* Cardiology * Dr.

Jelani

1) Stress test is indicated in:

A- diabetic patient with atypical chest pain
B- unstable angina with recent chest pain
C- critical aortic dissection
D- acute MI since 2 days

2) Which one of the following will increase the risk of peri operative cardiac
complication in non cardiac procedure :
A- signs of HF
B- history of chronic smoking
C- MI 4 months ago
D- lipid profile

3) Young lady with chest pain mainly at the left parasternal area cannot take full
breath because of pain that is not related to exertion and increase with palpation:
- Costochondritis

4) A patient collapsed and was found to have VT. DC shock was done twice but
patient didn't respond what could be the cause :
A- Hypokalemia
B- Hypomagnesemia
if there was no other suitable answer (eg. ischemia)
C- Hypocalcemia

5) Pregnant lady with diastolic murmur. What will you find in ECG ? *
A- LV hyper trophy
B- left atrial dilatation
if there was no other suitable answer (eg. RBBB)

6) Male with recurrent retrosternal chest pain burning in nature shortly after he
falls asleep, not related to exertion and lasting 20 minutes. He went to ER and
received sublingual nitrate and relieved *
A- UA
B- prinzmital angina
C- spasmodic esophagitis

7) Kussmal sign Dx
- Constrictive pericarditis

8) Patient with recent posteroinferior MI. Found to have SOB with pan-systolic
murmur mainly on the apex with soft S1:
A- MR
B- TR
C- VSD
9) 70 years old k/c DM and Hypertension came to your clinic , How you will control
his HTN:
A-ARB
B-Ca Chanal Bloker
C-Beta Bloker
D-Duritic

10) pt present to ER with pulsatile abdominal mass. aortic anurysm of 6 cm was

diagnosed.
how to treat it ?
a. surgical correction
b. BB if no contraindication
c. stent graft
11) What would not help in acute management of NSTEMI:
A-TPA
B-ASA
C-plavix
D-Metoprolol

12) 15 y/o male was playing football then suddenly fall down after exertion, what is
the cause :
A-HOCM
B-Myocarditis

13) VT not responding to DC shock next step *

- Amidarone

14) Young male with history of flue like Sx since 1 week. Presented with dyspnea on
excursion and lower limb edema
P/E : bilateral crackles . Vitals : fever.
Tropi: 5 ecg: ST-T changes. Dx? *
A- Pericarditis
B- Myocarditis
* Pulmonology * Dr.Abraham

1) Young lady k/c BA with recurrent episodes of wheezing and SOB several days /
week especially after exercise. 3 times / week night Sx . Visiting ER 4-5 times / year

She is on inhaled fluticasone 4 buffs BID, inhaled salmetrol bid and albuterol TID.
What's next ?

A- cromolyn

B- oral prednisolone 20 mg od

C- change albetrol to nebs

2) 48 y/o male with peripheral parasthesia and history of recurrent episodes of

wheezing

CXR hyperinflated chest

Labs: wbc differential showed 0 eosinophil

Skin biopsy : granuloma with necrosis . Dx? *

A- Churg Strauss (eosinophilia)

B- Wagner's disease

C- microscopic polyangitis (non granuloma)

D- poly arthritis nodosa (non granuloma , no lung involvement)

E- sarcoidosis

3) young pregnant female came with SOB and chest pain preceeded by progressive
left leg swelling. what is the investigation of choice ?

a. doppler US

b. V/Q scan

c. pulmonary angio

d. arteial angio
4) young female present with SOB and palpitation. she had Rt ventricular
hypertrophy

BP 100/70. what is most appropriate Treatment ?

a. thrombolysis

b. heparin bulos then infusion

c. warfarin

d. LMH

5) pt came with COPD exacerbation. ABG showed respiratory acidosis. ABG : ph : 7.21

what is the most appropriate Treatment ?

a. C PAP

b. short acting beta agonist nebs

c. SABA+ inhaled steroid

d. SABA+ LABA

6) 58 y/o female presented with bilateral pulmonary emboli and metastatic uterine
adenocarcinoma to the liver. Past histroy of previous DVT two years ago when
she was diagnosed with cancer, completed 6 months of warfarin afterwards.

Now she received low molecular wt heparin for 7 days. Next step ?
A- Warfarin with aim INR 2-3
B- Warfarin with aim INR 3-4
C- continue Low molecular wt heparin

7) Po2 59 at sea level , Po2 at 40% inspired O2 61

which of the following is least likely to cause these finding : *

A- interstitial lung fibrosis

B- hereditary telengctasia

c- Atelactasis

D- one of the cyanotic heart disease (B and D is correct but you choose D
* Gastroenterology * Dr.Akwaa

1) 68 y/o male with long history of dyspepsia and wt loss 7 kg . Presented with
jaundice, rt upper quadrant pain , dark urine and pale stool . P/E he was comfortable
and jaundiced

Abdomen US showed multiple gall stones and dilated CBD

AST and ALT around 300 ALK high. Next step:

A- admission for work up

B- urgent ERCP to relieve the compression then Refer to hepatologist

C- abdomen CT with contrast

D- send for blood culture and start ABx

Look for pancreatic malignancy

2) Male presented with fever abdominal pain jaundice . Dx?

- Cholangitis

3) Male patient admitted with MI 3 days later developed upper GI bleeding found to
have esophageal varieces . Best tttx to stop bleeding ?

A- band ligation

B- IV telipressin

4) Patient presented with vomiting 6 hours after eating from local restaurant .

Most likely organism ?

- Staph aureus

5) What of the following suggest Crohn's disease rather than Ulcerative colitits :

A-cryptogenic abcess

B-Non caseating granuloma

C- Defuse colitis

D- rectal bleeding

6) Middle aged women on OCP presented with abdominal

pain, ascitis, hepatomegally. No asterix. Most likely Dx:

A- Bud-chiary syndrome
B- Acute hep B
* Nephrology * Dr. Khamees

1) A male patient diagnosed with post strept glumerulonrphritis what will you see in
biopsy?*

a- no deposit

B- sub endothelial deposit

C- mesangial thickening

D- subepithelial (,hump-like scattered deposits.)

2) Patient presented with SIADH. tttx ? *

- Restrict fluid

-restrict fluid, remove the cause if possible,?drug, hormonal treat,,vaptan.

3) Patient presented with DKA Sx

BS: 40 mmol . PH 7.12 co2 61 HCO3 5

Acid base disorder ?

A- High anion gap MA

B- High anion gap MA with RA

C- RA

4) Patient diagnosed to have HTN started on ARBS. Came for follow up and was found
to have k: 6.5 . What could be the underlying cause ?

A- type 4 RTA

B- type II RTA

C- renal artery disease (and this is an indication to stop ARB/ACEI.)

5) Neurological side effect of cyclosporin ?

- Interstitial nephritis (? Cyclosporine cause constriction pre-renal)

6) Psychiatric Patient having chronic headache on pain meds

Presented with renal failure picture what could be the cause ?

- Interstitial nephritis
7 ) HIV pt presented with nephrotic syndrome. biopsy showed focal segmental GN

what is the most appropriate Treatment ?

A-ACEI and immunospressive therapy

B- steroid

C- highly active retroviral and ACEI (collapsing FSGS variant-part of HIVAN,,NOT

idiopathic to give steroid.)

D-highly actice anti viral and Steroid

8) 35 year old Pregnant lady with abdomen US showing multible cyst in both kidney
and liver what is the most likely diagnosis: *

A-Acquired cystic disease

B-Autosomal ressive polycystic kidney disease

C-Autosomal dominant polycystic kidney disease

* Hematology *

1) Young lady with SCD on hydroxyurea and folic acid.

presented with palpitation and excertional dyspnea. Her mother reported that she
was not regularly taking her medication

Labs. Wbc 9. Hg 4. Plt 260 retics < 1. Dx? *

A- hydroxyurea side effect

B- parva b19

C- splenic sequestration

D- folate deficiency

THE ANSWER IS: B

2) Hydroxyurea is effective in preventing :

- VOC

- sequestration crisis

THE ANSWER IS: A

3) Patient with increases PT and thrombocytopenia *

THERE IS NO OPTIONS BUT POSSIBLE CAUSES INCLUDE: LIVER DISEASE, SPLENIC
DISEASE AND DIC (DIC ALSO HAS HIGH PTT)

4) Which one of the following will present with thrombosis : *

A- Protein c & s deficiency

5) Most series complication of HIT:

A- thrombosis

B- skin necrosis

THE ANSWER IS: A

6) How to diffrantiate Thalasemia B trait and Iron def. Anemia :

A-Normal Transferrin level

B- Hgb A2 level

C-Iron binding capacity

????? (MAY BE ALL EXCEPT!!)

7) 19 y\o Female presented with frothy urine and edema was found to have very low
Albumin, high cholesterol & protinurea. Renal biopsy was taken and a diagnosis of
minimal change was made. She was discharged on prednisolone.

Now she presented with painful leg swelling. On examination Leg swelling. Labs:
Low albumin
She was started on heparin and steroid and after few days she was re evaluated and
she did not improve. INR: 1.5. What's the most likely cause:
A- anti thrombin III deficiency
B- heparin dose not enough
C- protein C def

THE ANSWER IS:A

8) 40 y/o female had 11 hour long flight presented with leg swelling. dx of DVT was
made. She report positve family history of thrombosis in father and brother. She
used to take OCP and had one uncomplicated pregnancy. She is not taking any
medication now.

Next step:
A- Test for lupus group
B- Test for protein C, S and anti-thrombin III
C- No need for testing
D- screen for malignancy

THE ANSWER IS: B

9) 55 year old male came with constipation

Lab showed
Hb 10
Mcv 70
Ferritin 10 (low)
Iron 1 (low)

Next step:
A- Colonoscopy
B- Iron absorption study

THE ANSWER IS: A

10) young male had body weakness , skin rash and pale conjunctiva

Hg: 4. Wbc: 3. Plt: 90

- Apla
* Oncology *

1) Breast cancer marker:

- Ca15-3

2) Female with vague Sx

Labs low plt and Hg and positive for BCR-ABL . Dx?

- CML

3) Smoker patient with CXR lung mass near the hilum with labs showing high ACTH.
Dx?

- Small cell carcinoma

- adenocarcinoma

THE ANSWER IS: A

4) Cancer patient admitted with febrile neutropenia was on Imipenem and amikacin
for more than 5 days and didn't improve blood culture was taken from the central
line showing

What to do next *

A- anti fungal and don't remove the line

B- Cipro and remove the line

THE Q IS INCOMPLETE (TRY TO DISCUSS WITH ID/ONCO)!!

SO, I THINK:
 IF THERE IS NO ORGANISM FOUND >>>THEN A IS THE ANSWER
 IF THE ORGANISM WAS PERSISTAT AND SENSITIVE TO CIPRO>>> THEN B
5) What could be safely treated with Imatinib:

A- CML

B- CLL

THE ANSWER IS: A

* ID * Dr.Taha

1) A solder working in Gizan came back to his family in Rhyiad after 1

week with bloody diarrhea labs showed a picture of elevated liver enzymes. Dx? *

a. Rift valley fever

b. Dengue fever

C- malaria

2) Prophylaxis of Travelar diarrhea :

A-ciprofloxacin daily
(I am not sure Cipro is the right answer. Prophylaxis is not recommended at all for TD)

3) 45 y/o female came with hx of cough with greenish sputum and fever , CXR
showing Lobar consolidation(pneumonia), vitals are normal.

Which Abx you must give ?

A-Amoxicilin (ceftriaxone should ork as well! Are you sure the question was like
this)

B-Ceftriaxone

C-Azithromycin

4) pt presented with confusion, headache and photophopia, on examination he is

febrile

CT: ventricular dilatation

opening pressure 300

LP showed lymphocytes, low glucose, high protein

PPD negative

what is the most likely diagnosis?

a. TB meningitis

b. aseptic meningitis

c. viral meningitis
d. GBS

5) HIV with bloody diarrhea (5-6 times/day) no fever or abdominal Sx

Stool analysis :

WBC positives

Clostridium difficile, salmonella , shigella and parasite negative

What to do next ?

- CT abdomen

- MRI abdomen

- OGD with biopsy of small intestine

- Flexible sigmoidoscopy with biopsy (they are after CMV)

6) Young male presented with dyspnea on exertion and dry cough for 2 weeks CXR
showed bilateral infiltration. Labs CD4: 190 . Dx?

A- PCP

B- TB

7) A patient had induction of chemotherapy. He developed fever and was

started since 10 days ago on IV Amikacin and Imepinum for febrile neutropenia . 3
days ago he started to have diarrhea. Next step:
A- Stool ova and parasite
B- Blood culture
C- Send for C.diff toxin
* Endocrinology * Dr.Hatahit

1) 30 years old patient known case of DM, she is on Insulin aspart 12 – 15 – 8 , and
insulin Glargine 25 , develop hypoglycemia before dinner , What should you do:

A-Decrease glargine

B-Decrese lunch dose

C-Decrese dinner dose

D-Decrese Breakfast dose

2) Psychotic patient on lithium presented with polyurea and polydypsia

Labs: hypernatremia 146. Urine osmolality 250. Dx?

A- Psychogenic polydypsia

B- DM

D- Diabetes insepites (nephrogenic)

3) cancer pt presented for F/U. CT abdomen showed rt. adrenal mass

What also will help in Dx: *

A- Dexamethasone suppression test

B- 24h urine catecholamine

C- Octereotide infusion

(Q need more information, incidentaloma you rule out hyperaldosteronism – usually

small not exceed 2mm and patient hypertensive , Cushing syndrome and
phenochromocytoma – usually large- if there answer all invest is best , we choose B
supposed to be this is large mass)

4) 55 yo male with bronchogenic carcinoma, now presented with abdominal

pain, polyurea, nausea and vomiting. What’s electrolyte disturbance?

A- Hypokalemia
B- Hyperkalemia
C- Hypocalcemia
D- Hypercalcemia
5) BA on steroid presented with abdominal pain vomiting

Labs showed hyponatremia Hyperkalemia and hypoglycemia . Dx?

- Addison's disease

* Rheumatology * Dr.Arfaj

1) SLE with groin pain on steroid for 6 months then stopped. O/E limping with
limitation of internal rotation in right hip . X Ray Normal . What will you do next:

a. Hip MRI

b. Radioneoclear bone scan

2) Young male with urethritis, arthritis, fever, ankle swelling and pustular skin rash*

- reactive arthritis

- gonococcal sepsis

3) young female k/c of HTN on treatment developed rash , artharalgia. Which

medication could be the cause of her Sx:

- Hydrazine
* Neurology * Dr. Omer

1) Patient with myasthenia gravies was admitted to ICU as a case of aspiration

pneumonia and required ventilation support after treatment she Improved and
vitals were stable and ABG normal. How can you monitor her respiratory condition:

A- O2 saturation

B- bed side vital capacity

C- ABG

D- shallow breathing test

2) Patient complaining of bilateral throbbing headache lasting around 14 hours

multiple times per week associated with phonophobia with tearing and runny nose
dx?

A- episodic Tension headache

B- Migraine without aura

D- Clustered headache

C- chronic subdural hematoma

3) Old female with with gait disturbance, urinary in-continuance and memory loss.
Dx ?

- NPH

4) Elderly lady with intermittent episodes of altered consciousness:

A- chronic subdural hemorrhage

B- NPH

C- Creutzfeldt–Jakob disease

D- dementia with Alzheimer's

5) elderly male with herpes presented with pain after it was crusted tttx pain:

A- Gapabentine

B- Ibuprofen

C- Acyclovir

D- Abx

7) male with H/O unsteady gait, dysarthria , vertigo and visual disturbance

Past history of episodes of visual loss p 1 year back. P/E ataxic gait with dysarthria

Funds examination showed optic atrophy. Treatment ?

A- interferon A

B- interferon B

C- methotrexate

D- azathioprine
* Dermatology *

1) Most common cause of itching in elderly

a. SLE

b. Malignancy

c. CKD

d. Dryness

2) target skin lesion

- erythema multi forum

3) Middle aged man presented with painless penile ulcer, Dx:

A- Syphilus

B- Chancroid
* Ethics and EBM * Dr Taha

1) which to be considered a Conflict of interest ?

A. Promote yourself …

B. Prolong contact with the patient

C. Prolong patient admission

D. Disclose your financial interest

2) Best screening test for alcohol related disorder

a. CAGE questionnaire

b. Ethanol level

c. ALK, AST level

D- CBC

3) 49 y/o lady which noticed breast mass 3 weeks ago, painless, had menstruation 2
weeks back, her mother had breast cancer at age of 55, the lump in right upper
quadrant non-tender, mobile, discrete with no change with menstruation.
Mammography showed no suspicious structure. What you will do next

a. MRI (I think – Yusri)

b. Aspiration /biopsy

c. Repeat clinical examination after 1 month

d. Repeat mammography after 6 month

4) 15 y/o female came to ER with her mother with abdominal pain, diagnosed as
appendicitis; her father is out of the town in the meantime. What will you do

a. Immediate OR

b. Verbal consent from the patient

c. Inform the patient and take the mother consent

d. Delay the OR till the consent taken from the father

5) HIV newly diagnosed worry to tell his wife and ask not to tell his wife. What will
you do?

a. Tell his wife mother and ask her to tell her daughter

b. Tell his wife

c. Protect the patient confidentiality

d. Reassure him and offer your assistance to tell his wife

6) after she became post menopausal she had no interest in life. women Scenario of
suicidal attempt ( cutted her wrest ) came to ER. What you will do:

a. Give her least priority

b. Treat her then refer her to psychiatrist

c. Do not treat her because of religious matters

d. Try to shift her to another physician

7) 500 children were exposed to DES studied for risk of malignancy and were
followed for 20 years in comparison to 1500 children who were not exposed to DES.
What is the type of study

a. Cohort

b. Case control

8) Calculate median

-Value in the middle

9) Calculate range

- Highest - lowest
10) Drug that increase life duration but not cure the disease

A- increase prevalence

B- increase incidence

C- decrease prevalence

D- decrease incidence

11) when to disclose the confidentialty of pt medical information ?

a. when the pt allowed

b. when the senior consultant asked

c. if the case is rare

d. if for residant teaching

12) Student conducted a questionnaire about the relation of smoking and high blood
pressure, to 100 people and received the answers, what is the highest statistical
analysis that could be applied?

A- CHI Square

B- Correlation

C- Student T-test

D- ANOVA
* Critical care *

1) Patient was admitted to ICU with septic shock given norepinephrine and
vasopressin then he developed arrhythmia that stopped after discontinuing the
medication but patient still in shock what to do next: *

A- Dobutamin

B- Epinephrine

2) Hypotensive Patient with raised JVP PCWP and RA. Dx?

A- cardiogenic shock

B- temponade

C- distributive sepsis

D- Hypovolemic shock

THE ANSWER IS: B

* Psychiatry *

1) Medical student with 2 months history of lack of sleep, very active visited 3
hospital at the same day. Started clerking patient history without completing it .
Good appetite with wt gain and no delusion. Vitals Bp: 130/80 HR: normal . dx ?

- anxiety neurosis

- hypomania

- schizophrenia

- thyrotoxicosis
* Opthalmology *

1) Young female with frontal headache and visual disturbance . History of acnea for
which she was taking meds. Central venous artery pulseless on fundoscopy . Cause ?

A- erythromycin

B- clindamycin

C- tetracycline

D- OCP

* Wilson

* urine hemosiderin

* guac test

* propythioracel