5 daly a nab sl Date: 26/10/2023 4° year, intemal Medicine End term Exam Time allowed: 45minutes Coded en 122 Total Marks: 30 Exams in 6 pages (30 questions) 1, All questions are mandatory. 2. Each question one mark: 3. Please answer in the bubble sheet. 4. Choose only one single best answer. 1) A characteristic symptom of left ventricle heart failure: a) Dyspnea on lying on left side, ‘b) Lower limb swelling. e «¢) Paroxysmal noctumal dyspnea, @ Pain in the right hypochondrium.. 2) 55 year old man heavy snioker and known to have hypertension, presented with raised jugular venous pressure and pitting lower limbs ‘oedema, The most probable diagnosis is: a) Congestive heart failure. b) Right basal pneumonia. A ) Left sided heart faiture. 6) Pulmonary embolism. 3) A characteristic sign in chronic obstructive pulmonary disease: a) Clubbing. ) Cyanosis. ¢) Prolonged expiration. G 4) Tremors. - 4) Upper motor neuron weakness is characterized by: a) Proximal muscles are affected more than distal muscles. re b) Presence of fasciculations. ©) Distal muscles are affected more than proximal muscles. 4) Spontaneous discharge of a motor unit,+5) 60 years old heavy smoker male patient known to have COPD presents with clubbing on regular follow up visit. The most appropriate investigation to request is: a) Complete blood picture. b) Chest X-ray. B o) Liver function tests. 4) X-ray wrist. © Bilateral lower limbs oedema could be a sign of: ) Arterial thrombosis of the limb. b) Deep vein thrombosis. ©) Cellulitis. D 4) Liver cirthosis: 7) Flapping tremors is a characteristic sign i a) Liver cell failure. b) Right sided heart failure. ©) Senility. A 4) Thyrotoxicosis. 8) A sequel of prolonged uncontrolled bypertension is: - a) Hemia, b) Leg oedema. ©) Piles. D d) Ventricular hypertrophy. 9) Chest pain is a characteristic symptom of: a) Bicuspid aortic valve. b) Ludwig’s angina. ©) Silent angina. D 4) Unstable angina, 10) The following is a recognized complication of chronic cough: a) Change in color of urine. ) Cyanosis, c) Hernia, d) Hypertension. Cc11) A common cause of hemoptysis is: ) Bronchogenic carcinoma. ) Acute bronchitis. B ©) Anticoagulation, 6) Tuberculosis. 12) Frank hemoptysis could be a sign of: a) Chest wall hematoma. ») Peptic ulcer. c) Emphysema, D d) Small cell carcinoma. 13) Elevated jugular-venous pressure is a) Liver cirthosis, b) Peripheral oederna, ) Heart failure. G 4) Pulmonary fibrosis. a sign of: 14) Oedema of heart failure is: 4) Increase in intravascular hydrostatié pressure. 'b) Increase in the intravascular oncotic pressure. A «) Increase in the movement of fluids. 4) Increase in capillary vascular bed. 15) Paroxysmal dyspnea of left ventricle failure is characterized by: 1) Change from side to side. b) Nocturnal episodes. B «) Relieved spontaneously. 4) Relieved by lying comfortable in bed. 16) Acute pulmonary oedema is a sign oft a) Left sided heart failure. A ) Mediastinal syndrome. «) Right sided heart failure: d) Neoplastic invasion of pericardium. 17) Diagnosis of diabetes mellitus is confirmed by: a) Fasting blood sugar. 'b) Fasting and 2 hour post prandial blood sugar. ¢) Fasting blood glucose and glycated HbA 1c, B ) Presence of polyuria and polydepsia.18) Macrocytosis in blood film is observed in patients with: a) Fever. b) Flat nails. Cc c) Gastrectomy. 4) Hypersplenism. 19) Intrahepatic biliary cholestasis is caused by: 2) Gall stones. ») Sickle cell anemia. D c) Pancreatitis. 4) Autoimmune hepatitis. 20) Pre-hepatic jaundice is: a) Hemolytic jaundice. ) Hepatocellular jaundice. AK ¢) Obstructive jaundice. d) Surgical jaundice. 21) Stercobilinogen is absent in stool in: a) Congenital hyperbillirubinemia, b) Hemolytic jaundice. ) Hepatocellular jaundice. 4) Obstructive jaundice. - D 22) Regulation of erythropoietin production is linked to: a) Carbon dioxide. 'b) Hemoglobin concentration. (ie ¢) Oxygen. d) Red cell mass. 23) A -2lyear- male presented to out-patient clinic with fever, jaundice, right hypochondrium pain and markedly elevated hepatic transaminases, The most appropriate diagnostic investigation is: a) AFP. b)CA 19-9. ) HAVIgM, C 4) HCV antibody. 2424) A major cause of disturbed conscious level is: a) Hypoglycemia, ) Hyperglycemia, c) Hypercalcemia, A 4) Hypenatremia, 25) 18 years old girl presented fo ER suffering of severe epigastric pain and repeated vomiting. She has tachypnea with increased depth of inspiration, like (air hunger). Your immediate action in ER is: a) Ask for urgent abdominal U/S. b) Immediate chest X-ray. c) Request pulmonary function tests. D d) Measure blood sugar. 26) One of the general causes of dyspnea is: a) Anemia. b) Dissecting aortic aneurysm. ¢) Myocardial infarction. A d) Pulmonary fibrosis. — ~ 27) Aplastic anemia is characterized by: a) Diminished erythropoietin level. b) Granulocytosis. ) Hypocellular bone marrow. Cc 4) Markedly increased reticulocyte count. 28) A -62year- heavy smoker male presented to ER with crushing chest pain radiating to left shoulder. The most appropriate diagnosis is: a) Acute pericarditi ) Fracture riby ©) Myocardial infarction, c 4) Perforated peptic ulcer.29) 45 years old obese female presented to ER with acute dyspnea and hypoxia a few days after major orthopedic operation. The most probable diagnosis ist a) Anemia of blood loss. ») Hypertensive emergency. ) Pulmonary embolism. C d) Wound sepsis. 30) A common symptom of hypertension a) Asymptomatic. ) Blurring of vision. ©) Ringing ears. A d) Swelling of extremities. END OF THE EXAM