IM-MAJD-Final Exam

1. A 60-year-old woman with heart failure and normal renal function is started on furosemide (Lasix) 80 mg/day.
She notices a good diuretic response every time she takes the medication A few weeks later, she is feeling unwell
because of fatigue and muscle weakness, but her heart failure symptoms are better. Which of the following is
the most likely explanation for her muscle weakness?
A. Hypernatremia
B. Hyperkalemia
C. Hyponatremia
D. Hypokalemia
E. Hypercalcemia
Ans D

2. All the following prolongs survival in patients with “HF with reduced ejection fraction (HFrEF)” except:
A. ACE inhibitors
B. B-blockers
C. implantable cardioverter-defibrillator (ICD)
D. spironolactone
E. furosemide / digoxin
Ans E

3. A 20-year-old female with generalized body pains and fever for the last 4 weeks, ESR 70 mm/hr. She had low
serum albumin, leukopenia, platelets count 50,000 and blood film showed no abnormal cells. Chest Xray is
normal. The most likely diagnosis (similar case)
A. COVID 19 infection
B. Systemic lupus erythromatosis
C. leukemia
D. Lymphoma
E. Endocarditis
ANSWER: B

4. All the following conditions may lead to transudative ascites EXCEPT:

A. Liver cirrhosis
B. Spontaneous bacterial peritonitis
C. Hypoalbuminemia
D. Nephrotic syndrome
E. Congestive heart failure
B

5. A 45-year-old female complains of pain and swelling of 6 weeks duration in the joints of both hands and knees.
No skin rash. ESR is 65mm/1st hr., CRP positive. Which of the following is the most likely diagnosis?
A. Pseudo Gout
B. Systemic lupus
C. Gout
D. Spondyloarthropathy
E. Rheumatoid arthritis
ANSWER: E
6. Case, Post STEMI patient, develop hypotension, pansystolic murmur … next step?
A. ECG
B. Urgent echocardiogram
C. Cardiac catheterization
Answer: B

7. Asthmatic patient on high or medium dose inhaled steroid, salmeterol and salbutamol, the patient is
Asymptomatic for the last 3 months and no exacerbation and his PFT (FEV1/FVS) more than 90, the best next
step?
A. Stop all the medication
B. Keep it the same
C. Stop salbutamol
D. Stop salmeterol
E. Decrease the dose of steroid
Answer E

8. Which of the following medications doesn’t cause hypokalemia?

A. Propranolol
B. B-agonist
C. Gentamicin
Answer C

9. Which of the following not happen in rhabdomyolysis?

A. Anuria
B. Hyperkalemia
C. Dark urine
D. Red cast urine…
Answer D

10. False about IgA?

A. 4 subclasses (Ans)

11. Case, patient with SOB, orthopnea and PND, bilateral basal lung crackles Dx?
A. Pulmonary edema (Ans)

12. Not a cause of bloody diarrhea:

A. Shigella
B. V. cholera
C. Entamoeba histolytica
Ans B

13. Which of the following is True regarding acute upper GI bleeding

A. Gastroscopy should be done for every patient with GI bleeding in the first 4hours
B. Constipation in a patient with suspected upper GI bleeding makes the presence of significant bleeding unlikely
C. The commonest cause for red blood passing per rectum is bleeding from upper GI
D. Mortality depends upon the cause of bleeding
E. If a patient is suspected to have GI bleeding has normal gastroscopy and colonoscopy this excludes bleeding
from GI lesion
ANSWER: D

14. All of the followings are feature of primary adrenal insufficiency EXCEPT
 A. Hypokalemia
B. Hyperpigmentation
C. Hyponatremia
D. Hypoaldosteronism
E. Metabolic acidosis
ANSWER: A

15. wrong about Cushing syndrome?

A. Osteoporosis
B. Hyperkalemia
C. Abdominal stria
Ans B

16. Wrong about primary hyperaldosteronism?

A. Metabolic acidosis (Ans)

17. Which of the following statements is True regarding HCV infection

A. Hepatocellular carcinoma rarely develops in patients with cirrhosis due to HCV infection
B. Liver cirrhosis develops in 50 % of infections within 5 years of infection
C. Treatment with Ledipasvir/sofosbuvir cures more than 90% of chronic HCV infections
D. It is the commonest cause for fulminant hepatitis
E. Vaccination is the best measure to combat HCV infection
ANSWER: C

18. Which of the following conditions is least likely to cause peripheral blood eosinophilia?
A. Giardiasis
B. Lymphomas
C. Parasitic infections
D. HIV infection
E. Sarcoidosis
Ans D

19. Wrong about CML?

A. t(15:17) (Ans)

20. diagnostic test of reflux esophagitis?

A. 24-hour pH monitoring (Ans)

21. All are AIDS defining illness except :

A. Oral candidiasis
B. Kaposi sarcoma
C. CNS lymphoma
D. Esophageal candidiasis
E. PCP
Ans A

22. A patient has a sore throat then he developed hematuria after 2 days , the diagnosis:
A. IgA nephropathy
B. Alport's syndrome
C. Post strep. Glomerulonephritis
Answer: A
23. False about Macrocytic anemia?
A. Reticulocytosis (Ans)

24. Patient with low MCV the most likely cause?

A. Iron deficiency anemia (Ans)

25. Wrong about PRV

A. MUT (cant remember) bot its not Jak2 mutation
B. Normal O2
C. Splenomegaly
D. Low EPO
E. Myeloproliferative
Ans A

26. what is a major criterion for the diagnosis of multiple myeloma?

A. Hemoglobin level of 8.5 g/dL
B. High ESR
C. Clonal bone marrow plasma cells more than 10%
D. Calcium level of >12 mg/dL
E. Low level of Albumin
C

27. In evaluating a 26 year old female with generalized pain and daily fever. Which of the following is not helping in
making the diagnosis of systemic lupus erythromatosis?
A. Arthritis
B. Leukocytosis
C. Proteinuria and RBCs in urine
D. Hemolytic anemia
E. Discoid rash and photosensitivity
Ans B

28. If you are planning for screening test for Hepatitis B infection, which of the following tests you will advise to be
the screening test:
A. HBCAb
B. HBsAg
C. HBeAg
D. HBsAb
E. HBV PCR
B

29. All the following may be helpful for management of Ascites due to decompensated Liver cirrhosis EXCEPT:
A. Loop Diuretics
B. Low protein diet
C. Alfa pump subcutaneous implantation
D. Albumin infusion
E. Aldosterone antagonists
F. B

30. Patient come with dark eye, his ABG (PH 7.3, HCO3 18, K 2, Anion gab 11) Dx?
A. Septic shock
B. DKA
 C. Ethynyl glycol
D. Cardiac shock
E. Distal acute tubular necrosis
Ans E or D

31. Patient came with dyspnea his ABG (PH 7.33, CO2 high, HCO3 high) Acid-base d/o?
A. Acute Respiratory acidosis
B. Chronic respiratory acidosis
C. Mixed respiratory and metabolic acidosis
Ans B

32. 61-year-old male presents with oliguria and a serum creatinine concentration of 262 umol/L. Which of the
following DOES NOT suggest a pre-renal etiology of acute kidney injury (AKI)?
A. Urine analysis showing 2+ proteins, no glucose, 10-12 RBCs/hpf, 2-3 WBCs/hpf
B. History of heart failure
C. History of use of furosemide
D. Urine (Na+) of 10 mmol/L
E. Low jugular venous pressure on examination
Ans A

33. Case, a patient came to the hospital stabbed with a knife, with hypotension, tachycardia, muffled heart sound…
Dx?
A. Cardiac tamponade (Ans)

34. A 20-year-old female with 2 months joint pain and facial rash. The best screening test FOR systemic lupus
erythromatosis is:
A. Anti-citrullinated peptide anti body
B. Anti DsDNA
C. Anti-Smith
D. Rheumatoid factor
E. Anti-nuclear antibody
Ans E

35. A 40-Year-old female with proximal muscle weakness in both upper and lower limbs. Creatinine phosphokinase
(CPK) is elevated 8-10 time the upper limit of normal repeated to confirm. Strength in upper and lower proximal
muscles 3/5 and distal muscles are 5/5.Skin rash was seen on face and dorsum of both hands, what is most likely
diagnosis?
A. Congenital muscle disease
B. Hyperthyroidism
C. Osteoporosis
D. Dermatomyositis
E. Osteomalcia
Ans D

36. A 35-year-old construction worker presents with several days of fever and chills. Examination reveals a
temperature of 38.8°C, heart rate of 110 bpm, and blood pressure of 120/85mmHg. His teeth are in poor
condition. His lungs are clear, and cardiac examination is unremarkable Blood cultures are drawn and grow
Streptococcus Viridans. He is diagnosed as subacute bacterial endocarditis (SBE). Despite antibiotics, the patient
continues to have persistent fever, and on the fifth hospital day he develops acute dyspnea. Physical
examination is likely to reveal:
A. An early-peaking, crescendo-decrescendo murmur at the upper sternal border
B. An apical mid-diastolic murmur with presystolic accentuation and opening snap!
C. A 3-component pericardial friction rub
 D. A holosytolic murmur at the apex
E. Weak and delayed carotid upstrokes
Ans D

37. A 35-year-old nonsmoking male without significant past medical history presents with chest pain and exertional
dyspnea. Review of symptoms is notable for a one-week history of antecedent flu-like symptoms. Physical
examination reveals a jugular venous pressure (IVP) of 15 cm H2O, and rales halfway up the lung fields
bilaterally. An S3 and a III/1 holosystolic murmur at the apex are noted, as is pitting edema of bilateral lower
extremities. Electrocardiogram reveals diffuse ST-T wave abnormalities. The initial creatinine kinase (CK) is 586.
The most likely diagnosis is:
A. Viral myocarditis
B. Viral pericarditis
C. Acute myocardial infarction
D. Pulmonary embolism
E. Hypertrophic cardiomyopathy
Ans A

38. Regarding Bleeding from the gastrointestinal tract, which of the following statements is True
A. Hemodynamic disturbances usually do not occur if blood loss is less than 500 ml blood
B. Patient with hematemesis usually has more severe bleeding than the patient who has melena
C. Melena usually indicates bleeding from the colon
D. Occult bleeding occurs when the blood loss is more than 2 ml
E. Commonest cause for bleeding is Carcinoma of the gastrointestinal tract
ANSWER: A

39. Regarding Hepatic encephalopathy, all the following may precipitate an attack EXCEPT
A. High protein Diet
B. Periodontitis
C. Albumin Infusion
D. Diuretics
E. Constipation
Ans A

40. Which of the following features is not suggestive of decompensated liver cirrhosis
A. Presence of flapping tremors in outstretched hands
B. History of bleeding varices
C. Presence of positive shifting dullness on abdominal examination
D. Biphasic bilirubin 6 mg/dl
E. ALT above 500 IU/L
ANSWER: E

41. all are in favor of Crohn’s over UC except?

A. Respond to steroid
B. Respond to infliximab
Ans A

42. A 27-year-old male with back pain worse in the morning and after prolonged rest, improving on walking
and activity, this mostly will be seen in
A. Congenital Scoliosis
B. Osteoarthritis of the spine
C. Osteoporosis
D. Post car accident resulting in spine fracture
E. Ankylosing spondylitis
 ANSWER: E

43. A 28-year-old female presents with acute onset of shortness of breath and pleuritic chest pain. She has
just recently came back from Australia. She has no past medical history although she is on
contraceptive pills. On examination there is evidence of a swollen tender left calf. Auscultation of the
chest is clear with pulse rate 110 per minute. A CXR looks normal. What is the most likely diagnosis
A. Pneumothorax
B. Pulmonary embolism
C. Asthma attack
D. Myocardial infarction
E. Deep vein thrombosis
Ans B

44. Patient come with chest pain ECG shows ST elevation is V1-V4, what is the expected artery to be obstructed?
A. LAD (Ans)

45. All of the following are causes of clubbing except

A. Bronchiectasis
B. Idiopathic pulmonary fibrosis
C. Lung abscess
D. Bronchogenic Cancer
E. Emphysema
Ans E

46. All of the following statements are true regarding cardiac auscultatory findings EXCEPT:
A. Loud first heart sound (S1) is heard in mitral regurgitation
B. Fourth heart sound (S4) reflects forceful atrial contraction
C. Third heart sound (S3) reflects rapid ventricular filling.
D. Fixed splitting of S2 in atrial septal defect
E. Variable intensity of S1 in atrial fibrillation
Ans A

47. Patient with load S1 and diastolic ……… ?

A. Mitral stenosis (Ans)

48. All are causes of DVT except?

A. Primary biliary cholangitis (Ans)

49. All of the following diseases can cause mitral regurgitation EXCEPT:
A. Infective endocarditis
B. Marfan’s syndrome
C. Papillary muscle rupture
D. Rheumatic fever
E. Acute pericarditis
Ans E

50. Which of the following isn’t present in a patient with infective endocarditis?
A. Splinter hemorrhages
B. Roth spots
C. Deputryen’s contracture
D. Clubbing
 E. Osler’s nodes
Ans C

51. MI radiated to all of following except:

A. Upper Jaw (Ans)

52. Wrong about liver cirrhosis histology?

A. Necroinflammatory reaction
B. Fibrosis
C. Loss of the lobular and vascular architecture of liver lobules
D. Regenerating nodules with disturbed architecture.
E. The wrong (can’t remember it)
Ans E

53. All are causes of liver cirrhosis except?

A. HBV
B. HCV
C. HAV
D. Congestive heart failure
Ans C

54. All are given in esophageal varices Tx except?

A. Propranolol
B. Antibiotics
C. PPI
D. Variceal band ligation
ANS ?

55. Which of the following infections is transmitted from person to person and not through soil contact ?
A- Tetanus
B- Mycetoma
C- Scabies
D- Hookworm
E- Buruli ulcer
Answer: C

56. Familial Mediterranean Fever (FMF) commonly cause all of the following EXCEPT
A. Recurrent attacks of abdominal pain
B. Recurrent attacks of knee arthritis
C. Persistent fever
D. Recurrent Fever
E. Recurrent attacks of chest pain
Ans C

57. A 21 year old male who had recurrent uveitis, knee arthritis, and recurrent oral and genital ulcers, Which of the
following is most likely diagnosis
A. Behcet's disqase
B. Systemic lupus erythromatosis
C. Rheumatoid arthritis
D. Polymyositis
E. Crohns disease
Ans A
58. A 75 year old male with mild renal impairment and hypertension on indapamide 1.5 mg daily presenting with
recurrent pain and swelling of right knee. He refused knee synovial aspiration and analysis. The most helpful test
in making diagnosis is
A. ESR and C-RP
B. ANA
C. Rheumatoid factor
D. MRI of the affected joint
E. Serum Uric acid
Ans E

59. A 30 year old male with distal interphalangeal joints affected with arthritis. This finding should make this disease
very unlikely diagnosis:
A. Pseudo Gout
B. Gout
C. Psoriatic arthritis
D. Osteo arthritis
E. Rheumatoid arthritis
Ans E

60. 74- A 25-year-old female with fever and joint pain who is rheumatoid factor positive. She has been treated as
rheumatoid arthritis. What additional finding would make you suspect the diagnosis of systemic lupus?
A. Back pain
B. Facial rash
C. Elevated ESR
D. Joint pain and swelling
E. Elevated C-RP
Ans B

61. 42 year old female presents with bilateral lower limb edema, proteinuria of 73 g/day, serum albumin
concentration of 21 gm/L (normal 35-50 gm/L) and total serum cholesterol of 7.9 mmol/L (normal<5.2 mmol/L).
Which of the following is the LEAST likely to cause the condition she presented with?
A. Diclofenac Sodium
B. Acute tubular necrosis due to vancomycin
C. Colon cancer
D. Diabetes Mellitus
E. Systemic lupus erythematosus (SLE)
Ans C

62. A 76-year-old female with no other significant past medical history passes out while exercising. She has
intermittent chest pain and dyspnea on exertion as well. Her physical examination reveals an III/VI late-peaking
crescendo-decrescendo murmur at the right upper sternal border. Her S2 heart sound is very soft, and her
carotid upstroke is weak and delayed. Which of the following is most likely causing her symptoms
A. Aortic valve stenosis
B. Aortic valve regurgitation
C. Mitral valve stenosis
D. Mitral valve regurgitation
E. Mitral valve prolapse
Ans A

63. All of the following are features of diabetic autonomic neuropathy EXCEPT
A. Erectile dysfunction
 B. Postural hypotension
C. Gastroparesis
D. Peripheral neuropathy
E. Diarrhea
Ans D

64. In Addison disease all of the followings are true EXCEPT

A. Postural hypotension
B. Hyperpigmentation
C. Hyperkalemia
D. Low ACTH
E. Hyponatremia
D

65. A 30-year-old man with IgA nephropathy, 1.2 g proteinuria per day, estimated glomerular filtration rate (eGFR) is
80 ml/min/1.73m2, blood pressure 128/75 mmHg. Which of the following is the preferred initial therapy:
A. Dietary salt and protein restriction only
B. Dihydropyridine calcium channel blockers
C. Oral angiotensin converting enzyme inhibitor (ACE-I)
D. Oral calcitriol
E. Oral steroids and ACE-I
Answer: E

66. Doesn’t cause nephrogenic diabetes insipidus?

A. Hyperkalemia
B. Hypercalcemia
C. Amyloidosis
D. Lithium
Ans A

67. Which of the following is a cause of Anaphylactoid (non lgE mediated Mast cell Degranulation)?
A. Bee venom
B. Penicillin
C. Peanuts and see food
D. Radiocontrast media
Ans D

68. The following about acute pericarditis are true, EXCEPT:

A. Radiation is a recognized cause
B. The pain is relieved by leaning forward
C. Anticoagulant may be given safely
D. Prednisolone may be needed
E. May be secondary to myocardial infarction
C

69. Case about patient with latent TB (Asymptomatic with positive PDD induration 18 mm and normal CXR) what to
do?
A. Start Isoniazid for 9 months (Ans)

70. True about celiac

A. Increase the risk of enteropathy-associated T-cell lymphoma (EATL) (Ans)

71. Which of the following is most suited for detection of diabetic nephropathy?
 A. Urine albumin
B. Serum creatinine
C. Renal U/S
D. IV pyelogram
E. Urine analysis
A

72. Life threatening asthma?

A. Pco2 45

73. All are features of multiple myeloma include all the following EXCEPT
A. Hypercalcemia
B. Osteoblastic bone lesions
C. Normal Alkaline phosphates level
D. Hypoparathyroidism
E. Chronic renal failure
Ans B

74. Lung cancer (Paraneoplastic syndromes) with hypercalcemia?

A. Squamous cell carcinoma (Ans)

75. About primary hyperparathyroidism. All are true except:

A. High ALP
B. Low phosphorous
C. low PTH
D. Secondary osteoporosis
E. Pseudofracture
Ans: C

76. Not a feature of prolactinoma:

A. galactorrhea
B. Infertility
C. First line treatment is dopamine antagonist
Ans C

77. Not caused by exotoxins?

A. UC
B. Pseudomembranous colitis
C. HUS
Ans A

78. In acromegaly all are true EXCEPT:

A. High serum insulin like growth factor 1
B. Suppressed growth hormone after glucose tolerance test
C. Hypertension
Ans B

79. Screening of HCV?

A. HCV RNA measured by PCR
B. Hepatitis C antibody
C. LFT
D. Biopsy
Ans A or B
80. All are complication of HTN except?
A. DVT (Ans)

81. About beta lactams antibiotics, one is wrong:

A. Don doesn’t need re-adjustment in renal failure (Ans)

82. Patient with low TSH and hyperprolactinemia, What to do ?

A. Pituitary MRI
B. Give dopamine agonist
Ans B

83. All of the following are true about hypersensitivity EXCEPT:

A. Type 1 (food, bites)
B. Type 2 (hemolytic)
C. Type 3 SLE
D. Type 4 Contact dermatitis
E. Each type has its own autoimmune disease
Ans E

84. not cause increase in radioactive iodine uptake:

A. Subacute thyroiditis (Ans)

85. Wrong about CKD (not sure)

A. - w/o treatment hypophosphatemia will happen (Ans)

86. Thalassemia minor Tx?

A. No treatment (Ans)

87. DVT case you will give anticoagulant for?

A. 3months
B. 6 weeks
C. Life long
D. 1 year
Ans A

88. Why do we classify Pneumonia into CAP and HAP?

A. To know the type of empirical antibiotics we should give
B. Time of hospital stay
C. Severity of the infection
Ans A

89. patient already in atenolol treatment what drug is least effective to give
A. verapamil (Ans)

90. which of the following drugs are least to cause hyperkalemia?

A. Clopidogrel (Ans)

91. The most frequent indoor aeroallergen worldwide is:

A. Olive tree pollen antigen
 B. Cockroach antigen
C. Pencillium fungal spore antigen
D. House dust mite antigen
E. Cat antigen
Ans D

92. Pt comes to donate blood found to have Hbs Ag positive. He is asymptomatic. Normal LFT, HBV-DNA 20000. Your
next step is:
A. start Lamivudine
B. since he is asymptomatic, just observe
C. start Tenofovir
D. start entecavir
Answer: B

93. A 26 year old female, presented complaining of easy fatigability, investigations showed a Hb of 6.5, Retics 16 %,
MCV of 103, elevated total bilirubin, normal direct bilirubin and a high LDH. The next test to be done is :
A. Answer : Direct comb test

94. A patient was in a trip 2 days ago and he drunk a contaminated water and developed vomiting and diarrhea for 2
days Labs : High Cr and BUN, FENa 2.1% what is the type of AKI that he mostly developed?
A. Prerenal azotemia
B. ATN
Answer: B

95. Pt with long Hx of fatigue, SOB and cough, PFT as follow: FEV1/FVC: 84, Fev1 : 74, FVC : 62
A. Interstitial pulmonary fibrosis
B. COPD
C. Asthma
Answer: A

96. Case, Female with Hx of joint pain and long use of NSAIDs, present with proteinuria 7.9, Dx?
A. Amyloidosis (Ans)

97. All of the following are important in determining the severity of COPD except?
A. FEV1
B. Temperature
ANS B

98. All are component of Polysomnogram EXCEPT :

A. ECG
B. EEG
C. respiratory muscle effort
D. Evoked auditory potential
Ans D

Done by Ammar Zidan