1. A 22 year old woman has had four episodes of deep venous thrombosis (DVT).

Laboratory studies
should include each of the following EXCEPT :
A. Serum albumin.
B. Protein C.
C. Protein S.
D. Antithrombin ІІІ.
E. Lupus anticoagulant.

2. All of the following conditions cause prolongation of QT interval on ECG EXCEPT:

A. Heart failure.
B. Hypercalcaemia.
C. Amiodarone therapy.
D. Hypomagnesaemia.
E. Diuretic therapy.

3. Each of the following conditions is likely to be associated with increased incidence of acute gout
EXCEPT:
A. Chronic alcoholism.
B. Obesity.
C. Rheumatoid arthritis.
D. Diabetes mellitus.
E. Diuretic therapy.

4. Which one of the following medications should NOT be taken in aspirin-induced asthma:
A. Paracetamol.
B. Diclofenac sodium.
C. Codeine.
D. Ranitidine.
E. Tetracycline.

5. Each of the following clinical situations can cause gynecomastia EXCEPT:

A. Carcinoma of the bronchus.
B. Digoxin therapy.
C. Hyperthyroidism.
D. Captopril therapy.
E. Testicular tumor.

6. In septic arthritis, the most likely organism causes infection is:

A. Neisseria gonorrhoea.
B. Chlamydia trachomatis.
C. Staphylococcus aureus.
D. Streptococcus pneumonia.
E. Staphylococcus epidermidis.
1

7. Which of the following signs is NOT a feature of Parkinson's disease:

A. Action tremor.
B. Rigidity.
C. Bradykinesia.
D. Micrographia.
E. Loss of postural reflexes.
8. Each of the following conditions commonly cause splenomegaly EXCEPT:
A. Hereditary spherocytosis.
B. Chronic myeloid leukemia (CML).
C. Idiopathic thrombocytopenic purpura (ITP).
D. Polycythaemia rubra vera.
E. ß-Thalassaemia.
9. All of the following conditions cause pruritis ( itching) EXCEPT:
A. Primary biliary cirrhosis.
B. Hyperlipidaemia.
C. Renal failure.
D. Lymphoma.
E. Hyperthyroidism.
10. Which of the following antibiotics will be most effective in the treatment of mycoplasma pneumonia:
A. Vancomycin.
B. Metronidazole.
C. Tetracycline.
D. Ampicilline.
E. Acyclovir.
11. All of the following conditions cause exudative ascities EXCEPT:
A. Tuberculous peritonitis.
B. Malignancy.
C. Pancreatic ascities.
D. Budd-Chiari syndrome.
E. Constrictive pericarditis.
12. All of the following are causes of hypercalcaemia EXCEPT:
A. Sarcoidosis.
B. Primary hyperparathyroidism.
C. Multiple myeloma.
D. Osteoporosis.
E. Bronchial carcinoma.
13. In the management of acute hyperkalaemia, which one of the following drugs is administered first:
A. Sodium bicarbonate.
B. Insulin plus glucose, intravenously.
C. Calcium glucanate, intravenously.
D. Salbutamol.
E. Loop diuretic.
2

14. Which one of the following findings is LEAST consistent with nephrotic syndrome:
A. Haematuria.
B. Hypoalbuminaemia.
C. Oedema.
D. Proteinuria > 3g \ 24 hour.
E. High serum cholesterol.
15. Which ONE of the following drug regimens should be started in acute management of deep venous
thrombosis (DVT):
A. Start aspirin immediately.
B. Start warfarin (coumadin) immediately.
C. Start aspirin and warfarin together, immediately.
D. Start heparin, followed by warfarin.
E. Give streptokinase.
16. The most common ECG finding in pulmonary embolism is:
A. Sinus tachycardia.
B. Right bundle branch block.
C. Right axis deviation.
D. Atrial fibrillation.
E. ST- segment elevation.
17. The gold standard test for the diagnosis of acute interstitial nephritis is:
A. Urine oesinophil count.
B. Renal biopsy.
C. Renal ultrasound.
D. Urine red cells casts.
E. CT-scan of abdomen and pelvis.
18. All of the following are associated with an increased risk for ischemic heart disease EXCEPT:
A. Diabetes mellitus.
B. Obesity.
C. High level of high-density lipoprotein (HDL) cholesterol.
D. Hypertension.
E. Cigarette smoking.
19. Which physical finding is NOT a characteristic of dilated cardiomyopathy:
A. S 3 gallop.
B. Pulmonary crepitation.
C. Diffuse, medially displaced left ventricular impulse.
D. Mitral regurgitation.
E. S 4 gallop.
20. All of the following are indicated in the treatment of unstable angina EXCEPT:
A. Nifedipine (Adalat).
B. Intravenous heparin.
C. Aspirin.
D. Nitrates
E. Atenolol.
3

21. All of the following are consistent with the diagnosis of mitral stenosis EXCEPT:
A. Loud p2.
B. Opening snap.
C. Diastolic rumble.
D. Left ventricular strain pattern on ECG.
E. Dyspnoea.
22. All of the following drugs can be used in the treatment of hypertension EXCEPT:
A. Captopril.
B. Diltiazem.
C. Digoxin.
D. Atenolol.
E. Thiazide diuretics.
23. All of the following are major criteria for the diagnosis of rheumatic fever EXCEPT:
A. Arthritis.
B. Carditis.
C. Subcutaneous nodules.
D. Erythema marginatum.
E. High ESR.
24. Which of the following can cause a transudative pleural effusion:
A. Congestive heart failure.
B. Hypothyroidism.
C. Liver cirrhosis.
D. Nephrotic syndrome.
E. All of the above.
25. Which of the following disorders can cause hemoptysis:
A. Bronchiectasis.
B. Tuberculosis.
C. Aspergilloma.
D. Pulmonary embolism.
E. All of the above
26. Which one of the following drugs can precipitate bronchospasm in asthmatics:
A. Captopril.
B. Propronalol.
C. Subcutaneous heparin.
D. Diuretics.
E. Calcium channel blockers.
27. The best way to make a diagnosis of cystic fibrosis is:
A. Sweat chloride test.
B. Sputum culture.
C. Pulmonary function test.
D. Chest CT-Scan.
E. DNA analysis.
4

28. All of the following are causes of finger clubbing EXCEPT:

A. Bronchiectasis.
B. Bronchial squamous cell carcinoma.
C. Chronic bronchitis.
D. Fibrosing alveolitis.
E. Cystic fibrosis.
29. All of the following are complications of pancreatitis EXCEPT:
A. Ascites.
B. Pancreatic abscess.
C. Pancreatic pseuducyst.
D. Hypercalcemia.
E. Acute Renal failure.
30. All of the following are causes of diarrhoea EXCEPT:
A. Hyperthyroidism.
B. Zollinger-Ellison syndrome.
C. Carcinoid syndrome.
D. Hyperparathyroidism.
E. Diabetes mellitus.
31. Common findings in sepsis include all of the following EXCEPT:
A. A reduced cardiac output in early stages.
B. Tachycardia.
C. A decreased systemic vascular resistance.
D. Hypotension.
E. Metabolic acidosis.
32. Complications of diabetes mellitus include all of the following EXCEPT:
A. Autonomic dysfunction.
B. Atherosclerosis.
C. Blindness.
D. Bronchiectasis.
E. Peripheral vascular disease.
33. Hemochromatosis is associated with all of the following clinical manifestations EXCEPT:
A. Cirrhosis.
B. Diabetes mellitus.
C. Gonadotropin deficiency.
D. Cardiomyopathy.
E. Hypertension.
34. All of the following may result in nephrotic syndrome EXCEPT:
A. Diabetes mellitus.
B. Hodgkin's lymphoma.
C. Membranous glomerulonephritis.
D. Gout.
E. Amyloidosis.
5

35. Which of the following is not seen in addison's disease:

A. High serum Na.
B. High serum K.
C. Hpotension.
D. Low blood sugar.
E. Hyperpigmentation.
36. The most common organisim in acute bacterial pyelonephritis is:
A. Klebsiella.
B. Chlamedia.
C. E.coli.
D. Pseudomonas.
E. Candida.
37. Symptoms and signs associated with pheochromocytoma include all of the following EXCEPT:
A. Hypertension.
B. Sweating.
C. Palpitation.
D. Flushing.
E. Holosystolic murmur.
38. Thrombocytopenia may be associated with all of the following EXCEPT:
A. Cirrhosis.
B. Sepsis.
C. Viral infection.
D. Splenectomy.
E. Systemic lupus erythematosus (SLE).
39. All of the folowing are manifestations of hypercalcemia EXCEPT:
A. Depression.
B. Diarrhoea.
C. Polyuria.
D. Vomiting.
E. Seizures.
40. Which of the following cardiac conditions have the lowest risk for development of infective
endocarditis:
A. Coactation of aorta.
B. Ventricular septal defect.
C. Atrial septal defect.
D. Prosthetic heart valve.
E. Patent ductus arteriosus.
41. Malabsorption is associated with all of the following EXCEPT:
A. Giardiasis.
B. Coeliac disease.
C. Crohn's disease.
D. Helicopacter pylori.
E. Bacterial overgrowth.
6

42. Which one of the following antibiotics is effective against pseudomonas aergenosa infection:
A. Ampicilline.
B. Gentamycin.
C. Metronidazole.
D. Tetracycline.
E. Cephalexine (keflex).
43. Causes of macrocytosis in peripheral blood include all of the following EXCEPT:
A. Hypothyroidism.
B. Iron deficiency anemia.
C. Chronic alcohol abuse.
D. Liver cirrhosis.
E. Haemolysis.
44. Causes of metabolic acidosis include all of the following EXCEPT:
A. Renal failure.
B. Diabetic ketoacidosis.
C. Diuretics.
D. Sepsis.
E. Prolonged hypotension.
45. Characteristic features of achalasia of the oesophagus include all of the Following EXCEPT:
A. Increased lower oesophageal sphincter.
B. Abnormal histology of the oesophgeal wall.
C. Chest pain.
D. Dysphagia.
E. Heart pain.
46. All of the following are indications for haemodialysis EXCEPT:
A. Hypotension.
B. Uraemic encephalopathy.
C. Hyperkalemia.
D. Uraemic pericarditis.
E. Pulmonary oedema.
47. Causes of atrial fibrillation include all of the following EXCEPT:
A. Constrictive pericarditis.
B. Complete heart block.
C. Pulmonary embolism.
D. Ischemic heart disease.
E. Thyrotoxicosis.
48. Complications of infammatory bowel disease (cohn's disease, ulcerative colitis) include all of the
following EXCEPT:
A. Urinary tract stonea and gallbader stones.
B. Pyoderma gangrenosum as skin manefistation.
C. Chronic hepatitis.
D. Arthritis.
E. Congestive heart failure.
7

49. All of the following are causes of splenomegaly EXCEPT:

A. Portal hypertension.
B. Chronic myeloid leukaemia (CML).
C. Hodgkin's disease.
D. Ulcerative colitis.
E. Myelofibrosis.
50. Complications of Behcet's disease include all of the following EXCEPT:
A. Deep venous thrombosis.
B. Seizures.
C. Gout.
D. Bloody diarrhoea.
E. Erythema nodosum.
51. Which of the following is true about systemic lupus erythematosus (SLE):
A. Is a cause of haemolytic anaemia.
B. Can cause lymphadenopathy.
C. May cause focal central nervous signs.
D. Can cause hair loss ( alopecia).
E. All are true.
52. All of the following are causes of bloody diarrhoea EXCEPT:
A. Shigellosis.
B. Giardia infection.
C. Entamoeba histolytica infection.
D. Ulcerative colitis.
E. Diverticulosis.
53. Which one of the following is not a complication of blood tranfusion:
A. Haemolytic reaction.
B. Thrombocytopenia.
C. Fever.
D. Hypercalcemia.
E. Infection transmission.
54. Primary biliary cirrhosis can be described by all of the following statements EXCEPT:
A. 90% of affected individuals are men.
B. Pruritus, fatigue, and jaundice are common.
C. Serum transaminase levels (AST, ALT) are normal or slightly elevated.
D. Serum cholesterol level is elevated.
E. The most common causes of death are hepatic failure and bleeding oesopgeal varices.
55. The most common cause of bacterial meningitis in adult is:
A. Streptococcus pneumoniae.
B. Neisseria meningitidis.
C. Hemophilus influenzae.
D. Staphylococcus aureus.
E. Staphylococcus epidermidis.
8

56. A 35 year old man with nausea and vomiting, vertigo, nystagmus, tinnitus and nerve deafness in the
right ear most likely has:
A. Mastoiditis.
B. A cerebellar tumor.
C. Labyrinthitis.
D. A glioblastoma multiform.
E. Acoustin neuroma.
57. A 75 year old woman who is using warfarin, presented to emergeny room with left sided weakness and
difficulty in speech.The first test for diagnosis is to do:
A. MRI of the brain.
B. CT of the brain.
C. Elecrtoencephalogram (EEG).
D. Lumbar puncture.
E. ECG.
58. Which condition is least likely to present with polyarthritis:
A. Rheumatic fever.
B. Rheumatoid arthritis.
C. Systemic lupus erythematosus (SLE).
D. Gout.
E. Viral infection.
59. The most important first step in lowering chlesterol is:
A. Drug therapy.
B. Decreasing stress.
C. Decreasinf intake of carbohydrates.
D. Physical exercise.
E. A low-fat diet.
60. The first line drug for the treatment of status epilepticus is:
A. Intrvenous phenytoin.
B. Intrvenous diazepam or lorazepam.
C. Intavenous lidocaine.
D. Intravenous phenobarbital.
E. Intravenous digoxin.
61. Which one of the following is not a feature of ankylosing spondilitis:
A. Renal failure.
B. Uveitis.
C. Morning stiffness.
D. Symptoms improve with exercise.
E. Peripheral joints are affected.
62. In typhoid fever, which one of the following is true:
A. Stool culture is positive in the first week.
B. Antibiotic treatment is not always necssary.
C. Skin rash (Rose spots) occure in the first week of fever.
D. Blood culture is positive in the third week of illness.
E. The organism can be cultured from bone marrow.
9

63. Drugs which are safe in pregnancy include all of the following EXCEPT:
A. Penicillins.
B. Paracetamol.
C. Cephalosporins (keflex).
D. Heparin.
E. Methotrexate.
64. Hepatosplenomegaly is usually found in all the following conditions EXCEPT:
A. Beta-thalassaemia major.
B. Aplastic anemia.
C. Myelofibrosis.
D. Myeloid leukaemia.
E. Lymphoma.
65. The following drugs are nephrotoxic EXCEPT:
A. Indomethacin.
B. Cyclosporin.
C. Gentamycin.
D. Diltiazem.
E. Amikacin.
66. The following are associated with increased risk of stroke EXCEPT:
A. Diabetes mellitus.
B. Hypertension.
C. Hyperlipidaemia.
D. Psoriasis.
E. Smoking
67. The following may be present in myasthenia gravis EXCEPT:
A. Thymoma.
B. Antibodies to acetylcholine receptor.
C. Sensory neuropathy.
D. Diplopia.
E. Respiratory failure.
68. In rheumatoid arthritis which one of the following is true:
A. women are affected more than men.
B. Cerebral involvement is usual.
C. A positive rheumatoid factor is diagnostic.
D. Steroids are the preferd treatment.
E. Symptoms are worse after exercise.
69. All of the following conditions are causes of chronic liver disease EXCEPT:
A. Autoimmune active hepatitis.
B. Hepatitis C infection.
C. Hepatitis B infection.
D. Hepatitis A infection.
E. Alcohol.
10

70. Which one of the folllowing can cause polyuria:

A. Polydipsia.
B. Hypercalcaemia.
C. Hypokalaemia.
D. Diabetes mellitus.
E. All are true.
71. The most common skin manifestation in sarcoidosis is :
A. Erythema multiform.
B. Erythema marginatum.
C. Erythema chrinicum-migrans.
D. Erythema nodosum.
E. Granuloma annulare.
72. The following are causes of hypoalbuminaemia EXCEPT:
A. Sepsis.
B. Acute left ventricular failure.
C. Nephrotic syndrome.
D. Liver cirrhosis.
E. Protein losing enteropathy.
73. Which one of the following conditions causes aphthous ulcers:
A. Behcet's disease.
B. Crohn's disease.
C. Coeliac disease.
D. Ulcerative colitis.
E. All are true.
74. The following are causes of bradycardia EXCEPT:
A. Pregnancy.
B. Hypothyroidism.
C. ß blocker.
D. Complete heart block.
E. Hypothermia.
75. Characteristic features of ulcerative colitis include
A. invariable involvement of the rectal mucosa ( proctitis ) .
B. segmental involvement of the colon and rectum .
C. no pseudo polyposis following healing of mucosal damage .
D. inflammation extending from the mucosa to the serosa .
E. enter cutaneous and enter enteric fistulae .
76. Ulcerative colitis (UC) differs from Crohn's colitis in that
A. UC occurs at any age .
B. cessation of smoking is likely to reduce activity of Crohn's disease .
C. toxic dilatation only occurs in ulcerative colitis .
D. there is no association with aphthous mouth ulcers in UC (unlike Crohn's disease)
E. there is involvement of the small bowel in UC .
11

77. Recognized complications of ulcerative colitis include :

A. pyoderma gangrenosum .
B. per cholangitis .
C. amyloidosis .
D. colonic carcinoma .
E. enteropathic arthritis .
F. all of the above .
78. causes of ascites in the absence of intrahepatic liver disease :
A. congestive cardiac failure
B. nephrotic syndrome
C. peritoneal tuberculosis
D. lymphatic obstruction
E. Budd-Chiari syndrome
F. all of the above .
79. Causes of portal hypertension :
A. alcoholic cirrhosis ( Intrahepatic parenchymal )
B. myeloproliferative disease( Intrahepatic pre-sinusoidal )
C. hepatic schistosomiasis
D. abdominal trauma
E. hepatic vein obstruction (Budd-Chiari syndrome)
F. all of the above
80. Complications of portal hypertension :
A. variceal hemorrhage
B. congestive gastropathy
C. hepatorenal failure
D. hepatic encephalopathy
E. ascites
F. all of the above .
81. Prevention of recurrent variceal bleeding is achievable except:
A. somatostatin (octreotide) therapy
B. TIPSS
C. B -blocker treatment
D. variceal banding
E. sclerotherapy
82. In primary biliary cirrhosis :
A. middle aged males are affected predominantly
B. pruritus is invariably accompanied by jaundice
C. osteomalacia and osteoporosis both occur as the disease progresses
D. rigors and abdominal pain are presenting features
E. smooth muscle antibodies are present in high titres in the serum

12

83. In hepatitis C (HCV) except :

A. a chronic carriage rate of > 50% is the rule
B. the infecting agent is an RNA flavivirus
C. the disease progress to chronic hepatitis
D. most patients experience the symptoms of acute hepatitis
E. the virus is responsible for 90% of all post-transfusion hepatitis
84. The typical features of type A viral hepatitis (HAV) except:
A. picornavirus infection spread by the faecal-oral route
B. an incubation period of 2-4 weeks .
C. a greater risk of acute liver failure in the young than in the old
D. right hypochondrial pain and tenderness
E. not progression to cirrhosis (Chronic hepatitis does not occur )
85. Typical complications of chronic pancreatitis include
A. pancreatic pseudo cyst formation
B. obstructive jaundice
C. portal vein thrombosis
D. diabetes mellitus
E. opiate drug dependence
F. all
86. In the management of acute pancreatitis :
A. early laparotomy is advisable to exclude alternative diagnoses
B. opiates should be avoided because of spasm of the sphincter of Oddi
C. intravenous fluids are unnecessary in the absence of a tachycardia
D. the urine output and PaO2 not done .
E. persistent elevation in the serum amylase suggests pancreatic duct obstruction
87. Adverse prognostic factors in acute pancreatitis EXCEPT:
A. arterial hypoxaemia
B. leucopenia with white blood cell count below 5 109/l
C. serum albumin < 30 g/l and serum calcium < 7mg/dl
D. Hyperglycaemia > 10 mmol/l
88. Causes of acute pancreatitis EXCEPT:
A. measles
B. hypothermia
C. choledocholithiasis
D. azathioprine therapy
E. alcohol misuse
89. In gluten enteropathy (coeliac disease) EXCEPT:
A. Peak incidence in the age groups 1-5 years and 40-59 years
B. there is a predisposition to gut lymphoma and carcinoma
C. the toxic agent is the polypeptide &aacute; -gliadin
D. diets improve absorption but not the villous atrophy
E. serum anti-endomysium IgA antibody titres are characteristically elevated
13

90. Carcinoma of the stomach is associated with

A. adenomatous gastric polyps
B. chronic hypochlorhydria
C. Helicobacter pylori infection
D. Mntrier's disease
E. alcohol and tobacco consumption
F. all
91. In resuscitating a patient with an acute gastrointestinal bleed except:
A. oxygen should be administered if there are signs of hypovolaemia
B. transfusion requires whole blood rather than packed red cells
C. volume replacement with colloids is preferable to crystalloids
D. monitoring central venous pressure and/or urine output is advisable
E. surgical intervention should be considered if rebleeding occurs despite ulcer sclerotherapy
92. Gastro duodenal haemorrhage is
A. more often due to peptic ulcer than to esophageal varies
B. associated with a 5% mortality when due to chronic peptic ulceration
C. a recognized complication of severe head injury
D. best investigated by endoscopy
E. significantly associated with anti-inflammatory drug therapy
F. all
93. Typical features of peptic ulcer dyspepsia except:
A. pain relieved by eating (Hunger pain ) .
B. well-localized pain relieved by vomiting
C. pain-free remissions lasting many weeks
D. nausea and epigastric colic
E. absence of symptoms prior to acute perforation
94. Factors associated with chronic peptic ulcer disease except:
A. non-steroidal anti-inflammatory drugs therapy
B. pernicious anemia
C. Helicobacter pylori-associated gastritis
D. tobacco consumption
95. in esophageal carcinoma except:
A. associated with gluten enteropathy
B. more likely to be due to adenocarcinoma than squamous carcinoma
C. associated with Barrett's esophagus
D. 90% are in the lower two-thirds
E. associated with alcohol and tobacco consumption
96. Gastro-oesophageal reflux disease is associated with the following factors except:
A. decreased intra-abdominal pressure
B. delayed gastric emptying
C. prolonged esophageal transit time
D. decreased lower oesophageal sphincter tone
E. presence of a hiatus hernia
14

97. Typical features of esophageal achalasia except:

A. recurrent pneumonia
B. Failure to relax the LOS with loss of ganglion cells in Auer Bach's plexus on histology
C. heartburn and acid reflux
D. predisposition to oesophageal carcinoma
E. symptomatic response to pneumatic balloon dilatation
98. Recognised causes of dysphagia except:
A. iron deficiency anaemia
B. pharyngeal pouch
C. Barrett's oesophagus
D. myasthenia gravis
E. achalasia
99. Causes of mouth ulcers include
A. gluten enteropathy
B. Crohn's disease
C. lichen planus
D. adverse drug reaction
E. herpes simplex.
F. all
100. The typical features of hepatic cirrhosis except :
A. a small shrunken liver
B. painful splenomegaly
C. peripheral blood macrocytosis
D. parotid gland enlargement
E. central cyanosis
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

A
B
C
B
D
C
A
C
B
C
E
D
C
A
D
A
B
C
E
A

21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

A
C
E
E
E
B
E
C
D
D
A
D
E
D
A
C
E
D
B
C

41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60

D
B
B
C
E
A
B
E
D
C
E
B
D
A
A
E
B
D
E
B
15

61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80

A
E
E
B
D
D
C
A
D
E
D
B
E
A
A
B
F
B
F
F

81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100

A
C
D
C
F
E
B
A
D
F
B
F
D
B
B
A
C
C
F
B