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)4( عدد االوراق باطنية ظاهر الحبو.د 2012-11-22 MCQ's for the 6th year student How to answer the MCQs Always calculate the time available for each question before the exam and stick to that time strictly. Do not allow yourself to become delayed by any single question. Instead, answer the question using your first impression and mark the question with a star so you can return to it. After finishing your first run through the all questions, you should then start a second run returning to those questions which you have starred giving them further consideration. You should aim to answer at least 90% (ideally 100%) of MCQs in every paper. Only use the information given to you and don’t assume anything else. The root, stem and the options contain everything you need to answer each question. Perhaps an important fact is missing and you will need to identify what that is. Pay close attention to the facts. If you change your understanding of a topic based on the question, include that adjustment in your analysis and selection of an answer. Try to approach the questions simply and avoid introducing further complications. The exam is there to test your knowledge, not to trick you, so avoid unique interpretations of the facts. A process of elimination You should start by eliminating answers that you are sure are incorrect, and narrow the options down until you have the most likely answer. Always remember: Read the alternatives very closely. Look quickly at the modifier, then analyse the reasoning and then the result. The response will not be correct if the reasoning is not correct. Of the limited options possible, only one of them will identify and resolve the central issue. ‘Best’ answer questions Not every question will have several “wrong” answers. Often you will be asked to choose the “best” answer because there may be 1 more than one answer to solve the problem. When approaching a question like this, remember: If you can prove an answer more easily, it is likely to be the correct one. More precise answers are usually better, because they will address the factual situation better than less precise answers. Making educated guesses When faced with an MCQ that you are unsure about, a number of points can help you make an educated guess. An understanding and familiarity with the key words and phrases that commonly feature in MCQs is vital to maximising your score . Questions which include absolute and sweeping statements such as never, always, or exclusively are generally false (because exceptions can be found to virtually any rule). Questions which include the keywords could, possible, or may are more often true than not (after all, anything is possible). In acute paroxysmal nocturnal dyspnea ,all the following can occurs except. A-Acute dyspnea B-Cough C-Purulent sputum D- The sputum may be streaked with blood E- Tachycardia with inspiratory crackles The Answer is (C) One of the following condition is usually not associated with clubbing of fingers A.Primary biliary cirrhosis B.Chronic bronchitis C.Cryptogenic fibrosing alveolitis D. Bronchiectasis E.Bronchogenic carcinoma The Answer is (B) 2 Which of the following cause central Cyanosis A-Exposure to cold. B-heart failure. C-Shock. D-Right to left Cardiac shunt. E-Raynaud's phenomenon. The Answer is (D) A twenty year old girl is taking anti tuberculosis treatment. She presents in eye clinic with out door visual complaints. The most likely cause of her symptoms is side effect of: A-Isoniazid. B- Rifampicin. C- Ethambutol. D- Pyrazinamide. E- Streptomycin The Answer is (C) A patient presents with mild fever and haemoptysis from Sinjar. Which of the following tests would be diagnostic of active tuberculosis disease? A- Heaf test B-Mantoux test C-T-cell assay e.g. Quantiferon, ELIspot D- Sputum or biopsy cultures E- All of the above The Answer is (D) skin sensitivity tests (Heaf, Mantoux) and the newer T-cell based assays are only useful to determine latent tuberculosis infection and tell you nothing about disease activity. 21 year old man presented with history of fever( stepladder to intermittent fever), headach and abdominal pain. Abdominal examination shows tender spleen with palpable liver. Blood count no abnormality. According the most possible Diagnosis which antibiotic is more suitable. A-Ciprofloxacin. B-Gentamycin. C-Metrinidazol. D-Tetracycline. 3 E-Vancomycin. The Answer is (A) A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 60 per minute and skin is pale, coarse and dry. The most important investigation to find diagnosis in this case is: A-Adrenocorticotrophin hormone (ACTH). B-Cortisol level. C-Gonadotrophin levels. D-Insulin like growth factor (IGF). E-Thyroid function test. The Answer is (E) A fifteen year old boy presents with history of fever and a migratory polyarthritis that involves the large joints sequentially. According to the diagnosis you made. The treatment of choice for this patient’s symptom is A-Aspirin. B-Diclofenac. C-Ibuprofen. D-Paracetamol. E-Morphine. The Answer is (A) A 26-year-old woman with a history of a tingling sensation in her fingers and toes for 2 days and rapidly progressive weakness of her legs. Deep tendon reflexes are absent. She had an upper respiratory tract infection 2 weeks ago. The most likely diagnosis is? A -Myasthenia gravis B-Multiple sclerosis C-Guillain-Barré syndrome D-Poliomyelitis E-Tick paralysis The Answer is (C) 4 A 66-year-old woman presented with sudden onset of retrosternal chest discomfort with nausea and diaphoresis. She has hypotension,jugular venous distention, and a murmur of tricuspid regurgitation. An ECG shows ST-segment elevation in the right precordial leads. Which of the following is the most likely diagnosis? A-Constrictive pericarditis B-Dissecting aortic aneurysm C-Pericardial tamponade D-Pulmonary emboli E- Right ventricular infarction The Answer is (E) A 30-year-old man has had severe colicky right flank pain radiating into the thigh for 4 hours. He is afebrile. Urinalysis shows RBCs too numerous to count and no bacteria. Which of the following is the most likely diagnosis? A-Acute glomerulonephritis. B-Bacterial cystitis C-Benign prostatic hyperplasia D- Urolithiasis E-Bladder carcinoma The Answer is (D) A 67-year-old man comes to the physician because of progressive shortness of breath. He has smoked one pack of cigarettes daily for 52 years. O/E Barrel-shaped chest. Breath sounds are decreased, with bilateral faint expiratory wheezes. There is no peripheral edema. Which of the following is the most likely diagnosis? A-Angina pectoris B-Asthma C-Chronic obstructive pulmonary disease D-Chronic pulmonary embolism E-Congestive heart failure The Answer is (C) 5 An old lady presents with history of fever and left sided chest pain for one month. Examination of respiratory system shows decreased chest movements, stony dull percussion note and absent breath sounds on left side. Her chest X-ray is likely to reveal: A-Collapse. B-Consolidation. C-Fibrosis. D-Pleural effusion. E-Pneumothorax. The Answer is (D) A young girl complains of nocturnal cough and shortness of breath which disturbs her sleep. With bilateral high pitch expiratory rhonchi. The most important investigation to confirm the diagnosis you made is: A-Chest X-ray. B-Eosinophil count. C-Lung function tests. D-Serum IgG levels. E-Sputum examination The Answer is (C) A forty year old woman gives history of fever for last three weeks accompanied by dry cough, night sweats and weight loss. Chest examination is normal. Abdominal examination reveals hepatosplenomegaly. Chest X-ray shows symmetrically distributed fine nodules. The most likely diagnosis is: A-Typhoid. B-Chronic liver disease. C-Malaria. D-Pneumonia. E- Military tuberculosis The Answer is (E) A patient with history of fever, headache and neck stiffness, normal funduscopy, the most important investigation is: A-Magnetic resonance imaging brain. B-Complete blood counts. C-Computerized tomography scan brain. D-Cerebrospinal fluid examination. E-X-ray skull. The Answer is (D) 6 An old patient presented in emergency ward with history of weakness of right side of body of rapid onset. The most helpful first line investigation for management of this patient is: A-Cerebral angiography. B-Cerebro spinal fluid examination. C-Computerized tomography scan brain. D-Fasting lipid profile. E-Nerve conduction study The Answer is (C) A 68-year-old man presents to the ED with 3 episodes of coffee ground emesis over the past 2 hours, abdominal pain. Upper endoscopy is performed, which reveals a deep ulcer along the lesser curvature of the stomach . There appears to be a visible vessel in the center of the ulcer. The remainder of the endoscopic examination is normal. What is the next best step in this patient’s management? A-Begin IV octreotide B-Endoscopic therapy C-Insert a nasogastric tube D-Observation, nothing by mouth status, and IV proton pump inhibitor (PPI) E-Surgical consultation The Answer is (B) In a patient with history of haematemesis, the clinical feature which suggests that peptic ulcer is the underlying cause is: A-Ascites. B-Drowsiness. C-History of jaundice. D-Splenomegaly. E-Tender epigastrium. The Answer is (E) A patient presents with episodes of loss of consciousness. The GP's letter includes a list of their medications. Which could likely be responsible for the patient's blackouts? A- Aspirin B Simvastatin C- Metformin D- Ramipril 7 E- Persantin The Answer is (D) A 17-year-old boy has had two episodes of severe anaphylactic shock following bee stings. Which of the following is the most appropriate intervention? A. Administration of corticosteroids during the summer B. Long-term prophylactic antihistamine therapy C. Protective clothing D. Desensitization with bee venom extract E. Restrict him to the house during the summer months The Answer is (D) In Vivax malaria all the following are true except A. May be complicated by anaemia B. May be complicated by jaundice C. In a traveller may present more than six months after exposure D. Is sensitive to chloroquine E. Cannot co-exist with falciparum malaria in the same patient The Answer is (E) In Coeliac disease all the following are false except A-Is the most common cause of mal-absorption in developing countries. B-Is associated with an increased risk of GI lymphoma C-Patients benefit from a diet high in complex carbohydrates such as bread and pasta. D-Is usually diagnosed on CT abdomen. E-Patients are at lower risk of osteoporosis than the non-coeliac population. Answer( B) Common cause of mal-absorption in developed countries. 8