MEDICINE 2ND BATCH 2020

1. The following is false of hyperthyroidism

A. Hyperthyroidism is caused by excessive synthesis and secretion of thyroid hormone by the thyroid
gland

B. It caused by Exogenous thyroid hormone secretion

C. It is caused majorly by diffuse goitre (graves dx)

D. It caused Toxic adenoma

E. It is caused in toxic multinoduler goitre

2. DKA is a acute life threatening complication of DM. the following is true except

A. There is Hyperglycemia, ketonuria and ketonemia

B. Ketonemia 5 hyperglycemia 250mg/dl, pH is 7.3

C. Laboured breathing is an early sign

D intial fluid correction is by normal saline ringers lactate

3. Management of the patient includes the following except

A. Offloading pressure

B. Use of topical growth factor is a treatment option

C. Glycemic control should be a focus of management

D. Fore foot gangrene may be managed conservatively

E. Foot care should be emphasized

4 A coma patient with PaCO2 of 16mmol/l, HCo3 of 5mmol/l, and Ph of 7.1. What he have?

A) metabolic acidosis

B) respiratory acidosis

C) metabolic alkalosis

D) respiratory alkalosis

E) chronic acidosis

5 The following are incorrect of Anion gap?

A) Anion gap decrease in ketoacidosis

B)Anion gap decreases in lithium poisoning

C) Anion gap decrease metabolic acidosis

D) In lactic acidosis, anion gap is increased

E) Anion gap is normal

6. An obese 57 year old smoker presents with chest pain, diaphoresis and inability to lie down flat. His
physical examination shows him to have cold extremities, pulse rate of 120 beats per minute and blood
pressure of 85/55mmHg. The best treatment would be

A. Intravenous nitroglycerin

B. Intravenous 0.9% normal saline one litre fast and 500ml 6 hourly

C. IV hydrocortisone 200mg

D. IV dopamine in an infusion pump

E. Nebuliser salbutamol

7. A 45 year old woman with cancer of the breast developed chest infection and became very weak with
altered sensorium. Examination showed a lethargic woman with temperature of 38.9°C. The pulses were
fast and bounding. She had coarse crepitations in most lung fields. The liver and spleen were palpable
and tender. The treatment for this patient should be

A. Intravenous metronidazole and amoxy-clavunicacid

B. Intravenous ceftriaxone

C. Intravenous levofloxacin with clindamycin

D. Piperacillin-tazobactam with levofloxacin

E. Meropenem

8. The following are functions of the skin except

A. Thermoregulation

B. Calcium production

C. Immunity

D. Excretion

In management of dmfs, the following are not correct:

a) seeing of bone suggest osteomylitis

a)In d absence of intermittent claudication, there is no need of Doppler to access vascular integrity.Ans
2)Dmfs management

Ans: dry gangrene is managed conservatively

9) diagnosis of dmfs is right except

Ans.. ABPI of 0.9 is suggestive of monkeberg sclerosis

10. In a nervous student preparing for mbbs...the acid - disorder will be

A. Metabolic acidosis B. Metabolic alkalosis

C. Respiratory acidosis d. Respiratory alkalosis

E. Uremia

11. Renal Glutaminase activity

A metab acidosis.

B.resp acidosis

C. Both And B

D. None

E. All

12. All are true for Renal handling of acidity except

A. Hydrogen ion is increased

B.bicarbonate Is decrease

C. Urinary acid is increased

D.urinary Amonnia is increased

E. Urinary acid is decreased

13) which is appropriate about oesophageal varices

a) propranolol is not indicated

b)IV antibiotics is a cause

c)lancreotide is superior to octreotide in treatment

14) About PUD

a) forest class 1 can be treated with hemospray

b) forest class 4 suggest active bleeding

15)About renal control of Metabolic acidosis, which is not true

a)There is increase secretion of acid into d tubules

b) increased absorption of bicarbonate

c) increase in tubule ammonia

16: Which of the following is not a precipitant of acute pancreatitis

A. Alcohol

B. Hypertriglycaemia

C. Hyperglycaemia

D. Autoimmune

E. Gallstones

17. Which of the following is not a complication of pancreatitis

A. Walled-off necrosis

B. Pulmonary effusion

C. Abdominal abscess

D. Shock

E. Fatty Liver

18. Which of the following is not a useful modality in pancreatitis

A. Cholescystectomy

B. Analgesia

C. Crystalloid
D. Uss guided draining of fluid

E. Administration of pancreatic extract

19 Pre renal cause of AKI

cardiogenic shock

Sepsis

Toxin

Drug.

20. Which of these can cause occult bleeding

a) gastric ulcer

b) duodenal ulcer

c) esophageal varices

d) anorectal haemorrhoids

21. Which is appropriate in Obscure bleeding.

a) vomiting of fresh blood

b) use of capsule endoscopy...

c) colorectal ca is a cause

......

22. Pick the appropriate matching.

a) EUS....liver

b) Colonoscopy...Stomach

c) ERCP.... biliary tract.

....

23) Which of the following is accurate about hyperthyroidism and thyrotoxicosis?

A) In Grave’s, the thyroid gland is enlarged and painful

B) Presents with weight loss despite loss of appetite

C) Clinical manifestation of thyroid correlates with the extent of biochemical level

D) Systolic hypertension with widened pulse is found in hypothyroidism

24) Features of hypothyroidism are all except:

A) C.....

B) Increased diastolic pressure

C)Peri-oribital fullness and down-looking face

D) Bradycardia intermittent with tachycardia

E) Jaundice

25) The following is false in treatment of DM

A) Insulin is given IM in diabetic emergency

B) GLP1 receptor agonist is given parenterally

C) GLP1 receptor agonist is contraindicated in DM type2

D) Surgery is an option for DM type2

E) DPP4-inhibitors is used for DM type2

36e) 35e) add endoscopic video capsule

26) Raynaud phenomenon is associated with

A) autoimmune

B) drugs......

27) Rheumatoid Arthritis is differentiated from Osteoarthritis except

A) polyarthritis

B) wrists involvement

C) Monoarthritis
28) Metabolic Alkalosis causes include;

A) vomiting

B) Hiccups

29) Renal gluthaminase is increased in

(A) Metab Acidosis

B) Respiratory Acidosis

C) both A&B

D) None of the above

E)?????

30 Raynaud phenomenon is associated with

A) autoimmune

B) drugs......

31) Rheumatoid Arthritis is differentiated from Osteoarthritis except

A) polyarthritis

B) wrists involvement

C) Monoarthritis

32) Metabolic Alkalosis causes include;

A) vomiting

B) Hiccups

33) Renal gluthaminase is increased in

(A) Metab Acidosis

B) Respiratory Acidosis

C) both A&B
D) None of the above

E)?????

34. The following are true concerning Sjogren's syndrome except

A. Characterized by triad of dryness, joint pain and fatigue

B. Antinuclear antibody is elevated

C. Anti-Ro/SSA is elevated in all patients

D. It is a precursor of lymphoma

E. Extra-glandular organs are frequently involved.

35. The following are primary sites for osteoarthritis except

A. Wrist

B. Knee

C. Hip

D. Cervical spine

E. Lumbar spine

36. The following are true about arthritis except

A. Oligo arthritis is in 2 to 4 joints

B.

C. Fixed joint pain is seen in juvenile arthritis

D. Something about swollen big toe is seen in gouty arthritis

E. Something about swollen hot feet in diabetes

37. During examination of the pupils in comatose patient

Dilatation of one pupil fixed to light occurs in 3rd cranial nerve compression Ans

Bilateral midpoint reactive pupils indicate pontine hemorrhage

Bilateral fixed dilated pupils occur in brain

Bilaterally fixed pinpoint pupils occur in metabolic coma

Bilateral midpoint reactive pupil are indicative of Horner’s syndrome

38. Concerning respiration in comatose patient

A. Cheyne-stokes respiration: diabetic ketoacidosis and uremia

B. Kassmaul respiration is due to bilateral cerebral dysfunction

C. Ataxic: shallow halting irregular respiration, seen in medullary respiratory centre damage usually
precedes death Ans

39. Normal cerebral function the brain requires?

The minimum value to sustain conciousness are blood flow of 25ml/100g brain tissue, glucose
3-5mg/100g brain tissue/min or oxygen 0.2-3.5ml/100g/min Ans

40. which is not a principle in antibiotics administration?

A. Cost

B. Efficacy

C. Coverage

D. Safety

41.Which of these are part of connective tissues except

a)ligaments

b)ground tissue

c)synovial

d)extracellular matrix

e)...

42. A 75 year old woman with jaw pain and raised ESR.....

a)Takayasu arteritis

b) Beugers disease
c) Giant cell arteritis

d) Polyarteritis nodosa

43. This is not true concerning systemic sclerosis

a) It is characterized by hardening of the skin of the extremities and trunk

b) There are 2 types: diffuse and limited

c) It is associated with Raynaud phenomenon

d) It causes slow healing digital tips ulcer

e) Anti scl 70 and anti centromere may be elevated

44. 17 year old had respiratory disease in childhood and it was intermittent,

She developed respiratory signs to her exam and her usual medications where not working

RR=48cpm, PR=140bm, BP=110/86mmhg , PFR =75mil(her usual 250mil).

What is her diagnosis

A acute severe asthma

B recurrent pneumonia

C acute exercerbation copd

D airway obstruction

E pneumonitis

45 A banker who took sniper because her jilted her,

Which of the following Is false

A tachycardia is present

B bradycardia is present

C diahhorrea is present

46 Which is not a feauture of digoxin toxicity

A bradycardia

B yellow vision
C vomitting

D hypokalaemia

E gynaecomastia

47 Which is false in the treatment of respiratory failure type 2

A intranasal o2 1-3l/ml

B venti mask 24-48%

C non invasive ventilation

D doxapram is contraindicated

E invasive ventilation

48 Normal cerebral function

*The minimum value required to maintain consciousness is blood flow of 25ml/100g brain tissue

*glucose 3.5ml/100g brain tissue/min or o.2-3.5

49 During examination of a pupil in comatose patients

A dilation of one pupil fix to light suggest cn3 compression

B bilateral midpoint reative pupils indicate pontine hemorrhage

C bilateral pinpoint reactive pupil indicate metabolic

50 Respiratory pattern in a comatose patient

51 Combination of antibiotics

a. Synergism- combination of 2 bacteriostatics

b. Antagonism- 2 bacteriocidal

c. Additive- effect of combination in greater than some of individual comparison

d. Additive

e. None of the above

52 Multidrug resistance tb drugs

A 2 anti tb drugs

B 3 anti tb drugs

C anti tb first line drugs

D streptomycin

E pyrazinamide

53 EXTENSIVE MULTIDRUG RESISTANCE TB DRUGS

A 2 anti tb drugs

B 3 anti tb drugs

C 4 anti tb drugs

D 2nd line tb drugs

E resistance to rifampicin, isoniazide, ethambutol.

54. A 45-year-old man with D presents to the A and E with a DM foot ulcer. The following is/are true
concerning his condition

A. A biothesioeter reading of 30V is indicative of the presence of neuropathy

B. Walking unshod is a risk factor

C. An ABPI of 0.7 is suggestive of an intact vascular system

D. Nocturnal burning pain is a pointer to the presence of neuropathy

E. Automatic neuropathy is a possible contributor to his condition

55. In assessing the patient above, the following is/are true

A. A Semmes-Weinstein monofilament (SWM) is useful in detecting loss of protective sensation

B. The SWIM exerts a pressure of 10g

C. Features of sudomotor neuropathy may be found in the test

D. Atherosclerosis is the underlying pathology in PVD

E. An ABPI of 1.5 is suggestive of Monckebergs sclerosis

56. Investigating the patient. The ff is/are true

A. A plain X-ray of the foot should be done

B. Wound swab sample should be taken

C. Being able to probe or see the bone is a likely pointe to osteomyelitis

D. In the absence of a history of intermittent claudication, dopplers assessment for the vascular
integrity is not necessary

E. Lipid profile test should be done