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Entrance Exam 2011

Internal medicine
1- A 20 year old female presented withleg pain weakness, investigations showed low vitamin D, PTH, Calcium, Hb, MCV, RDW The most appropriate test to diagnose the cause is: A- Anti transglutaminase antibodies B- . C- .

2- 25 y/o female, presented with leg pain, gum bleeding, ecchymosis, which of the following vitamins may be deficient: A- Vitamin A B- Vitamin B12 C- Vitamin C D- Vitamin D E- Vitamin E

3- 20 y/o female, c/o headache, chest pain, dizziness, she came to ER, while waiting she started to have SOB, perioral numbness, palpitations, what is the most appropriate next step in management: A- Start her on dextrose B- Let her breathe in a paper bag C- CXR D- .

4- 19 y/o medical student, c/o chest pain, palpitations, SOB, feeling of impending death, the symptoms occurs every time he studies, the most likely diagnosis: A- Conversion disorder B- Panic attack

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C- Somatiform disorder D- Hypochondriasis 5- 35 y/o female, presented with bone pain, generalized weakness, labs showed PTH, Ca, NL vit D The most likely diagnosis is: A- 1 hydroxylase deficiency B- Hypoparathyroidism C- Vit D deficiency D- .

6- 55 y/o male presented with generalized weakness, he started lasix recently, the most likely electrolyte abnormality is: A- Hyperkalemia B- Hypokalemia C- Hypernatremia D- Hyponatremia E- Hypocalcemia

7- 50 y/o DM pt, on insulin, presented with DKA, ABGs showed pH 7.05, HCO3 12, K 3.1 the best management is: A- Fluids, insulin, K, HCO3 B- Fluids, insulin, K C- Fluids, insulin, HCO3 D- Insulin only E- Fluids, K, HCO3

8- 30 y/o male, Hx of arthritis, c/o SOB, ABGs showed: pH 7.40 , CO2 23, HCO3 12, Na 140, Cl 103, K 4.1 The acid base imbalance is: A- Metabolic acidosis with respiratory compensation B- Mixed metabolic acidosis and respiratory alkalosis C- Mixed metabolic alkalosis and respiratory acidosis D- Mixed respiratory acidosis and metabolic acidosis E- Normal ABGs

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9- Thyroid sorm can present with all except: A- Fever B- Seizures C- Weakness D- Very high T3, T4 compared to hyperthyroidism

10- Hyponatremia can present with all except: A- Bradycardia B- Hyperthermia C- Fever D- Seizures

11- 30 y/o patient presented to ER with headache, fever, +ve meningeal signs, best next step in management: A- Give ceftrixone and vancomycin B- Do CT first then lumbar puncture C- Transfer him to medical ward to do LP D- .

12- Scleroderma patient with esophageal involvement, manometric studies will show: A- Absent peristalsis, LES tone B- Absent peristalsis, LES tone C- Positive peristalsis, LES tone D- Positive peristalsis, LES tone

13- 29 y/o female, DM type I, found to have jaundice. Labs showed: ALT, AST +ve ANA +ve ASMA -ve antimitochondrial antibodies NL alkaline phosphatase The most likely diagnosis is:

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ABCD-

PBC PSC Viral hepatitis Autoimmune hepatitis

14- 30 y/o female nurse presented with level of consciousness, labs showed: Glucose 30 insulin C pep de -ve sulphonylurea The most likely cause: A- Exogenous insulin B- Insulinoma C- MEN I D- MEN II

15- 50 y/o male, asthmatic presented with palpitation, BP 130/85, ECG showed narrow QRS complex, regular, absent P waves, best management is: A- IV Propranolol B- IV diltiazem C- IV adenosine D- D/C shock E- IV amiodarone

16- In SIADH all can present except: A- serum osmolality B- serum sodium C- urine sodium D- Hyperkalemia E- urine osmolality

17- H.pylori causes all of the following except: A- MALT lymphoma B- Gastric ulcers C- Gastric adenocarcinoma

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D- Duodenal ulcers E- GERD

18- A patient known to have WPW syndrome, presented with A-Fib, stable vitals, the best management is: A- IV verapamil B- IV digoxin C- D/C shock D- IV amiodarone

19- 60 y/o male presented with chest pain, ECG shows ST elevation in V1-V6, BP 165/95, the patient had an episode of upper GI bleeding 6 months ago, the nearest cath lab is 2 hours away. Best next step: A- Send him to cath lab immediately B- Give him thrombolytics, because there is no contraindication C- Dont give thrombolytics due to recent bleeding D- Dont give thrombolytics due to high BP E- Dont give thrombolytics due to high BP and recent bleeding

20- One of the following differentiate asthma from COPD: A- Hyperreactive airways B- Variability C- Wheezes D- Hyperinflation

21- 50 y/o male patient presented with 1 hour retrosternal chest pain, BP 85/62, JVP 10 cm, ECG shows 3mm ST elevation in II,III, aVF and ST depression in V1-V4, troponin is negative, most likely diagnosis is: A- Unstable angina B- Stable angina C- Anterior wall MI D- Inferior wall and Rt ventricular MI

22- All of the following can cause false positive troponin except:

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ABCDE-

Septic shock Pulmonary embolism Pulmonary edema Uncontrolled HTN Renal failure

23- All are features of metabolic syndrome except: A- BP > 135/85 B- LDL>160 C- FBS>110 D- HDL<50 in females E- Waist circumference > 40 inch in males

24- 20 y/o male, presented with fever, arthritis, ESR, brucella is: A- Repeat titer in 3 months B- 6 weeks of doxycyclin and rifampin C- 6 week of doxycyclin D- 6 weeks of rifampin

e t r, best management

25- 53 y/o male, DM,HTN,IHD, on the following medications: Statin, insulin, beta blocker, and ACE inhibitors started recently, 1-2 weeks later he presented with weakness, and labs showed: K 7.1, FBS 300, CPK 300 The most likely cause of Hyperkalemia is: A- Hyperglycemia B- Rhabdomyolysis due to statins C- ACE inhibitors

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Surgery
1- Major component of pigmented stones: A- Cholesterol B- Calcium bilirubinate C- Calcium carbonate D- Calcium palmitate

2- About warthins tumor of salivary glands all true except: A- Occurs only in parotid B- Usually occurs in elderly C- Malignant transformation in one third of cases D- 10% bilateral

3- About Hirschsprungs disease all true except: A- Anal canal always involved B- More in females C- Diagnosis confirmed by rectal biopsy

4- About HNPCC(lynch syndrome), all true except: A- Autosomal dominant B- More in the right colon C- 5% will have metachronous within 10 years D- Most patients are less than 50 years old

5- Most common cause of massive lower GI bleeding is: A- Diverticulitis B- Angiodysplasia C- Crohns diseases D- Cancer E- Ulcerative colitis

6- One of the following is an indication for primary splenectomy: A- Hereditary spherocytosis

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B- Sickle cell disease C- G6PD deficiency

7- 45 y/o female u/w recurrent spinal fusion surgeries, during which she received 20 units of PRBC, 7 liters of lactated ringers, at closing the wound site, the surgeon noticed diffuse bleeding difficult to be cauterized. Emergent CBC showed: Hb 11.2, WBC 6900, platelets 65000 The best blood product to be given to stop the bleeding is: A- Whole blood B- Concentrated platelets C- Cryoprecipitate D- Fresh frozen plasma E- Packed RBCs

8- The most important cell in wound healing is : A- Leukocyte B- Erythrocyte C- Plateltes D- Monocyte E- Lymphocyte

9- All are documented risk factors for breast cancer except: A- Nulliparity B- Hormone replacement therapy C- Family Hx D- Cigarette smoking

10- The mechanism of type gastric ulcers(located at the lesser curvature) is: A- Hyperacidity B- Antral stasis C- Hypergastrinemia D- Decreased mucosal defenses

11- The most accurate test to assess lymph node involvement in esophageal cancer is:

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ABCDE-

CT MRI Endoscopic U/S PET scan Barium swallow

12- All of the following produced by the liver except: A- Von wilberand factor B- Fibrinogen C- Albumin D- Ferritin

13- About blood banking all true except: A- Platelets can be stored for 3 days B- Factors II and IX are stable at 4C C- Increased affinity to oxygen D- Hyperkalemia E- lac c acid

14- The most common complication of AAA repair is: A- Sexual dysfunction B- Ischemic colitis C- Renal failure D- Leg thromboembolism

15- Most common cause of death in acute pancreatitis is: A- Renal failure B- Secondary infections C- Pseudocyst rupture D- Hemorrhage

16- In neuro endocrine response to trauma all true except: A- Gluconeogenesis B- Glycogen synthesis

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C- Lipolysis D- Hyperglycemia

17- All cause visceral pain except: A- Distension B- Ischemia C- Heat D- Traction

18- All are associated with peptic ulcer except: A- H.pylori B- NSAID C- Alendonate D- Smoking

19- In replacement with crystalloids for intravascular loss you give: A- Same as lost B- 2-3 x C- 3-4 x D- 4-5 x E- as lost

20- All true about carcinoid except: A- Origin from kulchitsky cells B- Most common site is appendix C- Ileal tumors metastasize more than appendix D- Rarely multiple in small intestines

21- One of the following is an internal rotator of the shoulder: A- Subscapularis B- Teres minor C- Lattismus dorsi D- Teres major

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22- Nurse had a needle stick injury from a patient assumed to have all of the following infections, the most likely to be transmitted is: A- HBV B- HCV C- HIV D- Malaria E- Syphilis

23- About SIRS (systemic inflammatory response syndrome) all true except: A- WBC > 12000 or < 4000 B- Temperature > 38 or < 36 C- HR >90 D- Systolic BP <100 E- Respiratory rate >20

24- The gas with highest risk of combustion in laparoscopic surgery is : A- CO2 B- Helium C- Argon D- Nitric oxide E- Air

25- Most common cause of primary hyperaldosteronism is: A- Adrenal adenoma B- Adrenal cancer C- Bilateral hyperplasia

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Pediatrics
1- About polio vaccine all true except: A- Only OPV is associated with VAPP B- IPV is preferred in adults C- IPV doesnt give lifelong immunity D- OPV improves local immunity E- OPV is preferred in epidemics

2- All increase pulmonary blood flow except: A- TOF B- ASD C- VSD

3- All are associated with celiac disease except: A- Can present with short stature only B- appe te C- Rectal prolapsed D- Ataxia E- Constipation

4- 6 months old infant, most likely cause of heart failure: A- Small PDA B- Large VSD C- TOF

5- A neonate developed cyanosis 3 hours after birth, most likely due to: A- Transposition of great vessels B- Congenital pneumonia C- Diaphragmatic hernia

6- One of the following vaccines is C/I in pregnancy: A- MMR B- DTP

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C- Hepatitis B D- Hib vaccine

7- All are causes of neonatal jaundice except: A- ABO incompatibility B- Sickle cell anemia C- Breast feeding

8- A neonate with hypotonia and tongue fasciculation, most likely diagnosis: A- Spinal muscular dystrophy B- Muscle dystrophy C- Congenital myasthenia D- Becker dystrophy

9- Child brought to ER by his parents, the parents told you that he ingested a bottle kerosene, but he didnt complain from anything, on exam the child is looking well with normal vitals, best next step: A- Antibiotics B- Reassure the parents and tell them no intervention needed C- Pulse oxymetry D- Chest X-ray E- Activated charcoal

10- About meningitis in children, all true except: A- Treated by vancomycin and ceftrixone B- Oral antibiotics may lead to negative CSF cultures C- Dexamethasone the risk of hearing loss D- Early seizures carry poorer prognosis than late seizures E- Incidence of Hib as causative agent decreased after vaccination

11- 10 y/o boy, his height on the 5th percentile, his bone age=chronological age, most likely cause: A- Hypothyroidism B- Familial (genetic )short stature

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C- Constitutional D- GH deficiency

12- In iron deficiency anemia, all true except: A- hypochromic microcytic B- transferrin C- ferri n D- TIBC

13- Child with anemia his CBC showed MCV of 110 fl, most likely to be seen in blood film: A- Hypersegmented neutrophils B- Neucleated RBCs C- Myeloblasts D- Hypochromic microcytic RBCs

14- A diabetic mother gave birth to a full term infant, heavily stained with meconium, the most appropriate next step is: A- Suction of the mouth, oropharynx, and trachea B- Intubation with positive pressure ventilation C- Ambo bag and chest compressions D- Give 25% dextrose E- Tactile stimulation of the foot

15- One of the following is considered developmentally delayed: A- 3 months with no social smile B- 3 months not saying maorda C- 12 months walking one hand held

16- Child with seizures, hypopigmented skin lesions, mild developmental delay, the most likely diagnosis: A- Tuberous sclerosis B- Hypothyroidism C- Vitamin B deficiency

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17- Which of the following is a correct match: A- Mycoplasma- infants B- Staph aureus- pneumatocele C- Chlamydia trachomatis- adolescents

18- All of the following can cause polyhydroamnios except: A- Diabetic mother B- Renal agenesis C- Duodenal atresia

19- All cause invasive diarrhea except: A- Shigella B- Salmonella C- Giardia lamblia D- Yersenia entercolitica

20- A child with nephrotic syndrome, on steroids, he developed fever, abdominal tenderness, and leukocytosis, most likely cause: A- Primary peritonitis B- Cholecystitis C- Appendicitis

21- 6 months infant, presented with cough, rhinorrhea, wheezes, and distress. On exam you found bilateral wheezes most likely cause: A- Reactive airway disease (asthma) B- RSV

22- 4 y/o boy with symptoms of anemia (acute onset), but the mother stated that he always looks pale, same case in his father, the most appropriate test before blood transfusion is: A- Osmotic fragility test B- Hemoglobin electrophoresis

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C- G6P level

23- A baby was born at home , 5 days later presented with bloody stool and bleeding umbilicus, the most likely cause: A- DIC B- Vit K deficiency C- Thrombocytopenia

24- All true about simple febrile seizures except: A- Brief B- No recurrence in 24 hours C- Multifocal D- Occurs at age 3 months- 5 years E- Requires brain CT

25- About post streptococcal GN, one is false: A- urea B- Cr C- K D- Severe anemia E- complement

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OBGYN
1- Narrowest part of pelvis is : A- Pelvic inlet B- Pelvic outlet C- Midpelvis D- At level of sacral promontory E- Pelvic floor

2- One is a C/I for forceps delicery: A- Aftercoming head in breech B- Face C- Brow D- Occipitoanterior E- Occipitoposterior

3- One is true about prolonged latent phase of labor: A- May risk of PPH B- Oxytocin may be used C- Affect fetus wellbeing D- Is an indication C/S

4- Minimum time needed for oxytocin to reach its maximum effect is: A- 5 min B- 10 min C- 20- 30 min D- 30-40

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5- Duration of sleep cycle in fetus is: A- 10 min B- 23 min C- 54 min D- 76 min E- 84 min

6- About functional ovarian cyst all true except: A- Clomiphene citrate used for treatment

7- About benign ovarian disease all true except: A- May be cystic or solid B- Usually asymptomatic C- Abdominal distension is a common presentation D- Laparoscopic cystectomy is preferred for cystic lesions

8- About serous cystadenocarcinoma, all true except: A- Contains calcifications in their walls(psammoma bodies) B- Lined by columnar epithelium C- Can reach very large size D- Usually have papillary projections into the cyst

9- About gonadal differentiation all true except: A- If we removed gonads before differentiation, the fetus will be male or female according to their chromosomes B- XX chromosomes induce gonads to differentiate to ovaries C- Wolffian duct give rise to vas deferens and epididymis

10- About endometrial polyps all true except: A- Most are malignant B- Treated by hysteroscopic resection

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11- About endometrial cancer all true except: A- Spread to internal and external iliac LN the paraortic LN B- Usually occurs in perimenopause C- Increased risk in nulliparus

12- Irregular ripening of endometrium is associated with all except: A- Treated by progesterone B- Caused by defect in corpus luteum function C- Biopsy may show patchy areas of hyper progesteronemic endometrium D- Present with premenstrual spotting E- May be caused by defect in endometrium response to hormones

13- One is not used in labor induction: A- Oxytocin B- Prostaglandins C- Misoprostol D- Ergometrine E- Stripping of membranes

14- All true about injectable progesterone except: A- Can cause endometriosis B- Lead to weight gain C- Can cause acne

15- All are C/I for progesterone minipills except: A- Undiagnosed vaginal bleeding B- Mild hypertension C- Acne

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16- About OCPs and Breast cancer, which is true: A. OCPs with high estrogen increase risk of breast cancer B. OCPs with high progesterone increase risk of breast cancer C. OCPs with both high estrogen & progesterone increase risk of breast cancer D. There is no relation to breast cancer whatever the dose

17- Polycystic ovary syndrome, all true except: A. LH:FSH ratio is 1:1 B. Can present with amenorrhea 18- Regarding abortion, all are true except: A. Many of cases may be due to Trisomies B. Abnormal structure of chromosomes is more common than number of chromosomes

19- All can cause first trimester abortion except: A. Trisomies B. Cervical incompetence

20- Best time to measure MSAFP to assess NTDs is: A. 10-12 weeks B. 6-8 weeks C. 16-18 weeks D. 26-28 weeks

21- Antiphospholipid affects pregnancy by: A. Causing thrombosis and infarction of the placenta

22- Variable decelerations is most likely caused by: A. Pressure on the fetal head leading to a vagal response B. Uteroplacental insufficiency

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C. Cord compression

23- Best assessment of progression of labor is: A. Cervical Dilatation

24- Regarding menopause, all are true except: A. Time of menopause is likely to be genetically determined B. Associated with elevated FSH levels C. Occurs due to permanent loss of basal layer of endometrium

25- Question #4 was repeated

: . .