d) A and B

e) All of the above

81) Treatment of the ascites accompanying cirrhosis may include which of the following?
a) Spironolactone
b) Hydrochlorothiazide
c) Furosemide
d) All of the above
e) A and B only
82) Which of the following joints are typically spared in osteoarthritis (OA)?
a) Ankle
b) Cervical spine
c) Distal interphalangeal joint
d) Hip
e) Knee
83) All the following organisms have been implicated in reactive arthritis except
a) Chlamydia trachomatis
b) Neisseria gonorrhoeae
c) Salmonella enteritidis
d) Shigelladysenteriae
e) Yersinia enterocolitica
84) Which of the following statements regarding the diagnosis and treatment of gastric ulcers is
(are) true?
a) The pain of gastric ulcers in contrast with duodenal ulcers is sometimes aggravated rather
than relieved by food
b) Anorexia, nausea, and vomiting are more common in patients with a gastric ulcer than in
those with a duodenal ulcer
c) Endoscopy should follow the identification of a gastric ulcer on a gastrointestinal series
d) The healing rate and the time to heal for gastric ulcers are generally longer than for
duodenal ulcers
e) All of the above
85) Which of the following drugs is classified as an H2 receptor antagonist?
a) Cimetidine
b) Ranitidine
c) Famotidine
d) A and B
e) All of the above
86) Which of the following statements regarding irritable bowel disease is false?
a) The typical location of the abdominal pain is the lower abdomen
b) Defecation frequently relieves the pain
c) There is often a perception of incomplete emptying of the rectum
d) Bowel action is often irregular
e) Very severe abdominal tenderness is a hallmark of the disease
87) What is the most characteristic sign of rheumatoid arthritis?
a) Joint swelling
b) Bilateral (symmetrical) joint involvement
c) Erythema surrounding the affected joints
d) Joint bogginess
e) Involvement of theglenohumeral joint in all cases
88) Which of the following drugs show(s) effectiveness against [Link]?
a) Bismuth subsalicylate
b) Metronidazole
 c) Amoxicillin
d) B and C
e) All of the above
89) Which of the following maternalcervical infections causes blindness in the newborn?
a) Toxoplazmosis
b) Chlamydiathrachomatis
c) Candidosis
d) Cytomegalovirus
90) What is the most common medical cause of abdominal pain in children?
a) Sickle cell disease
b) Lactase deficiency
c) Gastroenteritis
d) Mesenteric lymphadenitis
91) 7 month old baby has new onset seizures. EEG showed hypsarrhythmia What is the next best
step in management?
a) Routine pediatric neurology consultation
b) Treat with adrenocorticotropic hormone (ACTH)
c) Lumbar puncture
d) Refferal for corpus callosotomy
92) Which is the first drug to improve spasticity in cerebral palsy?
a) Midazolam
b) Diazepam
c) Botulin toxin
d) Valproic Acid
93) Which is the first drug to improve spasticity in cerebral palsy?
a) Midazolam
b) Diazepam
c) Baclofen
d) Valproic Acid
94) Gold standard investigation for diaphragmatic hernia is:
a) Chest radiography
b) Bronchoscopy
c) Abdominal x-ray
d) CT chest and abdomen
95) A 1-year-old infant is admitted for failure to thrive. During the neonatal period he had an
exploratory laparotomy for intestinal obstruction. At 3, 8, 11 months of age he had respiratory
infections diagnosed as bronchitis. The essential diagnostic study in this child is:
a) serum immunoglobulin level
b) sweat electrolytes
c) tuberculin skin test
d) Bronchoscopy
96) Which of the following drugs increase(s) the excretion of uric acid?
a) Sulfinpyrazone
b) Probenecid
c) Allopurinol
d) A and B only
e) All of the above
97) Clinical manifestation of cirrhosis include which of the following?
a) Fatigue
b) Jaundice
c) Splenomegaly
 d) Hypoalbuminemia
e) All of the above
98) Which of the following classes of drugs is most likely to precipitate attack of gout?
a) Thiazide diuretics
b) Calcium channel blockers
c) ACE-inhibitors
d) beta-blockers
e) Alpha-blockers
99) Which of the following statements regarding the role of drugs in the development of peptic
ulcer is (are) true?
a) The incidence of this condition in patients taking indomethacin or other NSAIDs is
increased
b) The use of dexamethasone is a risk factor for this condition
c) Aspiring may precipitate this condition
d) Some NSAIDs seem more likely to precipitate peptic ulcer than others
e) All of the above are true
100) True about flail chest are all except:
a) Ultimately leads to respiratory chest
b) Paradoxical respiration
c) Fracture of 3-4 ribs
d) Mediastinal shift
101) A 2-year-old develops bone marrow suppression after a viral infection. Pure red cell aplasia
is found and the child is diagnosed with transient erythroblastopenia of childhood (TEC). The
mother is told it will pass. What type of anemia is this?
a) Hypochromic microcytic anemia
b) Hyperchromic microcytic anemia
c) Hyperchromic macrocytic anemia
d) Normocytic anemia
102) A 15-days-old girl with short stature, macroglosia, hypotonia and mongoloid eyes is found to
have atrial septal defect. The most likely diagnosis is:
a) Marfan's syndrome
b) Down's syndrome
c) Turner's syndrome
d) Inborn errors of metabolism
103) A 45 year old patient presents with the classic symptoms of left-sided CHF Which possible 2-
D ECHO findings are most correctly attributable to isolated systolic dysfunction?
a) Left ventricular dilatation, with mild to moderate mitral regurgitation and an EF of 25%
b) Left ventricular hypertrophy, with shrinking of the LV cavity and partial obstruction of the
aortic outflow
c) tract with increased heart rates
d) Left ventricular septal thinning, with aneurysmal paradoxical wall motion in systole and an
EF of 30%
104) A 75 year-old man is brought to the ER via EMS after his wife found him unresponsive on the
couch. His medical history is unknown, but EMS brought a bag of the man's medications,
including several different narcotic prescriptions from multiple different physicians Vitals are
notable for respiratory rate of 6 minute, blood pressure of 90/50 with a heart rate of 60, and
Sa02 of 80% on a 100% nonrebreather face mask. Exam shows a comatose man appearing his
stated age, with mottled cool extremities. poor respiratory effort, and no gag reflex. His heart
rate is regular, with no abnormal cardiac sounds, and thready peripheral pulses Chest
examination is normal, although his breaths are very shallow and slow. His pupils are pinpoint,
 with equal deep tendon reflexes bilaterally. Which blood gas findings would be most consistent
with this patient's presentation?
a) Respiratory acidosis and hypoxemia
b) Respiratory alkalosis and hypoxemia
c) Metabolic acidosis and hypoxemia
d) Mixed metabolic acidosis and respiratory alkalosis and hypoxemia
e) Mixed metabolic alkalosis and respiratory alkalosis and hypoxemia
105) Which statement is correct concerning non-verbal communication:
a) Non-verbal communication mostly occurs in a single mode
b) Non-verbal communication is mostly under our voluntary control
c) When verbal and nonverbal communication “messages” are inconsistent or contradictory,
non-verbal messages will override verbal messages
d) Nonverbal communication has a little influence on the effect of verbal communication
106) Tumor of which part of colon leads to toxico- anemic syndrome?
a) Descending colon
b) Transverse colon
c) Cecum
d) Sigmoid colon
107) Closed questions used during medical consultation are:
a) Questions the essence of which is not clear to the patient and includes hidden information
b) Specific questions which require concrete answers, like "Yes" or "No"
c) Questions which are aiming and clarifying the reason of the visit of the patient
d) Questions which require general and comprehensive answers
108) Hypochromic anemia is likely to be associated with one of following disorders
a) Thalassaemia
b) megaloblastic anemia
c) ABO incompatibility
d) Rh incompatibility
109) A cyanotic 20-month-old child has a continuous murmur over the precordium and over the
back. The child has in no visible distress. This clinical picture can be associated with one of the
following disorders
a) Bronchoilitis
b) Tetralogy of Fallot
c) Bronchopneumonia
d) Myocarditis
110) A 48-year-old male complains to his physician of chronic heartburn. He has been tried on
ranitidine and omeprazole, and completed an empiric course of amoxicillin, clarithromycin, and
omeprazole after serologic testing for H. pylori was positive. and esophagogastroduodenoscopy
is ordered, and evidence of chronic GERD are visible, with velvety red mucosa invading the distal
portion of the esophagus. biopsies of this mucosa show intestinal metaplastic changes. Which of
the following is true?
a) This finding is associated with an increased risk of squamous cell carcinoma
b) this finding is associated with an increased risk of adenocarcinoma
c) this finding is representative of endothelial hyperplasia in response to chronic acid
exposure
d) this finding is associated with elevated serum gastrin levels and an esophageal web
e) this finding does not indicate an increased risk of cancer
111) A 3-day-old infant born at 32 weeks gestation and weighing 1700g has 3 episodes of apnea,
each lasting 20-25 seconds and occurring after a feeding. Between episodes the child displays
normal activity, blood sugar and serum calcium is normal. The child's apneic periods most likely
are:
 a) due to an immature respiratory center
b) secondary to hypoglycemia
c) manifestations of seizures
d) evidence of pulmonary disease
112) Intracranial calcifications can appear in infants who have a congenital infection with:
a) treponema pallidum
b) Toxoplasma gondii
c) rubella virus
d) herpes simplex virus
113) The normal consciousness is the sign of:
a) Lennox-Gastaut syndrome
b) West syndrome
c) Absence
d) Simple partial seizures
114) 5-year-old boy who was previously healthy has a 1-day history of low-grade fever, colicky
abdominal pain and a skin rash. A diffuse erythematous maculopapular rash is present on his
buttocks and lower extremities. There is no localized abdominal tenderness or rebound: Your
tentative diagnosis is Henoch-Schonlein purpura. All the following laboratory findings would
support your clinical diagnosis, EXCEPT:
a) serum complement level: normal
b) urinalysis: 3 RBCs per field,
c) stool: blood positive
d) platelet count: 35.000/mm
115) Which of the following is the main etiological factor for respiratory distress and newborns:
a) Surfactant insufficiency
b) iron deficiency
c) low hematocrit
d) vitamin K deficiency
116) A 8-month-old girl is admitted to a hospital because of poor weight gain despite a voracious
appetite. The presence of steatorrhea and a right upper lobe pneumonia points to:
a) Lung tuberculosis
b) Cystic fibrosis
c) Lactose intolerance
d) Congenital syphilis
117) What is the main complication of status epilepticus?
a) Diarrhea
b) Herniation of the brain
c) Microcephaly
d) Anencephaly
118) In the fetus or neonate, what are the two sutures between the frontal and parietal bones?
a) frontal
b) sagittal
c) lambdoid
d) coronal
119) Which anemia usually accompanies rheumatoid arthritis?
a) Microcytic: hypochromic
b) Microcytic: normochromic
c) Normocytic: normochromic
d) Macrocytic: hyperchromic
e) Normocytic: hypochromic
120) The determination of the agent of choice for the prophylaxis of gout attacks is made by
which of the following?
a) A serum blood level
b) A joint fluid aspiration
c) A 24 hour urine determination of uric acid
d) A joint x-ray
e) None of the above
121) What is not a complication of Appendicitis:
a) Appendicular mass
b) Peritonitis
c) Ulcerative colitis
d) Pylephlebitis
122) Late complication of pancreatitis is
a) Shock
b) Pseudocyst
c) Peritonitis
d) Ascites
123) Presence of free air under the right diaphragm is indicative of
a) Acute pancreatitis
b) Intestinal obstruction
c) Duodenal perforation
d) Choledocholithiasis
124) Child has to sit unassisted at which age?
a) 4 months
b) 3 months
c) 6 months
d) 5 months
125) West's syndrome consists of the triad of
a) Infantile spasms, hydrocephalus, 3 Hz spike-wave
b) absence seizures, myoclonic seizures, 3 Hz spike-wave
c) myoclonic seizures, agenesis of the corpus callosum, hypsarhythmia
d) infantile spasms, developmental arrest, hypsarrhythmia
e) absence seizures, developmental arrest, 4-6 Hz spike-wave
126) Which is the best method to assess neuromuscular diseases?
a) EMG
b) EEG
c) Computerized tomography
d) Skull X-ray
127) Which is the best method to assess cerebral structures?
a) EMG
b) EEG
c) Computerized tomography
d) Skull X-ray
128) Which is the best method to assess cerebral structures?
a) EMG
b) EEG
c) Magnetic resonance imaging
d) Skull X-ray
129) The following drugs are recommended for the treatment of absences:
a) Succinimides
b) Neuroleptics
 c) Barbiturates
d) Carbamazepine
130) The transient Todd’s paresis is associated with:
a) Generalized epilepsy
b) Simple absence
c) Complex absence
d) Partial epilepsy
131) The typical EEG pattern of Juvenile absence epilepsy is:
a) Diffuse slow wave activity
b) Generalized bilateral synchronous 3,5-4 Hz. Spike-wave complexes.
c) Low amplitude activity
d) Hypsarrhythmia
132) West syndrome usually occurs in:
a) Neonatal period
b) Up to 1 year of age
c) School period
d) Pre-school period
133) Which of the following is the best environment or means for providing bad news to patients
(e.g. about the diagnosis of grave disease and prognosis related to it):
a) By phone
b) In the lobby
c) By the group of professionals involved in the care of the patient
d) By attending doctor in the consultation room
134) Which of the following are not supported by research concerning consultation and making
medical records
a) Making medical records during the conversation does not interfere with doctor-patient
communication
b) Patients hesitate to start talking until the doctor makes eye contact with the patient
c) During the consultation patients are tend to stop talking when the doctor turns to medical
records, patient will resume talking when the doctor re-establishes eye contact with
him/her
d) The patients flow of thoughts is impaired, when the doctor is mostly busy with writing
medical records and does not look at the patient
135) Which of the following is correct forHemolytic-uremic syndrome:
a) Antibiotic therapy is treatment of choice for Hemolytic-uremic syndrome
b) Hemolytic-uremic syndrome consists of the triad of microangiopathic hemolytic anemia,
thrombocytopenia, and acute renal failure
c) Atypical HUS (aHUS) is used to describe hemolytic-uremic syndrome mediated by Shiga
toxin
d) Hemolytic-uremic syndromeis the same as thrombotic thrombocytopenic purpura (TTP)
136) An infant presents with violent episodes of irritability, colicky pain, and emesis that are
interspersed with relatively normal periods. A barium enema is performed, showing a coiled-
spring appearance to the bowel. Which of the following is most likely?
a) Intussusception
b) Cholecystitis
c) Appendicitis
d) Testicular torsion
137) Virus of measles does not affect:
a) Brain
b) Bone and muscles
c) Intestines and respiratory tract
 d) Skin
138) In case of contact with measles what is the probability to get the infection for non-immune
people
a) 10-15%
b) 100%
c) 1-2%
d) 30-40%
139) Which of the following is correct for VZV infections:
a) Chickenpox follows zoster infection in immunocompromised children
b) Ramsay-Hunt syndrome is when there is no peripheral facial palsy, but only pain in the
upper extremities with intensive vesicles rash on fingers
c) When the presentation includes the typical dermatological rash, additional studies are
also required
d) Varicella-zoster virus (VZV) causes chickenpox and herpes zoster (shingles)
140) You have informed your patient about the results of PAP test which confirmed the diagnosis
of cervical cancer. As soon as she heard about the cancer she started crying. What would you do.
a) I will touch the patient and will try to reassure and comfort her
b) I will tell the patient that it is not right time for emotions and crying; this will help her to
calm down
c) After giving the patient time to express her feelings, I will try to express my support and
will try to reassure and comfort the patient
d) I will not interrupt the consultation and will continue delivering information expecting
that she will calm down step by step
141) Febrile seizure can occur:
a) Before 6 years of age
b) 6-12 years of age
c) Puberty period
d) Up to 20 years of age
142) The drug of the first choice in west syndrome is:
a) ACTH
b) Carbamazepine
c) Piracetam
d) Antibiotics
143) Complex febrile seizure is characterized by:
a) Duration < 15 minutes
b) Duration > 15 minutes
c) Rare episodes
d) Preserved consciousness in ictal period
144) Lennox-Gastaut Syndrome is defined as:
a) Only febrile seizures
b) Only partial seizures
c) Disease with benign course
d) Frequent, sometimes serial polymorphic seizures with mental retardation
145) Infantile spasms can occur at
a) 3 years of age
b) 3-7 months of age
c) In neonatal period
d) In puberty period
146) The source of infection for measles is not:
a) Acute patient in the beginning of the disease
b) Patient with fare rash of measles
 c) Patient with macular-papular rash in the middle of the disease
d) Patient having panencephalitis after attack of the disease 5-10 years later
147) In general, children with pharyngitis should not be treated with antibiotics empirically as
most episodes are viral. If Group A Streptococcus (GAS) is suspected, what is the drug of choice?
a) Doxycycline
b) Penicillin
c) Ketoconazole
d) Ceftriaxone
148) A continuous “machinery” murmur is heard in patients with
a) Patent ductus arteriosus
b) Tetralogy of Fallot
c) Coarctation of the aorta
d) Transposition of the great arteries
149) Which of the following is NOT characteristic of diabetic ketoacidosis?
a) Type II diabetes
b) Polyuria, polydipsia
c) Kussmaul breathing
d) Fruity breath and cerebral edema
150) An infant presents with anorexia, apathy, easy fatigability, and irritability. Physical exam
reveals skin pallor, glossitis, and koilonychias. Labs reveal iron deficiency. Which of the following
is most likely?
a) Hypochromic microcytic anemia
b) Hyperchromic microcytic anemia
c) Hypochromic macrocytic anemia
d) Hyperchromic macrocytic anemia
151) Which of the following can cause eye lens dislocation and involves a defect in the pathway
that converts methionine to cysteine and serine?
a) Gaucher disease
b) Hurler syndrome
c) Phenylketonuria
d) Homocystinuria
152) A 31 year-old woman G2P1 at 40 weeks’ gestation has progressed in labor from 4 to 7cm.
cervical dilatation during 2 hours. Which of the following best describes the labor?
a) latent phase of the I stage
b) Passive phase of the II stage
c) Active phase of the II stage
d) Active phase of the I stage
153) What is the approximate weight of the fetus at 20 gestational weeks?
a) 200g
b) 300 g
c) 480 g
d) 650 g
154) What is the approximate weight of the fetus at 16 gestational weeks?
a) 25 g
b) 50 g
c) 110 g
d) 250 g
155) What is the approximate eight of the fetus at 24 gestational weeks?
a) 500 g
b) 630 g
c) 750 g
 d) 890 g
156) What is the approximate eight of the fetus at 28 gestational weeks?
a) 750 g
b) 890 g
c) 1100 g
d) 1500 g
157) What is the average weight of the fetus at 36 gestational weeks?
a) 1990 g
b) 2500 g
c) 2850 g
d) 3000 g
158) At what gestational age will the fetus first demonstrate spontaneous movements if removed
from the uterus?
a) 8 weeks
b) 10 weeks
c) 12 weeks
d) 14 weeks
159) An 18-year-old woman had a yellowish vaginal discharge. On examination, the cervix is
erythematous an the discharge reveals numerous leukocytes. Which of the following is most
likely etiology?
a) Neisseria gonorrhea
b) Chlamydia thrachomatis
c) Thrichomona vaginalis
d) Ureaplazma species
160) A 34 year-old woman is diagnosed as having a vaginitis based on a “ fishy odor” to her
vaginal discharge and vaginal pruritus. The cervix is normal in appearance. Which of the
following most likely corresponds to the etiology?
a) Neisseria gonorrhea
b) Chlamydiathrachomatis
c) Gardnella
d) Cytomegalovirus
161) Where is the complete molecule of human chorionic gonadotropins primarily produced?
a) Syncytiotrophoblast
b) Cytotrophoblast
c) chorionic membrane
d) Hofbauer cells
162) Which of the following measures belongs to primary prevention
a) Mammography for detecting breast cancer
b) Measures for preventing osteoporosis in health women
c) Regular measurement of atrial blood glucose for detecting diabetes
d) Hearing loss evaluations in newborns
163) Which of the following is most likely to cross the placenta?
a) Thyroxine
b) Triiodothyronine
c) reverse triiodothyronine
d) thyroid-releasing hormone
164) Which of the following in not increased in pregnancy?
a) blood leukocyte count
b) C-reactive protein
c) leukocyte alkaline phosphate activity
d) alpha-interferon
165) What is the average increase in maternal blood volume during pregnancy?
a) 10%
b) 25%
c) 50%
d) 75%
166) What is the solid ball of cells formed by 16 or more blastomeres?
a) Morula
b) Blastocyst
c) Zygote
d) Embryo
167) What is a nulligravida?
a) a woman who never delivered a live-born baby
b) a woman who had one miscarriage
c) a woman who has never been pregnant
d) a woman who had only one pregnancy
168) What is the mean duration of pregnancy from the first day of the LMP?
a) 250 days
b) 260 days
c) 270 days
d) 280 days
169) Naegele’s rule estimates gestation age based on which of the following formulas?
a) Add 7 days to LMP and count back three months.
b) Subtract 7 days from LMP and count back three months.
c) Add 21 days to LMP and count back three months.
d) Subtract 21 days from LMP and count back three months.
170) Which of the following vitamins is important to be given prophylactically for the fetus soon
after birth (especially in the breast-feeding newborn)?
a) vitamin K
b) vitamin A
c) vitamin C
d) vitamin D
171) Which of the following types of uterine fibroids would most likely lead tu recurrent
abortion?
a) Submucosal
b) Intramural
c) Subserous
d) Intraligamental
172) A baby is born in the following condition at 1 minute. She is pink with a heart rate of 120
bpm. She is not moving or crying and has taken a few irregular gasps. Her limbs are flaccid but
she is moving her facial muscles. What is her Apgar score?
a) 9
b) 7
c) 6
d) 5
173) Which of the following statements are true of sexually transmitted infections (STIs)?
a) Gonorrhoea in women is best diagnosed by cultures of material from the posterior vaginal
fornix.
b) Syphilis is adequately treated in penicillin-allergic pregnant women by doxyciklin.
c) Contact tracing partners of women with first attack genital herpes is helpful.
d) Bacterial vaginosis should be diagnosed by culture of a high vaginal swab (HVS) for
Gardnerella vaginalis.
174) Which of the following are associated with causing tubal damage leading to tubal
subfertility?
a) Trichomonas vaginalis.
b) Gonorrhoea.
c) Candidos.
d) Gardnelos.
175) A woman on the postnatal ward bursts into tears when you go and see her 48 hours after
the birth of her [Link] of the following might indicate that she is at high risk of developing
postnatal depression?
a) She does not show any interest in her infant who is crying insistently.
b) She is bottle feeding the baby.
c) She is unable to sleep.
d) Her partner was present at the birth of the baby
176) The plane of which of the following diameters represents the greatest circumference of the
head?
a) Occipitofrontal
b) Suboccipitobregmatic
c) Bitemporal
d) Biparietal
177) What does the portion of the deciduas invaded by the trophoblast become?
a) decidua basalis
b) decidua capsularis
c) decidua vera
d) decidua parietalis
178) What is the duration of the proliferative phase of the menstrual cycle?
a) Variable
b) 10 to 12 days
c) 12 to 14 days
d) most commonly over 14 days
179) Which of the following is not increased during normal pregnancy?
a) glomerular filtration rate
b) renal plasma flow
c) creatinine clearance
d) plasma concentration of urea
180) TSH or Thyrotropin is secreted from
a) Anterior pituitary
b) Posterior pituitary
c) Hypothalamus
d) Thyroid gland
181) Which of the following agent is used to prevent malaria:
a) Mebendazole
b) Chloroquinone
c) Inactivated vaccine
d) Zinc tablet
182) Accidental intermediate host for hydatid disease is:
a) Cow
b) Cat
c) Dog
d) Pig
183) Congenitally transmitted parasitic infection:
a) Pneumocystis carinii
 b) Toxoplasma gondii
c) Amoebiasis
d) Trichuris trichura
184) Most common parasitic infection in AIDS:
a) Ancylostoma duodenale
b) Echinococcus granulosus
c) Strongyloides stercoralis
d) Enterobius vermicularis
185) The mucosa of the cystic duct is arranged in spiral folds known as:
a) Rugae
b) Marshall’s fold
c) Valves of Heister
d) Palmate folds
186) [Link]’s point is located at
a) Right upper quadrant
b) Around umbilicus
c) Left lower quadrant
d) Right lower quadrant
187) If a patient diagnosed with Graves’ disease is found to be pregnant or desire to conceive
soon after treatment, which method of treatment is indicated?
a) Antithyroid drugs
b) Radioactive Iodine therapy
c) Surgical treatment
d) Any treatment is contraindicated
188) Blood result in toxic nodular goiter will be
a) Suppressed TSH level and elevated free T4 or T3 levels
b) Elevated TSH level and elevated free T4 or T3 levels
c) Elevated TSH level and suppressed free T4 or T3 levels
d) Suppressed TSH level and suppressed free T4 or T3 levels
189) Aspiration of foreign bodies most often occurs:
a) Left lower lobe in bronchus
b) Right upper lobe in bronchus
c) Left main bronchus
d) Right lower lobe in bronchus
190) A massive hemothorax is defines as
a) <1500 mL of blood
b) >2500 mL of blood
c) >500 mL of blood
d) >1500 mL of blood
191) Gridirion incision for appendicectomy is centred on
a) Palmer’s point
b) Agnew point
c) McBurney’s point
d) Chevrons point
192) Acute suppurative thyroiditis is caused by
a) Streptococcus
b) Bacteroids
c) Rabies
d) Poliomyelitis
193) What is the most often complication of gastric ulcers?
a) Perforation
 b) Stenosis
c) Bleeding
d) Penetration
194) Grey Turner’s sign is
a) petechial rash all over body
b) cyanosis of extremities
c) greenish yellow coloration of body
d) blue discoloration of flanks
195) Tumor of head of pancreas caused the development of mechanical jaundice and frequent
vomiting. What is the mechanism of vomiting?
a) Neoplastic intoxication
b) Duodenal obstruction
c) Mechanical jaundice and bilirubinemia
d) Cholangitis and liver failure
196) What percentages of patients with thoracic trauma require thoracotomy:
a) 10%-15%
b) 20%-30%
c) 30%-40%
d) None of the above
197) Most valuable investigation for preoperative evaluation of extensive corrosive stricture is
a) Endoscopic ultrasound
b) Chest X-ray
c) CT Thorax
d) Pharyngoscopy
198) Which of the following is true regarding chest tube drainage
a) the tube is inserted into the 4th intercostal space slightly anterior to the mid axillary line
b) the tube is inserted into the 5th intercostal space slightly anterior to the mid axillary line
c) the tube is inserted into the 5th intercostal space slightly anterior to the midclavicular line
d) the tube is inserted into the 4th intercostal space slightly anterior to the midclavicular line
199) Which drug is most helpful in prevention of NSAIDs induced ulcers?
a) Omeprazole
b) Ranitidine
c) Steroids
d) H2 antagonists
200) The Iodine storage capacity of thyroid gland is
a) >70%
b) >80%
c) >60%
d) >90%
201) Appendicitis may lead to
a) Chrons disease
b) Peritonitis
c) Mechanical obstruction of intestines
d) Ulcerative colitis
202) Open pneumothorax occurs due to
a) full thickness loss of the chest wall
b) partial thickness loss of the chest wall
c) half the thickness loss of the chest wall
d) 70 % thickness loss of the chest wall
203) Hookworm infection leads to deficiency of :
a) Vitamin B12
 b) Vitamin A
c) Iron
d) Folic acid
204) Which of the following is the most common cause of cholecystitis?
a) Tumor of the head of pancreas
b) Liver cirrhosis
c) Cholelithiasis
d) Biliary cirrhosis
205) The triad of symptoms of cholecystitis includes:
a) Jaundice,fever and leukocytosis
b) Fever,leukocytosis and right upper quadrant tenderness
c) Fever,periumbilical tenderness and leukocytosis
d) Leukocytosis,jaundice and right upper quadrant tenderness
206) Appendicitis mostly may occur
a) After a bout of flu
b) when the opening of appendix becomes blocked
c) mainly as an auto immune process
d) After trauma
207) Usual procedure of choice for acute uncomplicated cholecystitis:
a) Laproscopic cholecystectomy in 3-4 days after the diagnosis
b) Open cholecystectomy in 3-4 days after the diagnosis
c) Laproscopic cholecystectomy in 10 days after the diagnosis
d) Open cholecyastectomy in 10 days after the diagnosis
208) Which of the following is (are) associated with Crohn’s disease?
a) Skip lesions on x-ray
b) Thumbprinting on x-ray
c) Ineffective surgical treatment
d) None of the above
e) A, B, and C
209) Which of the following conditions (symptoms) is not associated with irritable bowel disease?
a) Gastroesophageal reflux disease
b) Cholelithiasis
c) Noncardiac chest pain
d) Depression
e) Fatigue
210) What is the most common complication during laparoscopic cholecystectomy?
a) Excessive bleeding
b) Small bowel perforation
c) Injury to the biliary tract system
d) Inability to remove the gallbladder through the laparoscope
e) Liver laceraition
211) Which of the following is (are) complications of acute pancreatitis?
a) Ascites
b) Pleural effusion
c) Abscess formation
d) All of the above
e) None of the above
212) The main disadvantage of truncal vagotomy is
a) dumping syndrome
b) mortality
c) tachycardia
 d) delayed gastric emptying
213) Which of the following features is a characteristic of Ehlers-Danlos syndrome?
a) thickening of the skin
b) mental retardation
c) an increased incidence of skin carcinoma
d) thrombocytopenia
e) habitual dislocation of joints
214) Which of the following statements about acute pancreatitis is (are) true?
a) Many cases of this disease are associated with a pathologic condition of the biliary tract
b) strong evidence suggests a link between this disease and alcohol
c) The chronic condition of this disease is more likely to be associated with alcohol abuse
rather than biliary tract disease
d) All of the above statements are true
e) None of the above statements is true
215) You are approached by your patient who asks you to give him the copy of his medical
records, because he plans to visit another doctor, what would you do
a) I will refuse because the patient has not right to get acquainted with medical records
b) I will make the copy of medical records and give it to the patient
c) I will give the patient medical records
d) I will make the copy of medical records and give it to the patient s relative
216) Which of the following drugs would be most likely to provide significant relief in the case of
acute gout attack?
a) Oral prednisone
b) Oral dexamethasone
c) Intravenous hydrocortisone
d) Intravenous methylprednisolone
e) Intraarticular methylprednisolone acetate
217) Holistic approach in family medicine includes:
a) Assessment of all organs and organ systems during managing the problem of patient
b) Using a bio-psycho-social model taking into account cultural and existential dimensions
c) Assessment of patient's mental and physical status
d) Management of simultaneously multiple complaints and pathologies, both acute and
chronic health problems in the individual
218) A patient presents with 3 weeks of pain in the lower back. All the following are risk factors
for serious causes of spine pathology except
a) age more than 50 years
b) urinary incontinence
c) duration of pain more than 2 weeks
d) bed rest without relief
e) history of intravenous drug use
219) Which of the following recommendation is correct concerning delivering bad news:
a) Information shall be given quickly without interruption
b) Information shall be given in small chunks and patient s understanding shall be checked
Information shall periodically
c) It is better if doctor mostly uses technical terminology when breaking bad news
d) Information shall be given without any emotions
220) Which of the following statement is correct:
a) Family doctor is responsible for ensuring comprehensive and continuing care to every
individual
b) Family doctor is responsible for the provision of care only at the initial stage of the disease
c) Family doctor is primarily responsible for disease prevention and health promotion
 d) Family doctor is primarily responsible for maternal and child health care
221) Which of the following is correct for Dengue:
a) It is transmitted by mosquitoes of the genus Anopheles
b) Dengue is the most common and important arthropod borne viral (arboviral) illness in
humans
c) The incidence of dengue has decreased dramatically in recent decades
d) persons who have previously been infected by one dengue serotype never develop
bleeding and endothelial leak upon infection with another dengue serotype
222) A 55-year-old male with COPD is hospitalized for pneumonia and respiratory failure and
treated with broad-spectrum antibiotics. The month after leaving the hospital, he follows up
with his primary care doctor with a new complaint of hearing loss and dizziness. Bilateral
sensorineural deafness is diagnosed via audiometry. This is most likely related to the use of
which class of medications?
a) Corticosteroids
b) Beta-adrenergic agents
c) Beta-lactam antibiotics
d) Fluoroquinolones
e) Aminoglycosides
223) Bowel obstruction can be diagnosed by:
a) an elevated white blood cell count
b) serum creatinin level
c) abdominal X-Ray
d) chest X-Ray
224) Murphy’s sign is seen in:
a) acute pancreatitis
b) acute diverticulitis
c) acute cholecystitis
d) acute appendicitis
225) Which of the following is correct for Hemolytic-uremic syndrome:
a) Pneumococcal-associated hemolytic-uremic syndrome does not constitute a distinct
subgroup of HUS
b) WBCs are usually decreased in the blood of patients with hemolytic-uremic syndrome
c) STEC-HUS is usually preceded by a colitis caused by Shiga toxin-producing Escherichia
(STEC)
d) Hemolytic-uremic syndromeis the same as thrombotic thrombocytopenic purpura (TTP)
Thrombocytois is believed to result from a combination of platelet destruction
226) Initial screening for hepatitis B should include which of the following?
a) Anti-hepatitis B surface antigen (HBsAg) and anti-HBc
b) Hepatitis B early antigen (HBeAg) and anti-HBe
c) HBsAg and anti-HBs
d) HBsAg and anti-HBc
e) Anti-HBe and anti-HBc
227) Which of the following investigations is more informative NS cost-effective to diagnose
gallstones?
a) A white blood cell count
b) An oral cholecystogram
c) An abdominal ultrasound
d) An electrocardiogram
e) CT of abdomen
228) A 43-year-old man with diabetes and cardiomegaly has had an attack of pseudogout. He
should be evaluated for which of the following?
 a) Renal disease
b) Hemochromatosis
c) Peptic ulcer disease
d) Lyme disease
e) Inflammatory bowel disease
229) The ascites associated with cirrhosis should generally be treated by which of the following?
a) Sodium restriction
b) Water restriction
c) Spironolactone
d) A and C
e) A, B, and C
230) The disease described affects one particular part of the spine. What is the affected part, and
what are the affected vertebrae?
a) Cervical: C6-C7
b) Cervical: C1-C2
c) Thoracic: T7-T9
d) Lumbar: L1-L3
e) LumbarL L4-L5
231) Which of the following statements regarding cimetidine is (are) true?
a) Cimetidine is an H2 receptor antagonist
b) Cimetidine and antacids are no more effective than cimetidine alone in the treatment of
peptic ulcer
c) Exacerbation of peptic ulcer is common
d) Cimetidine may interfere with warfarin metabolism
e) All of the above are true
232) Which of the following is the most important component of the management of irritable
bowel disease?
a) Single-agent pharmacologic therapy
b) Multiple-agent pharmacologic therapy
c) A therapeutic physician-patient relationship
d) A focused diet
e) A diet elimination trial: eliminating one food at a time until the responsible food is found
233) What is (are) the essential diagnostic feature(s) of acute pancreatitis?
a) Abrupt onset of epigastric pain with radiation to the back
b) Nausea and vomiting
c) Elevated serum amylase
d) All of the above
e) None of the above
234) Which of the following laboratory tests is (are) usually abnormal in a patient with acute viral
hepatitis?
a) serum AST
b) serum bilirubin
c) serum ALT
d) serum alkaline phosphatase
e) All of the above
235) What is the most common extraarticular manifestation of ankylosing spondylitis?
a) Anterior uveitis
b) Aortic regurgitation
c) Cataracts
d) Inflammatory bowel disease
e) Third-degree heart block
236) Which of the following may develop if Kawasaki disease is suspected?
a) Hypoplastic left heart syndrome
b) Coronary artery aneurysms
c) Aortic stenosis
d) Mitral regurgitation
237) The following are related to the typical absences:
a) Abrupt onset
b) The gradually onset
c) 0,5-2,5 Hz. Spike-wave complexes
d) Duration of seizures 30 seconds and more
238) What kind of rash is measles characterized ?
a) petechiae on face
b) vesicles on body except extremities
c) macular-papular generalized
d) erythemanodosum
239) What is the normal head circumference in full term newborn?
a) 32 cm
b) 30 cm
c) 34 cm
d) 28cm
240) Aura can be:
a) Visual
b) Auditory
c) Gustatory
d) All of them
241) In the course of the pathophysiology of rheumatoid arthritis, which of the following is most
characteristic of the disease?
a) Synovial proliferation with cartilage erosion stimulated by cytokines
b) Cartilage destruction stimulated by the proliferation of proteoglycans
c) Cartilage destruction stimulated by the enzymatic action of proteoglycans
d) Loss of the synovial membrane
e) None of the above; the pathophysiology of the disease is not known with any certainty
242) On what is the pathophysiology of rheumatoid arthritis is based?
a) Bone destruction
b) Bone spur formation
c) Bone sclerosis
d) Symmetrical joint involvement
e) Synovial inflammation
243) Which of the following antibiotic works as a prokinetic drug and is used in delayed gastric
emptying?
a) penicillin
b) ceftriaxone
c) cefazoline
d) erythromycin
244) First step in the management of appendicular mass includes
a) Open surgery
b) Laproscopic appendicectomy
c) No treatment needed
d) Conservative Ochsner- Sherren regimen
245) Hydatid cyst is commonly seen in:
a) Liver
 b) Lung
c) Spleen
d) Heart
246) Usual diagnosis of pneumothorax is done using:
a) Barium swallow
b) Chest CT
c) X ray
d) MRI
247) Diffuse toxic goiter is otherwise called
a) Hamburger thyrotoxicosis
b) Graves’ disease
c) Hashimoto's thyroiditis
d) Subacute thyroiditis
248) Which of the following hormone affects the motor activity of gall bladder:
a) gastrin
b) cholecystokinin
c) aldosterone
d) somatostatin
249) Conditions which builds within hemithorax resulting in collapsed lung, flattened diaphragm,
contralateral mediastinal shift and compromised venous return of heart is known as:
a) Open pneumothorax
b) Tension pneumothorax
c) Massive pulmonary hemorrhage
d) Flail chest
250) Which of the following is the best treatment of a suspected dermoid cystfound in an 18 year
–old nulliparous woman?
a) Observation
b) Hysterectomy
c) Adnexectomy
d) Cystectomy
251) A 28 year-old woman has multiple painful pustules erupting through out the skin of her
body. Which of the following most likely corresponds to the etiology?
a) Neisseria gonorrhea
b) Chlamydia thrachomatis
c) Gardnella
d) Cytomegalovirus
252) Which of the following is true of choriocarcinoma?
a) There is early spread to bones.
b) Hysterectomy is only method of treatment
c) After hydatidiform mole the risk of choriocarcinoma is 40%.
d) After hydatidiform mole the risk of choriocarcinoma is 4%.
253) The condition of replacement of all or part of the thyroid parenchyma by fibrous tissue,
which also invades into adjacent tissues is named
a) Hashimoto's thyroiditis
b) Riedel's thyroiditis
c) Graves’ disease
d) Goiter
254) Nasotracheal intubation:
a) Is preferred for unconscious patient without cervical spine injury
b) Is preferred for patient with suspected cervical spine injury
c) Maximizes neck manipulation