End of round MCQ practice

Question 1

1) A characteristic symptom of left ventricle heart failure:

a) Dyspnea on lying on left side.
b) Lower limb swelling.
c) Paroxysmal nocturnal dyspnea.
d) Pain in the right hypochondrium.

Answer 1

c) Paroxysmal nocturnal dyspnea.

Question 2

2) 55 year old man heavy smoker and known to have hypertension, presented with raised jugular venous pressure and pitting lower limbs oedema. The most probable diagnosis is:

a) Congestive heart failure
b) Right basal pneumonia
c) Left sided heart failure
d) Pulmonary embolism.

Answer 2

a) Congestive heart failure

Question 3

3) A characteristic sign in chronic obstructive pulmonary disease:

a) Clubbing.
b) Cyanosis.
c) Prolonged expiration.
d) Tremors.

Answer 3

c) Prolonged expiration.

Question 4

4) Upper motor neuron weakness is characterized by:

a) Proximal muscles are affected more than distal muscles.
b) Presence of fasciculations.
c) Distal muscles are affected more than proximal muscles.
d) Spontaneous discharge of a motor unit.

Answer 4

c) Distal muscles are affected more than proximal muscles.

Question 5

5) 60 years old heavy smoker male patient known to have COPD presents with clubbing on regular follow up visit. The most appropriate investigation to request is:

a) Complete blood picture.
b) Chest X-ray.
c) Liver function tests.
d) X-ray wrist.

Answer 5

b) Chest X-ray.

Question 6

6) Bilateral lower limbs oedema could be a sign of:

a) Arterial thrombosis of the limb.
b) Deep vein thrombosis.
c) Cellulitis.
d) Liver cirrhosis.

Answer 6

d) Liver cirrhosis.

Question 7

7) Flapping tremors is a characteristic sign in:

a) Liver cell failure.
b) Right sided heart failure.
c) Senility.
d) Thyrotoxicosis.

Answer 7

a) Liver cell failure.

Question 8

8) A sequel of prolonged uncontrolled hypertension is:

a) Hernia.
b) Leg oedema.
c) Piles.
d) Ventricular hypertrophy.

Answer 8

d) Ventricular hypertrophy.

Question 9

9) Chest pain is a characteristic symptom of:

a) Bicuspid aortic valve.
b) Ludwig’s angina.
c) Silent angina.
d) Unstable angina

Answer 9

b) Ludwig’s angina.

Question 10

10) The following is a recognized complication of chronic cough:

a) Change in color of urine.
b) Cyanosis.
c) Hernia.
d) Hypertension.

Answer 10

c) Hernia.

Question 11

11) A common cause of hemoptysis is:

a) Bronchogenic carcinoma.
b) Acute bronchitis.
c) Anticoagulation.
d) Tuberculosis.

Answer 11

b) Acute bronchitis.

Question 12

12) Frank hemoptysis could be a sign of

a) Chest wall hematoma.
b) Peptic ulcer.
c) Emphysema.
d) Small cell carcinoma.

Answer 12

d) Small cell carcinoma.

Question 13

13) Elevated jugular venous pressure is a sign of:

a) Liver cirrhosis.
b) Peripheral oedema.
c) Heart failure.
d) Pulmonary fibrosis.

Answer 13

c) Heart failure.

Question 14

14) Oedema of heart failure is:

a) Increase in intravascular hydrostatic pressure.
b) Increase in the intravascular oncotic pressure.
c) Increase in the movement of fluids.
d) Increase in capillary vascular bed.

Answer 14

a) Increase in intravascular hydrostatic pressure.

Question 15

15) Paroxysmal dyspnea of left ventricle failure is characterized by:

a) Change from side to side.
b) Nocturnal episodes.
c) Relieved spontaneously.
d) Relieved by lying comfortable in bed.

Answer 15

b) Nocturnal episodes.

Question 16

16) Acute pulmonary oedema is a sign of:

a) Left sided heart failure.
b) Mediastinal syndrome.
c) Right sided heart failure.
d) Neoplastic invasion of pericardium.

Answer 16

a) Left sided heart failure.

Question 17

17) Diagnosis of diabetes meilitus is confirmed by:

a) Fasting blood sugar.
b) Fasting and 2 hour post prandial blood sugar.
c) Fasting blood glucose and glycated HbAlc.
d) Presence of polyuria and polydepsia.

Answer 17

b) Fasting and 2 hour post prandial blood sugar.

Question 18

18) Macrocytosis in blood film is observed in patients with:

a) Fever.
b) Flat nails.
c) Gastrectomy.
d) Hypersplenism

Answer 18

c) Gastrectomy.

Question 19

19) Intrahepatic biliary cholestasis is caused by:

a) Gall stones.
b) Sickle cell anemia.
c) Pancreatitis.
d) Autoimmune hepatitis.

Answer 19

d) Autoimmune hepatitis.

Question 20

20) Pre-hepatic jaundice is:

a) Hemolytic jaundice.
b) Hepatocellular jaundice.
c) Obstructive jaundice.
d) Surgical jaundice.

Answer 20

a) Hemolytic jaundice.

Question 21

21) Stercobilinogen is absent in stool in:

a) Congenital hyperbillirubinemia.
b) Hemolytic jaundice.
c) Hepatocellular jaundice.
d) Obstructive jaundice.

Answer 21

d) Obstructive jaundice.

Question 22

22) Regulation of erythropoietin production is linked to:

a) Carbon dioxide.
b) Hemoglobin concentration.
c) Oxygen.
d) Red cell mass.

Answer 22

c) Oxygen.

Question 23

23) A -21year- male presented to out-patient clinic with fever, jaundice, right hypochondrium pain and markedly elevated hepatic transaminases. The most appropriate diagnostic investigation is:

a) AFP.
b) CA 19-9.
c) HAV IgM.
d) HCV antibody.

Answer 23

c) HAV IgM.

Question 24

24) A major cause of disturbed conscious level is:

a) Hypoglycemia.
b) Hyperglycemia.
c) Hypercalcemia.
d) Hypernatremia.

Answer 24

a) Hypoglycemia.

Question 25

25) 18 years old girl presented to ER suffering of severe epigastric pain and repeated vomiting. She has tachypnea with increased depth of inspiration, like (air hunger). Your immediate action in ER is:

a) Ask for urgent abdominal U/S.
b) Immediate chest X-ray.
c) Request pulmonary function tests.
d) Measure blood sugar.

Answer 25

d) Measure blood sugar.

Question 26

26) One of the general causes of dyspnea is:

a) Anemia.
b) Dissecting aortic aneurysm.
c) Myocardial infarction.
d) Pulmonary fibrosis.

Answer 26

a) Anemia.

Question 27

27) Aplastic anemia is characterized by:

a) Diminished erythropoietin level.
b) Granulocytosis.
c) Hypocellular bone marrow.
d) Markedly increased reticulocyte count.

Answer 27

c) Hypocellular bone marrow.

Question 28

28) A -62year- heavy smoker male presented to ER with crushing chest pain radiating to left shoulder. The most appropriate diagnosis is:

a) Acute pericarditis.
b) Fracture rib.
c) Myocardial infarction.
d) Perforated peptic ulcer.

Answer 28

c) Myocardial infarction.

Question 29

29) 45 years old obese female presented to ER with acute dyspnea and hypoxia a few days after major orthopedic operation. The most probable diagnosis is:

a) Anemia of blood loss.
b) Hypertensive emergency.
c) Pulmonary’ embolism.
d) Wound sepsis.

Answer 29

c) Pulmonary’ embolism.

Question 30

30) A common symptom of hypertension is:

a) Asymptomatic.
b) Blurring of vision.
c) Ringing ears.
d) Swelling of extremities.

Answer 30

a) Asymptomatic.

Question 31

2. A 55-ycar-vid man has just arrived in accident and emergency complaining of 3 hours central crushing chest pain and sweating, the most appropriate initial investigation to be earned out is:

a) Chest X-ray
b) Electrocardiogram
c) Complete blood count
d) Echocardiography .

Answer 31

b) Electrocardiogram

Question 32

3- A 63-year-old woman develops exertional angina and has had two episodes of syncope. Examination shows a systolic ejection murmur with radiation to the carotids and a soft S2.
Which of the following is the most likely diagnosis?

a) Mitral stenosis
b) Mitral insufficiency
c) Aortic stenosis
d) Aortic insufficiency

Answer 32

c) Aortic stenosis

Question 33

A 16-year-old boy is found to have hypertension on routine evaluation. On examination the blood pressure in his arms is higher in his legs by more than 10 mmHg. Which of the following is the most likely diagnosis?

a) Aortic insufficiency
b) Coarctation of the aorta
c) Normal variant
d) Ventricular aneurysm

Answer 33

b) Coarctation of the aorta

Question 34

5. A 57-ycar-old man with a 40 pack-per-year history of smoking experiences symptoms of shortness of breath on exertion. He has bilateral wheezes on expiration and increased resonance to percussion of the chest. Pulmonary function tests confirm the diagnosis of chronic obstructive lung disease. Which of the following is the best definition of this condition?

a) It is caused by bronchial asthma
b) It is preceded by chronic bronchitis
c) It is airflow limitation that is not fully reversible
d) It is due to destruction and dilatation of lung alveoli

Answer 34

d) It is due to destruction and dilatation of lung alveoli

Question 35

7. A 32 year old develops symptoms of wheezing, cough and shortness of breath. He has bilateral expiratory wheezes, and the rest of the examination is normal. Further evaluation with pulmonary function tests reveals a reduced FEV1/FVC ratio that corrects with bronchodilators. Which of the following statements about diagnosis of idiosyncratic asthma is correct.

a) Known antigenic stimulus
b) Adult onset
c) History of atopy
d) Positive skin tests

Answer 35

b) Adult onset

Question 36

8. A 74-ycar-old man with a history of smoking notices blood in his chronic dally sputum production He has no lever or chills, but has lost 5 kg in the past 6 months On examination, he has biliteral expiratory wheezes. and his fingers are clubbed. There are no lymph nodes and the remaining examination is normal
   Which of the following is the most likely diagnosis?

a) Small cell lung cancer
b) Chronic bronchitis
c) Pulmonary embolism
d) Bronchial asthma

Answer 36

a) Small cell lung cancer

Question 37

9.A 23 year Old man develops sharp left sided chest pain, fever, and a friction tub heard at the lower left sternal border. unaffected by respiration, the pain is also aggravated by lying down and relieved by sitting up He is otherwise well with no other symptoms and the remaining physical examination u normal
Which of the follow tog is the most likely cause for his symptoms?

a) Rheumatic fever
b) Tuberculosis
c) Pericarditis
d) Ischemic heart disease

Answer 37

d) Ischemic heart disease

Question 38

10. Regarding hypertension the following statements arc true except.

a) The cause are unknown or idiopathic in 10% of cases.

b) The purpose of treatment in hypertension is to reduce the risk of devastating hypertensive complications.

c) Secondary causes constitute renal, endocrine and toxemia of pregnancy.

d) Weight reduction in obese patients, salt restriction increased consumption of fruit and vegetables are all general measures for treatment.

Answer 38

a) The cause are unknown or idiopathic in 10% of cases.

Question 39

11. A 65-year-old male presented by shortness of breath. known to have hypertension and ischemic heart disease, on examination he had signs of fluid retention. raised jugular venous pressure, lung crepitation. pitting leg edema, tender hepatomegaly.

Which of the following conditions could be the diagnosis?

a) Pulmonary embolism
b) Congestive heart failure
c) Chronic bronchitis.
d) Lt sided heart failure

Answer 39

b) Congestive heart failure

Question 40

12. The following are recognized causes of hemoptysis except:

a) Tuberculosis
b) Bronchial asthma
c) Mitral stenosis
d) Bronchiectasis

Answer 40

b) Bronchial asthma

Question 41

14. A 24-yearar old woman notices increasing shortness of breath after recent treatment after right lube pneumonia .She has no few. cough or sputum production On examination, the pertinent findings are decreased fremitus, dullness on percussion and absent breath sounds of the right lower lung -In addition, the trachea has shitted to the left

What is the most like diagnosis?

a) Acute asthmatic attack
b) Pneumothorax
c) Large pleural effusion
d) Atelectasis

Answer 41

c) Large pleural effusion

Question 42

15 A 30-year-old man presents to your clinic with a cough and finger clubbing. From the list below, which of these answers is not a respiratory cause of finger clubbing?

a) Empyema
b) Mesothelioma
c) Bronchogenic carcinoma
d) Chronic obstructive pulmonary disease

Answer 42

d) Chronic obstructive pulmonary disease

Question 43

18- A 25-year-old man with a history of a duodenal ulcer is noted to have a hemoglobin level of 10 g/dL Which of the following most likely will be seen on laboratory investigations;

a) Reticulocyte count of 10%
b) Elevated total iron binding capacity
c) Normal serum ferritin
d) Mean corpuscular volume of 105 fL

Answer 43

b) Elevated total iron binding capacity

Question 44

20. A 60-year-old alcoholic man presents with fatigue and difficulty concentrating. His daughter mentions that he has not been eating well. On physical exam, the conjunctiva and nail beds are pale Neurological exam is normal. Laboratory studies demonstrate macrocytic megaloblastic anemia

What is the most likely cause of macrocytic anemia in this patient?

a) Folate deficiency
b) B12 deficiency
c) Iron deficiency
d) Blood loss

Answer 44

b) B12 deficiency

Question 45

21.You are asked by your registrar to request an imaging investigation for a 49-yeor old woman with jaundice and abdominal pain. She has a past medical history of gallstones and you suspect this is a recurrence of the same problem. The most appropriate imaging investigation is:

a) Abdominal x-ray
b) Abdominal ultrasounds
c) Abdominal CT
d) Magnetic resonance imaging (MRI)

Answer 45

b) Abdominal ultrasounds

Question 46

Which of the following gastroenterological conditions would give rise to finger clubbing?

a) Hepatocellular carcinoma
b) Ulcerative colitis
c) Irritable bowel syndrome
d) Pancreatic carcinoma

Answer 46

b) Ulcerative colitis

Question 47

the most common cause of upper Gl bleeding?

Answer 47

Esophageal varices

Question 48

24. A 67 year old presents feeling unwell and complaining of general malaise. He mentions a long history of alcohol abuse and his past medical history shows derranged liver function tests. Which of the following signs does not form part of chronic liver disease?

a) Bruising
b) Palmer erythema
c) Spider naevia
d) Koilomychia

Answer 48

d) Koilomychia

Question 49

25 A 45 year-old man presents complaining of weight gain, on examination there is abdominal distension with a fluid thrill Which of following is not a cause of ascites secondary to venous hypertension?

a) Congestive heart failure
b) Cirrhosis
c) Constrictive pericarditis
d) Nephrotic syndrome

Answer 49

d) Nephrotic syndrome

Question 50

All are features of diabetic ketoacidosis except:

a) Hyperthermia
b) Air hunger
c) Dehydration
d) Drowsiness

Answer 50

Hyperthermia

Question 51

30.AU of the following conditions can produce microcytic anemia except:

a) Sideroblastic anemia
b) Thalassemia
C) Pernicious anemia
d) Lead poisoning

Answer 51

C) Pernicious anemia

Question 52

A 65 year-old male patient presented to the emergency unit by substernal chest pain related to exertion and radiating to the left hand, the most likely diagnosis is.

Answer 52

Angina pectoris

Question 53

A 72-year-old female patient presented to the emergency department by sudden onset of chest pain with profuse sweating, dyspnea, nausea, and vomiting. The important modality for her is to perform

a) Echocardiography
b) Chest x-ray
c) Electrocardiography
d) Lipid profile

Answer 53

c) Electrocardiography

Question 54

A 67-year-old female complains of a gradual history of increasing exercise intolerance and fatigue. She used to receive nonsteroidal anti-inflammatory drugs (NSAIDs) regularly for knee osteoarthritis. She is anemic, with a hemoglobin level of 8.2 g/dL and a mean corpuscular volume of 70 fL.

a) Iron-deficiency anemia
b) Megalobtstic anemia
c) Normocytic anemia
d) Hemolytic anemia

Answer 54

a) Iron-deficiency anemia

Question 55

A 60-year-old num presents to accident and emergency with a 3-day history of increasingly severe chest pain The patient describes the pain as a sharp, tearing pain starling in the center of his chest and radiating straight through to his hack between his shoulder blades.

The most likely diagnosis is:

a) Myocardial infarction
b) Myocardial ischaemia
c) Aortic dissection
d) Pulmonary embolism

Answer 55

c) Aortic dissection

Question 56

A 78-year-old woman is admitted to your ward following a 1-day history of shortness of breath and a productive cough of white, frothy sputum. On auscultation of the lungs, you hear bilateral basal coarse inspiratory crackles.

Which of the following is your possible diagnosis?
a) Left-sided heart failure
b) Pulmonary embolism
c) Pulmonary hypertension
d) Bronchial asthma

Answer 56

a) Left-sided heart failure

Question 57

Hepatic encephalopathy may he precipitated by all except.

a) Constipation
b) Infection
c) low protein intake
d) Diuretic therapy.

Answer 57

c) low protein intake

Question 58

A 58-year-old male patient, known cigarette smoker for 20 years, presents to the outpatient clinic with a productive cough, increasing dyspnea, leg edema, and right upper quadrant pain. The most likely diagnosis is:

a) Left sided heart failure
b) Cor pulmonale
c) Pulmonary embolism
d) Bronchial asthma

Answer 58

b) Cor pulmonale

It is right ventricular enlargement due to chest diseases (like COPD present in this case) +/- right ventricular failure (which presents as LL swelling, Rt hypochondrial pain and dyspepsia)

Question 59

Which of the following clinical signs does not form part of chronic liver disease?

a) Palmer erythema
b) Spider naevi
c) Koilonychia
d) Jaundice

Answer 59

c) Koilonychia

spoon-shaped nails and is more commonly associated with iron deficiency anemia

Question 60

Regarding bronchial asthma, the following statements are true except:

a) Asthma is a chronic inflammatory disease of the airways that is characterized by episodes of cough, wheezing, and dyspnea.

b) Approximately 80% of patients with asthma have an allergic tendency characterized by positive immediate hypersensitivity skin tests.

c) Extrinsic asthma usually occurs in adulthood.

d) Consider the diagnosis of asthma in patients with a history of wheezing or variable dyspnea with specific triggers.

Answer 60

c) Extrinsic asthma usually occurs in childhood or early adulthood.

Extrinsic asthma means allergic asthma which always triggered in childhood or youth at latest

Question 61

Causes of bilateral lower limb edema include the following except:

a) Liver cirrhosis
b) Nephrotic syndrome
c) Drugs, e.g., calcium channel blockers
d) Left sided heart failure

Answer 61

d) Left sided heart failure

It can lead to lower limb generalized edema but that is more cor pulmonale (rt sided HF). Lt sided HF causes pulmonary edema

Question 62

1. Causes of congestive heart failure include the following:

a) Severe hypertension
b) Valvular heart disease
c) Severe anemia
d) All of the above

Answer 62

d) All of the above

Question 63

2. Regarding indications for ambulatory blood pressure recording, the following statements are true except:

a) When blood pressure reading show variability
b) To exclude white coat hypertension
c) All cases of hypertension
d) When hypertension is resistant to drug treatment with 3 or more drugs

Answer 63

c) All cases of hypertension

Question 64

3. A 66-year-old woman presents to emergency with a 2-day history of shortness of breath. The patient notes becoming progressively short of breath as well as a sharp pain in the right side of the chest which is most painful when taking a deep breath. The patient also complains of pain and swelling in her right leg.
   The most likely diagnosis is:

a) Heart failure
b) Pneumothorax
c) Angina
d) Pulmonary embolism

Answer 64

d) Pulmonary embolism

Question 65

The first step to assess a case presenting with acute dyspnea:

a) Check the respiratory rate
b) Check blood pressure
c) Check pulse
d) Check airway patency

Answer 65

d) Check airway patency

Question 66

5. Which of the following is the mechanism of edema in patients with congestive heart failure?

a) Decreased plasma oncotic pressure
b) Endothelial damage
c) Increase hydrostatic pressure
d) Increase vascular permeability

Answer 66

c) Increase hydrostatic pressure

Question 67

6. Regarding treatment of mild hypertension, the following statements are true except:

a) Regular isometric physical exercise is beneficial
b) Regular dynamic physical exercise is beneficial
c) Weight reduction in obese patient is beneficial
d) Salt restriction is beneficial

Answer 67

a) Regular isometric physical exercise is beneficial

Isometric is like weight lifting, increase BP

Question 68

7. A 65-year-old male complains of central crushing chest pain radiating to both arms after running to catch a bus. Pain was relieved by rest and his ECG recording lh later was unremarkable, the most probable diagnosis is:

a) Ischemic heart disease
b) Pericarditis
c) Pulmonary embolism
d) Pneumothorax

Answer 68

a) Ischemic heart disease

Question 69

8. A 40-year-old man is brought to the emergency department with severe headache. On examination he has papilledema and fundal hemorrhages. His BP is 220/145 mmHg, the most probable
   diagnosis is:

a) Ischemic heart disease
b) Malignant hypertension
c) Heart failure
d) Renal failure

Answer 69

b) Malignant hypertension

Question 70

11. Hemoptysis may be found in the following except:

a) Tuberculosis
b) Pulmonary infarction
c) Mitral stenosis
d) Pericarditis

Answer 70

c) Mitral stenosis

It is the valve that is in the aorta (leads out of the Lt ventricle). Its stenosis can lead to pulmonary hypertension and congestion, which may result in hemoptysis due to increased pressure in the pulmonary circulation.

Question 71

12. Typical features of early onset bronchial asthma include the following except:

a) Individuals are usually atopic
b) A single allergen is often identifiable
c) Paroxysmal expiratory wheezes and dyspnea
d) A family history of allergic disorders

Answer 71

b) A single allergen is often identifiable

Question 72

13. A 50-year-old smoker presents with history of cough productive of mucoid sputum in every winter for the last two years. The most likely diagnosis is:

a) Bronchial asthma
b) Bronchiectasis
c) Chronic bronchitis
d) Bronchogenic carcinoma

Answer 72

c) Chronic bronchitis

Chronic bronchitis characterized by a productive cough that lasts for at least three months in two consecutive years, often associated with smoking. The mucoid sputum is a common feature, particularly in winter when respiratory infections may exacerbate symptoms.

Question 73

14. Regarding chronic obstructive pulmonary disease (COPD) the following statements are true except:

a) Patients typically have cough which is worse in the morning
b) The primary cause of COPD is exposure to tobacco smoke
c) It is a preventable and treatable disease state
d) Ratio of FEVl/FVC is more than 70%

Answer 73

c) It is a preventable and treatable disease state

Question 74

15. An 18-year-old girl presents to emergency with severe abdominal pain, nausea and vomiting. On examination, the patient is tachypneic, and she has a dry tongue. While listening to the patient’s lungs you detects a sweet odor from her breath, the most likely diagnosis is:

a) Diabetic ketoacidosis
b) Non-ketotic hyperosmolar state
c) Gastroenteritis
d) Adrenal crisis

Answer 74

a) Diabetic ketoacidosis

Question 75

16. Regarding diabetic ketoacidosis. The following is true EXCEPT:

a) It is common initial clinical presentation in type 1 diabetes.

b) The most common early symptoms are insidious increase in polydipsia and polyuria.

c) Missed or insufficient insulin doses may precipitating factor

d) It is more Common in type 2 diabetes

Answer 75

d) It is more Common in type 2 diabetes

Question 76

17. The following could be the underlying Cause of persistent dry cough except:

a) Bronchial asthma.
b) Reflux esophagitis.
c) Use of B2 agonists.
d) Sinusitis and postnasal drip.

Answer 76

c) Use of B2 agonists.

Question 77

19. A 65-year-old patient presented by jaundice, pruritus and abdominal pain, he reported that his urine is dark colored and stool is pale. The following condition could be the cause of his condition except:

a) Gall stones
b) Peptic ulcer disease.
c) Carcinoma of the pancreas
d) Cholangitis

Answer 77

b) Peptic ulcer disease.

Question 78

The symptoms of liver failure are

Answer 78

Portal hypertension + complications: splenomegaly and hypersplenism, Ascites, portosystemic shunts (varices) and porto-systemic encephalopathy

3Fs: Fatigue (+anorexia and loss of weight), Fever, Foeter hepaticus (fecal smell)

4VIP: Coagulopathy and bleeding tendency, Hepatocellular jaundice, Hepatic encephalopathy, Ascites

3 Skin: Palmar erythema, Spider naevi, Clubbing, ecchymosis, white nail & half and half nail

Question 79

20. A 25-year-old previously healthy female presented to outpatient clinic with fever, anorexia, vomiting. The condition was associated with right hypochondrial pain, she noticed dark colored urine.
    On examination she was jaundiced with right hypochondrial tenderness and temperature of 38 C.
    Her liver enzymes were markedly elevated with a serum bilirubin of 4 mg/dl.
    The most probable diagnosis is:

a) Acute hepatitis A
b) Acute pancreatitis
c) Cancer head of pancreas
d) Liver cirrhosis

Answer 79

a) Acute hepatitis A

Question 80

21. A 64-year-old woman accompanied by her husband comes to the emergency room seeking treatment for chest pain. The patient clearly tells you that she wants to have her aorta repaired and she signs consent for the procedure. She later becomes hypotensive and loses consciousness. Her husband is now the decision maker and says, “Let her die” what should you do?

a) Ask her other first degree relevant about their opinion

b) Ask the hospital manager about his opinion

c) Do an aorta repair and tell her husband that he cannot go against her wish after she loses consciousness

d) Respect the husband opinion and you will leave her to die

Answer 80

c) Do an aorta repair and tell her husband that he cannot go against her wish after she loses consciousness

Question 81

22. Generalized edema results from all the following except:

a) Pulmonary hypertension
b) Congestive heart failure
c) Liver cirrhosis
d) Nephrotic syndrome

Answer 81

a) Pulmonary hypertension

Question 82

23. Regarding hemolytic jaundice, the following clinical manifestations could occur except:

a) Splenomegaly
b) Pruritus
c) Leg ulcer
d) Gall stones

Answer 82

b) Pruritus

Question 83

24. A 45-year-old female presented by generalized weakness. Inability to do her routine work, she reported menorrhagia for the last 6 months, the most likely diagnosis for the patient is:

a) Megaloblastic anemia
b) Iron deficiency anemia
c) Aplastic anemia
d) Hemolytic anemia

Answer 83

b) Iron deficiency anemia

Question 84

25. Regarding liver cirrhosis the following is false except:

a) Diffuse process
b) Synonym to fibrosis
c) Always compensated
d) Needs no follow up

Answer 84

a) Diffuse process

Question 85

26. Regarding the site of bleeding in a case of hematemesis, the following is true except:

a) Upper gastrointestinal tract until stomach
b) Upper gastrointestinal tract until second part of duodenum
c) Upper gastrointestinal tract until ligament of Trietz
d) Gastrointestinal tract until ascending colon

Answer 85

d) Gastrointestinal tract until ascending colon

Question 86

27. Clinical poor prognostic indicators in liver cirrhosis include the following except:

a) Persistent jaundice
b) Failure to respond to therapy
c) Hypertension
d) Neuropsychiatric complication

Answer 86

c) Hypertension

Question 87

Which of the following clinical signs does not form part of chronic liver disease?

a) Palmer erythema
b) Spider naevi
c) Koilonychias
d) Jaundice

Answer 87

c) Koilonychias

Question 88

29. Regarding melena, the following statement is true:

a) At least 60 ml of blood is required
b) Black tarry semisolid stool
c) Offensive in odor
d) All of the above

Answer 88

d) All of the above

Question 89

30. Extrahepatic biliary obstruction can be due to any of the following condition except:

a) Biliary stones
b) Drugs
c) Cholangiocarcinoma
d) Pancreatic mass

Answer 89

b) Drugs

Question 90

A 40 -year-old male patient presented by palpitation and dizzness. on examination hit pulse was irregular .The following could be a cause for his symptoms?

a) Mitral valvular disease
b) ischemic heart disease
c) Thyrotoxicosis
d) All of the above

Answer 90

d) All of the above

Question 91

1- What is the most common complaint of a patient with myocardial infarction?

A. Breathlessness
B. Chest pain
C. Nausea/Vomiting
D. Syncope

Answer 91

B. Chest pain

Question 92

2- Which of the following can change the presentation of myocardial infarction?

A. Diabetes mellitus
B. If the patient is male
C. History of previous myocardial infarction
D. History of Hypertension

Answer 92

A. Diabetes mellitus

Question 93

3- Which of the following confirmed values meet the diagnostic threshold for diabetes mellitus?

A. Postprandial blood glucose 135 mg/dL
B. Fasting blood glucose 129 mg/dL
C. HBAIC 6.3%
D. Urine glucose +2

Answer 93

B. Fasting blood glucose 129 mg/dL

Question 94

Which of the following is among the pathogenic mechanisms of hyperglycemia in type 2 diabetes mellitus?

A. Increased glucose production by the liver
B. Impaired insulin secretion
C. Insulin resistance
D. All the above

Answer 94

D. All the above

Question 95

5. Which of the following is Not a cause of Jaundice?

A. Hemolytic anemia
B. Liver cell failure
C. Irritable bowel syndrome
D. Congestive heart failure

Answer 95

D. Congestive heart failure

Question 96

9- Which of the following could be a side effect of spironolactone?

A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia

Answer 96

C. Hyperkalemia

Question 97

12- Which of the following does Not cause hematemesis?

A. Carcinoma of the stomach
B. Mallory Weiss syndrome
C. Rectal hemorrhoids
D. Peptic ulcer

Answer 97

C. Rectal hemorrhoids

Question 98

13. Which of the following is the most common gastro-intestinal disease?

A. Peptic ulcer
B. Reflux esophagitis
C. Carcinoma of the stomach
D. Irritable bowel syndrome

Answer 98

D. Irritable bowel syndrome

Question 99

14. Which of the following can be a complication of diabetes mellitus?

A. Peripheral neuropathy
B. Third cranial nerve palsy
C. Sixth cranial nerve palsy
D. All the above

Answer 99

D. All the above

Question 100

20. An elevated reticulocyte count in the anemic patient indicates:

A. Hemolytic anemia
B. Iron deficiency anemia
C. Inappropriate response to treatment
D. Decreased erythropoietic response

Answer 100

A. Hemolytic anemia

Question 101

23. Which one of the following does Not cause liver enlargement?

A. Congestive heart failure
B. Hemochromatosis
C. Helicobacter pylori infection
D. Hepatitis C virus infection

Answer 101

C. Helicobacter pylori infection

Question 102

26. Obstructive jaundice is characterized by the following Except:

A. Generalized pruritus
B. Palpable gall bladder
C. Dark-colored stool
D. Xanthelasma

Answer 102

C. Dark-colored stool

Question 103

28. The following organisms can cause traveler’s diarrhea Except:

A. Escherichia coli
B. Brucella
C. Giardia
D. Shigella

Answer 103

B. Brucella

Question 104

29. Mitral valve stenosis can cause the following Except:

A. Orthopnea
B. Hemoptysis
C. Diastolic murmur best heard at the apex of the heart
D. Diastolic murmur best heard at the left sternal border

Answer 104

D. Diastolic murmur best heard at the left sternal border

Question 105

7. Which statement is correct regarding the first heart sound?

A. It is formed by closure of the aortic and pulmonary valves
B. It is formed by closure of the mitral and tricuspid valves
C. It is best heard at the left sternal border
D. It is loud in mitral valve regurgitation

Answer 105

B. It is formed by closure of the mitral and tricuspid valves

Question 106

11. Which of the following is Not a cause of finger clubbing?

A. Chronic lung abscess
B. Acute bronchitis
C. Infective endocarditis
D. Bronchogenic carcinoma

Answer 106

B. Acute bronchitis

Question 107

2. Which of the following is true regarding orthopnea?

A. One of the symptoms of right sided heart failure
B. It is dyspnea in supine position that is relieved or improved on sitting
C. It is dyspnea on standing
D. It is dyspnea on lying on the left side

Answer 107

B. It is dyspnea in supine position that is relieved or improved on sitting

Question 108

3. Which of the following is correct regarding normal vesicular breath sounds?

A. Has hollow character
B. Is one of the auscultatory findings of consolidation
C. The length of inspiratory phase equals the length of the expiratory phase
D. No gap between inspiration and expiration

Answer 108

D. No gap between inspiration and expiration

Question 109

Which of the following is correct regarding moderate ascites?

A. There is fullness of the flanks
B. Abdominal distension is mainly central
C. Hepatomegaly cannot be detected by palpation
D. Transmitted thrill is the best method to detect it

Answer 109

A. There is fullness of the flanks

Question 110

23. Which of the following is Not a cause of flapping tremors?

A. Liver cell failure
B. Thyrotoxicosis
C. Respiratory failure
D. Renal failure

Answer 110

B. Thyrotoxicosis

Question 111

9- Which of the following confirmed values meet the diagnostic threshold for diabetes mellitus?

A Fasting blood glucose 100 mg/dl
B. HBA1C 6.3%
C. Fasting blood glucose 129 mg/dl
D. All the above

Answer 111

C. Fasting blood glucose 129 mg/dl

Question 112

19- Which of the following could be a precipitating factor for heart failure?

A. Thyrotoxicosis
B. Upper respiratory infection
C. Irritable bowel syndrome
D. All the above

Answer 112

A. Thyrotoxicosis

Question 113

24. Which of the following could be a side effect of digitalis?

A. Bradycardia
B. Heart block
C. Ventricular extrasystoles
D. All the above

Answer 113

D. All the above

Question 114

28-Anemia of chronic kidney disease characterized by:

A. Increased erythropoietin production
B. Decreased erythropoietin production
C. Macrocytosis
D. Does not respond to erythropoietin

Answer 114

B. Decreased erythropoietin production

Question 115

30- Which of the following can be a cause of acute mono-arthritis?

A. Systemic lupus erythematosus
B. Osteoarthritis
C. Gouty arthritis
D. Psoriatic arthritis

Answer 115

C. Gouty arthritis

Question 116

2) Choose the correct answer:

a In left sided heart failure cough produces frothy, blood tinged sputum
b) Cough is dry in acute bronchitis
c) Sputum is chocolate color in bronchiectasis
d) Lung abscess cause cough with expectoration of large amount of purulent sputum

Answer 116

a In left sided heart failure cough produces frothy, blood tinged sputum

Question 117

The pain of stable angina is characterized by all the following except:

a) It occurs in the anterior chest.
b) It is referred to the shoulder.
c) It occurs with exertion and is relieved by rest after a few minutes.
d) It is sharp, localized, and increases with deep inspiration

Answer 117

d) It is sharp, localized, and increases with deep inspiration

Question 118

8) Choose the correct answer regarding orthopnea:

a) Orthopnea is a symptom of right-sided heart failure.
b) Orthopnea is shortness of breath on exertion.
c) Orthopnea is a symptom of left-sided heart failure.
d) Orthopnea is shortness of breath that awakens the patient 2 hours after sleep.

Answer 118

c) Orthopnea is a symptom of left-sided heart failure.

Question 119

One of the following does not cause liver cirrhosis

Hepatitis B
Hepatitis C
Hepatitis A
Alcoholism

Answer 119

Hepatitis A

Question 120

25) Regarding Hemophilia: one of the following is incorrect:

25) Regarding Hemophilia: one of the following is incorrect:
a) Hemophilia A is an X-linked disorder.
b) Hemarthrosis is common in hemophilia.
c) Hemophilia A is due to factor VIII deficiency.
d) Hemophilia A is due to hereditary impaired platelet function.

Answer 120

d) Hemophilia A is due to hereditary impaired platelet function

Question 121

10) Causes of dry cough include the following except:

a) Viral laryngitis
b) Angiotensin-converting enzyme inhibitors
c) Bronchiectasis
d) Gastroesophageal reflux disease (GERD)

Answer 121

c) Bronchiectasis

Question 122

In chronic lung abscess, one of the following is incorrect:

a) Cough is dry.
b) Sputum is large in amount.
c) Sputum is of bad odor.
d) Cough and sputum increase by lying on the opposite side of the abscess.

Answer 122

a) Cough is dry.

Question 123

12) Causes of dyspnea include the following except:

a. Pneumothorax,
b. Acute pulmonary edema.
c. Right sided heart failure.
d. Acute bronchial asthma. «-

Answer 123

c. Right sided heart failure.

Question 124

Manifestations of left-sided heart failure include all the following except:

a) Paroxysmal nocturnal dyspnea
b) Lower limb edema
c) Orthopnea
d) Exertional dyspnea

Answer 124

b) Lower limb edema

Question 125

Regarding ascites, one of the following is incorrect:

a) Ascites is a sign of hepatic failure.
b) Ascites precox occurs in mitral stenosis.
c) Ascites is a sign of right-sided heart failure.
d) Nephrotic syndrome is one of the causes of ascites.

Answer 125

b) Ascites precox occurs in mitral stenosis.

Question 126

A 70-year-old patient with coronary artery disease is woken up two hours after sleep with dyspnea and a cough of pink frothy sputum. The most likely cause is:

a) Cardiac asthma
b) Pleural effusion
c) Pneumothorax
d) Bronchial asthma

Answer 126

Cardiac asthma

refers to wheezing and dyspnea caused by pulmonary congestion due to left-sided heart failure. The presence of pink frothy sputum is characteristic of pulmonary edema, often seen in patients with heart failure.

Question 127

obstructive jaundice one of the following is incorrect.

a. Urine is dark in color.
b. Stool is pale in color.
c. Associated with pruritis.
d urine is normal in color.

Answer 127

Option d (Incorrect): In obstructive jaundice, urine is not normal in color; it is typically dark due to increased bilirubin levels.

Question 128

Symptoms and signs of rt sided heart failure include all the following except:

a) Neck veins congestion
b) Lower limb edema
c) Hepatomegaly
d) Orthopnea

Answer 128

d) Orthopnea

Question 129

Obstructive jaundice is characterized by

a) Elevation of indirect serum bilirubin.
b) Elevation of direct serum bilirubin.
c) Direct and indirect serum bilirubin are equal.
d) Normal total serum bilirubin.

Answer 129

b) Elevation of direct serum bilirubin.

Question 130

9) Hemolysis is associated with all of the follow ing except:

a) Indirect hyperbilirubinemia.
b) Jaundice
c) Direct hyperbilirubinemia.
d) Low hemoglobin level.

Answer 130

c) Direct hyperbilirubinemia.

Question 131

10) Diagnostic criteria of diabetes mellitus include

a) Fasting plasma glucose 126mg/dL or more. ♦
b) Plasma glucose 2hours after 75gm oral glucose 200mg/dLor more.
c) Glycosylated hemoglobin 6.5% or more.
d) All of the above.

Answer 131

d) All of the above.

Question 132

Fever is diagnosed when:
a) Oral measurement is 37.2°C.
b) Rectal measurement is 36.6°C.
c) Rectal measurement is 37.0°C.
d) Axillary measurement is 37.4°C.

Answer 132

d) Axillary measurement is 37.4°C.

Question 133

Regarding orthopnea which of the following is true?

a) It can be caused by abdominal obesity.
b) It does not improve with upright posture.
c) It improves with upright posture.
d) It improves on lying on the left side.

Answer 133

c) It improves with upright posture.

Question 134

Which of the following statement regarding chest pain due to recent myocardial infarction is true?

a) Precipitated by exertion.
b) Not related to exercise.
c) Increased by deep inspiration.
d) Relieved by meals.

Answer 134

a) Precipitated by exertion.

Question 135

0) Bleeding tendency can be caused by:

a) Thrombocytopenia.
b) Coagulation factors deficiency.
c) Liver cell failure.
d) All of the above.

Answer 135

d) All of the above.

Question 136

Which of the following is a normal sign in the skin of a 60-year-old man?

a) Campbell de Morgan spots.
b) Paper money skin.
c) Spider nevus.
d) Striae rubra.

Answer 136

b) Paper money skin.

Paper money skin refers to thin, fragile skin often seen in aging but is not a normal sign.

Question 137

Clubbing of fingers is a recognized sign in:

a) COPD.
b) Chronic non-specific colitis.
c) Primary biliary cirrhosis.
d) Rheumatic mitral stenosis.

Answer 137

Primary biliary cirrhosis can be associated with clubbing due to the chronic liver disease and its effects on blood circulation and oxygenation

Question 138

7) Flapping tremors is a sign in:

A Liver cirrhosis.
b) Left sided heart failure.
c) Right sided heart failure.
d) Senility.

Answer 138

A Liver cirrhosis.

Question 139

A patient with chronic hemolytic anemia usually presents with:

a) Change in color of urine.
b) Cyanosis.
c) Chest pain.
d) Dyspnea.

Answer 139

a) Change in color of urine.

Patients with chronic hemolytic anemia often present with changes in the color of urine due to the presence of hemoglobin or bilirubin from the breakdown of red blood cells, which can lead to dark or tea-colored urine

Question 140

Hemoptysis may occur in:

a) Anticoagulation.
b) Chest wall hematoma.
c) Fractured rib.
d) Herpetic neuritis.

Answer 140

a) Anticoagulation.

Question 141

Definitive pyramidal lesion is recognized clinically by:

a) Ankle clonus.
b) Hyperreflexia.
c) Hypertonia.
d) Pathological reflex.

Answer 141

d) Pathological reflex.

Question 142

Hypoglycemia symptoms include:

a) Anorexia
b) Dry skin
c) Headache
d) Kinetic tumors

Answer 142

c) Headache

Question 143

One of the causes of epigastric pain is

a) Anterior myocardial infarction
b) Diverticulitis
c) Gastrectomy
d) Diabetic ketoacidosis

Answer 143

a) Anterior myocardial infarction

Question 144

Regarding secondary hypertension:

a) Constitutes the major causes of hypertension.
b) Suspected in heavy smoking men.
c) Usually associated with obesity.
d) Serum creatinine may be elevated.

Answer 144

d) Serum creatinine may be elevated.