6th year Final Exam

2009
Internal Medicine
Multiple Choice Questions

MCQ
Dear colleagues, this is an attempt to write down final exam MCQs, it is not that professional, but it may be useful for someone.. we advise you not to memorize the questions but to try to imagine how they will be... Do your best, never give up hope, trust Allah Your colleagues Class of 2003

e-Copy @ www.icareunit.com

6th year final MCQ Exam 2009 Internal Medicine

e-Copy @ www.icareunit.com Dear colleagues, this is an attempt to write down final exam MCQs, it is not that professional, but it may be useful for someone.. we advise you not to memorize the questions but to try to imagine how they will be... Do your best, never give up hope, trust Allah Your colleagues Class of 2003

PLEASE SLEEP WELL BEFORE THE DAY OF THE EXAM. PLEASE STUDY THE TOPICS THAT ARE INCLUDED IN THE MCQs, DONT MEMORIZE THE ANSWERS ONLY, STUDY THE TOPICS. Questions were organized as cases, long cases, not as written here, so be prepared for the marathon..

1. Case of UTI, penicillin resistant, what to use? Pipracillin-tazobactam. 2. Best managent for H.pylori eradication? Amoxicillin + Clarithromycin + PPI. 3. Least to find in infective endocarditis? a. Duputryn contracture. * b. Clubbing. 4. What is inappropriate to be given in COPD emergency case? High flow oxygen. 5. What is the disease that presents specifically as a restrictive lung disease? a. Sarcoidosis. * b. eseonophilic granuloma.

6. A case of gout ( thiazide diuretic use, joint pain), one is true? Allopurinol can be used when the acute attack finishes. 7. Many symptoms, what is the diagnosis? Haemochromatosis. 8. Many symptoms ( dilated cardiomyopathy.), what is the diagnosis? Amyloid. 9. A case of celiac disease, what is the finding in the biopsy? Villous atrophy in small intestine. 10. Female presented with watery diarrhea, abdominal cramps, on examination: there is right sided tenderness, and in labs: there is microcytic anemia. What is the best investigation to reveal the diagnosis? a. Ileocolonoscopy. * (not sure) b. anti-endomyseal antibodies. c. ana. d. Double contrast barium enema. 11. A case of secondary hypertension, what is the LEAST to indicate the reason of it? Hyponatremia. 12. A case of Cushing, one is wrong? Osteomalacia. 13. A cause of primary amyloidosis? Myeloma. 14. One thing that doesnt indicate a flare up of SLE? Increased WBC. 15. A matched relationship between psoriatic arthritis and rheumatoid arthritis? ?? 16. All can increase the survival in heart failure, EXCEPT?

Digoxin. 17. All can cause decreased DLCO, except? Heart failure. 18. All can be considered as controlled asthma, EXCEPT? Night symptoms 19. Pleural effusion, given LDH levels indicate (transudate pleural effusion), all can cause this, EXCEPT? TB. 20. Asymptomatic healthy patient, on a pre-employment routine medical checkup, found to have bilateral hilar lymphadenopathy on chest x-ray, what is the BEST management? Reassurance. 21. One isnt included in the paraneoplastic syndrome in lung cancer? Horner syndrome. 22. One is a specific sign for congestive heart failure? a. Palpaple liver. * (not sure) b. pulmonary edema. c. ankle edema. 23. One cant be presented in the ECG in Hyperkalmia? Prolonged Q-T. (not sure) 24. One cant be presented in the ECG in 3rd degree heart block? Absent P wave. (not sure) 25. A case of COPD, and ABG findings, what is the acid-base disorder? Acute on chronic respiratory acidosis. 26. A case of hypoxia, and hypercapnia. What is the mechanism? a. Hypoventilation. * (not sure) b. V-Q mismatch.

c. Cardiac shunt. 27. All can cause hyperprotenimia, EXCEPT? Renal failure. (not sure) 28. The LEAST to cause microangiopathic hemolytic anemia? HSP. 29. ONE cant use cryoprecipitate in? a. Warfarin overdose. * b. DIC. c. VWF disease. 30. A case of aplastic anemia????? 31. A case of cold agglutinin??????? 32. A case of irritable bowel syndrome, what to use? Lactose and prokynetic. (not sure). 33. A case of upper GI bleeding, with very low BP, what is the best initial management? Volume resuscitation. 34. Which can be considered as a POSITIVE PPD test? A high risk person (history of close contact with a TB patient), with more than 10 mm reaction. 35. Which is the LEAST joint aspiration FINDING to indicate Septic arthritis? a. Hyper viscosity of the fluid. * b. WBC more than 70 000. c. positive culture, positive gram stain. 36. Which is the endocrine disease that causes LOW RENIN and hypertension? Conns disease.

- Drug not affect mortality in HF: digoxin - chronic aortic regurgitation: valsalva maneuver - hepatitis b immune status: -ve e -ve surface ag + antibody - pure diastolic dysfunction: long standing hypertension - hepatitis c one is true: liver enzymes could be normal - esophageal manometry for 10 years dysphagia - GERD one is true: improves by medical management - amoxicllin and clarithromycin and PPI are the 1st line of management of peptic ulcer - for + guiac stools and weight loss 72 years old man upper GI endoscopy - case of IBS: we give fibre diet - 25 years old female with watery diarrhea and right iliac fossa tenderness: we do coloiliacoscopy. - celiac disease one is true: total villous atrophy - one of the following do not cause microangiopathic hemolytic anemia the true is: HSP - case of hepatocellular carcinoma: (gamma GT was high in the case) - multiple myeloma one is wrong: osteoblastic bone lesion - complete AV block one is wrong: regular P-P interval - hyperkalemia management except: spironolactone - Acid base disorders, calculations. - behcet disease not associated with ESRD. - one thing is common between psoriatic arthritis and rheumatoid arthritis is: involvement of wrist joints. - wrong of ankylosin spondylitis is: involvement of small joints - case of cough fever and hypocomplementemia: post infectious glomerulonephritis - case of 72 years old man with hemolytic anemia what to do next : direct coombs test

- case ... there were few normal granulocytes the answer was acquired aplastic anemia - multiple myeloma associated with primary amyloidosis. - case of cough, fever and bilateral basal infiltrates according to my memorey associated with cold agglutitnins (i think the question meant mycoplasma pneumonia) - ceftriaxone and steroids in case of suspected meningitis. - cryoprecipitate is not given in case of increased warfarin INR. - case of suspected hemophilia we dont ask for antiphosopholipids. - case of ITP ( on routine check up platelets were 110 wt to do?: (steroids? or ?reassurance) - involvement of right middle cerebral artery is associated with motor aphasia. - septic arthritis not associated with is hyperviscosity of the synovium - giant cell arteritis is not associated with recurrent headache - hematology case ... the answer was CML. - Conn's disease is associated with decreased rennin. - not paraneoplastic syndrome in lung cancer is horner syndrome. - do not add benefit to diagnose pneumonia is sputum culture. - not poor diagnostic factor in pneumonia is HR of 114. - not controlled asthma is 2nights per month or week? - specific for congestive heart failure s3? - case of suspected PE in postpartum woman to diagnose by ct angio. - case of 70 pco2 and 60 o2 in copd patient wt is wrong in management is giving high flow O2. - true about sarcoidosis is giving restrictive PFT. - eosinophilic granumoma do not give bronchiectasis - case of transudative pleural effusion wt is wrong of the differential was TB. - diagnosis of TB is by closed lung biopsy???

- highly infectious TB in cavitary TB. - not associated with HIV is pneumococcal meningitis - least likely for abdomial distension and bilateral lower limb edema is TB infection - severe penicillin allergy wt to give was levofloxacin - fever of unknown origin not associated with is hypothyroidism. - growth hormone increase not associated with is hypocalcemia. - hyperprolactinemia is not associatedd with dopamine agonis - secondary hypothyroidism not associated with was galactorrhea - addison disease one is wrong was decrease ACTH. - crons one is wrong removed surgically - not associated with osteromalacia is decrease PTH - upper GI bleeding wt is the first step inmanagment is resuscitation - diabetic nephropathy normal Urine analysis do not rule out renal nephropathy - case of lipoid nephrosis cant remember at all - neuropathy of diabetes treated by gabapentin - not of the diagnostic criteria of RA photosensitivity - renal stones of gout one is true alloperinol is given after the resolution of acute attack - scleroderma not associated with pulmonary hemorrahage. - case of asymptomatic symmetrical hilar lymphadenopathy wt to do reassurance - polymiosistis wt is not inportant in physical examination? pelvic exam???? - plasmapharesis not indicated in SLE or membranous. - interfers with OCPs carpamazepine - case of epileptic woman on warfarin and INR was 8 mostly she is taking phenytoin - absolute contraindication for thrombolytic therpay is BP >180 over 100 - case of blood sugar 185 and hyoperpigmentation hemochromatosis

- impaired fasting glycemia 100-125 - pancarditis not of the major criteria of FMF - duputryn contracture not in infective endocarditis - case of pericarditis wt is the least valuable daignostic tool is cardiac cath - wechenbach av block in ar egular runner treatment by reassurance - v. tach and wide QRS treatment is by amiodarone. - case of new onset mi discharge on all the following except nefedipine - hyperkalemia do not cause prolonged QT - not used to differentiate btn secondary htn and primary htn is papilledema? - congestive heart failure do not cause decrease dlco - risk factor for stroke is TIA

2003

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