FINAL MEDICAL EXAMINATION

4th Year Medical Student

( Female ) 1432 2011
(Select ONE BEST Answer)

Pt has pernicious anemia ( vitamin b12 deficiency ) he is /1

? Romberg's test positive .. Where is the lesion
Cerebellar lesion Lesion in posterior column female pt has hypertension came to clinic for check up the Dr /2
noticed wgh. loss she said she has abdominal pain and discomfort
(^^) ?? after eating espically large meales what us the dx
Ishemia at intestine

3/ pt with hypothyroidism when we want to test for thyroid function

?? what should we do
TSH concenterationThyroxin level Free T3-

: Root of Biceps reflex /4

C5 + C6

?Which of the following type of diarrhea stop with fasting /5

a. Osmotic diarrhea
b. Secretary diarrhea
c. Exudative diarrhea
d. Steatorrhea

6/ An old female patient visit your clinical complain of weight gain

and change in the vocal sound. She was diagnosed as
hypothyroidism,
Which lab. Test will confirm the result:
a. Increased TSH, increased T4
b. Decreased TSH, increased T4
c. Decreased TSH, Decreased T4
d. Increased TSH, decreased T4
e. Normal TSH, Decreased T4

7/ A 16-year-old boy is referred to your practice for leg claudicating.

His right arm blood pressure is 150/110 mm Hg while his left leg
blood pressure is 80/60 mm Hg. On auscultation, a systolic murmur
best heard over the middle of the upper ...back is detected. You also
find that the patients femoral pulses are diminished when
compared to his brachial pulses.
Which of the following is the most likely diagnosis?
a. Patent ductus arteriosus
b. Ventricular septal defect
c. Coarctation of the aorta
d. Atrial septal defect
e. Tetralogy of Fallot

8/ A 38-year-old man arrives at the emergency room with the chief

complaint of hematemesis for 3 h. He does not drink alcohol and
has no previous medical history. He spent the previous night
vomiting approximately 1012 times after eating some... bad
chicken. The patient is squirming on the stretcher and is retching.
He is afebrile with a heart rate of 120/min and a blood pressure of
90/60 mm Hg. Abdominal exam is positive for diffuse tenderness,
but the patient has no rigidity, guarding, or rebound tenderness.
There is no hepatosplenomegaly. Rectal exam is negative for occult
blood. A nasogastric tube is inserted and reveals bright red blood.
Which of the following is the most likely diagnosis?
a. Esophageal varices
b. Mallory-Weiss tear
c. Gastritis
d. Peptic ulcer disease
e. Boerhaave syndrom

Patient of splenomegaly .. How to start examine him wt the most /9

:sensitive method
Percussion the spleen dullness by ( Castell's sign )

10/ A 42 year old male patient admitted to the hospital for possible
dehydration after several days of vomiting and diarrhea due to a
recent viral syndrome. Which of the following best defines
orthostatic changes from volume depletion?
a. T...he systolic blood pressure in the erect position is 5 mm Hg
lower than the systolic blood pressure in the recumbent position
b. The systolic blood pressure in the erect position is 15 mm Hg
higher than the systolic blood pressure in the recumbent position
c. The heart rate in the erect position is 5 beats/min higher than the
heart rate in the recumbent position
d. The diastolic blood pressure is 10 mm Hg higher in the erect
position than the diastolic blood pressure in the recumbent position.
e . The systolic blood pressure in the erect position is 15 mm Hg
lower than the systolic blood pressure in the recumbent position.

11/ A 39 year-old man presents with jaundice and ascites. He has a

history of diabetes mellitus and was recently diagnosed as having
heart disease. On physical examination, he has a bronze-like
appearance to his skin, arthritic changes of the... fingers, and
testicular atrophy.
What is the most likely diagnosis?
a. Hemochromatosis
b. Primary biliary cirrhosis
c. Sclerosing cholangilis
d. Chronic Hepatitis C
e. Alcoholic Hepatitis

12/ An 18-year-old woman presents with arthritis that is

asymmetrical and involves more than three joints. The arthritis is
migratory, affecting one joint for several days and improving, then
affecting another joint. On physical examination, the patient has
several subcutaneous nodules and her cardiac exam reveals an S3
gallop.
Which of the following is the most likely diagnosis?
a. Lyme disease
b. Endocarditis
c. Rheumatoid arthritis

d. Gout
e. Rheumatic fever

13/ A 21 year old woman presents to the emergency room with

palpitations. Physical examination reveals an anxious and highly
energetic patient. Her heart rate is 120 beats/min. She has bilateral
proptosis (exophthalmos), stare, and lid retraction. Thyroid
examination reveals diffuse enlargement with an audible bruit. The
thyroid gland is nontender. The patient has weakness of her
quadriceps muscles (need help to rise from a chair) and has fine
tremors.
Which of the following is the most likely diagnosis?
a. Graves disease
b. Hashimoto thyroiditis
c. Plummers disease
d. Struma ovarii
e. Subacute thyoriditis
14/ A 33 year old engineer presents to emergency room with acute
neck pain. It is worse with head turning, coughing and sneezing. A
senior physician examined the patient before you interviewed him.
He told that this patient has classical C7 radiculopathy! MRI findings
confirmed this.
What physical signs should you expect to see in your physical
examination of this patient?
A. Weakness of shoulder abduction and elbow flexion with absent
biceps reflex.
B. Weakness of biceps, brachioradialis and pronator teres with
absent biceps reflex.
C. Weakness of elbow extension, and wrist flexors with sensory loss
mostly over the middle finger.
D. Weakness in finger flexors and thumb abduction with sensory loss
mostly over the small finger.
E. Weakness of shoulder abduction, elbow flexion and extension,
wrist flexion and extension with loss of biceps and triceps reflexes.

15/ which of the following is most appropriate description of a

muscular power grade or strength of three(3):
a- muscle able to move joint against gravity with full resistance
(Grade 5)
b- muscle unable to move joint with gravity eliminated (Grade 2)
c- muscle unable to overcome resistance other than gravity (Grade
3)
d- muscle unable to move joint palpable contraction of muscle

16/ a 37y old woman who work as a computer data analyst present
with intermittent numbness & tingling of her right thumb, middle
finger, & index finger. The sensation awakens her from the sleep &
is worse when she is kitting or driving she denies back, neck, arm or
shoulder pain. There's no Hx. Of trauma. O/E, there's atrophy &
weakness of the muscle of abduction of the Rt. thumb. Flexion of
the wrist or percussion of the wrist intensifies the tingling sensation.
Which of the following is most likely diagnosis:
a- wrist drop
b- ulnar neuropathy
c- carpal tunnel syndrome
d- cervical radiculopathy

interruption of sympathetic innervations of eye at any point /17

:result in Horner syndrome
Partial ptosis, constricted pupil, intact light reflex & decrease in
sweating

18/ A 30 year old woman presents for a routine checkup. She has
no complaints and denies previous medical problems. On heart
examination, the patient has a loud S1. She has a low-pitched midto late diastolic murmur that is heard best at the apex. Immediately
preceding the murmur is a loud extra sound.
Which of the following is the most likely diagnosis?
a. Mitral valve prolapse
b. Mitral stenosis
c. Ventricular septal defect
d. Aortic insufficiency
e. Atrial septal defectthe

19/ Change of JVP which cause by constrective pericarditis :

sharp Y descent

20/ 18 male pt complain of severe headach , he recently diagnosed

of HTN , no family hx of HTN, on examination there is bruit in the
mid abdomen what is the most likely diagnosis : ( ^^ )
Pheochromocytoma

21/ A 49-year-old woman is brought to the emergency room after

suddenly losing consciousness.Her husband states that the patient
was in good health until 2 h ago, when she suddenly complained of
a severe headache. After one episode of vomiting,... the patient lost
consciousness. The husband states that there were no seizure-like
movements and no incontinence. The patient did not take any
medications, smoke, drink, or use illicit drugs. On physical
examination, the patient has a regular heart rate of 100/min, a
respiratory rate of 16/min, and a blood pressure of 120/80 mm Hg,
and is afebrile. Heart and lung examinations are normal. On
neurologic exam, the patient responds only to painful stimuli and
her deep tendon reflexes are bilaterally equal. She has bilateral
flexor plantar responses. She has neck stiffness and attempts to
resist forward flexion.
Which of the following is the most likely diagnosis?
a. Carotid artery thrombosis
b. Embolic infarction of the brain
c. Frontal lobe hemorrhage
d-Subarachnoid hemorrhage
e- Complicated migraine
( 21 )
Pretest

22/ one of the following cause of flapping tremor: ( ^^)

a-Diabetes mellitus
b-Typr II respiratory failure

23/ Corneal reflex done , only left eye is blinking , where is the
lesion :
a-Rt trigeminal nerve
b-LF trigeminal nerve
c-Rt facial nerve
d-LF facial nerve

^^

24/ What is the cause of Diplopia:

a-Palsy of VI nerve
b-Palsy of IV nerve
c-Palsy of III nerve

A 60-year-old man presents to your office with an 80-pack-year /25

history of cigarette smoking. He complains of some dyspnea on
exertion. He has an asthenic body habitus and pursed-lip
breathing. He has an increased anteroposterior thickness of the
thorax. Lung examination reveals decreased fremitus,
.hyperresonance on percussion, and diminished breath sounds
?Which of the following is the most likely diagnosis
a. Bronchiectasis
b. Asthma
c. Emphysema
d. Pleural effusion
e. Pneumonia

26/

Which of the following grades of deep tendon reflexes best

describes a patient with persistent clonus?
abcde-

Grade 0
Grade 1+
Grade 2+
Grade 3+
grade 4+

27/ patient complain of weakness in Rt arm and leg , but weakness

of arm more prominent, where is the defect :
a-Rt Anterior cerebral artery

b-Lf Anterior cerebral artery

c- Rt middle cerebral artery
d- Lf middle cerebral artery
^^

28/
:
Guillain-Barre syndrome
:
History of Influenza like illness

29/

JVP & raised of hepatojugulqar reflex

30 /

Weakness

- CT scan
- Chest X ray
- ECG
31/


112 5

32/
,
Positive Shifting dullness , Negative fluid thrill

Mild to moderate ascites

60 ,
.. ,
) ^^(
..
,,,