Paper 1(Medicine )

1.During percussion of chest in respiratory examination all of the following

are true except:
A. Right places is intercostal areas in midelavicular line in anterior exam.
B.Normally tympanic in percussion.
C. Stony dullness If patient has pleural effusion.
D. In consolidation percussion will be dull..
E Hyper resonance in COPD patient

2. Sign of Co2 retention include the following except:

A. Disoriented
B. Palmer erythema.
C. Flapping tremor.
D. Sweating.
E. Cold extremity and bradycardia

3. During examination of COPD patient the finding include:

A.Barrel chest, decrease chest wall expansion, AP diameter ›transverse diameter, hyper
resonance in percussion, Ronchi on auscultation.
B. Barrel chest, decrease chest wall expansion, AP diameter < transverse diameter, hyper
resonance in percussion, Ronchi on auscultation.
C. Barrel chest, decrease chest wall expansion, AP diameter ›transverse diameter, hyper
resonance in percussion, crepitas in auscultation.
D.Trachea shifted to It side, Barrel chest, decrease chest wall expansion, AP diameter
›transverse diameter, hyper resonance in percussion, Ronchi on auscultation.
E.Trachea shifted to It side, Barrel chest, decrease chest wall expansion, AP diameter ≤
transverse diameter, hyper resonance in percussion, Ronchi on auscultation.
4.All the following are sign of chronic liver
disease except:
Spider naive, Leukonychia.
Small size liver.
Lymphadenopathy.
Gynecomastia.
Ascites, splenomegaly
5. 60yrs old Libyan female presented with left side abdominal pain and feeling
heaviness in left side, and suspect she has Splenomegaly, what's your finding
in your examination to diagnose patient has Splenomegaly.
A. Not Moves with respiration.
B. Able to insert fingers between the mass and costal margin.
C, Palpable notch on the lateral surface..
D. Never extends beyond midline.
E. Tympanic in percussion.

6. Causes of tender hepatomegaly include all of the following except:

A. Acute viral hepatitis
B. Liver abscess
C. CCF
D. Primary biliary cirrhosis
E. Constrictive pericarditis

7.About examination of lymph nodes which of the following true:

A. If only left supraclavicular LN is palpable, it is called Troisier's sign which indicate
carcinoma of lung. )
B.Generalized lymphadenopathy means 3 or more anatomical non-contiguous areas
of LN involvement..
C. Normal LNs may be palpable in axilla, groin, usually, which are soft, rubbery,
shotty with Size
LNs = 3 cm.
D. Localized lymphadenopathy means 2 anatomical area of LN involvement.
E. Tender cervical lymphadenopathy most likely diagnosis is malignancy.

8.During general examination for hypothyroidism patient

which of the following indicate diagnosis
A. Bradycardia, dry skin, exophthalmos.
B. Tachycardia, delay relaxation of knee jerk.
C. Delay relaxation of knee jerk, exophtha mos.
D. Delay relaxation of knee jerk, dry skin, buffy face.
E,Delay relaxation of knee jerk, Tachycardia, buffy face

9.Which of the following are positive finding during general examination for
central cyanosis:
A. Cyanosis will be localized to extremity.
B. Cold affected part.
C. May be disappear with o2 therapy
D. Pathogenesis due to vasoconstriction or reduction of arterial flow.
E. Tongue not
10. Differences between venous pulse and arterial pulse in neck, which of
the following are true:
A. Two peaks with cardiac cycle. Upper limit falls with expiration, it is better seen than
palpation, Obliterated by light pressure at the root of the neck.
3. Two peaks with cardiac cycle, Upper limit falls with expiration, it is better seen than
palpation, Obliterated by light pressure at the root of the neck.
. One peaks with cardiac cycle, Upper limit falls with inspiration, it is better seen than
palpation, not Obliterated by light pressure at the root of the neck.
. One peaks with cardiac cycle, Upper limit falls with inspiration, it is better seen than
palpation, not Obliterated by light pressure at thé root of the neck.
wo peaks with cardiac cycle, Upper limit falls with inspiration, it is better seen than
palpation, Obliterated by light pressure at the root of the neck.

11.What are the following is true about the Murmur:

A.Aortic regurgitation (AR). Causing pan systolic murmur.
B.Pulmonary regurgitation (PR) causing early diastolic
murmur
C.ASD causing early diastolic murmur.
D.Tricuspid stenosis (TS) causing ejection systolic murmur.
E.Mitral stenosis causing pan systolic murmur.

12.Signs of pulmonary hypertension include the following except:

Right parasternal heave (indicates RVH).
Prominent 'a' wave in JVP. alpable P2.
Low volume pulse.
tricuspid regurgitation

13.which of the following conditions iron absorption will be decreased?

A.treatment with multivitamins
B.Chronic inflammation. on overload.
C.Taking king antibiotics
D.All of the above.

14. Which one of the following is seen in iron defi jency?

A. High transferrin
B. Low protoporphyrin level
C. High MCV low
D. Raised serum hepcidin levels
E.High serum ferrtin

15. Macrocytic anemia seen with all of the following conditions, except:
A. Liver disease
B. Folate deficiency
C. Vitamin B12 deficiency
D. Renal disease
E. Hypothyroidism.
16. Which of The following true about thalassemia:
A. Peripheral film finding is diagnostic
B. Diagnosis by hemoglobin electrophoresis
C. All cases treated with blood transfusion
D. Calcified as normocytic normochromic anemia
E. Low s. ferritin during investigation.

17. The comment on planter reflex in neurologic examination of the lower

limbs?
A. Extensor
B. Flexor
C. Equivocal
D. All of the above
E. It is sign of lower motor neuron lesion.

18. During history taking the following is true:

A. Occupational history is useful only for financial purposes.
B. History of presenting illness is best told as points and numbers.
C. Family history is only important in the gynecological cases.
D. History of drug allergy can save the patient from anaphylaxis.
E. Systemic review is not important in cardiac cases.

19. Which of the following is true regarding H/O chest pain:

I Pleuritic chest pain is aggravated by deep breathing.
3. Chest pain due to esophagitis can be relieved by lowering blood pressure.
C. C. epigastric pain is always due to gastrointestinal causes.
D. chest pain radiates between scapulae is not significant.
E.Retrosternal chest pain occurring only during exercise is treated by analgesia

20.Which of the following is true:

A. Ain a patient with left hypoglossal nerve palsy the tongue deviates to the left when
protruded.
B.A patient with upper motor neuron facial palsy has no wrinkling at the side involved.
C. A patient with lower motor neuron lesion does not have atrophy of the muscles involved.
D. Babinski sign indicate extrapyramidal lesion.
E.The position and vibration sense is carried by the lateral spinothalamic tract.

21. 49yr old Libyan male hypertensive presented with H/o severe headache
followed of transient lose conscious, oriented, no neurological deficit but
there is neck stiffness, no fever, likely diagnosis:

A. Acute viral meningitis.

B. Acute bacterial meningitis.
C. Intra parenchymal hemorrhage.
D.Subarachnoid hemorrhage.
E. Migraine headache.
22 The following are True Except:
A. TIDM is autoimmune in 90% of cases.
B. LADA is autoimmune disease in adulthood and needs insulin early.
C. Monogenic DM occur in first 6 months of age.
D. TDM is less common than TIDM in general population
E. T2DM is associated with genetic role and positive family history

23. The following statements are false except:

A. Opening snap heard by the bell of the stethoscope.
B. Loud S1 indicate pulmonary stenosis.
C. S3 occur just before S1 in diastole
D. Metal prosthetic click of aorta indicate non-functional prosthesis
E. Pericardial rub can be differentiated clinically from pleural rub.

24. The following are true about hypertension except:

A. It is silent killer. v
B. Masked hypertension diagnosis by by ABPM.
C. Urine analysis can give clue to the etiology of hypertension.
D. Patient with blood pressure over 200/100 mmg needs rapid lowering
of BP to norm 1hr.
E. Resistant hypertension require 3 drugs or more, one of them diuretics.

25. The following are false about diabetes mellitus except:

A. TDM always treatment by oral drugs.
B. TDM prone to ketoacidosis can present with DKA.
C. DKA is chronic complication of DM.
D. Hyperosmolar hyperglycemic state (HHS) needs large dose or insulin.
E. HBA1C 7% is not Diabetic.
 Paper two(Surgery)

26. Regarding systemic inflammatory syndrome (sirs) all the following

are true except
A. Hypothermia.
B. WBC less than 4000 /cumm.
C. Must be with documented infection.
D. d) Tachypnea more than 20 b/m
E. Tachycardia more than 100 b/m

27. The following Differential diagnosis of right iliac fossa pain,

tenderness and reboun tenderness are true except:
A. Acute salpignitis.
B. Acute appendicitis.
C. Michel's diverticulitis.
.D. Crohns disease.
E. Splenic vein thrombosis.

28. What is the commonest type of hernia in the women ?

A. Inguinal.
B. Femoral.
C. Epigastric.
D.Incisional.
E.Haitus hernia.

29. All these complication of massive blood transfusion true except:

A. Fluid overload.
B. Hypothermia.
C. Hypercalcemia
D. Hyperkalemia.
E.Coagulopathy.

30. Which of the following statement is not true?

A. Partial splenectomy can result in splenic regeneration.
B. During splenectomy the tail of the pancreas can be damaged.
C. A gastric or pancreatic fistula can occur as a post-splenectomy complication.
D. In a left hemicolectomy the spleen can be in danger
E. The risk of opportunist post-splenectomy infection (OPSI) is greatest after
the first 6 months, of splenectomy
31. The compressibility positive is an clinical sign of:
A. Soft tissue lesion.
B. Vascular lesion.
C. Hard lesion.
D. Hernia defect.
E. Cystic lesion.

31. The compressibility positive is an clinical sign of:

A. Soft tissue lesion.
B. Vascular lesion.
C. Hard lesion.
D. Hernia defect.
E. Cystic lesion.

32. All these are risk factor for DEEP VEIN THROMBOSIS DVT EXCEPT:
A. Pregnancy.
B. Previous history of DVT.
C. Major pelvic trauma.
D. Thrombophilia.
E. Elastic stocking.

33. All of the following statements are true with regard to complications in
acute pancreatitis except?
A. Patients with severe acute pancreatitis require a CT scan to detect pancreatic necrosis
B. Acute renal failure.
C. Aneurysm of the superior mesenteric artery can occur.
D. Hypercalcemia.
E. Pseudo cyst formation.

34. Which of the following is not a predisposing factor for a hernia?

A. Chronic obstructive pulmonary disease.
B. Obesity.
C. Urinary stones.
D. Pregnancy.
E. Peritoneal dialysis.

35. Which of the following the most typical presentation of the acute limb
ischemia?
A. Chronic pain.
B. Pulselessness
C. Poikilothermia (cool extremity).
D. Paresthesia and finally, onset of the paralysis.
E. Pallor.
36.Hyponatric patient with serum Na level 106 mmole is expected to has one
of the following:
A. Ventricular fibrillation
B. Atrial fibrillation. ,
C. Alter level of consciousness.
D. Gastric upset.
E. All of the above.

37. Which of the following is not a cause of

gangrene ?
A. Buerger's disease.
B. Infection
C. Intra-arterial drug injection.
D. Frostbite.
E. Chronic venous insufficiency.
38.Hyperamylisemia seen in the following condition except:
A. Acute pancreatitis
B. Acute gastritis
C. Mesenerteric infraction
D. Ectopic pregnancy
E. Acute parotitis

39.Non bitting leg edema seen in the;

A. In cellulitis.
B. Deep vein thrombosis.
C. Lymphatic obstruction.
D Chronic renal failure.
E. Erythema nodosium

40. All these are premalignant condition at the lower esophagus except:
A. Gastroesophagial reflux
B. Achalasia cardia
C. Canididasis
D. Corrosive injury
E. Plummer-venson syndrome

41.A 35-year-old woman undergoes an elective It hemicolectomy for carcinoma

colon.
Which of the following wound classes' best describes her procedure?
A. Class I, Clean
B. Class II, Clean/contaminated
C. Class III, Contaminated
D. Class IV, Dirty
E. None of the above
42.On a clinical examination regarding a big palpable spleen would be false ;
A. Dose move with respiration
B. Bimanual examination palatiment
C. Dull on percussion
D. Can get above it.
E. Palpable splenic notch.
43.Deep partial thickness, burn means:
A.Damage not deeper than papillary dermis.
B.Burn reaches deep parts of the reticular dermis.
C.Epidermis is not damaged,
D.Skin is completely damaged but subcutaneous is intact
E.None of above.

44.Regarding vermiform appendex which is true answer

A.About 70% has rerocaecal position
B.Paracaecal position present in about 20% of people
C.Has blood supply by an end artery Has abundant lymphoid tissue
D.All of above

45.45 old female ,presented with fever, rigor jaundice and colicky right
upper quadrant abdominal pain, on examination, mild tenderness with no
palpable gallbladder, her
most likely diagnosis :
WBC 20000 ,total bilirubin 5 mg /dl with slight increase liver enzymes,
what is the
A. Cancer head of pancreas.
B. Carcinoma of the gall bladder.
C. Chronic cholecystitis.
D.Bile duct stone cholangitis.
E. Acute cholecystitis.

46. Regarding cervical lymphadenopathy all of the following are true EXCEPT :
A. It is usually painless if due to malignancy
B. Needs careful examination of oral cavity
C. May occur in gastric carcinoma
D. It is the commonest presentation of Hodgkin's lymphoma
E. With a supportive component is usually due to myobacterial infection
47. All the following symptoms and signs are indicative of a tension pneumothorax
except ;
A. Short of breath.
B. Chest pain.
C. A bscent breath sounds unilaterally.
D. Shifting of the trachea toward the pneumothorax.
E. Hypotension

48. Aboil is:

A. Any abscess of the skin.
B It is the same as carbuncle.
C. It is the same as pyogenic granuloma.
D. An infection of the hair follicle.
E. All of above.

49.Blood stained discharge from the nipple indicate ; 50, which is the complication
A. Duct ectasia. of portal
B. Fat necrosis of the breast. A. Hypersplenism
C. Fibroadenoma. B. Ascites
D. Duct papilloma. C. Encephalopathy
E. The likely presence of the breast abscess. D. Variceal hemorrhage
E. All of above
 Paper three (clinical skills)
51.Travel history is important in one of following infectious diseases:
A.. Malaria
B. Community acquired pneumonia
C. Gastroenteritis
D. Urinary tract infection
E. Septic arthritis

52.One of the following symptoms is specific for respiratory system diseases:

A. Dry cough
B. Chest pain
C. Shortness of breath
D. Productive cough
E. Hemoptysis

53. Regarding urinary catheter except :

A.Urinary tract infection is the most complication and can be avoided by using
ase technique.
B. The supra- pubic catheter indicated in patient with bladder outlet
obstruction.
C. Bladder spasms and pain are the complications of insertion.
D.External catheter is more suitable in patient with urine retention
E: Experience is not necessary for insertion...

54. All of the following composition of Ringers Lactate Except :

A. Sodium
B. Potassium
C. Magnesium
D. Calcium
E. Chloride

55.ST elevation occurs with all these diseases except:

A. ST elevation MI
B. pericarditis
C. LV aneurysm
D. Coronary spasm
E. Stable angina

56.Early complications of Intra Muscular injection all true, Except :

A. Itching
B. Redness
C. Hotness
D. Pain
E. Tissue necrosis

57. Normal respiration range of human adult:

A. 12 to 20
B. 15 to 25
C. 10 to 15
D. 10 to 15
E. 12 to 15
58. Reversible causes of cardiac arrest includes all of the following except?
A. Hypoxia
B. Hypothermia
C. Hyperkalemia
D. Tension pneumothorax
E. Lung tumor with Brain and liver metastasis

59. Which of the following is uncorrect regarding dialysis line:

A. Infection and low blood flow happen less frequently in properly formed AV fistulas tha in central
venous catheters.
B. When the patient need urgent dialysis central venous catheter is first choice.
C. AV fistula is a type of permanent vascular access and suitable in patient need emergen dialysis.
D. Internal jugular venous catheter is type of temporary line.
E. Bleeding is one of the complication dialysis line insertion

60.The most effective preventive way for hospital

infection control:
1.Decontamination of medical equipment
2.Hand hashing for medical staff Isolation of infected patients
3.Using of PPE
4.Management of hospital sharp wastes

61.Regarding CPR all are true except :

A.Chest compression should be in rate 60-70 per minute
B.In BLS > 30 compression to 2 breaths
C.Depth of compression should be 5-6 cm
D.Chest allowed to recoil completely after each compression
E. Minimal interruption
62 . All of the following indications of Normal Saline Except :
A.Hypercalcemia
B.Hyperkalemia
C.Hyponatremia
D.All of the above
E.Hyperchloremic metabolic acidosis

63.CPR Steps :
A. C-B-A
B. A-B-C
C. C-A-B
D. B-A-C
E,A-C-B

C- compression, A= air way, B= breathing

64.About pulse oximeter :

A.Oxyhemoglobin absorb more Red light
B.Deoxyhemoglobin absorb more infrared light
C.Infrared wave length 650 nm
D.Red wave length 5,60 nm
EAmount of light absorbed is proportional to length of light path
65. One of the following methods not used to measure pulse and heart rate:
A. Pulsoximeter
B Electrocardiogram monitor
C. Invasive blood pressure monitoring
D. Capnogram
E. Manual finger technique

66. The first step of medical emergency in hospital is:

A. Peripheral intravenous access insertion
B. Provide oxygen to the patient
C. Call for help
D. History and examination
E. Intubate the patient

67. Regarding the ECG all of the following are true except?
A. There is 5 limb leads and 5 precordial leads
B. ECG means electro-cardio-gram
C. lead 1 : Positive input from left arm, negative input from right arm
D. Lead ll is unipolar lead
E. V6 is unipolar lead positioned at 5th intercostal space mid-axillary line

68. slow raising pulse is seen in :

A Aortic stenosis
B. Aortic regurgitation
C. Fever
D. Anemia
E. Heart failure

69. The most reliable site for temperature is:

A. Oral
B. Axillary
C. Rectal
D. Tympanic
E. Nasal

70. One of the following is arrhythmias is not tachyarrhythmias:

A. SVT
B. VT
C. AF
D. PWP syndrome
E. Mobtiz type II

71.Nomal value of PCO2 in arterial blood is:

A.35-45
B. 45-55
С. 25-35
D. 55-65
E. None of the above
72. Regardin ETT all the following statements are correct except:
A. The most of adult use cuffed ETT to create a seal allowing positive
pressure ventilatio and decrease the risk of aspiration.
B. High pressure (low volume) cuff produce more severe ischemic damage to
tracheal mucosa.
C. Armored tube (wire-reinforced ETT) It resist kinking so used in abnormal
positions.
D. Endotracheal tube is a supraglotic devise.
E. Part of emergency trolley in emergency department

73.- Contraindication of Ringer Lactate, all true Except :

A. Addison's disease
B. Severe Liver disease
C. Severe CHF
D. Hypovolemia associated metabolic alkalosis
E. Hypovolemia associated metabolic Acidosis
74. Regarding CPR, one of the following is shockable rhythm ?
A. Ventricular fibrillation
B. Asystole
C. Pulseless electrical activity
D. Sinus bradycardia
E. Atrial flutter

75. Color code for peripheral venous access (Canula) size 22G is:
A. Yellow
B. Green
C. Blue
D. Purple
E. Gray

76.PH 7.2N, Pco2 30 HCO3 17'

A. Metabolic alkalosis
B. Respiratory Acidosis
C. Respiratory Alkalosis
D. Metabolic Acidosis
E. None of the above

77.Hypercapnia and hypoxia:

A. PO2 80 PCQ2 34
B. PO2 80 PCO2 55
C. PO2 100 PCO22 55
D. PO2 75 PCO2: 25
E. PO2 100 PCO2 35

78. Best site to assess the pulse in comatose patient is :

A. Brachial artery
B. Femoral artery
C. Radial artery
D. Ulnar artery
E. Carotid artery
79. During taking BP at upper arm, chest piece of stethoscope will put'on
which artery?
A. Axillary
B. Brachial
C. Popliteal
D. Radial
E. Femoral

80. One of the following chest diseases occupational history very

important:
A. Pulmonary tuberculosis.
B. Bronchocarcinoma.
C. Asbestosis
D.Broncheal Asthma.
E. Chronic Obstructive Air way disease.