1. A 49 years old woman suffers of chronic diarrhea and weight loss.

Malabsorption is suspected. Which of the following investigations is most

likely to make a definitive diagnosis?
(A) presence of fecal osmotic gap
(B) D-xylose test
(C) stool fat measurements
(D) Schilling test
(E) mucosal biopsy

2. A 45 years old male reported that, since one year, he occasionally has
regurgitated particles from food eaten several days earlier. In addition, his
breath has been foul smelling and he has had occasional dysphagia for solid
foods.
The most likely diagnosis is:
(A). gastric outlet obstruction
(B). scleroderma
(C). achalasia
(D). Zenkers diverticulum
(E). diabetic gastroparesis

3. Inammatory bowel disease (IBD) may be caused by exogenous factors.

Gastrointestinal ora may promote an inammatory response or may
inhibit inammation. Probiotics have been used to treat IBD. Which of the
following organisms has been used in the treatment of IBD?
(A). Campylobacter spp.
(B). Clostridium difcile
(C). Escherichia spp.
(D). Lactobacillus spp.
(E). Shigella spp.

4. Which of the following statements about cardiac cirrhosis is not true?

(A) Elevated alkaline phosphatase and an enlarged liver.
(B) May develop with long standing right-sided congestive heart failure.
(C) Most patients will develop variceal hemorrhage or encephalopathy.
(D) Aminotransferases may be normal or slightly increased with AST usually higher than
ALT.
(E) Treatment is based on management of the underlying cardiac disease

5. A 53 years old man presents with diarrhea. He also complains of facial

flushing lasting minutes at a time. Physical examination reveals facial

telangiectasias and a heart murmur not present 2 years before. This

murmur is accentuated by deep breathing. Which of the following is the
most appropriate initial diagnostic test?
(A) urinary vanillylmandelic acid (VMA)
(B) serum noradrenaline levels
(C) barium enema
(D) serum serotonin levels
(E) urinary 5-hydroxyindolacetic acid(5-HIAA)

6. A 73 years old woman presents to the emergency room with black tarry
stools and symptoms of presyncope when standing up. She has also
Melena .She recently started using ibuprofen for hip discomfort.
Gastroscopy confirms the diagnosis of a gastric ulcer. Which of the
following is the most likely explanation for the gastric ulcer?
(A) increasing acid production
(B) causing direct epithelial cell death
(C) promoting replication of Helicobacter pylori
(D) an antiplatelet effect
(E) inhibiting mucosal repair

7. A 43 years old man feels vaguely unwell. Physical examination is

unremarkable except for evidence of scleral icterus. The skin appears
normal. Which of the following is the most likely explanation for why early
jaundice is visible in the eyes but not the skin?
(A) the high type II collagen content of scleral tissue
(B) the high elastin content of scleral tissue
(C) the high blood flow to the head with consequent increased bilirubin delivery
(D) secretion via the lacrimal glands
(E) the lighter color of the sclera

8. A 56 years old previously well woman presents with pruritus for 5 months.
There is no history of prior alcohol use, blood transfusions, or illicit drug
use. Her physical examination is entirely normal with no signs of chronic
liver disease or jaundice. An abdominal ultrasound conrms the suspicion
of cirrhosis. Laboratory evaluation reveals an alkaline phosphatase level of
three times normal. Which of the following is the most appropriate next
step in diagnosis?
(A) Hepatitis B serologies
(B) antinuclear antibodies
(C) Serum ferritin
(D) 24-h urine copper
(E) antimitochondrial antibodies

9. A 16 years old woman had suffered 1 month ago from jaundice, vomiting,
malaise, and anorexia. A diagnosis of hepatitis A was made. The patient

was treated conservatively, and she had a full recovery. After two weeks she
had returned complaining of the same symptoms she had 1 month ago.
She is jaundiced, and an initial panel of laboratory tests returns elevated
transaminases. Which of the following offers the best explanation of what
has occurred in this patient?
(A). Co-infection with hepatitis C
(B). Hepatitis A recurrence
(C). Inappropriate treatment of initial infection
(D). Incorrect initial diagnosis; this patient likely has hepatitis B
(E). Relapsing hepatitis

10. A patient is found to have a holosystolic murmur on physical examination.

With deep inspiration, the intensity of the murmur increases. This is
consistent with which of the following?
A. Atrial-septal defect
B. Austin Flint murmur
C. Carvallos sign
D. Chronic mitral regurgitation
E. Gallavardin effect

11. All the following disorders may be associated with thoracic aortic
aneurysm except
A. osteogenesis imperfecta
B. Takayasus arteritis
C. Ehlers-Danlos syndrome
D. ankylosing spondylitis
E. Klinefelters syndrome

12. A 28 year old man develops viridans group streptococci septicemia. Which
of the following cardiac lesions has the highest risk of developing
endocarditis?
(A) ventricular septal defect
(B) atrial septal defect, secundum type
(C) mitral valve prolapse with regurgitation
(D) pure mitral stenosis
(E) asymmetric septal hypertrophy

13. The ECG shown in the Figure was obtained during the initial stages of an
acute MI. The patient had just received thrombolytic therapy. What is the
rhythm?
(A) atrial fibrillation
(B) atrial flutter
(C) second degree heart block
(D) Wenckebach phenomenon
(E) nonsustained ventricular tachycardia

14. All of the following statements regarding Myocarditis are true except:
(A) may present with a functional systolic murmur
(B) usually causes hypertension
(C) causes nonspecific ST changes on ECG
(D) is often caused by Coxsackie virus
(E) is worsened by hypoxia and exercise

15. You have been treating a 75 year old man for hypertension for the last 20
years. He frequently misses medication doses, and his blood pressure is
rarely well controlled. In the office today, his blood pressure is 165/90. He
states that he feels well. Which of the following would you expect on his
physical exam?
(A). Basilar crackles in the lung fields
(B). S4 gallop and a left ventricular heave
(C). S4 gallop and a right ventricular heave
(D). S3 gallop and a left ventricular heave
(E). Papilledema

16. A 35 year old woman presents with five months of worsening shortness of
breath on exertion and leg swelling. She has no prior history of medical
problems. Physical examination reveals a blood pressure of 135/85,
crackles over both lung bases, an S3 gallop, and normal carotid
upstrokes. Her ECG shows Mobitz II second- degree heart block.
Echocardiographic findings include an ejection fraction of 55%, mild
enlargement of all four chambers, thickened left and right ventricular
walls, and E to A reversal. Which of the following is the most likely
diagnosis?
(A). Hypertensive cardiomyopathy
(B). Cardiac amyloidosis
(C). Cardiac sarcoidosis
(D). Constrictive pericarditis
(E). Viral myocarditis

17. Which of the following patients is least likely to have a left bundle branch
block on ECG?
(A). A 40 year old woman with bilateral hilar adenopathy and an S4 on cardiac
examination
(B). A 55 year old man with chronic hypertension and hyperlipidemia who develops new
onset chest pressure radiating to the jaw and lasting one hour
(C). A 79 year old woman with degenerative conduction disease
(D). A 44 year old man with hepatomegaly, cardiomegaly, and a ferritin of 2300
mg/mL
(E). A 65 year old woman who underwent hip replacement two days ago and now
has acute onset of shortness of breath and pleuritic chest pain

18. Ophthalmologic manifestations of rheumatoid arthritis may include all of

the following except:
(A). Secondary Sjgrens syndrome with sicca complex
(B). Sderitis
(C). Episcleritis
(D). Corneal melts
(E). Ischemic optic atrophy

19. What is the most common extraarticular manifestation of ankylosing

spondylitis?
(A). Anterior uveitis
(B). Aortic regurgitation
(C). Cataracts
(D). Inammatory bowel disease
(E). Third-degree heart block

20. Each of the following antibodies have been found in patients with HIV
infections except:
(A). Antinuclear antibodies (ANAs)
(B). Anticardtolipin antibodies
(C). Cryoglobulins
(D). Antilymphocyte antibodies
(E). Anti-G protein antibodies

21. An obese 45 year old woman presents with headaches and visual loss, and
found to have papilledema. A CT head scan is normal. What is the most
likely diagnosis:
A.
B.
C.
D.
E.

Optic neuritis.
Benign intracranial hypertension.
Migraine.
Normal pressure hydrocephalus.
Acromegaly.

22.Features of multiple endocrine neoplasia (MEN) type I include which one

of the following?
A.
B.
C.
D.
E.

Adrenal nodule.
Hyperparathyroidism.
Hyperthyroidism.
Hypothyroidism.
Phaeochromocytoma.

23. A patient with past anaphylaxis to honeybee stings should do which of the
following:
A.
B.
C.
D.
E.

Carry an epinephrine Kit.

Have total serum IGE measured.
Take up beekeeping.
Receive immunotherapy with honeybee whole body extract.
Receive immunotherapy with yellow jacket venom.

24. A 16 year old boy arrives in the emergency room 30 minutes after ingestion
a large amount of tricyclic antidepressants. He is tachycardic
hypertensive and deeply comatose. You should:
A.
B.
C.
D.
E.

Intubate the patient with a cuffed endotracheal tube and then perform gastric lavage.
Perform gastric lavage immediately.
Pass a nasogastric tube and administer 50 g of activated charcoal.
Intubate the patient and prepare for emergency hemodialysis.
Do nothing until confirming drug overdose via drug level.

25. Secretion of growth hormone (GH) is stimulated by:

A.
B.
C.
D.
E.

Oral glucose.
L-Dopa.
Dexamethasons.
Metyrapone.
Somatostatine.

26. Suprasellar extension of pituitary tumor is likely to result in:

A.
B.
C.
D.
E.

Bitemporal hemianopsia.
Diplopia .
Facial pain.
Prolactine deficiency.
Nasopharyngeal mass.

27. Laboratory confirmation of the diagnosis of active acromegaly is best

accomplished by:
A. Failure of growth hormone levels to suppress to < 2 ng/ml during a glucose tolerance
test.
B. High somatostatine levels.
C. High serum level of phosphorous.
D. Presence of associated hyperprolactinemia responsive to bromocrptine therapy.
E. Growth hormone responds to insuline tolerance test.

28. All the following statements about drugs used for the treatment of
hypertension are true except:
A.
B.
C.
D.
E.

Hydralazine may be associated with a lupus-like syndrome.

Methyldopa may cause hemolytic anemia.
Vrapamil may cause an increase in digoxin level in blood.
Thiazide may interfere with elimination of lithium.
Furosemide cause an increase in urinary calcium.

29.Abnormal endocrine disturbances in hemodialysis patients include all the

following except:
A.
B.
C.
D.
E.

Low total thyroxine.

Increased level of growth hormone.
Hypergastrinemia.
Inpaired fertility.
Low level of prolactin.

30. Stone formers with idiopathic hypercalciuria should be treated with.

A.
B.
C.
D.
E.

Thiarizide diuretics.
Aluminum hydroxide.
Loop diuretics.
Calcium carbonate.
Citrate.

31. All the following are characteristic of cluster headache except:

A.
B.
C.
D.
E.

unilateral pulsatile headache.

Nocturnal attacks.
Horner's syndrome.
More common in males than females.
Scalp and face tenderness.

32. All of the following are characteristic of dementia except:

A.
B.
C.
D.
E.

Impairment of intellect.
Impairment of memory.
Changes in personality and behavior.
Impairment of orientation and judgment.
Impairment of consciousness.

33. A 63 year old man is found to have a left homonymous hemianopia. What
structure is likely to be damaged?
A.
B.
C.
D.
E.

Left occipital lobe.

Right occipital lobe.
Optic chiasm.
Left optic nerve.
Left lateral geniculate nucleus.

34. A 75 year old man is confused, restless and disoriented two days after an
aortic aneurysm repair. Serum sodium is 112 meg/L, serum osmolarity is low
and urine is hypertonic. The most appropriate treatment is:
A.
B.
C.
D.
E.

Restriction of fluid intake.

Administration of hypertonic (3%) saline solution.
Administration of isotonic saline solution.
Infusion of mannitol 25g.
None of the above.

35. Metabolic acidosis due to early chronic renal failure is:

A.
B.
C.
D.
E.

A type four renal tubular acidosis.

Secondary to decreased ammonia production.
A high anion gap acidosis.
Associated with hyperkalemia.
All of the above.

36. All are true in cystic fibrosis in adults except one?

ABCD-

Pseudomonas is a common infecting organism .

Malabsorption is the commonest presentation .
Sinusitis is common .
Impotence is common in the majority .

37. All are common anterior mediastinal masses except one ?

A. Schwannoma .
B. Teratoma-dermoid
C. Thymoma .
D.Lymphoma .
38. All except one are true for monoclonal antibodies as Mepolizomub ?
AIt is an anti interlukin 5 .
BBest used in eosinophilic asthma .
CInhibits the release of eosinophilic cytokines .
DIt is an anti interlukin 4 .

39. A 40 year-old housewife asthmatic for 5 years, presented with fever &
bilateral lungs infiltrates . Her WBC is 40 000 /mm of which 60 % are
eosinophils, normal stool & urinalysis , negative C-ANCA . No headache ,
no hypertension & no temporal arteritis .
All are true except one ?
ABCD-

The most likely diagnosis is Polyarteritis Nodosa .

The most likely diagnosis is Churg Strauss disease .
The best treatment is systemic steroids .
This is a variant of pulmonary eosimophilia syndrome.

40.A 60 year- old woman with mid back pain of 6 months duration was treated
for pneumonia 2 months ago , presented with fever , dull percussion
notes & bronchial breathing sounds of her Rt. Lower chest . Bone X-Rays
showed multiple osteolytic ribs & thoracic spine lesions. Her CBC showed
leucocytosis & a Hct. of 18 % with MCV of 82 % . All are true except ?
ABCD-

CXR will show pneumonia of her Rt. Lower lobe .

There will be elevated serum proteins .
There will be decreased serum proteins .
Renal failure could be anticipated .

1)All of the following statements are true concerning patients with untreated
celiac disease except :
A.
B.
C.
D.
E.

They are likely to have subtotal or total villous atrophy

Usually glucose absorption is impaired .
Usually have anorexia , and weight loss.
May safely resume a normal diet in adult life .
May have abdominal distension

2)All of the following are true regarding acute hepatitis B infection except:
A. Most patients are asymptomatic.
B. Some patients present with polyarthritis.
C. Glomerulonephritis is a known complication

D. There is increased infectivity in the presence of the e antigen.

E. Pruritis is an important early symptom.

3)All of the following are true regarding pyloric stenosis except:

A.
B.
C.
D.

usually not present at birth.

The characteristic radiological feature is the string sign,
It is commonest in first-born male children
A hyperchloraemic acidosis would be expected.

4)All of the following suggest a diagnosis of Hirschsprung's disease except:

A.
B.
C.
D.
E.

A contrast study will show the affected segment to be tonically contracted.

Patient's present typically with constipation.
Neonatal large bowel obstruction.
Early treatment may involve rectal irrigation or an emergency colostomy.
Red current jelly stools.

5)All of the following are true regarding Gilbert's syndrome except:

A.
B.
C.
D.
E.

Inheritance is autosomal dominant.

Serum unconjugated bilirubin levels are elevated .
Serum bilirubin levels are decreased by fasting .
Affects 2-5% of the population.
Glucuronyl transferase levels are reduced.

6)All of the following are true regarding oesophageal atresia except:

A.
B.
C.
D.
E.

Frequently associated with trachea-oesophageal fistula.

Often present prenatally with oligohydramnios.
Postnatally presents with difficulty swallowing and aspiration.
The diagnosis may be confirmed by the inability to pass a nasogastric catheter.
Radiological evidence of gas in the stomach confirms the presence of distal
tracheooesophageal fistula.

7)All of the following are true regarding Cyclic Vomiting except:

A.
B.
C.
D.
E.

Is a syndrome with numerous episodes of vomiting interspersed with well intervals.

May be precipitated by stress and excitement.
Patients may have prodromal symptoms of nausea headache or fever.
Diagnosis can be confirmed by brain MRI.
May be prevented with the antimigraine agent amitriptyline or cyproheptadine.

8)All of the following are true concerning Intussusception in children except:

A. Is more common in the first 3 years.
B. Most cases are idiopathic.

C. Bleeding per rectum is the most common presenting symptom.

D. May be caused by a polyp or pedunculated tumour .
E. Hydrostatic reduction plays an important role in the management.

9)All of the following are true regarding gastrooesophageal reflux in infants

except:
A. A long term cure may be expected in infants
B. Metoclopramide reduces symptoms by stimulating gastric emptying and esophageal
motility
C. Thickening an infants formula with cereals decreases the volume of vomitus
D. A barium swallow would be the investigation of choice to diagnose.

10)A 6-year-old boy is brought to the emergency room with a 3-hours history
of fever up to 39.5 C and sore throat. The child appears alert but anxious
and toxic. He has mild inspiratory stridor and is drooling. You should
immediately
A.
B.
C.
D.
E.

Examine the throat and obtain a culture

Obtain an arterial blood gas and start an IV line
Order a chest x-ray and lateral view of the neck
Prepare to establish an airway
Admit the child and place him in a mist tent

11)Which of the following bacteria grown from a throat culture of a 5 years

old child needs to be treated with antibiotics?
A.
B.
C.
D.
E.

Group B streptococcus
Methicillin resistant staphylococcus aureus
Klebsiella pneumonia
Group A beta hemolytic streptococcus
Pseudomonas aeruginosa

12) The antibiotic of Choice for the treatment of pneumonia in a 3 year old
child is?
A.
B.
C.
D.

Penicillin V K
Erythromycin
Amoxicillin
Gentamicin
E. Tetracycline

13)An 18-month-old boy presents to the emergency center having had

a brief, generalized tonic clonic seizure. He is now postictal and has a
temperature of 40C. During the lumbar puncture (which proves to be
normal), he has a large, watery stool that has both blood and mucus in it.
The most likely diagnosis in this patient is:-

A.
B.
C.
D.
E.

Salmonella
Enterovirus
Rotavirus
Campylobacter
Shigella

14)The infant pictured above develops infantile spasms. The disorder most
likely to be affecting this infant is:A.
B.
C.
D.

Neurofibromatosis
Tuberous sclerosis
Incontinentia pigmenti
Pityriasis rosea
E. Psoriasis

15)Invasive group B streptococcal infection in young infants is categorized

into two classes based on the time of onset of clinical manifestations after
birth. Early-onset disease occurs within the first week after birth and

late-onset disease occurs at 3 to 4 weeks after birth. Of the following, the

most prevalent clinical manifestation of late-onset GBS disease is:
A.
B.
C.
D.
E.

Arthritis
Pneumonia
Cellulitis
Meningitis
Oseomyelitis

16)A 15-yr-old boy is seen in your office for dysuria and is noted to have 4+
hematuria and >100 red blood cells per high-power field on urinalysis. All
of the following organisms may cause infection leading to these symptoms
EXCEPT:
A. Group A Streptococcus
B. Chlamydia
C. E. coli
D. Proteus
E. Enterovirus

17)A 15-yr-old-girl is admitted with a 5-day history of worsening fever, left

flank pain, and vomiting. Physical examination reveals an ill appearing,
dehydrated adolescent. Pulse rate is 110/min; temperature is 40C. Left
costovertebral angle tenderness is present. Serum sodium is 131 mmol/L,
potassium 6.7 mmol/L, chloride 108 mmol/L, and bicarbonate 15 mmol/L.
The most likely diagnosis is:
A. Addison's disease
B. Ingestion of high potassium-containing foods
C. Distal renal tubular acidosis
D. Acute pyelonephritis
E. Congenital adrenal hyperplasia

18)Urine dipstick testing of a specimen obtained from a febrile 4- yr-old child

with acute viral gastroenteritis shows specific gravity 1.030, pH 5.0, 2+
proteinuria, and no blood cells. The most likely cause of the patient's
proteinuria is:
A. Transient proteinuria
B. Nephrotic syndrome
C. Orthostatic proteinuria
D.Acute glomerulonephritis
E. Chronic glomerulonephritis

19) Initial evaluation of a child with fixed proteinuria should include all of the
following EXCEPT:
A. Serum creatinine level
B. Complement level (C3)
C. Renal biopsy
D. 24-hr urine collection for measurement of protein and creatinine
E. Serum albumin level

20) A 2-yr-old boy presents with a 2-wk history of gradually increasing

periorbital and pedal edema. Urine dipstick testing reveals 4+ proteinuria
and is negative for blood. Diagnostic studies are likely to show all of the
following EXCEPT:
A. Serum albumin 1.5 mg/dL
B. Serum cholesterol 130 mg/Dl
C. Serum creatinine 0.5 mg/dL
D. Complement C3 100 mg/dL
E. Urine protein to creatinine ratio 4.0

21) A 5-yr-old boy presents with new-onset nephrotic syndrome. Which of the
following clinical findings is most likely?
A. Gross hematuria
B. Periorbital edema
C. Hypertension
D. Pleural effusions
E. Fever

22) A 2-year-old boy is admitted to the intensive care unit with severe
dehydration from bacterial gastroenteritis. Initial laboratory work
reveals BUN of 80 mg/dL and serum creatinine of 2.5 mg/dL. With
rehydration, his BUN and creatinine fall to 20 mg/dL and 0.5 mg/dL in 2
days. The most likely diagnosis is:
A. Acute tubular necrosis
B. Hemolytic-uremic syndrome
C. Rhabdomyolysis syndrome
D. Prerenal acute renal failure
E. Acute glomerulonephritis

23) A previously well 1-year-old infant has had a runny nose and has been
sneezing and coughing for 2 days. Two other members of the family had
similar symptoms. Four hours ago, his cough became much worse. On
physical examination, he is in moderate respiratory distress with nasal
flaring, hyperexpansion of the chest, and easily audible wheezing without
rales. The most likely diagnosis is
A. Bronchiolitis

B.
C.
D.
E.

Viral croup
Asthma
Epiglottitis
Diphtheria

24) The most likely agent responsible for the infants condition in the
preceding question is
A.
B.
C.
D.
E.

Staphylococcus aureus
Haemophilus influenzae
Corynebacterium diphtheriae
Respiratory syncytial virus
Echovirus

25) A 10-month-old infant has poor weight gain, a persistent cough, and a
history of several bouts of pneumonitis. The mother describes the child as
having very large, foul-smelling stools for months. Which of the following
diagnostic maneuvers is likely to result in the correct diagnosis of this
child?
A.
B.
C.
D.
E.

CT of the chest
Serum immunoglobulins
TB skin test
Inspiratory and expiratory chest x-ray
Sweat chloride test

26) You are awakened in the night by your 2-year-old son, who has developed
noisy breathing on inspiration, marked retractions of the chest wall, flaring
of the nostrils, and a barking cough. He has had a mild upper respiratory
infection (URI) for 2 days. The most likely diagnosis is
A.
B.
C.
D.
E.

Asthma
Epiglottitis
Bronchiolitis
Viral croup
Foreign body in the right mainstem bronchus

27) A previously healthy 18-month-old has sudden onset of coughing, which

resolves over a few minutes. Subsequently, the patient appears to be
normal except for increased amounts of drooling and refusal to take foods
orally. The most likely explanation for this toddlers condition is
A.
B.
C.
D.
E.

Severe gastroesophageal reflux

Foreign body in the airway
Croup
Epiglottitis
Foreign body in the esophagus

28) Patient groups that should be targeted for annual influenza vaccination
include:
A.
B.
C.
D.

Persons aged 65 yr and older

Persons with cardiovascular disease
Otherwise healthy children with asthma
Women who will be in the second or third trimester of pregnancy during influenza
season
E. All the above.

29) A 2-mo-old infant presents with conjunctivitis, tachypnea, and a mild

cough. There is no fever. Physical examination reveals the presence of
crackles bilaterally.The most likely etiologic agent is:
A.
B.
C.
D.
E.

Influenza virus
Parainfluenza virus
Respiratory syncytial virus
Adenovirus
Chlamydia trachomatis

30) A previously healthy 12-yr-old boy presents with upper respiratory

symptoms of 8 days' duration, with worsening cough and fever.
Examination reveals a temperature of 39C, a respiratory rate of 24/min,
and inspiratory crackles in both lung fields. Oxygen saturation is 93-94%.
Chest film shows scattered infiltrates in multiple lung fields, more focal
consolidation in the right lower lobe, and blunting of the right
costophrenic angle. White blood cell count is 11,000/mm3 with a normal
differential.Which of the following is the most appropriate next step in
diagnosis?
A.
B.
C.
D.
E.

Sputum culture
Tuberculin skin testing
Throat culture
Cold agglutinins titer
Erythrocyte sedimentation rate

31) Which of the following is the most appropriate next step in the
management of the patient described in Question 32?
A.
B.
C.
D.
E.

Erythromycin PO
Amoxicillin PO
No antibiotic therapy
Ceftriaxone IM
Cefuroxime IV

32) A 3-yr-old boy has been coughing daily for 2 mo. The cough is
nonproductive and occurs during sleep in the early morning hours as well

as during the day, particularly when the child is active. On physical

examination both height and weight are in the 50-75th percentile, and
chest examination is unremarkable. There is no evidence of digital
clubbing. A chest roentgenogram is interpreted as normal. The diagnostic
procedure most likely to ascertain the cause is:
A.
B.
C.
D.
E.

Sputum cytology and culture

Sweat chloride testing
Bronchoscopy
Complete blood count
Trial of bronchodilator therapy

33) All of the following represent passive humoral immunity Except:a. The administration of intramuscular or intravenous human
immunoglobulin.
b. The transplacental transfer of maternal IgG to the fetus.
c. The transfer of immunoglobulins via colostrum and breast milk
through transepithelial Ig to the newborn.
d. Immunity following tetanus immunization

34) A previously healthy, active 18-month-old child presents with unilateral

nasal obstruction and foul-smelling discharge. The childs examination is
otherwise unremarkable. The most likely diagnosis is
A.
B.
C.
D.
E.

Foreign body
Nasal polyps
Frontal sinusitis
Deviated septum
Choanal atresia

35)An 11-month-old girl who has acute lymphoblastic leukemia in early

remission was inadvertently exposed to varicella 1 day ago. To reduce the
risk of life-threatening varicella, within 72 hours she should receive:A.
B.
C.
D.
E.

An increase in her dose of prednisone.

Intravenous acyclovir.
Oral acyclovir.
Subcutaneous( varicella VZV vaccine- Oka strain).
VariZIG( Varicella zoster immunoglobulin)

1) -Chronic diarrhea tends to produce:

A.hypochloremic acidosis

B. hypochloremic alkalosis
C. hyperchloremic acidosis
D. hyperchloremic alkalosis
E. alkalosis with a normal chloride

2) Which organ has the highest risk of ischemia under the conditions of
isovolemic hemodilution?
A.
B.
C.
D.
E.

A.Heart
Brain.
Lung
Liver
Kidney

3) Which of the following is the most common infection associated with red
cell transfusion?
A.
B.
C.
D.
E.

Hepatitis A
Cytomegalovirus (CMV)
Hepatitis C
Human immunodeficiency virus (HIV)
Ebstein-Barr virus (EBV)

4) Which of the following is/are important factors in the decision to transfuse

red blood cells?
A.
B.
C.
D.

Hematocrit
Oxygen saturation
Cardiac output
All of above

5) The sinoatrial (S-A) node is located:

A. The wall of the right atrium .
B. The wall of the right ventricle
C. the wall of the left atrium
D. the wall of left ventricle .

6- An acute blood loss of 2000 ml represents % of the predicted blood volume

in a previously healthy 70-kg male.
A.
B.
C.
D.
E.

10
20
30
40
50

7) ALL of the following ARE TRUE In consolidated lobar pneumonia

EXCEPT ONE

A. Reduced chest wall movement ipsilaterally

B. A dull percussion note
C. Bronchial breathing
D. Reduced vocal resonance

8) WHICH of the following is TRUE regarding The right lung ?

A. Has one fissure
B. Has no Sibson's fascia
C. Has two pulmonary veins
D. Has 7 bronchopulmonary segments

9) All of thefollowing are TRUE regarding Tension pneumothorax EXCEPT

ONE.
A. Mediastinal deviation to the opposite side
B. Cyanosis
C. Hypertension
D. Decreased air entry

10) ALL of the following ARE NOT TRUE regarding the prothrombin time
when it is prolonged in
A. Haemophilia A
B. Liver failure
C. Vitamin C deficiency
D. von Willebrand's disease

1)

Regarding technique one of the following is false :

a) The tube anode is of tungsten material.
b)To have an XRAY we need electricity, tube, films and processing machine.
c) In digital radiograph we can reduce exposure.
d) Air absorbs most radiations.

2)

CT is able to do :
a) Axial sections only.
Axial and sagittal sections.

b) Axial and coronal sections .

d) All the sections.

3)

For iodine contrast study all the following are true except :
a) Pt must be NPO for 8hrs.
b) BUN and creatinine to be done before.
c) It's better to hydrate the pt.
d) It's a must in acute head trauma.

4)

In a case of acute head trauma one of the following is false :

a) Skull Xray has no place.
b) Plain CT is the exam of choice.
c) MRI with contrast is more sensitive.
D) MRI in the 1st hours is useful.

c)

5)

One of the following is not contraindications for MRI :

a) Pacemakers.
b) Old surgery for brain aneurysm.
c) Pregnancy.
D) Coiling of AVM.

1.Negative symptoms of schizophrenia include all of the

following except:
A. affective blunting and flattening
B. hallucinations of voices speaking to the patient
C. lack of motivation and initiative
D. anhedonia
E. poverty of thought content

2. Common side effects of tricyclic antidepressants include

all of the following except:
A. orthostatic hypotension
B. dry mouth
C. diarrhea
D. blurred vision
E. sedation

3. Which one of the following is the most common cause

of dementia:
A. Alzheimer disease
B. cerebrovascular disease
C. head trauma
D. thiamine deficiency
E. human immunodeficiency virus (HIV)

4.

A 38-year-old man has gradually become more

apathetic and moody. At times he is confused and
forgetful. His gate is unsteady, and deep-tendon
reflexes are diminished. He complains of tingling in his
legs. Which one of the following is the most likely
diagnosis?
A. cerebellar neoplasm
B. B-12 deficiency
C. hypothyroidism
D. Manganese intoxication
E. Multiple Sclerosis

5.

A 29-year-old man presents with a history of three

distinct episodes of emotional lability. During the first

episode, he experienced a right visual field deficit.

During another episode, he experienced mild ataxia.
Which one of the following is the most likely diagnosis?
A. B-12 deficiency
B. Herpes encephalitis
C. Multiple Sclerosis
D. Neurosifilis
E. Systemic lupus erythematosus (SLE)