All IM MCQs
2011-2012 A 2008
1. Which one does NOT belong to the clinical manifestations of asthma?
A. cough may be the only symptom
B. a large number of pink bubble cough sputum
C. abdomen abnormal movement
D. symptoms can be self-mitigation
2. Which one is the typical symptom of asthma lung?
A. limitations inspiratory dry rales
B. diffuse inspiratory dry rales
C. recurrent limitations breathe of dry rales D. recurrent diffuse expiratory stem dry rales
3. Which of the following investigations maybe abnormal in the remission of an young
asthmatic?
A. FEV1 B. bronchial provocation test
C. PaO2
D. chest X-ray imaging
4. What is the typical sign in the lung when asthma exacerbates?
A. prolonged expiration and diffuse wheezes
B. full of moist rales
C. together with dry and moist rales
D. bronchial breathing sound
5. The main differential diagnosis of COPD consists of
A. lung cancer B. emphysema
C. chronic asthma
D. pleural effusion
6. An inexperienced resident physician is asked to draw arterial blood gases from a patient with
severe chronic obstructive pulmonary disease, who is not yet on oxygen therapy. The resident
attempts to draw blood from the femoral artery at the groin, but actually draws blood from the
femoral vein. When compared to the arterial sample that should have been obtained, this
venous sample will show which of the following differences?
PO2
PCO2
PH
A. Decreased Increased
Decreased
B. Decreased Increased
Increased
C. Increased Decreased
Decreased
D. Increased Decreased
Increased
7. The likely pathogens of Community-Acquired Pneumonia are these but:
A. Common viruses
B. Mycoplasma
C. Gram-negative enterobacteria D. Gram-positive bacteria
8. A patient acquired pneumonia 24 hours later at hospital after he was admitted to hospital.
What is the classification type of pneumonia:
A. Hospital-acquired pneumonia(nosocomial) B. Community-acquired pneumonia
C. Atypical pneumonia
D. Bronchopneumonia
9. The transudate will be caused by
A. tuberculosis
B. pneumonia
C. rheumatoid disease D. heart failure
10. What one is not the major carcinoma cell type of primary lung cancers?
A. squamous cell carcinoma
B. adennocarcinoma
C. small cell carcinoma
D. non-small cell carcinoma
11. Treatment of bronchial carcinoma includes EXCEPT
A. radiotherapy B. surgery C. chemotherapy D. anti infection
12. The most common symptoms of acute pericarditis is:
A. chest pain B. pericardial friction rub C. pericardial knocks D. low-grade fever
13. The following statements are correct EXCEPT
A. Systolic failure means the heart loses its ability to contract or pump blood into the
circulation. Diastolic failure means the heart loses its ability to relax because it becomes stiff.
B. Hypertropic cardiomyopathy is usually developing systolic failure.
C. Systolic and diastolic dysfunction often coexist, particularly in patients with coronary artery
disease.
D. Systolic and diastolic heart failure are treated with different types of medications.
14. If _____ is normal, evaluating the patient with chest pain will be able to exclude the
diagnosis of acute coronary syndrome.
A. CK-MB
B. troponin
C. ultrasonic cardiogram
D. 18-lead ECG
15. Which antiplatelet drug is ADP(adenosine diphosphate) receptor inhibitor?
A. aspirin
B. dipyridamole C. clopidogrel D. hirudin
16. Which of the following is the most valuable parameter of acute myocardial damage?
A. lactate dehydrogenase increased
B. troponin T increased
C. serum myoglobin increased
D. creatine phosphokinase increased
17. It is defined as severe stenosis of mitral valve if the valve area is less than:
A. 6cm2
B. 4cm2
C.2cm2
D. 1cm2
18. Valvular heart disease is
A. always caused by streptococcal infection
B. rarely treated surgically nowadays.
C. often seen as multivalve heart disease
D. only be diagnosed using Doppler studies
19. The following groups of people are more susceptible to IE (infective endocarditis) except:
A. the elderly
B. people with congenital heart defects
C. people who have had rheumatic fever D. people with diabetes mellitus
20. The most important clinical evidence for the diagnosis of IE (infective endocarditis) is
A. new valvular regurgitation
B. positive blood culture
C. fever
D. embolic phenomenon
21. The patient average baseline blood pressure was 142/110 mmHg if he did not take antihypertensives. Which stage of hypertension it is？（Based on the seventh report of the Joint
National Committee on Detection, Evaluation and Treatment of High Blood Pressure）
A.Stage 1
B.Stage 2
C.Stage 3
D.Stage 4
22. What is the correct diagnosis of this ECG?
A. Normal variant ST segment elevation
B. Acute lateral wall subendocardial ischemia
C. Acute inferior transmural ischemia
D. Acute pericarditis
23.Choose the correct diagnosis for this ECG:
A. Sinus arrhythmia
B. Type I 2nd Degree AV Block
C. Type II 2nd Degree AV Block
D. 3rd Degree AV Block
24.Which is the major symptom of GERD (gastroesophageal reflux disease)?
A. Heartburn
B. dysphagia
D. odynophagia
D. chest pain
25. Which of the following statements regarding IBS(irritable bowel syndrome) is FALSE
A. the typical location of abdominal pain is the lower abdomen
B. defecation frequently relieves the pain
C. there is often a perception of incomplete emptying of the rectum
D. very severe abdominal tenderness is a hallmark of the disease
26. Which one of the following is not related to the common causes of acute gastritis
A. NSAIDs B. Alcohol C. Severe physiological stress D. Autoimmune
27. Which of the following is considered the type I carcinogen for gastric cancer?
A. Smoking B. Alcohol C salt D. H. pylori
28. Metastases of gastric cancer occur most commonly in the following organ except
A. liver B. lungs C. peritoneum D. bone
29. The most common symptom of ulcerative colitis is
A.abdominal pain
B.abdominal mass C.gross blood in stool D.fistulas
30. Hypertrophic lesions of intestinal TB may occur with the following manifestations
EXCEPT
A.diarrhea
B.constipation
C.abdominal masses D.abdominal distention
31. All of the following factors correlate well with risk of variceal bleeding EXCEPT
A .presence of red color signs identified during endoscopy
B. jaundice
C. severity of liver function
D. size of the varices
32. All of the following are the presentations of portal hypertension EXCEPT:
A. ascites
B.esophageal varices C.splenomegaly
D.spider angioma
33. Which of the following delineation for delineation of diagnostic tests for H. pylori is wrong.
A. Immunoglobulin G serologic testing can differentiate current from past infection.
B.C14 urea breath test uses ratioactivity and has high sensitivity.
C. Microbiological culture is “gold standard”
D. Rapid urease tests has low sensitivity
34. Acute pancreatitis usually begins with ____ in the upper abdomen that may last for a few
days.
A. Nausea
B. vomiting
C. Fever
D. Pain
35. The complications of Acute pancreatitis include all of the following , EXCEPT
A .Necrosis
B. Abscess
C. Pseudocyst
D. Hepatic coma
Questions 36-38 are based on this case:
A 32-year-old woman is involved in a road traffic accident and experiences a blow to the right
side of the chest and extensive bruising of her right leg. She is in such pain that she is bedbound
for a week afterwards. When she begins to mobilize, she notices that her whole right leg is
larger than her left. She has pain in the right side of the chest which catches her when she
breathes. The antero-medial aspect of her right thigh is tender below the inguinal region.
36. Which of the following would be appropriate actions? .
A. recommending anti-embolism stockings
B. prescribing aspirin
C. prescribing low molecular weight heparin and then warfarin
D. requesting an ultrasound scans of the leg veins
37. What is most likely to cause her pain in the right side of the chest?
A. pulmonary embolism B. pneumothorax C. pneumonia D. myocardial infarction
38. Which factors directly caused her whole right leg larger than her left?
A. bedbound for a week afterwards B.32-year-old
C. woman
D. extensive bruising of her right leg
39. A 65-year –old man with hyperlucent lung field develops extreme shortness of breath over
a period of about 15 minute .Chest x-ray shows a shift of the mediastinum to the right, and the
lung field on the left appears even more hyperlucent than before, with the exception of a white
shadow near the heart border . Which of the following is the most probable cause of the
patient’s current problem?
A. Bronchogenic carcinoma
B. Pleural effusion
C. Pulmonary embolism
D. Rupture of an emphysematous bulla
40. A 30-year-old man was suffer from SARS (SEVERE ACUTE RESPIRATORY DISTRESS
SYNDROME) in the Guangdong Probince in late 2002. He was unconsciousness when he was
brought to the hospital. His arterial blood gas assay show a PCO2 of 35 mmHg, a PO2 of 40
mmHg. Which is the best treatment for him?
A. inhale high concentrations of oxygen
B. continues low-concentration controlled oxygen therapy
C. oxygen treatment with mask
D. invasive mechanical ventilation
Questions 41-44 are based on this case:
A 52-year-old man who has long history of smoking presents with frequent episodes of
coughing up blood over the previous 4 weeks. She has otherwise been well. On examination,
there are no abnormal findings. A plain chest radiograph shows a mass in the left upper zone,
which is confirmed on a CT scan together with metastatic spread to the liver.
41. Which would be the most likely cause of his disease?
A. benign node in lung B. pneumonia C. tuberculosis D. bronchial carcinoma
42. Which examination should do next in order to make definite diagnosis
A. bronchoscopy
B. lung function test
C. blood gas analysis
D. positron emission tomography
43. Treatment of bellows could be offer exclude
A. surgery
B. chemotherapy
C. radiotherapy D. pain killer injection
44. How long will the patient live
A.30 years
B.10 years
C.6 months
D.5 years
Questions 45-47 are based on this case:
A 58-year-old woman presents with biventricular failure. She admits to drinking a bottle of
sherry and smoking 20 cigarettes per day and recently cough and asthma. Echocardiography
reveals a dilated, poorly contracting left ventricle.
45. Which investigation is most valuble for diffirential ?
A. Chest X-ray.
B. Electrolytes.
C. Thyroid function. D. Brain natriuretic peptide (BNP)
46. What’s most likely cause of this patient?
A. Hypertension.
B. Valvular heart disease.
C. Coronary heart disease. D. Dilated cardiomyopathy.
47. Which treatments are correct EXCEPT:
A. Diuretics.
B. ACE inhibitor.
C. Beta-adrenoceptor antagonist (β-blocker) D. Digoxin.
Questions 48-49 are based on this case:
A 48-year-old male is admitted to hospital in congestive heart failure. After approprite
treatment, the patient is discovered to have a diffusely hypokinetic ventricle with an ejection
fraction of 20%. There is moderate mitral regurgitation. Exercise testing is negative for
ischmia, and coronary angiogram shows normal. Laboratory studies, including iron and thyroid
studies, are normal. The patient admits to heavy alcohol use over 20 years but denies tobacco
or illicit drug use.
48. Which of the following medications will improve this patient’s survival?
A. Digoxin.
B. Enalapril
C. Furosemide.
D. propranolol.
49. Which complications will occur in this patient?
A. Arrhythmia. B. Hyperkalaemia. C. Cardiac shock.
D. Diabetes Mellitus.
50. A 45-year-old man was admitted to the hospital because of sudden and severe pain for 4
hours.The pain initially develops in the upper abdomen and rapidly becomes generalized. The
temperature was 38°C, the pulse 100 beats per minute, the respiratory rate 25 breaths per
minute.The blood pressure was 110/65mmHg.The entire abdomen is held immobile with
“board-like” rigidity.He had Abdominal tenderness,rebound tenderness.Liver dullness to
percussion decreases.Bowel sounds are absent.He has a history of peptic ulcer for 1 year.The
primary diagnosis is
A. Gastric outlet obstruction
B. Acute pancreatitis
C. Perforation from stomach or duodenum.
D. Intestinal tuberculosis
Questions 51-52 are based on this following case:
A 40-years-old woman, complaining of abodominal pain for the recent three months. Pain
located around the right lower quadrant. Weigh loss of 5kg. Temperature ranges 37.5-38.2℃.
PE:tender at RLQ(right illiac fossa）;
LAB data :WBC 6.9*10^9/L,HB 89g/L,PLT
325*10^9/L; ESR(erythocyte sedimentaion rate):49mm/H; Chest X-ray: tuberculosis nodles
in both lungs apices
51. Which prefer to be next investigation for the patient ?
A. surgery
B. Laparoscopy
C.CT-scan
D.Colonscopy
52. The patients had colonscopy ,and mucosa biopsy results in Caseation necrosis Granuloma.
The most suspected diagnosis is_____
A.Tumor(colon cancer) B.Corhn’s disease C.Acute appendititis D. Intestinal tuberculosis
Questions 53-55 are based on this following case:
A 50-years-old man with chronic alcoholism is evaluated because of bright-red haematemesis
and syncope. At 11 PM his pulse rate is 110/min and blood pressure is 90/60mmHg. There is
“coffee-grounds” material presents in the nasogastric tube. The patient has mutiple, vascular
spider angiomara and a distend abdomen with shifting dullness.
53. What is the most likely diagnosis for this patient?
A. peptic ulcer
B. GI varices
D. gastric cancer D. others
54. What is the optimal management for these patients at first?
A. Immediate endoscopy B. Endoscopy next morning
C. Surgery
D. Iv injection
55. What is the optimal management for this patients after his vital signs were stable ?
A. endoscopy
B. TIPS
C. Surgery D.CT scan
2011-2012 B 2008
1. What is the nature of asthma?
A. allergic reaction
B. airway inflammation
C. airway hyperresponsiveness
D. bronchospasm
2. The clinical manifestations of asthma have
A. shortness of breath
B. coughing
C. wheezing
D. all of the above
3. The best drug to treat severe asthma exacerbation is
A .theophylline
B. glucocorticoids C.β2-agonists
D. anticholinergics
4. Pulmonary emboli usually comes from
A. the iliac, femoral or distal leg veins
B. right side of the heart
C. pulmonary veins
D. arm veins
5. The hallmark of COPD is chronic airflow limitation which is:
A. FEV1/FVC <70%(%precdicted) and reversibility<12%
B. FEV1/FVC <80%(%precdicted) and reversibility<12%
C. FEV1/FVC <70%(%precdicted) or reversibility<12%
D. FEV1/FVC <80%(%precdicted) or reversibility<12%
6. COPD consists of
A. chronic bronchitis and emphysema B. asthma and emphysema
C. bronchiectasis and emphysema
D. asthma and chronic bronchitis and emphysema
7. Which is the most valuable indicator to judge the respiratory acid-base imbalance?
A. pH
B.PaCO2
C.BE
D.AB
8. 24 hours later, a patient acquired pneumonia at hospital after he was admitted to hospital,
What is the classification type of pneumonia?
A. Hospital-acquired pneumonia (nosocomial)
B. Community-acquired pneumonia
C. Atypical pneumonia
D. Bronchopneumonia
9. The tension pneumothorax most need is
A. a lot of drugs
B. reduction of the thoracic pressure
C. variety examination
D. enough rest and comfortable
10. First Line anti-tuberculous drugs included
A Isoniazid，Rifampin
C Streptomycin, p-amino salicylic acid
B quinolones，Kanamycin
D Amikacin, Ethambutol，
11. Staging of non-small cell lung cancer:
A. using the tumor (T), node(N) and metastases(M) system(TNM)
B. according to the cell types
C. according to patient’s age, sex and the carcinoma cell types
D. using the carcinoma cell type(T), node(N) and metastases(M) system(TNM)
12. The vast majority of bronchial carcinoma is related to
A. air pollution
B. chemical exposure C. smoking
D. tuberculosis
13. Symptoms of cardiac tamponade include:
A. severe drop in blood pressure
B. rapid and difficult breathing
C. weak pulse
D. all above answers are right
14. Which statement is INCORRECT in Classification of Heart Failure (New York Heart
Association)?
A. classⅠ: No symptoms or limitations in ordinary physical activity.
B. classⅡ: Marked limitation in activity even during minimal activity. Comfortable only at
rest.
C. class Ⅲ: Marked limitation in activity even during minimal activity. Comfortable only at
rest.
D. class Ⅳ: Severe limitation. Experiences symptoms even at rest.
18. The following groups of people are more susceptible to IE(infective endocarditis)
EXCEPT:
A. the elderly
B. people with congenital heart defects
C. people who have had rheumatic fever D. people with diabetes mellitus
19. Which of the following is the most common clinical manifestation of constrictive
pericarditis ?
A. chest pain，dry cough
B. slight fever，night sweats
C. distended neck veins，hepatomegaly，ascites
D. enlarged border of cardiac dullness
20. Choose the correct diagnosis for this ECG:
A. LBBB
B. RBBB
C. LAFB
D. RBBB + LAFB
21. What is the diagnosis of this bigeminal rhythm?
A. 2nd degree AV block type II (Mobitz)
B. Nonconducted PACs following every two consecutive sinus beats.
C. 2nd degree AV block (Type I, Wenckebach)
D. Sino-atrial exit block
22. The most common cause of UGIB is?
A.esophageal varices
B.gastritis
C.peptic ulcers D.Mallory-Weiss
23. The following statement ____ is not a major risk factor for coronary heart disease.
A. hypercholesterolemia B. Smoking C. heavy drinking D. hypertension
24. One of the following items is not related to the features of IBS(irritable bowel syndrome).
A. Altered bowel habit B.Colicky abdominal pain C.Rectal mucus D.Weight losing
25. Each of the following is considered a risk factor for gastric adenocarcinoma EXCEPT
A. duodenal ulcer
B. adenomatous polypus of the stomach
C.dietary nitrosamines
D. immunodeficiency
26. The most common symptom of Crohn’s disease is
A. abdominal pain
B. abdominal mass
C. gross blood in stool
D. mucus in stool
27. The specific complication of Crohn’s disease is
A. Toxic megacolon B. Fistula C. Cancer D. Hemorrhage
28. Intestinal TB can be diagnosed by ‫ لين‬، ‫لين السؤالجدي مافي تغيير يعني األجوبة الي باالخضر كلها صح‬
‫حطو باستثناء فبكون باالحمر‬
A. acid-fasting bacilli in sputum and stool, B. PPD,
C. ESR
D. coloscophy
29. The histopathological features of cirrhosis include all of the following factor EXCEPT
A. diffusive fibrosis of the hepatic parenchyma
B. regenerative nodule formation
C .loss of the normal liver architecture
D. hepatic inflammation
30. All of the following are the complications of cirrhosis EXCEPT:
A. hepatocellular carcinoma
B. spontaneous bacterial peritonitis
C. hepatic encephalopathy
D. ascites
31. How to judge the causes of UGIB?
A. History
B. Physical examination
C. Blood test
D. Endoscopy
33. The common (90%) causes of Acute pancreatitis include all of the following , EXCEPT
A. Gallstone
B. Alcohol
C. Drugs
D. Post-ERCP
36-39.A 54-year-old man gives a history of a cough, progressive dyspnea over 10 years, which
often requires bronchodilator. He go to see his general practioner because of breathlessness and
increased sputum,which has turned green. He is a heavy smoker. On examination, he has
dyspneic, barrel chest, decreased breath sounds and prolonged expiratory time, and he has no
clubbing.
36. What his possible disease:
A. bronchiectasis
B. asthma
C. fibrosing alveolitis
D. acute exacerbation of COPD
37. Which test is best to confirm the dagnosis?
A. pulmonary function test
B. bronchoscopy
C. white blood count
D. chest X ray and chest CT scan
38. Which is best treatment of this patients ?
A. nebulized short-acting bronchodilator and antibiotics
B. inhale long-acting bronchodilator and antibiotics
C. nebulized long-acting bronchodilator
D. nebulized anticholinergics
39. When he become well and go home, what advice must be given?
A. regular inhaling long-acting bronchodilator
B. rehabilitation
C. smoking cessation
D. oxygen therapy
40. A 70-year-old man is brought to the emergency room because of extreme shortness of
breath .He has a history of chronic cough , hard to breath after activity for 15 years. His arterial
blood gas assay show a PCO2 of 80 mmHg, a PO2 of 45 mmHg. Which is the best treatment
for him?
A. High concentrations of oxygen
B. center respiratory stumulant
C. continues low-concentration controlled oxygen therapy
D. continues low-concentration controlled oxygen therapy and center respiratory stumulant
41-43. A female patient, 58 years old. She has a chest pain for 1week, and dyspnea while
walking slowly or liying down. ECG test shows sinus tachycardia with 110 bpm and low QRS
voltage (all leaders). The chest CT-scan reveals the normal size heart and a large fluid
surrounding it.
41. What signs could be found in the patient?
A. high BP and narrow pulse pressure
B. pericardial knock
C. pulsus paradoxus and tachycardia
D. pericardial friction rub
42. What is the most important tests for the diagnose of the case?
A. pericardio centesis and diagnostic biopsy
B. chest X-ray
C. UCG
D. blood test
43. What urgent treatment should be chosen?
A. nonsteroidal anti-inflammatories (NSAIDs), such as aspirin or ibuprofen
B. morphine or codeine
C. pericardio centesis
D. antibiotics and Corticosteroids
Questions 44-46 are based on this following case:
A 60-year-old male has a history of fever for one week and was adimitted to hospital for chest
pain and despnea.Physical examination shows jugular vain distention,paradoxical pulse,grade
2/6 systolic murmurs at the apex and muffled heart sounds.
44. What is the most likely disease that the patient suffered from?
A. rheumatic valvular heart disease, mitral regurgitation B. viral myocarditis
C. dilated cardiomyopathy
D. acute effusive pericarditis
45. Which of the following is not the common manifestation of the disease that the patient
suffered from?
A. pericardial knock
B. elevated pulse pressure
C.ECG shows diffuse (limb leads and precordial leads) ST segment elevations
D. arterial pressure is reduced by more than 11.3KPa when inspiration
46. Which of the following is the most sensitive and safest technique to confirm this disease :
A. right catheterization and coronary angiography B.ECG
C. echocardiogram D.chest X-ray
47-48. A 35-year old female presents to your clinic with a 6-month history of loose bowel
movement. Blood has been presented in many of them. She has lost weight for 10 kg within 6
months. She has had an intermittent fever. A sigmoidoscopy reveals a friable rectal mucosa
with multiple bleeding points. Select the one best answer to the following questions.
47. What is the most likely diagnosis in this patient
A. Irritable bowel syndrome
B. Crohn’s disease
C. Ulcerative colitis
D. Bacterial dysentery
48. The most important investigation at this time should be which of the following
A. Colonoscopy
B. Barium enema
C. Ultrasonagraphy of the abdomen
D. CT scan of the abdomen
49. If an X-ray examination shows her transverse colon is dilated to 7 cm, what kind of
complication does this patient have?
A. Diverticula
B. Colorectal cancer C. Toxic megacolon D. Hemorrhage
50. A 30-year-old man was admitted to the hospital because of nausea, vomiting, and weight
loss for 2 months. Physical examination showed evidence of wasting and dehydration.
Succussion splash is elicited 4 hours after the last meal or drink. Gastric peristalsis is visible.
He has peptic disease for 3 years.The serum level of carcinoembryonic antigen is normal.The
primary diagnosis is
A. Gastric outlet obstruction
B. Chronic gastritis
C. Perforation from stomach
D. Gastric cancer
51-52.A 51-year-old man was admitted to the hospital because of abdominal pain ,nausea and
vomiting for 2 days, Physical examination showed BP:140/90mmHg，P120/minute, abdomen
tenderness and rebounce pain in the left Epigastrium. Laboratory examination：Wbc: 20.0 *
109，Blood sugar: 20mmol/ l,The serum level of carcinoembryonic antigen is normal.
51. About the pain in the case, you should ask others, but not include:
A. Where is the pain location?
B. Where the pain radiates?
C. Continuously or Intermittence of the pain?
D. Did the pain begin from the head?
52. What is the most important examination next step for this patient?
A. Serum Amylase
B. Liver function
C. Renal function
D. Urine routine test
53-55.A 39-year-old woman was admitted to the hospital because of abdominal pain in the
Epigastrium ,the pain radiates to the back, the pain was Worse when the patient eat some food
or in supine position ,and vomiting for 1 days , Physical examination showed abdomen
tenderness and rebounce pain in the Left Epigastrium . Laboratory examination：Serum
Amylase:1200U / L,C-reactive protein（CRP）:110mg/L ,She has Choledocholithiasis
disease for 1 years. ‫ الكيس مكرره بس في اول سؤال في اختالف فركزو‬،‫انتبهو للسؤال األول‬
53. The primary diagnosis is
A.Gastric ulcer B.Chronic gastritis
C.Acute pancreatitis
D.Hepatic cirrhosis
54. About this patient,What is the most important examination next step for diagnosis?
A. X—ray B.Abdominal CT scan C. Gastroscopy
D. colonoscopy
55. About the treatments of the disease, not include:
A. Patients who have developed necrotising pancreatitis or pancreatic abscess don't require
surgical débridement of the pancreas, followed by drainage of the pancreatic bed.
B. Pancreatic rest and supportive care.
C. In servere acute pancreatitis, nutritional support is usually required.
D. Patients who present with cholangitis or jaundice in association with severe acute
pancreatitis should undergo urgent ERCP to diagnose
2012-2013A 2009
1. The mean pressure in pleural space is_______
A. -3cmH2O B. -4cmH2O C. -5cmH2O D. -6cmH2O
3.The result of physical examination: Percussion: dull, fremitus:increased,breath
sounds :bronchial, Rale: present voice sounds:inceased. That means as follow:
A. large pleural effusion
B. pulmanory emphysema C. closed pneumothorax
D. thick walled cavity
E. massive consolidation
6. A 57-year-old man develops acute shortness of breath shortly after a 12-hour automobile
ride. The patient consults his internist, and findings on physical examination are normal
except for tachypnea and tachycardia. An electrocardiogram reveals sinus tachycardia but
is otherwise normal. Which of the following is correct?
A. A definitive diagnosis can be made by history alone
B.The patient should be admitted to the hospital, and, if there is no contraindication to
anticoagulation, intravenous heparin should be started pending further testing
C. Normal findings on examination of the lower extremities are extremely unusual in this
clinical setting
D. Early treatment has little effect on overall mortality
7. A 70-year-old patient with chronic obstructive lung disease requires 2 L of nasal O2 to
treat his hypoxia, which is sometimes associated with angina. While receiving nasal O2,
the patient develops pleuritic chest pain, fever, and purulent sputum. He becomes
stuporous and develops a respiratory acidosis with CO2 retention and worsening hypoxia.
The treatment of choice is
A. Stop oxygen
B. Begin medroxyprogesterone
C. Intubate the trachea and begin mechanical ventilation
D. Observe patient 24 hours before changing therapy
E. Begin sodium bicarbonate
8. Blood gas measurements of a patient shows the following values pH 7.2, pC02 80 mm Hg,
p02 46 mm Hg. Which of the following could be the most probable diagnosis:
A. Acute asthma
B. Acute exacerbation of COPD
C. ARDS
D. Severe pneumonia
9. Carbon monoxide diffusion capacity decreases in all, exccpt:
A. Emphysema
B. Primary pulmonary hypertension
C. Alveolar haemorrhage
D. Infiltrative lung disease
10. A 68-year-old man was treated with intravenous antibiotics for 5 days because of a left
lower lobe pneumonia. On review in the outpatient department 8 weeks later, he has
improved but still has a troublesome cough with some flecks of dullness to percussion at
the left base , with some bronchial breathing and coarse crackles.Vocal resonance is
increased. What is the most likely diagnosis?
A. Parapneumonic effusion
B. Pulmonary infarction
C. Empyema
D. Carcinoma of the bronchus
11. The most common cause of mass in the posterior mediastinum is
A.Vascular B.Esophageal diverticula C. Neurogenic tumors D. Lymphomas
12. Optimal management at discharge includes a review of antihypertensive therapy, a
ventricular rate control agent, and which of the following?
A. Automated implanted cardioverter-defibrillator (AICD)/permanent pacemaker to avoid the
need for anticoagulation
B. Immediate direct-current cardioversion
C. Antiplatelet therapy such as aspirin, without warfarin
D. Antiplatelet therapy plus warfarin with a target INR of 1.5
E. Warfarin with a target INR of 2.0 to 3.0.
13. A 55-year-old African American female presents to the ER with lethargy and blood
pressure of 250/150mmHg. Her family members indicate that she was complaining of
severe headache and visual disturbance earlier in the day. They report a past history of
asthma but no known kidney disease. On physical examination, retinal hemorrhages are
present. Which of the following is the best approach?
A. Intravenous labetalol therapy
B. Continuous-infusion nitroprusside
C. Clonidine by mouth to lower blood pressure
D. Nifedipine sublingually to lower blood pressure
E. Intravenous loop diuretic
14. All of the following are features of Mobitz type I block except:
A. Constant PR interval
B .Normal QRS morphology
C. Regular Atrial Rhythm
D. Atrial rate>ventricular rate
15. Atrial fibrillation may occur in all the following condition except:
A. Mitral stenosis
B. hypothyroidism
C. Dilated cardiomyopathy
D. Mitral regurgitation
16. All of the following are seen in cardiac tamponade except:
A. Pulsus paradoxus
B. Diastolic collapse of right ventricule on echocardiogram
C. Electrical alternans
D. Kussmaul’s sign
17. Pulsus paradoxus is a characteristic feature of
A. Constrictive pericarditis
B. Cardiac tamponade
C. Hypertrophic obstructive cardiomyopathy
D. Restrictive cardiomyopathy
18. A 25 years old basket ball player suddenly collapsed while undergoing an athletic event
and died. At autopsy the septum was hypertrophied. The most probable diagnosis is
A. HCM B. Right ventricular conduction abnormality C.Epilepsy
D.Snake bite
19. Each of the following is considered a physiologic mechanism for GERD EXCEPT
A. Impaired esophageal clearance
B. Impaired esophageal integrity
C. Reduced resting pressure of LES
D. Delayed gastric emptying
E. HP infection
20. The diagnostic methods for GERD DO NOT include:
A. Endoscopy
B. Ambulatory pH monitoring
C. Detection of H. pylori Infection D. Esophageal manometry
E. Acid Perfusion Test
21. Which group of Bormann Classification does polypoid or proliferative gastric cancer
belong to
A. I B. II C. III D. IV E.V
22. The following is true of haematemesis :
A. When it occurs in a patient with alcoholic liver disease, it is always due to oesophageal
varices.
B. A visible vessel seen at gastroscopy is a risk factor for further bleeding.
C. When it occurs in patients over 70 years of age who may have arthritis, usually indicates
malignancy.
D. When it is caused by duodenal ulcer, a partial gastrectomy is usually necessary.
23. If a 40-year alcoholic patient presents with retching and vomiting preceding hematemesis.
What is the probable diagnosis
A.esophageal varices
B.gastritis
C.peptic ulcers
D.Mallory-Weiss
24. The frequently involved site of intestinal TB is _______
A.rectum B.descending colon C. ascending colon D.ileocecum
25. The distinguishing lesion of intestinal TB is _____
A. caseating granulomas B.Inflammatory exudate C. proliferation D.necrosis
26. Diagnostic tests for H. Pylori include all of the following except:
A. Urea-breath test
B. Rapid urease test
C. Gastric biopsy & Warthin-starry stain D. SAFA test
27. Peptic ulcer is associated with all except one:
A. Cirrhosis
B. Zollinger Ellisons syndrome
C. Primary hyperparathyroidism
D. Pernicious anemia
28. Results of endoscopic examination about peptic ulcer not include:
A. 90% gastric ulcers are situated on lesser curvature within the antrum or at the junction
between body and antral mucosa.
B. 50% duodenal ulcers are situated on anterior wall within the duodenal bulb.
C. 80 to 90% cases present with single ulcer.
D. Mostly more than 2 cm in size, clean base.
Questions 31-33 are based on this case:
Middle fever, 10 days with right side chest pain, little productive cough with breath shortness
while labor. Oral antibiotics for 3days without taking effect.
31. For clear diagnosis and farther examination, what best we have to do
A. lung function test B. ESR test
C. chest X-ray film
D. PPD test
E. sputum culture for microorganism
32. What examinations is need EXCEPT
A. blood routine B. CRP test C. chest CT scan D. blood culture E. lung capacity test
33. Most possible diagnosis impression
A. lung TB
B. right lung infection or right pleurisy C. lung infarction
D. right pneumothorax
E. asthma
Questions 34-35 are based on this case:
A 62-year old male presents to your clinic with a 10-month history of mild epigastric
abdominal pain. He has lost weight for about 5 kg within the past 10 months. He looks
anemic, but you can’t find any other obvious signs of abnormal during your physical
examination.
Select the best answer to the following questions.
34. What is the most likely diagnosis in this patient
A. Irritable bowel syndrome B. Crohn’s disease C. Ulcerative colitis
D. Gastric Cancer
E. GERD
35. The most important investigation at this time should be which of the following
A. Gastroscopy B. Barium enema C. Ultrasonography of the abdomen
D. Ambulatory 24 hr. pH Monitoring E. MRI scan of the abdomen
2012-2013 B 2009
2. The following causes will bring up the hydrostatic pressure except
A. congestive heart failure
B. constrictive pericarditis
C. obstructed upper cava
D. hypoalbuminemia
5. What is the first line of therapy in acute asthmatic attack?
A. Short-acting beta2 agonists (SABA)
B. LTRAs
C. Anticholinergic agents
D. Theophylline
E. Steroids
7. A 62-year-old man who has chronic bronchitis and chest pain is given oxygen via mask in
the ambulance en route to the hospital and becomes lethargic in the emergency room.
Select the arterial blood gas and pH values. Which it is most likely to be associated?
A. pH 7.50, PO2 75, PCO2 28
B. pH 7.15, PO2 78, PCO2 92
C. pH 7.06, PO2 36, PCO2 95 D. pH 7.06, PO2 108, PCO2 13
E. pH 7.39, PO2 48, PCO2 54
10. Drug of choice for Mycoplasma pneumonia is :
A. Penicillin B. Tetracycline C. Cefuroxime D. Erythromycin
15. Which of the following is LEAST likely to cause constrictive pericarditis?
A. Tuberculous pericarditis effusion
B. Staphylococcal effusion
C. Post cardiac surgery
D. Acute rheumatic fever
20. All are the true regarding hypertrophic obstructive cardiomyopathy, except:
A. Digitalis is useful
B. LV outflow obstruction
C. Asymmetrical septal thickness
D. Double apical impulse
16. Grade D in Los Angeles Classification System means
B. At least one mucosal break longer than 5 mm confined to the mucosal fold but not
continuous between two folds
C. Mucosal breaks that are continuous between the tops of mucosal folds but not
circumferential
D. Extensive mucosal breaks engaging at least 75% of the esophageal circumference
E. Extensive mucosal breaks engaging at least 95% of the esophageal circumference
17. Which situation is related to Curling Ulcer?
A. burns B. CNS trauma C. CNS surgery D. sepsis E. GERD
Questions 37-38 are based on this case:
A 70-year-old woman presents for routine follow-up. Her medical problems include
hypertension, hyperlipidemia, and osteoarthritis. She does not smoke or drink. On further
discussion, she describes sometimes dyspnea without chest pain on exertion. She also notes
increasing ankle swelling and fatigue. Her medications include atenolol, amlodipine,
pravastatin, and acetaminophen. Examination reveals blood pressure 150/84mmHg, pulse
74bpm and irregular, respiratory rate 16bpm. Lungs are clear, and cardiac examination shows
an irregular rhythm with no murmur. Extremities show edema bilaterally without tenderness.
Electrocardiogram shows atrial fibrillation, normal axis and nonspecific ST wave change.
37. Which of the following medications should be started at this time?
A. Digoxin. B. Warfarin. C. Quinidine. D. Diltiazem.
38. Which of the following medications will improve this patient’s survival?
A. Digoxin. B. Enalapril C. Furosemide. D. propranolol.
2013-2014 A 2010 done
1.The most common disease lead to type Ⅱ respiratory failure in china is
A．severe tuberculosis
B．pneumoconiosis
C. chronic obstructive pulmonary disease
D．Pulmonary contusion
2. When respiratory failure happened, that the first clinical symptoms appeared on is
A. Cyanosis B. Gastrointestinal bleeding C. dyspnea D. palpitation
6. 1. According to above features,we may consider the likely diagnosis of the patient:
A .Pneumonia
B . Pulmonary tuberculosis
C. Bronchial carcinoma
D. Pulmonary infarction
7. Pulmonary tuberculosis is
A .Pulmonary tubercle change caused by bacilli
B .chronic lung infection caused by bacilli
C .chronic lung disease caused by bacilli
D .chronic pulmonary tubercle change
E .Pulmonary tubercle caused by M. tuberculosis
10. So far,there’s no miracle drug for asthma treatment.However there’re still many drugs
can be used to prevent or relieve acute attacks . Which of the following drugs couldn’t
controll airway inflammation but is effective for relief of symptoms ?
A. corticosteroids B. leukotriene modifiers
C. cromolyn
D. hort-acting beta-adrenergic receptor agonists
15. The patient average baseline blood pressure was 182/112 mmHg if he did not take antihypertensives. Which stage of hypertension it is？（Based on the seventh report of the Joint
National Committee on Detection, Evaluation and Treatment of High Blood Pressure）
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
18. Which cells play an active role in liver fibrosis?
A. Fibrous tissue B. Hepatic stellate cells C. Hepatocytes D. Kupffer cells
19. If a 30 y/o patient with hematemesis presents with hypotension, clammy hands, but
without tachycardia. How much blood has he lost?
A. >30%
B. 20-30%
C. 10-20%
D .<10%
20. Which of the following transmitters inhibit pariental cells secrete gastric acid：
A. Histamine B. Gastrin
C. Acetylcholine D. Prostaglandins
21. Acute pancreatitis accounts for ______of all cases of abdominal pain admitted to hospital.
A.1%
B.3%
C.5%
D :10%
26. Pulmonary tuberculosis is characterized by
A. granuloma formed in infected tissues
B. cell-mediated hypersensitivity.
C. granuloma formed in lung tissues
D. both granuloma formed in infected tissues and by cell-mediated hypersensitivity.
E. cell-mediated hypersensitivity in all patien
27. If the fluid in the pleural space is cholesteral,it is called
A. empyema
B. chylothorax C. pseudochylothorax
D. urinothorax
29. The most common cause of mitral stenosis is, especially in developing countries:
A. rheumatic fever
B. infective endocarditis
C. mitral valve relapse D. degeneration of mitral valve
2013-2014 B 2010 done
1. A 60-year-old male with stage I squamous cell carcinoma, which treatment should be
considered （ ）
A. Radiotherapy B. surgery C. chemotherapy D. target therapy
2. First Line anti-tuberculous drugs means ( )
A. are the more effective and have low toxicity.
B. are the most commonly used and have less toxicity.
C. are the most cheap and have high effectiveness.
D. less drugs-resistant and Less toxic effects
E. are the most effective and have lowest toxicity.
5. A 60-year-old man is brought to the emergency room because of shortness of breath and
edema of lower limbs .He has a history of chronic cough , hard to breath after activity for 15
years. His arterial blood gas assay show a PCO2 of 70 mmHg, a PO2 of 50 mmHg. Which is
the key point of treatment for him. ( )
A. proper management of respiratory infection
B. use center respiratory stimulant medication
C. maintenance airway patency and oxygen treatment
D. active diuresis treatment to decrease the blood volume and lessen the cardiac load
7. Deep venous thrombosis is treated by except （ ）
A. low molecular weight heparin
B.warfarin
C. compression stockings relieve swelling D.aspirine
9. Which statement is true EXCEPT ( )
A. Cardiomyopathy means heart muscle disease
B. It is the deterioration of the function of the myocardium for any reason
C. Valvular heart disease is one type of Cardiomyopathies
D.Cardiomyopathies can generally be categorized into two groups (based on World Health
Organization guidelines): Extrinsic cardiomyopathies, Intrinsic cardiomyopathies
11. The primary mechanism of cardiogenic shock in acute myocardial infarction ______.
A.systolic discharge blocked
B. diastolic underfilling
C. extensive myocardial necrosis, cardiac output decreased sharply
D. hypovolemia
E.neural reflex mechanisms
13. The 55-year-old male patient average baseline blood pressure was 142/95 mmHg if he did
not take anti-hypertensives. He is a smoker. Which risk of hypertension from risk stratification
it is?
A. Average risk
B. Low added risk
C.Moderate added risk
D. High added risk E.Very high added risk
23. A three-year-old child is brought to the emergency room after inhaling a peanut .The peanut
has lodged in the right mainstem bronchus, largely occluding it. The child is cyanotic, and noninvasive transcutaneous monitoring reveals a PO2 of 60 mmHg. Which of the following
mechanisms best accounts for the child’s hypoxemia? ( )
A. Decreased capacity of pulmonary diffusion
B. Decreased PO2 in inspired air
C. Hypoventilation of central origin
D.Hypoventilation of peripheral origin
E. Inequalities of ventilation and perfusion
24. According to anatomical classification of pneumonia there are three but:
A. Alveolar(lobar) pneumonia B. Bacterial pneumonia
C. Bronchopneumonia
D. Interstitial pneumonia
27. Typical symptoms of aortic stenosis include the following except: ( )
A. Angina pectoris
B. Syncope during exertion
C. rhythmic nodding of the head D. Congestive heart failure
28. Evaluation for secondary hypertension is indicated in the following conditions, EXCEPT：
A. Hypertension refractory to three-drug regimen
B. Hypokalemia
C. Continued creatinine rise while on appropriate antihypertensive therapy
D. None of the above
Questions31-34 are based on this case
A 30-years old office worker presented with fever, chills, left upper chest pain and productive
cough with yellow suptum for 10 days. He has no basic disease, examination showed crackles
at the left middle lung, WBC count of 12400/L with 80% granulocytes, Serum sodium was 131
mEq/L,his CRP was 56.20mg/L, ESR 91mm/h, his chest film and CT scan show left upper
lobe infiltrates and focal consolidation,
31. According to above features,we may consider the likely diagnosis of the patient: ( )
A .Pneumonia
B. Pulmonary tuberculosis
C .Bronchial carcinoma
D. Pulmonary infarction
32. Evidence of your likely diagnosis are but: ( )
A. Fever
B. Yellow sputum
C. WBC and CRP are raised
D. Serum sodium was 131 mEq/L
33. Many tests had to be used to confirm your diagnosis but: ( )
A. Sputum examination B. Blood culture C. Pleural fluid D. Bronchoscopy
Questions 38-40 are based on this case
A 55-year-old woman was admitted to the hospital because of abdominal pain in the
Epigastrium ,the pain radiates to the back, the pain was Worse when the patient eat some food
or in supine position ,and vomiting for 1 days , Physical examination showed abdomen
tenderness and rebounce pain in the Left Epigastrium . Laboratory examination：Serum
Amylase:220U / L,C-reactive protein（CRP）:110mg/L ‫ الكيس مكرره بس في اول‬،‫انتبهو للسؤال األول‬
‫سؤال في اختالف فركزو‬
38.The perhaps primary diagnosis include all of the following , EXCEPT ( )
A. Gastric ulcer B. Chronic gastritis C .Acute pancreatitis D. Choledocholithiasis
39.About this patient,What is the most important examination next step for diagnosis? ( )
A. X—ray B. Abdominal CT scan C. Gastroscopy D. colonoscopy
40.About the treatments of the disease, not include ( ).
A. Patients who have developed necrotising pancreatitis or pancreatic abscess don't require
surgical débridement of the pancreas.
B. Pancreatic rest and supportive care.
C .In servere acute pancreatitis, nutritional support is usually required.
D. Patients who present with cholangitis or jaundice in association with severe acute
pancreatitis should undergo urgent ERCP to diagnose
2014-2015A 2011
1.The pathological classification of lung cancer include
A. Small cell lung cancer
B. Adenocarcinoma C. Squamous cell carcinoma
D. Large cell carcinoma
E. All above
4. A 50-year-old construction worker continues to have elevated blood pressure of 160/95 even
after a third agent is added to his antihypertensive regimen. Physical examination is normal,
electrolytes are normal, and the patient is taking no over-the-counter medications. Which of
the following is the best next step for this patient?
A. Check pill count
B. Evaluate for Cushing syndrome
C. Check chest x-ray for coarctation of the aorta
D. Obtain a renal angiogram
E. Obtain an adrenal CT scan
7.Which is the best indication for intra-aortic balloon counterpulsation in acute myocardial
infarction?
A. cardiac shock B. acute left ventricular failure C. malignant arrhythmia
D. right ventricular infarction
E. chronic renal insufficiency
8. The following groups of people are more suspected to IE except______.
A. the elderly B. people with congenital heart defects
C. people who have had rheumatic fever D. people with diabetes mellitus
10. Transmitted routes of Intestine TB include________.
A. by swallowing of sputum with MBT
B. by hematogenous spread
C. by direct seeding from intra-abdominal TB
D. all of above
11. Which hormone is related to the testicular atrophy, liver palmar in cirrhotic patients?
A. high androgen B. high adrenocortical hormone
C. high estrogen D. high aldosterone
12. Which is not the clinical presentation of hepatorenal syndrome?
A. Hypertension B. Hypotension C. Hyponatremia D. low urinary
15. Characteristics of H pylori not include_____.
A. Can split off urea by urease
B. Do not invade cells –colonizes only mucous layerc.
C. Most common endpoint of HP infection for individuals –Peptic ulcer disease
D. Gram-negative, curved, flagellated rod
16. Which one is not belong to the clinical manifestations of acute pancreatitis?
A. cough B. cullen-sign C. abdomen pain D. Grey-Turner-sign
17. Which of the following is not related to the common causes of upper gastrointestinal
bleeding?
A. peptic ulcer B.gastric ancer C.acute pancreatitis
D. Hemorrhoids
18. How should the causes of UGIB be judged?
A. History B. Physical examination C. Blood test D. Endoscopy
19. Transudative pleural effusion is caused by which one of the following diseases?
A. Bacterial pneumonia B. Malignancy C. Cirrhosis D. Viral infection
20. Obstructive airway defect is characterized on pulmonary function testing by which one of
the following?
A. Reduced FEV1/FVC ratio
B. Decreased total lung capacity (TLC)
C. Reduced residual volume (RV)
D. Decreased residual volume/total lung capacity
(RV/TLC)
21.About asthma, which one is FALSE?
A. The peak expiratory flow rate is increased.
B. There is constriction os smooth muscle in bronchiles.
C. There is mucosal edema in the airway.
D .House dust may be allergen.
22. Which of the following is a determinant of Cardiac decompensation?
A. Increasing heart rate
B. Myocardial hypertrophy and cardiac enlargement
C. enhanced myocardial contractility
D. Cardiac output was significantly reduced
E. Ventricular end-diastolic volume increase
23. Which one of the following is the main reasons inducing left ventricular heart failure
clinical manifestation?
A. pulmonary edema
B. Left ventricular enlargement
C. increased pulmonary arterial pressure
D. Ventricular remodeling
E.elevated venous pressure of systemic circulation
24. Which symptom will be earlier presentation of left ventricular heart failure?
A. less urinary B. exertional dyspnea C. Cardiac asthma
D. orthopnea E. Edema of lower extremities
25. Which one of the following is disable to treat the diastolic heart failure?
A. Diuretics B. beta blockers C. ACE inhibitor
D. Digoxin E. Calcium channel blockers
26. Which of the following is not the clinical manifestation of upper GI bleeding?
A.Melena B.hematemesis C.hemoptysis D. Hematochezia
27. Nosocomial pneumonia is most commonly caused by_____.
A. Gram- ve bacilli B. Gram+ve bacilli C. Gram-ve cocci D. Mycoplasma
28.Respiratory System Drug of choice for Mycoplasma pneumoniae is_____.
A. Penincillin B.Tetracycline C.Cefuroxime D.Erythromycin
29. What is diagnostic of fresh myocardial infarction in ECG?
A. QT ivterval prolongation B. P mitrale
C. ST segment elevation
D. ST segment depression
30. Which drug is not effective against H.pylori?
A. Colloidal Bismuth B. Metronidazole C. Amoxicillin D. Erythomyin
Questions31-32 are based on this case
Male, 25 years old. Cough with fever for 2 weeks, wheezing for 5 days.
Two weeks ago after exposure to cold weather ,the patient suffered from a cough ,with fever
and the maximum temperature is 37.8℃ ,without fatigue 、night sweats. After the symptomatic
theatment, he still have cough without expectoration.5 days ago he felt wheezing particularly
at night and he can hear“wheezing sound”when breathing, exposure to cold air and smoke
made him felt worse. He has had allergic rhinitis for 5 years. No habits of smoking and
drinking. Physical examination: T:36.2℃，R:24bpm，P:80bpm， BP:120／80mmHg, no
cyanosis. There are scattered wheezing sound in both lungs. The heart border is normal, heart
rate is 80bpm and the rhythm is regular, no murmurs. Abdomen is flat, liver and spleen are not
palpable. No pitting edema in lower extremities. Neural system (-).
Laboratory and diagnostic tests: Blood routing: WBC 7.6×109／L，N 75%，L 12%，E7%
（normal values:0.5～5%），Hb 135g／L，PLT 234×109／L。X-ray:(-).
31. What is the main diagnosis of this patient ?
A. chronic obstructive pulmonary disease B. Vocal cord dysfunction
C. bronchial tuberculosis
D. Bronchial asthma attack
32. Which is the most important examination for this patient?
A. Pulmonary function test B. CT scans of the lungs C. ECG
D. Serum IgE
E. Antigen skin test
Questions 33-35are based on this case:
A 35-year-old male complains of substernal chest pain aggravated by inspiration and relieved
by sitting up. He has a history of tuberculosis. Lung fields are clear to auscultation, and heart
sounds are somewhat distant. Chest x-ray shows an enlarged cardiac silhouette.
33. The next step in evaluation is______.
A. Right lateral decubitus film B. Cardiac catheterization C. Echocardiogram
D. Serial ECGs
E. Thallium stress test
34. The patient then develops jugular venous distention and hypotension. The ECG shows
electrical alternans. The most likely additional physicalfinding is______.
A. Basilar rales halfway up both posterior lung fields B. S3 gallop
C. Pulsus paradoxus
D Strong apical beat
35. What would be the best therapy strategy for this patient______.
A. pericardiocentesis B. diuretics C. digitalis D. calcium channel blockers
Questions 36-37are based on this case
A 45 years old men has liver cirrhosis and ascites, dyspnea. Use Spironolactone and furosemide
remains oliguria.If you need to drainage ascites:
36. Ascites for the first time, how much do you need to drainage?
A.1000ml B.1500-2000ml C.2500-3000ml D.6000-8000ml E. <500ml
37. After the paracentesis, we can supply albumin by intravenouslly guttae. How much do you
need to drainage is appropriate?
A. <500ml B.1500-2000ml C.2500-3000ml D.4000-6000ml E.6000-8000ml
Extraaaaaa
3.Which of the following delineation for Clinical Presentation of peptic ulcer is wrong:
a.“Acid dyspepsia” is the classic ulcer symptom
b.Recurrent epigastric pain is the most common symptom.
c.The diagnostic value of individual symptoms for peptic ulcer disease is good; the history is
a good predictor of the presence of an ulcer
d. Many ulcer patients have”atypical” symptoms
1.A 46-year-old woman asks about the need for surgery, since she was recently diagnosed
with Crohn disease. Indications for operation in Crohn disease include all but which of the
following?
A.Intestinal obstruction
B.Enterovesical fistula
C.Ileum-ascending colon fistula
D.Enterovaginal fistula
E.Free perforation
2.A 32-year-old woman undergoes uncomplicated appendectomy for acute appendicitis.The
pathology report notes the presence of a 1-cm carcinoid tumor in the tip of the
appendix.Which of the following is the most appropriate management of this patient?
A.Right hemicolectomy
B. Right hemicolectomy and chemotherapy
C.Chemotherapy only
D.Radiation only
E.No further treatment
3. Which of the following is the most important to diagnose acute appendicitis.
A.Periumbilical colic
B.Tenderness localize at Mcburney’s point
C.Nausea and vomiting
D.Elevated WBC
E.Low-grade pyrexia
Respiratory department of internal medicine examination questions
1, Early chronic bronchitis, lung X-ray expression is: (
A, No special signs
B, Two lung markings thickening, disorder
C, Lung transparency increase
D, Descent of the diaphragm
E, Thoracic expansion, the gap widened
)
2, Tuberculous exudative pleurisy and pleurisy identification of cancer, most of which are:
A, The size of the age
B, Grass yellow exudate
C, A fearless cold, fever
D, Bloody exudate
E, Pleural fluid cytology
3, Smoking patients most likely to cause lung cancer is: ( )
A, Adenocarcinoma
B, Small cell carcinoma
C, Alveolar cell carcinoma
D, Squamous cell carcinoma
E, Bronchial adenocarcinoma
4, The main ways and means of tuberculosis infection: ( )
A, Drinking unpasteurised cow's milk
B, Skin trauma
C, Genitourinary trauma
D, Inhalation of infected sputum spray drying
E, Droplet nucleus inhalation cough sneeze expelled
5, Most reliable criteria for diagnosis of pulmonary tuberculosis in adult is: ( )
A, Fever, cough, night sweats, fatigue
B, ESR
C, With exudative shadow chest X-ray
D, Sputum smear positive tuberculosis
E, Positive tuberculin test
6, Male, 50 years old. Sudden chills, fever, cough, purulent sputum, sticky with blood, white
blood cell was 18 × 109/L, penicillin therapy, chest X-ray findings of right upper pulmonary
large opacities, falling leaf gap. Diagnosis may be: ( )
A, The pneumococcal pneumonia
B, Klebsiella pneumoniae
C, Staphylococcus aureus pneumonia
D, Pulmonary tuberculosis
E, Exudative pleurisy
7, Chronic obstructive pulmonary disease with respiratory failure, easy to occur during
treatment and electrolyte disorder types are: ( )
A, Hyponatremia
B, Hyperkalemia, hypochloremia
C, Hypocalcemia
D, Low potassium, low serum chlorine
E, Hyperchloremia
8, Clinical characteristics of bronchial asthma is: ( )
A, Repeated episodes of paroxysmal expiratory dyspnea
B, Repeated episodes of inspiratory dyspnea
C, Repeated episodes of mixed dyspnea
D, Paroxysmal nocturnal dyspnea
E, The lungs more wheezing with lung bottom rales
9, The asthma patient`s changes under the microscope may not include: ( )
A, Mast cells, macrophages, eosinophils, lymphocytes and neutrophil infiltration under
epithelium
B, Tissue edema
C, Vascular permeability increasing
D, Bronchial secretions increase and storage
E, Intravenous fluids
10, Patients with bronchial asthma increased PaCO2 expression is: (
A, No clinical significance
B, The condition improved
C, Serious illness
D, Early onset
E, Respiratory alkalosis
11, Asthma, Respiratory function examination not including : ( )
)
A, Ventilation function examination
B, Bronchial provocation test
C, Bronchial dilation test
D, Peak expiratory flow and its variability examination
E, A large dose of broad-spectrum antibiotics and antigen desensitization therapy
12, The following measures, the most suitable for the remission stage of chronic bronchitis is:
A, Oral antibiotics to prevent infection
B, Oxygen therapy improve hypoxia
C, Enhanced physique, immune therapy and respiratory Gymnastics
D, The drug antispasmodic, anti asthma
E, The drug expectorant, cough
13, The main route of transmission of tuberculosis is: ( )
A, Digestive tract
B, Respiratory tract
C, Genitourinary tract
D, Blood
E, Skin
14, Female, 50 years old, have diabetes, fever, cough for 3 weeks. The chest radiograph
shows a right dorsal segment of lower lobe 3 cm size hole, smooth inner wall, with mottled
shadows around. The most likely diagnosis is ( ):
A, Atelectasis
B, Lung cancer
C, Staphylococcus aureus pneumonia
D, Secondary pulmonary tuberculosis
E, Pulmonary cyst
15, Pneumococcus pneumonia antimicrobial treatment choice: ( )
A, Streptomycin
B, Ofloxacin
C, Penicillin
D, Amikacin
E, Erythromycin
16, Male, 70 years old, the left lung, the left pleural metastasis, massive pleural effusion. The
shortness of breath significantly, which should be adopted to alleviate the symptoms of the
measures are: ( )
A, Oxygen inhalation
B, Intravenous injection of Aminophylline
C, Oral administration of furosemide
D, Immediately pumping pleural effusion
E, Supine immediately
17, Patient, male, 65 years old, 45 years of smoking. Cough, nearly more than in January
even with blood sputum, with fatigue, fever. Physical examination revealed: the left chest
fullness, frem weakened, percussion is voiced, the left lower pulmonary respiration.
Consideration should be given to the patients of pulmonary lesions: ( )
A, Left lung atelectasis
B, Left pleural effusion
C, Left lung consolidation
D, Left pulmonary bulla
E, Left pneumothorax
18, Chronic bronchitis and emphysema, its are main the symptom is: ( )
A, Suddenly appeared dyspnea
B, The increased difficulty breathing
C, Breathing
D, Cyanosis
E, Palpitation
19, The following primary bronchial lung cancer clinical manifestations, the most common
early symptoms are: ( )
A, Cough
B, Hemoptysis
C, Chest pain
D, Breathing difficulties
E, Fever
20, To identify patients with or without respiratory failure, the most significant of the
following indicators are: ( )
A, Blood gas analysis
B, Cyanosis
C, Consciousness changes
D, Breathing difficulties
E, Sweating
21, Causes of chronic respiratory failure is the most common ( )
A, Pulmonary vascular disease
B, Chronic obstructive pulmonary disease
C, Extensive pleural thickening
D, Extensive pulmonary interstitial fibrosis
E, Respiratory muscle disease
1, The lung is described, is correct ( )
A, 2 leaves right lung
B, 3 leaves left lung
C, Right lung left lung with narrow and long, short wide
D, Pulmonary conical
E, Lung bottom sudden downward
2, The pleural cavity is described, is correct ( )
A, From the diaphragmatic pleura and costal pleura surrounded
B, A left, right lung
C, Left, right pleural cavity
D, Is a serous cavity closed, in a vacuum
E, Above all wrong
3, The bronchial and bronchial tree description, is correct ( )
A, The main bronchi into secondary bronchi, called lobar bronchus
B, Left lung have 3 lobe bronchus
C, Right lung have 2 lobe bronchus
D,Branch of the bronchial a tree, called the bronchial tree
E, Above all wrong
4, Male, 67 years old, cough, sputum production for many years, nearly 2 years of repeated
shot breath , each lasting 3 to 4 months. The most likely diagnosis is ( )
A, Pulmonary tuberculosis
B, Bronchial asthma
C, Bronchiectasis
D, Lung abscess
E, Chronic obstructive pulmonary disease
5, Diagnosis of bronchial asthma is ( )
A, X-ray examination of lung markings, coarse and random
B, Repeated episodes of expiratory dyspnea with diffuse wheezing
C, Double lung covered with dry, wet rales
D, Arterial blood gas analysis of respiratory alkalosis
E, Aminophylline is effective in the treatment of
6, Treatment of acute exacerbation of chronic bronchitis, the following is not appropriate
A.The application of sensitive antibiotics
B.The application of expectorant, antitussive drug
C.The application of bronchodilators
D. Inhalation in dilute sputum
E. Vaccine injection
7,The diagnostic criteria of chronic bronchitis, cough, expectoration recurrent time should be:
A. Episodes per year for at least 3 months, for 10 years
B. Episodes per year for at least 1 months, for 2 years
C. Episodes per year for at least 2 months, for 3 years
D. Episodes per year for at least 3 months, for 2 years
E. Episodes per year for at least 6 months, for 4 years
8, The following check the most meaningful to the diagnosis of chronic obstructive
pulmonary disease is
A. Physical examination a barrel chest, cyanosis
B.ECG showed low voltage
C. Chest X-ray showed lung touliangdu increased, the gap widened
D.Blood gas analysis in PaO2<60mmHg, PaCO2>50mmHg
E. FEV1/FVC<60% pulmonary function, expected value measured MVV / <60%
9, Emphysema, the main symptom is
A. Paroxysmal dyspnea
B. Paroxysmal nocturnal breathing difficulties
C. Increased difficulty breathing, the activity is heavy
D. Cyanosis
E. Palpitation
10, Chronic obstructive pulmonary disease pulmonary emphysema symptoms, the following
is not true
A. Prolonged expiratory phase, expiratory wheezes
B. Reduced breath sounds
C. Sound of distant
D. Pleural friction sound
E. Barrel chest
11, Chronic obstructive pulmonary disease combined with chronic pulmonary heart disease,
the most common cause of death is
A. Arrhythmia
B. Shock
C. Hemorrhage of digestive tract
D. Respiratory failure
E. Electrolyte disorder
12, Laboratory examination can confirm the diagnosis of bronchiectasis is
A, HRCT
B, CT
C, X-Ray
D, B-mode ultrasonography
E, MR
13, Blood gas diagnosed type I respiratory failure should be
A. Arterial oxygen content (CaO2) of less than 20%
B. Arterial partial pressure of oxygen (PaO2) less than 60mmHg
C.PH<7.35
D. Partial pressure of carbon dioxide (PaCO2) is higher than 50mmHg
E. Arterial oxygen saturation (SaO2) of less than 90%
14, The most typical symptoms of patients with hypoxia
A. Accelerated heart rate
B. Cyanosis
C. Headache
D. Excited
E. Dyspnea
15, Changes of pulmonary function in patients with type II respiratory failure is the main
A. Arteriovenous shunt increase sample
B. Alveolar ventilation dysfunction
C. Ventilation / perfusion ratio
D. Diffusion dysfunction
E. Increased consumption of oxygen
16, Hospital acquired pneumonia, the most common pathogens
A. Virus
B. Anaerobic bacteria
C. Gram positive cocci
D. Fungi
E. Gram negative bacilli
17, For bronchiectasis is described, which is not correct?
A, Chronic cough, purulent sputum (related to changes in position)
B, To estimate the severity of available amount of expectoration:
C, Acute infection occurs, yellow green purulent sputum daily volume up to hundreds of ml.
D, With hierarchical feature
E, Sputum no taste
18, Adult hospital acquired pneumonia pathogens is the most common
A. Pneumococcal
B. Haemophilus influenzae
C. Legionella pneumophil
D. Pseudomonas aeruginosa
E. Mycoplasma pneumoniae
19, The most common pathogenic bacteria causing pneumonia for
A. Hemolytic streptococcus
B. Mycobacterium tuberculosis
C. Pneumococcal
D. Staphylococcus aureus
E. Klebsiella pneumoniae
20, Elderly patients with sudden chills, fever, cough, expectoration, sticky sputum, brick red,
jelly, cause infection pathogens most probably
A. Klebsiella
B. Haemophilus influenzae
C. Legionella pneumophila
D. Staphylococcus aureus
E. Pseudomonas aeruginosa
21, Treatment of Streptococcus pneumoniae pneumonia antibiotic is preferred
A. Ofloxacin
B. Erythromycin
C. Penicillin
D. Streptomycin
E. Ciprofloxacin
1, Blood gas analysis, the following 1 given that a type I respiratory failure ( )
A、PaCO2 58mmHg Pa O2 60mmHg
B、PaCO247mmHg Pa O2 40mmHg
C、PaCO2 66mmHg Pa O2 55mmHg
D、PaCO280mmHg Pa O2 40mmHg
E、PaCO2 60mmHg Pa O2 50mmHg
2, Agreed that the lung cancer associated with smoking, the smoke is the major carcinogen
A, Soot
B, Vinyl chloride
C, Chloromethyl methyl ether
D, Tar
E, BAP
3, Which of the following diseases belong to COPD ( )
A, Asthma, bronchiectasis
B, Chronic bronchitis, bronchiectasis, asthma
C, With airflow obstruction, chronic bronchitis and emphysema
D, Chronic bronchitis, asthma, emphysema
E, No airflow obstruction, chronic bronchitis and emphysema
4, Acute exacerbation of chronic obstructive pulmonary disease treatment period is ( )
A, Antitussive, expectorant, antispasmodic,
B, Improving ventilation, correction of acidosis
C, Effective antibiotics
D, Drainage anti infection, supplemented by posture
E, Combination of static and dynamic, systemic medication
5, Treatment of asthma are not included
A, Reduce exposure to the allergens
B, Drug treatment
C, Treatment of acute asthma
D, Treatment of non-acute asthma
E, Operation treatment
6, Type II respiratory failure 6, serious, not inhaling high concentration of oxygen, mainly
because ( )
A Is not the main factor, hypoxia
B, Can cause oxygen toxicity
C, Sleep apnea, promote CO2 discharge too quickly, induced respiratory alkalosis
D, Induced generation of alkali
E, None of the above
7, A measurement of arterial blood gas analysis in patients with pulmonary heart disease PH
7.25, PaO25.3KPa (40mmHg), PaCO267.5mmHg, HCO2 - 19mmol/L, BE-6 mmol/L, ask the
patients ( )
A, Decompensated respiratory acidosis
B, Respiratory acidosis and metabolic acidosis
C, Metabolic acidosis
D, Respiratory acidosis associated with metabolic alkalosis
E, Metabolic acidosis
8, Correct acidosis, the main measure is ( )
A, Transmission and alkaline solution, the pH value is returned to normal
B, Correction of electrolyte imbalance
C, Improving ventilation
D, The use of dehydrating agent to alleviate cerebral edema
E, None of the above
9, Inspiratory dyspnea, serious person can appear three depressions, three concave syndrome
refers to ( )
A, Suprasternal fossa, supraclavicular fossa and intercostal space was sunken on the inhale
B, Suprasternal fossa, supraclavicular fossa and intercostal space was sunken on the exhale
C, Suprasternal fossa, infraclavicular fossa and intercostal space was sunken on the inhale
D, Substernal fossa, supraclavicular fossa and intercostal space was sunken on the inhale
E, Suprasternal fossa, infraclavicular fossa and intercostal space was sunken on the exhale
10, Acute asthma is common cause ( )
A, Pollen
B, Dust mite
C, Infection
D, Aspirin
E, Strenuous exercise
11, The Foundation treatment is incorrect of chronic pulmonary is
A, Improving alveolar ventilation
B, A continuous low flow oxygen
C, There is edema limitation of water, salt intake
D, Improve the nutritional status
E, Application of sedative
12, No urine means ( )
A 24h < 100ml, urine volume
B 24h < 200ml, urine volume
C 24h < 300ml, urine volume
D 24h < 400ml, urine volume
E 24h < 500ml, urine volume
13, COPD is main reason of airflow obstruction ( )
A, Large airway obstruction
B, Small airway disease
C, Double lung wheeze
D, Barrel chested
E, Lung texture thicken
14, Classification of according to the most common etiology, clinical pneumonia ( )
A, Bacterial pneumonia
B, Viral pneumonia
C, Mycoplasma pneumonia
D, Fungal pneumonia
E, Chlamydia pneumonia
15,In pulmonary tuberculosis is the most important source of infection ( )
A, TB contaminated food
B, For bacterial pollution
C, Bacterial pollution of pig
D, Rows of bacteria in patients with pulmonary tuberculosis
E, Sputum negative pulmonary tuberculosis patients
16,Method the diagnosis of pulmonary tuberculosis is the most specific ( )
A, X-ray examination
B, CT examination
C, Sputum examination for tubercle bacillus
D, PPD test
E, B Ultrasound
17, In pleural effusion, pleural effusion diagnosed for acid fast bacilli, the clinical diagnosis
of the patient is most likely ( )
A, Primary pulmonary tuberculosis
B, Infiltrative pulmonary tuberculosis
C, Hematogenous disseminated pulmonary tuberculosis
D, Chronic cavitary pulmonary tuberculosis
E, Tuberculous pleurisy
18, The important risk factors, the incidence of lung cancer is ( )
A, The causative factors of occupation
B, Long-term smoking
C, Immunodeficiency
D, Chronic lung disease
E, Genetic factors
19, The most dangerous big hemoptysis complications ( )
A, Shock
B, Anemia
C, Atelectasis
D, Pulmonary infection
E, Asphyxia
20, Massive hemoptysis refers to ( )
A, A massive amount less than 100ml
B, A massive amount is greater than 100ml
C, A massive amount is greater than 200ml
D, A massive amount is greater than 300ml
E,The amount of 24h by more than 300ml
21, Patients with the most typical symptoms of hypoxia ( )
A, Heart rate
B, Cyanosis
C, Headache
D, Excited
E, Breathing difficultie