1)-Features indicative of severe acute asthma include:

a. pulse rate =80 per minute.

b. peak expiratory flow rate (PEFR) = <70% of expected.
c. arterial Pa02=10KPa
d. arterial PaCO2=6KPa

2)-The initial management of severe acute asthma should include:

a-24% oxygen delivered by a controlled low mask.
b- Salbutamol Smg by inhalation.
c-Ampicillin 500mg orally and cromoglycate 10mg by inhalation.
d-Hydrocortisone 200mg iv it has no value.

3)-Typical features of asthma include:

a. Eosinophilic bronchial infiltrate.
b. Increased airway macrophages
c. Goblet cell hyperplasia.
d. All of the above

4)-In the diagnosis of asthma:

a- only increases in FEV1 of >15% following bronchodilators are likely to be
significant.
b- A peripheral blood eosinophilia is diagnostic.
c- If doubt exists the methacholine bronchial provocation test should be
carried out.
d-Arterial blood gas analysis is usually unhelpful between attacks.
5)-Etiology of chronic corpulmonale:
a-Chronic bronchitis.
b-Recurrent pulmonary thromboembolism.
c- Idiopathic pulmonary fibrosis
d-B and C are true
e- All of the above are true.

6)-Atrial tachycardia (supraventricular tachycardia) characterized by

all of the following EXCEPT?
a. Usually narrow QRS complex.
b. Wolff Parkinson White (WPW) is one of the causes
c. Could be terminated by Valsalva maneuver.
d. Atropine is the treatment of choice.

7)-Which one of the following is the best diagnostic investigation for valvular
heart disease;
a. ECG
b. Holter ECG monitoring
c. Echocardiography
d. CT scan
e. Cardiac catheterization

8)-All of the following ECG changes suggest the diagnosis of acute

pericarditis EXCEPT?
a. Wide spread ST elevation concave upward.
b. PR segment depression in AVR lead.
c. Wide spread T inversion
d. Wide spread Flat T wave

9)-According to the Jones Criteria, all of the following are major criteria for
diagnosis of Acute Rheumatic fever, EXCEPT:
a- Elevated ASO titer
b-Carditis
c- Erythema marginatum.
d- Sydenham chorea.
e- Migratory polyarthritis

10)-all of the following are treatment of TB pericarditis except;

a- Rifampicin
b-Isoniazid
c-Salbutamol
d-Prednisolone
e. Ethambutol

11)-Cardiac Tamponade usually presented with all of the following EXCEPT?

a. Dyspnea.
b. A paradoxical pulse.
c. Hypotension.
d. Kussmauls sign...
e. Normal JVP

12) Pulsus paradoxus may be caused by all of the following EXCEPT?

a. Severe bronchial asthma.
b. Cardiac tamponade
c. Dilated cardiomyopathy
d. Obesity
e. Constrictive pericarditis.

13) All of the following are mechanisms for tachy arrhythmia EXCEPT?
A) Increased Automaticity.
B) Triggered activity.
C) Increased vagal tone.
D) Re-entry through accessory pathway.

14) Hypertrophic cardiomyopathy characterized by all of the following

EXCEPT?
A) A genetic disorder, usually with autosomal dominant transmission.
B) Characterized by inappropriate left ventricular hypertrophy.
C) Usually presented by right side heart failure.
D) Beta-blocker or Calcium channel blocker can be used as treatment if
symptomatic.

15)-Mitral stenosis can cause all of the following complications, EXCEPT:

A) Atrial fibrillation
B) Pulmonary hypertension
C) Right ventricular dilation
D) LV hypertrophy
E) Hemoptysis

16)-Patient with Chronic constrictive pericarditis usually presented with all of

the following EXCEPT?
A) Bilateral lower limbs edema.
B) Raised JVP.
C) Ascites.
D) Lung congestion.

17)-Which combination of symptoms is typical for patients with severe aortic

stenosis? Choose the correct combination:
A) Dyspnea, Orthopnea & paroxysmal nocturnal dyspnea.
B) Angina pectoris, Syncope & pulmonary edema.
C) Angina pectoris, Syncope & Congestive heart failure.
D) Angina pectoris, Syncope & Arrhythmias.

18)-Clinical signs of pure mitral stenosis include all the following, EXCEPT?
A) Loud first heart sound.
B) Mid diastolic rumbling murmur.
C) Shifted heart apex downward-laterally.
D) Presystolic accentuation of the murmur during sinus rhythm.

19)-According to Duke Criteria for infective endocarditis, All of the following

are minor criteria, EXCEPT:
A) Janeway's lesions.
B) Pericardial effusion.
C) Osler's nodes,
D) Elevated rheumatoid factor.
E) Septic pulmonary emboli.

20)-Which one of the following ECG finding is least associated with digoxin
use?
A) Bradycardia
B) Down-sloping ST depression
C) Flattened T waves
D) Prolonged QT interval
E) AV block

21) What is the single most important risk factor for stent thrombosis?
a. Age of the patient
b. Duration of procedure
c. History of diabetes mellitus
d. Premature withdrawal of antiplatelet therapy
e. Failing to adhere to cardiac rehabilitation program

22) What is the most common cause of death in patients following a

myocardial infarction?
a. Pulmonary embolism
b. Cardiogenic shock
c. Papillary muscle rupture
d. Ventricular fibrillation
e. Complete heart block

23) Which one of the following is the best cardiac marker to investigate chest
pain of reinfarction?
A) LDH
B) Troponin I
C) CK-MB
D) Troponin T
E) AST
24) What is the mechanism of action of clopidogrel?
A) Non-selective phosphodiesterase inhibitor
B) Inhibits ADP binding to its platelet receptor
C) Inhibits ATP binding to its platelet receptor
D) Phosphodiesterase Vinhibitor
E) Glycoprotein IIb/Illa inhibitor

25)-Which one of the following treatments have not been shown to improve
mortality in patient with Heart Failure?
A) Beta-blockers
B) Spironolactone
C) Nitrate and Hydralazine
D) Frusemide
E) Enalapril

26)-The majority of Pulmonary Embolism arias from:

A) DVT of lower limbs
B) septic emboli from Infective Endocarditis.
C) fat emboli.
D) Air emboli.

27) Which of the following features of Pulmonary Embolism associated with

Metabolic Acidosis:
A) Acute massive PE with cardiovascular collapse.
B) Acute small PE.
C) Acute medium PE
D) Chronic PE.
28)-The best gold standard methods for diagnosis of Pulmonary Embolism Is:
A) Chest MRI.
B) V/Q Scan.
C) ECG & Echocardiography.
D) Chest CT Pulmonary Angiography.

29)-Female lady 40y.old age, pregnant in 10 weeks GA, came to ER c/o chest
pain, dyspnea 2days duration. Vital signs are normal, D-Dimer was high, ECG
was normal Doppler US of lower limbs show DVT in Lt femoral vein. What is
the appropriate choice for treatment?
A) subcutaneous Low Molecular Weight Heparin.
B) Insertion of Inferior vena cava filter.
C) Warfarin.
D) Streptokinase.

30)-The most common cause of chronic type II respiratory failure is:

A) Acute Neuropathy.
B) Acute Severe Asthma
C) Acute exacerbation of COPD.
D) Upper airway obstruction.

31)-All the following can cause respiratory failure type 1 EXCEPT:

A) Upper airway obstruction.
B) Acute Asthma.
C) Pulmonary Edema \ PE.
D) ARDS

32)-Which of the following is NOT a common cause of interstitial lung

disease?
a. Idiopathic pulmonary fibrosis
b. Sarcoidosis
c. Rheumatoid arthritis
d. Pulmonary embolism

33)-Which of the following tests is used to confirm the diagnosis of

interstitial lung disease?
a. Chest X-ray
b. Pulmonary function tests
c. Bronchoscopy
d. High Resolution CT scan

34)-Which of the following is the most common cause of community-

acquired pneumonia?
a. Streptococcus pneumoniae
b. Haemophilus influenzae
c. Legionella pneumophila
d. Mycoplasma pneumoniae

35)-Which of the following medications is a first-line treatment for COPD?

a. Inhaled corticosteroids
b. Long-acting beta-agonists
c. Oral steroid
d. Anticholinergics

36)-All of the following drugs are of value in acute exacerbation of COPD

except?
a. High flow oxygen
b. Steroid
c. Inhaled bronchodilator
d. Antibiotic

37)-All of the followings are proposed pathophysiologic mechanisms of

ascites EXCEPT
a. Increased portal hypertension
b. Increased oncotic blood pressure
c. Activation of renin angiotensin system
d. Splanchnic vasodilatation

38)-All of the following drugs are of value in acute exacerbation of COPD

EXCEPT?
a. Steroid
b. Antibiotic
c. High flow oxygen
d. Inhaled bronchodilator

39)- A 70-year-old woman who lives independently and has been doing well is
hospitalized for pneumonia. She is begun on ceftriaxone and erythromycin
but continues to deteriorate and have high fevers 4 days after admission.
Which of the following factors is a poor prognostic sign in community-
acquired pneumonia?
a. Age >50
b. Systolic BP >160
c. Leukocytosis >15,000
d. Altered mental status
e. Infection with mycoplasma pneumonia

40)-A 70-year-old female presents with fever, cough, and shortness of breath.
She has a history of diabetes and hypertension. On physical examination, she
has crackles in the right lower lobe. Chest X-ray shows consolidation in the
right lower lobe. Which of the following is the most likely diagnosis?
a. COPD exacerbation
b. Community-acquired pneumonia
c. Hospital-acquired pneumonia
d. Aspiration pneumonia

41)-A 60-year-old male presents with smoking for 30 years. On physical

examination, he has decreased breath sounds and eezing. Pulmonary
function tests show a decreased FEV1/FVC ratio. Which of the following is
the most likely diagnosis?
a. COPD
b. Pneumonia
c. Idiopathic pulmonary fibrosis
d. Hypersensitivity pneumonitis

42)-Which of the following character of somatic pain:

A) dull, crampy, burning or gnawing
B) poorly localized
C) sharp and more localized
D) None of the above

43)-Upper endoscopy evaluates the following, EXCEPT:

A) esophagus,
B) stomach, and duodenum
C) distal ileum
D) All above

44)- Atrophic gastritis is characterized by all the following EXCEPT

A) Increase MCV. B) Carcinoid tumor.
C) Auto parietal antibody.
D) Antral predominance.
E) Predispose to H pylori.

45)-The following are alarm features in dyspepsia EXCEPT One

A) Dysphagia
B) Weight loss.
C) Persistent vomiting.
D) Normal hemoglobin level.
E) Hematemesis and or melena.

46)-The following are indications for upper Gl endoscopy EXCEPT

A) Dysphagia.
B) GIT bleeding.
C) Atypical chest pain.
D) Dyspepsia at age over 55 years old.
E) Severe hemorrhagic shock.

47)- All the followings are definite indications of H. Pylori eradication EXCEPT
one:
A) GERD
B) MALTOMA
C) Gastric ulcer
D) Duodenale ulcer
E) HP associated dyspepsia

48)- With regards to Peptic Ulcer Disease in young man select the best
response
A) This patient requires urgent endoscopy.
B) Smoking is not risk factor for its development.
C) Duodenal ulcers are 10 times more common than gastric ulcers.
D) Duodenal ulcers are more common in patients with blood group A.
E) The most appropriate initial investigation is testing Helicobacter pylori.

49) Which one of the following is the commonest cause of hematemesis

worldwide?
A) Drug
B) Malignancy
C) Peptic ulcer
D) Esophageal varices,
E) Mallory Weiss tar

50)-The best management of acute inflammatory diarrhea include all,

EXCEPT:
A) Rehydration.
B) Antidiarrheal agents.
C) Antibiotics in some cases.
D) Hospitalization for severe cases.

51)-Disorders that predispose to small bowel bacterial overgrowth, EXCEPT:

A) Gastrectomy.
B) Bile salts malabsorption.
C) Long-term PPI therapy.
D) Diabetic autonomic neuropathy.

52)- Crohn's disease, all are true EXCEPT

A) Affects any part of the GIT from the mouth to the anus.
B) Particular tendency to terminal ileum.
C) The inflammation is transmural.
D) Caseating granulomas are present.

53)-The following are true about hepatitis A virus EXCEPT one:

A) The incubation period is 15-50 days (average 30 days)
B) Hepatitis A viral infection manifests as a chronic hepatitis.
C) Most cases are related to food-borne outbreaks affecting nonimmune
children between 5 and 14 years of age.
D)- Acute hepatitis A can cause a fulminant hepatitis that often requires
hospitalization.
E)- HAV is usually transmitted feco-orally.

54)-Hepatitis B virus infection is characterised by the following EXCEPT one:

A)- It causes only chronic infection.
B)- HBV carrier prevalence is about 8% in Yemen.
C)- The incubation period ranges from 15 to 180 days (average 60-90 days).
D)- The main mode of transmission is through blood and sexual intercourse.
E)- Chronic infection is linked with chronic hepatitis, cirrhosis and
hepatocellular carcinoma.
55)-Hepatitis C virus is characterised by the following EXCEPT one:
A) It is RNA virus
B) It is endemic in Yemen.
C) commonly cause acute viral hepatitis
D) The predominant mode of transmission is through blood. E) Chronic
infection is linked with chronic hepatitis, cirrhosis and hepatocellular
carcinoma

56)- The disease exists in short-term (acute) and long-term (chronic) forms,
how long does acute hepatitis last?
A) Less than 6 months
B) Less than 3 months
C) About 6 months
D) One month

57)-The followings occur in the hepatopulmonary syndrome EXCEPT:

A) Intrapulmonary vascular dilatations
B) Occurs in 50% of patients with cirrhosis.
C) An increased alveolar-arterial gradient while the patient is breathing room
air.
D) Arteriovenous communications that result in a right-to-left intrapulmonary
shunt.

58) Complications of portal hypertension are the followings EXCEPT:

A) Ascites.
B) Hypersplenism.
C) Esophageal varices
D) Splanchnic vessels constriction
59)-The clinical syndromes of alcoholic liver disease:
a. fatty liver.
b. alcoholic hepatitis.
C. cirrhosis
d. all of the above.

60) Features of non-alcoholic fatty liver disease and non-alcoholic

steatohepatitis:
a. Fat infiltration > 5% with or without mild inflammation.
b. Steatosis + necroinflammation (ballooning, Mallory bodies,
megamitochondria).
c. Increasing fibrosis, eventually leading to cirrhosis.
d. all of the above.

61)-Hemochromatosis is:
A) mutation in the HFE gene on chromosome 6.
B) An autosomal dominant disease.
C) About 50% of persons with well-established hemochromatosis are
homozygous for the C282Y mutation. D) Hemochromatosis is characterized
by increased accumulation of copper in the liver, pancreas,heart, adrenals,
testes, pituitary.

62)-The diagnosis of Wilson disease should always be considered with the

followings EXCEPT:
A) Hepatitis.
B) splenomegaly with hypersplenism.
C) Coombs positive hemolytic anemia.
D) neurologic or psychiatric abnormalities.
63)-Primary biliary cirrhosis (PBC) is
A) a chronic disease of the liver characterized by autoimmune obstruction of
extrahepatic bile ducts.
B) The disease occurs usually in women aged 20-30 years.
C) The frequency of the disease among first-degree relatives of affected
persons is 20-30.
D) Ursodeoxycholic acid is the preferred medical treatment for PBC.

64)-Components of child - pugh score for prognosis of liver cirrhosis are the
followings EXCEPT:
A) AFP.
B) Ascites.
C) Bilirubin.
D) Encephalopathy.

65)-All the following is sign of malignancy EXCEPT:

A) Capsulated.
B) Metastatic.
C) Life threatening.
D) No wall defined border.

66)-Tumor carcinoma is arising from:

A) Muscle.
B) Epithelium.
C) Lymphoma.
D) Connective tissue.

‫؟‬
67)-All the fowling cause cancer EXCEPT:
A) Environment.
B) Chemical.
C) Radiation.
D) Bactria.

68)-Warning sign of cancer EXCEPT:

A) Change of bowel or bladder habit.
B) Sore throat dose not heal.
C) Simple bleeding.
D) Thickening or lump in breast.

69)-Treatment of cancer by EXCEPT:

A) Chemotherapy.
B) Radiotherapy.
C) Surgery.
D) Hormonal.
E) NSAIDS.

70)-Prevent of HCC EXCEPT:

A) Vaccination of HBV.
B) Vaccination of HCV.
C) Stop alcohol.
D) Prevent obesity and metabolic syndrome.