End of round MCQ practice Flashcards
(144 cards)
1
Q
1) A characteristic symptom of left ventricle heart failure:
a) Dyspnea on lying on left side.
b) Lower limb swelling.
c) Paroxysmal nocturnal dyspnea.
d) Pain in the right hypochondrium.
A
c) Paroxysmal nocturnal dyspnea.
2
Q
2) 55 year old man heavy smoker 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
c) Left sided heart failure
d) Pulmonary embolism.
A
a) Congestive heart failure
3
Q
3) A characteristic sign in chronic obstructive pulmonary disease:
a) Clubbing.
b) Cyanosis.
c) Prolonged expiration.
d) Tremors.
A
c) Prolonged expiration.
4
Q
4) Upper motor neuron weakness is characterized by:
a) Proximal muscles are affected more than distal muscles.
b) Presence of fasciculations.
c) Distal muscles are affected more than proximal muscles.
d) Spontaneous discharge of a motor unit.
A
c) Distal muscles are affected more than proximal muscles.
5
Q
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.
c) Liver function tests.
d) X-ray wrist.
A
b) Chest X-ray.
6
Q
6) Bilateral lower limbs oedema could be a sign of:
a) Arterial thrombosis of the limb.
b) Deep vein thrombosis.
c) Cellulitis.
d) Liver cirrhosis.
A
d) Liver cirrhosis.
7
Q
7) Flapping tremors is a characteristic sign in:
a) Liver cell failure.
b) Right sided heart failure.
c) Senility.
d) Thyrotoxicosis.
A
a) Liver cell failure.
8
Q
8) A sequel of prolonged uncontrolled hypertension is:
a) Hernia.
b) Leg oedema.
c) Piles.
d) Ventricular hypertrophy.
A
d) Ventricular hypertrophy.
9
Q
9) Chest pain is a characteristic symptom of:
a) Bicuspid aortic valve.
b) Ludwig’s angina.
c) Silent angina.
d) Unstable angina
A
b) Ludwig’s angina.
10
Q
10) The following is a recognized complication of chronic cough:
a) Change in color of urine.
b) Cyanosis.
c) Hernia.
d) Hypertension.
A
c) Hernia.
11
Q
11) A common cause of hemoptysis is:
a) Bronchogenic carcinoma.
b) Acute bronchitis.
c) Anticoagulation.
d) Tuberculosis.
A
b) Acute bronchitis.
12
Q
12) Frank hemoptysis could be a sign of
a) Chest wall hematoma.
b) Peptic ulcer.
c) Emphysema.
d) Small cell carcinoma.
A
d) Small cell carcinoma.
13
Q
13) Elevated jugular venous pressure is a sign of:
a) Liver cirrhosis.
b) Peripheral oedema.
c) Heart failure.
d) Pulmonary fibrosis.
A
c) Heart failure.
14
Q
14) Oedema of heart failure is:
a) Increase in intravascular hydrostatic pressure.
b) Increase in the intravascular oncotic pressure.
c) Increase in the movement of fluids.
d) Increase in capillary vascular bed.
A
a) Increase in intravascular hydrostatic pressure.
15
Q
15) Paroxysmal dyspnea of left ventricle failure is characterized by:
a) Change from side to side.
b) Nocturnal episodes.
c) Relieved spontaneously.
d) Relieved by lying comfortable in bed.
A
b) Nocturnal episodes.
16
Q
16) Acute pulmonary oedema is a sign of:
a) Left sided heart failure.
b) Mediastinal syndrome.
c) Right sided heart failure.
d) Neoplastic invasion of pericardium.
A
a) Left sided heart failure.
17
Q
17) Diagnosis of diabetes meilitus is confirmed by:
a) Fasting blood sugar.
b) Fasting and 2 hour post prandial blood sugar.
c) Fasting blood glucose and glycated HbAlc.
d) Presence of polyuria and polydepsia.
A
b) Fasting and 2 hour post prandial blood sugar.
18
Q
18) Macrocytosis in blood film is observed in patients with:
a) Fever.
b) Flat nails.
c) Gastrectomy.
d) Hypersplenism
A
c) Gastrectomy.
19
Q
19) Intrahepatic biliary cholestasis is caused by:
a) Gall stones.
b) Sickle cell anemia.
c) Pancreatitis.
d) Autoimmune hepatitis.
A
d) Autoimmune hepatitis.
20
Q
20) Pre-hepatic jaundice is:
a) Hemolytic jaundice.
b) Hepatocellular jaundice.
c) Obstructive jaundice.
d) Surgical jaundice.
A
a) Hemolytic jaundice.
21
Q
21) Stercobilinogen is absent in stool in:
a) Congenital hyperbillirubinemia.
b) Hemolytic jaundice.
c) Hepatocellular jaundice.
d) Obstructive jaundice.
A
d) Obstructive jaundice.
22
Q
22) Regulation of erythropoietin production is linked to:
a) Carbon dioxide.
b) Hemoglobin concentration.
c) Oxygen.
d) Red cell mass.
A
c) Oxygen.
23
Q
23) A -21year- 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.
c) HAV IgM.
d) HCV antibody.
A
c) HAV IgM.
24
Q
24) A major cause of disturbed conscious level is:
a) Hypoglycemia.
b) Hyperglycemia.
c) Hypercalcemia.
d) Hypernatremia.
A
a) Hypoglycemia.
25
25) 18 years old girl presented to 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) Measure blood sugar.
d) Measure blood sugar.
26
26) One of the general causes of dyspnea is:
a) Anemia.
b) Dissecting aortic aneurysm.
c) Myocardial infarction.
d) Pulmonary fibrosis.
a) Anemia.
27
27) Aplastic anemia is characterized by:
a) Diminished erythropoietin level.
b) Granulocytosis.
c) Hypocellular bone marrow.
d) Markedly increased reticulocyte count.
c) Hypocellular bone marrow.
28
28) A -62year- heavy smoker male presented to ER with crushing chest pain radiating to left shoulder. The most appropriate diagnosis is:
a) Acute pericarditis.
b) Fracture rib.
c) Myocardial infarction.
d) Perforated peptic ulcer.
c) Myocardial infarction.
29
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 is:
a) Anemia of blood loss.
b) Hypertensive emergency.
c) Pulmonary’ embolism.
d) Wound sepsis.
c) Pulmonary’ embolism.
30
30) A common symptom of hypertension is:
a) Asymptomatic.
b) Blurring of vision.
c) Ringing ears.
d) Swelling of extremities.
a) Asymptomatic.
31
2. A 55-ycar-vid man has just arrived in accident and emergency complaining of 3 hours central crushing chest pain and sweating, the most appropriate initial investigation to be earned out is:
a) Chest X-ray
b) Electrocardiogram
c) Complete blood count
d) Echocardiography .
b) Electrocardiogram
32
3- A 63-year-old woman develops exertional angina and has had two episodes of syncope. Examination shows a systolic ejection murmur with radiation to the carotids and a soft S2.
Which of the following is the most likely diagnosis?
a) Mitral stenosis
b) Mitral insufficiency
c) Aortic stenosis
d) Aortic insufficiency
c) Aortic stenosis
33
A 16-year-old boy is found to have hypertension on routine evaluation. On examination the blood pressure in his arms is higher in his legs by more than 10 mmHg. Which of the following is the most likely diagnosis?
a) Aortic insufficiency
b) Coarctation of the aorta
c) Normal variant
d) Ventricular aneurysm
b) Coarctation of the aorta
34
5. A 57-ycar-old man with a 40 pack-per-year history of smoking experiences symptoms of shortness of breath on exertion. He has bilateral wheezes on expiration and increased resonance to percussion of the chest. Pulmonary function tests confirm the diagnosis of chronic obstructive lung disease. Which of the following is the best definition of this condition?
a) It is caused by bronchial asthma
b) It is preceded by chronic bronchitis
c) It is airflow limitation that is not fully reversible
d) It is due to destruction and dilatation of lung alveoli
d) It is due to destruction and dilatation of lung alveoli
35
7. A 32 year old develops symptoms of wheezing, cough and shortness of breath. He has bilateral expiratory wheezes, and the rest of the examination is normal. Further evaluation with pulmonary function tests reveals a reduced FEV1/FVC ratio that corrects with bronchodilators. Which of the following statements about diagnosis of idiosyncratic asthma is correct.
a) Known antigenic stimulus
b) Adult onset
c) History of atopy
d) Positive skin tests
b) Adult onset
36
8. A 74-ycar-old man with a history of smoking notices blood in his chronic dally sputum production He has no lever or chills, but has lost 5 kg in the past 6 months On examination, he has biliteral expiratory wheezes. and his fingers are clubbed. There are no lymph nodes and the remaining examination is normal
Which of the following is the most likely diagnosis?
a) Small cell lung cancer
b) Chronic bronchitis
c) Pulmonary embolism
d) Bronchial asthma
a) Small cell lung cancer
37
9.A 23 year Old man develops sharp left sided chest pain, fever, and a friction tub heard at the lower left sternal border. unaffected by respiration, the pain is also aggravated by lying down and relieved by sitting up He is otherwise well with no other symptoms and the remaining physical examination u normal
Which of the follow tog is the most likely cause for his symptoms?
a) Rheumatic fever
b) Tuberculosis
c) Pericarditis
d) Ischemic heart disease
d) Ischemic heart disease
38
10. Regarding hypertension the following statements arc true except.
a) The cause are unknown or idiopathic in 10% of cases.
b) The purpose of treatment in hypertension is to reduce the risk of devastating hypertensive complications.
c) Secondary causes constitute renal, endocrine and toxemia of pregnancy.
d) Weight reduction in obese patients, salt restriction increased consumption of fruit and vegetables are all general measures for treatment.
a) The cause are unknown or idiopathic in 10% of cases.
39
11. A 65-year-old male presented by shortness of breath. known to have hypertension and ischemic heart disease, on examination he had signs of fluid retention. raised jugular venous pressure, lung crepitation. pitting leg edema, tender hepatomegaly.
Which of the following conditions could be the diagnosis?
a) Pulmonary embolism
b) Congestive heart failure
c) Chronic bronchitis.
d) Lt sided heart failure
b) Congestive heart failure
40
12. The following are recognized causes of hemoptysis except:
a) Tuberculosis
b) Bronchial asthma
c) Mitral stenosis
d) Bronchiectasis
b) Bronchial asthma
41
14. A 24-yearar old woman notices increasing shortness of breath after recent treatment after right lube pneumonia .She has no few. cough or sputum production On examination, the pertinent findings are decreased fremitus, dullness on percussion and absent breath sounds of the right lower lung -In addition, the trachea has shitted to the left
What is the most like diagnosis?
a) Acute asthmatic attack
b) Pneumothorax
c) Large pleural effusion
d) Atelectasis
c) Large pleural effusion
42
15 A 30-year-old man presents to your clinic with a cough and finger clubbing. From the list below, which of these answers is not a respiratory cause of finger clubbing?
a) Empyema
b) Mesothelioma
c) Bronchogenic carcinoma
d) Chronic obstructive pulmonary disease
d) Chronic obstructive pulmonary disease
43
18- A 25-year-old man with a history of a duodenal ulcer is noted to have a hemoglobin level of 10 g/dL Which of the following most likely will be seen on laboratory investigations;
a) Reticulocyte count of 10%
b) Elevated total iron binding capacity
c) Normal serum ferritin
d) Mean corpuscular volume of 105 fL
b) Elevated total iron binding capacity
44
20. A 60-year-old alcoholic man presents with fatigue and difficulty concentrating. His daughter mentions that he has not been eating well. On physical exam, the conjunctiva and nail beds are pale Neurological exam is normal. Laboratory studies demonstrate macrocytic megaloblastic anemia
What is the most likely cause of macrocytic anemia in this patient?
a) Folate deficiency
b) B12 deficiency
c) Iron deficiency
d) Blood loss
b) B12 deficiency
45
21.You are asked by your registrar to request an imaging investigation for a 49-yeor old woman with jaundice and abdominal pain. She has a past medical history of gallstones and you suspect this is a recurrence of the same problem. The most appropriate imaging investigation is:
a) Abdominal x-ray
b) Abdominal ultrasounds
c) Abdominal CT
d) Magnetic resonance imaging (MRI)
b) Abdominal ultrasounds
46
Which of the following gastroenterological conditions would give rise to finger clubbing?
a) Hepatocellular carcinoma
b) Ulcerative colitis
c) Irritable bowel syndrome
d) Pancreatic carcinoma
b) Ulcerative colitis
47
the most common cause of upper Gl bleeding?
Esophageal varices
48
24. A 67 year old presents feeling unwell and complaining of general malaise. He mentions a long history of alcohol abuse and his past medical history shows derranged liver function tests. Which of the following signs does not form part of chronic liver disease?
a) Bruising
b) Palmer erythema
c) Spider naevia
d) Koilomychia
d) Koilomychia
49
25 A 45 year-old man presents complaining of weight gain, on examination there is abdominal distension with a fluid thrill Which of following is not a cause of ascites secondary to venous hypertension?
a) Congestive heart failure
b) Cirrhosis
c) Constrictive pericarditis
d) Nephrotic syndrome
d) Nephrotic syndrome
50
All are features of diabetic ketoacidosis except:
a) Hyperthermia
b) Air hunger
c) Dehydration
d) Drowsiness
Hyperthermia
51
30.AU of the following conditions can produce microcytic anemia except:
a) Sideroblastic anemia
b) Thalassemia
C) Pernicious anemia
d) Lead poisoning
C) Pernicious anemia
52
A 65 year-old male patient presented to the emergency unit by substernal chest pain related to exertion and radiating to the left hand, the most likely diagnosis is.
Angina pectoris
53
A 72-year-old female patient presented to the emergency department by sudden onset of chest pain with profuse sweating, dyspnea, nausea, and vomiting. The important modality for her is to perform
a) Echocardiography
b) Chest x-ray
c) Electrocardiography
d) Lipid profile
c) Electrocardiography
54
A 67-year-old female complains of a gradual history of increasing exercise intolerance and fatigue. She used to receive nonsteroidal anti-inflammatory drugs (NSAIDs) regularly for knee osteoarthritis. She is anemic, with a hemoglobin level of 8.2 g/dL and a mean corpuscular volume of 70 fL.
a) Iron-deficiency anemia
b) Megalobtstic anemia
c) Normocytic anemia
d) Hemolytic anemia
a) Iron-deficiency anemia
55
A 60-year-old num presents to accident and emergency with a 3-day history of increasingly severe chest pain The patient describes the pain as a sharp, tearing pain starling in the center of his chest and radiating straight through to his hack between his shoulder blades.
The most likely diagnosis is:
a) Myocardial infarction
b) Myocardial ischaemia
c) Aortic dissection
d) Pulmonary embolism
c) Aortic dissection
56
A 78-year-old woman is admitted to your ward following a 1-day history of shortness of breath and a productive cough of white, frothy sputum. On auscultation of the lungs, you hear bilateral basal coarse inspiratory crackles.
Which of the following is your possible diagnosis?
a) Left-sided heart failure
b) Pulmonary embolism
c) Pulmonary hypertension
d) Bronchial asthma
a) Left-sided heart failure
57
Hepatic encephalopathy may he precipitated by all except.
a) Constipation
b) Infection
c) low protein intake
d) Diuretic therapy.
c) low protein intake
58
A 58-year-old male patient, known cigarette smoker for 20 years, presents to the outpatient clinic with a productive cough, increasing dyspnea, leg edema, and right upper quadrant pain. The most likely diagnosis is:
a) Left sided heart failure
b) Cor pulmonale
c) Pulmonary embolism
d) Bronchial asthma
b) Cor pulmonale
It is right ventricular enlargement due to chest diseases (like COPD present in this case) +/- right ventricular failure (which presents as LL swelling, Rt hypochondrial pain and dyspepsia)
59
Which of the following clinical signs does not form part of chronic liver disease?
a) Palmer erythema
b) Spider naevi
c) Koilonychia
d) Jaundice
c) Koilonychia
spoon-shaped nails and is more commonly associated with iron deficiency anemia
60
Regarding bronchial asthma, the following statements are true except:
a) Asthma is a chronic inflammatory disease of the airways that is characterized by episodes of cough, wheezing, and dyspnea.
b) Approximately 80% of patients with asthma have an allergic tendency characterized by positive immediate hypersensitivity skin tests.
c) Extrinsic asthma usually occurs in adulthood.
d) Consider the diagnosis of asthma in patients with a history of wheezing or variable dyspnea with specific triggers.
c) Extrinsic asthma usually occurs in childhood or early adulthood.
Extrinsic asthma means allergic asthma which always triggered in childhood or youth at latest
61
Causes of bilateral lower limb edema include the following except:
a) Liver cirrhosis
b) Nephrotic syndrome
c) Drugs, e.g., calcium channel blockers
d) Left sided heart failure
d) Left sided heart failure
It can lead to lower limb generalized edema but that is more cor pulmonale (rt sided HF). Lt sided HF causes pulmonary edema
62
1. Causes of congestive heart failure include the following:
a) Severe hypertension
b) Valvular heart disease
c) Severe anemia
d) All of the above
d) All of the above
63
2. Regarding indications for ambulatory blood pressure recording, the following statements are true except:
a) When blood pressure reading show variability
b) To exclude white coat hypertension
c) All cases of hypertension
d) When hypertension is resistant to drug treatment with 3 or more drugs
c) All cases of hypertension
64
3. A 66-year-old woman presents to emergency with a 2-day history of shortness of breath. The patient notes becoming progressively short of breath as well as a sharp pain in the right side of the chest which is most painful when taking a deep breath. The patient also complains of pain and swelling in her right leg.
The most likely diagnosis is:
a) Heart failure
b) Pneumothorax
c) Angina
d) Pulmonary embolism
d) Pulmonary embolism
65
The first step to assess a case presenting with acute dyspnea:
a) Check the respiratory rate
b) Check blood pressure
c) Check pulse
d) Check airway patency
d) Check airway patency
66
5. Which of the following is the mechanism of edema in patients with congestive heart failure?
a) Decreased plasma oncotic pressure
b) Endothelial damage
c) Increase hydrostatic pressure
d) Increase vascular permeability
c) Increase hydrostatic pressure
67
6. Regarding treatment of mild hypertension, the following statements are true except:
a) Regular isometric physical exercise is beneficial
b) Regular dynamic physical exercise is beneficial
c) Weight reduction in obese patient is beneficial
d) Salt restriction is beneficial
a) Regular isometric physical exercise is beneficial
Isometric is like weight lifting, increase BP
68
7. A 65-year-old male complains of central crushing chest pain radiating to both arms after running to catch a bus. Pain was relieved by rest and his ECG recording lh later was unremarkable, the most probable diagnosis is:
a) Ischemic heart disease
b) Pericarditis
c) Pulmonary embolism
d) Pneumothorax
a) Ischemic heart disease
69
8. A 40-year-old man is brought to the emergency department with severe headache. On examination he has papilledema and fundal hemorrhages. His BP is 220/145 mmHg, the most probable
diagnosis is:
a) Ischemic heart disease
b) Malignant hypertension
c) Heart failure
d) Renal failure
b) Malignant hypertension
70
11. Hemoptysis may be found in the following except:
a) Tuberculosis
b) Pulmonary infarction
c) Mitral stenosis
d) Pericarditis
c) Mitral stenosis
It is the valve that is in the aorta (leads out of the Lt ventricle). Its stenosis can lead to pulmonary hypertension and congestion, which may result in hemoptysis due to increased pressure in the pulmonary circulation.
71
12. Typical features of early onset bronchial asthma include the following except:
a) Individuals are usually atopic
b) A single allergen is often identifiable
c) Paroxysmal expiratory wheezes and dyspnea
d) A family history of allergic disorders
b) A single allergen is often identifiable
72
13. A 50-year-old smoker presents with history of cough productive of mucoid sputum in every winter for the last two years. The most likely diagnosis is:
a) Bronchial asthma
b) Bronchiectasis
c) Chronic bronchitis
d) Bronchogenic carcinoma
c) Chronic bronchitis
Chronic bronchitis characterized by a productive cough that lasts for at least three months in two consecutive years, often associated with smoking. The mucoid sputum is a common feature, particularly in winter when respiratory infections may exacerbate symptoms.
73
14. Regarding chronic obstructive pulmonary disease (COPD) the following statements are true except:
a) Patients typically have cough which is worse in the morning
b) The primary cause of COPD is exposure to tobacco smoke
c) It is a preventable and treatable disease state
d) Ratio of FEVl/FVC is more than 70%
c) It is a preventable and treatable disease state
74
15. An 18-year-old girl presents to emergency with severe abdominal pain, nausea and vomiting. On examination, the patient is tachypneic, and she has a dry tongue. While listening to the patient's lungs you detects a sweet odor from her breath, the most likely diagnosis is:
a) Diabetic ketoacidosis
b) Non-ketotic hyperosmolar state
c) Gastroenteritis
d) Adrenal crisis
a) Diabetic ketoacidosis
75
16. Regarding diabetic ketoacidosis. The following is true EXCEPT:
a) It is common initial clinical presentation in type 1 diabetes.
b) The most common early symptoms are insidious increase in polydipsia and polyuria.
c) Missed or insufficient insulin doses may precipitating factor
d) It is more Common in type 2 diabetes
d) It is more Common in type 2 diabetes
76
17. The following could be the underlying Cause of persistent dry cough except:
a) Bronchial asthma.
b) Reflux esophagitis.
c) Use of B2 agonists.
d) Sinusitis and postnasal drip.
c) Use of B2 agonists.
77
19. A 65-year-old patient presented by jaundice, pruritus and abdominal pain, he reported that his urine is dark colored and stool is pale. The following condition could be the cause of his condition except:
a) Gall stones
b) Peptic ulcer disease.
c) Carcinoma of the pancreas
d) Cholangitis
b) Peptic ulcer disease.
78
The symptoms of liver failure are
Portal hypertension + complications: splenomegaly and hypersplenism, Ascites, portosystemic shunts (varices) and porto-systemic encephalopathy
3Fs: Fatigue (+anorexia and loss of weight), Fever, Foeter hepaticus (fecal smell)
4VIP: Coagulopathy and bleeding tendency, Hepatocellular jaundice, Hepatic encephalopathy, Ascites
3 Skin: Palmar erythema, Spider naevi, Clubbing, ecchymosis, white nail & half and half nail
79
20. A 25-year-old previously healthy female presented to outpatient clinic with fever, anorexia, vomiting. The condition was associated with right hypochondrial pain, she noticed dark colored urine.
On examination she was jaundiced with right hypochondrial tenderness and temperature of 38 C.
Her liver enzymes were markedly elevated with a serum bilirubin of 4 mg/dl.
The most probable diagnosis is:
a) Acute hepatitis A
b) Acute pancreatitis
c) Cancer head of pancreas
d) Liver cirrhosis
a) Acute hepatitis A
80
21. A 64-year-old woman accompanied by her husband comes to the emergency room seeking treatment for chest pain. The patient clearly tells you that she wants to have her aorta repaired and she signs consent for the procedure. She later becomes hypotensive and loses consciousness. Her husband is now the decision maker and says, "Let her die" what should you do?
a) Ask her other first degree relevant about their opinion
b) Ask the hospital manager about his opinion
c) Do an aorta repair and tell her husband that he cannot go against her wish after she loses consciousness
d) Respect the husband opinion and you will leave her to die
c) Do an aorta repair and tell her husband that he cannot go against her wish after she loses consciousness
81
22. Generalized edema results from all the following except:
a) Pulmonary hypertension
b) Congestive heart failure
c) Liver cirrhosis
d) Nephrotic syndrome
a) Pulmonary hypertension
82
23. Regarding hemolytic jaundice, the following clinical manifestations could occur except:
a) Splenomegaly
b) Pruritus
c) Leg ulcer
d) Gall stones
b) Pruritus
83
24. A 45-year-old female presented by generalized weakness. Inability to do her routine work, she reported menorrhagia for the last 6 months, the most likely diagnosis for the patient is:
a) Megaloblastic anemia
b) Iron deficiency anemia
c) Aplastic anemia
d) Hemolytic anemia
b) Iron deficiency anemia
84
25. Regarding liver cirrhosis the following is false except:
a) Diffuse process
b) Synonym to fibrosis
c) Always compensated
d) Needs no follow up
a) Diffuse process
85
26. Regarding the site of bleeding in a case of hematemesis, the following is true except:
a) Upper gastrointestinal tract until stomach
b) Upper gastrointestinal tract until second part of duodenum
c) Upper gastrointestinal tract until ligament of Trietz
d) Gastrointestinal tract until ascending colon
d) Gastrointestinal tract until ascending colon
86
27. Clinical poor prognostic indicators in liver cirrhosis include the following except:
a) Persistent jaundice
b) Failure to respond to therapy
c) Hypertension
d) Neuropsychiatric complication
c) Hypertension
87
Which of the following clinical signs does not form part of chronic liver disease?
a) Palmer erythema
b) Spider naevi
c) Koilonychias
d) Jaundice
c) Koilonychias
88
29. Regarding melena, the following statement is true:
a) At least 60 ml of blood is required
b) Black tarry semisolid stool
c) Offensive in odor
d) All of the above
d) All of the above
89
30. Extrahepatic biliary obstruction can be due to any of the following condition except:
a) Biliary stones
b) Drugs
c) Cholangiocarcinoma
d) Pancreatic mass
b) Drugs
90
A 40 -year-old male patient presented by palpitation and dizzness. on examination hit pulse was irregular .The following could be a cause for his symptoms?
a) Mitral valvular disease
b) ischemic heart disease
c) Thyrotoxicosis
d) All of the above
d) All of the above
91
1- What is the most common complaint of a patient with myocardial infarction?
A. Breathlessness
B. Chest pain
C. Nausea/Vomiting
D. Syncope
B. Chest pain
92
2- Which of the following can change the presentation of myocardial infarction?
A. Diabetes mellitus
B. If the patient is male
C. History of previous myocardial infarction
D. History of Hypertension
A. Diabetes mellitus
93
3- Which of the following confirmed values meet the diagnostic threshold for diabetes mellitus?
A. Postprandial blood glucose 135 mg/dL
B. Fasting blood glucose 129 mg/dL
C. HBAIC 6.3%
D. Urine glucose +2
B. Fasting blood glucose 129 mg/dL
94
Which of the following is among the pathogenic mechanisms of hyperglycemia in type 2 diabetes mellitus?
A. Increased glucose production by the liver
B. Impaired insulin secretion
C. Insulin resistance
D. All the above
D. All the above
95
5. Which of the following is Not a cause of Jaundice?
A. Hemolytic anemia
B. Liver cell failure
C. Irritable bowel syndrome
D. Congestive heart failure
D. Congestive heart failure
96
9- Which of the following could be a side effect of spironolactone?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
C. Hyperkalemia
97
12- Which of the following does Not cause hematemesis?
A. Carcinoma of the stomach
B. Mallory Weiss syndrome
C. Rectal hemorrhoids
D. Peptic ulcer
C. Rectal hemorrhoids
98
13. Which of the following is the most common gastro-intestinal disease?
A. Peptic ulcer
B. Reflux esophagitis
C. Carcinoma of the stomach
D. Irritable bowel syndrome
D. Irritable bowel syndrome
99
14. Which of the following can be a complication of diabetes mellitus?
A. Peripheral neuropathy
B. Third cranial nerve palsy
C. Sixth cranial nerve palsy
D. All the above
D. All the above
100
20. An elevated reticulocyte count in the anemic patient indicates:
A. Hemolytic anemia
B. Iron deficiency anemia
C. Inappropriate response to treatment
D. Decreased erythropoietic response
A. Hemolytic anemia
101
23. Which one of the following does Not cause liver enlargement?
A. Congestive heart failure
B. Hemochromatosis
C. Helicobacter pylori infection
D. Hepatitis C virus infection
C. Helicobacter pylori infection
102
26. Obstructive jaundice is characterized by the following Except:
A. Generalized pruritus
B. Palpable gall bladder
C. Dark-colored stool
D. Xanthelasma
C. Dark-colored stool
103
28. The following organisms can cause traveler's diarrhea Except:
A. Escherichia coli
B. Brucella
C. Giardia
D. Shigella
B. Brucella
104
29. Mitral valve stenosis can cause the following Except:
A. Orthopnea
B. Hemoptysis
C. Diastolic murmur best heard at the apex of the heart
D. Diastolic murmur best heard at the left sternal border
D. Diastolic murmur best heard at the left sternal border
105
7. Which statement is correct regarding the first heart sound?
A. It is formed by closure of the aortic and pulmonary valves
B. It is formed by closure of the mitral and tricuspid valves
C. It is best heard at the left sternal border
D. It is loud in mitral valve regurgitation
B. It is formed by closure of the mitral and tricuspid valves
106
11. Which of the following is Not a cause of finger clubbing?
A. Chronic lung abscess
B. Acute bronchitis
C. Infective endocarditis
D. Bronchogenic carcinoma
B. Acute bronchitis
107
2. Which of the following is true regarding orthopnea?
A. One of the symptoms of right sided heart failure
B. It is dyspnea in supine position that is relieved or improved on sitting
C. It is dyspnea on standing
D. It is dyspnea on lying on the left side
B. It is dyspnea in supine position that is relieved or improved on sitting
108
3. Which of the following is correct regarding normal vesicular breath sounds?
A. Has hollow character
B. Is one of the auscultatory findings of consolidation
C. The length of inspiratory phase equals the length of the expiratory phase
D. No gap between inspiration and expiration
D. No gap between inspiration and expiration
109
Which of the following is correct regarding moderate ascites?
A. There is fullness of the flanks
B. Abdominal distension is mainly central
C. Hepatomegaly cannot be detected by palpation
D. Transmitted thrill is the best method to detect it
A. There is fullness of the flanks
110
23. Which of the following is Not a cause of flapping tremors?
A. Liver cell failure
B. Thyrotoxicosis
C. Respiratory failure
D. Renal failure
B. Thyrotoxicosis
111
9- Which of the following confirmed values meet the diagnostic threshold for diabetes mellitus?
A Fasting blood glucose 100 mg/dl
B. HBA1C 6.3%
C. Fasting blood glucose 129 mg/dl
D. All the above
C. Fasting blood glucose 129 mg/dl
112
19- Which of the following could be a precipitating factor for heart failure?
A. Thyrotoxicosis
B. Upper respiratory infection
C. Irritable bowel syndrome
D. All the above
A. Thyrotoxicosis
113
24. Which of the following could be a side effect of digitalis?
A. Bradycardia
B. Heart block
C. Ventricular extrasystoles
D. All the above
D. All the above
114
28-Anemia of chronic kidney disease characterized by:
A. Increased erythropoietin production
B. Decreased erythropoietin production
C. Macrocytosis
D. Does not respond to erythropoietin
B. Decreased erythropoietin production
115
30- Which of the following can be a cause of acute mono-arthritis?
A. Systemic lupus erythematosus
B. Osteoarthritis
C. Gouty arthritis
D. Psoriatic arthritis
C. Gouty arthritis
116
2) Choose the correct answer:
a In left sided heart failure cough produces frothy, blood tinged sputum
b) Cough is dry in acute bronchitis
c) Sputum is chocolate color in bronchiectasis
d) Lung abscess cause cough with expectoration of large amount of purulent sputum
a In left sided heart failure cough produces frothy, blood tinged sputum
117
The pain of stable angina is characterized by all the following except:
a) It occurs in the anterior chest.
b) It is referred to the shoulder.
c) It occurs with exertion and is relieved by rest after a few minutes.
d) It is sharp, localized, and increases with deep inspiration
d) It is sharp, localized, and increases with deep inspiration
118
8) Choose the correct answer regarding orthopnea:
a) Orthopnea is a symptom of right-sided heart failure.
b) Orthopnea is shortness of breath on exertion.
c) Orthopnea is a symptom of left-sided heart failure.
d) Orthopnea is shortness of breath that awakens the patient 2 hours after sleep.
c) Orthopnea is a symptom of left-sided heart failure.
119
One of the following does not cause liver cirrhosis
Hepatitis B
Hepatitis C
Hepatitis A
Alcoholism
Hepatitis A
120
25) Regarding Hemophilia: one of the following is incorrect:
25) Regarding Hemophilia: one of the following is incorrect:
a) Hemophilia A is an X-linked disorder.
b) Hemarthrosis is common in hemophilia.
c) Hemophilia A is due to factor VIII deficiency.
d) Hemophilia A is due to hereditary impaired platelet function.
d) Hemophilia A is due to hereditary impaired platelet function
121
10) Causes of dry cough include the following except:
a) Viral laryngitis
b) Angiotensin-converting enzyme inhibitors
c) Bronchiectasis
d) Gastroesophageal reflux disease (GERD)
c) Bronchiectasis
122
In chronic lung abscess, one of the following is incorrect:
a) Cough is dry.
b) Sputum is large in amount.
c) Sputum is of bad odor.
d) Cough and sputum increase by lying on the opposite side of the abscess.
a) Cough is dry.
123
12) Causes of dyspnea include the following except:
a. Pneumothorax,
b. Acute pulmonary edema.
c. Right sided heart failure.
d. Acute bronchial asthma. «-
c. Right sided heart failure.
124
Manifestations of left-sided heart failure include all the following except:
a) Paroxysmal nocturnal dyspnea
b) Lower limb edema
c) Orthopnea
d) Exertional dyspnea
b) Lower limb edema
125
Regarding ascites, one of the following is incorrect:
a) Ascites is a sign of hepatic failure.
b) Ascites precox occurs in mitral stenosis.
c) Ascites is a sign of right-sided heart failure.
d) Nephrotic syndrome is one of the causes of ascites.
b) Ascites precox occurs in mitral stenosis.
126
A 70-year-old patient with coronary artery disease is woken up two hours after sleep with dyspnea and a cough of pink frothy sputum. The most likely cause is:
a) Cardiac asthma
b) Pleural effusion
c) Pneumothorax
d) Bronchial asthma
Cardiac asthma
refers to wheezing and dyspnea caused by pulmonary congestion due to left-sided heart failure. The presence of pink frothy sputum is characteristic of pulmonary edema, often seen in patients with heart failure.
127
obstructive jaundice one of the following is incorrect.
a. Urine is dark in color.
b. Stool is pale in color.
c. Associated with pruritis.
d urine is normal in color.
Option d (Incorrect): In obstructive jaundice, urine is not normal in color; it is typically dark due to increased bilirubin levels.
128
Symptoms and signs of rt sided heart failure include all the following except:
a) Neck veins congestion
b) Lower limb edema
c) Hepatomegaly
d) Orthopnea
d) Orthopnea
129
Obstructive jaundice is characterized by
a) Elevation of indirect serum bilirubin.
b) Elevation of direct serum bilirubin.
c) Direct and indirect serum bilirubin are equal.
d) Normal total serum bilirubin.
b) Elevation of direct serum bilirubin.
130
9) Hemolysis is associated with all of the follow ing except:
a) Indirect hyperbilirubinemia.
b) Jaundice
c) Direct hyperbilirubinemia.
d) Low hemoglobin level.
c) Direct hyperbilirubinemia.
131
10) Diagnostic criteria of diabetes mellitus include
a) Fasting plasma glucose 126mg/dL or more. ♦
b) Plasma glucose 2hours after 75gm oral glucose 200mg/dLor more.
c) Glycosylated hemoglobin 6.5% or more.
d) All of the above.
d) All of the above.
132
Fever is diagnosed when:
a) Oral measurement is 37.2°C.
b) Rectal measurement is 36.6°C.
c) Rectal measurement is 37.0°C.
d) Axillary measurement is 37.4°C.
d) Axillary measurement is 37.4°C.
133
Regarding orthopnea which of the following is true?
a) It can be caused by abdominal obesity.
b) It does not improve with upright posture.
c) It improves with upright posture.
d) It improves on lying on the left side.
c) It improves with upright posture.
134
Which of the following statement regarding chest pain due to recent myocardial infarction is true?
a) Precipitated by exertion.
b) Not related to exercise.
c) Increased by deep inspiration.
d) Relieved by meals.
a) Precipitated by exertion.
135
0) Bleeding tendency can be caused by:
a) Thrombocytopenia.
b) Coagulation factors deficiency.
c) Liver cell failure.
d) All of the above.
d) All of the above.
136
Which of the following is a normal sign in the skin of a 60-year-old man?
a) Campbell de Morgan spots.
b) Paper money skin.
c) Spider nevus.
d) Striae rubra.
b) Paper money skin.
Paper money skin refers to thin, fragile skin often seen in aging but is not a normal sign.
137
Clubbing of fingers is a recognized sign in:
a) COPD.
b) Chronic non-specific colitis.
c) Primary biliary cirrhosis.
d) Rheumatic mitral stenosis.
Primary biliary cirrhosis can be associated with clubbing due to the chronic liver disease and its effects on blood circulation and oxygenation
138
7) Flapping tremors is a sign in:
A Liver cirrhosis.
b) Left sided heart failure.
c) Right sided heart failure.
d) Senility.
A Liver cirrhosis.
139
A patient with chronic hemolytic anemia usually presents with:
a) Change in color of urine.
b) Cyanosis.
c) Chest pain.
d) Dyspnea.
a) Change in color of urine.
Patients with chronic hemolytic anemia often present with changes in the color of urine due to the presence of hemoglobin or bilirubin from the breakdown of red blood cells, which can lead to dark or tea-colored urine
140
Hemoptysis may occur in:
a) Anticoagulation.
b) Chest wall hematoma.
c) Fractured rib.
d) Herpetic neuritis.
a) Anticoagulation.
141
Definitive pyramidal lesion is recognized clinically by:
a) Ankle clonus.
b) Hyperreflexia.
c) Hypertonia.
d) Pathological reflex.
d) Pathological reflex.
142
Hypoglycemia symptoms include:
a) Anorexia
b) Dry skin
c) Headache
d) Kinetic tumors
c) Headache
143
One of the causes of epigastric pain is
a) Anterior myocardial infarction
b) Diverticulitis
c) Gastrectomy
d) Diabetic ketoacidosis
a) Anterior myocardial infarction
144
Regarding secondary hypertension:
a) Constitutes the major causes of hypertension.
b) Suspected in heavy smoking men.
c) Usually associated with obesity.
d) Serum creatinine may be elevated.
d) Serum creatinine may be elevated.
