1. An asymptomatic 43 years old male patient is found to have a consistent B.
P
reading of 150/105 mm Hg . The best management is:
a) reassurance and no therapy until patient is
symptomatic.
b) alpha methyl dopa (Aldomet) 250 mg . BID.
c) hydralazine 50 [Link].
d) furosemide (lasix) 80 [Link].
e) hydrochlorthiazide 50 mg. BID.
2. Schistosomiasis mansoni is associated with all of the
following EXCEPT:
a) portal hypertension.
b) hepatic fibrosis.
c) haematuria .
d) eosinophilia.
e) diarrhoea.
3. The following is true of malabsorption EXCEPT:
a) osteomalacia
b) Increased fat excretion in stools.
c) low s. calcium
d) low s. potassium
e) high s. phosphate
4. A 45 years old man comes to the emergency room with
severe dyspnea. Physical exam reveals prolonged expiration
with loud wheezing, a diffuse apical impulse displaced to the
left of the mid-clavicular line , and an apical s3 gallop. The
most likely diagnosis is :
a) left ventricular failure .
b) acute asthmatic bronchitis.
c) acute bronchopneumonia.
d) decompensated chronic obstructive lung disease.
e) none of the above.
5. A 35 years old male with cavitatory disease of left upper
lobe of the lung is started on Ethambutol, INH and
Rifampicin. Which one of the following is not a complication
of this regimen :
a) retrobulbar neuritis .
b) neuropathy .
c) hepatitis.
d)cardiomyopathy.
e) Discolouration of urine.
1
6. A 63 year old man suddenly becomes ill and has a fever of
40 degrees C . There is pain in the left eye and discomfort
over both orbits as well as edema and chemosis of the
conjunctivae, and lids. The left eye is proptosed and there is
diplopia, left ptosis and both pupils are slow in reacting to
light and accommodation. The most likely diagnosis is :
a) cavernous sinus thrombosis .
b) thyrotoxicosis.
c) subarachnoid hemorrhage.
d) brain abscess.
e) none of the above.
7. The vitamin most commonly implicated as being deficient
in alcoholic polyneuropathy is:
a) riboflavin
b)thiamine
c) cyanocobalamin (Vit .B12)
d) niacin
e) pyridoxine
8. Which one of the following organisms is the commonest
cause of infective endocarditis:
a) candida
b) serratia
c) pseudomonas
d)streptococcus fecalis
e) escherichia coli.
9. For the investigation of seizure in a 50 year old man the
least helpful investigation is:
a) isotope brain scan
b) cat scan
c) electroencephalogram .
d)nerve conduction studies
e) cerebral angiograpy.
10. A young man experienced sudden shortness of breath ,
and severe pain in his left shoulder region; the pain was
aggravated by breathing . On examination a hyper-resonant
percussion note was found over the left upper chest with
decreased breath sounds. Which is the most appropriate
therapy?
a) insertion of chest tube with drainage.
b)thoracentesis.
c) heparin 7500 units I.V push followed by 30.000 units
[Link]/24 hrs.
d) procaine penicillin 600.000 units IM B.I.D.
e) propranolol 40 mg. T.I.D.
11. Complications of chronic pancreatitis include all of the
following EXCEPT:
a) steatorrhea .
2
b) glucose intolerance.
c) hypercalcemia.
d) obstructive jaundice.
e) pancreatic calcification.
12. The best initial treatment of myasthenia gravis:
a)prostigmine (Neostigmine).
b) ephedrine.
c) mestinon (Pyridostigmine bromide).
d) thymectomy .
e) prednisone.
13. A patient was found to have a plasma sodium
concentration of 143 mEq/L, glucose 1800 mg/dl, and a BUN
of 28 mg /dl. The plasma osmolality is approximately.
a) 315 m0sm /L
b) 365 m0sm /L
c) 395 m0sm /L
d)425 m0sm /L
14. The ideal treatment for acute amoebic dysentery is:
a) praziquantel
b) tetracycline and Diloxanide furoate (Furamide).
c) dehydroemetine hydrochloride.
d)metronidazole and Diloxanide furoate.
e) thiabendazole and Tetracycline.
15. Side effects of Corticosteroids include all the following
EXCEPT:
a) peptic ulcer.
b) osteoporosis.
c) psychosis.
d)hyponatraemia.
e) myopathy.
An elderly man complaining of pain and clusters of .16
:vesicles overlying a rib is suffering from
a) erythema multiforme
b) chicken pox
c) fractured rib
d)herpes zoster
e) neuralgia
17. The human asymptomatic carrier is important in the
epidemiology of all the following except:
a) hepatitis B
b) shigella infection
c) h.i.v (AIDS) infection
d)leprosy
e) ascariasis infection
3
18. Active salmonella typhi infection in the first week of the
disease is best confirmed by:
a) leucocytosis
b)positive blood culture for causative organism
c) high ESR.
d) positive Widal agglutination test 1 /80.
e) positive stool smear for causative organism.
19. Combined schistosoma mansoni and schistsoma
haematobium infection is best treated by:
a)praziquantel .
b) metronidazole
c) albendazole
d) oxamniquine.
e) metrifonate.
20. In a patient with a stroke , cerebral emboli is more
likely if the patient has:
a) loss of consciousness.
b) blood pressure of 200/140 mmHg.
c) subhyaloid haemorrhage.
d)apical diastolic murmur.
e) history of gradual onset of weakness.
21. Which of the following is in keeping with the diagnosis of
nephrotic syndrome?
a) bilateral renal angle tenderness.
b)serum albumin of 2.0 gm /dl
c) oliguria.
d) hypertension.
e) increased urinary sodium excretion .
22. A urine sediment showing protein and granular casts is
suggestive of:
a) urinary schistosomiasis
b) renal cell carcinoma .
c) ureteric stone .
d)glomerulonephritis.
e) gonococcal urethritis.
23. In patients with underlying cardiac disease, congestive
cardiac failure can be precipitated by:
a) excessive salt intake .
b) non-steroidal anti-inflammatory drugs.
c) arrhythmias.
d) pulmonary embolism.
e)all of the above.
24. A 30 year old male presented with a history of fever,
arthralgia and myalgia 3 weeks following a dental
procedure . On examination he was ill febrile and has
clubbing . An early diastolic murmur of aortic regurgitation
4
was detected. What is the most appropriate investigation to
reach a diagnosis?
a) chest x- ray
b) ECG
c) urine analysis
d) CBC (complete blood count)
e)echocardiography.
25. The following laboratory data were obtained on a patient
with acute Renal Failure. Which one will you give priority in
management?
a) blood urea 180 mg %
b) Hb 8 gms/100 ml
c) serum potassium 7 mEq/L
d) serum Ca++ 8 mg /100 ml .
e) serum uric acid 7 mg/100 ml
26. Plain x-ray of the abdomen of a patient with chronic
kidney disease showed moderately enlarged kidneys. Which
one of the following is the likely underling disease?
a) chronic glomerulonephritis
b) chronic pyelonephritis
c) analgesic nephropathy
d) sickle cell disease
e) amyloidosis
27. A 55 years old merchant from Omdurman presents to the
emergency department at 2 o’clock am complaining of
severe pain in the big toe which was swollen , hot and
tender . His immediate drug treatment is:
a) prenisolone
b) colchicine
c) indomethacin
d) allopurinal
e) aspirin
28. A previously normal adult male develops fever, jaundice
and a progressively rising blood urea. The underlying disease
is most likely.
a) viral hepatits
b) infectious mononucleosis
c) leptospirosis
d) hair dye poisoning
e) bengin tertian malaria.
29. A 72 years old lady has been immobile for 3 weeks after
total hip replacement. She had sudden onset of crushing
central chest pain associated with dyspnoea. She had
tachycardia with unremarkable examination of the chest.
What is the most likely diagnosis?
a) acute myocardial infration
b) acute pericarditis.
5
c) aortic dissection .
d)massive pulmonary embolism .
e)pneumothorax.
30. A young adult has history of headache, recurrent
epistaxis and claudication. He was found to have high blood
pressure on both arms with diminished femoral pulses. The
most likely diagnosis is:
a) aortic valve stenosis
b) subvavular aortic stenosis
c) supravalvular aortic stenosis
d) Aortic coarctation
e) essential hypertension
31. Which of the following is most sensitive for detecting
diabetic nephropathy?
a) serum creatinine
b) blood urea.
c) urine albumin
d) renal ultrasound
e) glucose tolerance test
32 . A 46 year old woman discovered to have a 1.5 cm thyroid
nodule during a routine examination. She had no symptoms
and her TSH, T4, T3 were normal. Which of the following
would be the most appropriate management?
a) fine needle aspiration
b) uniltearal thyroid lobectomy
c) thyroxine suppressive therapy
d) radioiodine therapy
e) no intervention needed , wait and see.
33. in acute hepatic encephalopathy:
a) The level of ammonia correlates with the degree of mental
disturbance.
b) liberal protein diet should be allowed
c) may be precipitated by diuretics
d) the EEG ( electrencephaalogram ) is normal
e) flapping tremors are diagnostic
A 70-year-old woman has been in long-standing poor .34
health, with severe diabetes mellitus and rheumatoid
arthritis. Her physician notes that she appears pale and
orders a hematocrit, which shows a result of 35%.
Examination of the blood smear reveals a microcytic anemia.
The physician is considering a differential diagnosis of iron
deficiency anemia versus anemia of chronic disease. Which
of the following laboratory determinations would be most
?helpful in distinguishing these conditions
a) Erythrocyte:granulocyte ratio in bone marrow
b) Presence or absence of target cells
c) Presence or absence of stippled erythrocytes
6
d) Serum ferritin
e) Serum iron
35. A 31-year-old man comes to the clinic two weeks after
being seen in the emergency room for acute nephrolithiasis.
He passed his stone in the emergency room and he reports
that it was made of calcium oxalate. He is concerned about
recurrences, as the pain was very severe. Which of the
following is the most appropriate next step in management?
a) Initiation of thiazide diuretic therapy
b) Initiation of loop diuretic therapy
c) Initiation of allopurinol therapy
d) Maintenance of an alkaline urine
e) Maintenance of large urine volumes via copious water
consumption
36. A 16-year-old boy is bitten by a rattlesnake on his right
ankle. Pain and swelling of the bitten area become rapidly
intense. While the boy is transported to the closest medical
facility, which of the following is the most appropriate initial
step in management?
a) Apply ice to the bitten part
b) Apply a tourniquet
c) Give alcohol to the patient
d) Immobilize the bitten part in horizontal position
e) Perform incision and suction on the bite
37. A 60-year-old man complains of extremely severe, sharp,
shooting pain in his face. He describes the episodes as being
"like a bolt of electricity" that are brought about by touching
a specific area, last about 60 seconds, and occur many times
during the day. Neurologic examination is completely
normal. MRI shows no abnormalities of the trigeminal nerve.
Which of the following is the most appropriate initial
treatment?
a) Anticonvulsants
b) Aspirin
c) Nonsteroidal anti-inflammatory drugs
d) Vasoconstrictors
e) Vasodilators
38. A patient with acute hepatitis B presents to your office
complaining of severe fatigue, low-grade fevers and weight
loss. He was diagnosed 2 weeks earlier, and hepatitis B
surface antigen was positive. A physical examination reveals
jaundice with diffuse skin excoriations. His liver and spleen
are both markedly enlarged and tender. Peripheral edema is
present. Which of the following would be the worst
prognostic sign?
a) Albumin of 3.1 g/dL
b) Bilirubin of 9.4 mg/dL
c) Prothrombin time of 19 seconds with an INR of 2.1
7
d) SGOT (AST) of 2 U/L
e) SGOT (AST) of 1200 U/L
39. A healthy 27-year-old man has a cough with sputum
production for 2 days. The cough has been keeping him up at
night and it is affecting his job performance. He has no
history of respiratory disease. His temperature is 37 C, blood
pressure is 130/80, pulse is 70/min, and respirations are
18/min. Physical examination is normal. Which of the
following is the most appropriate next step in management?
a) Admit to the hospital for medical management
b) Perform a chest x-ray film
c) Perform a sputum culture
d) Send home with antibiotic therapy
e) Send home with no therapy
40. A 32-year-old man has had asthma for the past 9 years.
The symptoms are frequently exacerbated by changes in the
weather and household allergens. He has had two emergency
department visits over the past year but has not required
hospitalization. He uses a ventolin inhaler sporadically for
symptom relief. Which of the following would be the most
appropriate therapy to maintain remission between his
asthmatic attacks?
a) Aminophylline
b) Beclomethasone inhaler
c) Cromoglycate nasal spray
d) Ventolin inhaler
e) Oral prednisone
41. The most common cause of cardiac arrest in children
is;
a)Diabetic ketoacidosis
b)Acute severe asthma
c)Congenital heart disease
d)Hypothermia
e)Grand mal epilepsy
42. Which of the following is most useful in assessing
severity of an acute asthmatic attack in children?
a) Pulse rate
b)Respiratory rate
c) Blood pressure
d) PCO2
e) Tremors
[Link] nodosum;
a) Is a painless lesion
b) Occurs only bellow the knees
c) Is type IV immune reaction
d) Often follows viral infection
8
e) May occur in infective endocarditis
44. Manifestation of pneumothorax in children include;
a) Haemoptysis
b) Paroxymal nocturnal dyspnea
c) Shift of the mediastinum to the affected side
d) Bronchial breathing on the affected side
e) Pulsus paradoxus
45. One of the following statements about adrenaline is
true:
a) It is recommended to be used as an infusion in children
b) It can not be given via endotracheal tube (ETT)
c) The beak level of adrenaline given via (ETT) is much
lower than intravenous route
d) The first dose to give to children with cardiac
arrest is 10mg\kg of 1:10.000
e) It is the drug of choice for a child with acute asthma
46. One of the following does not test cellular immunity?
a) Nitro blue tetrazolium Test
b) Tuberculin test
c) Quantitative serum immunoglobulins
d) CD4 and CD8
e) Neutrophil motility
47. One of the following is not a major factor that leads to
a decrease in the incidence of rheumatic fever?
a) Improvement in hygiene in the community
b) Improvement in social scales
c) Early diagnosis
d) Increasing coverage of primary vaccination
e) Prevention of recurrence
48. One of the following statements about birth trauma is
false:
a) Subconjunctival hemorrhage is common
b) Cephalhaematoma is confined by the cranial sutures
c) Caput sussedanum is effusion due to laceration of blood
vessels
d) Facial nerve palsy follow forceps delivery
e) Erb's palsy result form a lesion at C8-T1
49. One of the following is not a common cause of acute
renal failure in a newborn infant;
a)septicemia
b)hemorrhage
c)polycythemia
d)renal vein thrombosis following asphyxia
e)urinary obstruction
9
50. Physical examination of a 2 weeks old boy showed,
weight 3kgm, pulse 110\minute, rectal temperature
37.8°c, respiratory rate 50 per minute. This patient most
likely has:
a) Pneumonia
b) Bronchiolitis
c) Metabolic acidosis
d)Nothing abnormal
e) Heart failure
51. The most likely developmental age of a child who
can roll-over, reach an objects, coos and bubbles, hold
an object in the palm, takes of a paper from his face is:
a) 3 months
b) 5 months
c) 7 months
d) 9 months
e) 14 months
52. A one year old child is found to have a weight of
6kgm, height 75 cm. His birth weight was 3.5 km. The
most likely nutritional grade of this child is:
a) Mild acute under nutrition
b) Moderate acute under nutrition
c) Severe acute under nutrition
d) Normal
e) Chronic under nutrition
53. CSF examination of a child shows blue-colored
diplococci a gram stain. These organisms are?
a)Pneumococci
b) Meningococci
c) [Link]
d) Haemophilus influenzae
e) Mycobacterium TB
54. The sodium content of RESOMAL in mmol/liter is:
a) 30
b)45
c) 90
d) 120
e) 154
55. The drug of choice for a 5 year old child with grand-
mal seizure is:
a) Carbomezapine
b) Phenytoin
c) Sodium valproate
10
d) vegabatrin
e) clonazepam
56. Physical examination of a 12 year old boy showed a
testis of 3 ml in volume. This child's tanner stage of
puberty is:
a) Zero
b)One
c) Two
d) Three
e) Four
57. Blood sodium level of a child is found to be 120
mmol/L. The level likely cause is:
a) Acute renal failure
b)Diabetes insipidus (wrong)
c) Adrenal failure
d) Gastroenteritis
e) Water intoxication
58. cardiovascular examination of a 6 month old boy
showed; cyanosis, pulse 98/minte, apex beat at the 4th
intercostals space within mid-clavicular line, left
parasternal heave, normal heart sound, pansystolic
murmur in the left parasternal region and grade 3/6
systolic murmur in the pulmonary area. The most likely
diagnosis is:
a) Aortic stenosis
b) Pulmonary stenosis
c) Fallot's tetrollogy
d) Tricuspid atresia
e) Ventricular septal defect (VSD)
59. respiratory system examination of a newborn showed
the following; cyanosis, respiratory rate of 75/minute,
trachea shifted to the right, apex beat is just to the left of
the sternum, reduced air entering left side with dull
percussion on the left side. The most likely diagnosis is:
a) pneumothorax
b) pneumonia
c) foreign body right lung
d)diaphragmatic hernia
e) situs inversus
60. A one year old child is considered to have anaemia if
his Hb (in gm/dl) is below;
a) 8
b) 15
c) 11
11
d) 13
e) 5
61. A child with polyuria, polydipsia and dehydration is
considered to be diabetic if his random blood sugar is
equal to or above;
a) 100 mg
b) 150 mg
c) 200 mg
d) 240 mg
e) 300 mg
62. A 6 year old child is admitted with weakness of both
lower limbs. Physical examination showed; no wasting,
hypotonia, hyporaflexia, normal sensation and power of
grade 4 on the right side and grade 2 on the left side. The
most likely diagnosis is:
a) Guillain barre syndrome
b)Poliomyelitis
c) Pott's disease of the spine
d) Viral myositis
e) Transverse myelitis
63. A 10 year old boy is admitted with fever. He had
cervical lymphadenopathy. Aspiration of the node showed
an organism with nucleus and kinetoblast. This patient
should be treated with:
a) cloxacillin
b) pencillin
c) sodium stibogluconate
d) prednisolone
e) antituberculous drugs
64. A 2 year old child is admitted with fever and
convulsion; on examination he was found to be jaundiced,
pale with hepatosplenomaegaly and left sided
hemipareses. He gave past history of recurrent painful
swelling of hands and feet. The urgent treatment of this
patient is:
a) I.V ceftriaxone
b) Blood transfusion + antibiotics
c) I.V quinine
d)Exchange blood transfusion + antibiotics + I.V
fluids
e) I.V acyclovir + I.V cetriaxone
65. An 11 month old child is admitted with diarrhea and
vomiting. Examination showed a conscious child with
12
depressed fontanele, pulse 160 moderate volume, dry
mouth, loss of skin turgor. Weight is 10kgm. Axillary
temperature 37.3°C. This child should be given the
following treatment in the first 4-6 hours;
a) Oral 750 resomal
b)Oral 750 ml of WHO ORS
c) I.V 5% dextrose + 1/2 normal saline 750ml
d) I.V antibiotics + WHO ORS 750ml
e) Oral metronidazone plus oral WHO ORS 750ml
66. A newborn whose parents are living in Khartoum
north is found to be jaundiced on the 10th day, he also
has protruded tongue, umbilical hernia and goiter.
Thyroid function test showed low free T4 and high TSH.
The most likely cause of his hypothyroidism is
a) Iodine deficiency
b) Thyroid dysgenesis
c) Thyroid dyshormonogenesis
d) Hypopitutrism
e) Hashimoto's thyroiditis
67. A 18 month old child is brought for evaluation of
bowing of lower limbs with wide wrist and prominent
Costochondral junction. Laboratory test showed calcium
of 6 mg/dl (8-11mg/dl),phosphate 1.2mg/dl (2.8-4mg/dl)
the most likely cause for his problem is:
a) Chronic renal failure
b) Proximal renal tubular acidosis
c) Familial hypophosphatemic rickets
d)Nutritional vitamin D deficiency
e) distal renal tubular acidosis
68. A one year old child is admitted with convulsion. His
blood glucose is found to be 36mg/dl (2mmol/l).
Differential diagnoses include all of the following except;
a) Malnutrition
b) Glycogen storage disease
c) Galactossemia
d) DM
e) Hypothyroidism
69. A 6-yr-old girl presents to the emergency room with
fever, cough, respiratory distress and upper quadrant
abdominal pain. Examination of the chest reveals tachypnea
and right lower lobe crackles. Chest radiograph shows
consolidation and small pleural effusion on the right side.
You make a diagnosis of lobar pneumonia. What is the most
likely etiologic cause of this child's pneumonia?
13
a) Group B hemolytic streptococci
b)Streptococcus pneumoniae
c) Mycoplasma pneumoniae
d) Staphylococcus aureus
e) Haemophilus influenzae type B
70. The cause of the abdominal pain in this child is
a) Acute appendicitis
b) Acute cholecystitis
c) Congestive heart failure.
d) Liver congestion
e)Pleurisy
71. A 5-year-old boy presents to hospital with abrupt-onset
petechiae and ecchymoses over the trunk and the lower
limbs. He looks well and hemodynamically stable. He has
small palpable cervical lymph nodes, but no
hepatosplenomegaly. A complete blood count reveals a
normal white blood cell count, a normal hematocrit and a
platelet count of 25,000. Large platelets are seen in the
peripheral smear. The parent reports that the child had flu-
like symptoms 2 weeks before presentation. Which of the
following is the most likely diagnosis?
a) Isoimmune Thrombocytopenic Purpura
b) Anaphylactoid Purpura
c) Acute Leukemia
d)Autoimmune Thrombocytopenic Purpura
e) Glanzmann Thrombasthenia
72. A bone marrow examination was done for the patient.
What do you expect it to show?
a) Normocellular Bone Marrow
b) Arrested Myeloid Cell Development
c) Erythroid Hyperplasia
d)Increased Megakaryocytes
e) Blast Cells & macrocytes
73. Which treatment or action is most appropriate?
a) Anti-D given as single dose if his blood group is rhesus
positive
b)Intravenous Immunoglobulins for 5 days
c) No treatment is needed because platelets count is
>20,000
d) Oral Prednisolone for 4 weeks
e) Three units of platelets transfusion to be given urgently
74. A 4-year-old child presents to the emergency room with
vomiting and progressive stupor for the past 24 hours.
Mother was not concerned because he had similar episode of
confusion with the high fever he had a week ago when he
developed chicken pox, which she treated at home with
14
aspirin. Examination reveals a comatose child with
decorticate posture & hyperreflexia. There was no jaundice
or hepatomegaly. What is the most likely diagnosis?
a) Acute Fulminant hepatitis
b) Hemolytic-Uremic Syndrome
c) Meningococcal Meningitis
d)Reye's Syndrome
e) Tuberculous Meningitis
75. Which of the following lab results is most supportive of
the likely diagnosis?
a) Hyperammonemia
b) Hypercalcemia
c) Hyperchloremia
d) Hypoglycemia
e) Hyperkalemia
76. In the treatment of neonatal jaundice
a) In exchange transfusion Blood volume exchanged should
equal the baby's blood volume
b) Phenobarbitone is regularly used to reduce the need for
exchange transfusion
c) Phototherapy converts unconjugated bilirubin to
water soluble compounds
d) Surgical therapy for extra hepatic biliary atresia should
be delayed until 1 year of age
e) The best treatment for breast milk jaundice is switching
to formula feeds
77. A 3-year-old boy presents to hospital with high-grade
fever of 6 days duration. On examination you noted bilateral
conjunctivitis, dry & red fissured lips, a maculopapular rash
over the trunk, cervical lymphadenopathy and swelling of the
hands and feet. Investigations showed a Hb of 10 g/dl with
normal peripheral blood film. What is the most likely
diagnosis?
a) Acute Leukemia
b) Glandular Fever
c) Kawasaki Disease
d) Typhoid Fever
e) Sickle Cell Disease with bacterial sepsis Typhoid Fever
78. Which investigation is diagnostic?
a) Bone Marrow Examination
b) ECG & Echocardiography
c) Lymphnode Biopsy
d) Serum Immunoglobulin Levels
e)No investigation is diagnostic
15
79. What is the most appropriate initial therapy?
a) Blood Transfusion
b) Corticosteroids
c) Intravenous Ceftriaxone
d) Intravenous Immunoglobulins
e) Non-Steroidal Anti-Inflammatory Drugs
[Link] is the most serious complication the doctor will be
worried about?
a) Hepatic encephalopathy
b)Coronary Aneurysm
c) Disseminated Intravascular Coagulopathy
d) Necrotizing Nephritis
e) Meningo-encephalitis
16
