TRAS-1 MEDICINE

1-Henoch Scheonline purpura ,recognised features: a-flitting large joint arthritis . T b-erythema nodosum. F c-decreased platelets. F d- malaise. T e-ankle oedema. THenoch-Schönlein purpura, the most common systemicvasculitis in children, occurs in adults as well. Typical featuresare palpable purpura (Figure 20–8), arthritis, andhematuria. Abdominal pain occurs less frequently in adultsthan in children. Pathologic features include leukocytoclasticvasculitis with IgA deposition. The cause is not known.The purpuric skin lesions are typically located on thelower extremities but may also be seen on the hands, arms,trunk, and buttocks. Joint symptoms are present in themajority of patients, the knees and ankles being most commonlyinvolved. Abdominal pain secondary to vasculitis ofthe intestinal tract is often associated with gastrointestinalbleeding. Hematuria signals the presence of a renal lesionthat is usually reversible, although it occasionally mayprogress to chronic kidney disease. Children tend to havemore frequent and more serious gastrointestinal vasculitis,whereas adults more often suffer from chronic kidney disease.Biopsy of the kidney reveals segmental glomerulonephritiswith crescents and mesangial deposition of IgA.Chronic courses with persistent or intermittent skin diseaseare more likely to occur in adults than in children. Thevalue of corticosteroids has been controversial. In children oradults, prednisone (1 mg/kg/d orally) may benefit those withsevere extrarenal manifestations and with evidence of kidneydisease. The incremental efficacy of steroid-sparing drugssuch as azathioprine and mycophenolate mofetil—oftenused in the setting of kidney disease—is not known2-UTI : a-can present asymptomatic in more than 1% in school girls. T b-reliable diagnosed by proteinuria . F

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c-contamination by faecal normal flora is the common cause of infection. T d-if more than 10power6 organisms can be obtained by supra- pubic sample indicates infection. e-medical treatment is not effective alone if there is gross vesico-ureteric reflux. t3-The following pairings are true. a-partial RBBB ----ASD secondum . b-atrial flutter-------saw-tooth appearance in the ECG. c-st elevation in in I ,II ,Avf,-------anterior MI. d-digoxin toxicity --------peaked t wave. e-short p-r interval------first degree heart block. 4-causes of death in diabetic ketoacidosis : a-aspiration of gastric contents. F b-cerebral oedema. T c-thrombo-embolism. T d-septicaemia. T e-disturbance of K metabolism. T5-In renal disease the following are true pairs: a-polycystic kidney and cerebral aneurysm. T b-nephrotic syndrome and Memb. Glom. T c-good past. Syndrome and haemorrhagic alveolitis. T d-tubular interstitial nephritis and paracetamol. T e-renal tubular acidosis and hyperchloraemia . 6-chronic iron deficiency : a-Decreased MCV. T b-clubbing. F c-decreased ferritin. T d-brittle nails. T e-parotid enlargement. F7-Paget disease: a-asymptomatic in most cases. T b-osteogenic sarcoma is a complication. T c-high alkaline phosphatase due to osteoclastic activity. F d-deafness can occur. T e-cardiac failure is low output type. F8-Risk of cerebral embolism increase in the following: a-HTN Ht. Disease. b-infective endocarditis. c-chronic core pulmonale. ?

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d-mitral stenosis with AF. T e-viral myocarditis. 9-Oral polio vaccine, should not be given to adult in the following conditions: a-early pregnancy. T b-patient having hypogamaglobulinaemia. c-one week following rubella vaccination. d-chronic rheumatic heart disease. e-febrile with upper respiratory tract infection. F10-In Psoriasis: (β-blockers, lithium, and ACEIs, can also induce psoriasis)

a-scalp is rarely affected. b-there is hereditary predisposition. c-the rash is dry and scaly. d-the rash typically aggravated by sunshine. F(sunshine helps clear the lessions) e-nail pitting is a recognised feature. 11-Cardiogenic shock occurs in the following: a-Myocardial infarction. b-Pulmonary embolism. c-ruptured aortic aneurysm. d-cardiac tamponade. e-atrial fibrillation.. 12-The following are correctly matched with the mentioned therapy: a-established anuric renal failure and fluid restriction 2—3 L/day. b-acute paracetamol toxicity and N-acetylcystine. T c-heparin overdose and vit.K F d-osteomalacia and biphosphonate. e-generalised angioedema and subcutaneous adrenaline. t13.The following are characteristic features of Cardiognic Shock: a. Hypotension.b. Bilateral basal crepitations.c. Vasodilatation.d. Cyanosis.e. Increased Anion gap.14-36-year- female who is known asthmatic presents with wheezes & cough and she is unable to complete a sentence. The following signs are expected:

a. Pulsus Paradoxus.b. Cyanosis.c. B-Agonist nebulizer is not effective.

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d. PEFR< 50%.14- The following are causes of bulky Diarrhoea:

a. Divcrticulosis.?b. Cystic Fibrosis.c. Chronic Pancreatitis.td. Primary Biliary Cirrhosis.te. Irritable Bowel Syndrome.t

15-Aspiration Pneumonia can occur in:a. Bronchiactesis.b. Acilia Syndrome.c. Achalasia.d. Gastro-esophageal. Reflex.

16- Regarding polycystic disease of the kidney:a. May be autosomal recessive. tb. Associated with Interstitial Hemorrhage.c. Is Premalignant. Fd. Causes renal failure. T

17- Regarding haematuria: a. IVP is an urgent investigation. F b. Cystoscopy is mandatory. F c. Can be treated conservatively. d. Urethral catheter should be inserted to prevent obstruction. T e. Urgent CT scan should be done.??

18-In Terminally iII Patient:a. The patient should always know the Diagnosis. Tb. Morphine should not always be given to relief pain in order to prevent

Dependence. Fc. Hospital admission is indicated if the relatives are not able to care

about the patient. Td. The rest of the staff should be aware of what you told the patient. T

19- In Disease Prevention:a. Screening is an example of Secondary Prevention. Tb. Has no side effects. ??c. Health Education is part of primary Prevention. Td. Tertiary prevention means Prevention of Complications. T

20- In Screening, the disease should be:

One. ChronicTwo. Ultimately fatal.

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Three. Treatable. TFour. Recognizable early. TFive. The natural history known. T

21-In common practice, the following are True about Sore Throat:One. Commonly caused by Virus. Two. Erythromycin is the treatment of choice if the patient is Allergic

to Penicillin.Three. Throat Swab should be taken from all patients. FFour. It is possible to differentiate between Viral & Bacterial

infections Clinically. F22- In lower Limb Examination:Dorsalis Pedis is Absent in 10-15%.Posterior Tibial Artery lies behind the lateral Malleolus. FLong Saphenous vein starts posterior to the Medial Malleolus. F(ant. To medial mel)Injuries to the superficial peroneal nerve result in foot drop. T23- Peptic Ulcer is associated with:Hypercalcaemia. THead injury. TBurns. TIron Deficiency Anemia. Acute Pancreatitis. T?24- The following are used in Management of Acute Asthma:Inhaled Steroids. Sodium Cromoglycate. FInhaled Beta Agonist. Ipratropium. Oxygen.25- The following consequences are correctly paired:

One. Amiodarone & Thyroid Dysfunction. Two. Warfrain & Pin-point Petechial hemorrhage.Three. Aspirin & Platelet aggregation.Four. Isoniazid & SLE-like Syndrome.Five. B-blockers & Tachycardia.

26- Signs of Anaphylaxis: One. Broncho-dilatation.Two. Laryngeal Spasm. Three. Diarrhoea. Four. Wheezes.Five. Hypertension.

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27- Dermatological Lesions: One. Satellite Lesions are found in Candidiasis.Two. After treatment of Acne with Antibiotics you can tell the patient

to expect Improvement in less than 2 Weeks. Three. In Scabies, Itching disappears within 2-4 days of the Treatment.

F ( Pruritus may persist for two weeks after treatment,)

Four. Impetigo is caused by Staph. Epidermis. F (Staph. A, strep))28- The following are True:

One. In 7th Nerve Palsy there is Difficulty in Opening the Eye.Two. In 3rd Nerve Palsy the Eyeball is Internally Rotated. tThree. Subarachnoid Haemorrhage can lead to Signs of Meningism.tFour. There is no Brain Injury if Glasgow Coma Scale (GVS) is 15.

29- Hypokalaemia:One. Occurs in Primary Hyperaldosteronism-tTwo. In Vomiting more than in Diarrhoea fThree. There is Peaked T-wave in ECG. fFour. Occurs in Spironolactone Therapy. f

30- The Following are truly paired:One. Cushing’s Disease & Hypopigmentation. Two. Coeliac disease & Osteomalacia.Três. Posterior Subcapsular Cataract & Diabetes Mellitus.T(cortical

and post. subcapsular)Quatro. Hepatic Encephalopathy & Constructional Apraxia.Five. Portal Hypertension & Pancytopenia. T

31- In Insulin Dependent diabetes Mellitus:Patients should measure the Glycosylated HB at least twice yearly. T10% Decrease in Glycosylated HB will lead to 50% Decrease in Mortality & Morbidity.?When discovered for the First Time, the patient should be referred to Endocrinologist. Can result in Silent Heart Ischiamia.Can cause Paradoxical Rise in BP on Standing. F( orthostatic hypo)Can be treated by Combined Care between GP & Consultant T32- The following Treatments are True:a. Salicylate Poisoning & Forced Alkaline Diuresis, tb. Heparin & Vitamin K. c. Generalized Angioneurotic Oedema & S\C Adrenalined. Osteomalacia & Biphosphanate. Fe. Established acute Anuric Renal Failure & 2-3 liters of water/day.33-The following are True:

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One. Vitamin B12 deficiency leads to Sub-acute Combined Degeneration of the Cord with decreased Reflexes & up -going Toe. t

Two. Paget’s Disease of the bone occurs with preservation of the Skull.f

Three. Osteomylitis of the vertebral bodies spares the Vertebral Discs.Four. Pseudobulbar Palsy causes Wasting & Fasciculation of the

Tongue. F (bulbar is LMN while pseuFive. Normal Temporal biopsy rules out Cranial Arteritis. f

34-A patient with serum Na 122 mmol, the following are the likely causes

a. Hypoadrenalism.b. Hyperosmolar Non-ketotoic diabetic acidosis.c. Prolonged infusion of 5% Dextrose.td. Syndrome of Inappropriate ADH secretion.te. In a young lady who is psychologically disturbed and drinks water

excessively.t35-The following are causes of death in a patient with DKA:

a. Aspiration of gastric contents. ??( RDS)b. K level disturbances. c. Septicemia.d. Cerebral Oedema.e. Thrombo-embolism

36-The following are correctly paired:Digoxin overdose & Atrial Tachycardia with block. (acute overdosage,nausea and vomiting, bradycardia, hyperkalemia, and AV block frequently occur.)

a. Complete obstruction of the RT Coronary artery & Q wave in leads aVL, V3- V6.

b. Flat T wave, U wave & hyperkalaemia. Fc. Ventricular Aneurysm & persistent ST segment elevation.d. ASD & RT Bundle Branch Block.

37-In Mitral Regurgitation: a. If there is Mid Systolic click, it is due to Mitral Valve Prolapse T

(MRholocystolic, high piched, apex to axilla)b. If accompanied with Mitral Stenosis, it is commonly caused by

Rheumatic Heart Disease.c. If due to Papillary Muscle rupture, it will present with Acute Pulmonary

Oedema. td. The 1st heart sound is muffled. te. The 3rd heart sound is rarely heard. f

38-Regarding Aspirin Prescription:

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a. With caution if prescribed to a patient with Nasal Polyps. tb. In Over –dose, treat promptly with Forced alkaline Diuresis.tc. When given to a patient with Thrombo-embolic tendency, the dose given

6 hourly prophylacticaly. ??d. When affects the stomach, it is due only to direct effect on the mucosa. Fe. In children, half the dose should be given to reduce the risk of Rye’s

disease.F39- A 56-year-old female known hypertensive on bendrofluazide 2.5 mg daily, developed pain mainly in the big toe which was swollen & tender, her BP was 170/110, the following are true:

a. Aspirin and paracetamol are suitable treatment,b. Allopurinol 100mg should be given following the acute attack. c. Septic Arthritis is a likely diagnosis.d. Controlling the BP by increasing the dose of bendrofluazide.e. Hypokalaemia, Hyperkalaemia & Hypocalcaemia are likely side effect

of Bendrofluazide. (hypokalemia, hypophosphatemia hypomagnecemia, hypercalcimia)

40-Causes of Ascitis:a. Aortic Aneurysm.b. Appendicitis.c. Peptic Ulcer disease.d. Constrictive Pericarditis.e. Ovarian tumours.

41-the following are true about Non-valvular Atrial fibrillation:a. Warfarin is contra-indicated in patients>75year age.fb. Aspirin or Warfarin can be used for prophylaxis.tc. If paroxysmal, reassure the patient and no need for prophylaxis.fd. Thyroid function should be investigated.te. Echocardiography is initial investigation to exclude valvular lesions.t?

42-The following are true about Antibiotics:a. Amoxycillin is no longer the treatment of Community Acquired

Pneumonia.fb. When given with contraceptive pills may reduce their efficacy.tc. May cause Candidiasis.td. It is important to be given for a patient with 3 days history of cough.fe. If Amoxycillin is given to patient with Infectious Mononucleosis, it

causes a characteristic rash. T43- In Acromegaly there is:

a. Widely separated teeth.t b. Thickening of frontal tissues.t?

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c. Typically Homonymous Hemianopia.td. Galactorrhea in male patients.te. Parasthesia along the distribution of Radial nerve.t

44- The following are correctly paired:a. Mycoplasma & bullae of Tyympanic membrane.tb. Alcohol &the rarely prevalent painful Neuropathy.tc. Motor neurone Disease & UMN signs in the upper limbs.td. Facial nerve palsy & Hemi-facial anesthesia.fe. Tuberculosis & 6th nerve palsy.t?

45-The following are true about the complications of long standing DM:a. Selective loss of pain & Temp Sensation.b. Absence of sperms in Seminal Vesicle fluid.fc. Postural Hypotension.td. Excessive sweating.fe. Avascular necrosis of the femoral head.f

46- In BP measurement:a. Systolic pressure is accurately measured by palpating the Radial Pulse.fb. Diastolic pressure is better measured at Kortkov’s 5th tc. Reading is taken while the patient sitting.t (sitting or supine)d. The arm should be supported.Te. Best measured by Non-mercuric than Mercuric method.f

47- In severe tight Aortic Stenosis there is:a. Left Ventricular Hypertrophy.tb. Peripheral Vasodilatation.fc. Loud 2nd heart sound.fd. Adam-stock Syncope.te. Late systolic murmur.t (classic crescendo-decrescendo systolic murmur

48- The following are correctly paired:a. 3rd nerve palsy with Ptosis & Meiosis.fb. 5th nerve palsy with loss of corneal reflex.tc. 6th nerve palsy with lateral deviation of the Eye.fd. 12th nerve palsy with wasting & fasciculation of the tongue.te. Choreoform movement on the face with Huntingdon’s Chorea.t

49- Dermatological lesions:a. Satellite lesions are found in Candidiasis tb. After treatment of Acne with antibiotics, you can tell the patient to

expect improvement within 2 weeks.c. In Scabies, itching disappears within 1-2 weeks of treatment.d. Impetigo is caused by Staph epidermidis.

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e. Erysipelas is caused by group B streptococci.50- Ascitis:

a. If infected is more due to Gram + ve rather Gram – ve bacteria.fb. Spironolactone can be used for treatment.tc. Removal of large amount can lead to Renal Failure. td. Is more common with hepatic vein thrombosis than portal vein

thrombosis.te. Can be caused by Constrictive Pericarditis.t

51- A 28 year female, presented to A & E complaining of unilateral Temporal Migraine and Photophobia, she is on oral contraceptives:

a. Contraceptive pills should be stopped immediately.fb. Blood ESR should be done tc. Anti-depressant can be used .td. If associated with transient Hemiparesis, has no prognostic

significance.fe. Sumatriptan and other 5 HT agonists can be used. t

52- Paget’s disease of the bone:a. Causes Deafness.tb. Causes Osteogentic Sarcoma.tc. High alkaline phosphatase is due to excessive osteoclastic activity.fd. Causes heart failure of low cardiac output type.f

53- Henoch-scholien purpura:a. Common in young children. tb. Can lead to haematuria.tc. Resolves spontaneously.t?d. Can lead to Arthritis in big joints.te. The rash more in the flexor surface of the arm.f

54-In a patient with primary hyperparathyroidism:a. Serum calcium is low.fb. PTH is usually high.tc. Mostly due to thyroid adenoma. T(80% single adenoma, 15

hyperplasia)d. 50% of patients present with renal stones.t?

55-Osteomalacia:Associated with high serum calcium.fAssociated with low serum phosphate.tAssociated increased alkaline phosphatase.fAssociated with nephrocalcinosis.fLooser’s zone is seen on x-ray.t56-In cardiogenic shock there is:

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Peripheral vasodilatation.fb. Polyuria.fIncreased anion gap.t57-Aspiration pneumonia is caused by:Bronchiectasis.f?Dental sepsis.tPseudobulbar palsy.tAcilia syndrome.f?Excessive alcohol ingestion.t58-In cerebral embolism:Occurs in patients with mitral stenosis and AF.tCan be secondary to hypertensive heart disease. tCan be caused by cor pulmonale.fInfective endocarditis is a cause.t59-Non-valvular atrial fibrillation:Aspirin and warfarin can be used for prophylaxis.60-Polymyositis:EMG is associated with low amplitude action potential.fDistal muscle is affected more than the proximal.fRaynaud’s phenomenon is associated.tAssociated with high creatinine kinase.t61-Recognized features of essential hypertension include:A/V nipping on fundoscopy.tHard exudates on fundoscopy. T Low serum potassium.f50% of patients are unrecognized.f/(33%)62-Characteristic features of infective endocarditis include:High ESR.tLeucocytosis.tNormocytic anaemia.tSplinter haemorrhage.tMicroscopic haematuria.t63-Causes of eosinophilia include:Strongyloidosis.tPolyarteritis nodosa.fFarmer’s lung.fSarcoidosis.f64-Primary biliary cirrhosis:Remission does not occur.t?

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Associated with high level of KLM antibodies (kidney, liver and muscle).f (antimitochondrial antibodies)More common in males.fMay be associated with portal hypertension.t65-Recognized functions of PTH:Increased absorption of calcium in GIT.tIncreased absorption of vitamin D in GIT.fIncreased formation of 1,25 vitamin D in the kidney.tIncreased osteoclastic resorption of bone.t66-Myocardial infarction:Silent in a significant number of diabetic patients.tCK reaches the peak in 72 hours.fChest pain is increased by change of posture.f67-Hepatitis A:Associated with chronic hepatitis.fIt is a virus resistant to chlorinating of water.fIncubation period is 2 to 3 weeks.t(2- 6 wks)Can be prevented by immunization.tCan be transmitted by saliva droplets.f?68-Gastric carcinoma:Associated with pernicious anaemia.tAssociated with blood group A.- TIs a cause of iron deficiency anaemia.tThe lesser curvature is the commonest site.f(antrum)Mostly will be cured by surgery.t?69-Late complications of partial gastrectomy include:Dumping syndrome.tOsteomalacia.f?Iron deficiency anaemia.tRecurrence of ulcer at the site of anastomosis t.70-Crohn’s disease:Can present with polyarthritis. TThe distal small bowels the commonest type.TRecurrence is less than 10% if resection and anastomosis is performed. F 20% IN ONE YEAR71-Blood pressure measurement:Small cuff over-estimates blood pressure.Treatment of moderate hypertension will prevent one stroke in every 170 patients.???????

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In postural hypertension systolic drops and diastolic rises on standing.?????????f72-Basic life supportIn 2 rescuers, the rate of compression/ ventilation is 2/15.fCompression rate is 60/minute.fIf the choked patient is coughing normally, it is inappropriate to slab his back.fPulse should be checked after the 6th cycle of the CPR.f2 to 3 decreases indicate deterioration.f?73-Sore throat:At least more than 60% is due to viral infections.tIt is easy to distinguish between bacterial and viral infections. fShould be treated by penicillin V. fThroat swab should be done before starting treatment.Bone marrow depression occurs in patients taking chloramphenicol. T74-Opiate addiction:??????????????????More common in developing countries. TMore common in deprived urban areas. TFemale tendency for addiction is more than males. More than 30% 0f patients have hepatitis c infection.Cross addiction with diazepam occurs.t75-Screening Wilson criteria:Chronic.f?Serious.tTreatable t.Ultimately fatal.fCommon.f76-Common viral infection:Koplick spot is a prodrome of measles. tMicrocephally in rubella.TMumps can be asymptomatic.TChickenpox is classically maculopapular and vesicular.T77-Dermatological condition:Acne is treated by a course of tetracycline in 1 month.FIn scabies when the infestation is cleared, the itching subsides.fIn females acne can be treated by cyproterone.tShingles can never be bilateral. F

78-the following feature are more suggestive of crohn’s than ulcerative colitis :-

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a. an abdominal mass.t

b. Rectal bleeding fc. Severely inflamed rectum.fd. Flesh anal skin tag.te. Pnuematuria.t

79-In a pt. with transudate pleural effusion the cause may be :f. uaemia.tg. CCFth. Sarcoidosis. fi. Pulmonary embolism. Fj. TBfk. CARCINOMA F

80-In a pt. with wheeze the following support the diagnosis of asthma more than COPD.

l. reversal of obstruction.tm. History of atopy.tn. Reduction of residual capacity .fo. Hyperinfation on CXR.fp. Reducd FEV1/ VC.f

81-The following are causes of hyperyerkalemiaq. Cushing’s syndrome.fr. ACE inhibiter.ts. Rabdomyolosis.tt. Spironlactone.tu. Conn’s syndrome.f

82-Hypercalcimia is associated with :- v. sarcoidosis.tw. Multiple myeloma.tx. Thiazide diuretics.ty. Pancreatits.f

83-The following are classical feature of rheumatoid arthritis :-z. symmetrical bilateral joint involvement.taa. Node in the olecranon bursa. Tbb.Distal interphalingeal joints are affected.fcc. Positive family history. t

84-SLE :-dd.Leucopenia tee. butterfly rash tff. deforming arthroathy f

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gg.more in male fhh.pleural effusion t

85-the following are correctly pairedii. aortic regurgitation -- decrescendo systolic murmur fjj. aortic stenosis -------- mid diastolic murmur f mid systolickk.tricuspid regurgitation ------ murmur increasing with inspiration

tll. tricuspid regurgitation ------ pulsatile liver tmm. aortic stenosis ------- wide pulse pressure f

86- in HIV :-a. the commonest opportunistic infection is oropharyngeal

candidasis. fb. The commonst fatal opportunistic infection is Pneumocystic

carnii.t?c. Toxoplasmosis is the commonest CNS infection. td. CMV is the commonest cause of retinitis. te. Miliary pattern is the commonest presentation of TB.f?

87-- the following viruses are associated with malignancies:-a. EBV---Burkitt’s lymphoma.tb. EBV--- larynengeal cancer.fc. Papiloma virus --- vaginal cancer.td. HTLV --- leukaemia.te. CMV --- hepatoma.f

88-- sings of raised ICP:-a. contralateral miosis.fb. Tachycardia.fc. CSF rhinorrhea.fd. Hypertension.te. Battle sign.f

89- the following drugs potentiate the effets of warfarin:-a. cimtidine.tb. rifampicin.fc. Barbiturates f.d. Vitam K.fe. Macrolides antibiotics.t

90- pheocromocytoma :-a. caused by adreno cortical tumour.fb. The tumour is malignant in 50% f.c. First line treatment is alpha blockers.td. The tumour is multiple in 10%.t(25%)

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91-Tricuspid Regurgitation:a. Giant a-wave is found.f(large cv)b. Should be corrected Surgically.t?c. Liver Congestion occurs.td. Can occur due to MI.t

92- Cystic Fibrosis:a. Occurs in 1:4000 Caucasians.f(1:2000)

b. Is Autosomal Recessive.tb. Genetic Studies showed Specific Gene.t

93- Features of Cerebellar Disease include:a. Pendular Nystagmus.????????b. Scanning Dysarthria.tc. Increased Muscle Rigidity.fd. Past pointing.t

94- Acromegaly:a. Growth Hormone is secreted by basophils.f ( acidophils)b. Is supported by a normal GTT.fc. Causes Enlarged Heart.td. Affects Skin as well as bones.te. Glycosuria Occurs.t

95- Rheumatoid Arthritis:a. Affects males> females.fb. Usually present before the age of 30.f (30s-50s)c. Synovial Membranes are usually Swollen & Inflamed together with the

overlying Connective Tissue.t?d. Usually leads to Destruction of the Articular Cartilage.t

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e. Associated with HLA DR4.t96- In Primary Biliary Cirrhosis:

a. There is Osteoporosis & Osteomalacia.tb. Recurrent Rigors occurs.f

b. Pruritis occurs only if the patient is Jaundiced.fc. Erythema Marginatum occurs in the majority of patients. fd. Serum Smooth Muscle Antibodies are present in High Tire.f (anti

mitochondrial)e. Middle age males are affected.f

97- Papilloedema is caused by:a. Migraine.fb. Retinal Vein Thrombosis.fc. Cavernous Sinus Thrombosis. td. Glaucoma.f

98- Hepatic Encephalopathy is precipitated by:a. Surgical Operations.tb. Oral Neomycin.fc. Hyprekalaemia.f?d. Barbiturates.t

Constipation.t(constipation, alkalosis, and potassium deficiencyinduced by diuretics, opioids, hypnotics, and sedatives;medications containing ammonium or amino compounds;paracentesis with consequent hypovolemia; hepatic or systemicinfection; and portosystemic shunts (including TIPS)

99- In Bronchial carcinoma:a. Oat Cell Cancer is of Good Prognosis. fb. Patient may present with Haematuria.t( hypercalcemia)c. Oat Cell type can secrete ADH.t, also ACTH (PTH by Sq. cell)d. If the Diaphragm is paralyzed, it is lifted when the patient sniffs.te. If Apical can lead to Honer’s Syndrome.t

100- Phenylbutazone causes:???????????????One. Oedema. a.Haematemesis.b. Alopecia.c.Aranulocytosis.

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d. Nausea & vomiting.101-The following are related to each other:

a. Sugar Cane & Byssinosis.f( cottonb. Tin Mining & Siderosis.f?c. Metal Grinding & Silicosis.f?d. Farming & Extrinsic Allergic Alveolitis.te. Plastic and Rubber & Bronchial Asthma.t?(latex

102-Crohn’s Disease is characterized by: a. Skip Lesions.t

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b. Cobble Stone Lesions.tc. Affects only Mucosal Layers.f103-Double Blind Trial can be used to compare:a. Methldopa & Labitolol in the treatment of PET.tb. Clomiphine & Tamoxifen in Induction of Ovulation.t?c. Hysterectomy & Endometrial Resection in the TR. of Menorrhagia.fd. Aspirin & Placebo in the Prevention of PER. T?e. Out-pt & In-pt Management of Asymptotic Placenta Praevia.f

104-Osteoporosis: a. May complicate thyrotoxicosis.t b. Characterized by bone pain.f c. Complicates heparin therapy.t d. There is Looser’s zone.f e. There is high alkaline phosphatase.f105-Psoriasis:

a. Occurs in extensor surfaces.tb. Characterized by silvery scales.tc. Pruritus is characteristic.fd. Affects mucous membranes.fe. Kobner’s phenomenon occurs.t(lesions can be provoked by local irritation or by

trauma)

106-In pure pre-renal uraemia there is:a. Low urinary sodium.tb. Severe hypotension.t?c. Normochromic normocytic anaemia.t?d. Granular casts are present.fe. Raised urinary urea/creatinine ratio.t107-Features of UMNL of the facial nerve include:a. Patient cannot wrinkle his forehead.fb. Drooling of the mouth.f(deviation?c. Ptosis.fd. Weakness of the masseter muscle.te. Meiosis.f108-Pulmonary embolism:a. Typically associated with bypass (portal) surgery.fb. Can cause metabolic acidosis.f (alkalosis due to hyperventilation)c. Can be diagnosed by venograph.f

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d. The cause is clinical DVT in more than 80% of cases.f (50-70 % only when evaluated)

e. Typically associated with biliary bypass surgery.ff. Can be prevented by compressing the calves.t109-Increased serum prolactin level may result from:a. Stress.t (pregnancy, breast feeding, stress, orgasm)b. Chronic renal failure.tc. Infection with HIV. fd. Hypothyroidism.t (due to raised TRH)e. Shehan’s syndrome.f110-The following are features of sarcoidosis:a. Bilateral parotid gland enlargement.tb. Cranial nerve palsy.tc. Polyarthropathy.td. Caseating granuloma.fe. Positive Mantoux test.f111-Bronchial breathing is found in the followings:a. Consolidation.tb. Pneumothorax.fc. Emphysema.f?d. On top of pleural effusion.te. Empyaema.f112-The following are associated with Crohn’s disease:a. Iritis.tb. Cholangitis.tc. Erythema marginatum.f? (erythema nodosum)d. Perianal diseases.te. Polyarhtropathy.t

113- Hepatitis A:a. No carrier state.ttb. Prevented by passive immunization.t

Is an entero virus.f?( Hepatitis A virus (HAV) is a 27-nm RNA hepatovirus (in

c. the picornavirus family)

d. Incubation period is 6 weeks.t (2- 6 wks)e. Aerosol spread.f

114-Galactosaemia:a. Reducing sugar in the urine.tb. Can cause cataract.t

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c. E coli evolve after ingestion of milk.d. It does not come apparently after ingestion

of milk.e. Increased level of lactose.f115-In acute severe bronchial asthma:a. PEFR is of no value.fb. Nebulized B-blocker can be given safely.fc. Hydrocortisone IV should be given instantly.td. High concentration of oxygen is contraindicated.fe. The patient should be given a sedative if he is severely anxious.f116-Hypovolaemic shock is found in the following:a. Pulmonary embolism.fb. Fracture of the pelvis.tc. Acute pancreatitis.td. 5% third degree burn.f?e. Upper GIT obstruction.t117-The following are associated with acute pancreatitis:a. Hypoglycemia.fb. Sentinel loop on X-Ray.tc. Hypercalcaemia.fd. Grey-Turner sign.te. Ca pancreas.f118-Splenomegally can be found in the following:a. Gaucher’s disease.tb. Crohn’s disease.fc. Still disease.t

Sickle cell disease.t (Still disease - Juvenile Idiopathic Arthritis (JIA) Systemic-onset (Still’s disease): May present with recurrent high fever(usually > 39°C), hepatosplenomegaly, and a salmon-colored macular

d. rash; usually RF _ and ANA _

119-Signs of Expansion of Intra-cranial Lesions include:a. Tachycardia.f

b. Hypertension.tc. Small Pupils.fd. Increasing GCS score.fe. Deteriorating level of consciousness.t

120-Complications of Crohn’s Disease include:a. Perianal Abscess.t

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b. Iritis.tc. Ascending Cholangitis.fd. Polyarhtropathy. te. Pyoderma Gangrenosum t 121-the following are Reliable in UMN Lesions:a. Extensor Plantars.tb. Increased Abdominal Reflexes.fc. Persistent Ankle Clonus.td. Hyperreflexia.te. Positive Babiniski’s Sign.t

122-Third Nerve Palsy causes the following on the same side of the Lesion:

a. Pupil Dilatation.tb. Ptosis.tc. Absence of Facial Sweating.fd. Loss of Lateral Gaze.fe. Loss of Accommodation.t

123-Recognized Features of Thyrotoxicosis includes:a. Glycosuria.tb. Deafness.fc. Ataxia.fd. Unilateral exophthamos.fe. Pretibial myxoedema. t

124-Recognized Features of Rheumatoid Arthritis include:a. Hypertrophied Lymph nodes.?

b. Osteoarthrosis in later Stages.tb. Acute Febrile iIIness.tc. Early involvement of Sacro-iliac joint.fd. Granulomatous Disease of the Sclera.t?

125-Features of SLE include:a. Equal incidence in males & females.fb. Leucocytosis.fc. Butterfly on the Face is Characteristic.td. Renal Failure.te. May be caused by Sulfonamides t.

126-Recognized causes of Clubbing are:a. Chronic Bronchitis.fb. Aortic Aneurysm.fc. Fibrosing Alveolitis.td. Crohn’s disease.t

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e. Infective Endocarditis.t127-The following are causes of Diminished Breath Sounds:

a. Pneumo-thorax.tb. Pleural effusion.tc. Consolidation.fd. Lung Collapse due to Foreign Body Obstruction.te. Bronchiectasis.f

128-Well-recognized features of Crohn’s disease are:a. Iritis.tb. Hydronephrosis.t (oxalate nephrolithiasis & gallstones unlike UC.)c. Erythema Marginatum.fd. Cholangiocarcinoma.t( complicates PS cholangitise. Small bowel carcinoma.f ( colorectal )

129-Recognized Complications of Ulcerative Colitis are:a. Carcinoma of the Colon.tb. Erythema Nodosum.tc. Ascending Cholangitis.f?d. Sponyloarthritis.te. Pyoderma gargenosum.t

130-Recognized features of Acromegaly are:a. Hypotension.fb. Hypoglycaemia.fc. Dry Skin.f ( hyperhydrosis)d. Homonymous Hemianopia.te. Carpal Tunnel Syndrome.t

131-Recognized features of Chronic Myeloid Leukaemia are:a. Increased Neutrophil Alkaline phosphatase.fb. Frequent Nucleated RBCs in Peripheral Blood.t?c. TWBCs of 50.000/cm cube.td. Philadelphia Chromosome.te. Anaemia.t

132-.Regarding Cystic fibrosis of the Pancreas:a. It is Autosomal Dominant.f

b. May present with Intestinal Obstruction in the Newborn tb. It is associated with Fat Embolism.f???c. It is associated with Generalized Dysfunction of the Mucous Glands.td. CL in the Sweat is 80 mmol/L.t

133-A patient with Serum Na of 122 mmol\L, the following are likely causes:

One. DKA.t

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Two. Hypoadrenalism.tThree. Prolonged Infusion of 5% Dextrose.tFour. Syndrome of Inappropriate ADH secretion.t

Five. In young lady psychologically disturbed and drinks water excessively.t134-The following are causes of Death in DKA:

One. Aspiration of Gastric contentTwo. K+level is disturbetThree. Septicemia.tFour. Cerebral Oedema.tFive. Thrombo-embolic Phenomena.f

135-The following are correctly paired:One. Digoxin overdose & Atrial Tachycarida with block. T?Two. Complete Obstruction of the Right Coronary Artery & Q-waves

in lead l, aVL, V3-V6.fThree. Ventricular Aneurysm & Persistent ST Segment Elevatio tFour. Atrial Septal defect & Right Bundle Branch Block.t

Flat Twave and U wave and hyperkalaemia.f136-Regarding Congenital Heart Disease:

One. In ASD there is left to right shunt.tTwo. Coarctation of the Aorta lead to right to left shunt.fThree. Transposition of great vessels leads to Cyanosis.tFour. Atrio-ventricular Canal defects associated with Down’s

Syndrome.tFive. VSD may close spontaneously.t

137-In Mitral Regurgitation:If there is Mid-systolic Click, it is due to Mitral Valve Prolapse t

One. If accompanied by Mitral Stenosis, it is commonly caused by RHD.t

Two. If due to Papillary Muscle Rupture, will present with Acute Pulmonary Oedema.t

Three. The first Heart Sound will be muffled.tFour. There is Pulsation of the Liver.f .Five. The 3rd ht sound is rarely heard.f

138-The following are important in Aspirin Prescription:One. With precaution if prescribed to a patient with Nasal

Polyps.????tTwo. In Overdose, treat promptly with Forced Alkaline Diuresis.tThree. When given to a patient with Thrombotic Tendency, the

dose is given 6\hourly Prophylactically.f

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Four. When it affects the Stomach, it is due only to direct effect on the Mucosa.f

Five. In children, 1\2 the adults dose should be given to reduce the risk of Rye’s Syndrome.f

139-56- year- old known Hypertensive on Bendrofluazide 2.5 meg, he developed Foot Pain more in the big toe which was swollen & tender, his BP was 160/110:

One. Aspirin & Paracetamol are suitable treatments.fTwo. Controlling his PB by increasing the dose of Bendrofluazide to

5mg.fThree. Allopurinol 100 mg should be given directly after the attack.fFour. Hypokalaemia, Hypelipidaemia & Hyperglycemia are likely

side effects of Bendrofluazide.tFive. Septic Arthritis is likely the cause.f

140-Causes of Ascitis include:One. Gram + ve rather than Gram – ve Bacteria, if found

infected.f( Ecoli, klebsiella, enterococciTwo. Aortic Aneurysmf.Three. Ovarian tumors.tFour. Heart Failure.tFive. Appendicitis.f

141-The following are True about Non-valvular Atrial Fibrillation:One. Warfrain is Contra-indicated in >70 year patients.Two. Aspirin or Warfrain can be used for Prophylaxis.Three. If paroxysmal, reassure the patient and no need for

Prophylaxis.Four. Echocardiography is needed in the investigations.Five. Thyroid function can be investigated.

142-Antibiotics:Amoxycillin is no longer the treatment of Community Acquired Pneumonia.

One. If given with Contraceptive Pills may reduce their EfficacTwo. May cause Candidiasi

Are important to be given for a patient of 3 days history of cough.Three. Amoxil causes rash in infectious mononucleosis.

143-The following are True about Acute pancreatitis:a. Flank Pigmentation is a finding.tb. Can cause tetany.tc. Commonest cause in Ireland is Gallstones & Alcohol.td. Renal failure is a Complication.te. Difficult to differentiate from Ischaemic Bowelt.

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144-The following are correctly paired:a. Alcoholic Peripheral Neuropathy rarely develops Painful Neuropathy.fb. Upper Motor Neurone lesion & Upper Limb Fasciculation with Wasting.

fc. Pseudo-bulbar Palsy & Wasting with Tongue Fasciculation.fd. Facial Nerve Palsy & Hemi-facial Anesthesia.fe. TB meningitis and 6th nerve palsy.t145-The following are True about Complications of long Standing DM:

a. Selective loss of Pain & Temp Sensation.b. No Sperms in Seminal Vesical fluid.c. Postural Hypotension.d. Excessive Sweating.fe. A-vascular Necrosis of the Femoral Head.

146-In Acromegaly there is:a. Widely separated teeth.b. Hypertrophy of Frontal Tissue.c. Homonymous Hemiapnopai.d. Hyperglyeaemiae. Galactosaenia In male patients.

147-In BP Measurement:a. Systolic Pressure is accurately measured by palpating the Radial Artery.b. Diastolic Pressure is measured better at Kortkov’s 5th sound.c. Reading is taken while the patient sitting.d. The Arm should be supported.

e. It is accurately taken by average of Lower & Upper limb measurement.f148-Glue Ear:a. The Drum is Dull, Blue & Congested.tb. Can Present with Hearing Difficulty in Childhood.t

c. Can result in Sensory Neural Deafness.fd. Associated with congenital deafness.f149-Regarding skin lesions: -Satellite lesion is present in Candida: t --Erythema nodosum with contraceptive use.t -treating acne ,you can tell the patient that clinical improvement can occur in less than 2 weeks -In treatment of scabies you can tell the patient that itching can disappear after 2 weeks. - Impetigo is caused by Staph epidermedis150-contraindications to thrombolysis: -systolic>200 diastolic>120. t

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-prolonged CPR(2_3min).f recent stroke and TIA t recent MI.f chest pain <4hrs.f

151-carotid stenosis: Pathology at bifurcation at common carotids.t Common in females.f Associated with amaurosis fugax t If symptomatic should be treated by carotid end arterectomy.f Can be adequately assessed by duplex.t152-the following may present with dysphagia:Mallory Wies syndrome.fDiabetes .tSjogrene syndrome. tSystemic sclerosis.tAchalasia.t153-pagets disease of bone:????????Affect any bone in the body.tDeafnesstAffect cansellus and cortical bone.?tAppear as osteoclastic bone lesion in X ray .??tStrong than normal bone .f154-hypercalcemia :Polydipsia and thirst.tDiffuse nephrocalcinosis.tIn cancer it is always due to PTH fIf associated with high ACE suggest sarcoidosis.tIf it is due to 1ry hyperparathyroidism it will be associated with high PO4 f155-adult RDS:Generally is of good prognosis fVentilation rarely required. f High PCWP.May be due to fat embolism.tRarely due to septicemia. f156-the following is correctly paired:

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Pituitary tumor and bitemporal hemianopia.t6th nerve palsy and partial ptosis.fSubhyoid hage and berry aneurysm.f??Optic nerve atrophy and MS.tSarcoidosis and anterior uveitis.t157-Multiple sclerosis More than one lesion is needed for diagnosis tCT is better than MRI fVisual evoked potential can be done even if visual acuity is normal t ( in clinically uninvolved sites )Tinnitus is a recognized feature f ( vertigo)Optic atrophy t158-Thyrotoxicosis classical features: Increase TSH fPretibial myxedemaDyspnoea tCarpal tunnel syndrome fMyopathy t159-features of pneumonic consolidation:Bronchial breathing tDullness topercussion.tWhispering pectroliquys t Increase tactile vocal fremitus tKausmal breathing.f160-asprin prescription:Should be given 6hrly in TIA. fIf bleeding peptic ulcer it is strictly due to its local effect.fShould be avoided in patients with nasal polyp.tShould be avoided in children to avoid Rye synd t.If toxicity occur should be treated by prompt alkaline diuresis . f

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