Internal Final exam (6th) - 4/5/2023
Oath Batch (2017) - 97 out of 100
1. All are used in the management of tumor lysis syndrome except:
A. Rasburicase
B. Hydration
C. Alluprinol
D. Steroid
E. Furosemide
Answer: E
Explanation: Rasburicase is a medication used to lower the levels of uric acid, which gets increased in tumor
lysis syndrome. Diuretics such as furosemide have no role in the management of tumor lysis syndrome.
2. Patient with prosthetic valve undergoing colonoscopy, what prophylactic antibiotic he should receive?
A. Oral amoxicillin one hour before the procedure
B. IV amoxicillin and gentamycin one hour before the procedure
C. IV amoxicillin and gentamycin one hour before the procedure and amoxicillin after 8 hours
D. No prophylactic should be used
Answer: D
Explanation: Patients with a prosthetic valve are given antibiotics after a dental procedure to prevent
infective endocarditis, in case of colonoscopy there is no need for antibiotics
3. For diagnosis of antiphospholipid syndrome:
A. clinical arterial or venous thrombosis with positive anticardiolipin or lupus anticoagulant is enough
B. isolated B2-glycoprotein antibodies alone can confirm the diagnosis
C. clinical arterial or venous thrombosis with history of abortion can confirm the diagnosis
D. ptt should be prolonged to confirm the diagnosis
Answer: A
4. 24 y male patient who has watery diarrhea for years , he eats cereals with milk every morning with
high fecal elastase level (more than 200) his colonoscopy was normal dx?
A. Lactase deficiency
B. Pancreatic exocrine insufficiency
C. Celiac
D. IBS
E. Microscopic colitis
Answer: A
Explanation: high fecal elastase indicates functional exocrine pancreas)
5. All are true about hyperaldosteronism except :
A. Metabolic alkalosis
B. Muscle weakness
C. Polyuria
D. Hypertension
E. Hypocalcemia
Answer: E
6. A patient who came complaining of proximal muscle weakness and has ELEVATED creatinine kinase
which of the following drugs is most likely to cause this presentation?
A. Simvastatin
Answer: A
Explanation: Statins cause rhabdomyolysis
7. False about Ebola virus:
A. Causes viral hemorrhagic fever
B. Mortality 25 - 90 %
C. Marburg disease
D. Transmitted by mosquito
Answer: D
Explanation: transmitted by direct contact
8. Next step in a patient with large B cell lymphoma who started to have Superior vena cava syndrome
A. Debulking surgery
B. Chemotherapy +stenting when needed
C. Steroids
D. Radiotherapy
Answer: B
Explanation: steroid has no role in SVC syndrome
9. Which is not matched correctly:
A. Hook worm -- Tsetse fly
B. Filariasis - - mosquito
C. Echinococcus granulosus = Dogs and Sheeps
D. Cystocercosis = Pigs
E. Schistosomiasis = Snails
Answer: A
Explanation: Hook worm gets transmitted by direct contact
10. Left lower lung nodule with effusion which is false
A. History of Normal X ray one year ago indicates a benign lesion
B. Presence of malignant cells in the pleural effusion means no surgery can be done
C. Presence of malignant cells in the effusion Stage IVB according to TNM staging
D. Bronchoscopy can aid in the diagnosis
E. Ct guided biopsy can aid in the diagnosis
Answer: A
Explanation: Presence of malignant cells in pleural effusion indicates thoracocentesis to get rid of the fluid
and start chemotherapy. CT and bronchoscopy are indicated also. A is wrong because malignant lesions
grow rapidly, so a normal x-ray one year ago is not confirmative that it is benign. Stage IVB requires distant
metastasis.
11. All are x ray features of pulmonary edema except
A. Kerly B line
B. Batwing sign
C. Blunting of costophrenic angle
D. Increased vascular markings
E. Venous diversion
Answer: C
Explanation: C is seen in pleural effusion and not in pulmonary edema.
12. All are appropriate management of patients with immunodeficiency except :
A. Should be fully vaccinated
B. Early aggressive appropriate antibiotic of they get infected
C. Prophylactic antibiotics
D. Good nutrition and calorie intake
E. Avoidance of pathogens
Answer: A
Explanation: Immunosuppressed are not given vaccines, instead they are given prepared antibodies.
13. An elderly man went hiking in Petra drank water then started to have non bloody diarrhea for two
days. BP was normal but decreases upon standing. Creatinine was high no rbc or protein in urine
fractional Na excretion 2.1 normal hb,platelets and wbc. What is the cause of his kidney injury?
A. ATN
B. Prerenal azotemia
C. Infection induced nephritis
D. Thrombotic cause
Answer: A
Explanation: it doesn’t indicate a prerenal injury (FeNa = 2.1), so the answer is A = acute tubular necrosis.
Acute Kidney Injury, 3 types:
- Prerenal: hypovolemia / decreased kidney effusion
o BUN/Cr >20
o FeNa<1%
o Increasing the absorption fluid and Na
- Intrinsic (renal)
- Postrenal
14. Patient with advanced metastatic prostate cancer and bilateral hydronephrosis with acute renal
failure asked for management:
A. Double J catheter
B. Radiotherapy
C. Chemotherapy
D. Refer to surgery
Answer: A
Explanation: A is indicated to relieve the hydronephrosis
15. All true about DIC except:
A. High fibrongen
B. Prolonged ptt
C. Low platlets
D. High d dimer
Answer: A
Explanation: all coagulation factors are depleted. Fibrinogen is degraded so there will be low levels of it.
16. Most common complication of coronary angiography:
A. Peripheral vascular complication
B. Contrast nephropathy
C. MI
D. Stroke
E. Cholesterol embolization syndrome
Answer: A
Explanation: because we insert a catheter from the femoral artery mostly, so it may cause damage or
hematoma most commonly.
17. A patient who developed fever, myalgia, headache, and a blue toe following PCI all of the following
may be related to the differentials of his case EXCEPT:
A. Interlobar pulmonary artery showing cholesterol clefts
B. Eosinophilia and eosinophiluria
C. Thrombocytopenia and hypocomplementimia
D. Focal segmental glomerulosclrosis
E. High ESR normal platlets and leukocytes
Answer: C
Explanation: this patient has cholesterol embolism syndrome
18. A case about a patient with recurrent palpitations and syncope he has a mid-diastolic murmur relieved
when she lies on her right side with vasculitic rash what is the most likely cause of his symptoms
A. Mitral stenosis
B. Left atrial myxoma
C. Tricuspid stenosis
D. Aortic stensois
Answer: B
Explanation: Left atrial myxoma causes vasculitic rash and other mentioned symptoms, not caused by
stenosis.
19. Hypokalemia ECG changes , all true except:
A. U wave
B. QT prolongation
C. ST depression
D. Delta wave
E. flattening of T wave
Answer: D
Explanation: Delta wave is seen in WPW syndrome, which causes early depolaixation due to an accessory
pathway of the nerve bundles in the heart.
20. Regarding drugs and their antidote which of the following is incorrectly matched:
A. Cyanide —> Oxygen
B. Warfarin —> Vitamin K
C. Iron —> Desfuraxamine
D. Calcium channel blocker —> Adrenaline
E. Lead —> DMSA
Answer: A
Explanation: Currently, the available cyanide antidotes are hydroxocobalamin, sodium nitrite, and sodium
thiosulfate.
21. Which of the following is an Indication for revascularization in renal artery stenosis :
A. HTN for 15-20 years
B. Acute MI
C. HTN refractory for 3 drugs
D. Stroke
E. Flash pulmonary edema
Answer: C
Explanation: resistant hypertension is an indication for revascularization
22. Asthma patient in inhaled corticosteroids, develop oral thrush, next step :
A. Decrease steroid dose
B. Same dose + nystatin
C. Stop steroid.
D. Same dose + acyclovir
Answer: B
Explanation: Candida infection as a result of decreased immunity. Steroids are not stopped in asthma
patients even if oral thrush develops. Instead, nystatin (which is an antifungal) is added.
23. Patient with recurrent dysphagia and resistant to PPI, gastrodoudenoscopy was done, GI tumors
excluded which do you expect to see in a biopsy taken from the esophagus
A. Eosinophils more than 20
B. Absent ganglion cells in the myenteric plexus
C. Lymphocytes more than 50
Answer: A
Explanation: Case of eosinophilic esophagitis (most important they are resistant to PPI).
24. Wrong about GERD
A. Causes IDA
B. May cause SCC of the esophagus
C. May cause adenocarcinoma of the esophagus
D. Benign lower esophageal stricture
Answer: B
Explanation: GERD causes adenocarcinoma in the lower third of the esophagus. SCC is most commonly in the
upper 2/3 and it is caused by other factors.
25. Patient with chronic GERD for 30 years on 20mg PPI endoscopy shows 3cm area biopsy showed
metaplastic columnar epithelium (high grade dysplasia):
A. Management
B. Fundoplication surgery
C. Increase PPI dose
D. Endoscopic resection of the metaplastic mucosa
E. Radiotherapy
Answer: D
Explanation: this is Barrett’s esophagus and it is managed by the resection of the metaplastic mucosa.
26. Patient with Wolff Parkinson white syndrome came to the ER with palpitations and his ECG showed
Irregular Broad complex tachycardia , his BP 80/50 what is the most appropriate management:
A. IV amiodarone
B. DC cardioversion
C. Amlodipine
Answer: B
Explanation: it is not sinus tachycardia because of broad complex, and not stable due to the irregularity, thus
it is managed by cardioversion
27. Right Pancoast tumor, all true except:
A. Anhidrosis
B. Miosis
C. Exophthalmos
D. Hoarseness of voice
E. Ptosis
Answer: C
Explanation: Anhidrosis, ptosis and miosis are part of Horner’s syndrome caused by Pancoast Tumor.
Hoarseness of voice is caused by the pressure on the recurrent laryngeal nerve. Exophthalmos is specific for
Grave’s disease not for Pancoast tumor.
28. A 65-year-old woman came to the clinic complaining of fatigue EVERYTHING NORMAL except Hgb was
8gm/dl what would you do next?
A. Peripheral blood smear
B. Colonscopy
C. Give folate & b12
Answer: B
Explanation: any elderly patient with microcytic anemia we should rule out the causes of iron deficiency
anemia. The most important to rule out is occult bleeding due to colon CA which is done by colonscopy.
29. A 30-year-old man with IgA nephropathy, 1.2 g proteinuria per day, estimated glomerular filtration
rate (eGFR) is 80 ml/min/1.73m2, blood pressure 128/75 mmHg. Which of the following is the
preferred initial therapy:
A. Dietary salt and protein restriction only
B. Dihydropyridine calcium channel blockers
C. Oral angiotensin converting enzyme inhibitor (ACE-I)
D. Oral calcitriol
E. Oral steroids and ACE-I
Answer: C
30. Type 1 dm, 6.2% hba1c, planning to get pregnant, <25 microalbuminuria, something in her eyes as
well, she’s NORMOTENSIVE on enalapril (she takes enalapril for microalbuminuria), your advice ?
A. Stop enalapril give labetolol 100mg twice daily
B. Stop enalapril and observe blood pressure
C. Advice not to get pregnant until hba1c <5.5 to minimize further microvascular complications
Answer: B
Explanation: any DM patient is given enalapril to protect their kidney. Enalapril has a teratogenic effect so it
should be stopped.
31. CKD case, GFR 20, hypocalcemia, hyperPTh, hyperphosphatemia what to give to slow down
progression?
A. CaCO3
B. Sevilamir
C. Alphucalcidiol
D. Cinacalcit
E. AIOH3
Answer: B
Explanation: Sevilamir is given to manage the phosphate level.
32. Patient found to have Afib on ECG, was given aspirin, digoxin & …, recurrent TIA. Next step
management?
A. Anticoagulant
B. Carotid endartectomy
C. Clopidogrel
Answer: A
Explanation: CHA2DS2VASC score should be calculated. Management of AFib consists of 3 parts: rate control,
rhythm control, anticoagulant if needed and it is determined by the score.
33. Hypertensive crisis Goal of BP
A. Lower MAP by 15-25% in the first hour
B. Lower MAP by 30-40% in the first hour
Answer: A
34. Patient having wrist and knee pain takes ibuprofen for pain for long time . Presents with nephrotic
range proteinuria and spot Cr protein >4.2, most likely ?
A. MPGN
B. FSGS
C. Amyloidosis
Answer: C
Explanation: AL amyloidosis Is seen with chronic diseases, and this patient has RA. NSAIDs cause
membranous nephropathy which is a subtype of nephrotic syndrome.
35. What is the complications we aim to avoid in FMF:
A. Amyloidosis
B. Arthritis
C. Pericarditis
Answer: A
Explanations: Symptoms of FMF:
- Peritonitis
- Pleuritis
- Abdominal pain
- Arthritis
- Pericarditis
- It affects the kidney (Nephrotic Syndrome)
- Dilated cardiomyopathy in the heart
So we treat to prevent amyloidosis.
36. All of the following pairs of infections and skin rash are matched except
A. Vesicular rash and measles
B. Hemorrhagic Rash and Ebola virus
C. Ulcerating nodules (chancres) and syphilis
D. Erythema marginatum and rheumatic fever
E. Erythema nodosum and tuberculosis
Answer: A
Explanation: Measles cause maculopapular rash, with cough, coryza, Koplik spots. Remember Jones criteria
in rheumatic fever.
37. All the following clinical signs of poisoning are paired with the offending agent, except:
A. Rhabdomyolysis – Amphetamines
B. miosis – opioids
C. Tachycardia – Theophylline
D. 8Decreased respiratory rate – Salicylates
E. Right upper quadrant tenderness – Paracetamol overdose
Answer: D
Explanation: Salicylates cause respiratory alkalosis (by increasing RR) with metabolic acidosis. E is correct
because Paracetamol overdose cause fulminant hepatitis. Opioid decrases the sympathetic activity leading
to miosis.
38. Acute asthma exacerbation, during transport experienced SUDDEN worsening of dyspnea and pleuritic
chest pain , what to order to confirm diagnosis?
A. CXR
B. ECG
C. ABG
D. CT
E. CT angio
Answer: A
Explanation: We do CXR to exclude pneumothorax.
39. A case about asthma exacerbation he was given steroids , salbutamol , … etc. his ABG showed PCO2 =
53mmHg (showed type 1 rs failure), we gave magnesium sulfate and there was no response. What
would you do?
A. BiPaP
B. CPAP
C. Mechanical ventilation
D. Theophylline
E. IV salbutamol
Answer: C
Explanation: Severe asthma exacerbation is characterized by silent chest + normal ot high PCO 2. As
magnesium sulfate was given and there was no response we should do mechanical ventilation.
40. HBV found to have 3/4 ? fibrosis, and high viral load (20000) DNA, management ?
A. No need to treat just observe
B. Give interferon for 1 year
C. Give anticavir for 5 years
D. Give Lamivudine
E. Give tenofavir
Answer: D (most likely)
Explanation: I cant only observe the patient as he has a high viral load, if it was asymptomatic I could keep
the patient on observation and that would be OK. We give Lamivudine which is an anti-viral acc. to the
doctor’s slides.
41. About HIV, what is wrong?
A. Vertical transmission mostly during pregnancy
B. Transmission through breastfeeding
C. Circumcision decreases the risk of transmission
Answer: A
Explanation: vertical transmission mostly during delivery, less likely in pregnancy so the answer is mostly A.
42. One is false about insulin hypoglycemia test:
A. It will cause increase in GH secretion
B. Can be used safely in coronary artery disease patients
C. Normal response: cortisol rising to > 18 microgram/dL
D. It works on the principle of stimulation to diagnose a deficiency
E. It will activate the whole HPA axis
Answer: B
Explanation: It is contraindicated in CAD. Insulin test causes hypoglycemia and elevation in hormones that
increase glucose (GH and cortisol).
43. All of the following can be found in a patient with primary hyperparathyroidism EXCEPT:
A. Hyperphosphatemia
B. Hypercalcemia
C. Ostietis fibrosa cystica
D. Psuedofracture
E. Elevated PTH
Answer: A
Explanation: It causes the excretion of phosphate and the reabsorption of Ca → Hypophosphatemia. In 2ry
and 3ry hyperPTH it presents with hyperphosphatemia (CKD→Hyperphosphate→HyperPTH) not like the
primary hyperPTH. Osteitis fibrosa cystica is caused by the excessive excretion of PTH.
44. Which is false about H1N1 :
A. Can be prevented by influenza seasonal vaccine.
B. Does cause myositis , pneumonia, hepatitis.
C. Incubation period 1-3 weeks
D. Can be treated by neuraminidase inhibitor.
E. Can cause secondary pneumonia due to strep.pneumonia
Answer: C
Explanation: Incubation period is about 3 days. If it was early we can treat with neuraminidase inhibitor.
45. A female patient developed severe abdominal pain 3 weeks postpartum, with gallstone and CBD
dilation on US, High amylase and lipase what would be your management?
A. Urgent ERCP
B. Refer to surgery for cholycystectomy
C. Ergent MRCP
D. IV fluid and observation
Answer: A
Explanation: typical case of Gall stone pancreatitis, Urgent ERCP is indicated in cholangitis that leads to
abscess or a stone in the common bile duct.
46. Absolute contradiction for Alteplase?
A. A 42-year-old women with absent menses for 7 months and abdominal distention
B. Laser eye surgery
C. LBBB
D. Old lady has acute chest pain STEMI and was transferred to CCU. Her BP was found to be 180/100
but it’s easily controllable
E. New onset diastolic murmur
Answer: E?
Explanation: Mostly there was a choice of hx of hemorrhagic stroke. Alteplase is a thrombolytic so it will be
indicated in cases of hemorrhagic strokes. E doesn’t seem to be a contraindication, except if it means that
the patient has aortic dissection.
47. An old woman with a history of stroke who is currently being fed via a gastrostomy tube presents with
sudden onset dyspnea and fever 38.3 and on physical exam was found to have bilateral rhonchi and
her CXR showed bilateral lower lobe infiltrate which of the following would be the best management?
A. IV antibiotics
B. Semi sitting position
C. Deep tracheal suctioning
D. Iv furosemide (not sure)
Answer: C (Most likely)
Explanation: In cases of lung abscess we do deep tracheal suction. There is no abscess in the question but
most likely it is the answer.
48. A young athlete male who recently suffered ankle sprain and he is taking excessive amounts of NSAIDs
to relieve his pain , he had two episodes of hematemesis and his endoscopy showed a 1cm clear base
ulcer, Hgb = 8gm/dl, Which of the following is the least likely to be recommended?
A. Admit for observation
B. Avoid all NSAIDs and acetaminophen
C. Prepare PRBCs for infusion
D. Order H-pylori stool antigen
Answer: C (NOT SURE)
Explanation: We do blood transfusion as he had two episodes of hematemesis and drop in Hgb, but it is not
a necessity in this case as it can be managed by other options.
49. Patient with COPD and signs of cor pulmonale PO2 54mmHg which of the following will increase
survival?
A. Continuous O2 therapy
Answer: A
50. In which of the following scenarios is BiPAP used?
A. COPD in a patient who is awake.
B. Patient with stroke
C. In a comatosed patient
Answer: A
Explanation: BiPAP or VPAP, is a positive airway pressure device that provides two levels of pressure: a
higher-pressure during inhalation (inspiratory positive airway pressure, IPAP) and a lower pressure during
exhalation (expiratory positive airway pressure, EPAP).
51. A thin tanned patient with TB and adrenal insufficiency signs and symptoms, cosyntropin stimulation
test failed to increase cortisol level what Is the cause of his symptoms?
A. Disseminated TB
B. Stopping inhaled steroids
C. Stopping steroids after more than one year of using it
Answer: A
Explanation: Cosyntropin stimulation test is the same as ACTH stimulation test. TB is one of the bacterial
infections that cause damage to the adrenal gland, so one it is disseminated it causes adrenal insufficiency
and thus it will be no longer responding to ACTH.
52. Patient with hemoptysis and abnormal KFT (1 week ago was normal) with low C3 and normal C4 which
of the following is unlikely to be the cause of his Acute/subacute renal failure?
A. Dense deposit disease
B. C-ANCA
C. Infective endocarditis
D. MPGN
E. SLE
Answer: B
Explanation: C-ANCA doesn’t cause low complement levels, it is associated with diseases such as
Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA) which are types of vasculitis.
53. Case of sarcoidosis all true except
A. Hypocalemia
Answer: A
Explanation: Hypercalcemia in sarcoidosis is due to the uncontrolled synthesis of 1,25-dihydroxyvitamin D3
by macrophages. 1,25-dihydroxyvitamin D3 leads to an increased absorption of calcium in the intestine and
to an increased resorption of calcium in the bone.
54. Young patient (20s) with 7-8 times bloody diarrhea most likely diagnosis:
A. Ulcerative colitis
B. IBS
Answer: A
Explanation: among the choices there was nothing that causes bloody diarrhea. Note that this type of
diarrhea doesn’t happen in Crohn’s patients.
55. Best test to screen for DM nephropathy:
A. Urine albumin
B. Creatinine Clearance
C. Creatinine serum level
Answer: A
Explanation: Creatinine clearance cant be measured accurately, so the answer is A.
56. Which of the following is a side effect of heparin?
A. Skin necrosis
B. Thrombocytopenia
C. Hemolytic anemia
Answer: B
Explanation: warfarin causes skin necrosis, but heparin may cause HIT end by thrombocytopenia. Hemolytic
anemia can be caused by other drugs.
57. False about Cushing syndrome:
A. High dose dexamethasone suppression test used for screening
B. 24-hour urine cortisol
Answer: A
Explanation: for screening Cushing syndrome we use LOW dose dexamethasone suppression test NOT high
dose. ACTH should be decreased by low dose dexamethasone thus there will be no cortisol secretion.
58. Patient has a sore throat then he developed hematuria after 2 days, the most likely diagnosis is:
A. IgA nephropathy
B. Alport's syndrome
C. Post strep. Glomerulonephritis
Answer: A
Explanation: C could be correct if the duration is about 1 week at least, but here it is 2 days so its IgA
nephroathy. Alport syndrome is a case of collagen IV defect, known as “cant see (cornea), cant pee (kidney),
cant hear a bee (cochlea)”
59. LDL goal in a diabetic patient who had CABG:
A. 70
B. 40
C. 100
D. 120
E. 160
Answer: A
Explanation: Managing LDL levels in these patients is crucial to reduce the risk of future cardiovascular
events and to promote long-term cardiac health.
60. Regarding Bleeding from the gastrointestinal tract, which of the following statements is True
A. Hemodynamic disturbances usually do not occur if blood loss is less than 500 ml
B. Patient with hematemesis usually has more severe bleeding than the patient who has melena
C. Melena usually indicates bleeding from the colon
D. Occult bleeding occurs when the blood loss is more than 60 ml
E. Commonest cause for bleeding is Carcinoma of the gastrointestinal tract
Answer: A
Explanation: B) melena can be more severe than hematemesis. C) Melena usually indicates bleeding from
the upper GI.
61. A 40-year-old man with liver cirrhosis due to hepatitis C virus infection diagnosed 10 months ago
presented with repeated hematemesis and melena for last 24 hours. Physical examination showed
blood around the mouth and on his bed with pulse of 125 per minute and BP of 80/50mmHg.
Abdominal examination showed palpable liver 4 cm and spleen felt 3cm below costal margin, no
ascites and no LL edema. What is the best management for this patient at this stage:
A. Patient should be given PI therapy, octreotide infusion and Blood transfusion as needed with
antibiotics and Lactulose orally
B. Immediate TIPS is the best immediate management
C. Admit the patient to ICU and transfuse him with blood to keep him hemodynamically stable
D. To be given Nonselective beta-blockers to stop bleeding and give Octreotide
E. Infusion with antibiotics IV and start Harvoni therapy as early as possible intubate the patient and
arrange for urgent gastroscopy after resuscitation
Answer: C
Explanation: in esophageal varices hemorrhage the beta blocker is contraindicated, but for long term
management of NON bleeding esophageal varices we use betablocker. The patient is unstable so we should
stabilize him by blood transfusion.
62. A 23-year-old male patient complains of back pain that is worse at the morning and relieved with
activity. Which of the following from history helps confirming the diagnosis?
A. History of disc
B. History of Dm
C. History of psoriasis
D. Irritable bowel disease
E. History of gout
Answer: C
Explanation: History is consistent with ankylosing spondylitis. The patient presents with sacroiliitis. To
confirm the diagnosis of ankylosing spondylitis we should check the presence of seronegative
spondyloarthropathy. 4 types:
- Ankylosing
- Psoriasis
- IBD
- Reactive arthritis
63. All of the following are correct regarding DKA except?
A. Normal anion gap
B. Bicarb < 16
C. pH < 7.3
D. Ketonemia and ketonuria
Answer: A
Explanation: Anion Gap = Na - (Cl+HCO3), normally 10-12 mEq/L
64. A 55-year-old Man presents with orthopnea and recurrent paroxysmal nocturnal dyspnea attacks. He
has Raised JVP, tender hepatomegaly with palpable swelling in the epigastrium and gross pitting LL
edema. There was dullness in both flanks which showed positive shifting on lying at one side. What is
the most likely diagnosis for his ascites
A. Protein losing nephropathy secondary to heart failure
B. Liver cirrhosis
C. Carcinoma of the stomach with peritoneal metastasis
D. Hepatocellular carcinoma
E. Congestive heart failure
Answer: E
Explanation: typical presentation of heart failure.
65. Distention of neck veins during inspiration is most likely to be found in
A. Cardiac tamponade
B. Constrictive pericarditis
C. Myocarditis
D. Normal physical exam
E. Dilated cardiomyopathy
Answer: B
Explanation: Positive Kussmaul’s (in constrictive pericarditis) sign a paradoxical rise in jugular venous
pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration.
66. All of the following causes bronchiectasis except?
A. Rheumatoid arthritis
B. Kartagener syndrome
C. Cystic fibrosis
D. Hypogammaglobulinemia
E. Hypersensitivity pneumonitis
Answer: E
67. (PYQ) acromegaly saying patient has widely space teeth and other sign of acromegaly asking about
most important thing to confirm diagnosis.
A. Increased insulin like growth factor
Answer: A
Explanation: Acromegaly patients have elevated levels of IGF-1 and GH. GH here is not suppressed by
glucose in glucose tolerance test.
68. Which of the following features is not suggestive of decompensated liver cirrhosis:
A. Presence of flapping tremors in outstretched hands
B. History of bleeding varices
C. Presence of positive shifting dullness on abdominal examination
D. Biphasic bilirubin 6 ma/dl
E. ALT above 500 IU/L
Answer: E
Explanation: Flapping indicates encephalopathy. Varices can happen also due to portal hypertension. Liver
enzymes are not elevated in liver cirrhosis.
69. Treatment of thyrotoxicosis all except:
A. Anti thyroid
B. Steroids
C. Salicylate
D. Cold baths
Answer: C
Explanation: Salicylate has no role in the management of thyrotoxicosis.
70. A patient who was diagnosed with TB and is currently being treated he notices peripheral numbness
and tingling sensation which of the following TB medications is most likely to cause his symptoms:
A. Rifampicin
B. Ethosuximide
C. Ethambutol
D. Isoniazid
E. Rifabutin
Answer: D
71. An ABG case pH=7.15,HCO3=12, PaCO2=35, Na=145, Cl=99, which of the following best describes the
acid base abnormality:
A. High anion gap metabolic acidosis with respiratory acidosis
B. Low anion gap metabolic acidosis with respiratory acidosis
C. High anion gap metabolic acidosis and respiratory alkalosis
Answer: A
72. Young patient with chronic dry cough for 3 months that awakens him from sleep upon examination he
has some nasal and mucosal congestion what is the most likely diagnosis:
A. Postnasal drip
B. GERD
C. Variant Asthma
Answer: C (most likely)
Explanation: Mostly variant asthma because postnasal drip should be preceded by hx of URTI then dry cough
73. In a patient with hyponatremia which of the following is least important to measure?
A. Random glucose
B. LDH
C. TSH
D. Urinary sodium excretion
Answer: B
Explanation: thyroid and parathyroid can affect serum calcium and sodium in the body, so it is important to
measure TSH and not very important to measure LDH.
74. Alcoholic patient with
palpitations came to the
ER with the following ECG
what is the most likely
diagnosis:
A. Atrial flutter
B. SVT
C. Atrial fibrillation
D. Multifocal atrial
tachycardia
Answer: C
Explanation: A) saw tooth appearance is not present. B) The beats are regular, while in the ECG here they are
not. D) Preceded by respiratory disease and appears on ECG as ectopic P wave. C is correct, atrial fibrillation
is irregularly irregular with absence of P wave.
75. Female patient 21 years old fainted while she was running to the bus. She had a brother who died in a
small age. What is the diagnosis:
A. HCOM
B. Dilated cardiomyopathy
C. Aortic stenosis
Answer: A
Explanation: Cardiac syncope is rapid onset and rapid recovery with no post syncope confusion (this
differentiates it from seizures). Cardiac syncope happens in hypertrophic cardiac obstructive
cardiomyopathy (HCOM). B) Dilated cardiac myopathy doesn’t present as fainting and sudden death. C)
Aortic stenosis is not common in this age and presents with syncope, angina and dyspnea (SAD).
76. A patient with history of DVT and his father also had DVT what is the most probable diagnosis:
A. Factor V leiden mutation
B. Hyper – homocysteinemia
C. Antiphospholipid syndrome
Answer: A
Explanation: Factor V Leiden is the most common inherited form of thrombophilia, hx indicates
hypercoagulability.
77. A case of DVT with history going with Bechet disease which of the following goes with diagnosis:
A. Recurrent oral and genital ulcers
Answer: A
78. 74 y old patient with Normal platelets and HB but very high (>100000) WBC which is mostly
lymphocytes and there was no lymphadenopathy or hepatosplenomegaly discovered through routine
follow up
A. CLL
B. Leukemoid reaction
Answer: A
79. All of the following can be seen in primary adrenal insufficiency except:
A. Hyperkalemia
B. Hyponatremia
C. Metabolic Alkalosis
D. Skin hyperpigmentation
E. High ACTH
Answer: C
Explanation: Alkalosis is an effect of aldosterone, so insufficiency leads to acidosis.
80. Which of the following statements is True regarding HCV infection:
A. Hepatocellular carcinoma rarely develops in patients with cirrhosis due to HCV infection
B. Liver cirrhosis develops in 50% of infections within 5 years of infection
C. Treatment with Ledipasvir/sofosbuvir is usually effective
D. It is the commonest cause for fulminant hepatitis
E. Vaccination is the best measure to combat HCV infection
Answer: C
Explanation:
A: most common cause of HCC is (HBV, HCV)
B: Around 30% (15–45%) of infected persons spontaneously clear the virus within 6 months of infection
without any treatment. The remaining 70% (55–85%) of persons will develop chronic HCV infection. Of those
with chronic HCV infection, the risk of cirrhosis ranges from 15% to 30% within 20 years
C,E: First-line treatment regimens for people with no cirrhosis: sofosbuvir + velpatasvir for 12 weeks.
glecaprevir + pibrentasvir for 8 or 12 weeks. There is no vaccination against HCV
D: Fulminant hepatitis is most often caused by: An overdose of acetaminophen.
81. A 30-year-old female with intermittent dysphagia to both liquids and solids for several years with
history of 10Kg weight loss (Was 70Kg now 60Kg can’t remember the duration) which of the following
would be done to diagnose this patient:
A. Manometry
B. Endoscopy
C. Barium Swallow
D. 24 pH monitoring
Answer: C
Explanation: Dysphagia to solids and liquids indicates achalasia while mechanical obstruction manifests with
dysphagia to solids, the first step in the investigations is barium swallow.
82. All of the following statements are true regarding hyperprolactinemia EXCEPT
A. May cause infertility
B. May cause Galactorrhea
C. Antipsychotic therapy is well
known cause
D. Treatment is by using Dopamine
ANTAGONISTS
E. It causes erectile dysfunction in
males
Answer: D
Explanation: we use dopamine AGONIST for treating it
83. A female patient symmetrical joint pain and stiffness of all metacarpophalangeal and PIP joints (20
small joints) with positive rheumatoid factor, which of the following will be used to conform her
diagnosis:
A. Anti CCP
B. No need for further investigations
C. ANA
D. ESR
Answer: Most likely B
Explanation: according this criteria they write ACPA OR RF SO i
think that is suffeceint to dx patient without any other
investigation.
84. A patient with history of joint pain , fever , leukopenia (case of SLE) which of the following
investigations will be used to screen for the disease:
A. ANA
B. Anti Ds-DNA
C. Anti Smith
Answer: A
Explanation: for screening → ANA // for confirming → Anti-ds-DNA
85. A case about a man who was found to be anemic with MCV 136 and low retics count (< 1%) which of
the following test is most helpful:
A. B12
B. Direct coombs test
Answer: A
Explanation: The patient has microcytic anemia, so there is a problem in the genetic material and the
division of RBCs. That’s why it has low retics count while in Iron Deficiency Anemia causes high retics count.
Direct Coombs test is used to detect hemolysis.
86. A non smoker male patient came complaining of dyspnea and on physical exam he has bilateral fine
crackles with PFT of restrictive long disease (LOW FEV1 , LOW FVC, normal FEV1/FVC) which of the
following is the most likely diagnosis:
A. Idiopathic pulmonary fibrosis
B. COPD
C. Asthma
Answer: A
Explanation: Idiopathic Pulmonary Fibrosis is the most common to cause the restrictive pattern). COPD and
Asthma are obstructive.
87. Regarding secondary HTN which statement is more accurate:
A. Pure white coat HTN accounts for 5% of cases
B. Renal parenchymal disease is the most common secondary cause of HTN
C. A small cuff will cause lower than the actual BP measurement
D. Brachial artery sclerosis will result in lower readings than the actual
E. Pheochromocytoma , and other 2 causes account for the majority of secondary HTN
Answer: B
Explanation:
A) 95% of HTN are essential or idiopathic (primary)
B) Renal/renovascular disease like renal artery stenosis (most common cause of secondary HTN)
C, D) it causes higherreadings.
E) Majority of causes are due to renal parenchymal disease
88. All of the following are secondary causes of FSGS except:
A. Morbid Obesity
B. Multiple Myeloma
C. HIV
D. Low nephron number
E. Sickle cell disease
Answer: B
89. A known diabetic patient (type 1) came to the ER with nausea vomiting and abdominal pain which of
the following is incorrect: (CO2 = 25mmHg pH = 7.24 HCO3 = 12mmHg)
A. Wide anion gap metabolic acidosis
B. Inadequate respiratory compensation
C. Hyponatremia and hyperosmolarity
D. Admit to the ICU
E. Insulin infusion
Answer: B
Explanation: According to winter formula its not decompensated
90. Case about patient who take steroid and then get infected, which of the following is a thing that you
will not do in the management:
A. Weaning the patient from the steroid while getting the antibiotics
Answer: A
Explanation: It's safe to take most antibiotics with steroids—and the combination may even help you
recover from infection faster. from google”)
- Mostly the original question was about an adrenal insufficiency patient who takes steroids, so we
don’t stop steroid for these patients.
91. Which of the following is least likely associated with DVT
A. Diarrhea
B. Hemoptysis
Answer: Probably A
Explanation: Hemoptysis can appear if the is vasculitis in the lung.
92. Which of the following is not used in the management of hypercalcemia.
A. Hydration
B. Calcitonin
C. Denosumab
D. Zoledronic acid
E. Steroids
Answer: E
93. Case of dermatomyositis (obvious)
Explanation: patients came wth proximal muscle weakness and rash around the eye and sometimes on the
hands it is violet in color.
94. Case of SCLERODERMA
Explanation: autoimmune disease, may be systematic or localized, if it is localized → CREST Syndrome
95. Case about celiac disease and how would you confirm it? Anti tissue transglutaminase Antibody
96. Question about CML all of the following are true except? T13:14
97. A patient with DM , HTN with painful joint swelling (something like that)? Gout
Done By: Dr. Waleed Osho & Dr. Yousuf Alzoubi
Checked by: Dr. Mohammad Alzoubi, Saja Radaideh, Wasan Abadi