GOMAL MEDICAL COLLEGE, MTI, D.I.

KHAN
MCQs Written Test 4th YEAR MBBS (Block-K) Date: 29th June, 2022
Name of Student: ____________________ Roll No.______________
Please encircle the correct answer with blue/black pen Paper ID: Blue
TIME ALLOWED: 02-HOUR’S TOTAL MARKS: 120
Note: Attempt ALL questions from this section. Select ONE best answer. Each question carries 01 mark.
Q#1: Choose the incorrect: Hepatitis D virus (HDV)
a) Is directly causing acute hepatitis
b) Co-infection with hepatitis B virus(HBV)
c) Super infection in HBs antigen positive patient
d) Combined with HBV is a cause of fulminant hepatitis.
e) No vaccine can prevent HDV infection.

Q#2: Hepatotropic viruses are:

a) A, B and C
b) A, B, C and D
c) A, B, C, and E
d) None of the above
e) A, B, C, E, and cytomegalo virus

Q#3: A 14 years male came to OPD with symptoms and signs of malabsorption. He is suspected celiac disease. To
confirm it which of the following is most appropriate?
a) full blood count ,serum ferritin, and vit- D level
b) Tissue transglutaminase antibodies
c) family history of celiac disease
d) Tissue transglutaminase antibodies followed by small intestinal endoscopic biopsy histopathology
examination
e) antigliadin antibodies

Q#4: Microscopic examination of a histopathlogy slide shows Rokitansky Aschoff sinuses, the site of biopsy is
a) liver
b) stomach
c) gall bladder
d) small intestine
e) rectum

Q#5: Most common cause of peptic ulcer disease in a 28 yrs male patient is
a) Helicobacter- pylori infection
b) NSAIDS
c) zollinger ellisson syndrome
d) cigarette smoking
e) eosinophilic ga

Q#6: 45years male patient's liver biopsy shows Onion skin appearance the diagnosis is
a) Liver cirrhosis
b) Cholangio carcinoma
c) Primary Sclerosing cholangitis
d) NASH
e) hepatocelluler carcinoma

Q#7: A female Ascaris can be identified on which basis?

a) Curved posterior end.
b) Common cloacal aperture.
c) Presence of post anal papillae.
d) Straight posterior end.
e) Two spicules found at the posterior end.
Q#8: A patient with cirrhosis is at risk for developing complications. Which condition is most serious and potentially
life threatening?
a) Ascites.
b) Oesophageal varices.
c) Gastric ulcer.
d) Hepatomegaly.
e) Peripheral edema

Q#9: Bilirubin which is insoluble in water is called?

a) Conjugated bilirubin.
b) Direct bilirubin.
c) Indirect bilirubin.
d) Unconjugated bilirubin.
e) Urobilinogen.

Q#10: A 50 years old patient came to hospital with diagnosed case of peptic ulcer. Which of the following is most
common site for peptic ulcer?
a) Cecum.
b) Duodenum.
c) Esophagus.
d) Ileum.
e) Pancreas.

Q#11: What is best used for detecting small or healing ulcers?

a) Abdominal CT.
b) Barium radiography.
c) Endoscopy.
d) MRI.
e) Urea breath test?

Q#12: A patient develops hepatic encephalopathy. Which clinical manifestation is most common with this condition?
a) Altered level of consciousness.
b) Deceased tendon reflex.
c) Hypertension.
d) Hypotension.
e) Increased urine output

Q#13: Diagnostic test for Wilson's disease is

a) Antimitrochondrial antibodies
b) Glucose intolerance
c) Liver biopsy
d) Serum copper level
e) Serum ceruloplasmin
Q#14: Risk of lichen planus into malignancy is
a) 10-15yrs
b) 15-20yrs
c) 5-10yrs
d) 25-35yrs
e) 35-45yrs
Q#15: Afla toxin causes which carcinoma
a) Bladder Cancer
b) Hepatocellular carcinoma
c) Leukemia
d) Myelodysplastic syndrome
e) Skin cancer
Q#16: Which of the following is precancerous lesion?
a) Angiodysplasia
b) Cervical erosion
c) Duodenal ulcer
d) Hemarthrosis
e) Leukoplakia
Q#17: In liver cell injury, enzyme decreased is
a) ALP
b) ALT
c) AST
d) GGT
e) 5-neucleotidase
Q#18: Which one of the following is risk factor in Esophageal cancer
a) Benzene
b) Nitrogen
c) Nitrosamines
d) Nephthaline
e) Hydrocarbon

Q#19: A young boy presents with loss of appetite, vomiting yellow color urine and yellow sclera. What test should be
done for diagnosis?
a) ALT
b) Bilirubin and ALT
c) Hep A and B serology
d) Hep C serology
e) Liver biopsy
Q#20: A quak has given drug to patient after which he developed jaundice.Which enzyme will be raised in this
condition
a) Alanine transaminase
b) Aspartate transaminase
c) ADH
d) Alkaline phosphatase
e) Acid phosphatase
Q#21: Which one of the following is precancerous lesion??
a) Angiodysplasia
b) Cervical erosion
c) Duodenal ulcer
d) Heamarthrosis
e) Leukoplakia
Q#22: Long term smoker feeling difficulty in swallowing for solids. Appropriate statement for this is?
a) Decrease antigravity
b) Decrease peristalsis
c) Damage to neurons
d) Neuropathy
e) Unknown
Q#23: Juvenile polyp of colon is also called
a) Adenomatous polyp
b) Epithelial polyp
c) Hemartomatous polyp
d) Pedunculated polyp
e) Sessile polyp
Q#24: Uncongugated bile is carried by which proteins?
a) Albumin
b) Alpha globulin
c) Beta globulin
d) Fibrinogen
e) Pre albumin
Q#25: WHICH type of pneumonia is caused by Ascaris lumbricoides?
a) Bacterial pneumonia
b) Fungal pneumonia
c) Loeffler ‘s pneumonia
d) Mycoplasma pneumonia
e) Viral pneumonia
Q#26: Toxic megacolon is a complication of which of the following?
a) Alcoholic liver disease
b) Crohn disease
c) Hepatitis B
d) Irritable bowel syndrome
e) Ulcerative colitis
Q#27: Granulomas are present in which of the following?
a) Crohn disease
b) Hepatitis A
c) Hepatitis C
d) Liver cirrhosis
e) Ulcerative colitis
Q#28: Crohn disease is also known as.
a) Granulomatous disease
b) Terminal ileitis
c) Irritable bowel syndrome
d) Intestinal perforation
e) Toxic megacolon
Q#29: Which of the following part of the intestine is involved in Ulcerative colitis?
a) Colon and rectum
b) Duodenum
c) From mouth to anus
d) Ileum
e) Small intestine
Q#30: Skip lesions are present in which of the following?
a) CA colon
b) Cirrhosis of liver
c) Crohn disease
d) Hepatitis A
e) Ulcerative colitis
Q#31: Risk factor for alcoholic liver disease is
a) Cirrhosis
b) Hepatitis C infection
c) Hormones
d) Obesity
e) Regular intake of alcohol

Q#32: Diphyllobothriasis is caused by eating

a) Raw fish
b) Raw fruits
c) Raw meat
d) Raw milk
e) Raw vegetables

Q#33: Enterobius vermicularis is commonly known as?

a) Flatworm
b) Fish worm
c) Hook worm
d) Pinworm
e) Tapeworm

Q#34: High risk transmission for HCV is

a) Breast feeding
b) Fomite transmission
c) Needle stick injury
d) Sexual transmission
e) Vertical transmission

Q#35: What is the most common symptom associated with chronic HCV infection?
a) Abdominal pain with or without ascites
b) Asymptomatic
c) Dark stool
d) Fever with or without jaundice
e) Jaundice

Q#36: Which of these is a symptom of pinworm infection?

a) Nausea
b) Paranoia
c) Intense itching
d) Diarrhea
e) abdominal pain
Q#37: A 59 Year old man has had increasing dyspnea on exertion for the past year. His dyspnea is worse in the upright
position and diminishes when he is recumbent. On physical examination he has clubbing of the fingers. Exercise
induces a decrease in his po2 that improves when he stop and lies down. Which of the following liver abnormalities is
he most likely to have?
a) Biliary obstruction
b) Chronic inflammation
c) Cirrhosis
d) Metastases
e) Steatosis

Q#38: A 50-Year- old man has a history of chronic alcoholism, but he stopped drinking alcohol 10 years ago. He has
been taking no medications. On physical examination, he is afebrile. The abdomen is not enlarged, and there is no
tenderness. The liver span is normal. Serologic test results for hepatitis A,B , and C, are negative . The hematocrit is
35%. Which of the following morphologic features is most likely to be present in his liver?
a) Concentric “onion-skin” bile duct fibrosis
b) Hepatic venous thrombosis
c) Interface hepatitis
d) Massive hepatocellular necrosis
e) Periportal PAS- positive globule deposition

Q#39: A 65-Year- old man with a history of alcohol abuse has had hematemesis for the past day. Physical examination
reveals mild jaundice, spider angiomas, and gynecomastia. He has mild pedal edema, normal jugular venous pulsation
(JVP), and a massively distended abdomen. Paracentesis is performed and the fluid obtained shows accumulation of
protein-poor fluid that is free of inflammatory cells. Which of the following factors is most likely to be responsible for
the collection of abdomen fluid in this man?
a) Congestive heart failure
b) Hepatopulmonary syndrome
c) Hyperbilirubinemia
d) Portosy stemic shunts
e) Splanchnic arterial vasodilation

Q#40: A study of patient with ascites includes measurements of serum and ascitic fluid protein level. The serum-
ascites albumin gradient (SAAG) is calculated. Some patients are found to have a high gradient, along with
splenomegaly. They are found to have serum albumin less than 2.5 g/dL. Which of the following conditions is most
likely to produce a SAAG greater than1.1?
a) Budd-Chiari syndrome
b) Cirrhosis
c) Nephrotic syndrome
d) Pancreatitis
e) Peritonitis

Q#41: A 54-Year-old man woman has a long history of chronic hepatitis B infection and has held increasing for the past
year. She was hospitalized 1 year ago because of upper gastrointestinal hemorrhage. Physical examination now shows
a firm nodular liver. Laboratory findings show a serum albumin level of 2.5 g/dL and prothrombin time of 28 seconds.
Which of the following additional physical examination findings is most likely to be present in this woman?

a) Caput medusa
b) Diminished deep tendon reflexes
c) Distended jugular veins
d) Papilledema
e) Splinter hemorrhage

Q#42: Which of the following is true in regards to Digital rectal examination?

a) The sacrum is palpated anteriorly
b) The pubic bone is palpated anteriorly
c) In males, testes can be appreciated anteriorly
d) Cervix can be sometimes palpated in females anteriorly.
e) A written consent is required to perform DRE
Q#43: Which of the following is true about hemorrhoids?
a) Bleeding hemorrhoids leads to melena Per rectum
b) Pregnancy is a predisposing factor for hemorrhoids
c) First and second degree hemorrhoids are associated with pain.
d) Second degree hemorrhoids cannot be reduced into anal canal manually.
e) Hemorrhoids are considered pre-malignant
Q#44: This is true about rectal bleeding.
a) A painful DRE suggests anal fissure.
b) Bright red PR bleed suggests cecal lesion.
c) Proctoscopy is of no use in bleeding PR.
d) Rectal cancer is the most common cause of PR Bleed.
e) Fresh bleeding can indicate a gastric ulcer
Q#45: An anal fissure is:
a) A linear ulcer of squamous epithelium below dentate line
b) A linear ulcer of columnar epithelium below dentate line
c) Always caused by constipation
d) Typically found at 12 o’clock position.
e) Secondary to rectal tumor
Q#46: Presenting symptoms of anal fissure are
a) Pain abdomen with fresh PR bleed
b) Anal pain and fresh PR bleed
c) Anal pain and dark PR bleed
d) Pain abdomen and dark PR bleed
e) Fresh bleed and flank pain
Q#47: When examining anal fissure?
a) Digital rectal examination is must.
b) Typical location is 6 o’clock
c) Anal spasm is not a feature of fissure
d) Patient feels something coming out of anus.
e) There is no need to do PR examination
Q#48: Which of the following treatment of anal fissure cause headaches as a side effect
a) GTN ointment
b) Diltiazem ointment
c) Injection of botulinum toxin
d) None of the above
e) Antibiotics
Q#49: Which of the following factors is most likely the primary case of hemorrhoids in a female patient?
a) He age and gender
b) History of three vaginal deliveries
c) Her job as a school teacher
d) Her vegetarian diet.
e) Excess of fiber diet

Q#50: External hemorrhoids below dentate line are

a) Painful
b) Needs no intervention
c) Not appreciated on local examination
d) Capable of malignancy
e) None of the above
Q#51: Which is a well-known risk factor for hemorrhoids?
a) Chronic constipation
b) Chronic diarrhea
c) Obesity
d) Pregnancy
e) All of the above
Q#52: What is the most significant mechanism leading to hemorrhoids in pregnancy?
a) Acid reflux
b) Edema
 c) Venous compression
d) Morning sickness
e) None of the above
Q#53: Investigation of choice in hemorrhoids is
a) DRE
b) Proctoscopy
c) Colonoscopy
d) MRI Pelvis
e) Ultrasound abdomen

Q#54: Gluten sensitivity leading to chronic Malabsorption in children is observed in,

a) Acute pancreatitis
b) Ch. Diarrhea
c) Celiac Disease
d) Amebiasis
e) None of the above
Q#55: Positive stool reducing substances is diagnostic in,
a) Lactose Malabsorption
b) Celiac Disease
c) Giardiasis
d) Tropical Sprue
e) None of the above
Q#56: Three year child presented with loose motion more than 3 weeks leading to failure in thrive, perianal rash &
anemia. Most common cause of chronic diarrhea in developing world is?
a) Toddler diarrhea
b) Worms infestation / Infections
c) Lactose intolerance
d) Celiac disease
e) None of the above
Q#57: The mechanism of action of corrosive acids is:
a) Chelation
b) Precipitation
c) Systemic toxicity
d) Local coagulation necrosis
e) Metabolism

Q#58: Acids when taken in diluted form act as:

a) Irritant
b) Stimulant
c) Corrosive
d) Protoplasmic poison
e) Hallucinogen

Q#59: The following is a late complication in acid poisoning:

a) Perforation
b) Peritonitis
c) Stricture formation
d) Systemic toxicity
e) Stroke

Q#60: Gastric Lavage is contraindicated in corrosive poisoning as it can cause:

a) Aspiration
b) Perforation
c) Stricture formation
d) Embolism
e) Stroke
Q#61: The following should be avoided in neutralization of acid present in the stomach in acid poisoning:
a) Water
b) Milk
c) Weak Alkali
d) Milk with magnesium oxide
e) All of above

Q#62: Castor oil is a following kind of poison:

a) Irritant
b) Deliriant
c) Inebriant
d) Narcotic
e) Corrosive

Q#63: The active principle in castor seed is:

a) Drowsiness
b) Crotin
c) Ricin
d) Cannabinol
e) Abrin

Q#64: The principle symptom in castor oil poisoning is:

a) Drowsiness
b) Severe diarrhea
c) Neuralgia
d) Unconsciousness
e) Stroke

Q#65: The fatal dose of croton seeds is:

a) One
b) Four
c) Ten
d) Fifty
e) Hundred

Q#66: The active principle in ratti seeds is :

a) Crotin
b) Ricin
c) Cannabinol
d) Abrin
e) Paracetamol

Q#67: The following symptom is produced when metallic arsenic is ingested:

a) Shock
b) Coma
c) Gastric irritation
d) No symptom
e) Stroke

Q#68: Acute arsenic poisoning is confused with following illness:

a) Pneumonia
b) Cholera
c) Tetanus
d) Meningitis
e) Cardiac arrest
Q#69: The predominant symptom in acute arsenic poisoning is:
a) Rice water stools
b) Changes in voice
c) Cerebral irritation
d) Hyperthermia
e) Hypothermia

Q#70: Mees’s lines are observed in poisoning due to :

a) Lead
b) Mercury
c) Arsenic
d) Thallium
e) Antimony

Q#71: Raindrop appearance of the skin is seen in chronic poisoning due to :

a) Lead
b) Arsenic
c) Mercury
d) Antimony
e) Thallium

Q#72: Rigor mortis last longer than usual in poisoning due to:
a) Arsenic
b) Lead
c) Thallium
d) Mercury
e) None

Q#73: A sample of 100,000 nurses was enrolled in a study to see association between obesity and breast cancer. Out
of them 30,000 were obese. After a follow up of 25 years, 3000 among obese and 4000 among non-obese developed
breast cancer. What type of study design is this?
a) Cross sectional
b) Case control
c) Cohort
d) RCT
e) Case series

Q#74: A sample of 100,000 nurses was enrolled in a study to see association between obesity and breast cancer. Out
of them 30,000 were obese. After a follow up of 25 years, 3000 among obese and 4000 among non-obese developed
breast cancer. What measure of association will be used for this study design?
a) Odds ratio
b) Relative risk
c) Prevalence ratio
d) SE of difference between two proportions
e) Population attributable risk

Q#75: A population of health care providers and support staff of a hospital was inquired about their hepatitis B
vaccination status. Among them only 20% were fully vaccinated. What type of study design is this?
a) Cross sectional
b) Case control
c) Cohort
d) RCT
e) Case series

Q#76: A sample of children born with congenital anomalies was enrolled in a study. Another group of healthy children
born in same hospital during that period were also recruited in study and their mothers were inquired about history of
drugs intake during pregnancy. What type of study design is it?
a) Case series
b) RCT
c) Cross sectional
d) Case control
e) Cohort
Q#77: A sample of children born with congenital anomalies was enrolled in a study. Another group of healthy children
born in same hospital during that period were also recruited in study and their mothers were inquired about history of
drugs intake during pregnancy. It was found mothers of abnormal children were taking a hypnotic that was not used
by mothers of healthy children. What measure of association will be used to show association between cause and
effect?
a) Prevalence ratio
b) Attributable risk
c) Population attributable risk
d) Odds ratio
e) Relative risk

Q#78: To get prevalence of disease, what type of study design will you use?
a) Quasi experimental
b) RCT
c) Cross sectional
d) Case control
e) Cohort

Q#79: To get incidence of disease, what type of study design will you use?
a) Quasi experimental
b) RCT
c) Cross sectional
d) Case control
e) Cohort

Q#80: Which type of study design will you use for rare exposures?
a) Quasi experimental
b) RCT
c) Cross sectional
d) Case control
e) Cohort

Q#81: Which type of study design will you use for rare diseases?
a) Case report
b) Ecological study
c) Retrospective cohort
d) Prospective cohort
e) Case control

Q#82: An expert in the field of public health is required to estimate the magnitude of a health problem. Which rate
would he calculate for this?
a) Incidence
b) Prevalence
c) Case fatality
d) Proportionate mortality
e) Total mortality
Q#83: Patients admitted for carcinoma of the stomach are age and sex-matched, with smoking history to assess the
possible association. Which option explains the given example?
a) Case series report
b) Case-control study
c) Clinical trial
d) Cohort study
e) Case report
Q#84: Residents of three villages with three different types of water supply were asked to participate in a study to
identify cholera carriers because several cholera deaths had occurred in the recent past. Virtually everyone was
present at the time of examination. The proportion of carriers in each village was computed and compared. Which
type of study design is this?
a) aCross-sectional study
b) Case-control study
c) Concurrent cohort study
d) Retrospective cohort study
e) Clinical trial
Q#85: An epidemiologist is assigned to conduct a study on 5000 people. Some having hyperlipidemia and other having
normal lipid profile. He has to keep track of all the participants to observe the development of stroke in these patients
to confirm that hyperlipidemia increases the risk of stroke. This study is:
a) Retrospective cohort study
b) Retrospective study
c) Case Series study
d) Cross – sectional study
e) Prospective cohort study
Q#86: Acute hemorrhagic conjunctivitis affected a large proportion of population over a wide geographic area in 2001
and 2011. This spread of disease is:
a) Epidemic
b) Sporadic
c) Pandemic
d) Endemic
e) Opportunistic

Q#87: Smoking leads to esophageal carcinoma. Coffee intake has its effect on smoking and also esophageal carcinoma.
This factor can distort the results of the study which intends to prove an association between smoking and esophageal
cancer. This effect of coffee intake is known as:
a) Confounding
b) Multiple causation
c) One to one relationship
d) Dose response relation
e) Strength of association

Q#88: While investigating a point source epidemic it was found that 120 students ate five different foods (meat
burgers, fried fish, steak, and rice and fruit salad). The odds ratio was calculated for all those five foods. It was
concluded that fish was not responsible for this epidemic. The Odd Ratio of fish is:
a) 0.7
b) 1.2
c) 1.7
d) 3.0
e) 7.0

Q#89: The trend in mortality from tuberculosis in England showed a steady fall in years 1855 – 1965 but thereafter a
gradual rise in the incidence of this disease was reported. What is this type of time trend?
a) Epidemic trend
b) Cyclical trend
c) Seasonal trend
d) Secular trend
e) Pandemic trend

Q#90: 10 cases of food poisoning had been reported in a hospital, 2 out of these succumbed to the disease. The
characteristic of the organism of food poisoning that produces the severest form of the disease is called virulence.
Which of the following rates can measure the virulence?
a) Crude Mortality Rate
b) Specific Mortality Rate
c) Case Fatality Rate
d) Survival Rate
e) Proportional Mortality Rate

Q#91: Regarding interferon alpha which of the following statement is false?

a) At start of treatment most patient experience flu like symptoms.
b) Indication include genital warts
c) It is used in management of hepatitis Band C
d) Lamivudine interfere with its activity against hepatitis B.
e) Toxicity includes bone marrow suppression.
Q#92: Which one of the following best describes the mechanism of action of ribavirin?
a) Inhibits viral aspartate protease
b) Inhibits viral DNA polymerase
c) Inhibits viral RNA polymerase
d) Inhibits viral reverse transcriptase
e) Prevent integration of viral genome

Q#93: Treatment of neurocyticercosis include all of the following except:

a) Albendazole
b) Mebandazole
c) Praziquantel
d) Prednisolone
e) Niclosamide

Q#94: Drug of choice for echinococcosis treatment

a) Albendazole
b) Iodoquinol
c) Piperazine
d) Niclosamide
e) Suramin

Q#95: The following helminthic disease can be treated by albendazole but not by mebendazole.
a) Hookworm infestation
b) Threadworm infestation
c) Trichuriasis
d) Neurocyticercosis
e) Nematodes

Q#96: Malabsorption due to a mucosal intestinal defect occurs in:

a) Chronic pancreatitis
b) Cystic fibrosis
c) Coeliac disease
d) Ulcerative colitis
e) None of the above

Q#97: 22year old man with inflammatory bowel disease is noted to have Astring sign in the ileal area on barium
enema which is seen in the following conditions:
a) In the stenotic and nonstenotic phase of thedisease.
b) In the stenotic phase only
c) With gastric involvement.
d) With rectal involvement
e) None of the above

Q#98: In ulcerative colitis only one statement is true:

a) I s m o r e c o m m o n i n s m o k e r s t h a n i n n o n smokers.
b) The first line of treatment is infliximab
c) C o m m o n l y i n v o l v e s t h e i l e u m .
d) Is associated with HLA B27
e) None of the above

Q#99: Which one of the following antiemetic agent has pro kinetic effect?
a) Ondansetron
b) Metclopramide
c) Hydroxyzine
d) Cinnarizine
e) Granisetron
Q#100: A 30 years old male who is on chemotherapy taking cisplatin, now presented with nausea and vomiting. Which
one of the following drug, would you prescribe him to control nausea and vomiting?
a) Haloperidol
b) Lorazepam
c) Ondansetron
d) Dexamethasone
e) Metclopramide
Q#101: All of the following are true regarding loperamide and diphenoxylate, except
a) Both are analogs of meperidine
b) Both have opiod like action on gut
c) Both of these can lead to toxic megacolon
d) Both of these are treatment of choice in patient with severe colitis
e) Both of these lead to decreased peristalsis.

Q#102: A 30 years old pregnant lady presented with complaint of constipation. Which one of the following medicine is
contraindicated in this patient?
a) Docusate sodium
b) Glycerin suppository
c) Castor oil
d) Lactulose
e) Mineral oil

Q#103: Which one of the following laxatives can also be used in management of hepatic encephalopathy, due to its
ability to reduce ammonia levels?
a) Lactulose
b) Docusate sodium
c) Lubiprostone
d) Methylcellulose
e) Bisacodyl

Q#104: You are going to start triple therapy regimen in 40 years old male with h.pylori associated peptic ulcer. Which
three drugs will you prescribe to him?
a) Ciprofloxacin, metronidazole, famotdine
b) Omeprazole,amoxicillin, clarithromycin.
c) Omeprazole, ranitidine, metronidazole
d) Metronidazole, amoxicillin, ranitidine
e) Levofloxacin,metronidazole, ranitidine

Q#105: A 30 years old male presented to you with gynecomastia. He was taking medicines for peptic ulcer for the last
few years. Which one of the following will be the culprit drug?
a) Omeprazole
b) Bismuth subsalicylate
c) Imetidine
d) Rabeprazole
e) Misoprostol

Q#106: A 30 years old pregnant lady presented to you with heart burn. Which one of the following medicine is
absolutely contraindicated in this patient?
a) Aluminum hydroxide
b) Sucralfate
c) Magnesium hydroxide
d) Misoprostol
e) Bismuth subsalicylate

Q#107: What is the predominant route of transmission for HEV infection?

a) Person-to-person contact
b) Consumption of contaminated drinking water
c) Vertical transmission from mother to child
d) Parenteral route of infection
e) Transmission by blood transfusion

Q#108: Which of the following agents is recommended for primary prophylaxis of large esophageal varies and acts to
decrease both portal flow and intrahepatic resistance?
a) Prazosin
b) Isosorbide mononitrate
c) Carvedilol
d) Propranolol
e) Simvastatin
Q#109: A 55-year-old man with cirrhosis due to hepatitis C liver disease presents with 3 months of abdominal
distention and weight gain. On physical exam, he has bulging flanks and shifting dullness on percussion. Laboratories
studies include the following: Sodium 130 mEq/L, BUN 12 mg/dL, Creatinine 0.4 mg/dL, Total bilirubin 1.3 mg/dL,
Albumin 2.9 g/dL, Prothrombin time 13.4 seconds. Which of the following medical therapies is most likely to control
his ascites?
a) Fluid restriction
b) Dietary sodium restriction and diuretics
c) Fluid restriction and dietary sodium restriction
d) Dietary sodium restriction
e) Single large-volume paracentesis

Q#110: Which of the following is the first line regimen for secondary prevention of spontaneous bacterial peritonitis?
a) Doxycycline 100 mg twice daily
b) Amoxicillin 500 mg twice daily
c) Trimethoprim-sulfamethoxazole daily
d) Norfloxacin 400 mg daily
e) Ciprofloxacin 500 mg daily

Q#111: Which of the following class of hepatitis C direct acting antiviral drugs is potent, pan-genotypic, and has a high
barrier to resistance?
a) Protease inhibitors (second generation)
b) Non-nucleos(t)ide polymerase inhibitors
c) Nucleos(t)ide polymerase inhibitors
d) NS5A inhibitors
e) Interferon lamda

Q#112: A 45-year-old man comes to your office for a followup visit. One year ago he was diagnosed with hereditary
hemochromatosis after routine blood work found elevated ferritin and genetic testing revealed he had a C282Y/H63D
genotype. He has been treated by phlebotomy with one unit of blood removed every week for the past year. His most
recent laboratory results include the following: Hemoglobin 12.0 g/dL, Hematocrit 36%, Serum ferritin 50 ng/mL,
Serum iron 100 ug/dL, Serum total IBC 260 mg/dL, What is the most appropriate next step in his therapy?
a) Phlebotomy 1 unit every 3 months
b) A low iron diet
c) Phlebotomy 1 unit every 2 weeks until the hemoglobin concentration is less than 10.0 g/dL
d) Liver biopsy to assess hepatic iron overload
e) Phlebotomy 1 unit every 2 weeks until the serum iron level is less than 20 ug/dL

Q#113: A 65-year-old Asian man with chronic HBV and cirrhosis is referred to your clinic. He is not currently on HBV
treatment. A recent abdominal ultrasound did not show any suspicious lesion in the liver. His laboratory values are as
follows: AST 45 U/L, ALT 34 U/L, HBeAg negative, HBeAb positive, HBV DNA 3000 IU/mL, INR 1.3, Total bilirubin 1
mg/dL. What is the most appropriate recommendation at this time?
a) A liver biopsy to assess for inflammation
b) An abdominal MRI
c) Initiating antiviral treatment with tenofovir
d) Holding antiviral treatment for now and monitor liver function tests every 6 months
e) Treatment with interferon

Q#114: A 60-year-old man with chronic HCV and cirrhosis is referred to your clinic for further evaluation. A recent MRI
showed a new 2 cm lesion with imaging characteristics typical for hepatocellular carcinoma. AFP level is 230 ng/mL.
The patient’s liver disease has been complicated by ascites and encephalopathy. He does not have significant medical
comorbidities and has good social support. What is the most appropriate next step?
a) Refer for a transplant evaluation
b) Refer to oncology
c) Refer to surgery for resection
d) Observation with serial imaging every 3 months
e) Start antiviral therapy for HCV
Q#115: A 49-year-old man is referred for evaluation of hepatitis B virus (HBV). He is asymptomatic. He notes a family
history of viral hepatitis and his father was treated for hepatocellular carcinoma (HCC). Physical exam is significant for
anicteric sclera, soft and nontender abdomen with no hepatosplenomegaly. No spider nevi or jaundice noted.
Laboratory values are as follows: ALT 21 U/L, AST 23 U/L, Bilirubin 0.6 mg/dL, ALP 76 U/L, WBC 4500/μL, Hematocrit
43%, Platelet count 230,000/μL, HBsAg positive, HBeAg negative, HBe antibody positive HBV DNA 80 IU/mL, Hepatitis
C virus (HCV) antibody negative, Abdominal ultrasound shows normal-appearing liver. Which of the following would
you recommend?
a) Liver biopsy
b) Entecavir
c) Tenofovir
d) Pegylated interferon (IFN)
e) Abdominal ultrasound every 6 months

Q#116: A 35-year-old woman presents to the emergency department with nausea, vomiting, and epigastric pain of 6-
hour duration. Significant past medical history includes hypertension for which she takes lisinopril. Physical exam
shows the following: Temperature 97° F,Heart rate 105 bpm, Respiratory rate 15 breaths/min, Blood pressure 120/65
mm Hg, Her abdomen is distended and is tympanic to percussion. There is tenderness to deep palpation in the
epigastrium. Abdominal ultrasound reveals cholelithiasis. CBD was 6 mm in diameter. Laboratory values are as follows:
WBC 11,000/μL, Hematocrit 40%, Hemoglobin 14 g/dL, Calcium 7.2 mg/dL, ALT 75 U/L, AST 83 U/L, Alkaline
phosphatase 180 U/L, Bilirubin 2.5 mg/dL, Amylase 1200 IU/L, BUN 20 mg/dL. Which of the following is the most
appropriate next step in management?
a) Abdominal CT scan
b) Fluid resuscitation
c) Wide-spectrum IV antibiotics
d) ERCP
e) Insert nasogastric (NG) tube
Q#117: A 45-year-old woman with a history of chronic pancreatitis presents to your clinic with increased frequency of
bowel movements for the past 10 months. She passes greasy, foul smelling stool multiple times per day for the past 6
months. Deficiency of which of the following micronutrients is more likely to develop in this patient?
a) Vitamin A
b) Vitamin B12
c) Vitamin C
d) Folate
e) Biotin
Q#118: 20 year old male presented with jaundice, diarrhea, and fever for 01 week. His liver function test show ALT:
300 mg/dl, bilirubin: 5mg/dl, HbsAg negative, Anti HCV negative. He has been traveling to the village where there is
the poor sanitation. What is best management plan for him?
a) Advise PCR HbsAg, Anti HCV
b) Advise supportive management and send Anti HAV Ab
c) Do the stool analysis
d) Refer to gastroenterologiest
e) None of the above.
Q#119: 30 year old female presented with severe watery diarrhea and vomiting for 01 day. On examination she is
dehydrated BP: 90/60, CBC: Hb: 12, TLC: 12000. What is best management for her?
a) Rehydrate with fluids and antibiotic
b) Give anti-diarrheal agents
c) Metronidazole flagyl
d) ORS
e) Probiotics

Q#120: Being assigned responsibility for something that you have done or something you are supposed to do?
a) Responsibility
b) Morality
c) Punctuality
d) Accountability
e) Respectfulness