SLE October 2008

Medicine
1. The best investigation to differentiate iron deficiency anemia from other anemias of chronic illness: a) Serum iron b) Serum ferritin c) TIBC d) .. 2. A male patient who is a known case of hypercholesterolemia, BMI :31, his investigations show (numbers): high total cholesterol, high LDL & high TG......Of these investigation what is the most important risk factor for developing coronary artery disease:: a) Elevated LDL b) Elevated HDL c) Low HDL d) Elevated cholesterol e) Elevated triglyceride level 3. A side effect of L-Dopa: a) Dyskinesia b) .. c) .. d) .. 4. The most common cause of secondary hypertension is: a) Renal artery stenosis b) Adrenal hyperplasia c) Pheochromocytoma d) Cushing's disease 5. A 27 yo girl came to the ER, she was breathing heavily, RR 20/min. she had numbness & tingling sensation around the mouth & tips of the fingers. What will you do? a) Let her breath into a bag b) Order serum electrolytes ?? ca+2 c) First give her 5ml of 50% glucose solution d) .. 6. A pt was brought by his son. He was pulseless & ECG showed ventricular tachycardia, BP 80/? Your action is: a) 3 set shock b) One D/C shock (cardioversion) c) Amiodaron 1

d) CPR 7. One of the following is a characteristic of cardiac syncope (vasovagal attack): a) Rapid recover b) Abrupt onset c) When turn neck to side d) Bradycardia e) Neurological deficit 8. An elderly female presented with history of bilateral hand stiffness that is worse in the morning. On examination she had bony swellings in the distal interphalangeal joints. These swellings are: a) Heberden nodule b) Buchard's nodule c) Synovial thickening d) Synovial cysts 9. An elderly male pt who is a known case of debilitating disease presented with fever, productive cough. Sputum culture showed a growth of G-ve organisms on a buffered charcoal yeast agar. The organism is: a) Mycoplasma pneumoniae b) Klebsiella pneumoniae c) Ureaplasma d) Legionella 10. An elderly lady presented with chronic knee pain bilaterally that increases with activity & decreases with rest. The most likely diagnosis is: a) Osteoarthritis b) Rheumatoid arthritis c) Septic arthritis d) .. 11. The most common cause of chronic renal failure: a) HTN b) DM. c) Hypertensive renal disease d) Parenchymal renal disease e) Acute glomerulonephritis 12. Aspirin & clopedogril indicated for: a) A 55 year old man with acute coronary syndrome. b) A 65 year old man with hx of MI c) A 65 yo man with stroke.

d) A 65 yo man with CHF e) After cardiac catheterization ?? 13. One of the following is true about the home treatment of COPD: a) Give O2 if SO2 is less than 88% b) Give O2 if SO2 is 88-95% c) Give O2 at night (nocturnal) only d) .. 14. Which of the following indicate inferior wall MI (Inferior chest leads) in ECG are: a) II, III, AVF b) V1,V2,V3 c) V2, V3, V4 d) I, V6 e) I, aVL, VI 15. Treatment of pseudomembranous colitis: a) Metronidazole b) Vancomycin c) Amoxicillin d) Clindamycin 16. A pt who is a KCO posterior MI presented with syncope. Examination showed canon (a) wave with tachycardia, unreadable BP & wide QRS complexes on ECG. The diagnosis is: a) Atrioventricular re-entrant nodal tachycardia b) Ventricular tachycardia c) Pre-existing AV block d) Anterograde AV block e) Bundle branch block 17. A pt had HBsAB +ve, but the rest of the hepatitis profile was negative. The diagnosis is: a) Immunization from previous infection, past exposure or vaccination b) Carrier state c) Chronic hepatitis d) Active infection 18. The drug with the least side effects for the treatment of SLE is: a) NSAIDs b) Methotrexate c) Corticosteroid d) Hydroxychloroquin

19. A young male who is a known case of sickle cell anemia presented with abdominal pain & joint pain. He is usually managed by hospitalization. Your management is: a) In-patient management & hospitalization b) Out-patient management by NSAID c) Hydration, analgesia, monitoring. d) Narcotic opioids 20. A lot of bacteria produce toxins which are harmful. Which one of the following is used in amiddirs: a) Botulism b) Tetanus c) Diphtheria d) Staph aureus 21. All the following cause hyponatremia except: a) DKA b) Diabetes insipidus c) High vasopressin level d) Heart failure 22. A pt is a known case of moderate intermittent bronchial asthma. He is using ventoline nebulizer. He develops 3 attacks per week. The drug to be added is: a) Increase prednisolone dose b) Add long acting B agonist c) Add ipratropium d) IV aminophyllin 23. Warfarin is given to all the following except: a) Young male with Atrial fibrillation & mitral stenosis b) Male with AF & cardiomyopathy c) Male with AF & prosthetic heart valve d) Elderly male with normal heart 24. The antihypertensive of choice for diabetics who have HTN: a) Ca channel blocker b) -blocker c) ACEI d) Blocker 25. A 24 Y/o man presented with 4 month Hx of diarrhea with streaks of blood & mucous. Ulcerative colitis was confirmed by colonoscopy. The initial therapy for this patient: a) oral corticostreiod b) azathioprine

c) infleximabe d) 5-Aminosalicylic acid e) Sulfasalazine 26. The typical ECG change associated with the first hour of acute pericarditis: a) Q wave inversion b) ST inversion c) ST elevation d) T wave inversion e) prolong PR interval 27. A 20 years old male who is a known asthmatic presented to the ER with shortness of breath. PR 120, RR 30, PEFR 100/min. examination revealed very quite chest. What is the most propable management? a) Nubelized salbutamol b) IV aminophyline c) Pleural aspiration d) Hemlich maneuver e) Chest drain 28. Plavix & aspirin used for: a) Pt with previous history of ischemic stroke b) Pt going for angiogram c) MI d) Acute coronary syndrome 29. A hypothyroid pt on thyroxin had anorexia, dry cough, dyspnea & left ventricular dysfunction. She had normal TSH & T4 levels, Hyperphosphatemia & hypocalcemia. The diagnosis is: a) Primary hypoparathyroidism b) Secondary hypoparathyroidism c) Hypopituitaritism d) Uncontrolled hyperthyroidism 30. A female patient presented with symptoms of hyperthyroidism, tender neck swelling & discomfort. She had low TSH & high T4 level. The diagnosis is: a) Subacute thyroiditis b) Thyroid nodule c) Grave's disease d) . 31. Which of the following is a drug-induced SLE: a) Hydralazine b) Azithromycin

c) Metoprolol d) Digoxin e) Penicillin 32. Treatment of pseudomembraneous colitis: a) Metronidazole b) Amphotiricin B c) Vanconazole d) Vancomycin IV e) Docicyclin 33. A patient on IV line developed fever due to infection. The most common source of bacterial contamination of IV cannula: a. Contamination of fluid during manufacturing process b. Contamination of fluid during cannula insertion c. Contamination at site of skin entry d. Contamination during injection of medication e. Seeding from remote site during intermittent bacteremia

Surgery
34. A 55 yr old man presenting with Hx of streakes of blood in stool and dull pain on defecation that persists for half an hour after defecation, on examination there was a 3x2 cm thrombosed mass at 3 oclock. What is the management? a) Sitz bath 5 times/ day. b) Application of local anesthetic and incision. c) Application of antibiotic d) Band ligation and wait for it to fall e) Application of local anesthetic ointment 35. A 42 year old woman presented with a painful breast mass about 4 cm in the upper lateral quadrant. It increases in size with the menstrual period. Examination showed a tender nodularity of both breasts. What is the management: a) Hormonal treatment with oral contraceptive pills b) Hormonal treatment with danazol c) Lumpectomy d) Observation for 6 months 36. A 48 year old man complaining of right lower quadrant pain, bleeding per rectum, nausea & vomiting. What is the best pre-operative investigation? a) Air contrast enema b) Fecal occult blood c) CBC

d) 37. 17 year old young male presented with abdominal pain that started periumbilical then became localized in the right iliac fossa. CBC showed high WBC count (typical presentation of acute appendicitis). The best next step is: a) CT b) US c) Serial 3 abdominal films d) Sigmoidoscopy e) Diagnostic laproscopy 38. A 26 year old woman had a perforated gallbladder post cholecystectomy. She presented with right upper guadrant pain that was tender, with fever of 380C, a pulse of 120 bpm & raised right diaphragm on CXR. The most probable diagnosis is: a) Acute cholecystitis b) Acute pancreatitis c) Acute appendicitis d) Subphrenic abscess e) Perforated peptic ulcer 39. A 10 year old boy came to the ER with Rt scrotal pain and swelling, on examination: tender Rt testis, with decreased flow on Doppler study. Your diagnosis is: a) Hernia b) Hematocele c) Testicular torsion d) Orchitis 40. A 17 year old man presented with a 12 hours history of central abdominal pain then it became localized in the right iliac fossa. On examination he had pyrexia, guarding & rebound tenderness (a case of acute appendicitis). The most appropriate investigation is: a) CT scan b) Pelvic Ultrasound c) Diagnostic laparoscopy d) MRI 41. A 60 year old diabetic man presented with dull abdominal pain & progressive jaundice. On examination he had a palpable gallbladder. The most probable diagnosis is: a) Chronic cholecystitis b) Common bile duct stone c) Carcinoma of the head of pancreas d) Gallbladder stone

e) Hydrocele of the gallbladder 42. A 30 year old man presented with feeling of heaviness in the lower abdomen. On examination he had a small bulge palpable at the top of the scrotum that was reducible & increases with valsalva maneuver. The most likely diagnosis is: a) Indirect inguinal hernia b) Direct inguinal hernia c) Femoral hernia d) Hydrocele e) Varicocele 43. A 48 year old woman presented with right abdominal pain, nausea & vomiting. On examination she had tenderness in the right hypochondrial area. Investigations showed high WBC count, high alkaline phosphatase & high bilirubin level. The most likely diagnosis is: a) Acute cholecystitis b) Acute appendicitis c) Perforated peptic ulcer d) Acute pancreatitis e) Inferior MI 44. An elderly male pt came with bleeding per rectum & abnormal bowel habit. O/E liver span was 20 cm. what is the next step? a) Colonoscopy b) .. c) .. d) .. 45. The most accurate tool for diagnosis of appendicitis: a) US b) Diagnostic laparoscopy c) .. d) .. 46. A pt had perforated gallbladder during cholecystectomy. She developed fever, tachypnea, Rt sided chest pain. CXR showed elevation of Rt dome of diaphragm. The diagnosis is: a) Subphrenic abscess b) Cholecystitis c) Appendicitis d) .. 47. Which of the following indicate large uncomplicated pneumothorax: a) Symmetrical chest movement.

b) c) d) e)

Increase breath sound Dull percution note. Tracheal deviation Cracking sound with each heart beat

48. An 8 month old baby presented with a hx of recurrent crying with on & off jelly stool. The diagnosis is: a) Intussuception b) Intestinal obstruction c) Mickle's diverticulum d) Strangulated hernia

Obstetrics
49. A 27 yo pregnant lady, 19 weeks gestation, a smoker, presented with PV bleeding followed by painless delivery. She was told nothing was wrong with her or her baby. The diagnosis is: a) Cervical incompetence b) Fetal chromosomal anormaly c) Molar pregnancy d) .. 50. A pregnant woman, multigravida, 38 weeks gestational age presented with glucosuria. Gestational diabetes was confirmed by glucose tolerance test. The next step is: a) Repeat Glucose tolerance test b) Cesarean section c) Diet adjustment d) Start sliding scale insulin e) Start oral hypoglycemic medication 51. The commonest symptom in the presentation of abruptio placentae is: a) Vaginal Bleeding b) Abdominal pain c) Abdominal mass d) Irregular uterine contractions e) Hypogastric tenderness 52. A pregnant lady, 8 weeks gestation, came with Hx of bleeding for the last 12 hours with lower abdominal pain & she passed tissue. O/E the internal os was 1cm dilated. The diagnosis is: a) Complete abortion b) Incomplete abortion c) Missed abortion d) Molar pregnancy e) Threatened abortion

53. A young primigravida, 35 weeks gestation, had BP of 140/90, headache, proteinurea & lower limb edema. What is the best management: a) Oral labetolol b) Diuretics c) Low sodium diet d) Immediate C.section e) Admission & observation of feto-maternal condition 54. A 30 yo lady in the third trimester of her pregnancy developed a sudden massive swelling of the left lower extremity extending from the inguinal ligament to the ankle. The most appropriate sequence of work up & treatment: a. Venogram, bed rest, heparin b. Impedance plethysmography, bed rest, heparin c. Impedance plethysmography, bed rest, vena caval filter d. Impedance plethysmography, bed rest, heparin, warfarin e. Clinical evaluation, bed rest, warfarin

Gynecology
55. A 55 year old lady on HRT is complaining of spotting on day 21 of the cycle. What will you do? a) Pap smear b) Endometrial sampling c) Stop HRT d) Add progesteron 56. Elderly female married since 30 years had fever, chills, dysurea, and diarrhea. No back pain. The diagnosis is: a) Acute bacterial cystitis b) Acute pyelonephritis c) Bacterial gastroenteritis d) Viral gastroenteritis 57. A young female patient who is an office worker presented with itching in the vagina associated with the greenish-yellowish vaginal discharge. Examination revealed red spots on the cervix. The diagnosis is: a) Trichomoniasis b) Candidiasis c) Gonorrhea d) Gardnerella vaginalis

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58. A female pt presented with oligomenorrhea, she had 3 periods in the last year. She also had acne & hirsutism. Her body weight was 60 kg. PV examination was normal. The diagnosis is: a) Polycystic ovary disease b) Hyperprolactinemia c) Adrenal tumor d) Hypothyroidism e) Premature ovarian failure 59. Uterovaginal prolapse: a) Increase heaviness in erect position b) More in blacks c) A common cause of infertility d) .. 60. A couple is trying to have baby for the last 6 month of unprotected intercourse. They wanted to know the possible cause of their infertility. What will you do? a) Wait & see. b) Send to fertility clinic c) Semen analysis d) Pelvic exam e) Body temperature chart 61. A 34 year old lady presented with pelvic pain and menorrhagia. There is history of infertility. On examinations the uterus was of normal size & retroverted. She had multiple small tender nodules palpable in the uterosacral ligament. The most likely diagnsosis is: a) Fibroid b) Endometriosis c) Adenomyosis d) PID 62. A 50 year old woman (post menopausal woman) who is taking estrogen OCP every month & stops at the 21st day of the cycle. She presented with vaginal bleeding in the form of spotting 2-3 days after stopping the estrogen OCP (a case of postmenopausal bleeding). The best management is: a) Pap smear b) Endometrial sampling (biopsy) c) Stop estrogen d) Continue estrogen e) Add progestron

Pediatrics

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63. A patient presented with fatigue, loss a petite & bloody urine. She gave History of sore throat 3 weeks back. The most likely diagnosis is: a) hemorragic pyelonephritis b) Post streptococcal GN c) Heamorragic cystitis d) membranous GN e) IgA nephropathy 64. A child of an HIV positive mother. He is not immunized. Which of the following vaccines should not be given to him? a) Live oral polio b) DTP c) MMR d) Hepatitis B 65. A child swallowed his relative's medication. What is the best way of gastric decontamination? a) Gastric lavage b) Total bowel irrigation (whole bowel wash) c) Syrup ipecac d) Activated charcoal 66. The commonest chromosomal disease is: a) Down syndrome (Trisomy 21) b) Klinfelter syndrome c) Turner's syndrome d) .. 67. A young girl pt had URTI 1 week ago & received septra (trimethoprime + sulphamethoxazole). She came with crampy abdominal pain & proximal muscle weakness. The diagnosis is: a) Polymyositis b) Gullian parre syndrome c) Intermittent porphyria d) Periodic hypokalemic paralysis e) Neuritis 68. All the following are present in otitis media except: a) Signs & symptoms of inflammation b) Signs & symptoms of effusion c) High grade fever d) Pain 69. A child presented with respiratory distress & accessory muscle contraction. What is your treatment? a) Oxygen

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b) Bronchodilator c) IV corticosteroid d) IV Theophyllin 70. A child presented with dysphagia, sore throat, postnasal drip, drooling of saliva, rhonchi & fever of 38.50c. The treatment is: a) Hydrocortisone injection immediately b) Call otorhinolaryngology for intubation c) Admit to ICU d) Give antibiotics & send him home 71. A child presented with respiratory distress & accessory muscle contraction. What is your treatment: a) Oxygen b) Bronchodilator c) IV corticosteroid d) IV Theophyllin 72. A child was treated for otitis media with 3 different antibiotics for 6 weeks but without improvement. Which antibiotic is the best treatment: a) Amoxicillin b) Penicillin c) Cepahlosporin (ceprofloxacin) d) Amoxicillin + Clavulonic acid e) Erythromycin + sulfamethoxazol 73. A baby came complaining of croup, coryza, air trapping, tachypnea & retraction. The best management is: a) Erythromycin b) Penicillin c) Ampicillin d) 74. A 15 yo boy had hx of URTI 2 weeks ago. Now he is complaining of fever, bilateral knee pain with swelling & tenderness. The diagnosis is: a) Sickle cell anemia b) Post-streptococcal glomerulonephritis c) Rheumatoid arthritis d) Rheumatic fever e) Septic arthritis 75. A 4 yo baby boy complaining of fever, chills, rigors & nuchal rigidity. O/E he had positive Kurning's sign & petechial rash on his abdomen & lower limbs. The diagnosis is: a) Pneumococcal meningitis b) Meningococcal meningitis

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c) Aseptic meningitis d) Brain tumor e) Encephalitis

Psychiatry
76. A 70 year old female brought to your clinic by her daughter. The daughter said her mothers memory deteriorated in the last 2 years. She can cook for her self but sometimes leave the oven on. She can dress herself but with difficulties. The daughter mentioned that her mothers personality changed into a more aggressive person (pt has Alzehimer's disease). According to this history what is your appropriate management? a) Prescribe diazepam for the daughter and haloperidol for the mother b) Refer the mother into chronic illness institute c) Refer the mother to geriatric clinic d) Immediate hospitalization 77. A man was intent as if he is listening to somebody, suddenly started nodding & muttering. He is having: a) Hallucination b) Delusion c) Illusion d) Ideas of reference e) Depersonalization 78. A patient was intent as if he is listening to somebody, suddenly started nodding & muttering. He is having: a) Delusions b) Illusions c) Hallucinations d) Ideas of reference e) Depersonalization

ENT
79. A 45 yo lady was complaining of dizziness, sensory neural hearing loss on her left ear (VIIIth nerve palsy), tingling sensation & numbness on her face, loss of corneal reflex. MRI showed a dilated internal ear canal. The diagnosis is: a) Acoustic neuroma b) Glue ear c) Drug toxicity d) Herpes zoster e) Cholesteatoma

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80. A child presented with earache. On examination there was a piece of glass deep in the ear canal. The mother gave a history of a broken glass in the kitchen but she thought she cleaned that completely. The best management is: a) Refer to ENT b) Remove by irrigation of a steam of solution into the ear c) Remove by forceps d) Remove by suction catheter e) Instill acetone into the external auditory canal

Ophthalmology
81. Treatment of herpes zoster in ophthalmic division: a) Oral acyclovir alone b) Acyclovir & Prednisolone c) Prednisolone d) IV Acyclovir 82. Which of the following is not a sign or symptom of central retinal artery occlusion? a. Painful loss of vision b. Painless loss of vision c. Previous transient loss of vision d. Dilated pupil with sluggish reaction to light

Orthopedics
83. A foot ball player his knee was hit from the left lateral side, valgus test was positive; drawer test & Laschman test were negative. Which of the following was injured? a) Anterior cruciate ligament b) Posterior cruciate ligament c) Medial collateral ligament d) Lateral collateral ligament e) Medial meniscus 84. A pt had hairline metatarsal fracture. The x-ray was normal. What is the 2nd line? a) CT scan b) MRI c) US d) .. 85. A pt presented with open tibial fracture. Which antibiotic you will give? a) Cefazolin b) Gentamycin

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c) Cefazolin & gentamicin d) Cefazolin, Gentamycin & metronidazol

Urology
86. A Case scenario about a male patient present with prostatitis (prostatitis was not mentioned in the question), culture showed gram negative rodes. The drug of choice is: a) Ciprofloxacin b) Ceftriaxone c) Erythromycin d) Trimethoprime e) Gentamicin 87. A pt complaining of left flank pain radiating to the groin, dysurea, no fever. The diagnosis is: a) Pyelonephritis b) Cystitis c) Renal calculi d) .. 88. A 3 weeks old baby boy presented with a scrotal mass that was transparent & non-reducible. The diagnosis is: a) Hydrocele b) Inguinal hernia c) Epidydimitis d) .. 89. A 29 year old man complaining of dysurea. He was diagnosed as a case of acute prostitis. Microscopic ex showed G-ve rods which grow on agar yeast. The organism is: a) Chlamydia. b) Legonella. c) Mycoplasma d) .. 90. An 80 year old male presented with dull aching loin pain & interrupted voiding of urine. BUN and creatinine were increased. US revealed a bilateral hydronephrosis. What is the most probable Dx? a) Stricture of the urethra b) Urinary bladder tumor c) BPH d) Pelvic CA e) Renal stone

Dermatology
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91. A 10 yo boy presented with a 5 days history of skin lesion which was scaly & yellowish. The diagnosis is: a) Tenia corporum b) .. c) .. d) .. 92. A mother brought her baby & was complaining of diaper rash. She used cornstarch, talc powder, zinc ointment & 3 different types of corticosteroids prescribed by different physicians but with no benefit. The rash was well demarcated & scaly with satellite lesions. The most likely diagnosis: a) Candidal rash b) Seborrhic dermatitis c) Allergic contact dermatitis 93. A female pt presented with wheals over the skin with history of swollen lips. The diagnosis is: a) Chronic urticaria with angioedema b) Solar dermatitis c) Contact dermatitis d) Cholinergic dermatitis 94. A child presented with honey comb crust lesion. Culture showed staph aureus. The diagnosis is: a) Impetigo b) .. c) .. d) .. 95. A pt presented with a 6 week history of itching & redness all over the body with wheals. Which type of urticaria this pt has: a) Chronic urticaria. b) Solar urticaria c) Allergic urtecaria d) ..

Neurology/Neurosurgery
96. Which of the following reduces the risk of post-therapeutic neuralgia: a) Corticosteroid only b) Valacyclovir only c) Corticosteroid & Valacyclovir d) ..

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97. A middle age man presented with sever headache after lefting heavy object. His BP was high. He was fully conscious. Examination was otherwise normal. The most likely diagnosis is: a) Subarachnoid hemorrhage b) Central HTN c) Tension headache d) Migraine e) Intracerebral hemorrhage 98. An 18 yo male who was involved in an RTA had fracture of the base of the skull. O/E he had loss of sensation of the anterior 2/3 of the tongue & deviation of the angle of the mouth. Which of the following nerves is affected? a) I (Olfactory) b) III (Occulomotor) c) IV (Abducens) d) VII (Facial)

Medical Ethics
99. You were working in a clinic with a consultant who prescribed a drug that was contraindicated to the pt (the pt was allergic to that drug) but you didn't interfere & assumed that he knows better than you do. Which of the following you have violated: a) Professional competence b) Quality of caring of patient. c) Honesty. d) Pt relationship e) Maintaining trust 100. Physician's carelessness is known as: a) Malpractice b) Criminal neglect c) Malfeasance d) Nonfeasance

Statistics
101. You are reading a population study that states that 90% of lung cancer patients are smokers while 30% of lung cancer patients are non-smokers. What is the specificity of using smoking as a predictor of lung cancer? a) 10% b) 40% c) 30% d) 70%

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e) 90%

Family & Community Medicine

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