Residency exam 2016

King Abdullah University Hospital

1- All can cause lymphadenopathy except:

- AIDS
- sarcoidosis
- *AML
- lymphoma

2- most significant risk factor for AAA:

- age
- gender
- anti-hypertensive drugs
- *current smoking

3- all of the following cause hypercalcemia except:

- sarcoidosis
- *crohn'
- Hypervitaminosis D
- Hyperthyroidism

4- All can come with FMF except:

- can cause pleurisy
- cause fever in more than 50% of pts
- *first presentation in middle aged adults
- can cause abdominal pain
- inherited condition

Note: Ninety percent of all patients have their first attack before they are 18 years old

5- Young adolescent complaining of painful lump below the knee, with protruding of tibial
tuberosity. the pain occurs during activities :
- Legg-Calv-Perthes disease
- Slipped Capital Femoral Epiphysis
- *Osgood-Schaltter disease
6- a 70 kg man , with Na 120 >>> calculate deficit Na ??
- 1300
- 560
- *840 ( here the q adopted Na=140 as reference for the calculation not 135)

Note:
Na Deficit = Sex * Weight * (DesiredNa - SerumNa)
Male (0.6), Female (0.5)

7- A child with gastroenteritis, awake and alert, normal vital signs, sunken eyes, depressed
fontanelle, expected percent of dehydration:
- * 5-9%

8- Baby was born with a birth weight of 3 kg, at 1 year of age, he is expected to be:
- * 9 kg

9- Baby at 6 months of age, he is expected to have:

-* 44 cm head circumference with closed posterior fontanelle and open anterior fontanelle

10- a patient come to emergency with hypertension, bardycardia , most likely cause:
- * bleeding into cranial cavity

11- 11 yrs old boy complains of chew twitching with drooling and inability to speak which wakes
him from sleep .. which of the following is the best next test:
- * electroencephalogram
- CT scan without contrast
- MRI

12- what's true regarding bladder cancer :

-*Looks like UTI with irritative symptoms and hemtauria
- intravesical chemotherapy is preferred even when the tumor penetrate the muscularis layer
- partial cystectomy is preferred

13- most likely of the following that increase the risk of breast cancer:
- *BRCA genes
- biopsy proven LCIS
- age
- family history of breast cancer

14- About ovarian tumors, one is true:

- The risk of ovarian cancer is more with BRCA 1 than BRCA 2
- Epithelial tumors are most likely inherited

15- Patient with spherocytosis, came to ER with Hb of 5, blood transfusion was ordered. Patient
started to have fever, chills, and headache upon transfusion. The most immediate action to be
done:
- *stop transfusion and give antipyretics
- Recheck the type of donor's and recipient blood for possible mismatch
- give hydrocortisone and continue transfusion

16- All are true except:

- * Bluish discoloration of skin overlying the hernia is mandatory for diagnosis
- Femoral hernia is more like to strangulate
- The pain of the strangulated hernia disappear when it perforates
- a normal hernia can strangulate at any time

17- About hernias, all are true except:

- Indirect inguinal hernias are the most common in females
- Indirect inguinal hernias in infants are due to persistant processus vaginalis
- Direct inguinal hernias are always acquired
- Direct inguinal hernias become more common in the elderly
- * Indirect inguinal hernias are most likely to disappear as the child gets into adulthood

18- About constipation, one is true:

- * A recent change into constipation is more important than chronic constipation
- It's more commonly due to organic causes

19- Regarding blood transfusion, one is true:

- Hyperkalemia and metabolic acidosis may occur following blood transfusion
- * Thrombocytopenia is a complication following massive blood transfusion
20- All of the following about uterine prolapse are true, except:
- * Anterior and posterior colporrhaphy are the only effective treatment
- Rings can be used temporarily
- Sacrocolpopexy is a way of management

21- VBAC vs. repeat CS, one is true:

- VBAC has a lower risk of uterine rupture
- * VBAC has a lower risk of blood transfusion (or VBAC needs less blood transfusion)
- VBAC has a lower risk of perinatal morbidity and mortality

22- The strongest layer of the esophagus is:

- Mucosa
- Adventitia
- Muscularis
- * Submucosa

23- A 6-day old baby presented with vomiting and irritability. His serum sodium was 120 and
potassium was 7. What is the most likely cause:
- * CAH
- Hyperaldosteronism
- Pyloric stenosis

24- Infective endocarditis prophylaxis may be recommended in all of the following, except:
- Mitral stenosis
- Aortic stenosis
- * HOCM
- Mitral prolapse without regurgitation
- ASD

25- The most common complication of popliteal artery aneurysm is:

- * Thrombosis and embolism leading to limb ischemia
- Rupture

26- All are true about mesenteric adenitis, except:

- Most likley presents before 18 years of age
- May present with shifting abdominal tenderness
-* Definitive diagnosis can only be made at lapratomy (not sure of the answer)
- May lead to the formation of abdominal abscesses
- Can be associated with cervical lymphadenopathy

27- A child's length reaches 1 meter at:

- * 4 years

28- All of the following are risk factors for endometrial hyperplasia except:
- * Intermittent COCP use
- DM
- Obesity

29- One of the following vaccines is given by 2 routes in the Jordanian National Program:
- * Polio

30- One of the following is not caused by an enterovirus:

- * Herpetic whitlow
- Hand-foot-mouth disease
- Aseptic meningitis
- Herpangina
- Poliomyelitis

31- One of the following is most prognostic factor of the function in post trauma patient:
-the overall Glasgow coma scale
- low verbal response
-low motor response
-low eye response

32- 16 years old obese female .. With history of morning headache .. examination was normal
except for bilateral papilledema .. MRI was normal ... what's the next step :
_*LP with manometry
- CT scan without contrast
- EGG

33- All of the following are found in acute inflammatory demyelinating encephalomyelitis
except:
- * sensory level
- Normal CSF studies
- Fever and encephalopathy
- Loss of vision
- Cerebellar ataxia

34- All are true about b-lactam antiobiotic except:

- * no need for dose adjustment in renal impairmanet patients
- they inhibit bacterial cell wall synthesis
- they are bactericidal
- Penicillin can cause allergic interstitial nephritis

35- True about IUGR babies except:

- * all IUGR babies must be delivered by CS
- Usually associated with oligohydramnios
- Pre-eclampsia is a known potential cause

36- One is true in Pre-eclampsia:

- severe PET is when BP 140/90
- * uric acid level is expected to be elevated
- hematocrit is expected to be low

37- One of the following requires a patent foramen ovale for survival:
- Tetrology of Fallot
- * Tricuspid atresia
- Truncus arteriosus

38- All of the following are features of PCO, except:

- Acanthosis nigricans
- * Low risk of miscarriage
- High LH:FSH
- Low level of sex hormone binding globulin (SHBG)

39- About precocious puberty, one is true:

- It is defined as the development of secondary sexual characteristics at the age of 8
- It is more common in males
- * No management is needed in the constitutional type
- Occurs in Turner syndrome

40- The most common benign liver tumor is:

- * Hemangioma
- Hepatic adenoma
- Focal nodular hyperplasia

41- Which of the following is the most likely indicator of acute liver failure:
- * PT
- Bilirubin
- Albumin
- Ammonia

42- One of the follow is wrong:

- PT monitors the extrinsic pathway
- PTT monitors the intrinsic pathway
- Prolongation of both PT and PTT means a defect in the common pathway
- * Patients with a normal platelet count would have a normal bleeding time

43- The most common indication for intubation in trauma is:

- Inhalational injury
-* Altered level of consciousness
- Facial injury
- Hematoma in the cervical region

44- In the primary survey for a traumatized patient, it is important to ask him or his family about
all of the following, except:
- Last meal
- Current medications
- * Any abnormal movements while transferring the patient from the trauma scene
- Past diseases
- Allergies

45- One of the following is wrong about the uses of carcinoembryonic antigen:
-* for diagnosis
- for prognosis
- for follow up the treatment
- to know the severity of the disease

46- The most appropriate immediate management for a patient with anaphylactic shock is:
- * IM epinephrine
- H1 blocker
- H2 blocker
- Glucagon

47- About rheumatoid arthritis, one is wrong:

- * Asymmetric involvement of the joints

48- A 23-year-old female presented with a breast mass in the upper outer quadrant. She has no
past medical history. What is the most appropriate imaging modality:
- * Ultrasound
- Mammogram

49- Which of the following is wrong about nephrogenic diabetes insipidus :

- can occur in sickle cell child
- can be caused by hypercalcemia
- can be treated by thiazide
- x-linked
- * vasopressin levels normal or low

50- All of the following about solitary pulmonary nodule are true, except:
- Must be less than 3 cm
- Must be surrounded by aerated lung field
- Can't be multiple
- * Can be associated with atelectasis and lymphadenopathy
- Can be of any shape or border

51- The most appropriate test to start with in evaluating a thyroid nodule is:
- * Radioisotope scan
- FNA
- CT
- MRI

52- The most characteristic ECG finding in AV canal ..:

- * AV block
- ventricular ectopics
- atrial ectopics
- supra ventricular tachycardia

53- A 4-year-old child presented with left earache. Temperatue was 38.3 rectally. On otoscope, a
dull tympanic membrane was seen with absent light reflex. One of the following is true:
- * Streptococcus pneumonia is the most common cause
- Antihistamines are used in treatment
- This condition is not common in this age
- Tubes are usually needed for treatment
- The treatment of choice is giving one dose of ceftriaxone IM

55- One of the following is a mismatch:

- HSV 2: genital ulcers
- HPV 6: genital warts
- Trichomonas: sexually transmitted
-* Bacterial vaginosis: very itchy

56- All of the following can be associated with steotorrhea, except:

- * Lactose intolerance
- Celiac disease
- Pancreatic insufficiency

57- All of the following side effects of oxytocin except

- * hypernatremia
- hyperbilirubinemia
- increased risk of rupture

58- One of the following about IUCD is wrong:

- * The risk of infection after inserting an IUCD is 20%
- If pregnancy occurs on top of an IUCD, the IUCD should be removed
- Screening for STDs is recommended prior to insertion
- If PID develops, the IUCD should be removed

59- One of the following about contraception is wrong:

- Copper IUD may be used up to 10 years
- Hormonal IUD may be used up to 5 years
-* Implanon should be inserted every 3 weeks
- depo-provera is given every 3 months

60- Chronic atrial fibrillation can lead to all of the following except:
-* Pulmonary embolism
- Stroke
- Acute limb ischemia
- Mesenteric ischemia

61- All of the following are possible causes of metabolic alkalosis, except:
- * Hyperkalemia
- Vomiting
- Loop diuretics

62- Doppler ultrasound may be useful in all of the following, except:

- * Measurement of abdominal circumference
- Measurement of amniotic fluid pockets
- Detection of congenital heart defects
- Detection of the middle cerebral artery
- Detection of renal agenesis

63- One of the following is true regarding ureteric obstruction:

- * Mainly due to stones
- Usually associated with infection proximal to the obstruction
- it will increase urea and creatinine

64- All of the following about urge incontinence are true, except:
- Anticholinergics are an effective treatment
- *Colposuspension is a successful method for treatment