Promotion MCQ

1- 24y old man has noted for the last 2 m that his face is swollen in the morning. He has lost 10kg in weight over 6 m. O/E his external jugular veins are dilated. CXR shows mediastinal mass. Which one of the following is the most likely diagnosis of superior vena caval obstruction :

a- Aden carcinoma of the lung. b- Hodgkin's dis c- sarcoidosis d- seminomas e- TB

2- which one of the following is the most typical feature of adult SCA a- aplastic anemia b- neonatal spherocytic haemolytic anemia c- pulmonary emphysemia d- splenomegaly with hypersplenism e- polyarthritis

3- which of the following coz increase in the gastric motility a- anorexia nervosa b- gastrinoma c- vestibular neuronitis d- acute intermittent porphyria e- partial gastrectomy

4- which of the following m innervated by my 4th cranial n a- MR b- LR c- SO d- IO e- SR

5- which of the following m supply by median n a- external pollicis longus b- flexor carpi ulnaris c- abductor pollicis d- the medial 2 lumbricalis e- external pollicis brevis

6- 55y woman presented to emergency with C/o pain & tinnitus in the RT Ear facial numbness, one day history of facial asymmetry and abnormal Vesicles the most likely diagnosis is

a- pemphogus vulgarisb- ramsay hunt syndromec- lyme diseased- malignant OMe- bells palsy

7-the following vial haemorrhagic fever has been reported in SA except:a- rift valley feverb- alkhomra feverc- dengue feverd- yellow fevere- crernian congo hemorrhagic fever

8- 15y girl is admitted with palpitation & easy bruises. Her Menarche was 2y ago since then she is having heavy blood loss during her period O/E she was pale, few ecchymotic patches on lower limbs. Investigation shows microcytic anemia normal WBC & PLT renal, PT. PTT prolonged, serum feritin is markedly decreased.

The following test are likely to reveal the etiology:a- serum iron, TIBC, U/S examinationb- bone marrow aspirate & biopsyc- mixing study, anticardiolopind- PLT function test, VWF e- Factor 8 & 9

9- in pre marital clinic the ELISA test for HIV is positive & there is no risk factor for HIV infection before reporting the test result we should do Weston blot because the ELISA test for HIV in this settings has :

a- low positive predictabilityb- low negative predictabilityc- low sensitivityd- low specifitye- low reproducibility

10- autoimmune hemolytic anemia is a feature of the following diseases except :a- mycoplasma pneumoniab- Evans syndromec- hemolytic uremic syndromed- lymphomae- SLE

11- 55y old Saudi female returned from Philippines after non related kidney Transplant with no post op complication 3m ago. She presented to ER C/O dry Cough, fever, SOB for 15 days. She is on prednisone, cellcept, trim-sulfa. CXR revealed bilat Interstitial markings with effusion. Creatinine was normal.O2 sat 90% RR22 which of the following will most likely establish the diagnosis: a- blood culture b- VAL for M.tuberculosis complex c- CMV antigenemia & culture d- sputum induction for pneumocystis carinii stain e- urinary antigen for legionella

12- 57y old female is admitted with G- septicemia IV antibiotics & NS was started. 2 days later she get worse CXR bilateral infertilities. PMH HTN on regular antihypertensive she has never had any evidence of CHF She was diagnosed as ARDS. which of the following can be done to Distinguish btw cardiogenic & noncardiogenic pul edema :

a- measurement of the central venous pressureb- calculation of AA gradientc- measurement of pulmonary arterial wedge pressured- measurement of lung compliancee- measurement of EF

13- in the evaluation of venous thromboembolism D Dimer testing is :a- it has high sensitivity b- it is usually negative in sub segmental PE c- it is positive only in VTEd- it has high negative predictive value.

14- 60 y old man underwent a coronary angiogram for unstable angina whilst Recovering in hospital he C/O severe pain in his RT foot. and loss of sight in the LF eye O/E there is Gangrene of the lateral two toes. Fundoscopy reveals cholesterol emboli . the lower limb peripheral pulses are normal which of the following is The most possible Dx :

a- atheroembolic disease.b- Polyarteritis nodosac- Buergers diseased- Arterial thromboembolisme- DIC

15- 72y old woman in the cardiology clinic Dx CHF with EF 35% which of the Following treatment would be expected to achieve the greatest reduction in cardiovascular mortality:

a- atenololb- digoxinc- furosemided- spironolactonee- valsartan

16- 45y old man attends the ER C/O fatigue, SOB, fever joints pain, for 4 week O/E LL edema, raised JVP giant V waves, bil pulm creps, Hepatomegaly what is the Dx

a- alcohol-related cardiomyopathyb- bacterial endocarditisc- pul HTNd- pulm stenosise- sarcoidosis with cardiac involvement

17- middle aged man with a varied occupation history O/E there is fine inspiratory crepitations & central cyanosis CXR predominantly lower zone reticular nodular infiltrates which of the following disorders is the most likely explanation :

a- silicosisb- sarcoidosisc- asbestosisd- ankylosing spondylitise- TB

18- 58y old woman with known aortic stenosis C/O chest tightness & SOB Which of the following investigation would be most helpful

a- cardiac cathb- CXRc- Exercising ECGd- Pulmonary function testse- Repeat echo

19- 30y old male has one year H/O palpitation, dizziness but no syncope. positive H/O Alcohol. He is no regular medication Dx WPW

The most appropriate treatmenta- amiodaroneb- flecainidec- radiofrequency ablation of the accessory pathwayd- radiofrequency modification of the e- sotalol

20- 70 y old lady presents with severe chest pain & nausea. Pulse rate 40bpm BP120/60 ECG shows significant inf MI & complete HB. she has received 300mg ASA which of the following is the next step:

a- external pacingb- isoprenaline infusionc- thromblysis with streptokinased- thrombolysis with tissue plasminogen activatore- temporary pacing wire insertion

21- 66y old smoker presents with H/O wt loss, cough, O/E finger clubbing. CXR Showed a cavitating mass in the RT mid zone which of the following disoreders is the most likely Dx

a- squamouse cell carcinomab- small cell carcinomac- adenocarcinomad- large cell carcinomae- carcinoid tumour

22- 45y old woman is admitted to hospital confused, O/E respiratory distress RR 35. centeral cyanosis PH 7.4 PO2 6.5 PCO2 5.5 which of the following most likely the Dx a- DKA b- heroin overdose c- motor neron disease d- asthma e- anemia

23- 43y old man consults you as he is C/O productive purulent foul smelling sputum. O/E there is digital clubbing

What is the most likely Dxa- bronchectesisb- acute lung abscessc- bronchoalveolar cell carcinomad- sarcoidosis e- fibrosing alveolitis

24- 35y old man with fever, cough, night sweating Dx pul TB which of the following statement is true :

a- all pt should be managed in a negative pressure roomb- corticosteroids are contraindicatedc- ethambutol should not be used ind- multi drugs resistant TB requires addition of 2 or more antiTB drugse- rifampcin & INH must not be used in HIV pt

25- Which of the following statement is not truea- in diaphragmatic paralysis it occurs immediately after lying flatb- when it improves during exercise psychogenicc- in asthma shortly after cessation of exercised- in pul venous congestion it occurs during sleepe- in hypersensitivity pneumonitis its worse after noon and improves in

weekend

26- which one of the following pathological abnormality occur in Parkinson's dis a- Mallory bodiesb- Lewy bodiesc- Neurofibrilary tanglesd- Pick bodies e- Negri bodies

27- 62y old man presents with TIA LF side he had carotid Doppler U/S Which of the following is true

a- bilateral endarterectomy is indicated if there are bilat stenosisb- carotid bruit indicates severe underlying stenosisc- carotid stenosis more then 80% inicates an annual stroke rise25%d- endarterectomy is ass with .5-1% riske- endarterectomy is indicated if RT CR stenosis more then 80%

28- 42y old female C/O unilateral proptosis, O/E BP 148/76 pulse 98 Which of the following most likely the Dx a-cavernous sinus thrombosis b- Graves dis c- lipoma d- myasthenia gravis e- retro orbital lymphoma

29- 34y old woman C/O expressive aphasia which area of the brain is likely involved

a- Lf parietal lobeb- Lf temporal lobec- Occipital lobed- Rt parietal lobee- RT temporal lobe

30- 58y old man presents to the ER C/O SOB, haemoptysis, anorexia and Generalized fatigability, arthralgias. he is found to have a purpuric rash, peripheral edema . CXR reveals diffuse opacification investigation Na 135 k 5 WBC 14.2 PLT 448 creat 200 normal liver function test which of the following is the most likely Dx

a- ANCAb- Hepatitis cc- Mixed cryoglobulinemiad- Sepsise- Toxic shock syndrome

31- 42y old man with long standing SCA presented with H/O morbilliform rash overlying his trunk, face and neck, Polyarteritis. His Hb dropped from 9 to 5 which of the following is the most likely the Dx

a- anemia of chronic renal failureb- blast cell crisisc- blood loss due to multiple hemarthrosesd- parvovirus B19 infectione- tuberculosis bone marrow infiltration

32- 24y old pt Dx with pulmonary sarcoidosis all of the following is not true except

a- corticosteroids are of benefit in virtually in all types of sarcoidosis b- lupus pernio is a recognized skin lesionc- neuro ophthalmic involvement require steroid treatmentd- pulm sarcoidosis is commonly complicated by heart involvement

mainly conduction defectse- the kveim test is gold standard

33- which of the following is complication of streptococcal skin infectiona- amyloidosisb- GNc- Liver failured- Rheumatic fevere- Toxic shock syndrome

34- metformin therapy all true excepta- reduces absorption of carbohydo from the gutb- stimulate the pancreatic to release the insulinc- reduce hepatic glucogenesisd- clinical hypoglycemia raree- increase the utilization of glu in the peripheral

35- which of the following a- food dropb- HBc- Lymphadenopathyd- Parotid swellinge- Polycythaemia

36- which of the following drug coz neutropeniaa- acute goutb- bacterial skin infectionc- oral prednisoloned- respiratory viral infectione- Vit B12

37- 79y old man lives alone he came to ER C/O fatigability his Hb 10 MCV 92 What is the most likely explanation :

a- BM infiltrateb- Folate deficiencyc- Iron deficiencyd- Mixed iron & B12 deficiencye- Sub clinical IBD

37- 25y old presents with an acute swelling of the RT knee, fever, night sweats of several days duration. Which of the following statement consistent with the diagnosis of gonococcemia

a- clinical features are more likely to occur in male than femaleb- tenosynovitis is likely to occurc- joint involvement is flitting rather than additived- culture of the synovial fluid is likely to grow gonococcie- the development of erythema nodosum is likely

38-which one of the following features is most typical of the fibromyalgia syndrome

a- elevation of the ESRb- coexistent symptoms of nocturnal diarrheac- symptoms of insomnia & tirednessd- rapid spontaneous resolutione- musculoskeletal pain without local tenderness

39- 45 y old female attends her GP C/O tiredness, wt loss, rash over her face in malar distribution. Which of the following support ur diagnosis

a- high neutrophil count is a common findingb- high complement common featurec- ANA are specific for this diagnosisd- GN is a common renal complicatione- it is a recognized complication of rifampicin treatment

40- 59y old woman presents to the ER with an acute swelling and tender RT knee Microscopy of aspiration of the joint shows a neutrophil count of 3280 Rhomboid crystals that are weakly positive birefringent. What is the Dx

a- acute goutb- chrondrocalcinosisc- pseudo goutd- RAe- Septic arthritis

41- 18y old man presents with a three month H/O generalized joint pain dominantly affecting the lower back & sacroiliac joints & urethritis

Which of the following is a recognized feature of non specific urethritisa- benzyl penicillin is the treatment of choiceb- Chlamydia trachomatis is the most commonly identified causec- Lower than 25% of pt are HLA-B27d- Iritis is a common recognized featuree- Septic arthritis is a commonly recognized ass

42- which of the following statement is true about graves disease & pregnancya- neonatal hyperthyroidism is unlikely if the maternal TFT well

controlled during pregnancyb- carbimazole is absolutely contraindicated.c- Surgery can be safely conducted in the second trimesterd- The presence of persistent exophthalmoses indicates poor control of

the diseasee- Anti thyroid drugs do not enter breast milk

43- 53y old woman C/O galactorrhea. No other symptoms Which of the following drug is most likely the cause

a- bromocriptineb- co careldopac- cyclizined- metoclopramidee- tamoxifen

44- which of the following diseases dose not cause bilateral parotid gland enlargement

a- lymphomab- alcoholic liver diseasec- primary hypothyroidismd- sarcoidosise- sjogren's syndrome

45- which of the following is a side effect of cyclophosphamidea- absorbed poorly through the gut b- dermal photosensitivityc- hemorrhagic cystitisd- hirsuitisme- inhibition of folic acid synthesis

46- which of the following drugs cause infertilitya- prednisoloneb- penicillaminec- sulfasalazined- golde- hydroxycobalamin

47- which of the following is the most likely feature of beta thalassemia majora- macrocytic anemiab- absence of Hepatomegalyc- absence of pigment gallstonesd- neonatal hemolytic anemiae- chronic leg ulceration

48- 47y old man presents to ER 10 h after taking 28x 500mg paracetamol tablets C/O nausea, vomiting. What is the next step

a- acute alcohol intake increase the side effect of paracetamolb- cimetidine increase the risk of toxicityc- measure paracetamol level immediately & accordingly start N-acetyld- measure paracetamol level in 4 hourse- start N-acetylcysteine immediately

49- 30 y old woman with essential HTN came to the antenatal clinic 6 weeks after conception. She is concern about her BP what anti hypertensive treatment you should start to lower here BP

a- atenololb- bendroflunethiazidec- lisinoprild- methyldopae- valsartan

50- which one of the following feature is most commonly ass with carpal tunnel syndrome

a- remission during pregnancyb- wasting of the dorsal interossei & lumbricalisc- pain in the hand which is worse by day & improve at nightd- association with hyperthyroidisme- complication of both rheumatoid arthritis & amyloidosis

51- which one of the following statements about generalized seizure is truea- all pts should be admitted to hospital following the first attackb- pts may safely return to care driving after 1 year of free seizure c- a heavy goods vehicle driving license will be allowed after 3years of

free seizured- anticonvulsant therapy should be started after the first attacke- the use of two or more anticonvulsant during the attack is the best way

to control the seizure.

52-72y old woman C/O dizziness & she remembers feeling faint then losing consciousness, she now feels completely well. There is laceration on here

Forehead & examination otherwise normal which of the following explanation for here collapse

a- middle cerebral artery occlusionb- subarachnoid hemorrhagec- subdural hematomad- total anterior circulation strokee- TIA

53- Which of the following drugs you should be careful when u prescribe it to an elderly

a- amoxicillinb- beclmetasonec- bumetanided- nifedapinee- omeprazole

54- you see a 32y old woman with RA C/O pain in her wrist which of the following is true about NSAIDs

a- SE occur in aroundb- NSAIDs reduce the relapse in RAc- Therapeutic & SE are dose relatedd- They enhance the antihypertensive effectse- They are implicated in around

55- 34y old male farmer presents to ER as over dose which of the following Is true regarding organophosphorous poisoning

a- dilated pupilsb- bradycardiac- hyper salivationd- pulmonary edemae- muscle fasciculation

56- 42y old man with a 20y H/O poorly controlled IBD involving the whole colon Attends the clinic for a follow up on azathioprine for three m ,he reports intermittent rectal bleeding, bilirubin 35, alb 35 , ALK 200 , transamnase 50 , ANCA + , antimitrochondrial - , the most likely explanation is

a- alcoholic hepatitisb- drug induce azathioprinec- metastasis from CA colond- primary biliary cirrhosise- primary sclerosing cholangitis

57-55y old man with zolinger elison syndrome which of the following statement is true

a- it is ass with MEN 2b- it is ass with necrolytic migratory erythema c- it is most commonly benign diseased- pts commonly present with diarrhea & flushinge- secretin infusion has no effect on serum gastrin level

58- you are asked to check over a 36y old man who has been admitted for kidney biopsy later in the day . Which of the following would be most strongly ass with increase risk of complication

a- Creatinine > 300b- INR 2.5c- Persistent hematouriad- Proteinuria +++ on dipstick urinalysise- Systolic BP 146

59-42 y old woman has aware of passing dark urine dipstick shows Bl +++ Protein +, urine microscopy shows dysmorphic red blood cells & red cells casts Which of the following most likely explanation

a- ATNb- Amyloidosisc- Cystitisd- GNe- Pyelonephritis

60- You have been evaluating a 54 y old man for unexplained bleeding & easy bruising . investigation shows abnormally prolonged bleeding time. which of the following is most likely the diagnosis

a- autoimmune thrombocytopenic purpurab- henoch-schonlein purpurac- herediatary hemorrhagic telangiectasiad- MM

e- scurvy

61- 40y old man presents with gynecomastia which of the following diagnosis can be excluded as the cause

a- bronchogenic carcinoma c- XYY karyotypeb- spironolactone therapy d- Digoxin therapy e- Klinefelter's syndrome

62- A man of 50y old with wt loss & malaise of 6m, Na of 120 , which of the following findings support the Diagnosis of SIADH

a- urinary osmolality persistently less than 300b- serum K 6c- nocturia & polyuriad- collapsed RT upper lobe on CXRe- blood urea 40

63- an obese 55y old man presents with a 6wks H/O polyuria, polydypsia fasting blood sugar is 7.6 . which of the following is the best next step

a- advise that result are satisfactory & offer repeat the resultb- institute lifestyle modification to lose wt & excersiec- start glipizided- start metformine- start rosiglitazone

64- 34y old woman C/O intermittent crampy abdominal pain. O/E glossitis, tongue ulceration & angular stomatitis. Which of the following most likely to cause these physical findings

a- celiac diseaseb- erythema multiformc- peutz jeghers syndromed- porphyriae- ulcerative colitis

65- a 56y old woman is investigated for symptoms suggestive of benign esophageal stricture which is most likely to have caused this disorder

a- accidental ingestion of bleach 6y beforeb- achalasiac- barretts esophagusd- longstanding GERe- prolonged nasogastric tube insertion 1y ago

66- which of the following is the best test can be used in GEI with H.pyloria- blood culture & sensitivityb- 13C-urea breath testc- IgG antibody titersd- IgM antibody titrese- Stool culture

67- Which of the following statement about pt with severe encephalopathy is truea- dietary protein intake should be restricted to 60g / dayb- the use of sedatives is recommended to control the pt c- neomycin therapy should be given to reduce risk of SBPd- diuretic therapy often helps to prevent the encephalopathye- enteral or parenteral glucose up to 300g / day

68- 54y old pt with DM is admitted for toe ulcer. Culture of wound swab demonstrates multiple colony o staph aureus . what is the best Tx

a- benzylpenicillineb- ciproc- erythromycind- flucloxacilline- gentamycine

69- which of the following statement regarding herpes simplex virus is truea- encephalitis complicates primary or recurrent infectionb- HSV type 2 causes only genital infectionc- Recurrent infection is caused by repeated viral exposured- Serology is the most useful means of diagnosise- Ulcerative ………….. is a rare complication

70- 35y old woman has been diagnosed with HIV 18m ago. Which of the following disorders most strongly indicates the progression of the disease

a- basal cell carcinoma overlying the nasal bridgeb- CMV retinitisc- Pulmonary TBd- RT basal pneumoniae- Oral Candida

71- 25y old man with longstanding SCA presents with fever, rash overlying his trunk, face and neck. His Hb dropped from 9.8 to 6.6 . what is the most likely explanation

a- anemia of CRFb- a plastic cell crisisc- parvovirus B19 infectiond- BM infiltratione- Multiple hemarthroses

72- 19y old female university student presents with fever & headache O/E she is conscious but has neck stiffness the cerebrospinal stain shows intracellular Gram negative diplococci. The most probable diagnosis is

a- meningococcal meningitisb- hemophilus influenza meningitisc- streptococcus pneumonia meningitisd- listeria monocytogenese- E coli meningitis

73- 35y old man returns from a holiday in Egypt with a fever, headache, limb

pains. Which of the following features most suggests denguea- H/O a rat bite 2 weeks previouslyb- Marked peripheral blood leucocytosisc- Erythema nodosumd- Yellow fever vaccination prior to trvellinge- Cervical lymphadenopathy

74-Pneumocystis carinii infection in an HIV positive pt isa- the commonest cause of respiratory infection in African ptb- characterized by copious sputum productionc- characterized by widespread fine pulmonary cracklesd- more likely to occur when the CD4 count is <200e- excluded by the finding of a normal CXR

75- 54y old man presents to the local ER C/O acute onset severe & swelling of this LT knee O/E thee is erythema and limitation of movement. Plain XR

Which of the following diagnosis is most likelya- acute osteoarthritisb- hemarthrosesc- reactive arthritisd- RAe- Septic arthritis

76- 36y old woman with RA C/O increasing difficulty with supination, were is the lesion

a- auxiliary nerve lesionb- C5,C6 nerve root lesionc- C8 nerve root lesiond- Median nerve lesione- Ulnar nerve lesion

77- Which of the following true about Wilson diseasea- ADb- Cerebellar in coordinationc- Lens dislocationd- Serum copper level is highe- Urinary copper levels is low

78- Which of the following disease cause hyperkalemiaa- Addison's diseaseb- Anorexia nervosac- Bartter's syndromed- Conn's syndromee- Cushing's syndrome

79- Which of the following is true about mast cella- activated by complementb- derived from eosinophilsc- do not contain lytic lesiond- release histaminee- stimulate IgG mediated

80-65y old male C/O sudden onset LT side weakness, RT ptosis, diplopia Were is the lesion

a- Hypothalamus d- LT medullab- LT midbrain e- RT medullac- RT midbrain

81- 45y old man C/O LF facial weakness, what well strongly suggests a diagnosis of belt's palsy more then upper motor

a- impaired sensation over the LF sideb- inability to fully close LF eyec- increased chin jerk reflexd- loss of LF frontals m activitye- unable to close lips together

82-how to diff between ARF & CRFa- Hb level of 11.6b- Kidney size s of 6cm & 5cm on U/Sc- LVH on ECG d- PTH level 7.9e- PO4 2.39

83- Which of the following is typical of a renal biopsy in a pt with DM nephropathy

a- diffuse glomerular capillary thickening & BMb- green birefringence on staining Congo redc- intracapillary hyaline thrombid- mesangial hypercellularity & fibrinoid necrosise- mesangial widening, BM thickening

84-which of the following feature suggests Good pasture diseasea- circulating C- ANCAb- mesangial IgA depositionc- presenting with nephritic syndromed- haemoptysis & pulmonary infiltrate is common findinge- ass with HLA-DR3

85- in multiple drug resistant TB which one is not accuratea- usually coz by mycobacterium avium intracellularb- AIDS has increased the incidence of MDR-TBc- Sputum AFB is often positive d- Directly observed therapy or supervised therapy is recommendede- Qinolones such as cipro have an anti TB effect

86- An 18 y old male with known type 1 DM presented with general malaise. dipstick urine & ABG confirms a metabolic ketoacidosis. Which of the following would suggest an alternative diagnosis

a- CRP 50b- WBC 16.2c- Serum glu 36d- Serum NA 162e- Urea 13.8

87- 61y old male ALP 234, ALT 39, CA 1.88 . most likely Dx is a- alcoholic liver disease b- oseomalacia c- osteoporosis d- paget's disease e- BPC

88- 46y old man C/O sharp stabbing chest pain get worse by lying supine ECG 1mm ST segment elevation in lead 1,2,3, AVR,AVL, V5, V6 what is the most likely the diagnosis

a- acute MIb- acute pericarditisc- atypical anginad- prinzmetal's anginae- PE

89- A previously asymptomatic woman become pregnant. An echo show MS Which of the following statement is true

a- the lesion has been unmasked by the changes occurring during pregnancy.

b- a dilated cardiomyopathy of pregnancy………..c- most new cardiac murmurs detected during pregnancy d- she should be treated aggressively by termination of the pregnancye- pulmonary edema due to MS need urgent valvotomy

90- 19y old wan is admitted for suicidal attempt which of the following underlying problem increase the risk of recurrence

a- alcohol ingestion at the same time with the overdoseb- background depressionc- antisocial personalityd- family H/O drug overdosee- recent bereavement ……..

91-42y old female Dx anxiety disorder. Which of the following support our diagnosis

a- SOB & palpitationb- Early morning wakeningc- Fatigue & lack of interestd- Loss of libidoe- ………………..

92- Which of the following is best prescribe a- cutaneous target lesionb- necrotic genital ulcerc- preceding streptococcus infectiond- sparing of the mucouse- underlying TB

93- 47y old woman

a- allergic vasculitisb- polyarteritis nodosac- henoch schonline purpurad- SLEe- Urticarial vasculitis