ID 2

1. Most common oral infection in diabetes mellitus?

a. Candida
b. Aspergillus
c. Streptococcus
d. Staphylococcus

2. A young lady with symptoms of hyperthyroidism with elevated T4, TSH ¯ . Next step of
management?

a . Start anti - thyroid drugs

b . Start beta blockers
c. Conservative management
d . Start anti -thyroid drugs and wait for symptoms to
resolve

3. Which type diabetes is HLA associated:

a. Type I diabetes
b. Type II diabetes
c. Malnutrition related type disease
d. Pregnancy related type diabetes

4. According to ADA guidelines, the diagnosis of diabetesis made when the fasting blood
glucose is more than :
a . 126 mg/ dl
b . 100 mg/ dl
c. 140 mg/ dl
d. 200 mg/ dl

5.A 28 year old woman presents to you with a three month history of fatigue, weight gain, menstrual
irregularity and declining memory. Which of the following laboratory results is likely in the diagnosis of
the underlying problem?

a) TSH increased, free T4 increased

b) TSH decreased, free T4 increased

c) TSH increased, free T4 decreased

d) TSH decreased, free T4 decreased

6.A 30 year old woman presents with complaints of heat intolerance, sleeplessness, nervousness and
weight loss despite an excellent appetite. What changes in TSH and free T4 would you most likely expect
to see?
a) Decreased TSH, increased free T4

b) Increased TSH, increased free T4

c) Decreased TSH, normal free T4

d) Increased TSH, decreased free T4

7.A 32 year old woman complains of polyarticular symmetric arthritis and a diffuse maculopapular rash
that flares up with exposure to sun light. She is afebrile. Physical examination reveals tenosynovitis of
her wrists. Which one of the following is the most likely diagnosis?

a) Gonococcal arthritis

b) Reiter's syndrome

c) Rheumatoid arthritis

d) Systemic lupus erythematosus

8.A 33-year-old white female presents with tremor and a history of weight loss. On examination she is
found to have mild, regular tachycardia and exophthalmos. Laboratory tests confirm hyperthyroidism.
Which one of the following treatments has been found to potentially worsen ophthalmopathy?

a) Radioactive iodine

b) Propylthiouracil

c) Methimazole (Tapazole)

d) Thyroid hormone replacement plus propylthiouracil

e) Thyroidectomy

9. Diabetes is diagnosed when:

a. The level of fasting glucose is > 100 mg / dL and that
of postprandial glucose is > 140 mg / dL
b. The level of fasting glucose is > 126 mg/ dL and that of postprandial glucose is > 200 mg / dL
c. The level of plasma insulin is > 6 lU / dL
d . The HbAlc level is > 5.5%

10. The glucose lowering effect is least and delayed by several weeks with the following oral
hypoglycaemic agents
a. Insulin secretogogues
b. DPP - IV inhibitors
c. Biguanides
d . Alpha -Glucosidase inhibitors

11.A 35 year old white female comes to your office with a 3-month history of the gradual onset of pain
and tenderness in the wrists and hands. She also complains of 1 hour of morning stiffness. She denies
rash, fever, or skin changes. On physical examination she has symmetric swelling of the proximal
interphalangeal joints and metacarpophalangeal joints. Motion of these joints is painful. She has no rash
or mouth ulcers. Radiographs of the hands and wrists are negative, and a chest film is unremarkable.
Her CBC is normal, but the erythrocyte sedimentation rate is elevated at 40 mm/hr. Latex fixation for
rheumatoid factor is negative, and an antinuclear antibody (ANA) test is negative. The most likely
diagnosis in this patient is:

a) Rheumatoid arthritis

b) Systemic lupus erythematosus

c) Sarcoidosis

d) Lyme disease

e) Calcium pyrophosphate desposition disease

12.A 35 year old woman who was born in Vietnam has had her dyspepsia diagnosed by endoscopy as a
duodenal ulcer. Her pathology is positive for Helicobacter pylori. She has not previously been diagnosed
with peptic ulcer disease. What would be the preferred treatment option?

a) Combination antibiotics plus omeprazole

b) Omeprazole alone

c) Surgical vagotomy and pyloroplasty

d) Octreotide

e) Ranitidiine

13.A 35-year-old white male presents with dyspepsia. He has had no symptoms that suggest
gastroesophageal reflux or bleeding, but a test for Helicobacter pylori is positive. He was treated with
omeprazole (Prilosec), amoxicillin, and clarithromycin (Biaxin) for 2 weeks. On the follow-up visit, he is
asymptomatic.

Which one of the following is recommended to test for the eradication of H. pylori in this patient?

a) Immunoglobulin G serology

b) A urea breath test

c) Upper endoscopy with a biopsy

d) An upper gastrointestinal series

14.A 36 year old woman develops fever, chills and flank pain. She presents to the ER and is diagnosed
with pyelonephritis. What is the most likely causative organism?

a) E. coli

b) Chlamydia

c) S. pneumonia

d) S. aureus

15. Microalbuminuria refers to urinary albumin excretion rate of:

a. 30-300 mg/24 hour
b. 400-600 mg/24 hour
c. 700-900 mg/24 hour
d. > 100 mg/24 hour

16.A 38 year old woman presents complaining of epigastric pain that is exacerbated by eating. An EGD
reveals the presence of a duodenal ulcer. A test for Helicobacter pylori is positive for the H. pylori.
Which of the following is the most appropriate treatment?

a) Metronidazole

b) Lansoprazole

c) Clarithromycin and Amoxicillin

d) Metronidazole and amoxicillin

e) Lansoprazole and clarithromycin and amoxicillin

17.A 38 year old woman presents to you convinced that she has chronic fatigue syndrome. The history
reveals no evidence of fever or swollen glands, and no other symptoms other than fatigue and difficulty
sleeping. Her physical examination is completely normal. She has a high thyroid-stimulating hormone
level. You would then suspect and subsequently confirm:

a) Hyperthyroidism secondary to pituitary adenoma

b) Hypothyroidism

c) Grave disease

d) Thyroiditis

e) Chronic fatigue syndrome

18.A 40-year-old female comes to your office for a routine examination. She has been in good health
and has no complaints other than obesity. Her mother is diabetic and the patient has had a child that
weighed 4kg (9 lb) at birth. Her examination is negative except for her obesity. A fasting glucose level is
7.1 mmol/L, and when repeated 2 days later it is 7.5 mmol/L. Which one of the following would be most
appropriate at this point?

a) Diagnose type 2 diabetes mellitus and begin diet and exercise therapy

b) Begin an oral hypoglycemic agent

c) Order a glucose tolerance test

d) Tell the patient that she has impaired glucose homeostasis but is not diabetic

19.A 40 year old woman presents with painful swelling of the joints of her fingers, excessive fatigue and
a malar rash.

Which one of the following diseases is most likely?

a) Psoriasis

b) Pseudogout

c) Systemic lupus erythematosus (SLE)

d) Rheumatoid arthritis

e) Serum sickness

20.A 40-year-old white male has elevated transaminase levels at a routine visit, but your clinical
evaluation shows no apparent cause. At a follow-up visit 6 months later they remain elevated. He
remains asymptomatic and has a normal physical examination. You order further tests, including
serologic blood analyses.

Which one of the following imaging studies would be most appropriate?

a) Abdominal ultrasonography

b) CT with contrast

c) MRI of the abdomen

d) Magnetic resonance angiography (MRA) of the abdomen

e) Positron emission tomography (PET) of the abdomen

21.A 41 year old man is seen for hematuria. He states that he has had this on two previous occasions,
both in relation to an upper respiratory tract infection. On both previous occasions the urine cleared
spontaneously over a period of five to seven days.

At the time of the present visit he states that he has been feeling lethargic with a sore throat for the
past five days. Blood pressure is 170/95, urine analysis shows specific gravity 1020, nitrites negative, +++
blood and +++ protein. Urine microscopy reveals oxalate crystals, dysmorphic red blood cells and red
cell casts. The presence of dysmorphic red blood cells is indicative of:

a) Urine infection

b) Delay in analysis of the urine sample

c) Glomerular bleeding

d) Urothelial malignancy

e) Urinary tract calculus

22. Which of the following is not a test for diabetes mellitus

a. Fasting blood glucose
b. Random blood glucose
c. D-Xylose test
d. Oral Glucose tolerance test

23. The occurence of hyperthyroidism following administration of supplemental iodine to

subjects with endemic iodine deficiency goiter is known as:
a. Jod - Basdow effect
b. Wolff - Chaikoff effect
c. Thyrotoxicosis factitia
d . De quervain's thyroiditis

24. Which of the following is not associated with hypothyroidism:

a. Low T3
b. High TSH
c. High Triglycerides
d. Low cholesterol

25. Common neurological manifestations of thyrotoxicosis include all except:

a. Hyper reflexia
b. Muscle wasting
c. Chorea
d. Proximal myopathy without fasciculations
26.A 54 year old man presents with acute onset of painful first metatarsophalangeal joint. It is swollen,
red and tender. This is his first episode. You decide to order a serum uric acid and a 24 urine for uric
acid.

You then prescribe for him which of the following medicines?

a) Colchicine

b) Indomethacin

c) Allopurinol

d) Probenacid

27.A 55-year-old white male sees you for a routine annual visit. His fasting blood glucose level is 187
mg/dL. Repeat testing 1 week later reveals a fasting glucose level of 155 mg/dL and an HbA1c of 9.4%.
His BMI is 30 kg/m . He does not seem to have any symptoms of diabetes mellitus.

In addition to lifestyle changes, which one of the following would you prescribe initially?

a) Metformin (Glucophage)

b) Glyburide (DiaBeta, Micronase)

c) Rosiglitazone (Avandia)

d) Bedtime long-acting insulin (Lantus)

e) Bedtime long-acting insulin and rapid-acting insulin (Novolog) with each meal

28.A 57-year-old male has laboratory screening performed prior to his annual examination. One of his
six fecal occult blood tests is positive. A CBC, chemistry panel, lipid panel, and prostate-specific antigen
level are all normal.

Which one of the following would be the most appropriate course of action?

a) Repeat the fecal occult blood testing in 3 months

b) Perform a rectal examination in the office, and if a stool guaiac is negative repeat the fecal occult
blood testing in 3 months

c) Refer for colonoscopy

d) Refer for flexible sigmoidoscopy

29.A 60-year-old black male is found to have type 2 diabetes mellitus. Which one of the following should
be ordered before initiating treatment with metformin (Glucophage)?

a) Serum electrolytes

b) A serum creatinine level

c) A CBC

d) A lipid panel

e) A thyroid panel

30.A 62 year old white male comes to your office with pain and swelling of the left great toe at the
metatarsophalangeal joint. Examination shows it is erythematous, warm, swollen, and tender to touch.
The patient has a history of diabetes mellitus controlled by diet, and hypertension. His medications
include hydrochlorothiazide, 25 mg/day. A CBC and blood chemistry profile are normal, except for a uric
acid level of 9.2 mg/dL (N 3.6-8.5). Which one of the following is true in this situation?

a) This attack should resolve spontaneously in 3-4 days

b) Allopurinol (Zyloprim) therapy should be started

c) The elevated uric acid level establishes the diagnosis of gout

d) Intra-articular steroid injection should be avoided

e) Stopping the hydrochlorothiazide may control the hyperuricemia

31. A 65-year-old male smoker complains of dyspepsia, weight loss, early satiety, and occasional nausea
and vomiting. Which one of the following would be the initial diagnostic method of choice?

a) Upper gastrointestinal endoscopy

b) CT of the upper abdomen

c) A single contrast upper GI barium swallow

d) Endoscopic ultrasonography
 32.A 53 year old presents to your office with pain and stiffness in both hands and knees of 6 months
duration. You suspect rheumatoid arthritis. Which of the following findings on your history and physical
examination is most distinctive with a diagnosis?

a) Unilateral joint tenderness/effusions

b) Maculopapular rash

c) Joint stiffness worse in the morning

d) Hepatosplenomegaly

33. Which of the following statements regarding treatment of hypothyroidism in a patient with ischemic heart disease is true -
a) Low dose of levothyroxine
b) Normal dose of Levothyroxine
c) Do not use Levothyroxine
d) Use thyroid extract

34. A 68 year old patient presents with an acutely red and swollen right great toe without history of
trauma. Which one of the following findings is most useful for making a diagnosis in this patient?

a) Joint fluid aspiration

b) Good response to colchicine trial

c) Radiograph showing marginal joint erosion in the first metatarsophalangeal (MTP) joint

d) An associated right ankle effusion

e) Painless elbow nodule

35. A 55-year-old man presents with complaints of an acute gouty arthritis attack. His left big toe is red,
swollen, andtender to the touch. This is his first attack. He has no history of peptic ulcer disease. His uric acid
level is 8 mgldl. Which of the following agents would you recommend for treatment?
A. Prednisone
B. Colchicine
C. Allopurinol
D. Indomethacin
E. Probenecid

36. A laboratory analysis of one of your patients reveals a microcytic anemia.

The red cell distribution width (RDW) is elevated. Which of the following
is the most likely diagnosis?
a. Iron deficiency
b. Sideroblastic anemia
c. Thalassemia
d. Aplastic anemia
e. Chronic renal insufficiency

37. A 34-year-old man reports a 1-day history of hematemesis. He feels well, but does describe occasional
abdominal discomfort. He denies alcohol use. On examination, his abdomen is slightly tender without peritoneal
signs. His stool is not bloody, but his fecal test for occult blood is positive.
Which of the following is the most appropriate next step?
a. Gastric lavage
b. Barium study
c. Endoscopy
d. Red cell scan
e. Angiography

38. You are performing a screening physical examination on a 47-year-old man. He is generally healthy, and his
review of systems is negative. His mother has type 2 diabetes, and he is overweight. Which of the following is
generally accepted as the test of choice to screen for type 2 diabetes?
a. A random glucose test
b. A fasting glucose
c. A urinalysis to screen for glycosuria
d. A 1-hour glucose tolerance test
e. A 3-hour glucose tolerance test
39. You are evaluating a 36-year-old obese woman who complains of fatigue. She denies polydipsia, polyuria,
polyphagia, or weight loss. Which of the following laboratory reports confirms the diagnosis of diabetes?
a. A random glucose reading of 221 mg/dL
b. A random glucose reading of 221 mg/dL, and another, on a later date, of 208 mg/dL
c. A fasting glucose measurement of 128 mg/dL
d. A glucose reading, taken 2 hours after a 75-g glucose load, of 163 mg/dL
e. A fasting glucose of 114 mg/dL, and a reading of 184 mg/dL 2 hours after a 75-g glucose load
40. You are following a type 2 diabetic woman in her fifties. Six months ago, you checked her lipid profile. At that
time, her total cholesterol was 245 mg/dL, her low-density lipoprotein (LDL) was 148 mg/dL, her highdensity
lipoprotein (HDL) was 30 mg/dL, and her triglycerides were 362. She has tried lifestyle modifications, but despite
losing weight and exercising, her profile hasn’t substantially changed. Which of the following is the
first-line treatment for this patient?
a. Continued lifestyle modifications
b. A 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) [P1] reductase inhibitor (a “statin”)
c. Niacin
d. Fibric acid derivatives
e. Bile acid resin

41. Hypothyroidism is associated with the following clinical problems, except:

a. Menorrhagia b. Early abortions
c. Galactorrhoea d . Thromboembolism
42. A 26-year-old woman presents with weight gain, lethargy, dry skin, sweatiness, cold intolerance, and thinning
hair. You suspect hypothyroidism and order the appropriate laboratory tests. Her TSH is high, and her free T 3 and
free T 4 are both low. Which of the following is the most likely diagnosis?
a. Primary hypothyroidism
b. Secondary hypothyroidism
c. Iodine deficiency
d. Thyroid hormone resistance
e. Subclinical hypothyroidism
43. You are screening a 35-year-old woman who presents with tachycardia, nervousness, tremor, palpitations, heat
intolerance, and weight loss. You suspect Graves disease. What single test is best for differentiating Graves disease
from other causes of hyperthyroidism?
a. TSH
b. TSH with free T 4 and free T 3
c. Thyroid receptor antibodies
d. Radionucleotide imaging of the thyroid
e. Thyroid ultrasound

44. Which is not a symptom of hyperthyroidism?

a. Hyperactivity
b. Palpitation
c. Diarrhea
d. Hair loss

45. Which is incorrect about Rheumatoid arthritis?

a. Periarticular osteoporosis
b. Small joint involvement bilateral
c. Erosion of articular surface
d. Rheumatoid nodules is major criteria for diagnosis

46. In myxoedema which is not correct:

a. Slow pulse
b. Hypertension
c. Hypotension
d. Dry skin

47.Which one of the following clinical signs is not seen in ophthalmic Grave's disease ?
a. Lid retraction
b. Frequent blinking
c. Poor convergence
d. Upper lid "lad " on down gaze

48.Radioiodine uptake in endemic goitre is:

a. Normal
b. Increased
c. Decreased
d . Erratic

49. Most common cause of Thyroiditis is:

a. Reidl's Thyroiditis
b. Subacute Thyroditis
c. Hashimoto's Thyroiditis
d. Viral Thyroiditis
50. All of the following are true about Type I DM, Except:
a. Family history is present in 90 % of cases
b. Antibodies against p cells
c. Prone to Diabetic Ketoacidosis [ DKA ]
d . Insulin is required for management of DKA

51. Impaired glucose tolerance on an oral GTT is indicated by ;

a . Fasting plasma sugar > 126 mg/ dl
b. Random blood sugar > 200 mg/ dl
c. Fasting blood sugar < 90 mg/dl
d. Fasting blood sugar < 140 mg/ dl; two hours after glucose load > 200 mg / dl
e. 2 hrs after glucose load 140 - 200 mg/ dl; fasting blood sugar < 126 mg / dl

52. HbAlC level in blood explains:

a. Acute rise of sugar
b. Long terms status of blood sugar
c. Hepatorenal syndrome
d. Chronic pancreatitis

53.The most common presentation of endemic goiter is

a. Hypothyroid
b. Diffuse goiter
c. Hyperthyroid
d. Solitary nodule
54. A person js HBsAg positive, but Anti- HBc Ab is nega ¬ tive. What should be the
next step?
a. Repeat test after 6 months
b. Check HBeAg, if positive start interferon
c. Check HBV DNA load
d. Reassure patient that he does not have any disease

55. A patient has anti HBs without any other without any other antigen or antibody against
HBV.This indicates:
a. Vaccinated
b. Chronic infection
c. Persistent carrier
d. Acute infection

56. HbsAg Carrier state is not associated with:

a. Down's syndrome
b. Chronic renal failure
c. Poly-arteritis nodosa
d. Infectious mononucleosis
57. Most common route of transmission of hepatitis C:
a. I.V. drug abuse
b. Sexual contact
c. Factor 8 concentrate
d. Feco-oral route
58. Incubation period of hepatitis B is:
a. 6 weeks to 6 months
b. 6 days to 6 weeks
c. 6 months to 6 years
d. More than 6 years

59. Co-infection is essential for disease presentation in:

a. Hepatitis A
b. Hepatitis B
c. Non-A Non-B hepatitis
d. Delta hepatitis
60. Patient comes for blood donation but he has Hbs Ag and HbeAg positive, and serum
transminases level is normal. What would be the next line of management:
a . Treat with interferon
b. HBV DNA estimation
c. Liver biopsy
d. Observation

61. Which one of the following markers in the blood is the most reliable indicator of recent
hepatitis B infection ?
a. HbsAg
b. IgG anti- HBs
c. IgM anti - HBc
d. IgM anti - Hbe

62. Which statement is wrong regarding Hepatitis B?

a. It is due to RNA virus
b. Blood is the main source of infection
c. Chronicity is present
d. It may turn into hepatocellular carcinoma
 63. The most common type of hepatitis associated with blood transfusion:
a. Hepatitis C
b. Hepatitis B
c. Hepatitis A
d. Hepatitis D
64. Stigmata of chronic liver disease include all of the following, except:
a. Parmar erythema
b. Spinder naevi
c. Testicular atrophy
d. Subcutaneous nodules

65. The commonest hepatotropic virus progressing tochronicity is :

a. HEV
b. HAV
c. HCV
66. All of the following are seen in active chronic hepatitis B except:
a. IgM against core antigen
b. Total core antibody
c. HbeAg
d. HbsAg
67. Hepatitis B infectivity is indicated by:
a. Anti-HBsAg
b. HBsAg + HBeAg
c. Anti-HBsAg - Anti-HBc
d. Anti-HBeAg + Anti-Hbs Ag
68. Hera lal a 35 year old man was found +ve for HBsAg & HBeAg, accidentally during
screening of blood donation. What should you do next :
a. Liver biopsy
b. Interferon therapy
c. Observation
d. HBV-DNA estimation
69. Interferon treatment is recommended in chronic hepatitis B in patients with:
a. > HBV DNA and Normal ALT
b. > HBV DNA and > ALT
c. > HBV DNA and compensated cirrhosis
d. > HBV DNA and decompensated cirrhosis

70. Glycemic control indiabetes is best assessed

by-
a) HbAIC b) Urinary glucose
c)Fasting glucose d) Post prandial glucose

71. A 40 yrs old female who is known case of ischemic heart disease (IHD) is diagnosed having hypothyroidism. Which
of the following would be most appropriate line of management for her -
a) Start levothyroxine at low dose
b) Donotstartlevothyroxine
c) Uselevothyroxine
d) Thyroid extract is a better option

72. Cardiac manifestations of Grave’s disease would include all of the folloing except -
a) Wide pulse pressure
b) Atrial fibrillation
c) Pleuropericardial scratch
d) Aortic insufficiency

73. The laboratory test of choice to confirm myxoedema coma is -

a) Thyroid stimulating hormone (TSH)
b) Thyrotropinereleasinghormone (TRH)
c) Tri-iodothyronine (T3)
d) Tetraiodothyronine (T4)

74. Which of the following is found in primary hypothyroidism-

a) T3 decrease, T4 decrease, TSH increase
b) T3 decrease, T4 increase, TSH decrease
c) T3 normal, T4 normal, TSH increase
d) T3 decrease, T4 decrease, TSH normal

75. A large toxic retrosternal goiter is best treated by-

a) Antithyroid drugs b) Radio iodine
c) Surgicalresection d) Lugol’siodine

76. In a patient of primary hypothyroidism, the hormonal profile will read -

a) Low T 3, lowT4, lowTSH
b) Low T3> low T4, high TSH
c) High T3, high T4, high TSH
d) Low T„ low T4, normal TSH

77. Most common cause of hyperthyroidism-

a) Thyroidhyperplasia
b) Thyroidadenoma
c) Thyroidcarcinoma
d) Grave disease

78. All are true regarding Plummer Vinson syndrome, except -

a) Oesophageal web
b) Predisposes to malignancy
c) Koilongchia
d) Common in elderly males

79. The patient has chronic posthemorrhagic anemia, accompanied by lower

concentrations serum iron, hypochromia of erythrocytes, poikilocytosis and
anisocytosis. What is the value of color index at this anemia?

A 0,7

B 1,1

C 0,9

D 1,0
80. A B-12 -deficiency anaemia developed in a patient following the stomach
resection. What colour index of blood is typical for this pathology?

A. 1.4

B. 1.0

C. 0.8

D. 0.5

81. Female, 55 years old, complaints of prolonged cyclical uterine bleeding during
the year, weakness, dizziness. Objective: pale skin. In the blood: Hb - 70 g/l, er.-
3,2x1012/l, CI - 0,6, leuk.-6,0x109 /l, reticulocytes - 1%; hypochromia of
erythrocytes. What is anemia in patients?

A. Chronic posthemorrhagic

B. Hemolytic

C. Iron-deficiency

D. B12-deficiency
82. All of the following are noticed in cirrhosis of liver, except:
a. Raised serum albumin
b. Excessive urobilinogenuria
c. Prolonged prothrombin time
d. Raised serum globulin
83 . A man presents with history of hemetemesis of about 500 ml of blood . On examination ,
spleen is palpable 5 cms below the left costal margin . The most likely
diagnosis is:
a. Portal Hypertension
b. Gastric ulcer
c. Drug induced
d . Hepatitis A
84. Portacaval Encephalopathy is treated with:
a. Lactulose
b. Large amounts of proteins
c. Emergency portal systemic shunt surgery
d. Diuretics
85. Earliest sign in hepatic encephalopathy is:
a. Asterixis
b. Alternate constriction and dilated pupil
 c. Constructional apraxia
d. Psychiatric abnormalities
86. Diabetes mellitis diagnosed when -
a) Fasting blood glucose is 100 and post prandial 140
b) Fasting blood sugar 125 and 2 hour postprandial blood sugar is 199
c) Insulinlevel
d) HbAlc>6.5%
87. The earliest sign of iron deficiency anaemia-
a) Increase in iron binding capacity
b) Decreaseinserumferritinlevel
c) Decreaseinserumironlevel
d) Alltheabove

88. Most sensitive and specific test for diagnosis of iron deficiency is -
a) Serum iron levels
b) Serum ferritin levels
c) Serum transferrin receptor population
d) Transferrin saturation
89. Best test for assessment of iron status is-
a) Transferrin b) Ferritin
c) Serumiron d) Hemoglobin
90. Which of the following findings is diagnostic of iron deficiency anemia -
a) Increased TIBC, decreased serum ferritin
b) Decreased TIBC, decreasedserumferritin
c) Increased TIBC, increasedserumferritin
d) Decreased TIBC, increasedsermferritin
91. True about iron deficiency anemia -
a) Microcytichypochromicanemia
b) Decreased TIBC
c) Increasedferritin
d) Bone marrow iron decreased earlier than serum iron

92. “Protective” factors in pathogenesis of ulcer disease are:

a. mucous stomach cells regeneration; chloric acid, pepsin;
b. pepsin; mucus secretion; chloric acid.
c. prostaglandins; mucous stomach cells regeneration; mucus secretion;
d. mucus secretion; chloric acid, bile acid regurgitation;
93. Drug depended ulcer is induced:
a. aspirin; metoprolol;
b. metoprolol; prednisolon;
c. prednisolon; aspirin;
d. salmeterol; streptokinase.
94. Pain in epigastrium after meal is symptom ulcer disease of :
a. stomach;
b. distal part of esophagus;
c. duodenum.
95. Which drug is considered first-generation sulfonylureas?
A. Chlorpropamide
B. Glyburide
C. Glipizide
D. Glimepiride
E. Gliquidone

96. Anti -double stranded DNA is highly specific for :

a . Systemic sclerosis
b. S.L.E.
c. Polymyositis
d. Rheumatic sclerosis
97. Treatment of drug-induced gastritis:
a. Mesoprostol
b. H2 receptor blockers
c. Antacids
d. Aspirin
98.Duration of long-acting insulin is

A. 18-30 hours
B. 6-18 hours
C. 24-30 hours
D. 36-72 hours

99. Mechanism of sulphonylureas’ action includes

A. Stimulation beta cells to secrete insulin

B. Stimulating beta cells to synthesise insulin
C. Inhibiting beta cell to secrete insulin
D. Beyond pancreatic activity
E. Inhibiting insulin resistance

100. Duration of intermediate-acting insulin is

A. 12-18 hours
B. 6-18 hours
C. 12-24 hours
D. 24-36 hours

101. Which of the following is not a symptom of hyperthyroidism?

  A)loss of weight
  B)increased mental awareness
  C)increased heart rate
  D)increased ability to sleep
102. Indications of colonscopy:
a. rectal bleeding, anemia, suspected inflammatory bowel disease
b. suspected inflammatory bowel disease, severe shock.
c. severe respiratory disease
d. cardiac arrhythmia.
103. Contraindications of colonoscopy:
a. rectal bleeding, anemia, suspected inflammatory bowel disease
b. suspected inflammatory bowel disease,
c. severe respiratory disease, severe shock.
d. suspected inflammatory bowel disease
104. Normal serum bilirubin level is:
a. less than 1mg\dl,
b. less than 2mg\dl,
c. less than 3mg\dl,
d. less than 4mg\dl,
105. Hypothyroidism in infants can result in
  A)Grave's disease
  B cretinism
)
  C)Hashimoto's disease
  D myxedema
)

106. What can possibly cause the development of iatrogenic thyrotoxicosis?

a) overdose of thyroid hormones during treatment of hypothyroidism;
b) hypersensitivity of receptors to endogenous thyroid hormones;
c) all of the mentioned above

107. What are the complications of treatment with thyreostatics of imidazole group?
a) thrombocythosis;
b) lymphocytosis;;
c) leukopenia;

108. A 22-year-old pregnant is diagnosed with Graves' disease. Appropriate therapy includes:
A. Propylthiouracil therapy with the goal of maintaining her thyroid function tests in
the highnormal

B. Radioactive iodine to ablate her thyroid gland or slightly high range

C. Methimazole therapy

D. A beta blocker
109. Which statement regarding diabetes mellitus is true?
a. Diabetes increases the risk for development of epilepsy.
b. The cure for diabetes is the administration of insulin only
c. Diabetes increases the risk for development of cardiovascular disease.
d. Carbohydrate metabolism is disturbed in diabetes, protein and lipid metabolism are normal.

110. Ascites in liver cirrhosis is formed as a result of:

a. secondary hyperaldosteronism, hypoalbuminemia, Portal Hypertension
b. hypoaldosteronism, potassium loss, salt retention
c. hypertension, salt retention
d. all the above
111. Decrease acid-secretory function occurs more frequently:
a. in chronic superficial gastritis
b. in chronic gastritis, antrum
c. in chronic atrophic gastritis
d. with hypertrophic gastritis
112. The ranitidine is:
a. blocker of H2-histamine receptors
b. total anticholinergic action
c. anticholinergic topical
d. antacid
113. With which therapy for diabetes mellitus is the patient not at risk for hypoglycemia?
a. Regular insulin
b. Lente insulin
c. Biguanides
d. Sulfonylureas

114. The method of diagnosing the cause and localization of bleeding from the
upper gastrointestinal tract is:
a. Radiography
b. Portomanometriya
c. Laparoscopy
d. gastroduodenoscopy
115. Impaired glucose tolerance is corresponds to the concentration of glucose in capillary blood
(mmol / l)
1) fasting<6.7 through 2 hours ≥ 7,8 and <11.1
2) fasting<6.0 through 2 hours ≥ 6,1 and <7.8
3) fasting<6.1 through 2 hours ≥ 7,2 and <11.1
4) fasting<6.1 through 2 hours≥ 7,8 and <11.1

116. The risk factors for type 1 diabetes include all of the following except:
a. Diet
b. Genetic
c. Autoimmune

117. Type 2 diabetes accounts for approximately what percentage of all cases of diabetes in
adults?

a. 55%-60%
b. 35%-40%
c. 90-95%
d. 25-30%

118.To exclude the malignancy of gastric ulcer should be used:

a. X-ray examination
b. endoscopy
c. stool for occult blood
d. endoscopy with biopsy
119. Chronic atrophic gastritis is caused by:
a. Antibody response to the G cells of the stomach, which reduces the production
of gastrin leads to achlorhydria;
  b. mucosal atrophy in patients with atherosclerosis;
  c. long-term use of glucocorticoids;
  d. NSAIDs.
120. Complications of duodenal ulcer;
a. Bleeding;
b. portal hypertension;
c. jaundice;
d. ascites;

121. Risk factors for type 2 diabetes include all of the following except:

a. Advanced age
b. Obesity
c. Smoking
d. Physical inactivity

122. What are the etiological factors of autoimmune hepatitis:

a. The defeat of the endothelium of the liver vessels;
b. Hepatitis B;
c. Hepatitis C virus;
d. Non known;
123. DRUG-INDUCED CHRONIC HEPATITIS may be caused by:
a.Paracetamol
b. Isoniazid
c. Antibiotics
d. All of above

124. Blood sugar is well controlled when Hemoglobin A1C is:

a. Below 7%
b. Between 12%-15%
c. Less than 8%
d. Between 7%and 8%

125. Characteristic of pain in chronic gastritis:

a. localisation in mesogastriumbeginnig in night ;
b. localisation in right hypochandrium with irradiation in right shoulder;
c. localisation in epigastrium which is began after meal;
d. localisation in epigastrium which is redused after meal;
e. localisation in epigastrium, which is indused fat meal.
126. Localisaton of process in chronic gastritis В is:
a. antral part of the stomach;
b. gastroesophageal part of the stomach;
c. cardia;
d. body of the stomach
127. Ussually H. pylory islocalisated:
a. antrum, bulbus of the duodenum;
b. cardia of the stomach;
c. body of the stomach.
d. esophagus; antrum.
128. For the clinic of chronic gastritis is characterized by:
a.subfebrile temperature;
b. moderate leukocytosis;
c. dyspeptic syndrome;
d. diarrhea;
129. Gastric secretion decreases:
a. famotidine;
b.solkoseril;
c.Cytotec;
d. Venter;
130. Omeprazole belongs to the group of drugs:
a. blockers;
b. M-holinoblokatory;
c. blockers of histamine H1-receptor antagonists;
d.proton pump blockers.
131. Etiological treatment with interferon in chronic viral hepatitis are beginning to
phase:
a. Replication
b. integration
c. proliferation
d. fibrosis
132.Which is characteristic of cytolytic syndrome?
a. increase: ALT, AST, LDG5
b. increase: direct bilirubin, alkaline phosphatase, uGTP, cholesterol
c. The increase in indirect bilirubin, ALT decrease, uGTP
133. Which is typical for mesenchimal inflammatory syndrome?
a. reduction: albumin, prothrombin, transferrin, cholesterol
b. increase: gammaglobulin, ESR, thymol, CRP
c. increase: ALT, AST, LDG5
134. The clinical manifestations of anemia:
a. bleeding
b. anemic syndrome
c. signs funicular myelosis
d. infectious complications
135. Intrinsic factor is produced in
a. fundus area of the stomach
b. duodenum
c. Serum
d. the wall of the small intestine

136.Untreated hyperglycemia may lead to all of the following complications except:

a. Hyperosmolar syndrome
b Vitiligo
c. Diabetic ketoacidosis
d. Coma

137. The indication for the purpose of glucocorticoids in chronic

glomerulonephritis is:
a. nephrotic syndrome
b. hypertension
c. renal failure
d. hematuria
138. All of the symptoms characteristic of glomerulonephritis
a. Hypertension, the urine changes, edema
b. Pain in the lumbar region, edema, dysuria
c. dysuria, bleeding, pain
d. itching, dysuria, hypertension

139. Тhe treatment of chronic pyelonephritis is used:

a. antibiotics
b. antiplatelet agents
c. kortikosterovdov
d. methylxanthines
140. What does "uremia" mean?
a. The increase in blood urea level
b. The increase in urea and creatinine
c. The clinical manifestations of toxicity associated with renal failure
d. violation of the acid-base status
141. In glomerulonephritis affected:
a. tubules
b. glomerulus
c. renal pelvis
d. vessels

142.Patients with Diabetes Mellitus are at risk for developing complications.

Which of the following complications is NOT associated with Diabetes Mellitus?

a. Apathy

b. Neuropathy

c. Retinopathy

143. True about hepatitis with (HCV) is:

a. Present with fulminant liver failure B
b. Chronicity is not seen
c. Genotyping helps in treatment duration
d. Faeco / oral transmission

144.HBs Ag positive person may have all of the followingassociated Renal lesions,
Except:
a. Membranous Glomerulonephritis (MGN)
b. Membrano proliferative Glomerulnephritis (MPGN)
c. Mesangiocapillary Glomerulonephritis
d. Focal Segmental Glomerulosclerosis (FSGS)

145. All are anti – thyroid drugs excepts

a) Carbimazole
b) Chlorpropamide
c) Propylthiouracil
146. Enlargement of the thyroid gland is called

a. Thyroidectomy

b. Thyrotoxicosis

c. Goitre

d. None

147. A 55-year old woman recently diagnosed with hyperthyroidism started an

appropriate treatment. One month later the following laboratory values were obtained:
RBC 4.6 x 10 /mcl, WBC 0.9 x 10 /mcl, platelets 45 6 3 x 103/mcl. Which of the
following drugs most likely causes these results?
A. L-thyroxine

B. Potassium iodide

C. Methimazole

D. Propranolol

148. A59-year-old woman was admitted to the hospital with restlessness, insomnia,
tremor and a pronounced exophthalmos. The woman, who had been suffering from
hyperthyroidism for two months, had been treated with propylthiouracil but the drug was
discontinued because of the appearance of agranulocytosis. Which of the following
agents would be most appropriate for the patient at this time?
A. Methimazole
B. Radioactive iodine
C. Potassium iodide
D. Propranol

149. Which of the following is the most common cause of goiter?

A) Iodine deficiency
B) Iodine excess

C) Acute thyroiditis

150. Which of the following is the best therapy for hypothyroidism?

A) Dessicated thyroid

B) Levothyroxine

C) Liothyronine

D) Methimazole

151. What is the recommended dosage of levothyroxine in elderly adults with stable primary
hypothyroidism?

A) Initial dose of 25 µg daily, titrated every 4 to 6 weeks to achieve a normal serum TSH level

B) Initial dose of 50 µg daily, titrated every 2 weeks to achieve a normal serum TSH level

C) Initial dose of 75 µg daily, titrated every 2 weeks until the TSH level is suppressed below 0.1 mU/L

D) Initial dose of 100 µg daily, titrated every 2 months to achieve a normal T4 level E) Initial dose of 100
µg daily, titrated every 4 weeks to achieve a normal T4 level

152. Which of the following is NOT a clinical symptom of hypothyroidism?

A) Cold intolerance

B) Depression

C) Diarrhea

D) Muscle cramps

E) Weight gain

153.       A patient is admitted with complaints of palpations, excessive sweating, and unable to
tolerate heat.  In addition, the patient voices concern about how her appearance has changed
over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the
legs and feet. Which of the following is the likely cause of the patient’s signs and symptoms?

A.      Thyroiditis

B.      Deficiency of iodine consumption

C.      Grave’s Disease

D.      Hypothyroidism

154. A patient who is in her first trimester of pregnancy is diagnosed with

hyperthyroidism. Which medication do you suspect the patient will be started on?

A.      Propylthiouracil (PTU)

B.      Radioactive Iodine

C.      Tapazole

D.      Synthroid

155.   Which of the following side effects are possible for a patient taking an antithyroid
medication?

A.      Agranulocytosis and aplastic anemia

B.      Tachycardia

C.      Skin discoloration

D.      Joint pain and eczema

156. Which of the following is not a sulphonurea:

A. Chlorpropamide

B. Metformin

C. Gilbenclamide

D. Glipizide

157. Which of the following is not a microvascular diabetes complication:

A. Nephropathy

B. Retinopathy

C. Peripheral neuropathy

D. Myocardial Infarction

158. What measure is important for the prevention of diabetes at presence of family history?

a) prevention of acute infections

b) prevention of obesity
c) the exclusion of emotional stress
d) warning of marriage with diabetics

159.The main factors of the pathogenesis of diabetes mellitus type1:

a) insulin resistance and degradation in cells
b) the destruction of B-cells and insulin deficiency
c) 3 insulin deficiency and increasing contrinsulyarny hormones
d) increase in contrinsulyarnyhormones and insulin resistance
160. Diabetes of the type 1 should be treated in
a) diet therapy only;
b) 2.sulfanilamidnymi drugs;
 c) only insulin therapy
d) biguanides;

161. Which indicator is the most reliable criteria for the degree of compensation of diabetes in dynamic
survey
a) C-peptide;
b) the average daily blood glucose;
c) glycosylated hemoglobin;
d) the mean amplitude of glycemic fluctuations

162.An absolute contraindications for the oral sugar-reducing drugs is:

a) prostate adenoma;
b) psoriasis;
c) 3microbial eczema;
d) pregnancy;

163.The woman, 45 years old, with obesity 1st Class was found fasting glucose of 10 mmol \ l, after meal
14.8 mmol \ l, glucosuria 3% acetone in the urine is not. The brother of the patient suffers for diabetes.
What type of diabetes in a patient?
a) Diabetes mellitus type 1;
b) Diabetes mellitus type 2;
c) Diabetes is associated with a disease of the exocrine pancreas;
d) Diabetes is associated with endocrinepathies

164.Symptoms of early stage nephropathy

a) microalbuminuria
b) leucocyturia;
c) hematuria;
d) oliguria;
165. The most frequent cause of death in type 2 diabetes is
a) hyperosmolar coma
b) gangrene of the lower limbs
c) myocardial infarction
d) diabetic nephropathy

166. Diabetes diagnosis is confirmed by:

a. the level of fasting plasma glucose> 6,7mmol / l

b) capillary blood glucose level fasting> 6.7 mmol / l

с. the level of fasting plasma glucose> 7.0 mmol / l

d. the capillary level of fasting blood glucose> 6.1 mmol / l

167.Complications of insulin therapy include the following:

a. hypoglycemic condition
b. ketoacidosis
 c. the decrease in body weight

168. None invasive diagnostic methods for H.pylori verification are:

a. histologycal;
b. ureas test;
c. microbiological blood test on H. Pylori;
d. microbiological stool test on H. Pylori;

169. Acidity in gastritis B is:

a. normal;
b. high; *
c. lower than the normal.

170. Main clinical symptom in duodenum ulcer disease is:

a. pain on empty stomach; *
b. diarrhoea;
c. eructation;
d. early pain after meal;

171. First line drugs for H. Pylori eradication are:

a. amoxicillin, clarithromicin;
c. metronidazole; furazolidone.
d. sumamed;

172. Gastrin is prodused by:

a. H-cells;
b. М-cells;
c. G-cells;
d. Р-cells;
173. Typical localization of chronic gastritis type A is:
a. antral part of the stomach;
b. gastroesophageal part of the stomach;
c. cardia;
d. body of the stomach;

174. Clinical manifestations of chronic gastritis:

a) cytolytic syndrome;
b) cholestatic syndrome;
c) syndrome of portal hypertension;
d) syndrome of gastric dyspepsia.

175.Complication of PEPTIC ulcer;

a) Bleeding;
b) portal hypertension;
c) jaundice;
D) ascites;

176. Which of the interferons has mainly antiviral activity?

1) γ-IFN
2) α-IFN
3) β-IFN

177. A74-year-old woman has pain in her left hand and right knee, which started months ago, and
is now interfering with her activities. The paingets worse as the day progresses. There is no
history of any trauma, and she is otherwisewell. Taking over-the-counter acetaminophen
usually relieves the pain. On examination, thereis bony soft tissue swelling of her second and
third DIP joints in the left hand and crepitus over the right knee with flexion. There is noerythema or joint
effusion. Which of the followingis the most likely explanation for thejoint pain of osteoarthritis?
(A) synovial inflammation is not the cause
(B) ligament inflammation is a common
cause
(C) clinically visible (via plain x-ray)
fractures are a common cause of pain
(D) osteophytes can cause pain
(E) muscles are not involved

178. A29-year-old woman develops painful swellingof both hands. She is also very stiff in the morning.
Physical examination reveals involvementof the proximal interphalangeal joints and
metacarpophalangeal (MCP) joints. Her RF ispositive and ANA is negative. Which of thefollowing
medications is most likely toimprove her joint pain symptoms?
(A) D-penicillamine
(B) an antimalarial
(C) methotrexate
(D) NSAID or aspirin
(E) gold

179. A72-year-old man injures his right knee in a caraccident, and now it is swollen and extremely
painful to bend the knee. X-rays of the knee ruleout a fracture, and joint fluid aspiration reveals
an opaque-colored fluid containing rhomboidcrystals with weak-positive birefringence. Which
of the following is the most appropriate nextstep in management?
(A) oral prednisone
(B) intravenous antibiotics
(C) oral NSAIDs
(D) acetaminophen
(E) allopurinol

180. A 25-year-old woman develops painfulswelling of both hands and wrists. She is also
very stiff in the morning. Physical examinationreveals erythema, swelling and joint line tenderness
of the proximal interphalangeal, MCP,and wrists joints. Her RF is positive, ANA is negative, and x-rays of the
hands show earlyerosive joint changes. Which of the following medications is most likely to prevent
progressionof disease?
(A) D-penicillamine
(B) antimalarial
(C) methotrexate
(D) NSAID or aspirin
(E) gold

181. A 26-year-old man presents with dyspepsia. No alarm symptoms are present. This is his first episode and
he has no significant medical history of note. A test-and-treat strategy is agreed upon. What is the most
appropriate investigation to test for Helicobacter pylori?

A. Upper gastrointestinal endoscopy

B. Esophageal pH monitoring
C. Stool culture
D. Urea breath testing

182. A 27-year-old man complains of episodic abdominal pain. The pain is concentrated in the
epigastrium and is gnawing in quality. It wakes him up during the night and is promptly relieved by a
glass of water and a piece ofbread. He denies vomiting or diarrhea, but has experienced an
occasional "dark stool." His vital signs are with in normal limits. Physical examination shows
mildepigastric discomfort on deep palpation. What is the most likely diagnosis?

a) chronic gastritis В

b) chronic gastritis А
c) gastric ulcerdisease
d) duodenal ulcer disease

183. A 60-year-old woman comes to the physician with a 4-week history of abdominal symptoms.
She complainsof upper abdominal discomfort and occasional dull epigastric pain accompanied by
nausea. Her symptoms are often worse after eating, especially with large meals. Which of the
following is the most appropriate next step in management of this patient?
A. Abdominal ultrasound
B. Antacids and metoclopramide
C. Helicobacter pylorystool antigen testing
D. Esophagogastroduodenoscopy

184. A 44-year-old white male comes to the office and says, "I have had this persistent, upper
abdominal pain for the past 2 months. Physical examination reveals mild tenderness in the epigastric
region.
Esophagogastroduodenoscopy reveals peptic ulcer
What is the best next step in the management of this patient?
A. Radical gastrectomy with en bloc resection of spleen and regional nodes
B. Give a combination of omeprazole, clarithromycin, and amoxicillin.
C. Give combination chemotherapy.
D. Radiotherapy
~E. Observation and strict surveillance

185.A young man presents with HBsAg positive anti HBcIgM positive, HBeAg negative and normal levels of AST and ALT. He
is asymptomatic. What is the next line of management.

a) Wait and Watch b) Lamivudin

c) Immunoglobulin d) Liver Transplant

186.All the following hepatitis viruses is transmitted by parenteral route except- a) Hepatitis В virus b) Hepatitis С
virus
c) Hepatitis D virus d) Hepatitis E virus

187.A 52-year-old man presents to your office after passing a black stool. He also describes
occasional abdominal discomfort and nausea but denies hematemesis. He says that food
seems to help his abdominal pain, so he eats frequently during the day and keeps some
snacks on his night stand. As a consequence he has gained 5 pounds over the last year.
The fecal occult blood test is positive. Which of the following is the most likely cause of his
condition?
A. Gastritis
B.Peptic ulcer disease
C. Inflammatory bowel disease
D. Hepatitis B

188. A 56-year-old man is brought to the emergency department with lethargy and confusion. He
has a history ofcirrhosis secondary to chronic alcoholism. He is taking spironolactone and
furosemide.
Onphysical examination, he has a flapping tremor of his hands when they are held out. Abdominal
examination shows distension with shifting dullness anddiffuse tenderness to palpation. There is
bilateral pitting edema of his lower extremities.
Which of the following is the most appropriate next step in management?
A. Esophageal pH monitoring
B. Upper gastrointestinal endoscopy
C.Diagnostic paracentesis
D. He/icobacter pylori stool antigen testing

189. A 54-year-old man complaining of bitter taste and substernal burning 30-40 minutes after
meals. The burning is relieved with antacids and worsened by lying supine.He has had an
unintentional weight loss of 4.5 kg (1 0 lb}over the past 3 months. . Chest x-ray and
electrocardiogram show no abnormalities.
Which of the following is themost appropriate next step in management of this patient?
A.Upper gastrointestinal endoscopy
B. Esophageal pH monitoring
C. He/icobacter pylori stool antigen testing
D. Trial of famotidine

190. You wish to screen a patient for hepatitis B infection. Which one of the following is the most suitable test
to perform?
A. HBcAg
B. HBsAg
C. Hepatitis B viral load
D. anti-HBs
191. A 59-year-old female presents to her GP with a two month history of indigestion. She is otherwise well,
has not had a similar episode before and takes no regular medication. Of note there is no recent weight loss or
vomiting and abdominal examination is unremarkable. What is the most appropriate initial management?
A. Long-term course of a H2 receptor antagonist
B. Urgent referral for endoscopy
C. One month course of a full-dose proton pump inhibitor
D. Urea breath testing and treat for H pylori if positive

192. Which one of the following statements regarding hepatitis C is correct?

A. Cannot be transmitted vertically from mother to child

B. Interferon-alpha and ribavirin are the treatments of choice
C. It is more infectious than hepatitis B following a needle stick injury
D. Breast feeding is contraindicated in mothers with hepatitis C
193.A 45-year-old man with a long history of alcohol intake comes into the emergency room with
upper gastrointestinal (UGI) bleeding. Urgentendoscopy reveals - the following findings the esophageal folds
are thick and tortuous, giving rise to a wormy or worm-eaten appearance.
Which of the following is the most likely diagnosis?
(A) esophageal varices
(B) esophageal carcinoma
(C) foreign body
(D) tertiary waves
(E) Barrett’sesophagus

194.A young patient presenting with massive hematemesis was found to have splenomegaly.
In this case the most likely source of bleeding is -
a) Duodenal ulcer b) Esophageal varices, c)Erosive mucosal disease d) Gastric ulcer

195. Which one of the following serum levels would help in distinguishing an acute liver
disease from chronic liver disease - a) Aminotransaminase b) Alkaline phosphatase, c)Bilirubin
d) Albumin
196. In hepatic cirrhosis, which of the following is increased - a) Alpha 1 globulin b) Alpha 2
globulin
c) Gamma globulin d) All of the above

196.A 40 year old patient, a known case of cirrhosis develops acute episode of GI bleed. Initial
therapy given for 6 hours.Which of the following procedure is useful -
a)Nasogastric aspiration b) Urgent endoscopy , c)Sedation d) Ultrasound

197. A young boy, R. presents with massive hemetemesis. He had fever for 15 days few days
back which was treated. Clinical examination reveal moderate splenomegaly No other history is
positive Probable diagnosis is - a) Drug induced gastritis b) Oesophageal tear, b)
Bleeding duodenal ulcer d) Oesophageal varices
198.The most common infectious agent associated with chronic pyelonephritis is -
a) Proteus vulgari
b) Klebsiella pneumonia
c) Staphylococcus aureus
d) Escherichia coli

199. In pyelonephritis the diagnostic urinary finidng is -

a) RBC cast
c) Pus cells d) RBCs
 200.Microalbuminuria refers to urinary albumin excretion rate of -
a) 30-300mg/24 hour b) 400-600 mg/24 hour
c) 700-900 mg/24 hour d) >1000 mg/24 hour

201. Which part of the spine is most commonly affected in Rheumatoid arthritis -
a) Cervical b) Lumbar
c) Thoracic d) Sacral

202.Which of the following is true regarding Rheumatoid arthritis -

a) Typically involves small and large joints sym metrically but spares the cervical spine
b) Causes pleural effusion with low sugar
c) Pulmonary nodules are absent
d) Enthesopathy prominent

203. Which of the following is the most specific test for Rheumatoid arthritis -
a) Anti-ccp antibody
b)Anti IgA antibody
c) Anti IgM antibody
d) Anti IgG antibody

204Type of anemia seen in Rheumatoid arthritis is -

a) Microcytic hypochromic anaemia
b) Macrocytic hypochromic anaemia
c) Normocytic hypochromic anaemia
d) Normocytic normochromic anaemia

204. Which is the most common site of subcutaneous nodules in rheumatoid arthritis –
a) Elbow b) Wrist
c) Achilles tendon d) Occiput
206.The most common cardiac involvement in rheumatoid arthritis - a) Pancarditis b) Pericarditis
c) Myocarditis d) Endocarditis

207.Drugs used in treatment of acute gout –

a) Allopurinol b) Colchicinec) Pamidronate d) Methotrexate

208. Least common site to involved in osteoarthritis amongst the following is -

a) Hip joint
b) Knee joint
c) Metacarpophalangeal joint

209.Gout is a disorder of-

a) Purine metabolism b) Pyrimidine metabolism c) Ketone metabolism d) Protein metabolism
210. All of the following statements about primary Gouty arthritis are true, Except -
a) 90% of cases are caused by over production of uric acid
b) Uric acid levels may be normal at the time of an acute attack
c) Men are more commonly affected than women (Male > Females)
d) Definitive diagnosis requires aspiration of synovial fluid
211. False regarding gouty arthritis is -
a) Synovial fluid analysis is diagnostic
b) Allopurinol is the treatment of choice in acute gout
c) Arthritis occurs after long attack of hyperuricemia
 d) Level of uric acid in blood and severity of gout has good correlation
212.Most specific diagnostic finding in gout is -
a) Uric acid crystals in urine
b) Raised serum uric acid
c) Presence of calcium pyrophosphate crystals in synovial fluid
d) Presence of monosdium crystals in synovial fluid

213.Most common manifestation of cardiac lupu is -

a) Myocarditis b) Libman-Sacks endocardits c) Pericarditis d) Aortic regurgitation

214. A 23 years old woman has experienced episodes < myalgias, pleural effusion, pericarditis an arthralgias without joint
deformity over course < several years. The best laboratory screening test i diagnose her disease would be -
a) CD lymphocyte count
b) Erythrocyte sedimentation rate
c) Antinuclear antibody
d) Assay for thyroid hormones

215. Anti ds DNA antibody is specific for -

a) SLE b) Systemic sclerosi
c) CREST syndrome d) Sjogren’s syndroi
a) Wegener’s granulomatosis

216. Indications for use of cyclophosphamide in SLE

a) Arthritis
b) Anti DNA antibody + ive patients
c) Diffuse prolifereative glomerulonephritis
d) Oral ulcers
e) Discoid lipus

217. Anti-double stranded DNA is highly specific for -

a) Systemic sclerosis
b) S.L.E.
c) Polymyositis
d) Rheumatic sclerosis
218.Specific antibody for SLE is -
a) Anti-Ro b)Anti-Jo
c) Anti-Sm d) Anti ds DNA
e) Anti-La
219. A 23-year old woman has experienced episodes of myalgias, pleural effusion, pericarditis and arthralgias without joint
deformity over course of several years. The best laboratory screening test to diagnose her disease would be -
a) CD4 lymphocyte count
b) Erythrocyte sedimentation rate
c) Antinuclear antibody
d) Assay for thyroid hormones
220.Characteristic feature of SLE is -
a) Uveitisb) Joint deformity
c) Polyserositis d) Cavitating lesion is lung
221.Autoimmune destruction of platelet is seen in-
a) SLE b) Rheumatoid arthritis
c) Reiter disease d) Polyarteritis nodosa

222. Deposition of anti ds DNA Ab in kidney, skin, choroid plexus and joints is seen in- SLE

223. A middle aged female presents with polyarthritis with elevated rheumatoid factor ANA analevels, which among the
following will help you to differentiate rheumatoid arthritis from SLE ?
a) Soft tissue swelling at the proximal inter phalangial joint
b) Juxta articular osteoporosis or X-ray
c) Articular erosions on X-ray
d) d) Elevated ESR
 224. Laboratory signs in rheumatoid arthritis for monitoring activity of the
process:
a. increasing the level of CRP;
b.high ESR;
c. increase the level of anti-CCP antigen;
d.leukocytosis,titer SLA-O.
225.Rheumatoid arthritis often suffer from:
a. girls and young women aged 20-30 years
b. middle-aged women aged 35-55 years
c. old women and the elderly
d. young men aged 20-30 years
   

 226.In rheumatoid arthritis, specific autoantibodies to pathogenesis are:

a.antistreptolysin O
b. antinuclear factor
c. antibodies to the circulatingcitruline peptide
d. an antibody to DNA
227. It is characteristic of rheumatoid arthritis:
a. symmetrical inflammation of more than 3 peripheral joints
b. asymmetric inflammation of 2-3 large joints
c. asymmetrical inflammation of the 1st large joints
d. symmetrical inflammation of the sacroiliac joint
228.In rheumatoid arthritis occurs:
a. symmetric polyarthritis
b. asymmetric arthritis
c. an asymmetric oligoarthritis
d. asymmetrical monoarthritis

229.For rheumatoid arthritis is characterized by predominant involvement of:

a. the large joints
b. the joints of the lower extremities
c. the knee and small joints of the hands and feet
d. joints of the spine
e. I metatarsophalangeal joints
230.In rheumatoid arthritis, the most commonly affected:
a. knee joints
b. the sacroiliac joints
c. the small joints of the hands
d. small joints of the feet
e. I metatarsophalangeal joints
 231. In rheumatoid arthritis clinical signs of irreversible joint damage are:
a) chondritis
b) synovitis
c) ankylosis
d) achillitis

232. In late-stage rheumatoid arthritis are the following features of a symmetric

polyarthritis:
a) exudative signs of potentially reversible
b) irreversible exudative signs
c) potentially reversible proliferative (fibrotic, sclerotic) signs
d) irreversible proliferative (fibrotic, sclerotic) signs and ankylosing
 233. For the early stages of rheumatoid arthritis are characterized morning stiffness
duration:
a) up to 30 minutes
b) from 30 minutes to 1 hour
c) over 2 hours
d) during the day
e) from 30 sec to 1 min
234.  Late stages of rheumatoid arthritis are characterized morning stiffness
duration:
a) up to 30 minutes
b) from 30 minutes to 1 hour
c) over 2 hours, sometimes within days
d) from 30 sec to 1 min

235. In rheumatoid arthritis symptoms such as rheumatoid nodules, muscle

inflammation, lymphadenopathy, rheumatoid vasculitis, visceritis, nervous
system, eyes, and blood system, as well as fever and weight loss are:
a) a complication of the disease
b) a low disease activity
c) the systemic manifestations of the disease
d) transformation of a systemic lupus erythematosus
236.The most frequent type of systemic manifestations of rheumatoid arthritis
are:
a) rheumatoid nodules
b) muscle inflammation
c) lymphadenopathy
d) rheumatoidvasculitis

237.  Kidney damage in rheumatoid arthritis is manifested most often:

a) latent glomerulonephritis
b) nephrotic glomerulonephritis
c) secondary amyloidosis of the kidneys
 d) pyelonephritis
e) urolithiasis
238.   The most specific laboratory parameters of rheumatoid arthritis is the
detection of a high level of blood:
a) C-reactive protein
b) uric acid
c) factor and antinuclear antibodies to DNA
d) rheumatoid factors and antibodies to circulating citrulline peptide
239.  The most specific radiological sign of rheumatoid arthritis is:
a) periarticular osteoporosis
b) osteophytes and osteosclerosis
c) joint space narrowing
d) marginal bone erosion

240. Functions of kidney:

a) excretory, regulatory, endocrine, metabolic;
b) protein inhibitor, circulation, transportation, excretory;
c) protein produced, regulatory, excretory;
d) excretory, transportation, metabolic;
241. Treatmen of gout:
a)NSAIDs, corticosteroids;
b)B-blocers;
c) H2inhibitors, NSAIDs;
d) all of the above

242.         Select the "basic" drug in the treatment of rheumatoid arthritis:

a) benzylpenicillin
b) Biseptol (septran)
c) methotrexate
d) chondroitin sulfate
243.        SLE is more common in:
a) boys and young men
b) girls and young women
c) older men
d) elderly women
244.        What is the natural factor can exacerbate SLE:
a) solar radiation
b) the fog
c) magnetic storms
d) high humidity
245.        The specific type of skin lesions in SLE is:
a) vitiligo
b) hyperpigmentation
c) periorbital edema
d) erythematous skin rashes on the face of the type "butterfly"
246.        Photosensitivity (increased skin sensitivity to sunlight) - is a particular
feature:
a) rheumatoid arthritis
b) gout
c) osteoarthritis
d) systemic lupus erythematosus

247. Which is not a complication of hepatic cirrhosis:

a) spontaneous bacterial peritonitis;
b) hepatocellular carcinoma;
c) thrombocytosis;
d) portal hypertension;
e) portal vein thrombosis.

248. A 21-year-old woman presents with hypertension, fatigue, and mi-

croscopic hematuria. A renal biopsy demonstrates glomerulonephritis second-
ary to focal segmental glomerulosclerosis. Which of the following would be
the most appropriate step to take next in the treatment of this patient's disease:
a) renal dialysis;
b) cyclosporine;
c) prednisone;
d) cyclophosphamide;

249. A 45-year-old female complaints of increasing widespread joint

pains which are worse in the evening after a stressful day at work. She de-
scribes puffy hands and feet and a painful neck. Her concentration is very
poor and she has recently suffered from marital problems. Rheumatoid factor
is mildly positive. Examination reveals an increased body mass index and
global restriction of movement due to pain, but no synovitis. Which of the fol-
lowing investigations would be useful in this case:
a) anti-cycliccitrullinated peptide antibody;
b) ultrasound scan hands and feet;
c) anti-JO-I antibody;
d) erythrocyte sedimentation rate and CRP;
250. A 64 year old male presents with a symmetrical arthritis of both
hands with early morning stiffness. His X-rays of his hands done before clinic
show the following: periarticular osteoporosis of the metacarpeal joints; ero-
sion on the ulnar styloid; symmetrical distribution of disease; reduced joint
space at the carpal bones. What is the most likely diagnosis:
a) ankylosing spondylitis;
b) rheumatoid arthritis;
c) gout;
d) secondary osteoarthritis;
251. Osteoarthritis is characterized by all signs except:
a) degradation of articular cartilage and alterations in other joint tissues;
b) joint space narrowing, subchondral sclerosis, subchondral cysts, and pe-
ripheral osteophytes;
c) pain on movement, typically occurring when movement is initiated or
when the patient begins to walk;
d) morning stiffness in and around the joints, lasting at least 1 h before
maximal improvement;
252. A 25-year-old lady with known systemic lupus erythematosus (SLE)
presents with the nephrotic syndrome. A renalbiopsy is performed and this
confirms diffuse proliferative glomeronephritis (WHO Class IV). Which of the
following treatment regimens would you advise:
Variants of answer:
a) azathioprine alone;
b) prednisolone alone;
c) azathioprine and prednisolone;
d) prednisolone and intravenous cyclophosphamide;
253. Expected serum parameters in iron deficiency anemia are all except:
a) decresed serum iron level;
b) decresed serum TIBC (total iron-binding capacity);
c) decresed MCHC;
d) decresed serum ferritin level;
254. The complication of liver cirrhosis
1)esophageal bleeding
2)perforation of the stomach
3)penetration
4)pyloric stenosis

255.The most specific radiological sign of rheumatoid arthritis is:

a) periarticular osteoporosis
b) osteophytes and osteosclerosis
c) joint space narrowing
d) marginal bone erosion
256. Rheumatoid arthritis is an autoimmune disease that is characterized by:

a) synovial inflammation and hyperplasia;

b) autoantibody production;

c) cartilage and bone destruction;

d) systemic features, including cardiovascular, pulmonary, psychological,

and skeletal disorders;

257. Which of the following is a first line drug for patient with rheumato-

id arthritis:

a) ibuprofen;

b) methotrexate;

c) glucosamine sulfates;

d) pantoprazole;

258. Osteoarthritis is characterized by all signs except:

a) degradation of articular cartilage and alterations in other joint tissues;

b) joint space narrowing, subchondral sclerosis, subchondral cysts, and pe-

ripheral osteophytes;

c) pain on movement, typically occurring when movement is initiated or

when the patient begins to walk;

d) morning stiffness in and around the joints, lasting at least 1 h before

maximal improvement;

259. A 25-year-old lady with known systemic lupus erythematosus (SLE) presents
with the nephrotic syndrome. A renal biopsy is performed and this confirms
diffuse proliferative glomeronephritis (WHO Class IV). Which of the following
treatment regimens would you advise:

a) azathioprine alone;

b) prednisolone alone;

c) azathioprine and prednisolone;

d) prednisolone and intravenous cyclophosphamide;

260. Which is the most common cause of peptic ulcer disease (PUD) of

the following:

a) smoking;

b) NSAID’s;

c) Zollinger-Ellison syndrome;

d) ethanol excess;

261. General urinalysis in chronic pyelonephritis characterized by:

a) massive proteinuria;

b) leucocyturia;

c) hematuria;

d) nephrotic syndrome;

262. Which one of the following serum levels would help in distinguishing an acute liver
disease from chronic liver disease - a) Aminotransaminase b) Alkaline phosphatase, c)Bilirubin
d) Albumin
263. First line of treatment in severe ascites – a)Bed rest and salt restriction, b)Heavy
peracentesis
c)Shunt, d)Large dose of diuretics
264.A 40 year old patient, a known case of cirrhosis develops acute episode of GI bleed. Initial
therapy given for 6 hours.Which of the following procedure is useful -
a)Nasogastric aspiration b) Urgent endoscopy , c)Sedation d) Ultrasound

264. Adult organism contains: 1) 2-5 g of iron; 2) 4-5 g of iron; 3) 3-5 g

265. Symptoms of iron deaficiency are: 1) hair loss; 2) icteric skin; 3) increase of liver; 4)
paresthesia

266. Iron supplementations are prescribed: 1) for 1-2 weeks; 2) for 2-3 month,3) for 2-3 weeks;
4) for 1month

267. The level of ferritin in blood serum equal to: a)10 - 12 mg / l, b)80 - 350 mg / l , c)10 - 30
mg / l, d)15 – 300 mg / l

268.Which of the following contains iron in the form of storage: a) hemoglobin, b)ferritin,
c)transferase, d)transferrin

269. The criteria for recovery from iron deficiency anemia: а)appearance of reticulocytic crisis in
the first 7-10 days, b) normalization of ESR, c)The bone marrow hypoplasia, d) The total protein
level
 270. Gastrin is prodused: a) H-cells; b) М-cells;
c). G-cells; d). Р-cells; , e) parietal cells.
271. Pain in epigastrium after meal is symptom ulcer disease of :a. stomach;
b. distal part of esophagus; c. duodenum.
272. Main clinical symptom in duodenum ulcer disease is: a. pain on empty stomach; b.
diarrhoea; c. eructation; d. early pain after meal; e. nausea
273. A 27 year old male is is incidentally HBsAg positive. DNA-PCR for hepatitis В revealed
1000 copies/ml. The patient is suffering from?
a) Active HBV carrier b) Acute hepatitis Вс) Chronic hepatitis Вd) Inactive HBV carrier
274. Normal levels of Serum Iron : a)2-10 mmol / l, b)10-27mmol / l, c)15-45 mmol / l, d)26-
50 mmol / l, e)8-16 mmol / l

275. For iron deficiency anemia is characteristic: a)hypochromic anemia, b)The increase in direct
bilirubin, c)normochromic anemia, d)The increase in serum iron
276. In which cases indicated the use of parenteral iron supplements? A)with abundant hemorrhage,
b)when anemic coma, c)at a syndrome of impaired intestinal absorption, d)in atrophicgastritis
277.A young man presents with HBsAg positive anti HBcIgM positive, HBeAg negative and normal levels of AST and ALT. He
is asymptomatic. What is the next line of management.

b) Wait and Watch b) Lamivudin

ci) Immunoglobulin d) Liver Transplant

278. The normal rate of glomerular filtration by endogenous clearance is:

1)80 – 120 ml/min
2) 50 - 75 ml/min
3) 125 – 145 ml/min
4) 150 - 170 ml/min
5) 180 – 200 ml/min
279. Features of glomerular haematuria -
a) Dysmorphic R.B.C., R.B.C. cast

b) Fragmeneted R.BG.
c) Full of R.B.C. in high power field
d) Gross haematuria

280. All are used in treatment of Helicobacter pylori, EXCEPT-

a) Colloid bismuth b) Cisapride
c) Clarithromycin d) Metronidazole
281. Which drug is not effective against H.pylori-
a) Colloidal Bismuth b) Metronidazole
c) Amoxicillin d) Erythromycin

282. All are true regarding Helicobacter pylori except -

a) Less prevalent in developing countries
b) Toxigenic strains usually causes ulcers
c) Urea breath is positive
d) Gram negative organism

283. Diagnostic tests for H. Pylori include all of the following except-
a) Urea-breath test
b) Rapid urease test
 c) Gastric biopsy
d) Amylase

284. A patient with H. pylori infection is treated with drugs. The best method to detect presence of residual H. pylori
infection in this person is -
a) Rapid urease test
b) Urea breath test
c) Endoscopy and biopsy
d) Serum anti H. pylori titre

285. All except one are true for hepatitis В -

a) Vertical transmission more important than horizontal
b) Age of onset determines prognosis
c) Period of communicability lasts several months
d) Virus can be found in blood 1 month before jaundice

286. 35yo male with epigastric discomfort has been given triple therapy. He has

now returned after 4wks of epigastric discomfort. What inv would you do for
him?
a) ECG
b) H pylori breath test
c) Endoscopy and biopsy
d) US

287. A 64yo alcoholic who has been dx with liver cirrhosis presents with a massive
ascites. What is the mechanism of fluid accumulation in a pt with liver disease?
a. Cirrhosis
b. Portal HTN
c. Hypoalbuminemia
d. Liver failure
e. Hepatic encephalopathy

288. A 34yo man has an intermittent epigastric pain for 3wks. It is worse by
food but helped by some tablets he obtained from the pharmacy. He had a
similar episode 3yrs ago and his doctor gave him a course of 3 types of tablets
at the time. What is the most appropriate next inv?
a. Abdomen US
b. Barium meal
c. Serum H.Pylori antibodies
d. Urea breath test
e. Upper GI endoscopy

289. A 15yo boy presents with generalized edema. His urinalysis reveals protein
+++, eGFR =110. What is the most likely dx?
a. IgA nephropathy
b. Membranous nephropathy
c. Minimal change disease
d. Lupus nephritis

290. A 35yo man presented with hematuria, abdominal swelling and has a BP of
190/140. What is the most diagnostic inv?
a. Cystoscopy
b. USG
c. CT
d. Renal biopsy

291. A 32yo man develops hematuria 2wks after a sore throat. What is the
dx?
a. Post infection nephritis
b. IgA nephropathy
c. Membranous nephritis
d. Glomerulonephritis

292. A man has a BP of 160/90mmHg, proteinuria++. KUB US are equally reduced in

size with smooth borders and normal pelvic calyceal system. What is the cause
of HTN in the pt?
a. Chronic glomerulonephritis
b. Chronic pyelonephritis
c. Bilateral renal artery stenosis
d. Essential HTN
e. Polycystic kidney

293. 30yo man complains of vague pain in the loin with BP=140/90mmHg. He is
found to have proteinuria and hematuria. What is the inv to confirm the dx?
a. USG
b. ANCA
c. ANA
d. Urine microscopy and culture
e. Stool culture

294. A child presents with increasing jaundice and pale stools. Choose the most
appropriate test?
a. US abdomen
b. Sweat test
c. TFT
d. LFT

295. Best test for subacute cutaneous lupus Erythematosus:

a. dsDNA
b. ANA
c. Anti-Ro / SS-A
d. Anti-histone antibody
296.Normal CRP with elevated ESR seen in?
a. RA
b. SLE
c. Scleroderma
d. Polymyalgia rheumatica
297. A young girl is admitted with joint pains and butterflyrash and positive urine proteinuria.
The best test for her diagnosis is?
a. Anti ds- DNA antibody
b. Anti - centromere antibody
c. Antibodies to RNP
d . Antibodies to tRNA synthetase

298. Psychosis in SLE is caused by:

a. Anti-ribosomal P antibody
b. Anti-glutamate add decarboxylase antibody
c. Anti-endomyosial antibody
d. Anti-histone antibody
299. All of the following are indicators for use of corticosteroids in SLE except:
a. Neuropsychiatric lupus
b. Pericarditis
c. Endocarditis
d. Nephritic syndrome
300.Which of the following antibodies correlates with disease activity for S.L.E
a. Anti Smith antibody
b. Anti dS DNA antibody
c. Anti Histone antibody
d. Anti Rho

301. A 23-year old woman has experienced episodes ofmyalgias, pleural effusion, pericarditis
and arthralgias without joint deformity over course of several years. The best laboratory
screening test to diagnose her disease would be:
a. CD 4 lymphocyte count
b. Erythrocyte sedimentation rate
c. Antinuclear antibody
d. Assay for thyroid hormones

302. All of the following are true about SLE except:

a. Autoimmune HematolyticAnemia
b. Ted ANA
c. Anti-ds DNA
d. Raynaud’s phenomenon
e. Joint deformity
303. Deposition of Anti ds DNA Ab in kidney, skin, choroid plexus and joints is seen in:
a. SLE
b. Good pasture
c. Scleroderma
d. Raynauds disease

304. Autoimmune destruction of platelet is seen in :

a. SLE
b. Rheumatoid arthritis
c. Reiter disease
d . Polyarteritisnodosa
305. All are drugs used in treatment of acute gout except:
a. Allopurinol
b. Aspirin
c. Colchicine
d. Naproxen
306. Investigation of choice during follow up of patient with rheumatoid arthritis:
a. X-Ray of joints
b. ESR, Rh factor
c. Blood counts
d. Rh factor, Anti CCP antibodies

307. An 85-year-old woman presented with bilateral osteoarthritis of the knees. She had
no history of previous gastrointestinal disease. Which of the following
is the most appropriate initial treatment for her?
a. Paracetamol
b. Naproxen
c. Celecoxib
d. Dihydrocodeine

308. A patient aged 40 years having arthritis of PIP andDIP along with carpo-
metacarpal joint of thumb andsparing of wrist and metacarpo-phalangeal joint, the most
likely cause is:
a. Psoriatic arthritis
b. Osteoarthritis
c. Rheumatoid arthritis
d. Pseudogout

309. All are radiological findings of OA except:

a. Decreased Joint space
b. Osteophytes formation
c. Subchondral sclerosis
d. Deposit of Calcium salts

310. In rheumatoid arthritis the characteristic joint involvement is:

a. Spine
b. Knee
c. Metacarpophalangeal joint
d. Hip joint

311. Which of the following regarding rheumatic nodules is false?

a. Found over extensor surface
b. Tender on palpation
c. Associated with carditis
d. Pea size nodules Ref Harrison's 18th ed.ch.322
312. All of the following can be used to prevent gouty attack except:
a. Allopurinol
b. Aspirin
c. Probenecid
d. Sulfinpyrazone

313. Type of anemia seen in Rheumatoid arthritis:

a. Normocytic, normochromic
b. Hyperchromic, Normocytic
c. Hypochromic, normocytic
d. Hypochromic, leucopenia

314. Heberden nodes are seen in:

a. Rheumatoid arthritis
b. Rheumatic arthritis
c. Osteoarthritis
d. SLE

315. A middle aged female presents with polyarthritis, elevated Rheumatoid factor and ANA
levels . Which of the following features will help in differentiating
Rheumatoid arthritis from SLE
a. Soft tissue swelling in PIP Joint
b. Juxta-articular osteoporosis on X ray
c. Articular erosions on X Ray
d . Elevated ESR

316. Which part of the spine is most commonly affected in Rheumatoid arthritis:
a. Cervical
b. Lumbar
c. Thoracic
d. Sacral
317 . Which of the following is the most specific test for Rheumatoid Arthritis
a. Anti - ccp antibody
b. Anti IgM antibody
c. Anti IgA antibody
d. Anti IgG antibody

318.Which one of the following statements regarding pyelonephritis is correct?

a. Recurrent infection with the same strain usually
occurring after one week of cessation of therapy.
b. Xantho-granulomatous pyelonephritis is seen with diabetes mellitus
c. Emphysematous pyelonephritis is seen with staghorn calculus
d. 10,000 viable bacteria per ml in clean voided midstream urine is of significance
320. In hematuria of glomerular origin the urine is characterized by the presence of all of the
following except:
a. Red cell casts
b. Acanthocytes
c. Crenated red cells
d. Dysmorphic red cells

321. True about Post-Streptococcal Glomerulonephritis is:

a. 50% of cases occur after pharyngitis
b. Early treatment of Pharyngitis eliminates the risk of
P.S.G.N.
c. Glomerulonephritis, secondary to skin infection, is more common in summer
322. Renal vein thrombosis is most commonly associated
with:
a. Diabetic nephropathy
b. Membranous glomerulopathy
c. Minimal change disease
d. Membrano- proliferative glomerulonephritis
d. Recurrence is seen

323. HLA-DR4 is a marker of:

a. Rheumatoid arthritis
b. Sarcoidosis
c. Sero -negative gouty arthritis
d. Psoriasis

324. Heberden nodes are seen in:

a. Rheumatoid arthritis
b. Rheumatic arthritis
c. Osteoarthritis
d. SLE

325. In rheumatoid arthritis pathology starts in:

a. Articular cartilage
b. Capsule
c. Synovium
d. Muscle

326. Non - selective proteinuria is seen in:

a. Minimal change
b. Mesangio - proliferative GN
c. Membranous glomerulonephritis
d. Focal segmental Glomerulosclerosis

327. RBC cast in the microscopic examination of the urine is an indicator of:
a. Acute glomerulonephritis
b. Acute pyelonephritis
c. Chronic glomerulonephritis
d . Nephrotic syndrome

328. What is the minimum number of red blood cells per microliter of urine required for
diagnosis of hematuria ?
a. 3
b. 5
c. 8
d . 10

329. Manifestation of acute glomerulonephritis includes each of the following except:

a. Peri-orbital edema
b. Hypertensive encephalopathy
c. Acute renal failure
d. Optic atrophy

330. Post-infective glomerulonephritis present as:

a- ARF
b. Nephrotic syndrome
c. Nephritic syndrome
d. Asymptomatic hematuria
332. A 65-year-old man with a history of rheumatoid arthritis is found to have a microcytic anemia. He had a
colonoscopy 1 year ago which was normal and stool guaiac is negative. Which of the following is the
most likely cause of his anemia?
A. Iron deficiency
B. Chronic disease
C. Pernicious anemia
D. Folate deficiency
333. 45-year-old lady diagnosed to have anemia. Hb - 7.8, MCV - 72 and Serum ferritin - 8.
After 1 moth of iron therapy with adequate dose, Hb is still 8. Most probable cause for treatment
failure is.
a. Non-compliance
b. Acquired sideroblastic anemia
c. Inadequate intake of iron
d. Folate deficiencies
334. All the following are suggestive of iron – deficiency anemia except:
a. Koilonychia
b. Pica
c. Decreased serum ferritin
d. Decreased total iron - binding capacity (TiBC)
335. Renal vein thrombosis is most commonly associated with:
A. Diabetic nephropathy
B. Membranous glomerulonephritis
C. Minimal change disease
D. Membranoproliferative glomerulonephritis
336. Rheumatoid factor in rheumatoid arthritis is important because:
A. RA factor is associated with bad prognosis
RA factor rules out the diagnosis of rheumatoid
C. It is very common in childhood-rheumatoid arthritis
D. It correlates with disease activity

337. The drug of choice for hyperthyroidism in third trimester of pregnancy is;
a. Carbimazole
b. Prophylthyouracil
c. Sodium iodide
d. Radioactive iodine
338. Mechanism of action of exenatide in diabetes mellitus is
a. It is analogue of GLP released from gut and increase glucose dependant insulin secretion
b. It is DPP-4 inhibitor and result in decreased breakdown of GLP
c. It inhibits SGLT-2 and cause glucosuria
d. It is amylin analogue and decrease glucagon
339. Which of the following presents with edema due to decreased oncotic pressure?
a. CHF
b. Alcoholic Cirrhosis
c. Nephritic Syndrome

340. What features are characteristic of the upper part of the stomach ulcer?

a. chest pain
b. epigastric pain occurring immediately after a meal
c. epigastric pain arising in 30 minutes after eating
d. pain not associated with food intake
e. pain in the right upper quadrant
341. 3. A previously healthy 27-year-old woman comes to the physician because of a 3-month
history of moderate abdominal pain that improves for a short time after she eats. She has not had
any rectal bleeding. Her temperature is 36.4°C (97.5°F), pulse is 80/min, and blood pressure is
110/70 mm Hg. Abdominal examination shows midepigastric tenderness. Her hemoglobin
concentration is 12 g/dL, and leukocyte count is 8000/mm3. SerumHelicobacter pylori antibody
assay is positive. Which of the following is the most appropriate next step in management?
a. Ranitidine therapy
b. Amoxicillin, clarithromycin, and omeprazole therapy
c. Ciprofloxacin therapy
d. Omeprazole, magnesium hydroxide, and metoclopramide therapy
342. A 45-year-old man was brought to the emergency room (ER) after vomiting bright red
blood. H e has a blood pressure of 88/ 46 mm H g and heart rate of 120 bpm. Which of the
following is the best next step?
A. Intravenous fluid resuscitation and preparation for a transfusion
B. Administration of a proton pump inhibitor
C. Treatment for H pylori
343. Which one of the following patients should be promptly referred for endoscopy?
A. A 65-year-old man with new onset of epigastric pain and weight loss
B. A 32-year-old patient whose symptoms are not relieved with ranitidine
C. A 29-year-old H pylori-positive patient with dyspeptic symptoms
D. A 49-year-old woman with intermittent right upper quadrant pain following meals
344. Pains in the right upper quadrant or on an empty stomach at night, characteristic of the
ulcers:

a. stomach;
b. The lower third of the esophagus;
c. Duodenal ulcer

345. A 62-year-old man presents with dark tarry stoolsandlight-headedness.Upperendoscopy

finds an ulcerating lesion in his stomach and biopsies confirm gastric cancer. Which of the
following is a risk factor for carcinoma of the stomach?
(A) Helicobacter pylori infection
(B) high socioeconomic status
(C) high proteindiet
(D) high fat diet

346. A 77-year-old man comes to the physician because ofswelling of his legs and feet for 6
months. He has a 40-yearhistory of alcoholism and a 5-year history of hepatic
disease. Physical examination shows ascites and a 2+ edemaof the lower extremities. A decrease
in which of thefollowing most likely promotes edema formation in thispatient?
a. Plasma colloid oncotic pressure
b. Filtration coefficient
 c. Interstitial colloid osmotic pressure
d. Interstitial fluid hydrostatic pressure

347. A 33-year-old male presents with increasing right upper quadrant (RUQ) pain. The pain is dull, and it
does not radiate or change with eating. On examination the abdomen is soft, there is a mass in the RUQ, and no
ascitesis clinically detected. He has a prior history of hepatitis B. His laboratory investigations reveal hepatitis B
surface antigen (HBsAg) positive, hepatitis B surface antibody (HBsAb)negative,aspartate aminotransferase
(AST)60U/L, alanine aminotransferase (ALT)72 U/L, and an elevated alpha-fetoprotein level. Which of the
following is the most likely diagnosis?
a. hepatoma
b. hepatocellular carcinoma(HCC)
c. metastatic cancer
d. liver cirrhosis

348.An 88-year-old white woman is taking naproxen for osteoarthritis. She has noticed mild
epigastric discomfort for several weeks, but has continued the naproxen because of improvement
in joint symptoms. She suddenly develops hematemesis and hypotension.
a. Gastric ulcer
b. Chronic gastritis
c. Chronic hepatitis
d. Esophageal varices
349. The best way to eradicate H. pylori in this patient is
a. Omeprazole 20 mg PO daily for 6 weeks
b. Ranitidine 300 mg PO qhs for 6 weeks
c. Omeprazole 20 mg BID, amoxicillin 1000 mg BID, clarithromycin 500 mg BID
for 14 days
d. Pepto-Bismol and metronidazole BID for 7 days
e. Sulcrafate 200 g QID for 6 weeks

350. Which statement is wrong regarding Hepatitis B?

a. It is due to RNA virus
b. Blood is the main source of infection
c. Chronicity is present
d. It may turn into hepatocellular carcinoma