MED39 – Year 4

IGCP – Final MCQ

Q1 / What is considered to be a metabolic syndrome?
- High waist circumference, low HDL, and high triglyceride.
- High waist circumference, high HDL, and high triglyceride.
- Low waist circumference, high HDL, and high triglyceride.
- Low waist circumference, high HDL, and low LDL.

Q2 / You are evaluating a 40-year-old lady with hematuria for possible underlying
glomerular disease. Complement levels reveal low C4 and C3. What is the most likely
diagnosis?
- Membranous nephropathy.
- Lupus nephritis.
- Granulomatosis with polyangiitis.
- Infective endocarditis.

Q3 / Which of the following can exacerbate absence seizure?

- Valproate.
- Ethosuximide.
- Carbamazepine.
- Clonazepam.

Q4 / A scenario with very high PTH, high calcium and high phosphate?
- Secondary hyperparathyroidism.
- Tertiary hyperparathyroidism.
- Adynamic bone disease.

Q6/ A scenario of Addison disease, what are the expected lab results:
- Low cortisol, high ACTH and positive 21 alpha hydroxylase antibody.
- High cortisol, high ACTH and positive 21 alpha hydroxylase antibody.
- Low cortisol, low ACTH and positive 21 alpha hydroxylase antibody.
- High cortisol, low ACTH and positive 21 alpha hydroxylase antibody.

Q7 / Patient presented with early satiety and epigastric discomfort for 6 months, all lab
results were normal, H. pylori test was negative, what the diagnosis?
- IBS.
- IBD.
- Functional dyspepsia.
- Peptic ulcer.

Q8 / Scenario of patient with acute glomerulonephritis, which of the following could be

seen in UA?
 - Red blood cell cast.

- White blood cell cast.

- Granular cast.
- Fatty cast.

Q9 / Patient presented with headache, nausea, dizziness, and fatigue after the first session
of hemodialysis, what is the cause of this neurological manifestations?
- Cerebral edema from rapid urea removal.

Q10 / Patient with typical presentation of lung cancer, non-smoker with peripheral mass,
what is your diagnosis?
- Adenocarcinoma.
- Squamous cell carcinoma.
- Small cell lung cancer.
- Mesothelioma.

Q11 / Patient discovered to have speculated 1.3 cm nodule, without any lymph nodes
involvement, histopathology showed squamous cell carcinoma?
- Surgical removal.

Q12 / Difference between hypovolemic and distributive shock?

- No change in blood volume in distributive shock.
- Increase peripheral resistance.

Q13 / Which is a manifestation of increase peripheral vascular resistance in cardiogenic

shock?
- Tachycardia.
- 3rd heart sound.
- Cold extremities.

Q14 / Patient presented with trauma, examination showed bruises in lower sternum with
normal bilateral air entry and elevated JVP 12 cm?
- Cardiac tamponade.
- Hemothorax.
- Tension pneumothorax.

Q15 / A 67-year-old male patient presented with 4-month dyspnea on exertion, productive
cough, and wheezing. He smoked one and half packs per day for the last 35 years.
Examination showed thin patient, in mild respiratory distress, bilateral expiratory wheeze.
Chest X ray showed flattened both hemidiaphragms. Spirometry revealed reduced FVC,
FEV1 and FEV1FVC. Which of the following pathogenic mechanisms contributed to
patient's disease?
 - Suppurative inflammation around bronchi.

- Imbalance between proteases and antiproteases.

- Airway hyperresponsiveness to endogenous stimuli.
- Increase hydrostatic pressure in pulmonary vasculature.

Q16/ Patient came with trauma and suspected Tension pneumothorax. What is your initial
investigation?
- Chest x-ray.
- PFT.

Q17 / Which of the following is expected from stimulation of B-2 adrenergic receptors?
- Low serum potassium
- Bradycardia
- Improvement in somatic tremor
- Bronchoconstriction

Q18 / patient with apical lung tumor have ipsilateral ptosis, mitosis, anhidrosis, and have
upper limb weakness. Which of the following is affected?
- sympathetic chain and brachial plexus
- SVC syndrome

Q19 / patient with lung nodules 3.5 cm, located peripherally, speculated border, no
lymphadenopathy, suspected malignant mass, what is the next step?
- Bronchoscopy and biopsy.
- Refer for surgery for surgical resection.
- CT guided biopsy.

Q20/ patient 77 ears old with lung mass 8x12 cm, mediastinal lymph node metastasis
(Bilateral hilar lymph node, subcarinal) biopsy confirm adenocarcinoma, what is the
management?
- Curative high dose radiotherapy and adjuvant chemotherapy X
- Curative surgical removal and adjuvant chemotherapy
- systemic chemotherapy
- Tracheal stent

Q21 / Patient who works in Benzene company and lab test showed pancytopenia..?
- Aplastic anemia.

Q22 / Patient with neurological manifestations (ataxia, sensory impairment), CBC showed
Macrocytic anemia. What is the cause of his anemia?
- Vitamin B12 deficiency.
- Folate deficiency.
Q23 / Child with hemoptysis, Anti-GBM positive what is the diagnosis?
- Goodpasture syndrome.
- IgA nephropathy.

Q24 / Patient with CKD received a gadolinium contrast, developed:

- Calciphylaxis.
- Nephrogenic systemic fibrosis.

Q25 / Warm AIHA treatment :

- Steroid and folic acid.

Q26 / Old age male patient presented with bone pain, lab results showed: anemia,
leukopenia, hypercalcemia, abnormal liver function test, …?
- Multiple myeloma.
- Metastatic prostate cancer.
- Aplastic anemia.

Q27 / Patient presented with lymphadenopathy above and below the diaphragm and
infiltration to the spleen associated with wight loss and night sweating, what is the stage?
- Hodgkin’s lymphoma stage II A
- Hodgkin’s lymphoma stage III B
- Non- Hodgkin’s lymphoma IV A
- Non- Hodgkin’s lymphoma I

Q28 / Patient presented with heart failure symptoms; his carotid pulsations were weak
(slow rising pulse)?
- Aortic stenosis.
- Dilated cardiomyopathy.

Q29 / Patient presented with typical chest pain for aortic dissection, examination showed
difference of blood pressure between arms, x-ray showed widened mediastinum. What is
the diagnosis?
- Aortic dissection.
- ACS.

Q30 / Elderly patient presented with TLOC with unilateral tremor and slow motion,
known case of orthostatic hypotension, what is your next step?
- Brain MRI.
- Blood glucose.
- Electrolytes level.
 - Measuring blood pressure in the standing and recumbent position.

Q31 / Diabetic patient presented with TLOC, what is your next step?
- Brain MRI.
- Blood glucose.
- Electrolytes level.
- Measuring blood pressure in the standing and recumbent position.

Q32 / Elderly patient presented with gross hematuria, his prostate was firm and PSA: 2.1,
what is the next step?
- Cystoscopy.
- TURB.
- TRUS.

Q33 / Patient with PKD1 presented with headache and dizziness, what is the diagnosis?
- Subarachnoid hemorrhage.
- Migraine.

Q34 / An 89-year-old male presents with asymptomatic 8-cm abdominal aneurysm. He has
a recent history of myocardial infarction and is not a candidate for coronary artery bypass.
What should the treatment options include?
- Conservative treatment (observation)
- Endovascular repair

Q35 / What the expected pulmonary function test results in patient with COPD?
- Low FEV1 and FEV/FVC and DLCO with high TLC.
- Low FEV1 and FEV/FVC and high DLCO and TLC.
- High FEV1 and FEV/FVC and DLCO with low TLC.

Q36 / Patient with COPD, came with moderate symptoms, what to give?
- LABA + LAMA.
- SABA.
- LAMA + ICS.

Q37 / What is the management of diarrhea dominant IBS?

- Loperamide.
- Serotonin agonist.
- Probiotics.

Q38 / Patient presented with bloody diarrhea, colonoscopy showed ulcers in the colon, what
is the diagnosis?
- Crohn’s disease.
 - Ulcerative colitis.

Q39 / Which of the following is involved in croh’s disease:

- Rectal affection.
- Smoking is protective.
- Granuloma formation.

Q40 / Patient with stable heart failure, with high blood pressure, already on ACE-I and
beta blocker, what is your nest step?
- Frusemide.
- Digoxin.
- Increase ACE-I dose.
- Coronary angiography.

Q41 / Which of the following is secreted by juxtaglomerular cell?

- Urea
- Renin
- Water
- Aldosterone

Q42 / Nehal is 49-year-old woman presented to ER with 1-week history of excessive fatigue
and nausea. She has a history of hypertension and rheumatoid arthritis. She is being
treated with prednisolone, 5 mg/d, for almost 2 years before running out of her medications
2 weeks ago. On physical examination, temperature is 36.5 °C, blood pressure is 80/60
mmHg, pulse rate is 111/min with orthostatic changes, respiration rate is 16/min; BMI is
27. Examination of the lungs, heart, and thyroid gland are normal. A plethoric rounded
face and central obesity with supraclavicular and posterior cervical fat pads are noted.
Laboratory studies: Sodium 135 mmol/L [136- 142 mmol/L], Potassium 7 mmol/L [3.5- 5.0
mmol/L], Bicarbonate 18 mmol/L [22- 26 mmol/L], Adrenocorticotropic hormone 6 pg/mL
[10- 60 pg/mL], Cortisol (8 AM) 75 nmol/L [138-690 mol/L). Which of the following is the
most appropriate management?
- IV Fludrocortisone
- Oral Prednisolone
- IV Sodium chloride
- IV Hydrocortisone

Q43 / A 55-year-old male patient came to urology clinic complaining of hesitancy, weak
urinary stream, intermittency, and incomplete voiding. digital rectal examination showed
enlarged prostate with firm consistency, but no palpable nodule, prostate-specific antigen
(PSA) was 2 1 ng/ml. Urine analysis showed 2 red blood cells per high power field with
negative white blood cells. What is the next step?
- Ultrasound-guided biopsy of prostate
 - CT scan abdomen

- MRI pelvis
- Ultrasound and uroflowmetry

Q44 / A 66-year-old man is following in the outpatient clinic for lower urinary tract
symptoms secondary to benign prostatic enlargement on dual therapy (alpha blockers and
5-alpha reductase inhibitors) with recurrent bacterial cystitis. What is the best
management option?
- Increase the dose of alpha-blocker
- Add anticholinergic medication
- Transurethral resection of the prostate
- Permanent suprapubic catheter

Q45 / Majed is 44-year-old male patient presented with new onset diabetes and
hypertension. He complained of gaining 20 kg over the last 1 year. He looked puffy with
central obesity
and thin limbs. He was suspected to have Cushing’s syndrome. Initial screening with 1 mg
dexamethasone showed non-suppressed cortisol level. On further evaluation Majed's
ACTH level = 5 pg/ mL (Normal ACTH, serum 9-52 pg/mL). Which of the following
diagnostic tests you will order next in Majed's condition?
- High dose dexamethasone suppression test
- Pituitary MRI scan
- Adrenal CT scan
- Chest X-ray

Q46 / Patient on chemotherapy, high phosphate, high uric acid.

- Tumor lysis syndrome.
- Febrile neutropenia.
- Aplastic anemia

Q47 / Stable patient with CKD and has elevated potassium level of 5.6 and low bicarbonate
16, what is your next step?
- Dialysis.
- Give sodium bicarbonate.
- Phosphate binder

Q48/ Aure rods are typically seen in which type of leukemia:

- Acute lymphoblastic leukemia
- Chronic Lymphocytic leukemia
- Acute Myeloid leukemia
- Burkitt's lymphoma
Q49 / Which of the following neuromodulators is a potent vasodilatory that increases blood
flow in the gastrointestinal tract, and causes smooth muscle relaxation and epithelial cell
secretion?
- Somatostatin
- Cholecystokinin
- Acetylcholine
- Vasoactive intestinal polypeptide

Q50 / Where are the Baroreceptors located?

- Aortic arch and Carotid sinus.
- Circle of Willis.

Q51 / Which of the following a measurement of variation between Red blood cells?
- RDW.
- MCV.
- MCH.

Q52 / What is the most common lymph node for prostate cancer metastasis?
- Para-aortic lymph nodes.
- Obturator lymph nodes.
- Inguinal lymph nodes.
- Common iliac lymph nodes.

Q53 / Which part of the nephron contains a brush border and responsible for most of
absorption?
- Loop of Henle.
- Proximal convoluted tubule.
- Distal convoluted tubule.
- Colleting duct.

Q54 / What is the normal difference in blood pressure between standing and recumbent?
- 10 mmHg systolic and 5 mmHg diastolic.
- 15 mmHg systolic and 10 mmHg diastolic.
- 20 mmHg systolic and 10 mmHg diastolic.

Q55 / Myeloblast give rise to:

- Basophils, eosinophils, and neutrophils.
- Lymphocytes, neutrophils, and monocytes.
- Erythrocytes, monocytes, and neutrophils.
- Lymphocytes, basophils, and eosinophils.
Q56 / Epilepsy pathophysiology?
- Axonal.
- Cell body.
- Dendritic.
- Mylene.

Q57 / Patient with heart failure, bedridden, and his sons supervised his medications. ECG
showed flattened T-wave in most leads. What is the cause of decompensated heart failure?
- PE.
- ACS.
- AF.
- Nonadherence to medications.

Q58 / What is the function of prostate?

- Production of sperms.
- Enhance the motility of sperms.
- Nourishment of the sperms.

Q45/ Patient with FSG on steroids, tacrolimus and proteinuria decreased from 6 to 3 with
150/90 BP, what to give next?
- Add candesartan.

Q59 / Which of the following is included in the 5’R:

- Right patient
- Right nurse
- Right room

Q60 / Patient with morbid obesity and high risk for cardiovascular events, refused medical
and surgical intervention, which of the following ethical principle was applied?
- Autonomy.

Q61 / The patient was diagnosed with cancer, and he decided not to know the diagnosis,
which ethical concept was appreciated in this case?
- Patient’s right not to know.

Q62 / Time out definition:

- At admission.
- At the outpatient clinic.
- Immediately before surgery.

Q63 / Positive patient identification definition:

 - Ask the patient and conform it.

- Conform it.

Q64 / Decision of DNR, should be made by:

- By patient in advanced.
- By court.
- By family.
- By managing team.

Q65 / One of the following statements involving 'Hospital Accreditation" is accurate:

- Applying hospital standards for optimal and achievable performance is a goal.
- It is done through hospital survey by internal peer reviewers.
- Hospital accreditation is an obligatory process for any healthcare system.

Q66 / Health care must best use of limited resources. It is a definition of:
- Efficiency
- Effectiveness
- Efficacy.

Q67 / Patient with DNR presented with cardiac arrest, his family ordered resuscitation,
what should you do?
- Follow the DNR and explain to the family.
- Follow family wishes.

Q68 / Clinical risk steps:

- Identify, analyze, action, monitor, control.
- Action, analyze, Identify, monitor, control.
- Action, Identify, analyze, monitor, control.
- Identify, analyze, action, control, monitor.

Q69 / Patient with COPD and still a smoker, required to pay more by insurance company,
which of the following ethical principle was applied?
- Justice.

Q70/

Q71/

Q72/
Thank You