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Promotion MCQ 124y 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 vulgaris b- ramsay hunt syndrome c- lyme disease d- malignant OM e- bells palsy

few ecchymotic patches on lower limbs. SOB for 15 days.CMV antigenemia & culture d. PTT prolonged. Her Menarche was 2y ago since then she is having heavy blood loss during her period O/E she was pale.urinary antigen for legionella . PT. fever. TIBC. VWF eFactor 8 & 9 9in 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 : alow positive predictability blow negative predictability clow sensitivity dlow specifity elow reproducibility 10autoimmune hemolytic anemia is a feature of the following diseases except : amycoplasma pneumonia bEvans syndrome chemolytic uremic syndrome dlymphoma eSLE 11. CXR revealed bilat Interstitial markings with effusion.VAL for M. trim-sulfa.55y old Saudi female returned from Philippines after non related kidney Transplant with no post op complication 3m ago.O2 sat 90% RR22 which of the following will most likely establish the diagnosis: a.sputum induction for pneumocystis carinii stain e. cellcept. U/S examination bbone marrow aspirate & biopsy cmixing study. Investigation shows microcytic anemia normal WBC & PLT renal.blood culture b. She presented to ER C/O dry Cough. serum feritin is markedly decreased. The following test are likely to reveal the etiology: aserum iron. Creatinine was normal. She is on prednisone. anticardiolopin dPLT function test.tuberculosis complex c.7-the following vial haemorrhagic fever has been reported in SA except: arift valley fever balkhomra fever cdengue fever dyellow fever ecrernian congo hemorrhagic fever 815y girl is admitted with palpitation & easy bruises.

Fundoscopy reveals cholesterol emboli . the lower limb peripheral pulses are normal which of the following is The most possible Dx : aatheroembolic disease. fever joints pain. bil pulm creps.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: aatenolol bdigoxin cfurosemide dspironolactone evalsartan 16. PMH HTN on regular antihypertensive she has never had any evidence of CHF She was diagnosed as ARDS. for 4 week O/E LL edema.45y old man attends the ER C/O fatigue. raised JVP giant V waves. which of the following can be done to Distinguish btw cardiogenic & noncardiogenic pul edema : ameasurement of the central venous pressure bcalculation of AA gradient cmeasurement of pulmonary arterial wedge pressure dmeasurement of lung compliance emeasurement of EF 13in the evaluation of venous thromboembolism D Dimer testing is : ait has high sensitivity bit is usually negative in sub segmental PE cit is positive only in VTE dit has high negative predictive value. 14. Hepatomegaly what is the Dx aalcohol-related cardiomyopathy bbacterial endocarditis cpul HTN dpulm stenosis .60 y old man underwent a coronary angiogram for unstable angina whilst Recovering in hospital he C/O severe pain in his RT foot. SOB. and loss of sight in the LF eye O/E there is Gangrene of the lateral two toes.57y old female is admitted with G.12. 2 days later she get worse CXR bilateral infertilities. bPolyarteritis nodosa cBuergers disease dArterial thromboembolism eDIC 15.septicemia IV antibiotics & NS was started.

positive H/O Alcohol. O/E finger clubbing.66y old smoker presents with H/O wt loss. CXR Showed a cavitating mass in the RT mid zone which of the following disoreders is the most likely Dx asquamouse cell carcinoma bsmall cell carcinoma cadenocarcinoma dlarge cell carcinoma .30y old male has one year H/O palpitation. she has received 300mg ASA which of the following is the next step: aexternal pacing bisoprenaline infusion cthromblysis with streptokinase dthrombolysis with tissue plasminogen activator etemporary pacing wire insertion 21.e- sarcoidosis with cardiac involvement 17. cough.70 y old lady presents with severe chest pain & nausea. Pulse rate 40bpm BP120/60 ECG shows significant inf MI & complete HB.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 : asilicosis bsarcoidosis casbestosis dankylosing spondylitis eTB 18. dizziness but no syncope.58y old woman with known aortic stenosis C/O chest tightness & SOB Which of the following investigation would be most helpful acardiac cath bCXR cExercising ECG dPulmonary function tests eRepeat echo 19. He is no regular medication Dx WPW The most appropriate treatment aamiodarone bflecainide cradiofrequency ablation of the accessory pathway dradiofrequency modification of the esotalol 20.

heroin overdose c.43y old man consults you as he is C/O productive purulent foul smelling sputum.35y old man with fever.motor neron disease d.asthma e. centeral cyanosis PH 7. O/E respiratory distress RR 35. night sweating Dx pul TB which of the following statement is true : aall pt should be managed in a negative pressure room bcorticosteroids are contraindicated cethambutol should not be used in dmulti drugs resistant TB requires addition of 2 or more antiTB drugs erifampcin & INH must not be used in HIV pt 25Which of the following statement is not true ain diaphragmatic paralysis it occurs immediately after lying flat bwhen it improves during exercise psychogenic cin asthma shortly after cessation of exercise din pul venous congestion it occurs during sleep ein hypersensitivity pneumonitis its worse after noon and improves in weekend 26.45y old woman is admitted to hospital confused.DKA b.e- carcinoid tumour 22. O/E there is digital clubbing What is the most likely Dx abronchectesis bacute lung abscess cbronchoalveolar cell carcinoma dsarcoidosis efibrosing alveolitis 24.anemia 23.5 PCO2 5.4 PO2 6. cough.which one of the following pathological abnormality occur in Parkinson's dis aMallory bodies bLewy bodies cNeurofibrilary tangles dPick bodies eNegri bodies .5 which of the following most likely the Dx a.

62y old man presents with TIA LF side he had carotid Doppler U/S Which of the following is true abilateral endarterectomy is indicated if there are bilat stenosis bcarotid bruit indicates severe underlying stenosis ccarotid stenosis more then 80% inicates an annual stroke rise25% dendarterectomy is ass with .42y old female C/O unilateral proptosis. peripheral edema . CXR reveals diffuse opacification investigation Na 135 k 5 WBC 14.lipoma d. he is found to have a purpuric rash.retro orbital lymphoma 29.34y old woman C/O expressive aphasia which area of the brain is likely involved aLf parietal lobe bLf temporal lobe cOccipital lobe dRt parietal lobe eRT temporal lobe 30. His Hb dropped from 9 to 5 which of the following is the most likely the Dx aanemia of chronic renal failure bblast cell crisis cblood loss due to multiple hemarthroses dparvovirus B19 infection etuberculosis bone marrow infiltration .Graves dis c. O/E BP 148/76 pulse 98 Which of the following most likely the Dx a-cavernous sinus thrombosis b.5-1% risk eendarterectomy is indicated if RT CR stenosis more then 80% 28.42y old man with long standing SCA presented with H/O morbilliform rash overlying his trunk. haemoptysis.27. arthralgias. face and neck. Polyarteritis.myasthenia gravis e.2 PLT 448 creat 200 normal liver function test which of the following is the most likely Dx aANCA bHepatitis c cMixed cryoglobulinemia dSepsis eToxic shock syndrome 31.58y old man presents to the ER C/O SOB. anorexia and Generalized fatigability.

24y old pt Dx with pulmonary sarcoidosis all of the following is not true except acorticosteroids are of benefit in virtually in all types of sarcoidosis blupus pernio is a recognized skin lesion cneuro ophthalmic involvement require steroid treatment dpulm sarcoidosis is commonly complicated by heart involvement mainly conduction defects ethe kveim test is gold standard 33- which of the following is complication of streptococcal skin infection aamyloidosis bGN cLiver failure dRheumatic fever eToxic shock syndrome metformin therapy all true except areduces absorption of carbohydo from the gut bstimulate the pancreatic to release the insulin creduce hepatic glucogenesis dclinical hypoglycemia rare eincrease the utilization of glu in the peripheral which of the following afood drop bHB cLymphadenopathy dParotid swelling ePolycythaemia which of the following drug coz neutropenia aacute gout bbacterial skin infection coral prednisolone drespiratory viral infection eVit B12 34- 35- 36- 37.32.79y old man lives alone he came to ER C/O fatigability his Hb 10 MCV 92 What is the most likely explanation : aBM infiltrate bFolate deficiency cIron deficiency dMixed iron & B12 deficiency eSub clinical IBD .

ANA are specific for this diagnosis d.it is a recognized complication of rifampicin treatment 40.symptoms of insomnia & tiredness d.25y old presents with an acute swelling of the RT knee. night sweats of several days duration.coexistent symptoms of nocturnal diarrhea c.GN is a common renal complication e.rapid spontaneous resolution e.elevation of the ESR b.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. Which of the following support ur diagnosis a.37.high complement common feature c. rash over her face in malar distribution. What is the Dx aacute gout bchrondrocalcinosis cpseudo gout dRA eSeptic arthritis 41.high neutrophil count is a common finding b.musculoskeletal pain without local tenderness 39.18y 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 urethritis abenzyl penicillin is the treatment of choice bChlamydia trachomatis is the most commonly identified cause cLower than 25% of pt are HLA-B27 dIritis is a common recognized feature eSeptic arthritis is a commonly recognized ass .45 y old female attends her GP C/O tiredness. fever. Which of the following statement consistent with the diagnosis of gonococcemia aclinical features are more likely to occur in male than female btenosynovitis is likely to occur cjoint involvement is flitting rather than additive dculture of the synovial fluid is likely to grow gonococci ethe development of erythema nodosum is likely 38-which one of the following features is most typical of the fibromyalgia syndrome a. wt loss.

cSurgery can be safely conducted in the second trimester dThe presence of persistent exophthalmoses indicates poor control of the disease eAnti thyroid drugs do not enter breast milk 43.which of the following statement is true about graves disease & pregnancy aneonatal hyperthyroidism is unlikely if the maternal TFT well controlled during pregnancy bcarbimazole is absolutely contraindicated.which of the following is the most likely feature of beta thalassemia major amacrocytic anemia babsence of Hepatomegaly cabsence of pigment gallstones dneonatal hemolytic anemia echronic leg ulceration 48.which of the following diseases dose not cause bilateral parotid gland enlargement alymphoma balcoholic liver disease cprimary hypothyroidism dsarcoidosis esjogren's syndrome 45which of the following is a side effect of cyclophosphamide aabsorbed poorly through the gut bdermal photosensitivity chemorrhagic cystitis dhirsuitism einhibition of folic acid synthesis which of the following drugs cause infertility aprednisolone bpenicillamine csulfasalazine dgold ehydroxycobalamin 46- 47.47y old man presents to ER 10 h after taking 28x 500mg paracetamol tablets . No other symptoms Which of the following drug is most likely the cause abromocriptine bco careldopa ccyclizine dmetoclopramide etamoxifen 44.42.53y old woman C/O galactorrhea.

What is the next step aacute alcohol intake increase the side effect of paracetamol bcimetidine increase the risk of toxicity cmeasure paracetamol level immediately & accordingly start Nacetyl dmeasure paracetamol level in 4 hours estart N-acetylcysteine immediately 49. There is laceration on here Forehead & examination otherwise normal which of the following explanation for here collapse a.72y old woman C/O dizziness & she remembers feeling faint then losing consciousness. vomiting.subarachnoid hemorrhage c.30 y old woman with essential HTN came to the antenatal clinic 6 weeks after conception. she now feels completely well. She is concern about her BP what anti hypertensive treatment you should start to lower here BP aatenolol bbendroflunethiazide clisinopril dmethyldopa evalsartan 50which one of the following feature is most commonly ass with carpal tunnel syndrome aremission during pregnancy bwasting of the dorsal interossei & lumbricalis cpain in the hand which is worse by day & improve at night dassociation with hyperthyroidism ecomplication of both rheumatoid arthritis & amyloidosis 51which one of the following statements about generalized seizure is true aall pts should be admitted to hospital following the first attack bpts may safely return to care driving after 1 year of free seizure ca heavy goods vehicle driving license will be allowed after 3years of free seizure danticonvulsant therapy should be started after the first attack ethe use of two or more anticonvulsant during the attack is the best way to control the seizure.middle cerebral artery occlusion b. 52.C/O nausea.subdural hematoma d.TIA .total anterior circulation stroke e.

antimitrochondrial .. transamnase 50 .he reports intermittent rectal bleeding. ANCA + . bilirubin 35. Which of the following would be most strongly ass with increase risk of complication aCreatinine > 300 bINR 2. the most likely explanation is aalcoholic hepatitis bdrug induce azathioprine cmetastasis from CA colon dprimary biliary cirrhosis eprimary sclerosing cholangitis 57.53Which of the following drugs you should be careful when u prescribe it to an elderly aamoxicillin bbeclmetasone cbumetanide dnifedapine eomeprazole 54you see a 32y old woman with RA C/O pain in her wrist which of the following is true about NSAIDs aSE occur in around bNSAIDs reduce the relapse in RA cTherapeutic & SE are dose related dThey enhance the antihypertensive effects eThey are implicated in around 5534y old male farmer presents to ER as over dose which of the following Is true regarding organophosphorous poisoning adilated pupils bbradycardia chyper salivation dpulmonary edema emuscle fasciculation 5642y 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 .55y old man with zolinger elison syndrome which of the following statement is true ait is ass with MEN 2 bit is ass with necrolytic migratory erythema cit is most commonly benign disease dpts commonly present with diarrhea & flushing esecretin infusion has no effect on serum gastrin level 58you are asked to check over a 36y old man who has been admitted for kidney biopsy later in the day .5 . ALK 200 . alb 35 .

Klinefelter's syndrome 62A man of 50y old with wt loss & malaise of 6m. Na of 120 . which of the following is most likely the diagnosis aautoimmune thrombocytopenic purpura bhenoch-schonlein purpura cherediatary hemorrhagic telangiectasia dMM e.XYY karyotype b.spironolactone therapy d.scurvy 6140y old man presents with gynecomastia which of the following diagnosis can be excluded as the cause abronchogenic carcinoma c. Which of the following most likely to cause these physical findings aceliac disease . urine microscopy shows dysmorphic red blood cells & red cells casts Which of the following most likely explanation aATN bAmyloidosis cCystitis dGN ePyelonephritis 60You have been evaluating a 54 y old man for unexplained bleeding & easy bruising . investigation shows abnormally prolonged bleeding time. which of the following findings support the Diagnosis of SIADH aurinary osmolality persistently less than 300 bserum K 6 cnocturia & polyuria dcollapsed RT upper lobe on CXR eblood urea 40 63an obese 55y old man presents with a 6wks H/O polyuria.6 . tongue ulceration & angular stomatitis. O/E glossitis.Digoxin therapy e. polydypsia fasting blood sugar is 7.cde- Persistent hematouria Proteinuria +++ on dipstick urinalysis Systolic BP 146 59. which of the following is the best next step aadvise that result are satisfactory & offer repeat the result binstitute lifestyle modification to lose wt & excersie cstart glipizide dstart metformin estart rosiglitazone 6434y old woman C/O intermittent crampy abdominal pain.42 y old woman has aware of passing dark urine dipstick shows Bl ++ + Protein +.

Culture of wound swab demonstrates multiple colony o staph aureus .pylori ablood culture & sensitivity b13C-urea breath test cIgG antibody titers dIgM antibody titres eStool culture 67Which of the following statement about pt with severe encephalopathy is true adietary protein intake should be restricted to 60g / day bthe use of sedatives is recommended to control the pt cneomycin therapy should be given to reduce risk of SBP ddiuretic therapy often helps to prevent the encephalopathy eenteral or parenteral glucose up to 300g / day 6854y old pt with DM is admitted for toe ulcer. what is the best Tx abenzylpenicilline bcipro cerythromycin dflucloxacillin egentamycine 69true which of the following statement regarding herpes simplex virus is abcdeencephalitis complicates primary or recurrent infection HSV type 2 causes only genital infection Recurrent infection is caused by repeated viral exposure Serology is the most useful means of diagnosis Ulcerative …………. is a rare complication 7035y old woman has been diagnosed with HIV 18m ago..bcde- erythema multiform peutz jeghers syndrome porphyria ulcerative colitis 65a 56y old woman is investigated for symptoms suggestive of benign esophageal stricture which is most likely to have caused this disorder aaccidental ingestion of bleach 6y before bachalasia cbarretts esophagus dlongstanding GER eprolonged nasogastric tube insertion 1y ago 66which of the following is the best test can be used in GEI with H. Which of the following disorders most strongly indicates the progression of the disease abasal cell carcinoma overlying the nasal bridge bCMV retinitis cPulmonary TB .

The most probable diagnosis is ameningococcal meningitis bhemophilus influenza meningitis cstreptococcus pneumonia meningitis dlisteria monocytogenes eE coli meningitis 7335y old man returns from a holiday in Egypt with a fever. rash overlying his trunk. limb pains.de- RT basal pneumonia Oral Candida 7125y old man with longstanding SCA presents with fever. face and neck. Which of the following features most suggests dengue aH/O a rat bite 2 weeks previously bMarked peripheral blood leucocytosis cErythema nodosum dYellow fever vaccination prior to trvelling eCervical lymphadenopathy 74Pneumocystis carinii infection in an HIV positive pt is athe commonest cause of respiratory infection in African pt bcharacterized by copious sputum production ccharacterized by widespread fine pulmonary crackles dmore likely to occur when the CD4 count is <200 eexcluded by the finding of a normal CXR 7554y 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. what is the most likely explanation aanemia of CRF ba plastic cell crisis cparvovirus B19 infection dBM infiltration eMultiple hemarthroses 7219y 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.6 . His Hb dropped from 9. were is the lesion aauxiliary nerve lesion . Plain XR Which of the following diagnosis is most likely aacute osteoarthritis bhemarthroses creactive arthritis dRA eSeptic arthritis 7636y old woman with RA C/O increasing difficulty with supination.8 to 6. headache.

6 bKidney size s of 6cm & 5cm on U/S cLVH on ECG dPTH level 7.LT medulla bLT midbrain e.39 83Which of the following is typical of a renal biopsy in a pt with DM nephropathy adiffuse glomerular capillary thickening & BM . what well strongly suggests a diagnosis of belt's palsy more then upper motor aimpaired sensation over the LF side binability to fully close LF eye cincreased chin jerk reflex dloss of LF frontals m activity eunable to close lips together 82how to diff between ARF & CRF aHb level of 11.bcde77- C5.65y old male C/O sudden onset LT side weakness.9 ePO4 2. diplopia Were is the lesion aHypothalamus d.C6 nerve root lesion C8 nerve root lesion Median nerve lesion Ulnar nerve lesion Which of the following true about Wilson disease aAD bCerebellar in coordination cLens dislocation dSerum copper level is high eUrinary copper levels is low Which of the following disease cause hyperkalemia aAddison's disease bAnorexia nervosa cBartter's syndrome dConn's syndrome eCushing's syndrome Which of the following is true about mast cell aactivated by complement bderived from eosinophils cdo not contain lytic lesion drelease histamine estimulate IgG mediated 78- 79- 80. RT ptosis.RT medulla cRT midbrain 8145y old man C/O LF facial weakness.

dipstick urine & ABG confirms a metabolic ketoacidosis. BM thickening which of the following feature suggests Good pasture disease acirculating C. V5. AVR.paget's disease e. most likely Dx is a.2 cSerum glu 36 dSerum NA 162 eUrea 13.2.BPC 8846y old man C/O sharp stabbing chest pain get worse by lying supine ECG 1mm ST segment elevation in lead 1.8 8761y old male ALP 234.alcoholic liver disease b.3. ALT 39.bcde84- green birefringence on staining Congo red intracapillary hyaline thrombi mesangial hypercellularity & fibrinoid necrosis mesangial widening. An echo show MS Which of the following statement is true athe lesion has been unmasked by the changes occurring during pregnancy. Which of the following would suggest an alternative diagnosis aCRP 50 bWBC 16. ba dilated cardiomyopathy of pregnancy……….osteoporosis d.oseomalacia c. CA 1. cmost new cardiac murmurs detected during pregnancy .AVL.ANCA bmesangial IgA deposition cpresenting with nephritic syndrome dhaemoptysis & pulmonary infiltrate is common finding eass with HLA-DR3 in multiple drug resistant TB which one is not accurate ausually coz by mycobacterium avium intracellular bAIDS has increased the incidence of MDR-TB cSputum AFB is often positive dDirectly observed therapy or supervised therapy is recommended eQinolones such as cipro have an anti TB effect 85- 86An 18 y old male with known type 1 DM presented with general malaise. V6 what is the most likely the diagnosis aacute MI bacute pericarditis catypical angina dprinzmetal's angina ePE 89A previously asymptomatic woman become pregnant.88 ..

.dshe should be treated aggressively by termination of the pregnancy epulmonary edema due to MS need urgent valvotomy 9019y old wan is admitted for suicidal attempt which of the following underlying problem increase the risk of recurrence aalcohol ingestion at the same time with the overdose bbackground depression cantisocial personality dfamily H/O drug overdose erecent bereavement ……. 92Which of the following is best prescribe acutaneous target lesion bnecrotic genital ulcer cpreceding streptococcus infection dsparing of the mucous eunderlying TB 47y old woman abcdeallergic vasculitis polyarteritis nodosa henoch schonline purpura SLE Urticarial vasculitis 93- .. 91. Which of the following support our diagnosis aSOB & palpitation bEarly morning wakening cFatigue & lack of interest dLoss of libido e……………….42y old female Dx anxiety disorder.