SLE October, 20091) Pt has a picture of osteoarthritis w PIP joints nodules, these are called:

a. Heberden's nodesb. Bouchard nodes

2) In IDA , which of the following iron studies is most specific:a. Iron levelb. TIBCc. Ferritin level

3) DM with controlled blood sugar and his BP was 138/89 mmHg what will be your next step :

a. Nothingb. Add ACE inhibitor

4) Commonest cause of chronic renal failure in the kingdom is:a. DMb. HTN

5) ECG shows ST elevation in the following leads V1, 2, 3, 4 & reciprocal changes in leads aVF & 2. What’s your diagnosis:

a. Lateral MIb. Anterior MIc. Posterior MI

6) 10 years old boy presented to the ER with testicular pain. O/E: absent cremastric reflex and Doppler showed decreased blood flow. What’s your diagnosis:

a. Testicular torsion

7) 16 years old female, with 6 month Hx of lower mid abdominal pain. The pain is colicky, radiating to the back & upper thighs, begin with onset of menses, last for 2-4 d, she missed several days of school during the last 2 months, on exam. abd & pelvis normal, normal 2ry sex development. What will be your Tx (Primary Dysmenorrhea):

a. NSAID

8) Which of the following antidiabetic safe during pregnancy:a. Insulinb. Glyburide

9) Baby having HIV (transmitted from his mother) , which vaccination shouldn't

be given to him:a. oral poliob. MMR

10) Female patient presented with parasthesia in the Rt upper and lower limbs, nausea and vomiting after a conflict with her husband. Examination and lab results were normal. Dx:

a. Conversion disorder

11) Dx: somatization disorder

12) Pt had pain in the back, neck, abdomen and upper limb. You gave the pt a follow up in the clinic, but still the pt is complaining and concerning of the pain. Dx is:

a. Chronic pain syndrome

13) Pt came to u worried of having CA colon, because his father died from it. He was investigated several times with colonoscopies which were normal. He is a manager of a company and this affects his work. What’s your diagnosis:

a. Obsessive compulsive disorderb. Hypochondriasis

14) A female pt present to you complaining of restlessness, irritability and tachycardia. Also she has excessive worries when her children go outside home. What’s your diagnosis?

a. Panic disorderb. Generalized anxiety disorder

15) Male pt who is otherwise healthy, has depression for 4 months. He retired 6 months ago. O/E: unremarkable except for jaundice. What’s your diagnosis:

a. Major depressive disorderb. Mood disorder due to medical illnessc. Adjustment disorder, depressed type

16) A female pt is complaining of abnormality in her jaw. She was seen by multiple plastic surgeons about this problem, but they didn’t interfere because there was no abnormality in her jaw. What’s your diagnosis:

a. Body dismorphic disorder

17) The most powerful epidemiologic study is:a. retrospective case control studyb. cohort studyc. cross-sectional studyd. historic time datae. secondary data analysis ???

18) The most common cause of post partum hemorrhage is:a. Uterine atonyb. Coagulationc. Retained placenta

19) Apgar score:a. Heart rate is significantb. Checked in 2nd day of lifec. Has 12 score

20) A 15 years old boy present with 5 days history of pain behind his left ear and 3 days history of swelling over the mastoid. He had history of acute otitis media treated by amoxicillin but wasn’t a complete course. On examination he has tenderness over the mastoid bone with swelling, tympanic membrane shows absent cone reflex and mild congestion. what is the diagnosis:

a. acute otitis mediab. serious otitis mediac. acute mastoiditisd. glue ear

21) Evidence base medicine:a. practice medicine as in the book b. practice according to the department policy c. practice according to available scientific evidence d. practice according to facility e. practice according to latest publish data

22) Pt had fever in the morning after he went through a surgery (I couldn’t remember the type of surgery). What’s your diagnosis:

a. Atelectasisb. Wound infectionc. DVTd. UTI

23) Usefull finding in Acute appendicitis:a. Ageb. WBC more than 14.000

24) 23 yrs old female has mobile breast lump in the upper outer quadrant of the left breast. Size= 2 cm and doesn’t change with menstrual cycle. What’s the most likely diagnosis:

a. Fibroadenoma

25) Average length of the menstrual cycle:a. 22 daysb. 25 daysc. 28 daysd. 35 dayse. 38 days

26) A 45 yrs old male came to the ER with sudden headache, blurred vision, excruciating eye pain and frequent vomiting. The most likely diagnosis:

a. Acute conjunctivitisb. Acute angle glaucomac. Acute iritisd. Corneal ulceratione. Episcleritis

27) Breast feeding in the full term neonate:a. Increase URTI rateb. No need for vitamin supplementationc. Food introduce at 3 monthsd. Increase GE ratee. It’s recommended to give Vit K shortly at birth, & Vit D at 2 months

28) 9 days old neonate is brought by his mother for check up. He was delivered by spontaneous normal vaginal delivery without complications. Birth wt was 3.4 and his birth wt now 3.9. He is sucking well and looks normal except for jaundice. What’s your diagnosis:

a. Physiological jaundiceb. Breast milk jaundicec. Crijlar najar syndromed. ABO incompatibility

29) The best indicator of labor progression is:a. Dilatationb. Degree of painc. Fetal heart rated. Decente. Dilatation and decent

30) Pt came with metabolic acidosis with anion gap of 18 ,she took drug overdose. What could it be:

a. Salicylate

31) About Antepartum hemorrhage:a. Rarely due to hypofibrinogenemiab. Maternal mortality more than fetal mortalityc. PV exam is always indicated

32) Sciatica:a. Never associated with sensory lossb. Don’t cause pain with leg elevationc. Causes increased lumbar lordosisd. Maybe associated with calf muscle weakness

33) Pt come to the ER with weak rapid pulse, what is your next step: a. give him 2 breathsb. Do CPR (2 breaths / 30 compressions) !!!c. Waite until team of resuscitation group comes

34) Most common cause of otorrhea:a. acute otitis mediab. cholesteatomac. leakage of cerumend. estichian tube dysfunction

35) Most common cause of hearing loss in children:a. Chronic serous otitis mediab. Estuchian tube dysfunctionc. Ototoxic drugs

36) One of the following is manifestation of hypokalemia:a. Peaked T waveb. Wide QRSc. Absent P waved. Seizuree. Respiratory acidosis

37) Which of the following organisms can cause invasion of the intestinal mucosa, regional lymph node and bacteremia:

a. Salmonellab. Shigella

c. E. colid. Vibrio cholerae. Campylobacter jejeni

38) which of the following medications should be avoided in diabetic nephropathy:

a. nifidipine b. losartan c. lisinopril d. thiazide

39) Pt has saddle nose deformity, complaining of SOB, hemoptysis and hematiuria. The most likely diagnosis is:

a. Wagner’s granulomatosis

40) Most common manifestation of renal cell carcinoma is:a. Hematuriab. Palpable massc. HTN

41) OCP:a. Changes the cervical mucusb. increase pre menstrual tensionc. Have a failure rate of 3 %

42) OCP:a. Decrease the risk of ovarian cancerb. Increase the risk of breast cancer

43) Pt has 2 cm dome shaped mass in the dorsum of his hand. It’s covered by keratin. What’s the most likely diagnosis:

a. Basal cell carcinomab. Malignant melanomac. keratoacnathoma

44) Pt has hemorrhagic lesion in the mouth and papules in the face and back. He had SOB, fever, cough and mediastinal mass. What’s the diagnosis:

a. Kaposi sarcoma

45) In the neck, esophagus is:a. Posterior to the tracheab. Anterior to the tracheac. Posterior to vertebral column

46) Which of the following dietary factors considered protective against cancer:a. Vitamin Db. Fiberc. Calcium

47) High risk factor in CLL :a. Ageb. Smokingc. History of breast ca

d. History of radiation

48) Which of the following medications is considered as HMG-CoA reductase inhibitor:

a. Simvastatinb. Fibrate

49) Burn involved 3 layers of the skin called:a. Partial thicknessb. Full thicknessc. Superficiald. Deep

50) Cherry red skin found in:a. Polycythemab. CO poisoning

51) Most serious symptom of CO poisoning is:a. Hypotensionb. Arrhythmiac. Cyanosisd. Seizure

52) Pt presented to the ER with diarrhea, nausea, vomiting, salivation,

lacrimation and abdominal cramps. What do you suspect:a. Organophosphate poisoning

53) Patient with subconjuctival hemorrhage. What you will do for him:a. Reassurance b. Send him to the ophthalmologist

54) Male patient with hemarthrosis. The most likely diagnosis is:a. Thrombocytopeniab. Factor 8 deficiency

55) Patient with renal transplant, he developed rejection one week post transplantation, what could be the initial presentation of rejection:

a. Hypercoagulabilityb. Increase urine out putc. Feverd. Anemia

56) Indication for tonsillectomy is:a. Pharyngeal abscessb. Sleep apneac. Recurrent infectiond. Asymmetric tonsillar hypertrophy

57) Pregnant lady in her 30 wks gestation diagnosed as having swine flu. She has high grade fever and cough for 4 days and her RR= 25/min. what will you do for her:

a. Give her Tamiflu 75 mg BID for 5 daysb. Refer her to ER for admissionc. Give her antibiotics

d. Refer her to OBGY doctor

58) Female patient has morning stiffness and pain involving the metacarpophalengeal and proximal interphalengeal joints. What’s the likely diagnosis:

a. Rheumatoid arthritis

59) DPT vaccine shouldn’t given if the child has:a. Coryzab. Diarrheac. Unusual cryd. Fever = 38

60) A female patient has clubbing, jaundice and pruritis. Lab results showed

elevated liver enzymes (Alkaline phosphatase), high bilirubin, hyperlipidemia and positive antimitochondorial antibodies. What’s the most likely diagnosis:

a. Primary sclerosing cholangitisb. Primary biliary cirrhosis

61) Shoulder pain most commonly due to:a. Infraspinatus muscle injuryb. Referred pain due to cardiac ischemiac. In acute cholecystitis

62) Patient came recently from Pakistan after a business trip complaining of frequent bloody stool. The commonest organism causes this presentation is:

a. TBb. Syphilisc. AIDSd. Amebic dysenterye. E.coli

63) About hemorrhoid:a. Internal hemorrhoid is painless unless associated with prolapseb. More in people more than 50 yrs, pregnant ladies and …..

64) Patient has long history of constipation. He presented with pain during and after defecation relieved after 30 minutes. It’s also associated with bleeding after defecation. O/E: he has painful PR. Most likely diagnosis:

a. External thrombosed pilesb. Anal fissurec. Fistula in ano

65) Female patient with fatigue, muscle weakness, parasthesia in the lower limbs and unsteady gait. Do:

a. Folate levelb. vitamin B12 level c. Ferritin level

66) Patient developed lightheadedness and SOB after bee sting. You should treat him with the following:

a. Epinephrine injection, antihistamine and IV fluidb. Antihistamine alone

67) Patient is 74 yrs old female complaining of pain and stiffness in the hip and shoulder girdle muscles. She is also experiencing low grade fever and has depression. O/E: no muscle weakness detected (Polymyalgia rheumatic). Investigation of choice:

a. RFb. Muscle CKc. ESR

68) 2 yrs old boy with coryza, cough and red eyes with watery discharge (a case of measles). Most likely diagnosis of the red eyes is:

a. Conjunctivitisb. Blepharitis

69) Child has history of URTI for few days. He developed barky cough and SOB. Your diagnosis is:

a. Foreign body inhalationb. Pneumoniac. Croupd. Pertussis

70) Patient has bilateral abdominal masses with hematuria. Most likely diagnosis is:

a. Hypernephroma b. Polycyctic kidney disease

71) Patient with hematuria and diagnosed with bladder cancer. What’s the likely causative agent:

a. Schistosoma haematobium

72) Male patient working in the cotton field, presented with 3 wks Hx of cough. CXR showed bilateral hilar lymphadenopathy and biopsy (by bronchoscopy) showed non-caseating granuloma. What’s your diagnosis:

a. Sarcoidosis!!! (still not convinced)b. Amylidosisc. Histiocustosisd. Berylliosise. Pneumoconiosis

73) Pt presented with severe epigastric pain radiating to the back. He has past hx of repeated epigastric pain. Social hx: drinking alcohol. What’s the most likely diagnosis:a. MIb. Perforated chronic peptic ulcer

74) Erosive gastritis:a. Happened within one week of injuryb. Happened within 24 hrs of injury !!!

75) Elderly woman has epigastric pain, collapsed at home. In the ER she has mild low back pain and her BP= 90/60. What’s the most likely diagnosis:

a. Mesenteric ischemiab. Leakage/ruptured aortic aneurysmc. Perforated duodenal ulcerd. Gastric ulcer

76) In brainstem damage:a. Absent spontaneous eye movementb. Increase PaCO2c. Unequal pupilsd. Presence of motor movement

77) The most effective method of health education is:a. Group discussion b. Mass media !!!c. Individual approach

78) 35 yrs old male has SOB, orthopnea, PND, nocturia and lower limbs edema. What’s the most common cause of this condition in this patient:

a. Valvular heart dieaseb. UTIc. Coronary artery diseased. Chronic HTN

79) 60 yrs old male patient complaining of dysphagia to solid food. He is a know smoker and drinking alcohol. ROS: Wt loss. What’s the most likely diagnosis:

a. Esophageal cancerb. GERDc. Achalasia

80) Female patient had carpopedal spasm after measuring her BP. This is

caused by:a. Hypocalcemia

81) Patient known case of DM type 2 on insulin, his blood sugar measurement as following: morning= 285 mg/dl, at 3 pm= 165 mg/dl, at dinner time= 95 mg/dl. What will be your management:

a. Increase evening dose of long acting insulinb. Decrease evening dose of short acting insulinc. Decrease evening dose of long acting insulind. Increase evening dose of short acting insulin

82) Elderly male patient who is a smoker and known case of DM presented with fatigue, wt loss, loss of appetite and epigastric pain. O/E he has jaundice and palpable gall bladder. What’s the most likely diagnosis:

a. Acute pancreatitisb. Chronic pancreatitisc. Pancreatic cancer

83) Alcoholic and heavy smoker male patient presented with hematemesis. What’s the most likely cause of his presentation:

a. Esophageal varices

84) 5 days after MI, the patient developed SOB and crackles in both lungs. Most likely cause is:

a. Pulmonary embolism

b. Acute mitral regurgitation

85) Patient known case of IDDM, presented with DKA. K= 6 mmol/L and blood sugar= 350 mg/dl. You will give him:

a. IV fluidb. IV fluid and insulinc. Sodium bicarbonate

86) Diabetic patient on insulin and metformin, has renal impairment. What’s your next step:

a. Stop metformin and add ACE inhibitor

87) In newly onset atrial fibrillation, the management will be: ???a. Cardioversion b. IV procainmide

88) 4 weeks old male child with acute onset forceful non-billious vomiting after feeding. He is the first child in the family. He is gaining normal wt and looks hungry. What’s your diagnosis:

a. Pyloric stenosis

89) 1 week old infant presented with repeated forceful vomiting. What’s the diagnosis ???(the same history of pyloric stenosis but the age is 1 wk):

a. Pyloric stenosisb. Duodenal atresiac. Volvolusd. Hirschprung

90) About ventricular fibrillation:

a. Can only be treated with synchronized defibrillationb. The waves are similar in shape, size and patternc. Course VF indicates new VF and can be treated with……???

91) Patient with cancer. You want to break bad news, which of the following is the answer:

a. Inform his familyb. Inform him according to his moral background and religionc. Let social service inform himd. Don’t tell him

92) Elderly patient with mild grade fever, history of constipation and high WBC. O/E: LLQ pain. What’s your diagnosis:

a. Divericulosis

93) Another repeated Q about diverticulitis

94) Patient with untreated bronchogenic carcinoma has dilated neck veins, facial flushing, hoarsness and dysphagia (SVC syndrome). CXR showed small pleural effusion. What’s your immediate action:

a. Consult cardiologist for pericardiocentesisb. Consult thoracic surgeon for Thoracocentesis

c. Consult oncologist

95) Case of pneumothorax, what’s your initial management:a. Large needle in the 2nd intercostal space in the mid-axillary lineb. Large needle in the 5th intercostal space in the mid-clavicular linec. Chest tube in the 5th intercostal space in the mid-clavicular line

96) Patient with macrocytic anemia without megaloblast. What’s the most likely diagnosis:

a. Folic acidb. Vitamin B12 deficiencyc. Alcoholism

!!! not sure of the answer

??? incomplete Q