1- Scenario of Pt with HIV CD4 86 …..

CT brain image >>multi enhanced rings

Toxoplasma igG +ve and Toxoplasma igM –ve :
1- Hydatid
2- Leukoencephalopathy
3- Toxoplasmosis
4-
2- Scenario of pt with HIV presented by active TB
When to start antiretroviral drugs:
1- After 2 weeks
2- Continue both
3- Stop …..
4- ………
3- Scenario of pt after eating Oester shell >>>>> severe watery diarrhea
1- Vibrio parahemolyticus
2- Salmonella paratyphi
3- Campylobacter
4- ……
4- ADPKD >>> intra cranial hemorrhage due to aneurysm of:
1- Willis circle
2- ……..
5- Pt admitted as pneumonia TSH = 0.2 tT3 = 0.5 tT4= 186 mmol
1- 2ry hypothyroidism
2- Subclinical thyrotoxicosis
3- 1ry thyrotoxicosis
4- Sick euthyroid
6- Scenario of pt 60 y…… HTN 150/100 treatment
1- Amlodipine
2- BB
3- Thiazide
4- ……
7- Scenario of pt with Inf.MI + Bp 80/50 pulse 120 3hrs ago
1- Iv fluids
2- ……
8- Scenario of pt with Inf.MI + pulse 35 + Bp 90/60
1- Temp pacing
2- Permanent pacing
3- Iv atropine
4- ……..
9- Scenario of pt c/o face and upper part swelling + image CT abdomen
1- SVC obstruction
2- ………
10- scenario of pt with pneumothorax 15% what to do :
1- Chest tube
2- Aspiration
3- Observation
4- ……
11- scenario of shocked pt >>>>> fluid resuscitation >>> still shocked
What to do ?
1- Iv fluid
2- Dopamine
3- Dobutamine
4- …….
12- scenario of pt presented by chest pain ST elevation in V1 to V5 nitrate , ASA ,
O2, morphine given >>> still no improvement what to give to decrease mortality :
1- ACEi
2- BB
3- CCB
4- ASA

13- Scenario of pt c/o SOB, chest pain… CXR of RT side wedge shaped peripheral
opacity

What to do :
1- CTPA
2- MRA
3- Give Abs
4- ….
14- Pregnant woman 32 w with limited mobility c/o SOB chest pain how to Dx
1- D dimer
2- V/Q scan
3- CTPA
4- …..
15- Scenario of pt c/o irritability , sweating ecg

How to manage :
1- Amiodarone
2- Digoxine
3- Iv adenosine
4- ……
16- HNPC - Hereditary Non-Polyposis Colorectal carcinoma criteria:
1- Rome
2- Ranson
3- Besthesda
4- McDonald
17- scenario of pt with painful genital ulcer ..tender inguinal LN
1- HSV
2- CMV
3- ……..Chancre and chamcroid and lymph granuloma venerum and inguinal not
in options
18- Kaposi sarcoma feature :
1- Multiple blue …..
2- Maculopapular
3- Melanoic papule
4- ……
19- IE major criteria :
1- Fever
2- Immunologic
3- New regurge murmur
4- ….
20- Scenario of old female with peptic ulcer and colles Fx what to give
1- Ca
2- Ca and Vit D
3- Alendronate
4- Iv calcitonin + ca +vit D
21- Scenario of young pt had 3m frequent loose motion sometimes greasy … anemia
hypocalcemia hypokalemia … CT abdomen normal ,, stool culture and examination
negative for oocyte or organisms
1- Crohns
2- Lymphocytic enteritis
3- Coeliac disease
4- ……
22- Scenario of pt with MM treatment
1- Plasmapheresis
2- CST
3- Arabinoside
4- …..
23- Scenario of female pt with amenorrhea >>> progesterone no effect cervix exam is
irregular …. Pap smear cancer cervix
1- HPV 1
2- …….
24- drug induced fatty liver :
1- AZA
2- Cyclophosphamide
3- Ciclosporin
4- ….
25- Scenario of pt ….HBsAg +ve ..HBeAg +ve DNA = very high ..
Liver enzymes = high albumin low .. INR= 1.8 …Bilirubin high
Treatment :
1- Ribavirine
2- Iv interferon
3- ….
26- Scenario of Asthmatic pt diurnal variation expected :
1- 10% diurnal variation 3times / week
2- 10% diurnal variation 5times / week
3- 20% diurnal variation 3times / week
4- 20% diurnal variation 3times / week
27- Scenario of old pt presented by hemiplegia CT brain = hypodense area
1- ASA
2- Clopidogrel
3- Marivan
4- …
28- Scenario of young pt treated from cystitis presented by jaundice
Cbc = anemia … increase Retics … all LFTs = N
1- G6PD
2- ….

29- Stroke in AF without MS :

1- 10%
2- 2%
3- 8%
4- 15%
30- NSAIDs ulcer prophylaxis:
1- Misoprostol
2- PPi
31- Most common cause of cushing syndrome :
1- Iatrogenic
2- Ectopic ACTH
3- Pituitary adenoma
4- …
32- Scenario of asthmatic pt .. PEFR < 30% predicted .. Bp = 90/60 … Pco2 = N
Low Po2 … tachycardia RR = 30
1- Brittle asthma
2- Life threatening asthma
3- Near fatal asthma
4- Sever asthma
33- Scenario of obese pt c/o sleep disturbance .. headache morning BMI = 43
1- Night polysomnography
2- ….
34- Scenario of pt OSA .. BMI= 34 .. polysomnography = 34% …. Wt loss advised
next :
1- C-PAP
2-

35- Scenario of pt work in market for pets presented by SOB fever apical lung
infiltrate
1- Hypersensitivity pneuomonitis
Other choices not cause apical lesions

36- Scenario of pt with ascites … paracentesis S.albumin=30 …Ascitic albumin=15

Ascetic wbc =210
1- Liver cirrhosis
2- Malignant
3- Purulent
4- …..
37- Scenario of pt with ascites and abdominal pain ….paracentesis
Wbc>250 SAAG> 1.2
1- SBP
2- ……
38- Scenario of COPD pt >>>> flight test :
1- Methacholine challenge test
2- I don’t remember rest of choices sorry

39- Scenario of pt c/o morning stiffness 45 min … AntiCCp +ve

1- RA
2- ….
40- Scenario of RA pt …initial treatment :
1- NSAIDs
2- Methotrexate
3- …..

41- Scenario of renal disease with low complement level :

1- 1ry MPGN
2- ….

42- Scenario of old female T score -2.1 :

1- Raloxafine
2- Alendronate
3- Alcitonin + ca + vit d
4- ….

43- Scenario of pt c/o temporal headache and tender temporal area

1- CST
2- Temporal biopsy
3- ……
44- Scenario of pt with infection …. Culture = MRSA
1- Vancomycin
2- Amoxicillin
3- …..

45- Scenario of pt c/o chest pain fever , SOB , dry cough ,

Culture = G+ve cocci in chains
1- Strept. Pneumonia
2- Staph. A
3- H.influenza
4- ….

46- Scenario of pt 56 y conscious , Bp high , RR 29 ,, urea 8 mmol

1- Macrolide
2- Resp.quinolones
3- Iv Blactam + clarithromycin
4- …..

47- tinea saginata treatment :

1- Praziquental
2- Albendazol
3- Niclosamide

48 - A patient with Graves' disease, after subtotal resection of her thyroid

gland, she develops
tachycardia and fever, HR 150/min, T 39, treatment:
1- Steroids + PTU
2- Steroids + PTU + Propranolol
3- PTU + Propranolol + Iodide
4- Steroids + PTU + Propranolol + Iodide

49- Long scenario about a patient with Hyperthyrodism, during appendectomy

she develops
tachycardia, diaphoresis, fever and tremor, management all right EXCEPT:
A- Iodide C- Hydrocortisone
B- Thiamazole D- Aspirin

50- Long scenario about a patient with Macroprolactinoma doesn’t press the
optic chiasm, the
best management is:
A- Transsphenoidal surgery C- Bromocriptin
B- Somatostatin analogues D-….
51-60 years old patient has Creatinine: 7 mg/dl , Urea: 120 , Hb: 7 mg/dl,
what's the cause of
anemia:
A- Erythropoietin deficiency C- Uremia
B- Iron deficiency D- …

52- Long scenario about 60 years old patient has CKD treated by dialysis
from 5 years, complains
of numbness in both hands and bilateral pain in 2-3-4 fingers, diagnosis:
A- Carpal tunnel syndrome C- B2 microglobulin amylodosis
B- Proximal arteriovenous access D-…

53- Long scenario about 60 years old patient has CKD treated by dialysis,
during the dialysis he
develops hypotension, Bp 80/40 with severe fatigue, the most appropriate
management is:
A- Stop dialysis and infuse normal saline
B- Continue dialysis, this is normal side effect
C- Stop dialysis and do CXR & ECG D-…

54-All are right EXCEPT:

A- Ventilation / Perfusion mismatch is the leading etiology in respiratory
diseases
B- Alveolar arterial gradient helps in ventilation capacity evaluation
C- We don’t use bronchoalveolar lavage routinely in respiratory illnesses
evaluation
although it's helpful in diagnosis
D- …… E-……..

55- Pulmonary Fibrosis, one is right:

A- We don’t use pulmonary biopsy routinely in diagnosis
B- Asbestosis usually affects the upper lobes
C- … D-…..

56- Which one is a cause for eosinophilic pneumonia:

A- Aspergillosis C- Hemosidrosis
B- Lofgran syndrome D-….

57- All about aspergillosis is right EXCEPT:

A- Prick skin test is positive C-….
B- The biopsy shows septate hyphae D-….

58- 60 years old patient with DM, complains of productive cough accompanies
with fever and
dyspnea, the best treatment:
A- Itraconazole C- IV voriconazole
B- Corticosteroids D-…
59- 50 years old patient, has productive cough, urine test shows haematuria
plus proteinuria,
CXR shows bilateral infiltrations, the next step:
A- Pulmonary biopsy C- Renal angiography
B- Renal biopsy D- RF

60- 20 years old patient develops albuminuria and haematuria after 1 day of
upper respiratory
infection, the predicted pathophysiologic finding is:
A- Diffuse mesangial proliferation

61-Long scenario about 30 years old patient, Bp in the upper extremities

160/100, in the lower
extremities nonmeasureable, diagnosis:
A- Coarctation of aorta C-…..
B- Abdominal aortic dissection D-….

62- Question about Homocysteinurea, all right EXCEPT:

A- We have to exclude it in all patients with ACS C-…
B- It may cause Stroke D-…

63- 20 years old patient has asthma taking Inhaled corticosteroids plus
bronchodilator, comes to
you complaining of dyspnea repeated daily from one week ago, you put them
on
prednisone 30 mg daily for 14 days plus his inhaled medications, after 2
weeks he comes
with his recorded PEF ( there is a chart resemble this chart), the next step:
A- Increase the dose of prednisone and continue inhaled medications
B- Increase the dose of prednisone and increase the dose of inhaled
medications
C- Stop prednisone and increase the dose of inhaled medications
D- Stop prednisone and continue inhaled medications

64- 20 years old patient, alcoholic, complains of dyspnea with productive

cough from 2 weeks,
CXR (there is an image) shows pulmonary density in the right middle lobe, the
organism that
responsible for symptoms is:
A- Staph. Aureous C- Anaerobic
B- Nocardia D- Bacillus anthrosis

65- The best management for exercised induced asthma:

A- SABA C- ICS
B- LABA D- cromolyn
66- Long scenario about 15 years old patient with severe polyuria, MRI shows
craniopharingioma, all of the following is expected to find in the patient
EXCEPT:
A- Short stature C- Hypothyroidism
B- Delayed puberty D- Hyponatremia

67- All of the following cause Hypocalcaemia EXCEPT:

A- Hypoparathyrosism C- Graves disease
B- Pseudohypoparathyrodism D- Hypomagnesemia

68- Long scenario about a patient has bone pain in the back, radiographs
show pseudo fractures,
what do you expect to find laboratorially in the blood:
A- ↑Ca + ↓P C- ↓Ca + ↓P
B- ↑Ca + ↑P D- ↓Ca + ↑P

69- All of the following are right in cryptorchidism EXCEPT:

A- It increase the risk of malignancy
B- Testes may descend to the scrotum spontaneously
C- The best time to do surgery in age 10 years

70- Long scenario about a patient comes to the ER with adrenal insufficiency
symptoms,
management:
A- IV normal saline
B- Hydrocortisone
C- Draw blood for cortisol and ACTH
D- A & B E- A, B & C

71-30 years old patient, complains of dysphagia for both solids and liquids,
barium swallow
(there is an image) shows oesophagus dilation with tight LES, best treatment:
A- Surgical myotomy C- CCB
B- Botulinum toxin injection D- Nitrates

72- Helicobacter pylori, all right EXCEPT:

A- Gram-negatives bacilli
B- Located in duodenum and gastric mucosa
C- Eradication therapy causes completely recovery of the ulcer
D- Treatment include clarithromycin plus tetracycline plus bismuth

73- Alcoholic man complains of epigastric pain spreads to the back, the most
laboratory finding
related to acute pancreatitis is:
A- Elevation of Amylase C- Elevation of ALT,AST
B- Elevation of Lipase D-…

74- All are risk factors for acute pancreatitis EXCEPT:

A- Age < 55years C- LDH < 350
B- AST < 250 D- Amylase < 800

75- The most common liver tumor is:

A- Hamartoma C- Hepatocellular carcinoma
B- Hemangioma D- Metastasis

76- Patient has HBsAg +, HBeAg +, Anti HBc IgG +, ALT & AST normal, the
next step:
A- Lamivodine C- HBV.DNA
B- Review the patient after 3 months D-…

77-Another question about MM:

A- It causes CKD due to hypercalcemia, secondary amyloidosis and direct
toxic effect
B- Extramedullary plasmacytomas, that consist of soft tissue masses of
plasma cells are not
common.
C- ……. D-……..

78- One of the following predisposing factor related to cancer:

A- Fishing……………….. testis cancer
B- Tanning ……………… skin cancer
C- Radiologist …………. Bone cancer D-……
d- varnishing and dye factory ------------leukemia
e- farmer -------------lung cancer

79- A question about spleen function:

A- Blood cells Phagocytosis

80- All of the following causes PT prolongation EXCEPT:

A- Factor 9 deficiency B- Warfarine toxicity
B- Vit. K deficiency D- Factor 12 deficiency

81- 20 years old female patient, during a party feels very tired, brought by her
friends to the
hospital, In the hospital she develops generalized tonic clonic seizure, the first
line therapy is
A- Phenytoin C- Haloperidol
B- Diazepam D- Sodium Valproate
82- 60 years old patient, previous uncontrolled DM, complains of left
Hemiplegia develops from
90 min. Bp: 160/95, P: 88/min
Brain CT (there is an image): large right parietal and temporal infarction.
Management:
A- rTPA C- Nitrate
B- Aspirin D- Clopidogrel

83- 40 years old female patient, complains of episodes of diplopia, vertigo,

sight loss in the right
eye reverse spontaneously, spasticity in the left leg. Diagnosis:
A- Basilar TIA C- Myelopathy
B- MS D- …

84- 50 years old patient, complains of episodes of chest pain during rest
associated with ST
elevation regress spontaneously. The appropriate management:
A- Aspirin C- Beta Blockers
B- Nitrates D- Cardiac Catheter

85- 30 years old female without previous illnesses or current symptoms

comes to do routine
check-up, The Examination shows midsystolic murmur best hear in mitral
area, diagnosis:
A- Mitral Stenosis C- Mitral Valve Prolapse
B- Aortic Regurgitation D- HCM

86- 60 years old male patient who has chronic mitral regurgitation, No current
symptoms, No
medications, heart ultrasound shows: pulmonary artery pressure 50 mmHg,
LV diameter 40
mm, the best treatment:
A- ACEi C- Valvuloplasty
B- Beta Blockers D- no need for treatment

87- 60 years old patient complains of fatigue, ECG ( there is an ECG in the
case) shows complete
AV block, the best treatment:
A- Atropine C- …
B- Pacing D- …

88- All of the following are causes for Aortic Regurgitation EXCEPT:
A- Infective endocarditis C- Ankylosing spondilitis
B- Marfan D- Aortic dissection
89- All of the following helps to distinguish between Hemophilia and
Vonwillbrand disease
EXCEPT:
A- Bleeding time C- VW levels measure
B- Platelets function studies D- PTT prolongation

90- All of the following causes non palpable purpura EXCEPT:

A- ITP C- HUS
B- TTP D- HSP

91- All of the following about MM right EXCEPT:

A- There is an elevation in plasmic cell counts in the peripheral blood smear
B- It causes punched out lesions in 70% of cases
C- B2 microglobulin measurement has a strong prognostic value
D- Alpha interpherone usually causes remission

91- Female, 60 years old, complains of right knee pain increases during
walking. Clinical
examination shows mild enlargement. Synovial fluid shows WBC: 2000, No
crystals.
Diagnosis: A- Osteoarthritis B- Rheumatoid Arthritis
C- Rheumatoid Fever D- Reactive Arthritis

92- Lupus Nephritis classification, One right:

A- Class 2 treated by Corticosteroids
B- Class 3 treated by Corticosteroids plus Cyclophosphamide
C- Class 4 has the worst prognosis
D- Class 5 is reversible with treatment

93- In Rheumatoid Fever, Rheumatoid Heart disease develops in:

A- 20% C- 40%
B- 30% D- 50%

94- All are causes for Budd Chiari syndrome EXCEPT:

A- Alcoholic liver disease C- TPN
B- Oral contraceptives D- PN

95- All are causes for increase urine bilirubin EXCEPT:

A- Hemochromatosis C- Cirrhosis
B- Primary Sclerosing Cholangitis D- Gilbert

96- The Pathophysiology of Guillain Barre is:

A- Demyelinating polyneuropathy
B- Motor Axonal Neuropathy
C- Pan autonomic Neuropathy D-……

97-Acase of trauma with disturbed concious level , unequal pupil the dx is

Subdural Hge
Extradural Hge
Subarachnoide Hge
Intracerebral He

98-Patient with ischemic heart disease he was treat from depression suffer
from confusion and generalized oedema which drug caused it
Digoxin
Amiodarone
Antidepressants I can't remember it

99-Patient with dry cough, fever,arthritis, mylagia, dullness lower rt

lung,diminished breath sounds on lower rt lung,CXR showing opacity lower
lung zone what is the causitive organism
Ligionella
Strept pneumoni
Mycoplasma
Staph aureus

100-Patient with fever , neck rigidity, headache CSF show low glucose , high
protein ,increased polymorph what is the cause
Fungal minigitis
Acute bacterial minigiti
Viral minigitis
T.b minigitis

101-Acase hepatitis bsag +ve,hbeag+ve., antihbc IgG+ve normal

transaminases
What to do next
No thing
HBVDNA
Abd us
Biobsy

102-Ecg show inferior wall MI Bp 60/40 what to give

Strept
Iv fluid
Asprin

103-ECG show svt pt stable Bp100/70 what is the appropriate managment

1amiodarone
2adenosine
3digoxin
Dc shock
104-A 35yearold gentleman attends the renal clinic with weight gain and shortness of
breath. Laboratory results show a low albumin, raised cholesterol and urine dipstick
shows 3+ protein.
What is the minimum value of protein:creatinine ratio that would be classed as
'nephrotic range' from the answers below?
(Please select 1 option)
50 mg/mmol
100 mg/mmol
200 mg/mmol
250 mg/mmol
300 mg/mmol

105-A 25-year-old woman with a history of end-stage renal disease secondary

to focal segmental glomerulosclerosis presents to the Emergency
Department. For the past 12 months she has used Continuous Ambulatory
Peritoneal Dialysis [CARD). She feels generally unwell with abdominal pain
and a fever. She also describes her last bag as being cloudy'. Which
organism is most likely to be responsible for this presentation?
O Streptococcus pyogenes
O Enterococcus
O Staphylococcus epidermidis
O Streptococcus agalactiae
O Escherichia coli

106-What is the BP target for a patient with urinary albumin/creatinine ratio

≥70 mg/mmol?
<160/90
<130/80
<140/80
<150/90
<110/70

107-Patient recieve ttt of atrial fibrilation then suffer from cough and flushing
which drug cause this:
Amiodarone
Propranolol
Flecanides
Digoxin

108-Kowarskof encephalopathy
Cerebral atrophy
Cerebellar atrophy
Mammary body atrophy
Central pontine mylenolysis

109-Case of cystic fibrosis ask about most ominius complication

Corpulmonal
Sinusitis
PulmonaryHTN
110-AS regard long term use of short acting B2 agonist
Palpitation
Tremor
Anxiety

111-Peripheral neuropathy
INH
Rifampicine
Ethambutol
Pirazinamide

112-Type 1DM since 18 year on NPH insuline which drug decrease mortality
Captopril
Propranolol
Asprine
Metformin

113-Asthmatic patient with short of breath dyspnea FEV1 less than 30 chest
wheeze x_ray normal he took short acting B2 agonist and corticosteroids
inhaler what to do
Oral steroid
LABA inhaler
Increase dose of steroid inhaler
LABA Tab

114-Pt dysphagia to solid and food ttt

Nifidpine
BOTOK
SURGERY

115-18y patient with heavy proteinuria, hyperlipidemia renal biopsy minimal

changes GN what true
a- ARF most likely occur in acute phase
b- ttt by steroid and cyclophosphamide
c- Most of cases show spontaneous remission

116-Scenario of pt after eating Oester shell >>>>> severe watery diarrhea

1- Vibrio parahemolyticus
2- Salmonella paratyphi
3- Campylobacter
117- Scenario of young pt had 3m frequent loose motion sometimes greasy
… anemia hypocalcemia hypokalemia … CT abdomen normal ,, stool culture
and examination negative for oocyte or organisms
1- Crohns
2- Lymphocytic enteritis
3- Coeliac disease
118-Acase with severe coarctation of Aorta above level of ligamentum
venosum.which valvular lesion could be found.
Aortic stenosis
Pul stenosis
Mitral regurgitation
Not remember

119- Fluid in proximal convoluted tubules

Isotonic
Glucose not reabsorbed

120-Tip of the nose innervated by branch:

Ophthalmic
Trigeminal
Maxillary

121- Best treatment of frost bite?

Nerve block
Lidocaine + epinephrine
GA mimic…….. NPL

122- Median nerve

Supplies thumb, index, middle finger
Supplies adductor pollicis

123-Patient aged 59 y presented with severe backache. XRAY skull show

osteolytic lesions.lab.s ALP high s ca (honesty can't remember but mostly was
normal)
What diagnosis
M.M
PARATHYROID ADENOMA
PAGET DISEASE

124-Case presented with progressive shortness of breath.dry cough.onexam

Finger clubbing.end inspiratory crackles
CXR show honey comb appearance
Ask about most appropriate ttt
A:
Heart -lung transplantaio

125- Common cause exacerbate thyrotoxicosis.Options

A..infection
B..subtotal thyroidectomy
C..
D..can't remember
126-Diabetic patient 18 y ago ,blood glucose well controlled what adding
measure can reduce long term morbidity???
A.ACEis

127-Indication of surgery in RAS,? (renal artery stenosis)

A.CHF
B.impaired renal function
C.Anaemia
D. Can't remember

128- A case of confused pt. Dcl, s. Na 123, all lab are normal and BP is
normal.
Inv: MRI. Brain
Dx: SIADH
Ttt: hyper tonic saline

129- Long case pelvic inflammatory disease best treatment

130. Bactrim meningitis best treatment

131. Blood film type of malaria

132. Blood film sickle cell anemia and case of arthritis in it ask about
mechanism of arthritis

133. Ecg and case complaining of generalized fatigue has rf …..cause of

fatigue. ..ecg show hyperkalemia

134. Case pulmonary embolism ask about management

135. Pregnant woman with suspected p.e investigation done …d dimer…ct

angio ….mri …diffusion perfusion ratio

136. Anti tuberculosis drug cause macula papular rash

137. Type of glomerulonephritis caused by hcv and hbv

138. Patient on halopridol and hyperpyrexia and muscle rigidity …malignant

neuroleptic syndrome

139. Patient hiv and develop hest infection and chest x ray of milliary tb what
to do for diagnosis tuberculin test negative
140. Head trauma with scalp contusion and laceration unequal pupil ct brain
show lens shaped extra axial hyper dense opacity with midline shift
a- subdural
b-extra dural
c-subarachnoid

141. End stage cancer with obstructive jaundice best management

142. Ptn on metformin atorvastatin frusamide and atenolol ….this question in

Saber notes

142. Infective endocarditis blood culture reveals. ......forget the organism best
drug used
143. Infective endocarditis effect on the eye ...roth spot.

144. Drug therapeutic and side effect chart ....what is the drug cause .

145. Ptn has dudenal ulcer .helicopter + .....treatment

146. Polyp cauliflower in shape detected at stomach has tyrosine kinase

sensitive receptors not sure !! Management excision ,follow up , ppi .....

147. Image showing infection at thigh after minor trauma ask about diagnosis
if necrotizing fasciaitis, erysiplas, cellulitis

148. Ptn complaining of manifestation of corpulmonale ask about treatment

149. Meld criteria of transfer for liver transplant center

150. Ptn has adisson's disease her mother was coplaining if mexoedema.....in
crisis best treatment

151. Chest x ray in admitted patient for pneumonia cap that treated for 7
days now develop fever shortness of breath ..cxray show obliterated angle on
side of pneumonia? ?what to do .....repeat antibiotics course .sampling to
exclude empyema and chest tube with pleomycin intrapleur

151. Wernicks kowarsakoff is due to mamillary body lesion

152. Case of Malabsorption syndrome diagnosis by ..antiendomyosial ab

153-wide mouth meckels diverticulum is found accidentaly on laparotomy.

What will be t/t of choice -
A. Resection of diverticulum
B. Leave as such
C. Ligate at base
D. Resection with part of ileum

154 -pt has chest pain +sweaty

ecg st elevation v1_v4>>>>>>mi

155-pt 60 age has mitral valve replelecment want to dental procedure allerge
to pencilline how to prophylaxis
1 no treatment
2-600 mg clindamycine before an houre
3-600 mg clindamycine just before the procedure
4-600 mg clindamycine before an houre and after six hours

156-pt treatment for duodenal ulcre by triple therapy for 2 weeks after that
stool test didnot erredicated what to do
1-stop all medication and procedure culture and sensetivity
2-repet the treatment for 2 weeks
3-i dont remember

157- SICKLE CELL ANEMIA PATIENT IF MARRIED A NORMAL PERSON

POSSIBILITY OF SICKLE ANEMIA AND TRAIT 0 and. 100 100 AND 0
25 AND 50
50 AND 50

158- case symptos tachy cardia lid lag tsh low t4 high and has swelling in
neck>>>geaves
159- case about pt has tsh low t3 low t4 high and has intensive care.>>>>sick
euthiroid
160- obese pt with high blood suger >>>metformin

161-pt has fatigue about 2 months within aweek has a rash on examination
pollar +rombereg sign positive tests low hemoglopin low wbc anb low plt how
to confirm the dignosis
1-bone marrow biopsy
2-donq serology
3-serum b12
4-b12 and b9

162- Drug induced lupus

Occurs less in slow acetylators
Occurs more in slow acetylators
Not reversible on stopping the offending drug
163- Case of drawning, DCL, Vitally stable.
TTT: tube and suction, c-pap, correct electrolytes na, k,

164-Case of extensive erosive peptic ulcer not responding to ppi

Diag: gastrinoma

165- Case of refractory profuse reflux. No relief with ppi,

Pt. Asks about validity of fundoplication operation
Q is. What gives the best predictive outcome of success of op.
No good response to ppi for many years
Presence of metaplasia and Barriet eosopheus
24h lower eosph. PH

166 – pneumonia case with low NA cause :

Legonila_
strept_
staph

167-Senaro female take med 4 RA ...came with chest pain...normal ecg

1 .MI...
2 .angina...
3.reflux oesophgitis...
4.pils oesophgitis

177- Most common cause of lung cancer?

Smoking. .
.industrual...
asbestosis

178-1st choice in breast cancer ttt

cyclophosamid
Imantib
trastuzumab

179- Which of the following sign is the feature of both erythema

multiform minor and erythema multiform major(Steven Johnson
syndrome) ?
a) Target or iris type lesion
b) Mucus membrane involvement
c) Conjunctiva involvement
d) Involvement of esophagus and palate
180- years old male developed fever for 2 weeks. Cough +SOB is also -3
present for the same duration. On examination ↓ vocal fremitus in the
lower chest, percussion note is dull in the same region. What is your
diagnosis?
a) Consolidation
b) Collapse of the lower lope
c) Pleural effusion
d) Pericardial effusion

181- a lady presented with secondary amenorrhea. Prolactin,,, FSH, LH, and
Testosterone all normal .estradiol (70 little bit low) normal value given (75)..
U/S showed 3-4 ovarian cysts what is the cause
A. Primary Hypothyroidism
B. P.C.O
C. Hypothalamic pituitary dysfunction
D ovarian failure

182-Well controlled Rheumatoid arthritis with indomethacin presents with

knee swelling tenderness.After arthrocentesis what is the next
See for uric acid crystals in microscopy
Increase the dose of indomethacin
Blood culture
Final answer

183-Female patient presents with post-operative oliguria, RFT normal , what

is next step :
a. abdominal us
b.DMSA scan
c.IV fluid

184-In an 80 year old man, which of the following is the least likely symptom
of hyperthyroidism?
A. confusion
B. Weakness
C. Syncope
D. Tremor
E. Atrial fibrillation

185- Alf is a 56 year old farmer who presents with a 3 week history of
increasing pain in his left hip. The pain persists through the night and does not
respond to paracetamol. Alf also reports several weeks of pelvic discomfort
and a recent episode of haematuria. Which of the following is the most
appropriate initial investigation for Alfs hip pain?
A. Plain Xray
B. Magnetic resonance imaging MRI
C. CT lumbosacral spine
D. Bone scan
E. Gallium Scan

186- Aboroginal female bring her husband with small joint pain with signs and
symptoms of Rheumatoid Arthritis. What will be the treatment for him ?
a. Aspirin
b. Amoxycillin
c. Paracetamol
d. Hydrochloroquine

187- Pt diagnosed with AIDS before 6 months on ribavirin developed severe

loin pain with hematuria..his urine showed +++RBC asking for investigations
-triple phase ct scan
-non contrast ct scan
-abdominal x ray
Us

188- Someone who travel to Thailand and take complete prophailaxis for
malaria inane all precautions
A) check for antigen and thick smear
B) check for hepatitis a

189-Cardiac catheterization is about to get start , what can prevent contrast

nephropathy ?
1) Iv fluids before procedure
2) IV fluids before and during procedure
3) IV fluid during and after procedure
4 ) IV fluids after procedure

190- what is the most accurate diagnostic test for wilson disease?
1-liver biopsy
2-urinary excretion of copper after penicillamin

191- a patient with swelling painful right hand second MCP ..what is the most
likely diagnosis ???
1- gout
2- pseudogout
3- OA
4- reactive athritis
5- RA

192- Long case scenario of presentation ol adrenal tumour with sever

hypertension and papilledema what is mangment of hypertension
1-phentolamin
2-hydrocortisone
3-beta blocker
4-------can't remember

193-Pulm hypertension considered

1-15%
2-20%
3-25%
4-30%

194- Along case senrio of patient develops presentation of acute liver cell
failure after drugs and history of rheumatic disorder
1- acetaminophen
2-allopurinol
3- zoviudin
4-cyclosporin

195- Best diagnostic ol solitary thyroid nodule

1-fine needle aspiration biopsy
2- t3- t4- tsh
3-tsh stimulus tes

196-Headache now&-history head trauma since a week and he was free

1-SAH
2-extradural h
3-subdural h
4-intracerebrally

197-Mid systolic click followed by murmer of mitral regurge

1-mitral valve p

198-ECG of Lt vent h with strain &if you do echo what you found
1-Lt vent dilat
2-rt vent
3-pulm art dilt

199- ECG of VT with WPW, Rx?

A IV adenosine
B digoxin
C IV sotolol
D carotid sinus massage

200-A 75yr old man has just undergone bioprosthetic aortic valve
replacement. He has atrial fibrillation. He is hypertensive as well. On
examination no cardiac failure and rest of CVS examination is normal. What
will you choose for anticoagulation for him?
a. Warfarin
b. Asprin and clopidogrel
c. clopidogrel alone
d. warfarin and asprin

201-Someone who travel to Thailand and take complete prophailaxis for

malaria inane all precautions
A) check for antigen and thick smear
B) check for hepatitis a

202-A 60-year-old engineer who was previously well was found collapsed on
the floor. When he was admitted, examination revealed weakness of the right
side of his body, with his arm and face more severely affected than his leg,
and severe aphasia.
What is the most likely diagnosis?
A tumour of the left cerebral hemisphere
A tumour of the left thalamus
An occlusion of the left anterior cerebral artery
An occlusion of the left middle cerebral artery
An occlusion of the right anterior cerebral artery

203-x ray of Bambo spine in ankylosing spondylitis case asking better

management after paracetamol
a) ant physiotherapy
b) methotrexate
c) cortisone
d) sulf

204-Old man with a fracture between t8 n t10 showing increased uptake on X

ray. Labs were given with Anemia n very high ESR. What is the next
investigation.!
!
a. plasma electrophoresis!
b. PSA

205-Pt of DM, HTN, Peptic ulcer and Osteoarthritis came to you. For arthritis
he took NSAIDs, but no improvement. What will you prescribe him?
a. Etoricoxib
b. Prednisolone
c. Methotrexate

206-Ankylosing spondylitis known case, how to manage pain not responding

to paracetamol?
A) Sulfasalazine
B) Methotrexate
C) Steroids
207-Old age female with IHD on thyroxine, 75 mcg
Lab showed hypothyroidism, highTSH and low T3 and T4
What is next?
Increase thyroxine to 100
Keep the same dose
Decrease thyroxine

208-32 ys old f bmi32 , she used to b obese , she denies any change of her
obesity , came with irregular cycles , 5-6 /year . what is ur diagnosis :
a-pco
b-hypothyroidism
Nice Q

209-Young couple comes to you. The husband has history of Rheumatoid

Arthritis. He is on methotrexate and sulfasalazine. They planning on starting a
family. What will you advise?
A) Continue methotrexate stop sulfasalazine
B) Continue both methotrexate and sulfasalazine
C) Stop both methotrexate and sulfasalazine
D) Stop methotrexate continue sulfasalazine

210-Scenario of a lady with splenomegaly and rash on the legs

thrombocytopenia, borderline anemia and leucocytes decreased also hb 11
wbc 4000 plat 50000, complaining of fatigue past few months, diagnosis
sle
itp
hsp
aplastic anemia
AML

211-14 years old female with body mass index 32, complaining of tirdness.
She had menstruation at age of 12 and menses are regular. She has dark
pigmentation on back of her neck and axilla (this sentence was repeated twice
at the start and end of the scenario). Her grandmother has type 2 DM.
diagnosis?
A- Cushing disease
B- Addisson disease
C- Hypothyroidism
D- PCO
E- Metabolic syndrome

212-65 Pt with abdominal Pain with CT done suprarenal mass 5 cm wt to do

1 biopsy
2 partial nephrectomy
3 total nephrectomy
4 mibg
213-ECG about HEART BLOCK, last night found collapse in garden, brought
by her daughter to you. Hx of heart disease,hypothyroid hx, DM, temperature
was 34.3 deg. What was the cause of his collapse?
a) Acute myocardial ischamia
b) hypothyroidism
c)hypothermia

214-A 23 year old woman sees you with a new diagnosis primary ovarian
insufficiency. In addition to obtaining a karyotype, what other genetic test
should be done?
A. Bone morphogenic protein-15 (BMP15) mutations
B. Fragile X premutation
C. FSH receptor mutations

215-Each one of the following is a cause of sterile pyuria, except:

o Renal stones
o Membranous glomerulonephritis
o Renal tuberculosis
o Chlamydia
o Appendicitis

216-A 72-year-old man presents with gradually increasing shortness-of-breath

on exertion over the past six months.
He stopped smoking around 20 years ago and had a number of jobs including
a builder and miner when he was
younger. On auscultation of his chest fine crackles can be heard in both
bases. Oxygen saturations are 95% on
room air.
A number of tests are arranged:
 spirometry: normal
 chest x-ray: diffuse reticular shadowing suggestive of fibrosis affecting the
lower zones. Heart size
normal.
What is the most likely diagnosis?
A. Extrinsic allergic alveolitis
B. Histiocytosis
C. Asbestosis
D. Silicosis
E. Coal worker's pneumoconiosis

217-A preliminary diagnosis of extrinsic allergic alveolitis in a 55-year-old

man. Which one of the following features would most support this diagnosis?
Clubbing
Eosinophilia
Cyanosis
Fibrosis in the upper zones
History of working in the steel industry
218-Best ttt of o bstructive sleep apnea bmi 40 po2 90%
Weight reduction
cpap
Oyxgen therapy

219-Hyperkalaemia ttt ECG

220 -Inf mi and complete heart block ttt

Atropine
Pacing

221-SCD asked about bone pain

bone infarction or
arterial embolic crisis

222-nurse has reported pin prick on a ward of chronic viral illness requests a
serology done which would
you prefer
HBsag – negative
HBsab – positive
HBcag – negative
HIV – Positive

223- The most common cause of lung abcess

224-Severe pl. Effusion best intial ttt

225 - O.J. with ACC best intial ttt

Cholestectomy
ERCp
MRCP
IV AB

226-mechanism of loop of henele

hupomagnasemia
hypouracemia
pseudoaldosteronism

227-Causes lymphoma plasmacytoma

HPV8
H.Pylori

228-hyponatraemia , low normal k normal osmolarity

SIADH
Addison
hypothyroidism

229-cancer related to occupation

230-ttt of DN stage 2

231-ttt of mask prolactinaemia

232 -pnemonia with low TSH and low t3 and high t4

233-TTT Of trigeminal neuralgia

234- ttt of tonic clonic seizrur

235-idiopathic intracranial HTN NEXT STEP

236-TTTof metastatic breast cancer

237-giant cell arteritis best initial tt

238-DX of sarcoidosis

239-mycoplasma pnemonia how to confirm

240-Adenosine inhibitor
Imatimib
Clopidogrel
Alpha interferon

241- Pneumonia CURB65. 1 best ttt

Macrolide
Iv vancomycin

242-COPD and attack of haemetemesis best invx

243-Best indicator of primary hyperparathyroidism

ALp
Ca
PO4
244- A 25-year-old man explains that he has experienced episodes where he
is unable to move just before onset of sleep, and just after waking. Each time
it occurs it leaves him feeling frightened and anxious. It is sometimes
associated with visual disturbances.
What is the most likely diagnosis?
Panic disorder
Sleep paralysis
Periodic paralysis
Night terrors
Frontal lobe epilepsy

245 – paptic ulcer in strock patient

PPI
MESOPROSTOL
Randitene

246- ttt of T2 DM stage 2 retinopathy-

247-ttt of marco prolactinaemia trail of bromocripten

248-ttt of tonic clonic seizures:diazepam

-
249-idiopathic intracranial HTN NEXT STEP :ct brain or LP
-
250-TTTof metastatic breast cancer:trustuzumab

251- giant cell arteritis best initial ttt CSt or temporal biopsy-
-
252-DX of sarcoidosis CXR

: 253-mycoplasma pnemonia how to confirm DX

Direct coomb'test

254-SVTwith unstable pt bp 80/50 best ttt

255-Best ttt of o bstructive sleep apnea BMi 40

po2 90%
Weight reduction
cpap
Oyxgen therapy

256-Staging of oesphageal adenocarcinoma related to mucosa best ttt

257-male pt with inguinal LN AND axillary LN enlargement and night sweats
loss of weight
NHL
HL
TB

258-Dysphagia +failed ttt of h.pylori best next step

endoscopy after8 weeks
Ouadrable therapy
Urea breath test again or
Stool antigen and serology for h.pylori

259- TTT of neoplastic cold nodule

radioiodine
radiotherapy
total thyrodictomy

260- stroke 3 days with 300 ASA next

clopidogril
thrombolysis

261-tt of extradural hge due to accident

manitol
neurosurgery
consultation
neurosurgery intervention

262-Multiple sclerosis presenting early is often misdiagnosed as?

A. Polyneuropathy
B. Encephalopathy
C. Conversion d/o
D. Hysteria

263-Farmer injured . Big swelling and small red discoloration. What is the
causal organism?
�A. Clostridium tetani�
B. Clostridium perfringens�
C. Staphyllococcus aureus�
D. Streptoccus pyogenes�
E. Pseudomonas pseudomalle�

264-Emperical treatment of aspiration pneuomina??

265- 21 year old woman comes to the physician because of a 2 week history
of a small amount of vaginal discharge and itching. Her symptoms began
immediately before her LMP. She has had 2 sexual partners over the past 2
months and uses OCPs. One month ago she had pain on urination, urinary
frequency that resolved after a 7 day course of cephalexin. Exam shows red
introitus and vulva. There are erythematous vaginal walls with a normal
amount of vaginal discharge. The cervix and cervical discharge are normal,
vaginal pH is 4.5. The addition of KOH to the discharge produces no odor. A
wet mount prep shows no motile organisms. Which of the following is the
most likely causal organism?
A. Candida albicans
B. Chlamydia trachomatis
C. Gardnella vaginalis
D. Neisseria gonorrhea
E. Trichomonas vaginalis

266-The Pathophysiology of Guillain Barre is:

A- Demyelinating polyneuropathy
B- Motor Axonal Neuropathy
C- Pan autonomic Neuropathy D-……

267- All are causes for Budd Chiari syndrome EXCEPT:

A- Alcoholic liver disease C- TPN
B- Oral contraceptives D- PN

268- All are causes for increase urine bilirubin EXCEPT:

A- Hemochromatosis C- Cirrhosis
B- Primary Sclerosing Cholangitis D- Gilbert

269-Female, 60 years old, complains of right knee pain increases during

walking. Clinical
examination shows mild enlargement. Synovial fluid shows WBC: 2000, No
crystals.
Diagnosis: A- Osteoarthritis B- Rheumatoid Arthritis
C- Rheumatoid Fever D- Reactive Arthritis

270- Lupus Nephritis classification, One right:

A- Class 2 treated by Corticosteroids
B- Class 3 treated by Corticosteroids plus Cyclophosphamide
C- Class 4 has the worst prognosis
D- Class 5 is reversible with treatment
271- In Rheumatoid Fever, Rheumatoid Heart disease develops in:
A- 20% C- 40%
B- 30% D- 50%

272-All of the following helps to distinguish between Hemophilia and

Vonwillbrand disease
EXCEPT:
A- Bleeding time C- VW levels measure
B- Platelets function studies D- PTT prolongation

273- All of the following causes non palpable purpura EXCEPT:

A- ITP C- HUS
B- TTP D- HSP

274- All of the following about MM right EXCEPT:

A- There is an elevation in plasmic cell counts in the peripheral blood smear
B- It causes punched out lesions in 70% of cases
C- B2 microglobulin measurement has a strong prognostic value
D- Alpha interpherone usually causes remission

275-50 years old patient, complains of episodes of chest pain during rest
associated with ST
elevation regress spontaneously. The appropriate management:
A- Aspirin C- Beta Blockers
B- Nitrates D- Cardiac Catheter

276- 30 years old female without previous illnesses or current symptoms

comes to do routine
check-up, The Examination shows midsystolic murmur best hear in mitral
area, diagnosis:
A- Mitral Stenosis C- Mitral Valve Prolapse
B- Aortic Regurgitation D- HCM

277- 60 years old male patient who has chronic mitral regurgitation, No
current symptoms, No
medications, heart ultrasound shows: pulmonary artery pressure 50 mmHg,
LV diameter 40
mm, the best treatment:
A- ACEi C- Valvuloplasty
B- Beta Blockers D- no need for treatment

278- 60 years old patient complains of fatigue, ECG ( there is an ECG in the
case) shows complete
AV block, the best treatment:
A- Atropine C- …
B- Pacing D- …
279- All of the following are causes for Aortic Regurgitation EXCEPT:
A- Infective endocarditis C- Ankylosing spondilitis
B- Marfan D- Aortic dissection

280-20 years old female patient, during a party feels very tired, brought by her
friends to the
hospital, In the hospital she develops generalized tonic clonic seizure, the first
line therapy is
A- Phenytoin C- Haloperidol
B- Diazepam D- Sodium Valproate

281- 60 years old patient, previous uncontrolled DM, complains of left

Hemiplegia develops from
90 min. Bp: 160/95, P: 88/min

282-Brain CT (there is an image): large right parietal and temporal infarction.

Management:
A- rTPA C- Nitrate
B- Aspirin D- Clopidogrel

283- 40 years old female patient, complains of episodes of diplopia, vertigo,

sight loss in the right
eye reverse spontaneously, spasticity in the left leg. Diagnosis:
A- Basilar TIA C- Myelopathy
B- MS D- …

284- It causes CKD due to hypercalcemia, secondary amyloidosis and direct

toxic effect
B- Extramedullary plasmacytomas, that consist of soft tissue masses of
plasma cells are not
common.
C- ……. D-……..

285- A question about spleen function:

A- Blood cells Phagocytosis

286- All of the following causes PT prolongation EXCEPT:

A- Factor 9 deficiency B- Warfarine toxicity
B- Vit. K deficiency D- Factor 12 deficiency

287-years old patient, complains of dysphagia for both solids and liquids,
barium swallow
(there is an image) shows oesophagus dilation with tight LES, best treatment:
A- Surgical myotomy C- CCB
B- Botulinum toxin injection D- Nitrates
288- Helicobacter pylori, all right EXCEPT:
A- Gram-negatives bacilli
B- Located in duodenum and gastric mucosa
C- Eradication therapy causes completely recovery of the ulcer
D- Treatment include clarithromycin plus tetracycline plus bismuth

289- Alcoholic man complains of epigastric pain spreads to the back, the most
laboratory finding
related to acute pancreatitis is:
A- Elevation of Amylase C- Elevation of ALT,AST
B- Elevation of Lipase D-…

290- All are risk factors for acute pancreatitis EXCEPT:

A- Age < 55years C- LDH < 350
B- AST < 250 D- Amylase < 800

291- The most common liver tumor is:

A- Hamartoma C- Hepatocellular carcinoma
B- Hemangioma D- Metastasis

292- Patient has HBsAg +, HBeAg +, Anti HBc IgG +, ALT & AST normal, the
next step:
A- Lamivodine C- HBV.DNA
B- Review the patient after 3 months D-…

293-Long scenario about 15 years old patient with severe polyuria, MRI
shows
craniopharingioma, all of the following is expected to find in the patient
EXCEPT:
A- Short stature C- Hypothyroidism
B- Delayed puberty D- Hyponatremia

294- All of the following cause Hypocalcaemia EXCEPT:

A- Hypoparathyrosism C- Graves disease
B- Pseudohypoparathyrodism D- Hypomagnesemia

295- Long scenario about a patient has bone pain in the back, radiographs
show pseudo fractures,
what do you expect to find laboratorially in the blood:
A- ↑Ca + ↓P C- ↓Ca + ↓P
B- ↑Ca + ↑P D- ↓Ca + ↑P

296- All of the following are right in cryptorchidism EXCEPT:

A- It increase the risk of malignancy
B- Testes may descend to the scrotum spontaneously
C- The best time to do surgery in age 10 years
297- Long scenario about a patient comes to the ER with adrenal insufficiency
symptoms,
management:
A- IV normal saline
B- Hydrocortisone
C- Draw blood for cortisol and ACTH
D- A & B E- A, B & C
298- 20 years old patient has asthma taking Inhaled corticosteroids plus
bronchodilator, comes to
you complaining of dyspnea repeated daily from one week ago, you put them
on
prednisone 30 mg daily for 14 days plus his inhaled medications, after 2
weeks he comes
with his recorded PEF ( there is a chart resemble this chart), the next step:
A- Increase the dose of prednisone and continue inhaled medications
B- Increase the dose of prednisone and increase the dose of inhaled
medications
C- Stop prednisone and increase the dose of inhaled medications
D- Stop prednisone and continue inhaled medications

299- 20 years old patient, alcoholic, complains of dyspnea with productive

cough from 2 weeks,
CXR (there is an image) shows pulmonary density in the right middle lobe, the
organism that
responsible for symptoms is:
A- Staph. Aureous C- Anaerobic
B- Nocardia D- Bacillus anthrosis

300- The best management for exercised induced asthma:

A- SABA C- ICS
B- LABA D- cromolyn

301- Long scenario about 30 years old patient, Bp in the upper extremities
160/100, in the lower
extremities nonmeasureable, diagnosis:
A- Coarctation of aorta C-…..
B- Abdominal aortic dissection D-….

301- Question about Homocysteinurea, all right EXCEPT:

A- We have to exclude it in all patients with ACS C-…
B- It may cause Stroke D-…

302- 50 years old patient, has productive cough, urine test shows haematuria
plus proteinuria,
CXR shows bilateral infiltrations, the next step:
A- Pulmonary biopsy C- Renal angiography
B- Renal biopsy D- RF
303- 20 years old patient develops albuminuria and haematuria after 1 day of
upper respiratory
infection, the predicted pathophysiologic finding is:
A- Diffuse mesangial proliferation

304-All are right EXCEPT:

A- Ventilation / Perfusion mismatch is the leading etiology in respiratory diseases
B- Alveolar arterial gradient helps in ventilation capacity evaluation
C- We don’t use bronchoalveolar lavage routinely in respiratory illnesses evaluation
although it's helpful in diagnosis
D- …… E-……..

305- Pulmonary Fibrosis, one is right:

A- We don’t use pulmonary biopsy routinely in diagnosis
B- Asbestosis usually affects the upper lobes
C- … D-…..

306- Which one is a cause for eosinophilic pneumonia:

A- Aspergillosis C- Hemosidrosis
B- Lofgran syndrome D-….

307- All about aspergillosis is right EXCEPT:

A- Prick skin test is positive C-….
B- The biopsy shows septate hyphae D-….

308- 60 years old patient with DM, complains of productive cough accompanies with
fever and
dyspnea, the best treatment:
A- Itraconazole C- IV voriconazole
B- Corticosteroids D-…

309-60 years old patient has Creatinine: 7 mg/dl , Urea: 120 , Hb: 7 mg/dl,
what's the cause of
anemia:
A- Erythropoietin deficiency C- Uremia
B- Iron deficiency D- …

310- Long scenario about 60 years old patient has CKD treated by dialysis
from 5 years, complains
of numbness in both hands and bilateral pain in 2-3-4 fingers, diagnosis:
A- Carpal tunnel syndrome C- B2 microglobulin amylodosis
B- Proximal arteriovenous access D-…

311- Long scenario about 60 years old patient has CKD treated by dialysis,
during the dialysis he
develops hypotension, Bp 80/40 with severe fatigue, the most appropriate
management is:
A- Stop dialysis and infuse normal saline
B- Continue dialysis, this is normal side effect
C- Stop dialysis and do CXR & ECG D-…

312-A patient with Graves' disease, after subtotal resection of her thyroid
gland, she develops
tachycardia and fever, HR 150/min, T 39, treatment:
A- Steroids + PTU
B- Steroids + PTU + Propranolol
C- PTU + Propranolol + Iodide
D- Steroids + PTU + Propranolol + Iodide

313- Long scenario about a patient with Hyperthyrodism, during

appendectomy she develops
tachycardia, diaphoresis, fever and tremor, management all right EXCEPT:
A- Iodide C- Hydrocortisone
B- Thiamazole D- Aspirin

314- Long scenario about a patient with Macroprolactinoma doesn’t press the
optic chiasm, the
best management is:
A- Transsphenoidal surgery C- Bromocriptin
B- Somatostatin analogues D-….

315-systolic murmur on pericardium and increase on apex:

1- HOCM
2- AS
3- MR
4- MVP

316-diopathic DVT,ttt, heparin:

- For life
- 24 m
- 36 m

317-asthmatic pt FEV1 80 (predicted ˂30), shotness of breath, tachypnea,

hypotnsive, breath sound faint:
- Brittle asthma
- Near fatal asthma
- Acute severe asthma

318-endoscopic image show ulcer, c/o H&M, after endoscope there is also
hematemesis, he was previously on omeprazole, what to do :
- Repeat endoscope
- IV omeprazole
- Embolization

319-Scenario ofpt with infection …. Culture = MRSA -4

1- Vancomycin
2- Amoxicillin

320 -Stroke in AF without MS

%10 -1
%2 -2
%8 - 3
%15 -4

321- Scenario ofpt 56 y conscious , Bp high , RR 29 ,, urea 8 mmol

1- Macrolide
-3
322-Resp.quinolones -4
3- IvBlactam + clarithromycin
4- …..
323- Scenario of pt with Inf.MI + pulse 35 + Bp 90/60
1- Temp pacing
2- Permanent pacing
3- Iv atropine
4
324-Scenario ofpt 60 y…… HTN 150/100 treatment
1- Amlodipine
2- BB
3- Thiazide
4-
325-Scenario ofpt c/o chest pain fever , SOB , dry cough , -5
Culture = G+ve cocci in chains
1- Strept. Pneumonia
2- Staph. A
3- H.influenza
4- ….
326- Scenario of female pt with amenorrhea >>> progesterone no effect
cervix exam is irregular …. Pap smear cancer cervix
1- HPV 1
2

327- scenario of pt with painful genital ulcer ..tender inguinal LN

1- HSV
2- CMV
3- ……..Chancre and chamcroid and lymph granuloma venerum and inguinal

328-Scenario of old female with peptic ulcer and -0

collesFx what to give
Ca -1
Ca and Vit D -2
Alendronate -3
Iv calcitonin + ca +vit D -4

329- Scenario of old pt presented by hemiplegia CT brain = hypodense area

1- ASA
2- Clopidogrel
3- Marivan

330- Scenario of pt with HIV presented by active TB

When to start antiretroviral drugs:
1- After 2 weeks
2- Continue both
3- Stop …..

331-multi enhanced >> Scenario of Pt with HIV CD4 86 …..CT brain image -1
rings
: Toxoplasma igG +ve and Toxoplasma igM –ve
Hydatid-1
Leukoencephalopathy-2
Toxoplasmosis-3
-4

332- IE major criteria :

1- Fever
2- Immunologic
3- New regurge murmur
4

333-ineasaginata treatment :
1- Praziquental
2- Albendazol
3- Niclosamide

334-Scenario of old female T score -2.1 : -1

1- Raloxafine
2- Alendronate
3- Alcitonin + ca + vit d
4-
335-Most common cause of cushingsyndrome : -2
1- Iatrogenic
2- Ectopic ACTH
3- Pituitary adenoma
4
336- scenario of pt presented by chest pain ST -3
elevation in V1 to V5 nitrate , ASA , O2, morphine
given >>> still no improvement what to give to
decrease mortality :
1- ACEi
2- BB
3- CCB
4- ASA
337:Scenario of Asthmatic pt diurnal variation expected
diurnal variation 3times / week %10 -1
diurnal variation 5times / week %10 -2
diurnal variation 3times / week %20 -3
diurnal variation 3times / week %20 -4

338- Scenario of pt after eating Oester shell >>>>> severe watery diarrhea
1- Vibrio parahemolyticus
2- Salmonella paratyphi
3- Campylobacter
4

339- Scenario of renal disease with low complement level :

1- 1ry MPGN
2

340-Scenario ofpt c/o morning stiffness 45 min … AntiCCp +ve -9

RA -1
… -2

341-:flight test >>>>Scenario of COPD pt -38

Methacholine challenge test -1
I don’t remember rest of choices sorry -2

342- Scenario ofpt with ascites and abdominal pain ….paracentesis

Wbc>250 SAAG> 1.2
1- SBP
2

342-Scenario ofptOSA .. BMI= 34 ..polysomnography -4

= 34% …. Wt loss advised next :
1- C-PAP
2
343-Scenario of obese pt c/o sleep disturbance ..headache morning -4
BMI = 43
1- Night polysomnography
2-
334- Scenario of young pt treated from cystitis presented by jaundice
Cbc = anemia … increase Retics … all LFTs = N
1- G6PD
2

335- Scenario of pt c/o face and upper part swelling + image CT abdomen
1- SVC obstruction
2-

336-Scenario of pt with Inf.MI + Bp 80/50 pulse 120 3hrs ago-

Iv fluids

337-predicted ..Bp = 90/60 … %30 < Scenario of asthmatic pt .. PEFR -3

Pco2 = N
Low Po2 … tachycardia RR = 30
Brittle asthma -1
Life threatening asthma -2
Near fatal asthma -3
Sever asthma -4

338-Scenario of young pt had 3m frequent loose motion sometimes -1

greasy … anemia hypocalcemia hypokalemia … CT abdomen normal ,,
stool culture and examination negative for oocyte or organisms
1- Crohns
2- Lymphocytic enteritis
3- Coeliac disease
4-

339- scenario of pt with pneumothorax 15% what to do :

1- Chest tube
2- Aspiration
3- Observation

340- Scenario of RA pt …initial treatment :

1- NSAIDs
2- Methotrexate
3

341-Scenario ofpt ….HBsAg +ve ..HBeAg +ve DNA = very high .. -4

Liver enzymes = high albumin low .. INR= 1.8 …Bilirubin high
Treatment :
1- Ribavirine
2- Iv interferon
3

342- Scenario ofpt ….HBsAg +ve ..HBeAg +ve DNA = very high ..
Liver enzymes = high albumin low .. INR= 1.8 …Bilirubin high
Treatment :
1- Ribavirine
2- Iv interferon
3

343-scenario of shocked pt>>>>> fluid resuscitation >>> still -1

shocked
What to do ?
1- Iv fluid
2- Dopamine
3- Dobutamine
4

344- A 24-year-old man is found to have hypertension during an examination

for life assurance purposes. Over the next few months, this is demonstrated to
fluctuate considerably in severity and proves difficult to control. Which of the
following additional features would be most suggestive of the presence of a
phaeochromocytoma?
O Diarrhoea
O Flushing
O Headache
O Muscle weakness
O Tremor

345-Scenario ofpt c/o temporal headache and tender temporal area -2

1- CST
2- Temporal biopsy

346-pt e aspirin induced athma e oestarthrites you can give the pat.
a-peroxicam
b-brufen
c-indomethacine
d-melocam

347-drug induced fatty liver : -3

1- AZA
2- Cyclophosphamide
3- Ciclosporin
4
348:HNPC - Hereditary Non-Polyposis Colorectal carcinoma criteri
Rome -1
Ranson -2
Besthesda -3
McDonald -4

349- Scenario ofpt with MM treatment

1- Plasmapheresis
2- CST
3- Arabinoside

350. A patient with rheumatoid arthritis got a flare up and doctor wants to
administer azathioprine. which screening test should be done before starting
this drug?
• Tb Gold test
• Thiopurinemethyltransferase genotype screening
• Thiopurinemethyltransferase phenotype screenin

351. what virus not involved in common cold? rotavirus

352. case of lupuse nephrites specific for diagnosis

a- ANA
b- AntiDs DNA
c- RNP.

353- what anti TB cause

1- peripheral neuritis >>> INH

354- anti TB causing optic neuritis:

355- what is spleen?

- main lymohid producer in infancy
- main lymphoid tissue
- contain 25% of total body RBCs

256-scenario about 30 years man with acute oliguria and face and leg edema
B.P 160/90 Creatinine: 3 Urea : 100
is it
- prerenal ARF
- Postrenal ARF
- Acute tubular nrecrosis ARF

357. a drug that delay alcoholic hepatitis?

- Colchicine
- pentoxillamyn
- .......
358. what is the main prognostic for a case scenario with UC?
- Uveitits
- Erythema margnatum
- Pyoderma gangrosum
- .......
359. HIV patient started anti protease then after 4 weeks developed
generalized lymohadenopathy what is the cause?
- Immune inflammatory mediated complex

360. HIV patient with CD4 less than 50 what is chemoprophylaxix?

- Azithromycin + sulpha methexazole

361- What is present in primary aldoseronism and not present in secondary

aldosteronism?
Q- after returning from Thailand patient with fever, rash, sore throat?
- HIV

362. Ptient with GERD has Barret esophagus at risk of?

- Adenocarcinoma
- Squamous cell carcinoma

363. patint with hypoglycaemia and C-peptide what is the cause?

- insulinoma
- exogenous insuline
- Oral hypoglycemic
- beta cell metaplesia

364. Patient post MI stabilized presented with sever abdoominal distension,

no manifestation of ischemic colitis,
what is the tretment?
- Atropin
- phyostigmin
- ......
- ......
365. patient with multiple fracture an long bones presented with dyspnea,
chest pain and no chest tenderness, the cause is?
- Fat embolism
- Pulmonary embolism

366- Regard synovial fluid one is right :

a. Secreated by joint capsule
b. positively birefringent in gout
c. decrease viscosity in inflammation
d. high lymphocyte in rheumatoid

367-patient with sudden sever eye pain , hallos(glaucoma ) , investigation :

a. optometry
b. slit lamp

368-case of patient with sever headache ,,,,,,MRI show hemorrhagic

infarction , what next ?

a. MRI venogram
b. MRI
c. CT arteriogram

369- LUNG ,,,,,,,,,,,,,,,,,,,,,

a. Surfactant decrease surface tension

370- case of sick sinus treatment :

a. Pacing
b. BB

371 – the minimum FEV I can consider asthma moderate controlled :

a. <80
b. <75
c. <70
d. <65

372 – Patient with medullary breast cancer show calcifications , + axillary LN

, what is the most prognostic factor :
A. micro calcifications
B. TNM
C. Receptor status
373- case of inferior MI with complete heart block ;
a. Temporary wire paceing
b. External pacing
c. Atropin
374- case of 70 years old man , ,,,,,,what increase his chance of IHD :
a. Fasting blood glucose 6.6
b. Systolic BP 175
c. LDL 5.6
d. Family history
375 – PT , azospermia , normal FSH , LH , testosterone , semen analysis high
fructose , investigation :
a. Biobsy
b. Genetic analysis
c. CT brain

376- Breast cancer the most single important drug :

a. Trustozumab
b. Cyclophosphamid
c. Imitinib

377- patient with chronic diarrhea lab show anemia , history of cancer treated
with radio 14 month , colonscope (picture shows inflammation) , diagnosis

a.UC
b.radiology induced colitis

378 – PT with hematemsis , DU and treated , recurrent attack of hema ,

upper endoscope (picture shows dilated engorged vessels area ) , treatment
:
a. Angio and embolization
b. Sewing blood vessel
379- PT with mass in Liver hilum , dilated biliary ducts , lab show obstructive
jaundice , ask about management of this status :

a. Stent
b. Surgical
c. Chemotherapy
380 –case of recurrent vomiting , ph 7.48 , Co2 high , HCO3 high :
a. Primary metabolic alkalosis
b. Combined metabolic alkalosis and respiratory alkalosis
 c. Metabolic acidosis
381- pregnant women 24 weeks exposed to chicken box pt , can not
remember if she is immunized :
a. Give vari immunoglobulin and antiviral drugs later
b. Check antibodies and give anti viral if positive
c. Check antibodies and immunoglobulin if positive
d. Assure the women she is safe because she is in second trimester .
382- patient represent with confusion ,,,,,,,,,,,,,,,,,,,,,history of ingestion of
Raw milk , diagnosis :
a. Hemoagglutin
b. Stool analysis
c. CBC
383- asymptomatic 17 years boy for annual exam ,,,,,,,,,,,,,,,,MS discovered
on auscultation , all chest and cardiac exam normal , pulse normal :
a. Valve replacment
b. Valvotomy
c. Penicillin prophylaxis
d. Considred anticoagulant
384- pregnant women with painful nodules on shin :
a. Erythema nodosum
b. Eruthema multiform
c. Annular granuloma
385 – scenario of case with SLE m lab proteinuria , next :
a. Steroid
b. Cyclophosphamid
c. Wait until renal biobsy
386- case of tonic clonic seizures treatment :
a. Valproic acid
b. Gapbentin
c. Clonazepam
387- case of TB ask about best drug combinations in sever case :

a. INH , Rifa, ethamb, pyrithena

b. INH , Rifa, sterpto,
c. INH , Rif , ciprofloxacin
388-known case of regurgitation with recurrent chest pain main at night , (
chest xray : tracheal shift to right ) , ask about investigation :
a. Bronchoscope
b. Ct chest
c. Sputum analysis
389- case of patient with recurrent chest pain with same time and duration ,
(ECG shows elevation of st segment in 2, 3 , F )
a. Stable angina
b. Unstable angina
c. St segment elevation MI
d. NON st segment elevation MI
390 – case of diabetic foot ulcer treatment

6-

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