‫اذكرونا بدعوة‬

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End course Exam of Internal medicine
( Rheumatology- Haematology- Nephrology)
Theory & OSLER
Group A
23-9-2021

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Theory Exam
1. All of the following are characteristics of AML, except:

a) CNS infiltration ✓
b) Bone pain ✓
c) Recurrent infection
d) Sever anemia
e) May present with pneumonia
2. ALL is characterized by all the following, except:
a) Lymphadenopathy
b) Testicular infiltration
c) Mediastinal mass
d) gum hypertrophy ✓
3. Iron deficiency anemia is anemia of
a) ⁃ Anemia of inflammatory disease
b) ⁃ Anemia of malabsorption
c) ⁃ Anemia of blood loss ✓
d) ⁃ Anemia of malignancy
4. Macrocytic RBCs can’t be present in
a) megaloblastic anemia
b) Hypothyroidism
c) Folate deficiency
d) Iron deficiency anemia ✓
5. Folate deficiency is less likely to develop on which of following :
a) malabsorption
b) Methotrexate
c) Vegetarian ✓
d) Malignancy
e) Hemolysis
6. A patient with skin bruising and prolonged bleeding time, can be due to all
the following, except:
a) VWD
b) Aspirin
c) Myelodysplastic syndrome
d) Bernard souiler syndrome
e) Vitamin K deficiency ✓
7. A patient with prolonged aPTT is due to all the following except:
a) factor VIII
b) factor XI
c) Glanzman’s syndrome. ✓
d) VWD
8. About follicular lymphoma
a) characteristic chromosomal change t(14:18)
b) slow growing non tender lymph node enlargement.
c) it make about 20% of NHL
d) it is aggressive tumor ✓
9. JAK inhibitors can be given to:
a) Primary myelofibrosis
b) Only JAK2 positive myeloproliferative disorders. ✓
c) Acute leukemia
d) AML
10.A patient with B thalassemia minor is
a) Usually requiring iron chelating agents
b) Transfusuion is age depedent, but it is rare before 2 ys of age.
c) One of the parents must have the same disease so the offspring
can express it.
d) Folic acid is mandatory for all. ✓
11.Dose of methotrexate in adult:
a) 7.5-25 mg/day
 b) 7.5-25 mg/kg/day
c) 7.5-25 mg/kg/week
d) 7.5-25 mg/week ✓
12.Seronegative means
a) ANA negative
b) RF negative ✓
c) dSDNA negative
13.Organomegaly is present in which type of idiopathic juvenile arthritis.

a) ⁃ Systemic IJA ✓
b) ⁃ Psoriatic arthritis
c) ⁃ Polyarticulat JA
d) ⁃ Oligoarticular JA
14.Which of the following drugs cause renal crisis in systemic sclerosis
a) ⁃ paracetamol
b) ⁃ Azithromycin
c) ⁃ Prednisolone ✓
15.A college student presented with painful mouth ulcer and joint swelling,
hand discoloration when exposed to cold followed by reactive hyperemia.
His blood revealed dSDNA and ANA. What is the diagnosis?

a) ⁃ SLE ✓
b) ⁃ Bahçet disease
c) ⁃ Rheumatoid arthritis.
16.A diagnosed case of SLE have arthralgia and mouth ulcer, no end organ
damage. What is the management?
a) analgesia
b) Prednisolone ✓
c) Cyclophosphamide
d) Hydrochloroquine
17.A patient developed single joint pain and diagnosed as acute gout attack,
what is the treatment
⁃ steroid
⁃ NSAD ✓
⁃ Allopurinol
18.All of the following regarding infective arthritis are falls. Except:
 a) Needle aspiration contraindicated since might lead to septicemia
b) H.Influenzae is the most common agent in adults
c) Previous arthritis is a strong risk factor for septic arthritis✓
d) Small joints are affected more than large joints
19. which of the following can cause Raynoud disease:
a) Cervical rib
b) Systemic sclerosis ✓
c) Seronegative arthritis
d) Non of the above
20. Which of the following is wrong regarding anemia in CKD:
a) anemia in ckd appears when GFR is less than 30
b) anemia in ckd is well tolerated because of increase in 2,3DPG ✓
c) aneima maybe due to relative decrease in erythropoietin
d) anemia is less severe in patients with polycystic kidney disease
21. Which of the following is wrong about renal cell carcinoma:

a) Biopsy is indicated in all types of renal tumors. ✓

22.One of the following is uncomplicated UTI
a) UTI in a pregnant lady.
b) UTI in old male
c) UTI in metabolic disorder
d) UTI in premenopausal women. ✓
23.Most common cause of Chronic kidney disease in developed countries is

a) Diabetes ✓
b) Hypertension
c) Hyperlipidemia
24.All the following are complications of hemodialysis except

a) hyperglycemia ✓
b) Anaphylactic shock
c) Muscle cramps
d) Hypotension
25. A known case of RA, presented with shortness of breath and chest pain,
tachycardia, BP 80/70 and ECG change showed low voltage QRS. What is the
diagnosis?
a) Acute Pericarditis
b) Constrictive pericarditis
 c) cardiac tamponade ✓
d) Hypertrophic cardiomyopathy
26. ?????
27.Sterile pyuria can occur in the following conditions, except:

a) renal tuberculosis ✓
b) Renal cell carcinoma
c) Cystitis
d) Trauma to urinary tract
e) Appendicitis
28.Best test for diabetic nephropathy screening :
a) ⁃ creatinine clearance
b) ⁃ Serum creatinine level
c) ⁃ Ultrasonography
d) ⁃ Glucose tolerance test
e) ⁃ Urine Albumin ✓
29.Patient developed sepsis. He has renal impairment. Which antibiotic
requires a major reduction in its dose:
a) isoniazid
b) Erythromycin
c) Gentamicin ✓
d) Doxycycline
e) Ampicillin
30.Which of the following is not a cause of hyperkalaemia:

a) insulin therapy ✓
b) Spironolactone
c) ACEI
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OSLER Exam
Station 1:
A patient received blood, after 15 minutes from starting transfusion she
developed pain at site of cannula, shortness of breath, loin pain, fever and
deep color urine.
1. What is the diagnosis? Immediate hemolytic transfusion reaction.
2. You are in emergency. A patient brought a paper from a senior to get
blood transfusion. What you need to ask the patient ?
 a) Check the patient blood group.
b) Indications for transfusion
c) Check if there is previous history transfusion-related reactions
d) Check about comorbidities
3. Mention transfusion-related reactions: -----
4. How you will manage fluid overload reaction after blood transfusion?
a) -stop the transfusion
b) -Diuretics
c) -oxygen
Station 2:
A 65 yr old male patient developed fatigue and malaise for 6 weeks ago.
His investigation:
Hb 9g/dl
MCV 94
WBC 43.000
Platelet 210.000
Blast in marrow 2%
1. What are the findings?
normocytic anemai & leukocytosis.
2. Grade of anemia?
Mild anemia
3. What is the differential diagnosis?
CML & CLL
4. How you differentiate CML & CLL clinically?
LAP more likely in CLL while less likely in CML( unless developed blast
crisis).
Huge Splenomegaly occurs in CML, while it’s unusual in CLL.
5. What further instigations you need to do:
Complete blood picture
6. Diagnostic test for CLL:
Flowcytometry
5. What is the management of CML?
 Tyrosin kinase inhibitors: Imatinib
Station 3:
1. Do hand examination for this lady. He requested only wrist joint line
tenderness.
2. What is the cause of lateral wrist tenderness ?
De quervain's tenosynovitis
3. Mention 2 DDx of DIP arthritis ?
Generalized nodular OA – psoriatic arthritis.
Station 4:
1. Do knee joint examination.
2. Patellar sign positive indicates what? Effusion.
3. The finding was psoriatic area on knee. What is the differential diagnosis?
-Psoriatic arthritis.
4. What is the differential diagnosis of inflammatory oligoartiular arthritis?
-five seronegative inflammatory arthropathy (AS, EA,PA, Reactive A,
undifferentiated arthropathy).
5. For an old patient hypertensive, diabetic, diagnosed as acute attack of gout,
what you will do?
Station 5:
A case scenario with SOB, vomiting, pitting leg edema, pulmonary edema,
Mitral regurgitation, creatinine 9, potassium 7.5.
1. What is the finding?
2. What is the diagnosis?
3. Investigations?
4. What is the treatment?
Station 6:
A diabetic patient developed loin pain, fever, pyuria, RBCs in GUE, and a stone
in left
upper ureter
1. What is the underlying cause of the fever?
2. What is the next step?
3. For how long the patient should receive treatment?
4. What is the suspected complication?
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THE END
 ‫اذكرونا بدعوة‬

Internal Medicine
End-Block Exam and
OSLER - Group B
Prepared by:
Sarwar Sarkawt, Bakr Manaf, Mohammed Farouq and Ali Shahab

*NOTE: Each question is not a carbon copy of the actual ones present in the exam. They are a rough
view of them and at times, just the general idea of the question.
**NOTE: Answers are coloured in red with multiple red coloured for ones that are too unclear.
***NOTE: Every answer is just an overall opinion and are by no means the actual correct answers, so
please take the answers with a grain of salt (except rheumatology which are the doctors answers).
****NOTE: Copy-paste questions have their source next to them just for fun.
 Rheumatology
1. A guy presents with acute pain and swelling in the big toe for 1 day duration.
His ESR (80) was elevated with normal blood pressure. What is the
appropriate statement?
a. Give NSAIDs immediately
b. Give Allopurinol
c. The attack will never recur again
d. The attack will spontaneously resolve
e. Female to male ratio 9:1
2. A 62-year-old female patient complains of inability to walk upstairs and has
difficulty rising from her chair and on examination she has weakness and
proximal muscle wasting. What is the most likely diagnosis?
a. Polymyositis
b. Dermatomyositis
c. Polymyalgia rheumatica
d. Kawasaki disease
e. Giant cell arteritis
3. A male patient was referred from an ophthalmologist presenting with oral
and genital ulceration on rheumatological examination and diagnosed with
uveitis. Which of the following is the most probable diagnosis?
a. Giant cell arteritis
b. Polymyalgia rheumatica
c. Bèhcets disease
d. Takayasu’s arteritis
4. A 34-year-old female has paleness and bluish discoloration of fingers when
exposed to cold temperatures and also tightening of skin of hands. What is
the most probable diagnosis?
a. Systemic sclerosis
b. …
c. …
d. …
5. Which of the following is not associated with pseudogout?
a. Haemochromatosis
b. Sarcoidosis
c. Hypothyroidism
d. Hyperparathyroidism
e. Degenerative osteoarthritis
6. A 38-year-old female has been diagnosed with Ankylosing Spondylitis (AS).
She is HLA-B27 positive and is well controlled with NSAIDs. Now she is
worried about her 8-year-old son developing a similar condition. What do
you advise her?
 a. Send for HLA-B27 for the son
b. The chance of her son developing AS is 10%
c. Advise him to stay away from sports and exercise
d. Give low dose NSAID as preventive treatment
e. Advice to not travel to protect against pathogens
7. A female came to the rheumatology department complaining of pain and
stiffness of her knees for the past 7 days. She has recent travel history to
outside the country. She had a bout of Diarrhoea recently and 2 previous
Diarrhoea over the past year. Which of the following is not an appropriate
next step?
a. Refer to a gastroenterologist for ileocolonoscopy
b. Faecal Occult Blood
c. ESR and joint aspiration
d. Stool antigen
e. Ciprofloxacin for 2 weeks
8. A male presented to the accident and emergency department with fever,
lethargy and chills, as well as tender and swollen knees. What is the
appropriate next step?
a. Start Empirical antibiotic
b. Synovial aspiration and blood culture
c. X-ray of the knee
d. NSAIDs
9. A patient presented with shoulder girdle pain upon abduction. What is the
most likely cause?
a. Fracture of the humerus
b. Acromioclavicular arthritis
c. Glenohumeral arthritis
d. Rotator cuff tear
e. Bicep’s tendonitis
10.A female with swelling and pain of hand and foot joint for 2 weeks. What is
least likely to be a cause:
a. Rheumatoid Arthritis
b. SLE
c. Fibromyalgia
d. Viral arthritis
e. Psoriatic arthritis
 Hematology
11.JAK inhibitors can be given to:
a. Primary myelofibrosis
b. Only JAK2 positive myeloproliferative disorders
c. Acute leukaemia
d. AML
12.ALL is characterized by all the following, except:
a. CNS involvement
b. Lymphadenopathy
c. Testicular infiltration
d. Mediastinal mass
e. Gum hypertrophy
13.Which of the following does not cause cervical lymphadenopathy?
a. Toxoplasmosis
b. Brucellosis
c. ALL
d. CML
e. …
14.Which of the following statements is correct?
a. IV iron has fewer side effects than other types.
b. IM iron is preferred for elderly
c. Oral iron has fewer side effects and is more efficient
d. Oral iron is ineffective for haemodynamic instability
e. Oral iron has the same efficiency and time of action as IV Iron
15.A patient with confusion and fever, with a creatinine level of 4.5. What is the
most likely diagnosis?
a. …
b. Thrombotic Thrombocytopenic Purpura
c. Haemolytic Uraemic Syndrome
d. Immune Thrombocytopenic Purpura
e. …
16.Which one of the following is characteristic of CLL?
a. Recurrent bleeding
b. Recurrent infection
c. …
d. …
e. Iron deficiency anaemia
17.All of the following presents with mediastinal widening on CXR, except:
a. Multiple myeloma
b. Hodgkin lymphoma
c. Non-Hodgkin lymphoma
 d. ALL T-type
e. Thymoma
18.All of the following are likely to cause renal crisis in a patient with multiple
myeloma, except:
a. Painkiller
b. Hypocalcaemia
c. Hyperuricaemia
d. Frequent antibiotic
e. Light chain deposition
19.Mrs. R delivered by caesarean section and required blood transfusion. About
20 minutes after the start of transfusion, she developed fever, rigor, flank
pain, hypotension, and her urine turned red. The most probable cause of this
condition is: (question was a little different, but had the same idea)
a. Transfusion associated acute lung injury
b. Contaminated blood transfusion
c. Acute haemolytic transfusion reaction
d. Immediate febrile transfusion reaction
e. Late haemolytic transfusion reaction
20.A patient anemia and pancytopenia with increased adipose fat involvement
in the bone marrow. What is the possible cause?
a. Haemophagocytosis
b. Aplastic anaemia
c. Myelofibrosis
d. …
21.Which of the following does not cause skin bruises?
a. Multiple myeloma
b. Hereditary hemorrhagic telangiectasia
c. Protein C deficiency
d. Vitamin C
e. …
 Nephrology
22.The following are typical features of the haemolytic uraemic syndrome,
except:
a. Reticulocytosis
b. Low serum haptoglobin
c. Thrombocytosis
d. Fragmentation of red cell
e. Negative coomb's test
23.Which of the following is not frequently associated with microscopic
haematuria?
a. Infective endocarditis
b. Stones
c. Minimal change disease
d. Urinary Tract Infection
e. Glomerulonephritis
24.What is the most malignant renal tumor?
a. Wilm’s tumour
b. Renal Cell Carcinoma
c. Sarcoma
d. Leiomyofibroma
25.A 43-year-old uraemic patient is on regular haemodialysis. He complains
that many features of the disease have not improved after many sessions of
haemodialysis. Which one of the following usually improved by dialysis?
a. Anaemia
b. Encephalopathy
c. Hyperlipidaemia
d. Osteodystrophy
e. Peripheral neuropathy
26.In which of the following circumstances would the treatment of anaemia
with erythropoietin still be expected to be effective?
a. Aluminium toxicity
b. Folate deficiency
c. Hyperkalaemia
d. Infection
e. Iron deficiency
27.In which of the following asymptomatic bacteriuria should be treated?
a. Pregnancy
b. Catheterisation
c. Spinal cord injury
d. Old age
28.Most common cause of chronic kidney disease is:
 a. Diabetes
b. Hypertension
c. Hyperlipidemia
d. …
e. …
29.Which of the following is not a risk factor for PCKD? (Autosomal dominant
type)
a. Male gender
b. Hypertension
c. PKD1
d. Elderly diagnosed
e. …
30.Which of the following about minimal change nephrotic syndrome is
correct?
a. …
b. …
c. Minimal change disease in adults require biopsy for diagnosis
d. …
e. …
 OSCE
Haematology

Station 1 – Dr. Luqman or Dr. Muhammed Dhahir

A picture of an arm with ecchymosis purpura and a canula attached to the
dorsum. (Possibly had muscle wasting)
There was no case sheet or anything else. The doctor just asked questions.
1. Do general inspection for the picture.
a. There was clear purpura and a cannula…any other findings would
just be guesswork.
2. What would you do for this patient in general examination?
a. List everything…
3. What’s the difference between general examination and systemic
examination?
a. Everyone should know this…
4. What will you look for in systemic examination?
a. Say certain common systemic manifestations for haematology and
he would be satisfied…Organomegaly was enough.
5. Give differential diagnoses for this picture.
a. Dr. Luqman was not satisfied until we counted every single disease
of the course (maybe 30 conditions)
6. How will you treat ITP?
a. IVg
b. Prednisolone
c. Other stuff
7. He may have asked other questions to other students…

Station 2 – Dr. Ahmed Al-Mashhadany or Dr. …

A 22-year-old female is doing surgery tomorrow and needs blood transfusions
and her friend is worried about blood transfusions:
1. Mention 3 acute transfusion reactions
a. Acute haemolytic transfusion reaction
b. Febrile non-haemolytic transfusion reaction
c. Transfusion associated circulatory overload
d. Others…
2. Mention 3 delayed transfusion reactions
a. Post-transfusion purpura
b. Iron overload
c. Alloimmunisation
3. What’s the difference between TRALI and TACO?
a. TACO has no fever, while TRALI has.
 b. TACO may be hypertensive, while TRALI is hypotensive
c. TACO responds well to diuretics.
d. Others…
4. How will you treat TACO?
a. Diuretics
b. Oxygen
c. Others…

Rheumatology

Station 3 – Dr. Zekra or Dr. Muhammed Ibrahim

A young male cleaner. Perform hand examinations and give 2 differential
diagnosis:
a. 3ayba nazani…

Station 4 – Dr. Shwan or Dr. Masar

A young male cleaner. Perform knee examination:
a. 3ayba nazani…

Nephrology

Station 5 – Dr. Majeed Talib or 3amo Safa

A case of polycystic kidney disease with HTN and no other positive clinical
findings.
1. What are the extra-clinical manifestations of polycystic kidney disease?
a. Liver cyst
b. Ovarian cyst
c. Colonic diverticula
d. A-V malformation
e. Valvular heart problems
f. Aortic aneurysm
g. SAH in brain
h. And etc… (the doctor kept asking for more)
2. What is the treatment for hypertension here?
a. Amlodipine
b. ACE
c. ARB
d. Etc… (the doctor kept asking for more…)
3. What should you do to diagnose family members? (
a. You only need US
b. Dr. Majeed said say Genetic Study too…
4. What drug is best used for the treatment of ADPKD?
a. Tolvaptan
 b. Others… (the doctor kept wanting more drug names)

Station 6 – Dr. Mohammed Sami or Dr. Hussein Sinjari

A case of Nephrotic syndrome, with the doctor basically asking you to recite the
lecture from memory.
1. What is nephrotic syndrome?
a. 3ayba nazani…
2. What re the causes of nephrotic syndrome?
a. Just list the types
b. He also said list nephritic syndrome as that is a cause of nephrotic
syndrome…
3. What are the complications of nephrotic syndrome?
a. …
4. Other questions depending on the student…
 Group C-Medicine End Block
Theory Exam & OSCE
Rheumatology:
1. A male patient with worsening back pain especially on lateral flexion & bending forward.
X-ray normal.
What is the treatment of choice?
A. Sulfasalazine
B. Methotrexate
C. Azathioprine
2. A case with swollen, erythematous and painful knee joint
(features were typical for septic arthritis) . What is the diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Septic arthritis

3. A middle-aged woman with unilateral headache and visual impairment…(features of

GCA), what is the next step?
A. Start with corticosteroids
B. Take a biopsy from the temporal artery
C. Send her to an ophthalmologist for consultation
D. Send her for an ESR

4. All of the following regarding infective arthritis are false, except:

A. Needle aspiration contraindicated since might lead to septicaemia
B. H. Infl uenzae is the most common agent in adults
C. Previous arthritis is a strong risk factor for septic arthritis
D. Small joints are affected more than large joints

5. A child case complained of right knee pain, previously he got right ankle pain and
swelling then when his ankle pain resolved, his right knee pain started. What is the
diagnosis?
A. Septic arthritis
B. Rheumatoid arthritis
C. Reactive arthritis
D. Rheumatic fever

6. A man presented with left hip pain that was worse at the end of the day; after
movement. What is the diagnosis?
A. Osteoarthritis
B. Rheumatoid arthritis

7. A female patient known case of SLE, presented with left sided chest pain, febrile, ECG shows
a saddle shaped ST elevation, what is your dx?
A. Pericarditis.
B. Myocarditis.
C. STEMI
D. Cardiac tamponade.
8. A 9-year-old child with pain and swollen fingers and wrist, Rheumatoid factor is -ve,
what’s the diagnosis?
A. Juvenile Idiopathic Arthritis
B. Rheumatic fever
C….

9. A 43-year-old typist presents with hand pain for 2 months, MCPJs are swollen.
Rheumatoid factor: -ve, AntiCCP: +ve, high ESR (reference for ESR range of women <50
years was given). The medication of choice is?
A. Methotrexate
B. Sulfasalazine
C. Azathioprine

10. A man with joint pain and synovial fluid finding of negative birefringent needle-like
crystals, what is the treatment?
A. Corticosteroids
B. Diclofenac sodium tablet
C. Colchicine

Hematology:
11. All of the following statements regarding VWD are correct, except:
A. Normal PT
B. Prolonged aPTT, Bleeding time
C. Rarely present with haemarthrosis
D. Most of them are severe

12. A female with CBP of Hb: 12 g/dl, WBC: 40 * 10^9/mL, Plt 30 * 10^9/mL and many
basophils. What investigation is important to do now?
A. Philadelphia chromosome should be checked
B. Immunophenotyping
C. Bone marrow biopsy

13. A patient with diffuse large B-cell lymphoma) All are true, except:
A. It is more common than follicular lymphoma in our region
B. It is an aggressive tumor
C. It is common in old adults
D. It has indolent pattern
E. Weight loss, night sweats and bone pain indicate extra nodal dissemination of tumour.

14. A female with bleeding from the nose and mucosal membrane, has no family history,
and has not used any drug recently.
Hb: 12 g/dL, MCV: 84 fl, WBC: 6 * 10^9/mL, Plt: 40 * 10^9/ mL.
What is the lest useful investigation here?
A. Bone marrow examination
B. Immunophenotyping
C. ANA and antiDNAase
15. What signifies iron study?
A. Bone marrow study is more helpful than S. Ferritin and the investigation of choice
for diagnosis of IDA
B. S. Ferritin is diagnostic for IDA
16. Pernicious anemia can cause:
A. Neuropathy
B. …
17. Which one of the following causes intravascular hemolysis?
A. G6PD
B. Hereditary spherocytosis
C. Thalassemia major
18. Secondary polycythemia is not associated with?
A. Rheumatoid Arthritis
B. Smoking
C. CHD
D. Hydronephrosis

19. All of the following are likely to cause renal crisis in a patient with multiple
myeloma, except:
A. Painkiller
B. Hypocalcaemia
C. Hyperuricaemia
D. Frequent antibiotic
E. Light chain deposition

20. Regarding Beta Thalassemia Major, all are false except?

A. It is autosomal recessive
B. It is X-linked
C. One of the parents should have the same disease to pass it to the offspring
D. Blood transfusion is rarely needed before the age of 6 months

Nephrology:
21. All of the following are risk factors of ADPKD, except?
A. Male sex
B. Repeated attacks of gross haematuria
C. Diagnosis at an old age

22. What is the commonest causative microorganism of UTI?

A. E. Coli
B. Staphylococcus saprophytic
C. Klebseilla
D. Proteus

23. Which one of the following is false regarding Stages of Renal disease of Diabetic
Nephropathy?
A. Stage I: kidneys enlarge in size
B. Stage II: Albumin secretion >30 mg/24 hr
C. Stage III: Albumin secretion >300 mg/24 hr
D. Stage V: GFR <15 mL/min
24. What is the commonest cause of Acute Tubulointerstitial Nephritis?
A. Medications
B. Infections
C. Malignancies
D. Hypertension

25. Regarding renovascular hypertension, all are true, except?

A. Renal artery stenosis is the main cause
B. Surgical revascularization is the treatment of choice
C. It is one of the main causes of secondary hypertension

26. All the following are complications of haemodialysis, except?

A. Hyperglycaemia
B. Anaphylactic shock
C. Muscle cramps
D. Hypotension

27. All of the following are associated with low serum complements, except?
A. Post infectious GN
B. FSGN
C. SLE
D. Membranous nephropathy

28. A middle-aged man with gross hematuria, proteinuria and elevated s. Creatinine
for 6 months, what is the likely diagnosis?
A. IgA nephropathy
B. Minimal change disease

29. Best test for diabetic nephropathy screening:

A. Creatinine clearance
B. Serum creatinine level
C. Ultrasonography
D. Glucose tolerance test
E. Urine albumin

30. Which one of the following does not cause Membraneous Nephropathy?
A. Gastric cancer
B. Lymphoma
C. Gold
D. Syphilis
 OSCE Stations
Rheumatology:
Station no. 1: Dr. Niyaz or Dr. Shwan

Hand Examination of a case with the following findings of a rheumatoid hand:

Swan neck deformity, ulnar deviation of MCPJ, and hot joints.

Q: Dx?
Rheumatoid arthritis

Station no. 2: Dr. Khalid Aldabagh or Dr. Dhikra:

Knee Examination of a young man with Right knee limitation of passive movement.

Q: DDx?
-Gout
-Osteoarthritis (uncommon)

Hematology
Station no. 1: Dr. Kawa or Dr. Mohammed Dhahir:

A picture showing an illustrative figure of a man with a needle to be inserted to his

hip.
Q: What is this procedure called?
Bone marrow examination.

Q: What are the indications of BM Examination?

1. For Bone marrow harvest for (HSCT)
2. Bone marrow examination/ biopsy/ aspiration.

Q: What are the steps to do a bone marrow biopsy?

Say the steps of preparing the patient from sterilization to anesthesia then mention
the technique of aspiring (site, cc to be taken…)
Q: What are the complications of bone marrow harvest?
Hip/ back pain, mechanical trauma, infection, bleeding, anesthesia complications…
Q: What would the BM biopsy of each of the following show?
IDA: Prussian blue stains iron stores blue.
Acute Leukemia: Hypercellular marrow.
Aplastic Anemia: Hypocellular marrow with fat cells replacing the marrow.
Station no. 2: Dr. ? or Dr. Diveen
Case scenario: a middle-aged man with bone pain has the following tests done:

Q: What is this test called?

Protein electrophoresis.
Q: What does that segment show?
Monoclonal immunoglobulin band band in the gamma mobility region. The
proteins are M-proteins.
Q: What is the other test called?
Bone marrow biopsy.
Q: What does it show?
Fried-Egg appearance of plasma cells.
Q: yallah what’s the diagnosis?
Multiple Myeloma.
Q: What are the clinical features of MM?
Bone pain (especially backache), features of anaemia, recurrent infections, renal
failure and/or hypercalcaemia, bleeding tendency, Amyloidosis, and
hyperviscosity syndrome.
Q: Treatment?
For bone pain, hypercalcemia, Renal Failure, anemia, recurrent infections and
easy bleeding.
Q: Why does Renal Failure develop?
3 reasons: Light chain M proteins interfering with the kidneys, Hypercalcemia and
Amyloidosis.
 Nephrology:
Station no. 1: Dr. Hussein AlSinjary or Mohammed Sami

Case scenario:
A 35-year-old man, who has now presented with nausea and vomiting, has a 6-month
history of dysentery.
His blood pressure is 90/60 mmHg and his s.Cr is elevated.

Q: What is the Dx?

AKI
Q: Why did AKI develop?
Intra-renal cause of glomerulonephritis; Post-infectious GN—> Dysentery—> fluid
loss—> he wasn’t satisfied here reduced renal perfusion “hypovolemia” JUST LOOK
AT HIS BLOOD PRESSURE, HYPOTENSION NOT REDUCED RENAL PERFUSION! .
Q: What other tests would you send?
CBC, RFT, S. Electroytes…
Q: Treatment?
Correct hypovolemia by RL,
correct hyperkalemia, HTN if present, diet restrictions then dialysis.
Q: How much fluid is to be given?
U.O.P+500 ml to cover insensible losses.
Q: Indications of Dialysis?
High Creatinine, Hyperkalemia, acidosis, fluid overload, pericarditis, encephalopathy
and convulsions.

Station no. 2: Dr.?

A 40-year old man known for ADPKD:

Q: Type of ADPKD:
Adult type of ADPKD.
Q: Onset of ADPKD starts as…?
Young age.
Q: What are the types of PKD?
Simple renal cysts, acquired cysts, cysts associated with phakomatoses and
hereditary ARPKD & ADPKD.
Q: What are the extra-renal manifestations?
Cerebral aneurysm, thyroid cyst, cardiac: Mitral valve prolapse…, HEPATIC CYSTS
(the commonest organ w extrarenal cysts), pancreatic cysts, diverticula, hernia,
ovarian cysts…
Q: What are the main two organs affected?
Cerebral aneurysm (berry’s) & Heart (Mitral valve prolapse, AR)
Q: Screening tests?
US, CT, MRI, Genetic studies.
US is safer to be done for cerebral aneurysms than CT or MRI with ADPKD.
Q: What is the studied drug of choice?
Vasopressin 2 receptor antagonists (Tolvaptan).
Notice:
Questions are approximate and answers are not necessarily correct.
Medicine End Block Exam (Rheumatology – Hematology –
Nephrology)
Theory & OSCE – Group D 23/Dec./2021
--------------------------
‘Answers are not necessarily correct, few (1-2) may be wrong :) ’
1. Autologous BMT is used for all the followings except:
a. MM
b. AML.
c. Aplastic anemia.
d. Hodgkin lymphoma.
e. NHL.
2. All are causes of thrombocytosis except:
a. Splenectomy.
b. Infection.
c. IDA.
d. B12 deficiency.
e. Steroid therapy.
3. All are causes of splenomegaly except:
a. Polycythemia vera.
b. CML.
c. Kala azar.
d. Essential thrombocythemia.
e. Malaria.
4. Iron deficiency anemia is anemia of:
a. Blood loss.
b. Inflammatory.
c. Malabsorption.
d. Malignancy.
5. In a hx of a pt with skin bruises, you will concentrate on all the followings except:
a. Family hx.
b. Respiratory diseases. ?
c. Renal diseases. ?
d. Liver diseases.
e. Drug hx.
6. A 23 years old pt presented with cerebral venous sinus thrombosis, all of the
following are correct except:
a. Protein C and protein S should checked.
b. Family hx should be explored.
c. Checking for factor V Leiden is mandatory.
d. Use of anticoagulant for 6 weeks.
7. Which of the following is unlikely to occur in a case of AML?
a. CNS infiltration.
b. Oral candidiasis.
c. Severe anemia.
d. Bone pain.
8. DIC is characterized by all except:
a. Fatal outcome.
b. Low fibrinogen.
c. Thrombosis more common in acute DIC.
d. Fragmented red cells in blood film.
e. Most of them need fresh frozen plasma.
9. The cause of fever after blood transfusion could be all the followings except:
a. Immediate hemolytic Tx reaction.
b. Tx related acute lung injury.
c. Circulatory overload.
d. Reaction to leucocyte antigens.
e. Delayed hemolytic tx reaction.
10. ______
11. An old pt admitted and diagnosed as having stroke, he’s on NG tube for 5 days,
recently developed confusion, which electrolyte disturbance might be the cause of
his confusion?
a. Hypocalcemia.
b. Hypernatremia.
12. Risk factors for RCC include all except:
a. Smoking.
b. Obesity.
c. Female gender.
13. Male pt known to have HTN, on routine urine dipstick blood + was found, what
could be the cause?
a. Excessive meat intake last night.
b. Smoking.
c. Obesity.
d. Exercise.
e. Taking Ramipril.
14. Indications for biopsy in AIN includes all except:
a. Uncertainty of the dx.
b. Heavy proteinuria and hematuria.
c. Marked Renal impairment.
d. Mildly impaired renal function.
15. Pt admitted for dialysis her potassium level is 7.5 mmol/L, what is the quickest
way to decrease her potassium level?
a. Hemodialysis.
 b. IV calcium gluconate.
16. Tx of UTI in pregnancy all are accepted except:
a. Nitrofurantoin.
b. Fosfomycin.
c. Amoxicillin.
d. Ciprofloxacin.
17. Cause of acute flash pulmonary edema:
a. RCC.
b. PCKD.
c. Renal artery stenosis.
d. AIN.
18. One of the following is not a bad prognostic factor in IgA nephropathy:
a. Presence of proteinuria.
b. Presence of microscopic hematuria.
c. Presence of macroscopic hematuria.
d. Renal impairment.
19. A pt presenting with polycystic kidney disease with positive family hx, which of
the following is the next step to confirm the dx?
a. Ultrasound.
b. Genetic analysis.
c. Genetic analysis for 2 other family members.
d. MRI.
e. All of the above.
20. A pt known case of RA, presented with left sided chest pain, febrile, ECG shows a
saddle shaped ST elevation, what is your dx?
a. Pericarditis.
b. MI.
c. Cardiac tamponade.
21. A pt presents with oral ulcer, malar rash, hand joint pain, +ve anti dsDNA and
ANA, what is the dx?
a. SLE.
b. JIA.
c. Sjogren syndrome.
22. A pt (the signs and symptoms were suggestive of SLE), which investigation has a
diagnostic value?
a. Anti-dsDNA.
b. ANA.
c. ….
23. A 72 years old male pt presented with acute painful right knee joint, examination
revealed erythema and hotness, Xray of knee showed calcification of the cartilage
and reduced joint space, synovial fluid aspiration culture showed no growth.
What is your dx?
a. Pseudogout.
 b. Gout.
c. RA.
d. Septic arthritis.
24. What is true about Reiter's syndrome:
a. Associated with Shigella flexneri infection.
b. …
25. A 55 years old pt presented with 6 weeks duration of shoulder girdle pain and
stiffness, with high ESR, dx?
a. Polymyalgia rheumatica.
b. ….
26. Organomegaly is a characteristic feature of which type of JIA?
a. Systemic.
b. Polyarticular.
c. Oilgoarticular.
d. Psoriatic.
27. Radiological findings in grade 2 ankylosing spondyitis:
a. Pseudo widening.
b. Bone erosion.
c. Narrowing and osteosclerosis.
28. A pt presented with hip joint pain radiating to back and gluteal region, associated
with morning stiffness that lasts for around 2 hours, relieved by movement, what
is the type of pain?
a. Inflammatory.
b. Mechanical.
c. Degenerative.
29. A pt known case of RA, presented with 6 weeks hx of paresthesia and numbness
in both hands, was severe that awakened pt from sleep, there was no other
neurological deficits on examination however phalen test was positive bilaterally,
lab investigations showed (CBC …., ESR...,), what is the next step in
management?
a. Urgent MRI for the cervical spine.
b. Routine MRI of cervical spine.
c. X ray of the hands.
d. EMG.
30. ___ ?
Sariya Dler :)

--------------------
OSCE
6 stations (By Mutaz)

Station 1/ Hematology:
Young pregnant lady presents to you with multiple bruises on her skin with bleeding
from gum , no enlarged lymph nodes or organomegaly, US negative fetal heart,
Investigations
∑ Hb 8 g /dl
∑ WBC 9 x 109
Platelets 80 x 10
PT 24 sec
aPPT 43 sec (not sure about number but definitely increased)
1- What's your DDX? (DIC, Septicemia ......)
2- why DIC happened? (Could be due to placenta previa and excessive bleeding)
3- what will you do for the baby? (Induced Abortion)
4- How to treat DIC? (Admission, IV fluid, maybe o2 mask and treating the underlying
causes, then we give heparin, and anti fibrolytic Agent)
5- which blood component should we give?
(Fresh frozen plasma).

Station 2/ Hematology:
Patient got blood transfusion 1 hour ago, now he started to have shortness of breath
1- your diagnosis? Tx related acute lung injury....
2- What are the questions you will focus on during history taking? ( dysnea, tachy pnea,
fever, cyanosis, family history, blood group, previous blood transfusion) ….
3- what will you do for this patient?
(Stop the transfusion if he/ she is still on it, O2 mask, maybe tracheostomy,
documentations of any new sign and symptoms, don’t say Iv fluid bcz the patient was
already had fluid overload, give diuretic, corticosteroids and bronchodilators, and
adrenaline)

Station 3/ Rheumatology:
It was hand examination, and we did it on the doctor, while other groups did it on a real
patient.
You will do the procedure and for each finding the doctor will ask you about the
diagnosis
For the example the patient had a z shape thumb deformity, the doctor would ask about
the diagnosis.

Station 4/ Rheumatology:
It was knee examination, same as hand examination, you will do all the steps (our
doctor asked us to skip Gait) and then for each finding he will ask you it imply to
which disease.

Station 5/ Nephrology:
The patient has polycystic kidney disease with no positive clinical signs.
1- what are the extra clinical manifestations of polycystic kidney disease?
(Liver cyst, ovary cyst, colonic diverticula...)
2- what does it cause in the brain (really important question)? (It causes A-V
malformation). What does it cause to the aorta? (aneurysm)
3- what should you do diagnose family members? (You don’t need genetic study since
the patient himself doesn’t have any positive clinical signs, so you only need US)
4- how to confirm the diagnosis for the patient?
(By US, if the patient is less than 30 years old, 2 cysts either bilateral for each kidney or
two cysts on one kidney are diagnostic, 30-59 years, 4 cysts are diagnostic, older age: 8
cysts)
5- treatment? (Tolvaptan, Kidney transplant...).

Station 6/ Nephrology:
A patient presents to you with periorbital edema, pitting leg edema, proteinuria
+++, 160/110 mm Hb
1-What are abnormalities here?
2-what other investigations you may send?
3- How do you manage this patient?