaneous mitral valvuloplasty by balloon catheter
c) Mitral valve replacement

195.All can cause secondary hyperlipidemia except:

a) Hypothyroidism
b) Alcoholism
c) Nephrotic syndrome
d) Estrogen therapy
e) Hypertension

 Explanation: secondary hyperlipidemia causes: Diabetes mellitus, use of drugs such as diuretics,
beta blockers, and estrogens, hypothyroidism, renal failure, Nephrotic syndrome, alcohol usage,
and some rare endocrine and metabolic disorders.

196.Which of the following medications associated with QT

prolongation? a) chloropromazone
b) clozapine
c)
helopridol
d)
ziprasidone

197.How can group A beta streptococci cause rheumatic

heart disease? a) When they cause
tonsillitis/pharyngitis.
b) Via blood stream.
c) Through skin infection.
d) Invasion of the myocardium.

198.Pansystolic machinery murmur at left

sternal border: a) Aortic stenosis
b) Mitral
stenosis c) PDA
d) MR
Pulmonology
1. Young patient with history of cough, chest pain, fever CXR showed right lower lobe
infiltrate:
a) Amoxicillin
b) Ceferuxim
c) Emipenim
d) Ciprofloxacin
 Explanation: Lobar pneumonia is often due to S. pneumoniae. Amoxicillin is the drug of choice.

2. Best thing to reduce mortality rate in COPD:

a) Home O2 therapy
b) Enalipril
c) Stop smoking

 Explanation: Cigarette smoking is the most important risk factor for COPD, and smoking
cessation is, in most cases, the most effective way of preventing the onset and progression of
COPD.

3. Patient with TB, had ocular toxicity symptoms, the drug responsible is:
a) INH
b) Ethambutol
c) Rifampicin
d) Streptomycin
 Explanation:
 INH: peripheral neuritis and hepatitis. so add ( B6 pyridoxine ) for peripheral neuritis
 Ethambutol : optic neuritis
 Rifampicin : orange discoloration of urine & tears
 Streptomycin: causes ototoxicity & nephrotoxicity

4. Patient treated for TB started to develop numbness, the vit deficient is:
a) Thiamin
b) Niacin
c) Pyridoxine
d) Vitamin C
 Explanation: INH: peripheral neuritis and hepatitis. so add ( B6 pyridoxine ) for peripheral
neuritis

5. 17 years old patient with dyspnea Po2 , PCO2 , X-ray normal PH increase so diagnosis is:
a) Acute attack of asthma
b) PE
c) Pneumonia
d) pnemothrax

6. The most common cause of community acquired pneumonia:

a) Haemophilus influenza
b) Streptococcus pneumonia
c) Mycoplasma
d) Klebsiella

7. Patient presented with sore throat, anorexia, loss of appetite, on throat exam showed
enlarged tonsils with petechiae on palate and uvula, mild tenderness of spleen and
liver, what is the diagnosis?
a) Group A strep
b) EBV (INFECTIOUS MONONUCLEOSIS )

 Explanation: Viral pharngitis due to EBV presented with enlarged tonsil with exudates and
petechii on soft palate and enlargement of uvula and sometimes present with tender
spleenomegaly.
8. The most common cause of croup is:
a) Parainfluenza
b) Influenza

9. Young patient on anti TB medication presented with vertigo which of the following drug
cause this
a) Streptomycin
b) Ethambutol
c) Rifampicin
 Explanation: streptomycin causes ototoxicity & nephrotoxicity

10. Well known case of SCD presented by plueritic chest pain, fever, tachypnea and
respiratory rate was 30, oxygen saturation is 90 % what is the diagnosis?
a) Acute chest syndrome.
b) Pericarditis
c) VOC
 Explanation: The correct answer is a or pneumonia would be more correct if it was the answer
 Acute chest syndrome is noninfectious vaso-occlusive crisis of pulmonary vasculature presented
with chest pain, fever, tachypnea and hypoxemia

11. Child with atopic dermatitis at night has stridor plus barking cough on & off from
time to time, diagnosis is
a) BA
b) Croup
c) Spasmadic Croup
 Explanation: Spasmadic croup: recurrent sudden upper airway obstruction which present as
sridor and cough.
 Approximately 50% of children have atopic disease.

12. Patient with asthma, well controlled by albutarol, came complaining of asthma
symptoms not respond to albutarol, what medication could be added?
a) Corticosteroid inhaler
b) Long acting B-agonist
c) Oral corticosteroid
d) Theophyline
 Explanation: Asthma stepwise therapy: in step 2 to add ICS to control asthma

13. An old patient with history of cerebrovascular disease & Ischemic heart disease,
presents with a pattern of breathing described as: A period of apnea followed by slow
breathing which accelerates & becomes rapid with hyperpnea& tachycardia then
apnea again. What is this type of breathing?
a) Hippocrates
b) Chyene-stokes breathing
c) Kussmaul breathing
d) One type beginning with O letter and contains 3 letters only
 Explanation:
 Chyene-stokes respiration : rapid deep breathing phase followed by period of apnea ,
present with heart failure, stroke, brain trauma, also can be with sleep or high altitude
 Kusmmaul’s breathing: rapid and deep breathing. present with metabolic acidosis
particularly in diabetic ketoacidosis
14. Rheumatic fever patient has streptococcal pharingitis risk to
develop another attack a) Trimes more than normal
b)
100%
c) 50%

15. Young male had pharyngitis then cough & fever, what is the
most likely organism? a) staph aureus
b) Streptococcus pneumonia

16. 17 years old male with history of mild intermittent asthma attacks occur once or twice
weekly in the morning
and no attacks at night. What should be the initial drug to give?
a) Inhaled short acting B2 agonist as needed
b) Inhaled high dose corticosteroid as needed
c) Oral steroid
d) Ipratropium bromide

17. Case scenario about bronchial carcinoma, which is true:

a) The most common cancer in females
b) Squamous cell carcinoma spreads faster
c) Adenocarcinoma is usually in the upper part
d) Elevation of the diaphragm on the x-ray means that the carcinoma has metastasize outside the
chest
e) Bronchoscopy should be done
 Most common tumor in females is breast tumors
 Small cell carcinoma spreads faster, Not Squamous cell
 Adenocarcinoma usually located peripherally, so upper part could be correct
 Bronchoscopy is often used to sample the tumor for histopathology, so it could be correct also

18. 39 years old HIV patient with TB receive 4 drugs of treatment after one month:
a) Continue 4 drugs for 1 years
b) Cintinue isoniazide for 9 months
c) Contiue isonizide for 1 year
 Explanation:I don’t know if the question is complete or not but:
 According to various guideline committees, the standard duration of therapy for drug-susceptible
TB, regardless of HIV status, should be six months; this includes two months of isoniazid (INH), a
rifamycin
(eg, rifampin or rifabutin), pyrazinamide, and ethambutol followed by isoniazid and a
rifamycin for four additional months
 When to prolong therapy — The duration of TB therapy is longer in specific clinical situations,
regardless of HIV status:
 For those patients with cavitary disease and positive sputum cultures after two months of
treatment, the duration of isoniazid and rifampin treatment should be extended by three
months for a total of nine months of treatment
 For patients with bone, joint, or CNS disease, many experts recommend 9 to 12 months of
therapy.
 For all other patients with extrapulmonary disease, the recommended treatment is two
months of four-drug therapy followed by four months of isoniazid and rifampicin.
 The duration of therapy is also generally longer in patients with drug-resistant TB. HIV-infected
patients with MDR TB should be treated for 24 months after conversion of sputum culture to
negative. After the cessation of therapy, patients should be examined every four months for an
additional 24 months to monitor for evidence of relapse.
19. Child has history of URTI for few days. He developed barky cough and
SOB. Your diagnosis is: a) Foreign body inhalation
b)
Pneumonia
c) Croup
d) Pertussis

20. Asthma case what drug is prophylactic:

a) B2 agonist
b) thyophline
c) oral steroid

21. Male patient working in the cotton field, presented with 3 weeks history of cough.
CXR showed bilateral hilar lymphadenopathy and biopsy (by bronchoscopy) showed
non-caseating granuloma. What’s your diagnosis?
a) Sarcoidosis
b) Amylidosis
c) Histiocustosis
d) Berylliosis
e) Pneumoconiosis
 A or E
 Non-caseating granuloma support Sarcoidosis
 Pneumoconiosis is an occupational & a restrictive lung disease caused by the inhalation of
dust, depending on the dust type the disease is given its names, in cotton case it is called '
Byssinosis '
 Bilateral hilar lymphadenopathy present in both Sarcoidosis & Pneumoconiosis

22. Patient with untreated bronchogenic carcinoma has dilated neck veins, facial
flushing, hoarsness and dysphagia (SVC syndrome). CXR showed small pleural
effusion. What’s your immediate action?
a) Consult cardiologist for pericardiocentesis
b) Consult thoracic surgeon for Thoracocentesis
c) Consult oncologist

 Explanation:Consult oncologist for radiation therapy ± chemotherapy because SVC

syndrome symptoms and hoarseness suggest unrespectable lesion

23. Patient with typical finding of pleural effusion management :

a) Chest tube

24. Old patient with DM2, emphysema & non community pneumonia, Best to give is:
a) Pneumococcal vaccine & influenza vaccine now
b) Pneumococcal vaccine & influenza vaccine 2 weeks after discharge
c) Pneumococcal vaccine & influenza vaccine 4 weeks after discharge
d) influenza vaccine only
e) Pneumococcal vaccine only

25. Radiological feature of miliary TB:

a) Pleural effusion
b) 3-4 diffuse nodules
c) Small cavities

 Explanation:The classic radiographic findings of evenly distributed diffuse small 2–3-mm

nodules, with a slight lower lobe predominance, are seen in 85% of cases of miliary TB
26. Patient ingest amount of aspirin show nausea, vomiting & hyperventilation,
what is the diagnosis? a) Metabolic Alkalosis and respiratory alkalosis
b) Metabolic acidosis and respiratory
acidosis c) Respiratory alkalosis and
Metabolic Acidosis d) Respiratory
alkalosis and respiratory acidosis

 Explanation:Salicylate ingestion causes metabolic acidosis (from lactate, ketones) +

respiratory alkalosis due to stimulation of CNS respiratory center

27. Patient presented with sudden chest pain and dysnea, tactile vocal fremitus
and chest movement is decreased, by x-ray there is decreased pulmonary
marking in left side, what is the diagnosis?
a) Atelectasis of left lung
b) Spontaneous pneumothorax
c) Pulmonary embolism

28. A 20 years old male who is a known asthmatic presented to the ER with shortness
of breath. PR 120, RR 30, PEFR 100/min. examination revealed very quite chest. What
is the most propable management?
a) Nubelized salbutamol
b) IV aminophyline
c) Pleural aspiration
d) Hemlich maneuver
e) Chest drain

29. Patient is a known case of moderate intermittent bronchial asthma. He is using

ventoline nebulizer. He develops 3 attacks per week. The drug to be added is:
a) Increase prednisolone dose
b) Add long acting B agonist
c) Add Ipratropium
d) IV aminophyllin

 Explanation: I don’t know if the question right or wrong but by asthma stepwise if the patient
on ventolin and the asthma not controlled (partially controlled 3 attacks per week) then to add
low dose ICS

30. One of the following is true about the home treatment of COPD:
a) Give O2 if SO2 is less than 88%
b) Give O2 if SO2 is 88-95%
c) Give O2 at night (nocturnal) only
 Explanation:
 Acute COPD  Give O2 till reach 88-92%
 Chronic COPD  Give O2 if SaO2 < 88 %
31. Elderly male patient who is a known case of debilitating disease presented with
fever, productive cough, and sputum culture showed growth of Gram negative
organisms on a buffered charcoal yeast agar. What is the organism?
a) Mycoplasma pneumoniae
b) Klebsiellapneumoniae
c) Ureaplasma
d) Legionella

 Explanation :Buffered charcoal yeast extract (BCYE) agar is a selective growth medium used
to culture or grow certain bacteria, particularly the Gram-negative species Legionella
pneumophila
32. 27 years old girl came to the ER, she was breathing heavily, RR 20/min. she
had numbness & tingling sensation around the mouth & tips of the fingers.
What will you do?
a) Let her breath into a bag
b) Order serum electrolytes
c) First give her 5ml of 50% glucose solution

33. Patient with lung cancer and signs of pneumonia, what is the most common
organism?
a) Klebsiella
b) Chlamydia
c) Streptococcus
d) Suayionhigella

 Explanation: the primary respiratory infections in early phase (nonimmunocompromised

phase) include those caused by pathogens common to the general public. The predominant
organisms are Streptococcus pneumoniae, Haemophilisinfluenzae, and community-acquired
respiratory viruses

34. Patient 18 years old admitted for ARDS and developed hemothorax. What is the
cause?
a) Central line insertion
b) High negative pressure
c) High oxygen
 Answer is +ve pressure or lung injury

35. COPD patient with emphysema has low oxygen prolonged chronic high CO2, the
respiratory drive maintained in this patient by:
a) Hypoxemia
b) Hypercapnemia
c) Patient effort voluntary
 Explanation: The respiratory drive is normally largely initiated by PaCO 2 but in chronic
obstructive pulmonary disease (COPD) hypoxia can be a strong driving force and so if the
hypoxia is corrected then the respiratory drive will be reduced. There will also be a loss of
physiological hypoxic vasoconstriction

36. The most common cause of cough in adults is

a) Asthma
b) GERD
c) Postnasal drip

 Explanation: The most common causes of chronic cough are postnasal drip, asthma, and acid
reflux from the stomach. These three causes are responsible for up to 90 percent of all cases
of chronic cough.

37. Patient has fever, night sweating, bloody sputum, weight loss, PPD test was positive.
x-ray show infiltrate in apex of lung , PPD test is now reactionary , diagnosis
a) Activation of primary TB
b) sarcoidosis
c) Case control is
d) Backward study
 Explanation: The tuberculosis skin test is a test used to determine if someone has
developed an immune response to the bacterium that causes tuberculosis.

38. Best early sign to detect tension pneumothorax :

a) Tracheal shift
b) Distended neck veins
c) Hypotension
39. Holding breath holding, which of the following True?
a) Mostly occurs between age of 5 and 10 months
b) Increase Risk of epilepsy
c) A known precipitant cause of generalized convulsion
d) Diazepam may decrease the attack

 Breath holding spells are the occurrence of episodic apnea in children, possibly
associated with loss of consciousness, and changes in postural tone.
 Breath holding spells occur in approximately 5% of the population with equal distribution
between males and females. They are most common in children between 6 and 18 months
and usually not present after 5 years of age. They are unusual before 6 months of age. A
positive family history can be elicited in 25% of cases.
 They may be confused with a seizure disorder. They are sometimes observed in response to
frustration during disciplinary conflict.

40. 58 years old male patient came with history of fever, cough with purulent foul
smelling sputum and CXR showed: fluid filled cavity, what is the most likely
diagnosis is?
a) Abscess
b) TB
c) Bronchiectasis

41. what is the meaning of difficulty breathing:

a) Dyspnea
b) Tachycardia

42. Obese 60 year lady in 5th day post cholecystectomy, she complains of SOB &
decreased BP 60 systolic, on examination unilateral swelling of right Leg, what is
the diagnosis?
a) Hypovolomic shock
b) septic shock
c) Pulmonary embolism
d) MI
e) Hag. Shock

43. 55 years old male with COPD complains of 1 week fever, productive cough, on
CXR showed left upper pneumonia and culture of sputum shows positive
haemophilus influenza, what is the treatment?
a) Penicillin
b) Doxecycline
c) Cefuroxime
d) Gentamycin
e) Carbenicillin
 Explanation: 2nd generation cephalosporin used in respiratory infections “H. influenza and M.
catarrhalis”

44. Klebsiella faecalis cause the following disease:

a) Pneumonia
 Explanation: There is no klebsielafaecalis!
 Klebsiellapneumoniae
 Klebsiellaozaenae
 Klebsiellarhinoscleromatis
 Klebsiellaoxytoca
 Klebsiellaterrigena
 Klebsiellaornithinolytica
45. Hemoptysis, several month PPD positive, taken all vaccination, X-ray showed apical
filtration, PPD test has been done again, it came negative, diagnosis:
a) Sarcoidosis
b) Primary old TB
c) Mycoplasma

46. For close contact with TB patients what do you need to give:
a) Immunoglobulin
b) Anti-TB
c) Rifampin
d) INH
 Explanation: TB preventive therapy
 INH-sensitive: INH for 6-9 months
 HIV +ve: INH for 9 months
 INH-resistant: Rifampicin for 4 months

47. An outbreak of TB as a prophylaxis you should give :

a) Give BCG vaccine
b) Rifampicin
c) Tetracycline
d) H. influenza vaccine

 Explanation: if there is INH it is the best answer and if they mean by outbreak INH-resistant
then the answer is Rifampin

48. Patient sustained a major trauma presented to ER the

first thing to do: a) Open the air way give 2 breath
b) Open the airway remove foreign bodies
c) Give 2 breath followed by chest
compression d) Chest compression after
feeling the pulse

49. Patient with 3 weeks history of shortness of breath with hemoptysis the
appropriate investigation is: a) CXR,AFB,ABG
b) CXR, PPD,
AFB. c)
CT,AFB,ABG
 CXR, PPD, AFB “Ziehl Neelsen stain”, These are the basic investigations for TB pt

50. Treatment of community acquired pneumonia:

a) Azithromycin
b) Ciprofloxacin
c) Gentamicin
d) Tetracycline

51. Patient had fever in the morning after he went through a surgery, what’s your
diagnosis?
a) Atelectasis
b) Wound infection
c) DVT
d) UTI
 Explanation:Postoperative atelectasis generally occurs within 48 hours
52. The best prophylaxis of DVT in the post-op patient (safe
and cost-effective): a) LMWH
b)
Warfarin
c) Aspirin
d) Unfractionated heparin

53. 3 years old presented with shortness of breath and cough at night which resolved by
itself in 2 days. He has
Hx of rash on his hands and allergic rhinitis. he most likely had
a) Croup
b) Bronchial asthma
c) Epiglottitis

54. Pediatric came to you in ER with wheezing, dyspnea, muscle contraction (most
probably asthma), best to give initially is :
a) Theophylline
b) Albuterol nebulizers
c) oral steroids

55. Antibiotic for community acquired pneumonia:

a) Gentamicin+Amoxicillin
b) Erythromycin
 The question is deficient

56. Prophylaxis of Asthma:

a) oral steroid
b) Inhaler steroids
c) inhaler bronchodilator B agonists

57. Smoking withdrawal symptoms peak at:

a) 1-2 days
b) 2-4 days
c) 7 days
d) 10-14 days

 Explanation: Symptoms of nicotine withdrawal generally start within 2 - 3 hours after the last
tobacco use, and will peak about 2 - 3 days later

58. 6 month with cough and wheezy chest .diagnosis is (incomplete Q)

a) Asthma
b) Bronchiolitis
c) Pneumonia
d) F.B aspiration

59. Physiological cause of hypoxemia:

a) Hypoventilation
b) Improper alveolar diffusion
c) Perfusion problem (V/Q mismatch)
d) Elevated 2.3 DPG
60. Child with asthma use betamethazone, most
common side effect is: a) Increase intraocular pressure
b) Epilepsy
c) Growth retardation

61. The respiratory distress syndrome after injury is due to :

a) Pneumothorax
b) Aspiration
c) Pulmonary edema
d) Pulmonary embolus
e) None of the above
 Explanation: ARDS etiologies:
 Direct injury: pneumonia, inhalation injury, aspiration, lung contusion and near drowning
 Indirect injury: sepsis, pancreatitis, shock, trauma/multiple fractures, DIC and transfusion

62. Interstitial lung disease, All true except:

a) Insidious onset exertional dyspnea.
b) Bibasilar inspiratory crepitations in physical examination.
c) Hemoptysis is an early sign
d) Total lung volume is reduced

 Explanation: All patients with interstitial lung diseases develop exertional dyspnea and non-
productive cough. The examination revealed typical coarse crackles and evidence of
pulmonary hypertension. PFTs show evidence of restrictive pattern (decrease volumes)

63. The effectiveness of ventilation during CPR is measured by:

a) Chest rise
b) Pulse oximetry
c) Pulse acceleration

64. Regarding moderately severe asthma, all true except:

a) PO2 < 60mmHg
b) PCO2 > 60 mm Hg , early in the attack
c) Pulsus Paradoxus
d) IV cortisone help in few hours

 Explanation: A typical arterial gas during an acute uncomplicated asthma attack reveals normal
PaO2, low PaCO2 and respiratory alkalosis. Hypoxemis in a PaO2 range of 60 to 80 mm Hg
frequently is found even in moderately severe asthma.24 However; a PaO< 60 mm Hg may
indicate severe disease.
 Hypoxemia is due to ventilation perfusion mismatching, whereas low PaCO2 is a result of
hyperventilation.
 A progressive increase in PaCO2 is an early warning sign of severe airway obstruction in a child
with respiratory muscle fatigue, so the answer (PCO2 > 61 mm Hg “early attack”) is clearly
WRONG as this may happen late in the attack of asthma
 The answer (PO2 < 60 mm Hg) CAN BE CONSIDERED WRONG. As usually the PO2 goes
below 60 in SEVERE ASTHMA rather than a MODERATLY- SEVERE ASTHMA

65. What is the simplest method to diagnose fractured rib?

a) Posteronteriorx ray (sensitivity is low 50%)
b) Lateral x ray
c) Tomography of chest
d) Oblique x ray
66. Air bronchogram is
characteristic feature of: a) Pulmonary
edema.
b) Hyaline membrane
disease. c) Lobar
Pneumonia.
d) Lung Granuloma.
 Explanation: The most common causes of an air bronchogram are consolidations of various
origins and pulmonary edema. Similarly, widespread air bronchograms are seen in hyaline
membrane disease. Air bronchograms are also seen in atelectatic lobes on chest radiographs
when the airway is patent, notably when atelectasis is caused by pleural effusion,
pneumothorax or bronchiectasis.

67. The most specific investigation for pulmonary embolism is:

a) Perfusion scan
b) X-ray chest
c) Ventilation scan
d) Pulmonary angiography
 Explanation:
 V\Q( perfusion) scan: high sensitivity and low specificity
 CXR: limited sensitivity and specificity
 CT angiography high sensitivity and specificity.

68. A 62 years old male known to have BA. History for 1 month on bronchodilator &
beclomethasone had given theophylline. Side effects of theophylline is:
a) GI upset
b) Diarrhea
c) Facial flushing
d) Cardiac arrhythmia
 Explanation: The most common side effects are cardiac arrhythmia, anxiety, tremors,
tachycardia & seizures
Always monitor ECG

69. History of recurrent pneumonia, foul smelling sputum with blood and clubbing, what
is the diagnosis?
a) Bronchiectasis
b) Pneumonia
c) Lung Abscess
d) COPD

Explanation: Clinical features of Bronchiectasis are recurrent pneumonia because of the dilated
bronchi so there’s a reduction in the ability of the clearance of secretions and pathogens from the
airways. The sputum is copious and could foul smell and the patients would have clubbing. A lung
abscess also causes clubbing and foul smelling sputum but if properly treated why it would recur.
COPD has frequent infective exacerbations but doesn’t cause clubbing. Pneumonia is an acute
process and no clubbing occurs.

70. In mycoplasma pneumonia, there will be:

a) Positive cold agglutinin titer.
b) Lobar consolidation.

 Explanation: Both are correct! Positive cold agglutinin titer occurs in 50-70% of patients and
lobar consolidation may also be present but rare.

71. Patient in ER: dyspnea, right sided chest pain, engorged neck veins and weak heart
sounds, absent air entry
over right lung. Plan of treatment for this patient:
a) IVF, Pain killer, O2
 b) Aspiration of Pericardium
c) Respiratory Stimulus
d) Intubation
e) Immediate needle aspiration, chest tube.

72. Which of the following radiological features is a characteristic of miliary tuberculosis:

a) Sparing of the lung apices
b) Pleural effusion
c) Septal lines
d) Absence of glandular enlargement
e) Presence of a small cavity
 Explanation :typically would show glass ground appearance

73. A 30 years old man presents with shortness of breath after a blunt injury to his chest,
RR 30 breaths/min, CXR showed complete collapse of the left lung with pneumothorax,
mediastinum was shifted to the right. The treatment of choice is:
a) Chest tube insertion
b) Chest aspiration
c) Thorocotomy and pleurectomy
d) IV fluids & O2 by mask
e) Intubation

74. Right lung anatomy, which one true :

a) Got 7 segment
b) 2 pulmonary veins
c) No relation with azigous vein
75. A 24 years old woman develops wheezing and shortness of breath when she is
exposed to cold air or when she is exercising. These symptoms are becoming worse.
Which of the following isthe prophylactic agent of choice for the treatment of asthma
in these circumstances?
a) Inhaled β2 agonists.
b) Oral aminophylline.
c) Inhaled anticholinergics.
d) Oral antihistamines.
e) Oral corticosteroids.

76. Which one of the following regimens is the recommended initial treatment for
most adults with active tuberculosis?
a) A two-drug regimen consisting of isoniazid (INH) and rifampin (Rifadin).
b) A three-drug regimen consisting of isoniazid, rifampin, and ethumbutol (Myambutol).
c) A four-drug regimen consisting of isoniazid, refimpin, pyarazinamide and ethumbutol
d) No treatment for most patients until infection is confirmed by culture
e) A five-drug regimen consisting of Ionized, Rifampicin, pyrazinamide, ethumbutol and
ciprofloxacin

77. 55 years old male presented to your office for assessment of chronic cough. He
stated that he has been coughing for the last 10 years but the cough is becoming
more bothersome lately. Cough productive of mucoid sputum, occasionally becomes
purulent. Past history: 35 years history smoking 2 packs per day. On examination: 124
kg, wheezes while talking. Auscultation: wheezes all over the lungs. The most likely
diagnosis is:
a) Smoker’s cough
b) Bronchiectasis
c) Emphysema
d) Chronic bronchitis
e) Fibrosing alveolitis
 Explanation: An elderly male with a long history of heavy smoking and change in character of
cough is chronic bronchitis which is a clinical diagnosis (cough for most of the days of 3 months
in at least 2 consecutive years). Emphysema is a pathological diagnosis (dilatation and
destruction beyond the terminal bronchioles). Fibrosing alveolitis causes dry cough.

78. 25 years old man had fixation of fractured right femur. Two days later he became
dyspnic, chest pain and hemoptysis. ABG:-pH: 7.5, pO2:65, pCO2: 25, initial
treatment is:
a) Furosemide
b) Hydrocortisone
c) Bronchoscopy
d) Heparin
e) Warfarin

 Explanation: After fracture, fixation (immobile), dyspnea means pulmonary embolism. You
start treatment by heparin for a few days then warfarin.

79. All of the following are true about pulmonary

embolism, except: a) Normal ABG
b) Sinus tachycardia is the most common ECG finding.
c) Low plasma D-dimer is highly predictive for
excluding PE. d) Spiral CT is the investigation of
choice for diagnosis.
e) Heparin should be given to all pts with high clinical suspicion of PE.
 Explanation: in PE ABG will show decreased PaO2 and PaCO2.
80. In a child with TB, all is
found EXCEPT: a) History of
exposure to a TB patient. b) Chest x-
rays findings.
c) Splenomegaly.
d) Positive culture from gastric lavage.
 all are correct

81. All indicate severity of bronchial

asthma ,EXCEPT a) Intercostal and
supraclavicular retraction
b) Exhaustion
c) PO2 60 mmHg
d) PO2 60 mmHg + PCO2 45
mmHg e) Pulsusparadoxis >
20mmHg

 Explanation: Severe: PEFR<60%, Sa O2 <90%, PO2<60, PCO2 >45, dyspnea at rest,

inspiratory & expiratory wheezes, accessory muscle use , pulsusparadoxus>25 mmHg

82. Patient came with scenario of chest infection, first day of admission he treated with
cefotaxime, next day, patient state became bad with decrease perfusion and x-ray show
complete right Side hydrothorax, causative organism:
a) Streptococcus pneumonia
b) Staph. Aureus
c) Haemophilus influenza
d) Pseudomonas
 Explanation: Parapneumonic effusion/empyema especially seen with S. pneumoniae

83. which of the following treatment contraindication in

asthmatic patient: a) Non-selective B blocker

84. Which of the following shift the O2 dissociation curve to the right?
a) Respiratory alkalosis
b) Hypoxia
c) Hypothermia
85. 3 years old his parents has TB as a pediatrician you did PPD test after 72 hr you
find a 10mm indurations in the child this suggest:
a) Inconclusive result
b) Weak positive result
c) Strong positive result

 Explanation: High risk because of contact

86. Best way to secure airway in responsive multi-

injured patient is a) Nasopharyngeal tbue

87. Old patient with sudden onset of chest pain, cough and hemoptysis, ECG result right
axis deviation and right bundle branch block , what is the diagnosis
a) MI
b) Pulmonary embolism

 Explanation: ECG in PE: sinus tachycardia, right axis deviation, P pulmonale, RBBB,
S1Q3T3, and T wave inversion V1-V4
88. TB patient taking anti TB drugs developed color blindness which drug
caused this side effect? a) Ethambutol
 Explanation: Ethambutol adverse effects: optic neuritis

89. PPD positive, CXR negative :

( incomplete Q) a) INH for 6 moths
b) INH amdrefampicin
for 9 c) reassurance

90. Patient developed dyspnea after lying down for 2 hours, frothy sputum stained with
blood, +ve hepatojugular reflux, +1 leg edema, oncotic pressure higher than capillary
25% edema is:
a) Interstitial
b) Venous
c) Alveolar
d) Capillary

91. The chromosome of cystic fibrosis:

a) Short arm of chromosome 7
b) Long arm of chromosome 7
c) Short arm of chromosome 8
d) Long arm of chromosome 8
e) Short arm of chromosome 17

92. Patient present with sever bronchial asthma which of the following drug , not
recommended to give it :
a) Sodium gluconate.
b) Corticosteroid (injection or orally?)
c) Corticosteroid nebulizer.

93. Lady known to have recurrent DVT came with superior vena cava thrombosis, what is
the diagnosis?
a) SLE
b) christmas disease
c) Lung cancer
d) Nephrotic disease

94. Long scenario for patient smokes for 35 years with 2 packets daily, before 3 days
develop cough with yellow sptum, since 3 hours became blood tinged sputum, X ray
show opacification and filtration of right hemithorax, DX:
a) Bronchogenic CA
b) acute bronchitis
c) lobar pneumonia

95. Patient came with cough, wheezing, his chest monophonic sound, on x ray there is
patchy shadows in the upper lobe+ low volume with fibrosis, he lives in a crowded place,
What is the injection should be given to the patient's contacts?
a) Hemopheilus influanza type b
b) Immunoglobuline
c) Menngioc. Conjugated
d) Basil calament
96. Patient is a known case of moderate persistent bronchial asthma. He is using
ventoline nebulizer. He develops 3 attacks per week. The drug to be added is:
(incomplete Q)
a) Increase prednisolone dose
b) Add long acting B agonist
c) Add ipratropium
d) IV aminophylline

97. Known case of asthma

prevent: a) Exposure to
dust mite

98. Patient with severe asthma, silent chest

what is next step? a) IV theophylline
b) Neb salbutamol

99. 82 years old female presented to ER in confusion with hypotension. BP was 70/20,
P=160/min, rectal T 37.7oC. The most likely of the following would suggest sepsis as a
cause of hypotension is:
a) Low systemic vascular resistance & high cardiac output.
b) High systemic vascular resistance & low cardiac output.
c) Pulmonary capillary wedge pressure less than 26.
d) PH is less than 7.2
e) Serum lactate dehydrogenase more than 22.
 Explanation: Special features of septic shock:
1) High fever
2) Marked vasodilatation throughout the body, especially in the infected tissues.
3) High cardiac output in perhaps one half of patients caused by vasodilatation in the infected
tissues & by high metabolic rate & vasodilatation elsewhere in the body, resulting from
bacterial toxin stimulation of cellular metabolism & from high body temperature.
4) DIC.
 100.Child with picture of pneumonia treated with cefotaxime but he got worse with
cyanosis intercostals retraction and shifting of the trachea and hemothorax on x-
ray, the organism:
a) Pneumocystis carnii
b) Strepreptococcus pneuomonia
c) Staph aureus
101.PseudomonosWhat is the most effective measure to limiting
the complications in COPD? a) Pneumococcal vaccination
b) Smoking cessation

102.Goodpasture syndrome is associated with:

a) Osteoporosis.
b) Multiple fractures and nephrolithiasis
c) Lung bleeding and Glomerulonephritis

103.End stage of COPD:

a) ERYTHROCYTOSIS
b) HIGH Ca
c) Low K

104.Case of old male, heavy smoker, on chest X ray there is a mass, have hyponatremia and
hyperosmolar urine, what is the cause?
a) Inappropriate secretion of ADH.
b) Pituitary failure.

105.Patient K/C of uncontrolled asthma moderate persistent on bronchodilator came with

exacerbation and he is now ok, what you will give him to control his asthma?
a) Systemic steroid
b) Inhaler steroid
c) Ipratropium

106.Patient PPD test positive for TB before anti TB treatment:

a) Repeat PPD test
b) Do mantoux test

107.Old patient, smoker, COPD, having cough and shortness of breath in day time not at
night how to treat him?
a) Theophylline
b) Ipratropium
c) Long acting

108.patient with asthma use short acting beta agonist and systemic corticosteroid
<classification of treatment:
a) Mild intermittent
b) Mild persistent
c) Moderate"
d) Sever

109.Obese patient and his suffering with life, the important thing that he is snoring while
he is sleeping and the doctors record that he has about 80 apnea episode to extend that
po2 reach 75% no other symptoms. Exam is normal. Your action is:
a) Prescribe for him nasal strip
b) Prescribe an oral device
c) Refer to ENT for CPAP and monitoring refer for hospital

110.Patient came with Pneumocystis carinii infection. What is your action?

a) Ax and discharge
b) Check HIV for him
111.Patient wake up with inability to speak, he went to a doctor. He still couldn't speak.
But he can cough when he asked to do. He gave you a picture of his larynx by
laryngoscope. Which grossly looks normal, what is your diagnosis?
a) Paralysis of vocal cords
 b) Infection
c) Functional aphonia

112.COPD coughing greenish sputum, what's the organism?

a) Staph aureus
b) Strep pneumonia
c) Mycoplasma
d) chlamydia
e) Haemophilus influenzae

113.Patient with bilateral infiltration in lower lobe (pneumonia), which organism is

suspected?
a) Legionella
b) Klebsiella

114.Old Patient was coughing then he suddenly developed pneumothorax best

management:
a) Right pneuoectomy
b) Intubation
c) Tube thoracotomy
d) Lung pleurodisis
 Explanation :No choice like needle aspiration in second intercostal space

115.Patient with adult respiratory distress syndrome, he got tension pneumothorax,

what is the probable cause?
a) severe lung injury
b) Negative pressure
c) central venous line
d) Oxygen 100%

116.Patient has pharyngitis rather he developed high grade fever then cough then
bilateral pulmonary infiltration in CXR, WBC was normal and no shift to left,
what is the organism?
a) Staphylococcus aurous
b) streptococcus pneumonia
c) legionella
d) chlamydia

117.Asbestosis :
a) Bilateral fibrosis --- the end result
b) Pleural calcification --- the specific sign

118.Patient suffering from wheezing and cough after exercise, not on medications,
what’s the prophylactic medication?
a) Inhaled b2 agonist
b) Inhaled anticholinergic
c) Oral theophylline
119.Old patient stopped smoking since 10 years, suffering from shortness of breath after
exercise but no cough and there was a table FEV1=71% FVC=61% FEV1/FVC=95%
TLC=58% What's the dx?
a) Restrictive lung disease
b) Asthma
c) Bronchitis
d) Emphysema
e) Obstructive with restrictive

120.Patient with asthma on daily steroid inhaler and short acting B2 agonist what
category:
a) Mild intermittent
b) Mild persistent
c) Moderate
d) Sever

121.Young patient with mild intermittent asthma, attacks once to twice a week,
what's best for him as prophylaxis?
a) inhaled short acting B agonist
b) inhaled steroid

122.Young lady with emphysema:

a) Alpha 1 anti-trypsin deficiency

123.Patient live near industries came with attack of SOB the prophylactic:
a) B2 agonist.
b) Oral steroid
c) inhaled corticosteroid

124.Young patient with unremarkable medical history presented with SOB, wheeze,
long expiratory phase. Initial management:
a) Short acting B agonist inhaler
b) Ipratropium
c) Steroids
d) Diuretic
Gastroenterolog
y
1. Woman complaining of burning retrosternal pain with normal ECG what is the
treatment?
a) PPI (Proton Pump Inhibitor)

 Retrosternal pain is usually because of regurgitation but cardiopulmonary causes must be

excluded, in this case it is excluded by an ECG.

2. 15 years male with history of 3 days yellow sclera, anorexia, abdominal pain, LFT: T.
bilirubin = 253

Indirect =
98 ALT = 878, AST = 1005, what is the diagnosis?
a) Gilbert disease
b) Infective hepatitis
c) Obstructive Jaundice
d) Acute pancreatitis
e) Autoimmune hepatitis

 In Gilbert disease bilirubin is increased with normal liver enzymes, for obstructive jaundice the
indirect bilirubin would be normal and the direct would increase, acute pancreatitis serum
amylase and lipase are the main diagnostic test, infective hepatitis (Hep A) is of an acute onset
with elevated liver enzymes to more than 10 folds.

3. Middle age woman presented with upper abdominal pain, increase by

respiration. On examination temperature 39 oC, right hypochondrial
tenderness, her investigations: Bilirubin & ALT normal,
WBC 12.9, your next step is:
a) chest X-ray
b) abdominal ultrasound
c) Serum amylase
d) ECG
e) endoscopy

 By sign and symptoms most commonly this is an acute cholecystitis and sonography is a
sensitive and specific modality for diagnosis of acute cholecystitis.

4. Gastric lavage can be done to wash all of the followings except:

a) Drain cleanser
b) Vitamin D
c) Diazepam
d) Aspirin
 Drain cleanser is a sulphuric acid and its ingestion cause GI perforation and ARDS so no use of
gastric lavage.

5. Drug addict swallowed open safety pins since 5 hours, presented to the ER, X rays
showed the foreign body in the intestine. Which is the best management:
a) shift to surgery immediately
b) discharge and give appointment to follow up
c) admit and do serial abdominal X-rays and examination
d) give catharsis : MgSO4 250 mg

 There is a chance that safety pins pass without any significant damage to the GI tract but
caution must be taken and patient is under observation by serial X-rays.
 If patient develop signs of perforation immediate surgery is crucial.

6. Patient with hepatosplenomegally and skin bruises and cervical mass what is the initial
investigation;
a) Bone marrow

 The presenting symptoms is likely to occur in leukemic patients, bone marrow biopsy is
one of the initial investigations along with CBC with differential, chest X-rays.
7. which of the following is an indication of surgery in Crohn’s disease:
a) Internal fistula Or intestinal obstruction
 Most patients with Crohn's disease ultimately require one or more operations in their
lifetime. Operative indications are the same no matter where the disease manifests itself.
They include:
 Failure of medical therapy
 Obstruction , fistula, abscess or Hemorrhage
 Growth Retardation (in the pediatric population)
 Perforation , Carcinoma & extraintestinal manifestations

8. What is the contraindicated mechanism in a child swallowed a bleach cleaner solution:

a) Gastric lavage

 Bleach cleaner is a strong alkali that cause GI perforation, aspiration pneumonia and ARDS. The
best measure is to drink milk to normalize PH.

9. Patient with vomiting and diarrhea and moderate dehydration, how to treat:
a) ORS only
 Medications such as loperamide, anticholinergics, and adsorbents are not recommended in
dehydration because of questionable efficacy and potential adverse effects.
 Rapid oral rehydration with the appropriate solution has been shown to be as effective as
intravenous fluid therapy in restoring intravascular volume and correcting acidosis.

10. Initial investigation in small bowel obstruction :

a) Erect & supine abdominal X- ray

 Plain film is valuable for imaging triage and it has been recommended that where the initial
X-ray suggests complete or high-grade obstruction and a trial of conservative management
is contemplated.

11. In which group you will do lower endoscopy for patients with iron deficiency anemia
in with no benign cause: a) male all age group
b) children
c) perimanupausal women & male more
than 59 years d) women + OCP
 Older men and postmenopausal women with iron deficiency anemia are routinely
evaluated to exclude a gastrointestinal source of suspected internal bleeding.

12. Elderly women present with diarrhea, high fever & chills, other physical examination
is normal including back pain is normal , Diagnosis:
a) Pyelonephritis.
b) Bacterial gastroenteritis
c) Viral gastroenteritis.

 In general, viral infections are systemic affecting GI tract, causing fever and chills.
Pyelonephritis excluded no severe back pain.

13. Patient presented to the ER with diarrhea, nausea, vomiting, salivation, lacrimation
and abdominal cramps. What do you suspect?
a) Organophosphate poisoning

 cause the inhibition of acetylcholinesterase leading to the accumulation of acetylcholine in the

body which cause Salivation, Lacrimation, Urination, Defecation, Gastrointestinal motility,
Emesis, miosis.
14. Child with
garlic smell: a)
Alcohol toxicity
b) Organophosphate
toxicity c) Caynide
toxicity

15. Treatment of
pseudomembranous colitis:a)
Metronidazole
b)
Vancomycin
c) Amoxicillin
d)
Clindamycin

 Mild to moderate disease is treated with IV metronidazole, oral Vancomycin for sever disease
but presents the risk of the development of Vancomycin-resistant enterococcus.

16. Patient had HBsAB +ve, but the rest of the hepatitis profile was
negative. The diagnosis is: a) Immunization from previous infection, past
exposure or vaccination
b) Carrier state
c) Chronic hepatitis
d) Active infection

17. 24 years old man presented with 4 month history of diarrhea with streaks of blood
& mucous. Ulcerative colitis was confirmed by colonoscopy. The initial therapy for
this patient:
a) oral corticosteroid
b) azathioprine
c) infleximabe
d) Aminosalicylic acid
e) Sulfasalazine

 In Crohn's disease and ulcerative colitis, it is thought to be an anti-inflammatory drug

that is essentially providing topical relief inside the intestine.

16. Which of the following organisms can cause invasion of the intestinal mucosa,
regional lymph node and bacteremia:
a) Salmonella
b) Shigella
c) E. coli
d) Vibrio cholera
e) Campylobacter jejeni

 Shigella & E. coli do not invade beyond the lamina propria into the mesenteric lymph
nodes or reach the bloodstream while salmonella does.
b. Patient presented with severe epigastric pain radiating to the back. He has past hx
of repeated epigastric pain. Social history: drinking alcohol. What’s the most likely
diagnosis:
a) MI
b) Perforated chronic peptic ulcer
 Severe back pain with history of chronic peptic ulcer is indicative of perforation add the Hx of
alcohol.

20. A female patient has clubbing, jaundice and pruritus. Lab results showed elevated
liver enzymes (Alkaline phosphatase), high bilirubin, hyperlipidemia and positive
antimitochondrial antibodies. What’s the most likely diagnosis:
a) Primary sclerosing cholangitis
b) Primary biliary cirrhosis

 PBC is an autoimmune disease destroys (bile canaliculi) within the liver and leads to
cholestasis and elevated liver enzymes. 9:1 (female to male). Diagnosed by Presence of AMA
and ANA.

21. Patient came recently from Pakistan after a business trip complaining of
frequent bloody stool. The commonest organism causes this presentation is:
a) TB
b) Syphilis
c) AIDS
d) Amebic dysentery
e) E.coli
 Entamoeba histolytica is mainly found in tropical areas and presents as a bloody stool.

22. Erosive gastritis:

a) Happened within one week of injury
b) Happened within 24 hrs of injury.

23. pt with acute abdomen you will find :

a) Rapid shallow breath
b) rapid prolonged breath
 Peritonitis leading to reduction of abdominal and respiratory movement.

24. about hepatitis b vaccination scheduling for adult:

a) 3 doses only
25. Patient took high dose of acetaminophen presented with nausea & vomiting,
investigation shows increase alkaline phosphatase and bilirubin, which organ is
affected?
a) Brain
b) Gastro
c) Liver
 Alkaline phosphatase and bilirubin are part of LFT.

26. Old patient with cramp abdominal pain, nausea, vomiting and constipation but no
tenderness DX
a) Diverticulitis
b) Colon cancer
c) Obstruction
b. Diverticulitis usually present as diarrhea, crampy abdominal pain is an evidence of obstruction.

27. Old male patient came with fever, abdominal pain, diarrhea, loss of weight, positive
occult blood, labs shows that the patient infected with streptococcus bovis, what you
will do?
a) Give antibiotic
b) ORS
c) Abdominal X-Ray
d) Colonoscopy
e) Metronidazole

 Because there is a strong association between infections with S. bovis and colonic neoplasms and
other lesions of the gastrointestinal tract, evaluation of the gastrointestinal tract with colonoscopy
is important for patients with infections due to this organism

28. Patient came with chest pain, burning in character, retrosternal, increase when
lying down, increase after eating hot food, clinical examination normal, what is the
diagnosis?
a) MI
b) peptic ulcer
c) GERD

29. Benign tumors of stomach represent almost :

a) 7%
b) 21 %
c) 50 %
d) 90 %
 Benign tumors of stomach are not common and constitute only 5–10% of all stomach tumors.
 Benign tumors of Duodenum = 10-20%

30. 40 years old with mild epigastric pain and nausea for 6 months, endoscopy shows
loss of rugal folds, biopsy shows infiltration of B lymphocytes, treated with antibiotic,
what is the cause?
a) Salmonella
b) H.pylori

31. All of the following exaggerate the gastric ulcer except

a) Tricyclic antidepressant
b) Delay gastric emptying.
c) Sepsis.
d) Salicylates.
e) Gastric outlet incompetent
32. Old patient with history of recent MI complaining of severe abdominal pain,
distention, bloody diarrhea, slightly raised serum amylase diagnosis is
a) Ischemic colitis?

33. Old patient with positive occult

blood in stool a) Colonoscopy
 Risk of colonic malignancy increased in older age especially with positive occult blood test.

34. Adult patient with history of sickle cell anemia, he at risk of

a) Infarction

35. After dinner 4 of family members had vomiting & diarrhea, what is the
causetive organism? a) Salmonella
b)
Staphylococcu
s c) C. diff
 Staphylococcal food poisoning onset is generally 30 minutes to 8 hours after eating.
 In salmonella onset comes later to 8 hrs.

36. Vitamin C deficiency will affect

a) Collagen synthesis
b) Angiogenesis
c) Epithelization
d) Migration of microphage

37. Patient with perianal pain, Increase during night and last for few minutes
a) Proctalgia fugax
b) Ulcerative colitis
 Proctalgia fugax most often occurs in the middle of the night and lasts from seconds to minutes

38. Young patient came with peptic ulcer, which of the following doesn't cause it:
a) Sepsis
b) Delayed gastric emptying
c) TCA
d) Aspirin use
e) Pyloric sphincter stricture

39. Drug abuser, showed RNA virus what is the diagnosis:

a) HBV
b) HCV
c) HEV
d) HDV
 HBV and HCV are transmitted parentrally, HCV is a RNA virus and HBV is a DNA virus.

40. Patient with cirrhosis, ascites, lower limb edema best to give:
a) Thiazide
b) Spironolactone

144. Thiazide cause Hypokalemia and extracellular alkalosis and this is not tolerable by
cirrhotic patients. While spironolatone showed less complication with long term use.
41. Young male known case of sickle cell anemia presented with abdominal pain &
joint pain. He is usually managed by hospitalization. Your management is:
a) In-patient management & hospitalization
b) Out-patient management by NSAID
c) Hydration, analgesia & monitoring.
d) Narcotic opioids

42. Patient with celiac sprue he should take:

a) Carbohydrate free diet
b) Protein free diet
c) Gluten free diet
 To prevent immune reaction causing vilious atrophy.

43. First sign of MgSO4 overdose:

a) Loss of deep tendon reflex
b) Flaccid paralysis
c) Respiratory failure
 Clinical consequences related to serum concentration:
 4.0 mEq/l  hyporeflexia
 >5.0 mEq/l  Prolonged atrioventricular conduction
 >10.0 mEq/l Complete heart block
 >13.0 mEq/l  Cardiac arrest
44. 70 years old presented with weight loss, fatigue, anemia, upper quadrant pain
without any previous history, the stool sowed high fat he is a known smoker:
a) Acute pancreatitis
b) Chronic pancreatitis
c) Pancreatic carcinoma
 Paraneoplastic syndrome with decreased lipase and old age suggest a malignancy in the pancreas.

45. About alcohol syndrome?

a) Leads to facial anomaly and mental retardation
b) reduce to 1 glass of wine to decrease the risk of alcohol syndrome
c) wine will not cross the placenta

 Fetal alcohol syndrome is a pattern of mental and physical defects that can develop in a fetus in
association with high levels of alcohol consumption during pregnancy

46. What is the most common cause of chronic diarrhea

a) Irritable bowel syndrome

47. Patient with dysphagia to solid and liquid, and regurgitation, by barium there is
non peristalsis dilatation of esophagus and air-fluid level and tapering end, what is
the diagnosis?
a) Esophageal spasm
b) Achalasia
c) Esophageal cancer
 Achalasia characterized by incomplete LES relaxation, increased LES tone and lack of peristalsis
of the esophagus
48. Patient with nausea, vomiting and diarrhea developed postural
hypotension. Fluid deficit is: a) Intracellular
b)
Extracellula
r c)
Interstitial

49. 25 years old Saudi man presented with history of mild icterus, otherwise ok,
hepatitis screen: HBsAg +ve , HBeAg +ve, anti HBc Ag +ve (this should be core anti
body, because core antigen doesn’t leave hepatocyte to
the blood), the diagnosis :
a) Acute hepatitis B
b) Convalescent stage of hepatitis B
c) Recovery with seroconversion hepatitis B
d) Hepatitis B carrier
e) Chronic active hepatitis B
 HBsAg First detectable agent in acute Infection Present as early as incubation period.
 HBeAg Highly Infectious State, IgM anti-HBc +ve in acute infection

50. 23 years old female presented with finding of hyperbilirubinemia, normal

examination, invstigation shows total biliurubin= 3.1 , direct biliurubin= 0.4, the
most likely diagnosis:
a) Gilbert's disease
b) Crigler najjar syndrome 1
c) Duben Johnson syndrome
d) Rotor's disease
e) Sclerosing cholangitis
 Gilbert's disease: asymptomatic, discovered incidentally, no treatment required and slight
increase bilirubin
 Crigler najjar syndrome 1: this can't survive adult life. Only type II survive
 Duben Johnson syndrome & Rotor's disease: direct bilirubin (Q about indirect)
 Sclerosing cholangitis: 75% in men, pruritus & diagnosis by ERCP (MRCP)

51. Patient diagnosed with obstructive jaundice best to diagnose common bile duct
obstruction:
a) ERCP
b) US
 ERCP can be performed as diagnostic (standard) and therapeutic.

52. 48 years female patient with abdominal pain, nausea, vomiting tenderness in right
hypochondrial area your diagnosis is :
a) Acute cholecystitis

53. 50 years old male with 2 years history of dysphagia, lump in the throat, excessive
salivation, intermittent hoarseness & weight loss. The most likely diagnosis is:
a) Cricopharyngeal dysfunction
b) Achalasia
c) Diffuse spasm of the oesophagus.
d) Scleroderma.
e) Cancer of cervical esophagus.

 The presenting symptoms are suggestive of malignancy (old age, weight loss, hoarseness,
lump and excessive salivation)
54. Gastresophageal Reflux Disease best
diagnosed by: a) History
b) Physical examination & per-rectal
examination c) History & barium meal
d) History & upper GI endoscopy

 Because we have to rule out other important deferential diagnosis like oesophagitis,
infection, duodenal or gastric ulcers, cancers.

55. Irritable bowel syndrome all EXCEPT

a) Abdominal distention
b) Mucous PR
c) Feeling of incomplete defecation
d) PR bleeding
 Rome II criteria for IBS: At least 3 months (consecutive) of abdominal pain with 2 out of the
following 3:
 Relief with defecation, change in form of stool or change in frequency of stool. Symptoms that
support the diagnosis abnormal stool frequency, abnormal form, abnormal passage (straining,
urgency, sense of incomplete defecation), passage of mucous and bloating or feeling of
distention. Absence of alarming features which are weight loss, nocturnal defecation, blood or
pus in stool, fever, anemia and abnormal gross findings on flexible sigmoidoscopy.

56. Regarding H. Pylori eradication:

a) Clarithromycin for 1 week
b) Bismuth, ranitidine amoxil for 2 weeks
c) PPI 2 weeks, amxilor 1 week clarithromycin

 Recommended treatment of H.pylori: eradication upon documentation of infection is

controversial since most will not have peptic ulcer or cancer.
 1st line PPI+ clarithromicin + amoxicillin or metronidazole (3 drugs, twice daily for one week).

57. One type of food is protective against colon cancer:

a) Vitamin D
b) Fibers
 Colon cancer the presumed environmental influence is high fat consumption and low fiber
consumption.

58. 70 years old woman presented with 3 days history of perforated duodenal ulcer,
she was febrile, semi comatose and dehydrated on admission. The BEST
treatment is:
a) Transfuse with blood, rehydrate the patient , perform vagotomy and drainage urgently
b) Insert a NGT & connect to suction, hydrate the patient, give systemic antibiotics and observe.
c) Insert a NGT & connect to suction, hydrate the patient, give systemic antibiotics and
perform plication of the perforation.
d) Hydrate the patient ,give blood ,give systemic antibiotics and perform hemigastrectomy
e) None of the above
 Also, a NG tube is placed to suction out stomach juices so they do not flow out the perforation.
 Laparoscopic repair of duodenal perforation by Graham patch plication is an excellent alternative
approach

59. Patient was diagnosed to have duodenal ulcer and was given ranitidine for 2 weeks
and now he is diagnosed to have H. pylori. What is your choice of management?
a) Omeprazol, clarithromcin & amoxicillin
b) Bismuth+ tetracycline+ metronidazol
c) Metronidazoland amoxicillin.
d) Omeprazol+ tetracycline.
60. 28 year old lady presented with history of increased bowel motion in the last 8
months. About 3-4 motions/day. Examination was normal. Stool analysis showed
Cyst, yeast, nil Mucus, Culture: no growth, what is the most likely diagnosis?
a) Inflammatory bowel disease
b) Irritable bowel disease
c) diverticulitis
 After exclusion of infection, mucus secretion commonly happens in inflammatory bowel
disease more than irritable bowel disease.

61. 40 year old man presented to the ER with 6 hour history of severe epigastric pain
radiating to the back like a band associated with nausea. No vomiting, diarrhea or
fever. On examination the patient was in severe pain with epigastric tenderness. ECG
was normal, serum amylase was 900 u/l, AST and ALT are elevated to double normal.
Which of the following is the least likely precipitating factor to this patient’s
condition?
a) Hypercalcemia
b) Chronic active hepatitis
c) Chronis alcohol ingestion
d) Hyperlipedemia
e) Cholethiasis
 Hypercalcemia, chronic alcohol ingestion, cholethiasis and hyperlipidemia are precipitating
factors leading to acute pancreatitis.

62. Patient had abdominal pain for 3 months, what will support that pain due to duodenal
ulcer?
a) Pain after meal 30-90 min.
b) Pain after meal immediately.
c) Pain after nausea & vomiting.
d) Pain after fatty meal.
e) Pain radiating to the back.
 Ulcer-related pain generally occurs 2-3 hours after meals and often awakens the patient at night
and this pattern is believed to be the result of increased gastric acid secretion, which occurs after
meals and during the late night and early morning hours when circadian stimulation of gastric
acid secretion is the highest.
 Pain is often relieved by food, a finding often cited as being specific for duodenal ulcer.
63. The single feature which best distinguishes Crohn’s disease from ulcerative colitis is:
a) Presence of ileal disease.
b) Cigarette smoking history.
c) Presence of disease in the rectum.
d) Non-caseating granulomas.
e) Crypt abscesses.
 The best distinguishing feature is non-cassiating granuloma which is present in only 30 % of
patients with CD however when it occurs this is definitively CD. The rest of the features are
can occur in either.

64. 45 years old man presented with anorexia, fatigue and upper abdominal pain for one
week. On examination he had tinge of jaundice and mildly enlarged tender liver.
Management includes all EXCEPT:
a) Liver ultrasound
b) ERCP
c) Hepatitis markers
d) Serum alanine transferase
e) Observation and follow up
 The case looks like acute hepatitis with the acute history, the fatigue, mild jaundice and mild
Hepatomegaly.
 Investigations include LFT, hepatitis markers and US liver. Treatment is observation and
follows up. ERCP is not needed (not obstructive).
65. 30 years old man presented with upper abdominal pain and dyspepsia. Which of
the following doesn’t support the diagnosis of peptic ulcer:
a) Hunger pain
b) Heart burn
c) Epigastric mass
d) Epigastric tenderness
e) History of hematemesis

 The symptoms of peptic ulcer include pain, dyspepsia, heartburn, bleeding, gastric outlet
obstruction but don’t explain the presence of a mass.

66. Hepatitis most commonly transferred by blood is:

a) HBV.
b) HAV.
c) HCV
d) None of the above.

 HBV transmission by blood was common before effective screening tests and vaccines were
available. HAV is transmitted via enteral route. HCV recently with PCR technology began to have
a screening test, but transmission remains high as many infected individuals are carriers.

67. All of the following organisms causes diarrhea with invasion except:
a) Shigella
b) Yersenia
c) Salmonella
d) Cholera
e) Campylopacter

 Shigella does not invade beyond the lamina propria into the mesenteric lymph nodes or reach
the bloodstream while others do.

68. Premalignant lesions have:

a) Pedunculated polyps.
b) Villous papilloma (adenoma).
c) Polypoidpolyp.
d) Juvenile polyp.

69. Patient had abdominal pain and found to have gastric ulcer all are predisposing
factor, except:
a) Tricyclic antidepressant
b) NSAIDs
c) Delayed gastric emptying
d) Pyloric sphincter incompetence
e) Sucralfate
 Aggressive factors for peptic ulcer:
 Acids
 Pepsin
 H.pylori infection
 Alcohl & Smoking
 Diet (spicy food)
 Drugs(NSAID, CORTICOSTEROID)
 Stress
 SUCRALFATE: this is drug lead to formation of coat over the base of the ulcer and prevents
effects of HCL and promotes healing of ulcer.
70. In the neck,
esophagus is: a)
Posterior to the
trachea b) Anterior to
the trachea
c) Posterior to vertebral column

71. Patient with hepatitis B then he said which one of the following antigens appear
in the window period? a) HBS ag
b) Hbc ag
c) Anti
HBe
d) Anti Hbc antibody “IgM against HBc”

72. Treatment of erosive gastritis?

a) Antibiotics
b) H2 blocker
c) Depend on the patient situation
d) Total gastroectomy
e) sucralfate

73. Patient old with WBC 17000 and left iliac fossa tenderness and fever most likely has:
a) Diverticulitis
b) colon cancer
c) crohn disease

74. Which of the following features is related to crohn's disease:

a) Fistula formation
b) Superficial layer involvement

 Crohn's disease can lead to several mechanical complications within the intestines,
including obstruction, fistulae, and abscesses.

75. 60 years old male patient complaining of dysphagia to solid food. He is a known
smoker and drinking alcohol, he has weight loss, what’s the most likely diagnosis?
a) Esophageal cancer
b) GERD
c) Achalasia

76. Which is true about gastric lavage?

a) It is safer than ipecac if the patient is semiconscious
b) It is done to the patient in right Decubitus position
c) It is useless for TCA if the patient presented after 6 hrs
 Gastric lavage with Activated charcoal is most useful if given within 1 to 2 hours of ingestion.
 Lavage is effective only 1 hour after ingestion of any poison. After that its ineffective

77. Which of the following conditions is contraindicated

to use Ibuprofen? a) Peptic ulcer disease
 Reduction of prostaglandin secretion and protective mechanism of gastric mucosa.

78. Patient come with jaundice, three days after the color of jaundice change to
greenish what is the cause? a) Oxidation of bilirubin to bilivedin which is greenish in
color
 High content of saturated lipids.

80. Overcrowded area, contaminated water, type of hepatitis

will be epidemic: a) Hepatitis A
b) hep
B c)
hepC
 Cause of parentral transmission.

81. Celiac disease severe

form involve a) Proximal part
of small intestine b) distal part
of small intestine
c) proximal part of large
intestine d) distal part of
large intestine
 Pathological abnormalities of celiac disease may include severe, mild or moderate small
bowel mucosal architectural abnormalities that are associated with both epithelial cell and
lymphoid cell changes, including intraepithelial lymphocytosis.
 Architectural changes tend to be most severe in the duodenum and proximal jejunum and
less severe, or absent, in the ileum.

82. GERD which cancer is the patient at risk

of contracting? a) Adenocarcinoma
 The histology of the esophagus is columnar epithelium with persisting GERD changed to
Squamous epithelium
 Cancer of Squamous epithelium is an Adenocarcinoma.

83. High risk for developing colon cancer in

young male is: a) Smoking, high alcohol intake,
low fat diet
b) Smoking, low alcohol intake, high fat diet
c) Red meat diet, garden’s disease (Gardner
syndrome) d) Inactivity, smoking
 Gardner syndrome is now known to be caused by mutation in the APC gene predisposing to colon
cancer.

84. Patient with primary biliary cirrhosis, which drug helps the
histopathology of the liver? a) Steroid
b)
Interferon
c) Ursodiol
 Helps reduce the cholestasis and improves liver function tests. It has a minimal effect on
symptoms.

85. A man travelled to Indonesia and had rice and cold water and ice cream. He is
now having severe watery diarrhea and severely dehydrated, what is the most likely
he has:
a) Vibrio cholera
b) clostridium difficile
c) Clostridium perfringens
d) Dysentery
e) Shigella
 Watery diarrhea indicates cholera infection and it’s endemic in Indonesia.
86. Patient with peptic ulcer using anti acid, presented with forceful
vomiting food particle: a) Gastric outlet obstruction
 Forceful vomiting of undigested food indicate a proximal obstruction

87. 75 years old female with 2 days history of MI is complaining of abdominal pain,
vomiting, bloody stool, x-ray shows abdominal distension with no fluid level, serum
amylase is elevated. Dx :
a) Ulcerative colitis
b) acute pancreatitis
c) Ischemic colitis
d) Diverticulitis

88. Stop combined OCP if the patient has :

a) Chronic active hepatitis
b) breastfeeding
c) Varicose veins
d) Gastroenteritis
 Combined oral contraceptives increase the risk of venous thromboembolism.

89. All the following are differentials of acute abdomen except:

a) Pleurisy(Diaphragmatic pleurisy has sometimes been incorrectly diagnosed “acute disorder of
the abdomen
b) MI
c) Herpes zoster (visceral type cause acute abdomen)
d) polyarteritis nodsa (cause acute abdomen through ischemia)
e) pancreatitis

90. 6 month old baby presented to the clinic with 2 days history of gastroenteritis. On
examination: decreased skin turgor, depressed anterior fontanelle & sunken eyes.
The Best estimate of degree of dehydration:
a) 3%
b) 5%
c) 10%
d) 15%
e) 25%

91. Man with history of alcohol assocation with

a) high MCV
b) Folic acid deficiency
c) B12 deficieny
d) hepatitis
 People with excessive alcohol intake and malnutrition are still at high risk of folic acid deficiency.

92. In irritable bowel Syndrome the following mechanism, contraction and slow wave
myoelectricity seen in: a) Constipation
b) Diarrhea

93. kwashikor disease usually associated with

a) decrease protein intake, decrease carbohydrate
b) increase protein , increase carbo
c) Decrease protein, increase carbohydrate
 There is decrease protein and adequate amount of carbohydrate
94. 22 years old male patient was presented by recurrent attacks of diarrhea ,
constipation , and abdominal pain relieved after defecation , but no blood in the stool ,
no weight loss : what is the diagnosis
a) Irritable bowel Syndrome

95. Young healthy male has abdominal pain after basketball. Examination fine
except for Left paraumbilical tenderness, what to do?
a) Abdominal US
b) Flat plate graph
c) Send home & reassess within 48 hours

96. Prophylaxis of cholera :

a) Good hygiene, sanitation and oral vaccine, in epidemic public: mass single dose of
vaccine & tetracycline.

97. Chronic Diarrhea is a feature of:

a) HyperNatremia
b) HyperCalcemia
c) HypoMagnesemia
d) Metabolic Alkalosis

98. Teacher in school presented with 3 days history of jaundice & abdominal pain, 4
of school student had the same illness in lab, what is true regarding this patient?
a) Positive for hepatitis A IgG
b) Positive hepatitis A IgM
c) Positive hepatitis B core
d) Positive hepatitis B c anti-body
 IgM appears earlier than IgG in HBA infection

99. Which of the following features of ulcerative colitis distinguishes it from Crohn’s
disease
a) Possible malignant transformation (both but more in UC)
b) Fistula formation (common in CD)
c) Absence of granulomas
d) Colon involvement (both)

100. Inflammatory bowel disease is idiopathic but one of following is possible underlying
cause:
a) Immunological

101. Which of the following is true regarding varicella vaccine during breast feeding :
a) It is safe.
b) No breast feeding except after 3 days of the immunization.
 There are no data on the excretion of varicella virus vaccine in human milk.

102. Girl with amenorrhea for many months. BMI is 20 and is stable over last 5 years.
diagnosis
a) Eating disorder
b) Pituitary adenoma
1. Female patient with fatigue, muscle weakness, paresthesia in the lower limbs and
unsteady gait, next step?
a) Folate level
b) Vitamin B12 level
c) Ferritin level

2. In brainstem damage:
a) Absent spontaneous eye movement
b) Increase PaCO2
c) Unequal pupils
d) Presence of motor movement

3. What is the most reversible risk factor for stroke?

a) DM
b) HTN
c) obesity
d) Dyslipidemia

4. Which of the following found to reduce the risk of post herapeutic neuralgia?
a) Corticosteroids only
b) Corticosteroids + valacyclovi
c) Valacyclovir only

5. Cardiac syncope:
a) Gradual onset
b) Fast recovery
c) Neurological sequence after

6. An 18 years old male who was involved in an RTA had fracture of the base of the
skull. O/E he had loss of sensation of the anterior 2/3 of the tongue & deviation of
the angle of the mouth. Which of the following nerves is affected?
a) I (Olfactory)
b) III (Occulomotor)
c) V (Trigeminal)
d) IV (Abducens)
e) VII (Facial)
 Because loss of sensation , in Facial loss of taste in ant 2/3
 Innervation of tongue:
 Anterior 2/3rd of tongue: General somatic afferent: lingual nerve branch of V3 of the
trigeminal nerve,
taste: chorda tympani branch of facial nerve CN VII
 Posterior 1/3rd of tongue :General somatic afferent and taste: Glossopharyngeal nerve CN IX

7. A 35 years old patient, she is on phenytoin since she was 29 due to partial epilipsy she
didn’t have any attack since. She want to stop taking the drug due to facial hair
growth:
a) It is reasonable to stop it now
b) Stop it after 6 months
c) Stop after 10 years
d) Don’t stop it

8. Patient 22 years old with unilateral headache attacks:

a) Cluster headache
b) Migraine
c) Tension headache
9. Which of the following is true about migraine:
a) Aura occur after the headache
b) Each attack lasts about 4 hours
c) It is unilateral pounding headache

10. A middle age man presented with severe headache after lifting heavy object. His
BP was high. He was fully conscious. Examination was otherwise normal. The most
likely diagnosis is:
a) Subarachnoid hemorrhage
b) Central HTN
c) Tension headache
d) Migraine
e) Intracerebral hemorrhage

11. Patient has neck stiffness, headache and petechial rash. Lumber puncture
showed a high pressure , what would be the cause?
a) group B strep
b) Neisseria meningitides
c) m.tubecrlosis
d) staphylococcus aures

12. The most common cause of non traumatic subarachnoid hemorrhage is:
a) Middle meningeal artery hemorrhage
b) Bridging vein hemorrhage
c) Rupture of previously present aneurysm

13. Which is not true in emergency management of stroke?

a) Give IVF to avoid D5 50%  Hyperglycemia can increase the severity of ischemic injury whereas
hypoglycemia can mimic a stroke
b) Give diazepam in convulsions
c) Anticonvulsants not needed in if seizures
d) Must correct electrolytes
e) Treat elevated blood pressure Treat if SBP>220 or DBP>120 or MAP>130
14. A 26 year old female complaining of headache more severe in the early morning
mainly bitemporal, her past medical history is unremarkable. She gave history of OCP
use for 1 year. Ophthalmoscope examination showed papilledema but there are no other
neurological findings. The most probable diagnosis is:
a) Optic neuritis
b) Benign intracranial hypertension
c) Encephalitis
d) Meningitis
e) Intracranial abscess

 Explanation: BIH headaches are typically present on waking up or may awaken the
patient. It could be accompanied by other signs of increased ICP like vomiting,
papilledema, epilepsy or mental change

15. A 27 years old male with tonic colonic seizures in the ER, 20 mg Diazepam was given
and the convulsion did not stop. What will be given?
a) Diazepam till dose of 40 mg
b) Phenytoin
c) Phenobarbitone
16. Definition of status epilepticus:
a) Generalized tonic clonic seizure more than 15 minutes
b) Seizure more than 30 minutes without regains consciousness in between
c) Absence seizure for more than 15 minutes

17. 25 years old student presented to your office complaining of sudden & severe
headache for 4 hours. History revealed mild headache attacks during the last 5 hours.
On examination: agitated & restless. The diagnosis is:
a) Severe migraine attack
b) Cluster headache
c) Subarachnoid hemorrhage
d) Hypertensive encephalopathy
e) encephalitis

18. all of the following precipitate seizure except:

a) hypourecemia
b) Hypokalemia
c) hypophosphatemia
d) hypocalcemia
e) hypoglycemia

19. A 25 years old patient presented with headache, avoidance of light & resist flexion of
neck, next step is:
a) EEG
b) C-spine X-ray
c) Phonation
d) Non of the above
 Explanation: I suspect meningitis, the treatment is antibiotic & lumbar puncture

20. Which of the following side effect is not associated with phenytoin?
a) Hirsutism
b) Macrocytic anemia
c) Asteomalasia
d) Ataxia
e) Osteoporosis
 Explanation: Side effects of phenytoin:
1) CNS: cerebral edema, dysarthria & extrapyramidal syndrome
2) ENT: diplopia, nystagmus & tinnitus.
3) CVS: hypotension
4) GI: gingival hyperplasia & altered taste
5) GU: pink or red urine.
6) Dermatology: hypertrichosis & exfoliative dermatitis
7) Hematology: Agranulocytosis, aplastic anemia & macrocytic anemia
8) Other: Asteomalasia, Hypocalcaemia

21. Peripheral neuropathy can occur in all EXCEPT:

a) Lead poisoning.
b) DM.
c) Gentamycin.
d) INH (anti-TB).
 All can cause peripheral neuropathy!
22. Pain near eye prescribed by tingling and paresthesia occur many times a week in
the same time, also there is nasal congestion and eye lid edema, what is the diagnosis?
a) Cluster headache
b) Migraine with aura
c) Tension headache
d) Withdrawal headache

23. Girl with band like headache increase with stress and periorbital, twice a week, what
is the diagnosis?
a) Tension headache
b) migraine
c) cluster

24. Treatment of opioid toxicity

a) Naloxin

25. Strongest factor for intracerebral hemorrhage

a) HTN

26. Patient presented with nausea, vomiting, nystagmus, tinnitus and inability to walk
unless he concentrates well on a target object. His Cerebeller function is intact, what is
the diagnosis?
a) Benign positional vertigo
b) Meniere’s disease
c) Vestibular neuritis

27. 80 years old male patient, come with some behavioral abnormalities,
annoying, (he mentioned some dysinhibitory effect symptoms), most postulated
lobe to be involved:
a) Frontal
b) Parietal
c) Occipital
d) Temporal.

28. The commonest initial manifestation of increased ICP in patient after head trauma is
a) Change in level of consciousness
b) Ipsilateral pupillary dilatation
c) Contralateral pupillary dilatation
d) Hemiparesis

29. One of following true regarding systolic hypertension :

a) In elderly it’s more dangerous than diastolic hypertension
b) Occur usually due to mitral regurge
c) Defined as systolic, above 140 and diastolic above 111 “combined systolic and diastolic”

30. Typical picture of oculomotor nerve palsy: stroke with loss of smell, which lobe is
affected?
a) Frontal
b) Parital
c) Occipital
d) Temporal

31. Man is brought to the ER after having seizure for more than 30 min the most initial
drug you will start with:
a) IV lorazepam
b) IV phenobarbital
c) IV phynetoin
32. Middle aged patient with ataxia, multiple skin pigmentation and decrease hearing,
one of the family members has the same condition?
a) Malignant melanoma
b) Neurofibromatosis “ most likely”
c) hemochromatosis
d) measles
e) nevi

33. 19 years old after bike accident, he can't bring the spoon in front of himself to eat,
lesion is in:
a) Temporal lobe
b) Cerebellum
c) Parietal lobe
d) Occipital lobe

34. Young girl experienced crampy abdominal pain & proximal muscular weakness
but normal reflexes after receiving septra (trimethoprim sulfamethoxazole) :
a) Functional myositis
b) Polymyositis
c) Guillianbarre syndrome
d) Neuritis
 Explanation: Due to Septra

35. Sciatica increased incidence of :

a) Lumbar lordosis
b) Paresthesia

36. Patient is complaining of memory loss. Alzheimer disease is diagnosed what is the
cause of this:
a) Brain death cell

37. Female patient presented with migraine headache which is pulsatile, unilateral,
increase with activity. Doesn't want to take medication. Which of the following is
appropriate?
a) Bio feedback
b) TCA
c) BB

 Biofeedback has been shown to help some people with migraines. Biofeedback is a technique
that can give people better control over body function indicators such as blood pressure, heart
rate, temperature, muscle tension, and brain waves. The two most common types of
biofeedback for migraines are thermal biofeedback and electromyographic biofeedback

38. Diabetic patient was presented by spastic tongue, Dysarthria and spontaneous
crying what is the most likely diagnosis?
a) Parkinson.
b) Bulbar palsy.
c) Pseudobulbar
d) Myasthenia gravis.

 Explanation: This is a bit tricky. Bulbar palsy is the LMNL of the last 4 CN, while pseudobulbar
palsy is the UMNL of the last 4 CN. So spasticity of tongue is UMNL. But Diabetes causes LMNL
of cranial nerves due to peripheral neuropathy. So maybe the cause here is CNS affection due to
atherosclerosis from macroangiopathy of diabetes.
39. Patient with ischemic stroke present after 6 hours, the best treatment is:
a) ASA
b) Tissue plasminogen activator “TPA”
c) Clopidogril
d) IV heparin
e) Other anticoagulant
 Explanation:
 TPA : administered within 3 hours of symptoms onset (if no contraindication)
 ASA: use with 48 hours of ischemic stroke to reduce risk of death.
 Clopidogrel : can be use in acute ischemic& alternative to ASA
 Heparin & other anticoagulant : in patient has high risk of DVT or AF

40. Old male with neck stiffness, numbness and paresthesia in the little finger and ring
finger and positive raised hand test, diagnosis is:
a) Thoracic outlet syndrome
b) Impingement syndrome
c) Ulnar artery thrombosis
d) Do CT scan for Cervical spine

41. 1st line in Trigeminal Neuralgia management:

a) Carbamazepine

42. Prophylaxis for meningitis treatment of contact:

a) Cemitidine
b) Rifampicin

43. Old male with symptoms suggesting Parkinsonism such as difficulty walking,
resting tremors and rigidity in addition to hypotension. Then he asks about what is
the most common presenting symptom of this disease
a) Rigidity
b) Tremors
c) Unsteady Gait
d) Hypotension

44. Which of the following is a side effect of bupropion , a drug used to help smoking
cessation:
a) Arrhythmia
b) Xerostomia
c) Headache
d) Seizure

45. Most effective treatment of cluster headache:

a) Ergotamine nebulizer
b) S/C Sumatriptan
c) 100% O2
d) IV Verapamil

46. Old patient with HTN and migraine treatment:

a) B blockers
b) ACE Inhibitors
c) Ca blockers
 Explanation: The most commonly used
47. Patient presented with progressive weakness on swallowing with diplopia and
fatigability. The most likely underlying cause of her disease is.
a) Antibody against acetylcholine receptors
 Explanation: Diagnosis Myasthenia Graves
48. Young adult Sickle cell patients are commonly affected with
a) dementia
b) Multiple cerebral infarcts
 Explanation: Due to narrowing of the vessels

49. 70 years old with progressive dementia, no personality changes and neurological
examination was normal but there is visual deficit, on brain CT shower cortex atrophy
and ventricular dilatations, what is the diagnosis?
a) Multi micro infract dementia
b) Alzheimer dementia
c) parkinsonism dementia

50. 70 years old with progressive dementia, on brain microscopy amyloid plaques and
neurofibrillary tangles are clearly visible also Plaques are seen, what is the diagnosis?
a) lewy dementia
b) Parkisonism
c) Alzheimer

51. 87 years old who brought by his daughter, she said he is forgettable, doing
mess thing in room , do not maintain attention , neurological examination and the
investigation are normal, what is the diagnosis?
a) Alzheimer disease
b) Multi-Infarct Dementia

52. 73 year patient complain of progressive loses of memory with decrease in

cognition function. C.T reveal enlarge ventricle and cortical atrophy, what is the
diagnosis?
a) Alzheimer
b) multi infarct dementia
c) multiple sclerosis

53. Female patient developed sudden loss of vision (both eyes) while she was walking
down the street, also complaining of numbness and tingling in her feet ,there is
discrepancy between the complaint and the finding, on examination reflexes and ankle
jerks preserved,there is decrease in the sensation and weakness in the lower muscles
not going with the anatomy, what is your action?
a) Call ophthalmologist
b) Call neurologist
c) call psychiatrist
d) Reassure her and ask her about the stressors!

54. Female patient complaining of severe migraine that affecting her work, she
mentioned that she was improved in her last pregnancy, to prevent that:
a) Biofeedback
b) Propranolol
 Explanation: Beta blocker used in prevention

55. 6 months boy with fever you should give antipyretic to decrease risk of:
a) Febrile convulsion
b) Epilepsy
56. Max dose of ibuprofen for adult is :
a) 800
b) 1600
c) 3000
d) 3200

57. 65 year male presented with 10 days history of hemiplagia, CT shows: infarction, he
has HTN. He is on lisonipril & thiazide, 2 years back he had gastric ulcer. tratment that
you should add :
a) continue same meds
b) Aspirin 325
c) aspirin 81
d) warfarin
e) Dipyridamole (Antiplatlet agent)

58. Indication for CT brain for dementia, all true except:-

a) Younger than 60 years old
b) After head trauma
c) Progressive dementia over 3 years

 Alzheimer’s disease is primarily a clinical diagnosis. Based on the presence of characteristic

neurological and neuropsychological features and the absence of alternative diagnosis
 Commonly found in people aver 65 presenting with progressive dementia for several years

59. Investigation of Multiple Sclerosis include all except:

a) Visual evoked potential
b) LP
c) MRI
d) CT

60. Young man come with headache he is describing that this headache is the worst
headache in his life what of the following will be less helpful?
a) Asking more details about headache
b) Do MRI or CT scan
c) Skull x ray
d) LP

61. All of the fallowing are criteria of subarachnoid hemorrhage EXCEPT:

a) Paraplegia
b) confusion
c) nuchal Rigidity
d) Due to berry aneurysm rupture
e) Acute severe headache

62. The best treatment for the previous case is :

a) Benzodiazepines
b) Phenothiazine
c) monoamine oxidase inhibitor
d) selective serotonin reuptake inhibitor
e) supportive psychotherapy
63. After infarction, the patient become disinhibited, angrier & restless, The area
responsible which is affected:
a) Premotor area
b) Temporal area
c) Pre- frontal area

64. 26 years old female present with 6 month history of bilateral temporal headache
increased in morning & history of OCP last for 1 year, on examination BP 120/80 &
papilledema, what is the diagnosis?
a) Encephalitis
b) Meningitis
c) Optic nuritis
d) Benign intracranial hypertension
e) Intracerbral abscesses

65. 60 years old male complain of decreased libido, decreased ejaculation , FBS= 6.5
mmol , increased prolactin , normal FSH & LH , do next step:
a) Testosterone level
b) DM
c) NL FBG
d) CT of the head

66. A patient comes to you with long time memory loss and you diagnosed him as
dementia (Alzheimer), what to do to confirm the diagnosis:
a) CT scan

67. Side effects of Levodopa :

a) Dyskinesia
b) Speech
c) Fatal hepatic toxicity

68. Patient present with generalized seizures not known case before of any seizure , no
pervious history like that, The most important thing to do now is:
a) EEG. After that
b) Laboratory test in ER

69. Lactating mother newly diagnosed with epilepsy, taking for it phenobarbital your
advice is:
a) Discontinue breastfeeding immediately
b) Breast feed baby after 8 hours of the medication
c) Continue breastfeeding as tolerated

70. Sciatica:
a) Never associated with sensory loss
b) Don’t cause pain with leg elevation
c) Causes increased lumbar lordosis
d) Maybe associated with calf muscle weakness

71. Old male with stroke, after 9 days he loss left eye vision, what are the affect
structure?
a) Frontal lobe
b) Partial
c) Occipital
d) Temporal
72. Male old patient has signs & symptoms of facial palsy (LMNL), which of the following
correct about it?
a) Almost most of the cases start to improve in 2nd week
b) it need treatment by antibiotic and anti viral
c) contraindicated to give corticosteroid
d) usually about 25 % of the cases has permanent affection

73. What is the prophylaxis of meningococcal meningitis?

a) Rifampicin

74. Patient known of epilepsy on phenytoin, presented with history of abdominal pain,
bilateral axillary lymph node enlargement, what is the most like diagnosis?
a) Hodgkin's lymphoma
b) Reaction to drug
c) TB

75. Old age patient presented with neck stiffness, cervical arthritis, paresthesia on
palm and medial 2/3 fingers, the proper investigation:
a) CT cervical spine
b) NSAIDs
c) PT
d) Decompression of median nerve (carpal tunnel)

76. Diaphoresis and hyperreflexia, what is the diagnosis?

a) Neuroleptic malignant syndrome
b) Imatinib toxicity
c) odansetron toxicity

77. Young suddenly develops ear pain, facial dropping, what to do?
a) mostly will resolve spontaneously
b) 25% will have permanent paralysis
c) No role of steroid

78. Man with high fever, Petechial rash and CSF decrease glucose, he has:
a) Neisseria meningitis
b) N gonorrhea
c) H influenza

79. Romberg sign lesion in :

a) Dorsal column
b) cerebellum
c) visual cortex

80. Patient with positive Romberg test, what is the affected part :
a) Sensory cortex
b) Motor cortex
c) Brain stem
d) Cerebellum

81. In aseptic meningitis, in the initial 24 hours what will happen?

a) Decrease protein
b) Increase glucose
c) Lymphocytes
d) Eosinophils
e) Something
82. 50 years old female have DM well controlled on metformin, now c\o diplopia RT side
eye lis ptosis and loss of adduction of the eyes and up word and out word gaze !!
reacting pupil no loss of visual field:
a) Faisal palsy
b) Oculomotor palsy of the right side
c) Myasthenia gravies

83. increase IgG in CSF:

a) Multiple sclerosis
b) Duchene dystrophy

84. Brain cell death in Alzheimer disease (not recognized his wife and fighting with her)
a) Temporal lobe
b) Cerebellum
c) Parietal lobe
d) Occipital lobe
Nephrology
1. 62 years old male with DVT and IVC obstruction due to thrombosis so most like
diagnosis is
a) Nephrotic syndrome
b) SLE
c) Chirstm disease

2. Patient with abdominal pain hematuria, HTN and have abnormality in chromosome 16,
diagnosis is
a) Polycystic kidney

3. Long scenario about patient with polydipsia ad polyuria. Serum osmolarity high.
desmoprsin induction no change urine osmolarity and plasma osmolarity so dd is
a) Nephrognic type
b) central type
 Desmopressin acetate  synthetic analog of ADH, can be used to distinguish central from
nephrogenic DI.
 Central DI: DDAVP challenges will ↓ urine output and ↑ urine osmolarity.
 Nephrogenic DI: DDAVP challenge will not significantly ↓ urine output.
 Treatment:
 Central DI: Administer DDAVP.
 Nephrogenic DI: Salt restriction and water intake

4. Female presented with thirst and polyuria, all medical history is negative and she is not
know to have medical issues, she gave history of being diagnosed as Bipolar and on
Lithium but her Cr and BUN is normal. What is the cause of her presentation?
a) Adverse effect of lithium
b) Nephrogenic DI
c) Central DI

5. Female patient was presented by dysuria , epithelial cells were seen urine analysis ,
what is the explanation in this case :
a) Contamination.
b) Renal cause

6. Adenosine dose should be reduced in which of the following cases :

a) Chronic renal failure.
b) Patients on thiophyline.

7. Adult polycystic kidney disease is inherited as:

a) Autosomal dominant
b) Autosomal recessive
c) X linked

8. Best way to diagnose post streptococcus Glomerulonephritis (spot diagnosis):

a) Low C3
b) RBC casts

9. Patient came with HTN, KUB shows small left kidney, arteriography shows renal
artery stenosis, what is the next investigation?
a) Renal biopsy
b) Renal CT scan
c) Renal barium
d) Retrograde pyelography
10. Female patient did urine analysis shows epithelial cells in urine, it comes from:
a) Vulva
b) Cervix
c) Urethra
d) Ureter

11. Female with history of left flank pain radiating to groin, symptoms of UTI, what is
diagnosis?
a) Appendicitis
b) Diverticulitis
c) Renal colic

12. IVP study done for a male & showed a filling defect in the renal pelvis non-
radio opaque. U/S shows echogenic structure & hyperacustic shadow. The most
likely diagnosis is:
a) Blood clot
b) Tumor
c) Uric acid stone
 Stones cause hyperacustic shadows.
 All types of renal calculi are radiopaque except urate stones (5% of all stones)

13. Pre-Renal Failure:

a) Casts
b) Urine Osm < 400
c) Urine Na < 20 mmol/L
d) Decreased water excretion
e) Hematuria

 Casts are seen in interstitial nephritis & glomerulonephritis which are intrinsic renal failure
 Urine osm <400 in intrinsic renal failure but >500 in pre-renal failure
 Urine Na <200 mmol/L is in pre-renal failure if >200 it is intrinsic renal failure
 Decreased water excretion in all types of renal failure
 Haematuria  in intrinsic & post renal failure
14. Patient with history of severe hypertension, normal creatinine, 4g protein 24 hrs.
Right kidney 16cm & left kidney 7cm with suggesting of left renal artery stenosis.
Next investigation:
a) Bilateral renal angiography
b) Right percutanious biopsy
c) Left precutanious biopsy
d) Right open surgical biopsy
e) Bilateral renal vein determination

 Renal angiography is the gold standard but done after CT/MRI as it is invasive

15. All of them are renal complications of NSAIDs except:

a) Acute renal failure
b) Tubular acidosis
c) Interstitial nephritis
d) Upper GI bleeding
 All are complications of NSAIDs but upper GI bleeding is not renal complication!
16. Acute Glomerulonephritis, all are acceptable Investigations except:
a) Complement
b) Urin analysis
c) ANA
d) Blood culture
e) Cystoscopy

17. 20 years old female present with fever, loin pain & dysuria, management include all
of the following except:
a) Urinanalysis and urine culture
b) Blood culture
c) IVU (IVP)
d) Cotrimexazole
 I suspect pylonephritis. So, treatment includes admission, antibiotic & re-hydration.

18. Urine analysis will show all EXCEPT:

a) Handling phosphate.
b) Specific gravity.
c) Concentrating capacity.
d) Protein in urine.

19. In acute renal failure, all is true EXCEPT:

a) Phosphatemia.
b) Uremia.
c) Acid phosphate increases.
d) K+ increases.

20. A 6 years old female from Jizan with hematuria, all the following investigations are
needed EXCEPT:
a) HbS.
b) Cystoscopy.
c) Hb electrophoresis.
d) Urine analysis.
e) U/S of the abdomen to see any changes in the glomeruli.
 Cystoscopy is not generally required in children with nonglomerular hematuria. The only
indication is a suspicious bladder mass revealed on ultrasonography

21. Patient has bilateral abdominal masses with hematuria, what is the most likely
diagnosis?
a) Hypernephroma
b) Polycystic kidney disease

22. Old patient, bedridden with bactermia “organism is enterococcus fecalis”, what the
source of infection?
a) UTI
b) GIT

23. A 56 years old his CBC showed, Hb=11, MCV= 93, Reticlocyte= 0.25% the cause is:
a) Chronic renal failure
b) Liver disease
c) Sickle cell anemia
d) G6P dehydrogenase deficiency

24. 30 years old with repeated UTIs, which of the following is a way to prevent her
condition?
a) Drink a lot of fluid
b) Do daily exercise
163. 65 years old presented with acute hematuria with passage of clots and left loin and
scrotal pain. the Dx
a) Prostitis
b) Cystitis
c) Testicular cancer
d) Renal cancer

164. 5 years child diagnosed as UTI, what is the best investigation to exclude UTI
complication?
a) Kidney US
b) CT
c) MCUG
d) IVU

165. Old patient complain of urinary incontinence. Occur at morning and at night
without feeling of urgency or desire of micturation, without exposure to any stress,
what is the diagnosis?
a) Urgency incontinence
b) Urge incontinence
c) Stress incontinence
d) Over Flow incontinence

166. Heavy smoker came to you asking about other cancer, not Lung cancer, that smoking
increase its risk:
a) Colon
b) Bladder
c) Liver

167. The most common cause of secondary hypertension is:

a) Renal artery stenosis
b) Adrenal hyperplasia
c) Pheochromocytoma
d) Cushing's disease

168. The most common cause of chronic renal failure:

a) HTN
b) DM
c) Hypertensive renal disease
d) Parenchymal renal disease
e) Acute glomerulonephritis

169. Male patient present with prostatitis (prostatitis was not mentioned in the
question), culture showed gram negative rodes. The drug of choice is:
a) Ciprofloxacin “Floqinolon”
b) Ceftriaxone
c) Erythromycin
d) Trimethoprime
e) Gentamicin

170. Patient complaining of left flank pain radiating to the groin, dysuria and no fever.
The diagnosis is:
a) Pyelonephritis
b) Cystitis
c) Renal calculi
33. A 3 weeks old baby boy presented with a scrotal mass that was transparent & non-
reducible. The diagnosis is:
a) Hydrocele
b) Inguinal hernia
c) Epidydimitis

34. A 29 years old man complaining of dysuria. He was diagnosed as a case of

acute prostitis. Microscopic examination showed gram negative rods which grow
on agar yeast. The organism is:
a) Chlamydia.
b) Legonella
c) Mycoplasma

35. Uncomplicated UTI treatment:

a) TMP-SMX for 3 days
b) Ciprofloxacin 5 days

36. Patient with renal transplant, he developed rejection one week post transplantation,
what could be the initial presentation of rejection?
a) Hypercoagulability
b) Increase urine out put
c) Fever
d) Anemia

37. Patient with hematuria and diagnosed with bladder cancer. What’s the likely
causative agent?
a) Schistosoma haematobium

38. Diabetic patient on insulin and metformin has renal impairment. What’s your next
step:
a) Stop metformin and add ACE inhibitor

39. Patient has saddle nose deformity, complaining of SOB, hemoptysis and hematuria.
most likely diagnosis is:
a) Wagner’s granulomatosis

40. Most common manifestation of renal cell carcinoma is:

a) Hematuria
b) Palpable mass
c) HTN

41. Patient came with metabolic acidosis with anion gap of 18, she took drug overdose.
What could it be:
a) Salicylate

42. Patient with excessive water drinking and frequent urinate, FBS 6.8 diagnosis up to
now:
a) Normal blood sugar
b) IFG
c) DM 2
d) D. insepidus

43. Urine analysis showed epithelial cell diagnosis is:

a) Renal calculi
b) Chlamydia urethritis

44. Patient with DKA the pH=7.2, HCO3=5, K=3.4 the treatment:
a) Insulin 10 U
b) 2 L NS
c) 2 L NS with insulin infusion 0.1 U/kg/hr
45. 6 years old presented with cola colored urine with nephritic symptoms the First test
you would like to do:
a) Renal function test
b) Urine microscopic sedimentation
c) Renal ultrasound

46. Young adult presented with painless penile ulcer rolled edges, what next to do?
a) CBC
b) Darkfeild microscopy
c) culturing

47. Diabetic female her 24h-urine protein is 150mg

a) start on ACEIs
b) refer to nephrologist
c) Do nothing , this is normal range
 normal range < 300mg

48. Patient with flank pain, fever ,vomiting, treatment is

a) Hospitalization and intravenous antibiotics and fluid
 This is most likely a case of pyelonephritis which need urgent hospitalization

49. Elderly patient complaining of urination during night and describe when he feel the
bladder is full and need to wake up to urinate, he suddenly urinate on the bed this is:
a) Urgency incontinence
b) Urge incontinence
c) Stress incontinence
d) Flow incontinence

50. The best test for renal stones:

a) CT without contrast

51. 70 years old male patient with mild urinary dripping and hesitancy, your diahnosis
is mild BPH. What is your next step in management?
a) transurethral retrograde prostatectomy
b) Start on medication
c) open prostatectomy

52. Patient with dysuria, frequency and urgency but no flank pain, what is the treatment?
a) Ciprofloxacin po once daily for 3-5 days
b) Norfocin po od for 7 – 14 days

53. Man with sudden onset of scrotal pain, also had history of vomiting, on
examination tender scrotom and there is tender 4 cm mass over right groin, what
you will do?
a) Consult surgeon
b) Consult urologist
c) Do sonogram
d) Elective surgery

54. UTI >14 day, most probably cause pylonphritis

a) 0,05%
b) 0,5%
c) 5%
d) 50%
55. Man have long history of urethral stricture present with tender right testis & WBC in
urine so diagnosis is
a) Epididymo Orchitis
b) Testicular torchin
c) Varicosel

56. None opaque renal pelvis filling defect seen with IVP, US revels dense echoes &
acoustic shadowing, what is the most likely diagnosis?
a) Blood clot
b) Tumor
c) Sloughed renal papilla
d) Uric acid stone
e) Crossing vessels
 Radiopaque: calcium oxalate, cystine, calcium phosphate, magnesium-ammonium-phosphate
 Radiolucent: uric acid, blood clots, sloughed papillae

57. young age male presented after RTA with injured membranous urethra , best initial
ttt is :
a) Passage of transurethral catheter
b) Suprapubic catheter
c) Perineal repair
d) Retropubic repair
e) Transabdominal repair

58. Epididymitis one is true :

a) The peak age between 12-18 years
b) U/S is diagnostic
c) Scrotal content within normal size
d) Typical iliac fossa pain
e) None of the above
 Disease of adults, most commonly affecting males aged 19-40 year
 Doppler ultrasound to rule out testicular torsion hypoechoic region may be visible on the
affected side as well as increased blood flow or scrotal abscess
 Erythematous edematous scrotum
 It is mostly “5” none of the above

59. The most important diagnostic test for Previous Q is :

a) Microscopic RBC
b) Macroscopic RBC
c) RBC cast.

60. 17 year old male presented to you with history of abdominal pain and cramps in his
leg he vomited twice, his past medical history was unremarkable. On examination he
looks dehydrated with dry mucous membranes, His investigation: Na: 155 mmol/l, K:
5.6 mmol/l , Glucose; 23.4 mmol/l, HCO3: 13, Best tool to diagnose this condition is:
a) Plain X-ray
b) Ultrasound
c) Gastroscopy
d) Urine analysis (Dipstick analysis)

61. Patient come abdominal pain and tender abdomen with hypernatremia and
hyperkalemia and vomiting and diarrhoea, what is the next investigation:
a) Urin analysis
62. BPH all true except :
a) Prostitis
b) Noctouria
c) Haematouria
d) Urine retention
e) Diminished size & strength of stream
 BPH Symptoms :
 Waking at night to urinate
 Sudden and strong urge to urinate
 A frequent need to go, sometimes every 2 hours or less
 Pushing or straining to begin
 A weak stream Dribbling after finishing
 Feeling the bladder has not completely emptied after finishing
 Pain or burning while urinating

63. Screening program for prostatic Ca, the following is true:-

a) Tumor marker (like PSA) is not helpful
b) PR examination is the only test to do
c) Early detection does not improve overall survival

 Both prostate specific antigen (PSA) and digital rectal examination (DRE) should be offered
annually, beginning at age 50 years, to men who have at least a 10-year life expectancy and to
younger men who are at high risk (Family history, Black race..).
 Advocates of screening believe that early detection is crucial in order to find organ-confined
disease and, thereby, impact in disease specific mortality. If patients wait for symptoms or
even positive DRE results, less than half have organ-confined disease.
 No difference in overall survival was noted as watchful waiting, has been suggested as an
alternative treatment because many patients with prostate cancer will die from other causes
(most commonly heart disease).

64. The most accurate to diagnose acute

Glomerulonephritis is: a) RBC cast in urine
analysis
b) WBC cast in urine
analysis c) Creatinine
level increase d)
Shrunken kidney in US
e) Low Hgb but normal indices

65. 75 years old man came to ER complaining of acute urinary retention. What will be
your initial management: a) Send patient immediately to OR for prostatectomy
b) Empty urinary bladder by Folley’s catheter and tell him to come
back to the clinic c) Give him antibiotics because retention could be from
some sort of infection
d) Insert Foley’s catheter and tell him to come to
clinic later e) Admission, investigations which
include cystoscopy

66. Patient present with URTI, after 1 week the patient present to have hematuria
and edema, what is most probably diagnosis?
a) IgA nephropathy
b) Post streptococcus GN

67. Regarding group A strept pharyngitis what is true

a) Early treatment decrease incidence of post strept GN
68. All the following cause hyponatremia except:
a) DKA
b) Diabetes insipidus
c) High vasopressin level
d) Heart failure

69. The investigation of high sensitivity and specificity of urolithiasis :

a) IVP
b) X-RAY abdomen after CT scan
c) US
d) MRI
e) Nuclear scan.

70. Female patient present with dysuria , urine analysis shows epithelial cast :
a) Contaminated sample
b) Chlamydia urethritis
c) Kidney disease “ Most likely”
d) Cervical disease

71. Patient with PID there is lower abdominal tenderness, on pelvic exam there is
small mass in..… Ligament, what is the treatment?
a) Colpotomy
b) Laprotomy
c) laproscopy

72. 13 years old child with typical history of nephritic syndrome (present with an urea,
cola color urine, edema, HTN), what is the next step to diagnose?
a) Renal function test
b) Urine sediments microscope
c) US
d) Renal biobsy

73. Young male patient with dysuria fever and leukocutosis, PR indicate soft boggy
tender prostate, Dx :
a) Acute prostites
b) Chronic Prostites
c) Prostatic CA

74. Complication of the rapid correction of hypernatremia:

a) Brain edema

75. Most common cause of ESRD:

a) HTN
b) DM
 Causes of End-stage renal disease includes:
1) Kidney disease – obviously ESRD starts as early kidney disease.
2) Diabetic nephropathy - 43.2% of kidney failure is due to diabetes
3) Chronic kidney failure -ESRD is by definition the last state of chronic kidney failure
4) Hypertension - 23% of cases
5) Glomerulonephritis - 12.3% of cases
6) Polycystic kidney disease - 2.9% of cases
 UQU
2nd Edition 2012
76. Patient have DM and renal impairment when he had diabetic nephropathy: there is
curve for albumin
a) 5 years
b) 10 years
c) 20 years
d) 25 years

 Microalbuminuria generally precedes overt

proteinuria by 5-10 years. Once proteinuria is
detected, renal function gradually deteriorates
over 10-15 years

77. The most likely cause of gross hematuria in a 35 years old man is :
a) Cystitis
b) Ureteral calculi
c) Renal carcinoma
d) Prostatic carcinoma
e) Bladder carcinoma

78. Concerning urinary calculi, which one of the following is true?

a) 50% are radiopaque
b) 75% are calcium oxalate stones
c) An etiologic factor can be defined in 80% of cases
d) A 4-mm stone will pass 50% of the time
e) Staghorrn calculi are usually symptomatic

 Urinary calculi are often idiopathic, 90% are radiopaque and 75% are calcium oxalate stones.

79. Benign prostatic hypertrophy:

a) TRUSS is better than PSA
b) No role in PSA
c) PSA role
d) Biopsy

80. An 80 year old male presented with dull aching loin pain & interrupted voiding of
urine. BUN and creatinine were increased. US revealed a bilateral hydronephrosis.
What is the most probable diagnosis?
a) Stricture of the urethra
b) Urinary bladder tumor
c) BPH
d) Pelvic CA
e) Renal stone

81. 60 years old male known to have (BPH) digital rectal examination shows soft
prostate with multiple nodularity & no hard masses, the patient request for (PSA) for
screening for prostatic cancer what will you do?
a) Sit with the patient to discuss the cons & rods in PSA test
b) Do trans-rectal US because it is better than PSA in detection
c) Do multiple biopsies for different sites to detect prostatic ca

82. 82 years old patient with acute urinary retention, the management is:
a) Empty the bladder by Foley's catheter and follow up in the clinic.
b) Insert a Foley's catheter then send the patient home to come back in the clinic
c) Admit and investigate by TURP. d) Immediate prostatectomy.
83. Epididymitis, one is true:
a) The peak age between 12 &18.
b) U\S is diagnostic.
c) The scrotal contents are within normal size.
d) Typical iliac fossa pain.
e) None of the above.

84. Common cause of male infertility:

a) Primary hypogonadism
b) secondary hypogonadism
c) ejaculation obstruction

85. Benign prostatic hyperplasia , all are true EXCEPT:

a) Parotitis
b) Nocturia
c) diminished size and strength of stream
d) hematuria
e) urine retention

86. Patient present with testicular pain, O/E: bag of worms, what is the diagnosis?
a) Varicocele

87. In Testicular torsion, all of the following are true, except

a) Very tender and progressive swelling.
b) More common in young males.
c) There is hematuria
d) Treatment is surgical.
e) Has to be restored within 12 hours or the testis will infarct.

88. 50 years old patient complaining of episodes of erectile dysfunction, history of stress
attacks and he is now in stress what you will do?
a) Follow relaxation strategy
b) Viagra
c) Ask for investigation include testosterone

89. Premature-ejaculation, all true except:

a) Most common sexual disorder in males
b) uncommon in young men
c) Benefits from sexual therapy involving both partners
d) It benefit from anxiety Rx

 N.B. Premature ejaculation (PE) is the most common sexual dysfunction in men younger than 40
years.

90. Child with scrotal swelling, no fever, with a blue dot in the superior posterior aspect
of the scrotum
a) Testicular appendix torsion

 Patients with torsion of the appendix testis and appendix epididymis present with acute scrotal
pain, but there are usually no other physical symptoms, and the cremasteric reflex can still be
elicited. The classic finding at physical examination is a small firm nodule that is palpable on the
superior aspect of the testis and exhibits bluish discoloration through the overlying skin; this is
called the “blue dot” sign.
 Approximately 91%–95% of twisted testicular appendices involve the appendix testis and
occur most often in boys 7–14 years old
91. 10 years old boy woke up at night with lower abdominal pain, important area to check:
a) kidney
b) lumbar
c) rectum
d) Testis

92. Old age man, feel that the voiding is not complete and extreme of urine not strong
and by examination there is moderate BPH and PSA = 1ng/ ml what you will do?
a) Surgery
b) Refer for surgical prostatectomy

93. an opaque renal pelvis filling defect seen with IVP, US revels dense echoes & acoustic
shadowing , The MOST likely diagnosis:
a) Blood clot
b) Tumor
c) Sloughed renal papilla
d) Uric acid stone
e) Crossing vessels
 Radiopaque: calcium oxalate, cystine, calcium phosphate, magnesium-ammonium-phosphate
 Radiolucent: uric acid, blood clots, sloughed papillae

94. Old man presented with tender and enlarged prostate and full bladder.
Investigations show hydronephrosis. What is the likely diagnosis?
a) Acute Renal Failure
b) Bladder Cancer
c) BPH

95. A patient with gross hematuria after blunt abdominal trauma has a normal-
appearing cystogram after the intravesical instillation of 400 ml of contrast. You
should next order:
a) A retrograde urethrogram.
b) An intravenous pyelogram.
c) A cystogram obtained after filling, until a detrusor response occurs.
d) A voiding cystourethrogram.
e) A plain film of the abdomen after the bladder is drained.

96. Patient will do cystoscope suffer from left hypocondrial pain

a) Refer to vascular surgery
b) Refer to urologist

97. Old patient complaining of hematuria, on investigation, patient has bladder calculi,
most common causative organism is:
a) Schistosoma
b) CMV

98. Old man with urinary incontinence, palpable bladder after voiding, urgency & sense of
incomplete voiding dx;
a) Stress incontinence
b) Overflow incontinence
c) Reflex incontinence
d) Urge incontinence
99. Child with painless hematuria what initial investigation?
a) Repeat urine analysis
b) Renal biopsy
c) Culture

100. Young male with 3 day of dysuria, anal pain , O/E per rectum boggy mass :
a) Acute prostatitis

101. Radiosensitive testicular cancer:

a) Yolk sac
b) Seminoma
c) Choriocarcinoma.
Endocrinology
1. Patient known case of DM type 2 on insulin, his blood sugar measurement as following:
morning= 285 mg/dl, at
3 pm= 165 mg/dl, at dinner time= 95 mg/dl. What will be your management:
a) Increase evening dose of long acting insulin
b) Decrease evening dose of short acting insulin
c) Decrease evening dose of long acting insulin
d) Increase evening dose of short acting insulin

2. Patient known case of IDDM, presented with DKA, K= 6 mmol/L and blood sugar= 350
mg/dl. You will give him:
a) IV fluid
b) IV fluid and insulin
c) Sodium bicarbonate

3. Patient increase foot size 39 >> 41.5 and increase size of hand and joint which hormone
a) Thyropine
b) Prolactin
c) ACTH
d) Somatotropic hormone “ known as Growth Hormone”

4. Typical symptom of diabetic ketoacidosis what is the mechanism?

a) No insulin fat acid utilization  keton
5. Patient came with whitish discharge from the nipple, her investigation show
pituitary adenoma, which hormone responsible for this?
a) Prolactin

6. T4 high , Free T3 high TSH low diagnosis

a) Immune thyroditis “not the correct option”

7. Young male with unilateral gynecomastia

a) Stop soya product
b) compression bra at night
c) It will resolve by itself

8. 42 years old with thyroid mass, what is the best to do?

a) FNA

9. Hypothyroid patient on thyroxin had anorexia, dry cough and dyspnea & left ventricular
dysfunction. She had normal TSH & T4 levels, Hyperphosphatemia & hypocalcemia. The
diagnosis is:
a) Primary hypoparathyroidism
b) Secondary hypoparathyroidism
c) Hypopituitaritism
d) Uncontrolled hyperthyroidism

10. Patient with DM-II has conservative management still complaining of weight gain and
polyuria, give:
a) Insulin short acting
b) Metformin
c) Long acting insulin

11. 34 years old female patient presented with terminal hair with male hair
distribution and has female genital organs. The underlying process is:
a) Prolactin over secretion
b) Androgen over secretion
12. Female patient presented with symptoms of hyperthyroidism, tender neck swelling &
discomfort. She had low TSH & high T4 level. The diagnosis is:
a) Subacute thyroiditis
b) Thyroid nodule
c) Grave's disease

 Thyroiditis: Inflammation of the thyroid gland. Common types are subacute

granulomatous, radiation, lymphocytic, postpartum, and drug-induced (e.g.,
amiodarone) thyroiditis.
 Signs & syptoms: In subacute and radiation, presents with tender thyroid, malaise, and URI
symptoms.
 Diagnosis: Thyroid dysfunction (typically hyperthyroidism followed by hypothyroidism), all with
↓ uptake on
RAIU
 Treatment: β-blockers for hyperthyroidism; levothyroxine for hypothyroidism, Subacute
thyroiditis: Anti-inflammatory medication.

13. Pancreatitis
a) Amylase is slowly rising but remain for days
b) Amylase is more specific but less sensitive than lipase
c) Ranson criteria has severity (predictive) in acute pancreatitis
d) Pain is increased by sitting and relieved by lying down
e) Contraceptive pills is associated

 The Ranson and Glasgow scoring systems are based on such parameters and havebeen
shown to have 80% sensitivity for predicting a severe attack, although only after 48 hours
following presentation.
 Risk mortality is 20% with 3-4 signs, 40% with 5-6 signs, 100% 7 signs.

14. Primary hyperaldosteronism associated with:

a) Hypernatremia
b) Hypomagnesemia
c) Hypokalemia
d) Hyperkalemia

15. Patient presents with this picture only, no other manifestations “organomegaly or
lymphadenopathy” what is the diagnosis?
a) Mononucleosis
b) Goiter
c) Lymphoma
16. Thyroid cancer can be from
a) Hypothyroidism
b) Graves disease
c) Toxic nodule
 Best answer is B " there is a higher incidence of thyroid neoplasia in patients with Graves disease

17. Patient is complaining of irritation, tachycardia, night sweating, labs done

showed TSH: Normal, T4: High, diagnosis is:
a) Grave’s disease
b) Secondary Hypothyriodism
c) Hashimoto’s thyroiditis

18. 8 years old boy which is 6 year old height & bone scan of 5.5 years, what is the
diagnosis?
a) Steroid
b) Genetic
c) Hypochondriplasia
d) Hypothyroidism

 Achondroplasia, a nonlethal form of chondrodysplasia, is the most common form of short-limb

dwarfism. It is inherited as autosomal dominant trait with complete penetrance.
 Features include disproportionate short stature, megalencephaly, a prominent forehead
(frontal bossing), midface hypoplasia, rhizomelic shortening of the arms and legs, a normal
trunk length, prominent lumbar lordosis, genu varum, and a trident hand configuration.

19. Hirsutism associated with which of the following?

a) Anorexia
b) Juvinal hypothyroidism
c) Digoxin toxicity
d) c/o citrate

20. 60 years old male complain of decreased libido, decreased ejaculation, FBS= 6.5
mmol, increased prolactin, normal FSH and LH, what is the next step?
a) Testosterone level
b) DM
c) NL FBG
d) CT of the head

21. Single thyroid nodule showed high iodine uptake, what is the best treatment?
a) Radio Iodine 131
b) Send home
c) Antithyriod medication
d) Excision if presen

22. Thyrotoxicosis include all of the following, Except:

a) Neuropathy
b) Hyperglycemia
c) Peripheral Proximal myopathy

23. The most active form is:

a) T4
b) T3
c) TSH
24. 45 years old presented with polyurea, urine analysis showed glucosurea & negative
ketone, FBS 14mmol. What is the best management of this patient?
a) Intermediate IM insulin till stable
b) NPH or Lent insulin 30mg then diet
c) Sulphonylurea
d) Diabetic diet only
e) Metformin
 In older patients the first approach is by diet only, especially that he is not clearly into glucose
toxicity
 Tablet treatment for DM II are used in association with dietary treatment when diet alone
fails starting with Metformin if no contraindications

25. A 30 years old teacher complaining of excessive water drinking and frequency of
urination, on examination Normal. You suspect DM and request FBS = 6.8 .the Dx is :
a) DM
b) DI
c) Impaired fasting glucose
d) NL blood sugar
e) Impaired glucose tolerance

 Although reading of FBS suggest an impaired fasting glucose, but this does not explain
the symptoms (as patients with prediabetes are asymptomatic. so, DI is a reasonable
answer.
 In patients who present with symptoms of uncontrolled diabetes (eg, polyuria, polydipsia,
nocturia, fatigue, weight loss) with a confirmatory random plasma glucose level of >200
mg/dL (11.1 mmol/dl), diabetes can be diagnosed. In asymptomatic patients whose random
serum glucose level suggests diabetes, a fasting plasma glucose (FPG) concentration should
be measured.
 The oral glucose tolerance test no longer is recommended for the routine diagnosis of diabetes.
 An FPG level of >126 mg/dL (7 mmol) on 2 separate occasions is diagnostic for diabetes.
 An FPG level of 110-125 mg/dL (6.1 – 6.94 mmol) is considered impaired IFG.
 An FPG level of <110 mg/dL (6.1) is considered normal glucose tolerance, though blood glucose
levels above >90 mg/dL (5 mmol) may be associated with an increased risk for the metabolic
syndrome if other features are present.

26. 42 years old female presented with 6 month Hx of malaise , nausea &
vomiting, lab Na = 127 , K = 4.9 , Urea= 15, creatinine = 135, HCO3 = 13,
glucose = 2.7 mmol, the most likely Dx:
a) hypothyroidism
b) pheochromocytoma
c) hypovolemia due to vomiting
d) SIADH
e) Addison's disease

27. In DKA, use

a) Short and intermediate acting insulin
b) Long acting insulin.

 Short acting insulin is most preferred to avoid causing hypoglycemia. Also important measures
in treatment of DKA are fluid and potassium replacement along for searching for a source of
infection and treating it.

28. Metformin , which is true :

a) Cause hypoglycemia
b) Cause weight gain
c) Suppress gloconeogenesis
29. Hyperprolactinemia associated with all of the following except :
a) Pregnancy
b) Acromegaly
c) OCP
d) Hypothyroidism
 All are associated with hyperprolacinemia
 The diagnosis of hyperprolactinemia should be included in the differential for female patients
presenting with oligomenorrhea, amenorrhea, galactorrhea, or infertility or for male
patients presenting with sexual dysfunction. Once discovered, hyperprolactinemia has a
broad differential that includes many normal physiologic conditions.
 Pregnancy always should be excluded unless the patient is postmenopausal or has had a
hysterectomy. In addition, hyperprolactinemia is a normal finding in the postpartum period.
Other common conditions to exclude include a nonfasting sample, excessive exercise, a
history of chest wall surgery or trauma, renal failure, and cirrhosis. Postictal patients also
develop hyperprolactinemia within 1-2 hours after a seizure. These conditions usually
produce a prolactin level of less than 50 ng/mL.
 Hypothyroidism, an easily treated disorder, also may produce a similar prolactin level.
 If no obvious cause is identified or if a tumor is suspected, MRI should be performed.

30. Patient came to you & you found his BP to be 160/100, he isn’t on any
medication yet. Lab investigations showed: Creatinine (normal), Na 145 (135-145),
K 3.2 (3.5-5.1), HCO3 30 (22-30), what is the diagnosis?
a) essential hypertension
b) pheochromocytoma
c) addisons disease
d) Primary hyperaldosteronism
 Patient with high sodium, low k, and high bicarbonate  Primary hyperaldostronism
31. A 46-year-old man, a known case of diabetes for the last 5 months. He is maintained
on Metformin 850 mg Po TID, diet control and used to walk daily for 30 minutes.On
examination: unremarkable. Some investigations show the following: FBS 7.4 mmol/L, 2
hr PP 8.6 mmol/L, HbA1c 6.6% , Total Cholesterol 5.98 mmol/L, HDLC 0.92 mmol/L,
LDLC 3.88 mmol/L, Triglycerides 2.84 mmol/L (0.34-2.27), Based on evidence, the
following concerning his management is TRUE:
a) The goal of management is to lower the triglycerides first.
b) The goal of management is to reduce the HbA1c.
c) The drug of choice to reach the goal is Fibrates.
d) The goal of management is LDLC ≤ 2.6 mmol/L.
e) The goal of management is total cholesterol ≤ 5.2 mmol/L.

32. Regarding the criteria of the diagnosis of diabetes mellitus, the following are true
EXCEPT:
a) Symptomatic patient plus casual plasma glucose ≥ 7.6 mmol/L is diagnostic of diabetes mellitus
b) FPG ≥ 7.1 mmol/L plus 2 h-post 75 gm glucose ≥ 11.1 mmol/L is diagnostic of diabetes mellitus
c) FPG ≤ 5.5 mmol/L = normal fasting glucose.
d) FPG ≥ 7.0 mmol/L = provisional diagnosis of diabetes mellitus and must be
confirmed in another setting in asymptomatic patient
e) 2-h post 75 gm glucose ≥ 7.6 mmol/L and < 11.1 mmol/L = impaired glucose tolerance.

33. 36 years old female with FBS= 14 mmol & glucosuria, without ketones in urine, the
treatment is:
a) IntermittentI.M.insulinNPH
b) Salphonylurea + diabetic diet
c) Diabetic diet only.
d) Metformin
34. A 30 years male presented with polyuria, negative keton, Random blood suger 280
mg/dl. management:
a) Nothing done only observe
b) Insulin 30 U NPH+ diet control
c) Diet and exercise
d) Oral hypoglycemic

 Patient is symptomatic & RBS ≥ 11.1 DX is DM type 2. RX initially with diet and exercise and
decrease Wt for 6-8 wks if further add Metformin

75. Thyroid cancer associated with:

a. Euothyroid
b. hyperthyroid
c. hypothyroid
d. graves

76. Old patient take hypercalcemic drugs and developed gout, what is responsible drugs?
a. frosamide
b. Thiazide

77. Pathological result from thyroid tissue showed papillary carcinoma, the next step:
a. Surgical removal
b. Apply radioactive I131
c. Give antithyroid drug
d. Follow up the patient

78. A cervical lymph node is found to be replaced with a well differentiated thyroid
tissue. At the operation there are no palpable lesions in the thyroid gland. The
operation of choice is:
a. Total thyroidectomy & modified dissection
b. Total thyroidectomy and radical neck dissection
c. Total thyroidectomy
d. Thyroid lobectomy and removal of all local lymph nodes
e. Thyroid lobectomy and isthmusthectomy and removal of all local enlarged lymph nodes.

79. Which is true about DM in KSA?

a. Mostly are IDDM
b. Most NIDDM are obese

80. Female come with manfestations of hypothyroidism, sleeping, myxedema, cold

intelorance, now she suffer from difficulty in breathing, wheezing, TSH= normal, T4
normal, Ca = decrease, phosphorus= normal ALP= normal, what is your diagnosis?
a. Secondary hypoparathyrodisim

81. Patient comes with diarrhea, confusion and muscle weakness he suffers from which?
a. Hypokalemia
b. hyperkalemia
c. hypercalcemia

82. The FIRST step in the management of acute hypercalcemia should be:
a. Correction of deficit of Extra Cellular Fluid volume.
b. Hemodialysis.
c. Administration of furosemide.
d. Administration of mithramycin.
e. Parathyroidectomy.
43. Type 1 diabetic, target HA1C
a) 9
b) 8
c) 6.5

44. 19 years old athlete, his weight increase 45 pound in last 4 months. In examination,
he is muscular, BP 138/89, what is the cause?
a) Alcohol
b) Cocaine abuse
c) Anabolic steroid use

45. Adult had a history of palpitation, sweating and neck discomfort for 10 days , lab
CBC normal , ESR 80 , TSH 0.01, F T4 high , what is the diagnosis?
a) Graves disease
b) subacute thyroiditis
c) hashimoto thyroiditis
d) toxic multinodular goiter

46. Old diabetic patient who still have hyperglycemia despite increase insulin dose,
the problem with insulin in obese patients is:
a) Post receptor resistance

47. Female come to the clinic with her baby of 6 month, she had tremor and other
sign I forgot it, which of the following is most likely diagnosis?
a) Hashimoto
b) Postpartum thyroiditis
c) hypertyrodism
d) sub acute tyroditis
e) hypothriodism

48. Diabetic patient on insulin and metformin has renal impairment. What’s your next
step?
a) Stop metformin and add ACE inhibitor

49. Cushing syndrome best single test to confirm

a) palsma cortisone
b) ATCH
c) Dexamethasone Suppression test

50. The following more common with type 2 DM than type 1 DM:
a) Weight loss
b) Gradual onset
c) Hereditary factors
d) HLA DR3+-DR4

51. Patient was presented by tremor, fever ,palpitation ,diagnosed as case of

hyperthyroidism, what is your initial treatment:
a) Surgery.
b) Radio iodine
c) Beta blockers
d) Propylthioracil
 First B-blocker then Prophylthiouracil because we are afraid of arrhythmias
52. Patient with truncal obesity, easy bruising, hypertension, buffalo hump, what is the
diagnosis?
a) Cushing

53. Blood sugar in DM type 1 is best controlled by :

a) Short acting insulin
b) Long acting
c) Intermediate
d) Hypoglycemic agents
e) Basal and bolus insulin.

 Very vague question. We can exclude hypoglycemic agents. Short acting insulin is best in
emergencies like DKA as it can be given IV. We can use either long acting alone daily or a
mixture of short & intermediate acting insulin daily. Basal & bolus, (short acting + intermediate
or long), bolus of short-acting or very-short-acting insulin before meals to deal with the
associated rise in blood-sugar levels at these times. In addition, they take an evening injection of
long- or intermediate-acting insulin that helps normalise their basal (fasting) glucose levels. This
offers greater flexibility and is the most commonly adopted method when intensified insulin
therapy is used to provide optimal glycaemic control.

54. Well known case of DM was presented to the ER with drowsiness, in the
investigations: Blood sugar = 400 mg/dl, pH = 7.05, what is your management?
a) 10 units insulin + 400 cc of dextrose
b) 0.1 unit/kg of insulin , subcutaneous
c) NaHCO.
d) One liter of normal saline

55. Pregnant patient came with neck swelling and multiple nodular non-tender goiter the
next evaluation is:
a) Thyroid biopsy
b) Give anti-thyroid medication
c) Radiation Iodine
d) TSH & Free T4, or just follow up

56. Old patient with neck swelling, nodular, disfiguring, with history of muscle
weakness, cold intolerance , hoarseness, what is your management :
a) Levothyroxine
b) Carbamazole
c) Thyroid lobectomy
d) Radio-active iodine

57. Pregnant woman with symptoms of hyperthyroidism , TSH low :

a) Propylthyiouracil
b) Radio-active iodine
c) Partial thyroidectomy

58. You received a call from a father how has a son diagnosed recently with DM-I for six
months, he said that he found his son lying down unconscious in his bedroom, What
you will tell him if he is seeking for advice?
a) Bring him as soon as possible to ER
b) Call the ambulance
c) Give him his usual dose of insulin
d) Give him IM Glucagone
e) Give him Sugar in Fluid per oral
59. Diabetic patient on medication found unconscious his blood sugar was 60, what is
the most common to cause this problem?
a) Sufonylurease
b) Bigunides
60. 40 years old male, presented with large hands, Hepatomegaly, diagnosis :
a) Acromegaly
b) Gigantism
61. The cause of insulin resistance in obese is:
a)  insulin receptors kinase activity
b)  number of insulin receptor
c)  circulation of anti-insulin
d)  insulin production from the pancreas
e)  post-receptor action

62. Patient with DM presented with limited or decreased range of movement passive and
active of all directions of shoulder
a) Frozen shoulder
b) Impingment syndrome
c) Osteoarthritis

63. Female not married with normal investigation except FBS=142. RBS196, what is the
treatment?
a) give insulin subcutaneous
b) advice not become married
c) barrier contraceptive is good
d) BMI control

64. Younger diabetic patient came with abdominal pain, vomiting and ketones smelled
from his mouth. What is frequent cause?
a) Insulin mismanagement
b) Diet mismanagement
65. 70 years Saudi diabetic male suddenly fell down, this could be:
a) Maybe the patient is hypertensive and he developed a sudden rise in BP.
b) He might had forgot his oral hypoglycemic drug
c) Sudden ICH which raise his ICP.
 Explanation: The diagnosis is Non-ketotic hyperosmolar coma which can present with Hyper
viscosity and increased risk of thrombosis Disturbed mentation Neurological signs including
focal signs such as sensory or motor impairments or focal seizures or motor abnormalities,
including flaccidity, depressed reflexes, tremors or fasciculations. Ultimately, if untreated, will
lead to death.
66. Patient present with constipation “hypothyroidism”, To confirm that the patient has
hypothyroidism:
a) T4
b) TSH
c) Free T4

67. Which of the following medications should be avoided in diabetic nephropathy?

a) Nifidipine
b) losartan
c) lisinopril
d) Thiazide
68. Which of the following indicate benign thyroid lesion?
a) Lymphadenitis
69. Patient come to you for check up, he has DM his blood sugar is well controlled, but
his BP is 138/86 , all other physical examination show no abnormality including
neurological examination, he is following regularly in ophthalmology clinic, What you
will put in your plan to manage this patient?
a) Giving ACE inhibitor “ goal for BP fo DM : 130/80”

70. Female patient with hypothyroidism, TSH high but he did not give the total T4
nor free, pulse normal, BP normal, she is on thyroxin, what you will do?
a) Increase thyroxin follow after 6 months
b) Increase thyroxin follow after 3 months
c) decrease thyroxin follow after 6 months
d) decrease thyroxin follow after 3 months
71. All causes hyperprolactinemia, EXCEPT:
a) Pregnancy
b) Acromegaly
c) Methyldopa
d) Allopurinol
e) Hypothyroidism

72. DM1
a) HLA DR4

73. Difference between primary and secondary hyperaldosteronism :

a) Increase rennin in secondary

74. 50 years with uncontrolled diabetes, complain of black to brown nasal discharge. So
diagnoses is
a) Mycosis
b) Aspirglosis
c) Foreign body

75. Which hormone affect the bile acid & lowering the cholesterol
a) Cholecystokinin

76. Thyroid nodules non malignant

a) Multiple
77. Mechanism of Cushing disease
a) Increase ACTH from pituitary adenoma
b) Increase ACTH from adrenal
 The dawn phenomenon: Recurring early morning hyperglycaemia
 Treatment:
1) Increase evening physical activity
2) Increase amount of protein to carbohydrates in the last meal of the day
3) Eat breakfast even though the dawn phenomenon is presented
4) Individual diet modification only if HbA1c is lower than 7%
5) Antidiabetic oral agent therapy only if HbA1c is lower than 7%
6) Use an insulin pump
7) Long-acting insulin analogues like glargine instead of NPH insulin
 The Somogyi effect: Early morning hyperglycaemia due to treatment with excessive amount of
insulin
 Treatment:
1) Modify insulin dosage, Use an insulin pump
2) Long-acting insulin analogues like glargine instead of NPH insulin
3) More protein than carbohydrates in the last meal of the day
4) Go to bed with higher level of plasma glucose than usual
Rheumatology
1. An elderly lady presented with chronic knee pain bilaterally that increases with activity
& decreases with rest, The most likely diagnosis is:
a) Osteoarthritis
b) Rheumatoid arthritis
c) Septic arthritis

2. An old woman complaining of hip pain that increases by walking and is peaks by the
end of the day and keeps her awake at night, also morning stiffness:
a) Osteoporosis
b) Osteoarthritis
c) Rh. Arthritis

3. Old patient with bilateral knee swelling, pain, normal ESR:

a) Gout
b) Osteoarthritis
c) RA

4. What is the initial management for a middle age patient newly diagnosed knee
osteoarthritis.
a) Intra-articular corticosteroid.
b) Reduce weight
c) Exercise.
d) Strengthening of quadriceps muscle.

5. The useful exercise for osteoarthritis in old age to maintain muscle and bone:
a) Low resistance and high repetition weight training
b) Conditioning and low repetion weight training
c) Walking and weight exercise

6. Male patient present with swollen erythema, tender of left knee and right wrist,
patient give history of international travel before 2 month, aspiration of joint ravel,
gram negative diplococcic, what is most likely organism?
a) Neisseria gonorrhea
b) staphcoccus
c) streptococcus

7. Triad of heart block, uveitis and sacroiliitis, diagnosis:

a) Ankylosing Spondylitis
b) lumbar stenosis
c) multiple myeloma

8. Patient have urethritis now com with left knee, urethral swap positive puss cell but
negative for neisseria meningitidis and chlymedia
a) RA
b) Reiter's disease
c) Gonococcal

 Reiter's arthritis : characteristic triad of symptoms: an inflammatory arthritis of large joints,

inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or
cervicitis in women

9. Patient with Rheumatoid Arthritis he did an X-Ray for his fingers and show permanent
lesion that may lead to permanent dysfunction, what is the underlying process?
a) Substance the secreted by synovial
10. Which of following favor diagnosis of SLE?
a) Joint deformity
b) Lung cavitations
c) Sever raynaud phenomenon
d) Cystoid body in retina
e) Anti RNP+

11. Patient with Rheumatoid arthritis on hand X-Ray there is swelling what you will do for
him
a) NSAID
b) Injection steroid
c) positive pressure ventilation
 If there is DMARD choose it

12. True about dermatomyositis:

a) associated with inflammatory bowl disease
b) Indicate underlying malignancy
c) present as distal muscle weakness

13. Psuedogout:
a) Phosphate
b) Calcium
c) Florida
d) Calcium pyrophosphate

14. Patient complaints of abdominal pain and joint pains, the abdominal pain is
colicky in character, and accompanied by nausea, vomiting and diarrhea. There is
blood and mucus in the stools. The pain in joints involved in the ankles and knees,
on examination there is purpura appear on the legs and buttocks:
a) Meningococcal Infections
b) Rocky Mountain Spotted Fever
c) Systemic Lupus Erythematous
d) Henoch sconlein purpura

15. Long scenario, bone mineral density ,having T score - 3.5,, so diagnosis is
a) Osteopenia
b) Osteoporosis
c) Normal
d) Rickets disease
 Normal bone mineral density (T score > -1)
 Osteopenia (T score between -1 and –2.5)
 Osteoporosis (less than -2.5)

16. Patient with HTN and use medication for that, come complain of pain and swelling
of big toe (MTJ) on light of recent complain which of following drug must be change?
a) Thiazide
 side effect of Thiazide is gout

17. Elderly came with sudden loss of vision in right eye with headache, investigation
show high CRP and high ESR, what is the diagnosis?
a) Temporal arteritis
18. Old female patient with osteoporosis, what is exogenous cause?
a) Age
b) Decreased vitamin D

19. Patient with cervical spondylitis came with atrophy in Hypothenar muscle and
decreased sensation in ulnar nerve distribution. Studies showed alertness in ulnar
nerve function in elbow..to ur action is :
a) Physiotherapy
b) Cubital tunel decompression

20. Patient is known case of cervical spondylolysis , presented by parasthesis of the

little finger , with atrophy of the hypothenar muscles, EMG showed Ulnar tunnel
compression of the ulnar nerve, what is your action now:
a) Steroid injection
b) CT scan of the spine
c) Ulnar nerve decompression

21. Polymyalgia Rheumatica case with elevated ESR , other feature :

a) Proximal muscle weakness
b) Proximal muscle tenderness
 N.B. in polymyalgia Rhematica pain occurs on movement with normal strengths of the muscles.

22. Patient came with osteoarthritis & swelling in distal interphalangeal joint, what is the
name of this swelling?
a) Bouchard nodes
b) Heberden's nodes

23. An 80 year old lady presented to your office with a 6 month history of stiffness in her
hand, bilaterally. This stiffness gets worse in the morning and quickly subsides as the
patient begins daily activities. She has no other significant medical problems. On
examination the patient has bilateral bony swellings at the margins of the distal
interphalangeal joints on the (2nd-5th) digits. No other abnormalities were found on the
physical examination. These swellings represent :
a) Heberden’s nodes
b) Bouchar’s nodes
c) Synovial thickenings
d) Subcutaneous nodules
e) Sesamoids
 Explanation: the history suggests osteoarthritis which has both heberden’s nodes and
bouchard’s; depending on the location the names of the nodes differ heberden’s nodes are at the
DIPJ while bouchard’s nodes are at the PIPJ. Reference: Saunders’pocket essentials of Clinical
medicine (parveen KUMAR)

24. Regarding Boutonniere deformity which one is true

a) Flexion of PIP & hyperextension of DIP.
b) Flexion of PIP & flexion of DIP
c) Extension of PIP & flexion of DIP.
d) Extension of PIP & extension of DIP

25. Patient has history of parotid and salivary gland enlargement complains of dry eye,
mouth and skin, lab results HLA-B8 and DR3 ANA positive, rheumatoid factor positive,
what is the course of treatment?
a) physostigmin
b) Eye drops with saliva replacement
c) NSAID
d) plenty of oral fluid
26. Young patient with red, tender, swollen big left toe 1st metatarsal, tender swollen
foot and tender whole left leg. His temperature 38, what is the diagnosis?
a) Cellulitis
b) Vasculitis
c) Gout Arthritis

27. Patient elderly with unilateral headache, chronic shoulder and limb pain,
positive Rheumatoid factor and positive ANA, what is the treatment?
a) Aspirin
b) Indomethacin
c) Corticosteroid

28. Patient with recurrent inflammatory arthritis (migratory) and in past she had mouth
ulcers now complaining of abdominal pain what is the diagnosis
 Read about causes of migratory arthritis

29. Acute Gout management :

a) Allopurinol
b) NSAID
c) Paracetamol
d) Gold salt

30. Treatment of acute gouty arthritis

a) Allopurinol
b) Indomethacin
c) Pencillamin
d) Steroid

31. Best investigation for Giant Cell Arteritis

a) Biopsy from temporal arteritis

32. Patient with rheumatoid arthritis came to you and asking about the most
effective way to decrease joint disability in the future, your advice will be:
a) Cold application over joint will reduce the morning stiffness symptoms
b) Disease modifying antirheumatic drugs are sufficient alone

33. Osteoporosis depend on

a) Age
b) Stage
c) Gender

34. 30 years old male with hx of pain and swelling of the right knee, synovial fluid
aspiration showed yellow color opaque appearance, variable viscosity. WBC = 150,000 ,
80% neutrophil, poor mucin clot, Dx is :
a) Goutism Arthritis
b) Meniscal tear
c) RA
d) Septic arthritis
e) Pseudogout arthritis
 Explanation: WBC>50,000 with poly predominance>75% is suspicious for bacterial infection
35. Rheumatoid Arthritis:
a) Destruction in articular cartilage
b) M=F
c) No nodules
d) Any synovial joint
e) HLA DR4
 Explanation:
a  is true plus destruction of bones
b  is false the M:F is 1:3
c is false Nodules are present in elbows & lungs
d is false because it doesn't affect the dorsal &lumbar
spines e  is true but it also affects HLA DR1
36. Triad of heart block, Uveitis and sacroileitis, Dx:
b) Ankylosing Spondylitis
c) lumbar stenosis
d) multiple myeloma

37. Pseud-gout is
a) CACO3
b) CACL3
 Gout : Deposition of Monosodium Urate Monohydrate, –ve of birefringent, needle shape
 Psudogout : Deposition of Calcium Pyrophosphates Dehydrate crystal, +ve birefringent,
rhomboid shape, (CACO3)

38. Juvenile Idiopathic Arthritis treatment :

a. Aspirin
b. Steroid
c. Penicillamine
d. Hydrocloroquin
e. Paracetamol
39. Patient present with SLE, The least drug has side effect:
a. Methotrexate
b. name of other chemotherapy

40. Regarding Allopurinol:

a. is a uricouric agent
b. Decrease the development of uric acid stones
c. useful in acute attack of gout
 Allopurinol is used to treat Hyperuricemia along with its complications “chronic gout & kidney
stones”

41. Man with pain and swelling of first metatarso-phalyngeal joint. Dx:
a. Gout “also called Podagra”

42. 14 years girl with athralgia and photosensitivity and malar flush and protinurea , so
diagnosis is :
a. RA
b. Lupus Nephritis
c. UTI
43. Which of the following is a disease improving drug for RA :
a. NSAID
Hydroxychloroq
b. uine

 Disease Modifying Anti-Rheumatic Drugs (DMARDs) :

 Chloroquine & Hydroxychloroquine
 Cyclosporin A
 D-penicillamine
 Gold salts
 Infliximab
 Methotrexate (MTX)
 Sulfasalazine (SSZ)

44. 27 years old male has symmetric oligoarthritis, involving knee and elbow, painful
oral ulcer for 10 years, came with form of arthritis and abdominal pain. Dx is:
a) Behjets disease
b) SLE
c) Reactive arthritis
d) UC
e) Wipple’s disease

 Explanation: The diagnosis of Behçet disease was clarified by an international study group
(ISG) .This group developed ISG criteria, which currently are used to define the illness. At least
3 episodes of oral ulceration must occur in a 12-month period. They must be observed by a
physician or the patient and may be herpetiform or aphthous in nature.
 At least 2 of the following must occur:
1) recurrent, painful genital ulcers that heal with scarring;
2) ophthalmic lesions, including anterior or posterior uveitis, hypopyon, or retinal vasculitis;
3) skin lesions, including erythema nodosum, pseudofolliculitis, or papulopustular lesions
4) pathergy, which is defined as a sterile erythematous papule larger than 2 mm in size appearing 48
hours after skin pricks with a sharp, sterile needle (a dull needle may be used as a control).
5) Neurologic manifestations: The mortality rate is up to 41% in patients with CNS disease. This tends
to be an
unusual late manifestation 1-7 years after disease onset: Headache - 50% , Meningoencephalitis -
28% , Seizures - 13% , Cranial nerve abnormalities - 16% , Cerebellar ataxia , Extrapyramidal
signs, Pseudobulbar palsy , Hemiplegia or paralysi , Personality changes ,Incontinence ,Dementia
(no more than 10% of patients, in which progression is not unusual)
6) Vasculopathy: Behçet disease is a cause of aneurysms of the pulmonary tree that may be fatal. DVT
has been described in about 10% of patients, and superficial thrombophlebitis occurred in 24% of
patients in the same study. Noninflammatory vascular lesions include arterial and venous
occlusions, varices, and aneurysms.
7) Arthritis: Arthritis and arthralgias occur in any pattern in as many as 60% of patients. A
predilection exists for the lower extremities, especially the knee. Ankles, wrist, and elbows can also
be primarily involved. The arthritis usually is not deforming or chronic and may be the presenting
symptom and rarely involves erosions. The arthritis is inflammatory, with warmth, redness, and
swelling around the affected joint.Back pain due to sacroiliitis may occur.
8) Gastrointestinal manifestations: Symptoms suggestive of IBD, Diarrhea or gastrointestinal
bleeding, ulcerative lesions (described in almost any part of the gastrointestinal tract) ,
Flatulence ,Abdominal pain, Vomiting and Dysphagia.
9) Other manifestations : Cardiac lesions include arrhythmias, pericarditis, vasculitis of the coronary
arteries, endomyocardial fibrosis, and granulomas in the endocardium, Epididymitis ,
Glomerulonephritis Lymphadenopathy , Myositis, Polychondritis
45. Child with positive Gower sign which is
most diagnostic test : a. Muscle biopsy

 Gowers' sign indicates weakness of the proximal muscle of the lower limb. seen in
Duchenne muscular dystrophy & myotonic dystrophy “hereditary diseases”

46. Patient is 74 years female complaining of pain and stiffness in the hip and shoulder
girdle muscles. She is also experiencing low grade fever and has depression. O/E: no
muscle weakness detected. Investigation of choice is
a. RF
b. Muscle CK
c. ESR
 Typical presentation of Polymyalgia rheumatic

47. Female patient diagnosed as Polymyalgia Rheumatica, what you will find in
clinical picture to support this diagnosis
a. osteophyte in joint radiograph
b. Tenderness of proximal muscle
c. weakness of proximal muscle
d. Very high ESR

22.Polymyalgia Rheumatica is a syndrome with pain or stiffness, usually in the neck, shoulders, and
hips, caused by an inflammatory condition of blood vessels. Predisposes to temporal arteritis
23.Usually treated with oral Prednisone

48. Dermatomyositis came with the following symptoms:

a. Proximal muscle weakness
b. Proximal muscle tenderness
 Dermatomyositis (DM) is a connective-tissue disease that is characterized by inflammation of the
muscles and the skin. While DM most frequently affects the skin and muscles, it is a systemic
disorder that may also affect the joints, the esophagus, the lungs, and, less commonly, the heart

49. Most important point to predict a prognosis of SLE patient :

a. Degree of renal involvement
b. sex of the patient
c. leucocyte count

50. Patient was presented by back pain relieved by ambulation, what is the best initial
treatment:
a. Steroid injection in the back.
b. Back bracing.
c. Physical therapy “initial treatment”

51. Diet supplement for osteoarthritis

a. Ginger
51. Which drug causes SLE like syndrome:
a. Hydralazine
b. Propranolol
c. Amoxicillin
 High risk:
1) Procainamide (antiarrhythmic)
2) Hydralazine (antihypertensive)
 Moderate to low risk:
1. Infliximab (anti-TNF-α)
2. Isoniazid (antibiotic)
3. Minocycline (antibiotic)
4. Pyrazinamide (antibiotic)
5. Quinidine (antiarrhythmic)
6. D-Penicillamine (anti-inflammatory)
7. Carbamazepine (anticonvulsant)
8. Oxcarbazepine (anticonvulsant)
9. Phenytoin (anticonvulsant)
10.Propafenone (antiarrhythmic)

53. In patient with rheumatoid arthritis:

a. Cold app. over joint is good
b. Bed rest is the best
c. Exercise will decrease post inflammatory contractures

 Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many
tissues and organs, but mainly joints. It involves an inflammation of the capsule around the
joints (synovium)
 Increased stiffness early in the morning is often a prominent feature of the disease and
typically lasts for more than an hour. Gentle movements may relieve symptoms in early stages
of the disease

54. Gouty arthritis negative pirfringes crystal what is the mechanism :

a. Deposition of uric acid crystal in synovial fluid due to over saturation

315. Gout (also known as Podagra when it involves the big toe) is a medical condition characterized
by recurrent attacks of acute inflammatory arthritis — a red, tender, hot, swollen joint. The
metatarsal-phalangeal joint at the base of the big toe is the most commonly affected (50% of
cases). However, it may also present as tophi, kidney stones or urate nephropathy
316. Mechanism : disorder of purine metabolism, and occurs when its final metabolite, uric acid,
crystallizes in the form of monosodium urate, precipitating in joints, on tendons, and in the
surrounding tissues

55. Old patient with history of bilateral pain and crepitations of both knee for years now
come with acute RT knee swelling, on examination you find that there is edema over
dorsum and tibia of RT leg, what is the best investigation for this condition?
a. Right limb venogram

56. 40 years old male come to you complaining of sudden joint swelling, no history
of trauma, no history of chronic disease, what is the investigation you will ask?
a. CBC for WBCs
b. ESR
c. MRI of knee joint
d. Rheumatoid factor
57. Female with sudden blindness of right eye, no pain in the eye, there is temporal
tenderness when combing hair, what is the management?
a. eye drop steroid
b. oral steroid
c. IV steroids

 Giant-cell arteritis (temporal arteritis) : inflammatory disease of blood vessels most

commonly involving large and medium arteries of the head, predominately the branches of the
external carotid artery. It is a form of vasculitis.
 Treatment: Corticosteroids, typically high-dose prednisone (40–60 mg), must be started as soon
as the diagnosis is suspected (even before the diagnosis is confirmed by biopsy) to prevent
irreversible blindness secondary to ophthalmic artery occlusion. Steroids do not prevent the
diagnosis from later being confirmed by biopsy, although certain changes in the histology may be
observed towards the end of the first week of treatment and are more difficult to identify after a
couple of months. The dose of prednisone is lowered after 2–4 weeks, and slowly tapered over 9–
12 months. Oral steroids are at least as effective as intravenous steroids, except in the treatment
of acute visual loss where intravenous steroids appear to be better

58. Patient with oral ulcer, genital ulcer and arthritis, what is the diagnosis?
a. Behçet's disease
b. syphilis
c. herpes simplex

 Behçet's disease: rare immune-mediated systemic vasculitis, described as triple-symptom

complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. As a systemic disease, it
can also involve visceral organs and joints

59. Patient with history of 5 years HTN on thiazide, came to ER midnight screaming
holding his left foot, O/E pt a febrile, Lt foot tender erythema, swollen big toe most
tender and painful, no other joint involvement
a) cellulitis
b) Gouty arthritis
c) septic arthritis
 one of the Thiazide side effect is Hyperuricemia which predisposes to Gout

60. Joint aspirate, Gram stain reveal gram negative diplococci (N. gonorrhea), what is the
treatment?
a. Ceftriaxone IM or cefepime PO one dose

61. Commonest organisms in Septic arthritis:

a. Staphylococcus aureus
b. Streptococci
c. N. gonorrhea

62. Child with back pain that wake patient from sleep , So diagnosis (incomplete Q)
a. lumber kyphosis
b. Osteoarthritis
c. Juvenile Rheumatoid Arthritis
d. Scoliosis

 JRA or Juvenile Idiopathic Arthritis (JIA) is the most common form of persistent arthritis in
children. JIA may be transient and self-limited or chronic. It differs significantly from arthritis
seen in adults. The disease commonly occurs in children from the ages of 7 to 12

63. Patient with pain in sacroiliac joint, with morning stiffness, X-ray of sacroiliac joint,
all will be found EXCEPT:
a) RF negative
b) Subcutaneous nodules
c) male > female
 Explanation: This inflammatory joint disease characterized by persistently –ve test for RF
 It develops in men before age of 40 with HLA B27.It causes synovial and extra synovial
inflammation involving the capsule, periarticularperiosteum, cartilage and subchondral bone.
 Large central joints are particularly involved such as (sacroiliac, symphysis pubis &
intervertebral joints)
 Resolution of inflammation leads to extensive fibrosis and joint fusion, but no subcutaneous
nodules since it's not a seropositive disease

64. Allopurinol, one is true:

a) Effective in acute attack of gout.
b) decreases the chance of uric acid stone formation in kidneys
c) Salisylates antagonize its action

 Explanation: Indication of Allopurinol: Prevention of attacks of gouty arthritis uric acid

nephropathy. [but not in acute attack]

65. Mechanism of destruction of joint in RA :

a. Swelling of synovial fluid
b. Anti-inflammatory cytokines attacking the joint

66. 28 years old woman came to your clinic with 2 months history of flitting arthralgia.
Past medical history: Unremarkable. On examination: she is a febrile. Right knee joint:
mild swelling with some tenderness, otherwise no other physical findings. CBC: HB 124
g/L = 12.4 g\dl) WBC: 9.2 x 109/L ESR: 80 mm/h Rheumatoid factor: Negative, VDRL:
Positive,Urine: RBC 15-20/h PF Protein 2+, The MOST appropriate investigation at this
time is:
a) Blood culture.
b) A.S.O titer.
c) C-reactive protein.
d) Double stranded DNA.
e) Ultrasound kidney.

 Explanation: young female, with a joint problem, high ESR, Proteinuria and a positive VDRL
(which is false positive in SLE). Blood culture is not needed (patient is a febrile, inflammatory
features in the joint aren’t so intense), A.S.O. titer is also not top in your list although post
streptglomerulonephritis is possible but not top in the list since its more common in pediatric
age group. So the answer would be double stranded DNA which is one of the serology criteria in
SLE