MCQs and cases in medicine

1. A 70-year old women, presented with a history of syncopal attack. She has
ischemic heart disease and diabetes mellitus type. The clinical
examination revealed a pulse of 40 bpm, regular, normal blood pressure.
Cardiopulmonary auscultation revealed no added sounds or any murmurs.
Regarding the management,
all the followings are true, EXCEPT
A. Absence of anginal pain excludes acute myocardial infarction
B. Beta blockers can precipitate this attack
C. ECG is of diagnostic value
D. Pacemaker is used as treatment option
E. Neurological deficits may complicate this condition
2. A 20-year old student presented with a 3 days history of retro-sternal chest
pain, which is exaggerated by deep breathing, cough and lying flat. Pulse rate
is 115 beats, per min, blood pressure was 130/80 mmHg, both lungs are free,
cardiovascular examination revealed high-pitched superficial scratching
sound.
All the followings are true, EXCEPT
A. History of low grade fever is common
B. ECG changes seen only in limb leads
C. The non-steroidal anti-inflammatory drugs used in the management
D. Coxsackie virus is possible underlying causative agent
E. Pericardial effusion can complicate this condition
3. In hypertrophic obstructive cardiomyopathy, the followings are true,
EXCEPT:
A. Autosomal dominant inheritance
B. Left ventricular outflow tract obstruction is a feature
C. Echocardiography is usually diagnostic
D. Digoxin and vasodilators are indicated to decrease the outflow obstruction
E. Increase incidence of sudden cardiac death
4. A-23-year old man with family history of sudden cardiac death is diagnosed
as having hypertrophic obstructive cardiomyopathy.

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Which of the following is the strongest marker of poor prognosis
A. mitral regurgitation
B. apical hypertrophy
C. systolic anterior motion of mitral valve leaflet
D. septal wall thickness of ˃ 3 cm
E. asymmetric hypertrophy
5. A 65-year-old man with no significant past medical history is admitted to the
Emergency Department. His ECG is consistent with an anterior myocardial
infarction. Unfortunately he develops cardiac arrest shortly after arriving in the
department.
What is the most common cause of death in patients following a
myocardial infarction
A .Pulmonary embolism
B. Cardiogenic shock
C. Papillary muscle rupture
D. Ventricular fibrillation
E . Compete heart block
6. A 57-year-old man presents to the Emergency Department with a 15 minute
history of severe central chest pain radiating to his left arm. ECG shows T-
wave inversion in leads1,AVL, V5 and V6
Which coronary artery is most likely to be affected
A- Left circumflex
B - Posterior descending
C- Left main stem
D- Right coronary
E. Left anterior descending
7. A-64-year-old man is admitted to the Emergency Department with chest
pain radiating through to his back. On examination pulse 90 regular, BP
140/90. A CXR shows mediastinal widening. A CT shows dissection of the
descending aorta.
What is the most suitable initial management
A. Observe only
B. IV labetalol

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C. IV sodium nitroprusside
D .Immediate surgical referral
E. Oral verapamil
8. In pulmonary embolism, the followings are true, EXCEPT:
A. A chest X-ray may be normal
B. Anticoagulation therapy is indicated for 6 months or more
C. Sinus tachycardia is a feature
D. Deep vein thrombosis is always detected
E. D- dimer measurement is a helpful diagnostic test
9. A 72-year old man presented with a three month history of productive
cough, episodes of hemoptysis, weight loss of 8 kg in the last two months and
progressive dyspnea. He smoked 20 cigarettes per day for more than 30
years. On examination has finger clubbing and signs of left upper lobe
collapse.
The followings are true,EXCEPT:
A. Hypercalcemia is recognized complications.
B. Bronchoscopy is the most useful investigation.
C. Systemic chemotherapy is indicated in treating patients with small cell lung
cancer.
D. The majority of patients with lung cancer have limited disease at
presentation.
E. Prognosis is tumor stage dependent.
10. A 55-year old patient presents with progressive breathlessness and dry
cough. He has finger clubbing and bilateral basal crepitation. A lung function
test reveals decreased total lung volume and vital capacity with normal
FEV1/C ratio.
The most likely diagnosis is:
A. Bronchial asthma.
B. Idiopathic pulmonary' fibrosis.
C. Allergic bronchopulmonary Aspergillosis.
D. Chronic bronchitis.
E. Bronchiectasis

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11. A 46-year old man with sudden onset dyspnea, arterial blood gas analysis
showed: pH 7.47 ( 7.35-7.45) Pa02 60 mmHg( N 75-100) PaCO2 28 mmHg
( N 35-45)HCO3 24 mmol/I( 22-26)
This is compatible with all the followings, EXCEPT:
A. Lobar pneumonia.
B. Pulmonary embolism.
C. Obstructive sleep apnea syndrome.
D. Acute pulmonary edema.
E. Pneumothorax
12. The most common cause of acute cor-pulmonale:
A. sleep apnea
B. massive pulmonary embolism.
C. Chronic obstructive pulmonary disease.
D. Asthma
E. Myocardial infarction
13. The followings are true in Hepatic encephalopathy, EXCEPT:
A. Differential diagnoses include delirium tremens and Wernicke's
encephalopathy
B. Clinical features include changes of consciousness level,
C. Flapping tremor is recognized clinical finding
D. Could be prevented by lactulose and low protein diet
E. Rapid weight reduction of more than 3 Kg per day is recommended
14. Ascetic aspirate from A 55-year old showed: Protein 2.4 g/dl. Serum
Protein 6.2 g/dl. (N 5.5 - 8.0) Cell count < 100 cell/ul.
These are compatible with:
A. Tuberculous peritonitis.
B. Peritoneal carcinoma.
C. Acute pancreatitis.
D. Perforated viscous.
E. Portal hypertension
15. the following predisposing factor for CA stomach except
A. autoimmune gastritis

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B. adenomatous gastric polyp
C. previous partial gastrectomy
D. NSAIDs
E. H. pylori
16. A 45 years old woman presented with dysphagia to both solids & liquids of
gradual onset & progressive worsening over 6 years associated with episodes
of regurgitation of undigested food, cough.& loss of 7 Kg of her body
weight ,despite normal appetite , no history of nasal regurgitation & no H/O
heart burn no chest pain , no neurological symptoms
The most likely diagnosis is
A. Esophageal carcinoma
B. sliding hiatus hernia
C. Bulbar palsy
D. Achalasia
17. Which of the following are more suggestive of ulcerative colitis than
of Cohn's disease
A. Involvement of the transverse colon.
B. Presence of iron deficiency anemia.
C. Terminal ileal ulcers.
D. Elevated serum perinuclear anti-neutrophil cytoplasmic antibodies (p-
ANCA)
E. Elevated serum anti-Saccharomyces Cerevisiae (ASCA) antibodies.
18. The followings are true about Inflammatory bowel disease, EXCEPT:
A. Associated with other autoimmune diseases
B. Pan colitis occurs more in ulcerative colitis than Crohn's disease
C. Skip lesion is a characteristic feature in Crohn's disease than ulcerative
colitis
D. Acute exacerbation is ideally treated with opiates and anti-diarrheal agents
E. Periodic total colonoscopy is recommended
19. The followings are causes of Convulsions, EXCEPT:
A. Brain space occupying lesion
B. Hyperkalemia
C. Hypocalcaemia

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D. Hypoglycemia
E. Epilepsy
20. The following statements about myasthenia graves are true,
EXCEPT:
A. The muscular weakness becomes obvious after prolonged muscular effort
B. May present as intermittent ptosis
C. Has low anti-acetylcholine receptor antibodies
D. Respiratory failure is a known complication
E. Thymectomy is a treatment option
21. In management of hemorrhagic cerebrovascular diseases, all are
true, EXCEPT:
A. Anti-platelets drugs
B. Gradual blood pressure reduction
C. Close monitoring of vital signs
D. Good rehydration
E. Bed sores prevention
22. A 22-year old medical student developed a rapid progressive muscle
weakness, ascending from lower to upper limbs and bilateral distal numbness.
Neurological examination revealed bilateral lower limb hypotonia, normal
muscle bulk, muscle power of 2/5 and absent tendon reflexes. Concerning
this case the followings are true, EXCEPT:
A. History of respiratory infection in the last month is etiological significant.
B. The muscle weakness is more marked proximally
C. CSF examination revealed low protein and normal cell count.
D. Ventilatory support is advisable if respiratory muscles are affected.
E. Most of the patients showed complete recovery within 3-6 months.
23. A 55-year old man, hypertensive on irregular follow up and treatment,
presented with sudden onset of weakness, and paresthesia of the left side of
the body. His symptoms disappeared completely within 4 hours. On
examination his blood pressure is 165/98 mmHg, irregular pulse of 115b/min,
there were no any clinical neurological deficit. CT-brain showed no signs of
intracerebral bleeding.
The followings are true, EXCEPT:
A. Presence of atrial fibrillation is an important risk factor.

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B. Echocardiogram and carotid Doppler are helpful diagnostic investigations.
C. Anticoagulants (Warfarin) to be considered in the management.
D. Beta blockers are ideal antihypertensive drugs.
E. The risk of another stroke in this patient is very low.
24. This is a CSF result from a patient admitted due to headache and neck
stiffness: Cell count 1600 x 10^6/L (N 0-4) Cell type Mainly Neutrophils
Glucose 30 mg/dL (N 50-80) Protein 120 mg/dl (N < 45)
This CSF picture is compatible with:
A. Viral meningitis
B. Meningococcal meningitis
C. Tuberculous meningitis.
D. Multiple sclerosis.
E. Fungal meningitis
25. The followings are features of Acromegaly, EXCEPT:
A. Arthropathy
B. Hypertension
C. Carpal tunnel syndrome
D. Hypoglycemia
E. Prognathism
26. Regarding diabetes mellitus, the followings are true, EXCEPT:
A. Type 2 is caused mainly by insulin resistance
B. Diabetic ketoacidosis commonly seen in type
C. Prolonged hypoglycemia can induce brain damage
D. Microalbuminuria is an indicator of diabetic nephropathy
E. Sulphonyl urea drugs are used to treat type 1 diabetes mellitus
27. A 35-year old patient has carcinoma breast, presented with confusion, her
investigations showed: Serum Calcium 13.6 mg/dI (N 8.0-10.5) Alkaline
phosphatase 355 IU/l (N up to 160) Urea 95 mg/dI (N up to 45)
This condition can be treated with all the followings, EXCEPT:
A. I.V Normal saline.
B. Frusemide.
C.. Bisphosphonates

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D. Prednisolone.
E. Vitamin D
28. A 37-year female patient presented with lethargy the investigations
showed: TSH 25 (N 0.2 - 4.2) T3 2.3 mmol/I (N 3.1-6 .8 ) T4 0.04 mmol/l(N
0.6 - 1.8)
These are compatible with the followings, EXCEPT:
A. Hashimoto's disease.
B. Post total thyroidectomy condition.
C. Drug induced thyroiditis,
D. Post -partum pituitary failure.
E. Post radioactive iodine (1131) ablation therapy
29. Which of the following conditions may be detectable by growth
monitoring
A. Hyperthyroidism
B. Hypothyroidism
C. Sheehan's syndrome
D. Insulin dependent diabetes mellitus
E. Hypercalcemia
30. In a female patient with pan-hypopituitarism which one of the
following is the recommended priority for hormone replacement
A. Levo-thyroxine.
B. Estrogen.
C. Hydrocortisone.
D. Growth hormone.
E. Desmopressin.
31. Concerning Hodgkin's lymphoma, all are true, EXCEPT:
A. Is a mono-clonal B-cell lymphoma
B. painless rubbery lymphadenopathy
C. CT scan of chest and abdomen is essential for staging
D. It recognized by presence of Reed-Sternberg cells
E. Carries poor prognosis in comparison to other types

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32. The followings are seen in polycythemia rubra Vera (PRV), EXCEPT:
A. High ESR
B. Raised Hematocrit and red cell mass
C. Leukocytosis
D. Hyperuricemia
E. Bleeding diathesis
33. A 60-year old presented with history of Malaise, headache and exertional
dyspnea. The physical examination revealed pale skin and mucous
membrane, normal abdominal examination. The investigations showed: Hb
6.5 g/dl, MCV 122 fl (N80-100), MCH 32 (N26-34), normal iron and ferritin.
All the followings are true, EXCEPT:
A. Dietary history is significance
B. Sensory ataxia and neuropathy may associate this condition
C. It may caused by atrophic gastritis
D. Vitamin B12 should be measured
E. Corticosteroid therapy is treatment of choice
34. A 32-year body builder under aggressive muscular training program
presented with history of severe headache, blurred vision and reduction of
rime amount. He is not known hypertensive or diabetic. Clinically is
dehydrated, blood pressure 170/105 mmHg, no LL edema. Blood tests
revealed urea 120 mg/dI, creatinine 3.2 mg/dl, urine appears tea-like
appearance.
The followings are true, EXCEPT:
A. Urine examination for myoglobin is important.
B. History of drug intake is of etiological factor.
C. Good hydration is needed.
D. Renal biopsy is not indicated.
E. Plasma exchange is the treatment of choice
35. Features of chronic myeloid leukemia (CML) include
A. Generalized lymphadenopathies
B. It is almost a disease of children
C. Low level of serum vitamin B12 concentration
D. Translocation 9, 22

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E. Deletion 11g 13
36. Proteinuria more than 3 g/L per day is caused by the followings,
EXCEPT:
A. Chronic Pyelonephritis
B. D-penicillamine prolonged therapy
C. Minimal change nephropathy
D. Membranous Glomerulonephritis
E. Renal Amyloidosis.
37. The followings are true about renal artery stenosis, EXCEPT:
A. The commonest cause is atherosclerosis
B. Hypertension developed only in bilateral stenosis
C. The definitive diagnosis is made by renal arteriography
D. Ischemic nephropathy is a complication
E. Angioplasty is treatment option
38. Normal anion gap metabolic acidosis is caused by the followings,
EXCEPT:
A. Carbonic anhydrase enzyme inhibitor administration
B. Proximal renal tubular acidosis
C. Acute ethanol intoxication.
D. Distal renal tubular acidosis
39. The following statements about Infectious diarrhea are true,
EXCEPT:
A. May present with bloody diarrhea
B. Caused either by bacteria or virus
C. Can be complicated by septicemia
D. Isolation prevents the spread of infection
E. Colonoscopy is essential for diagnosis
40. The following associations are true, EXCEPT
A. Chronic myeloid leukemia----- Tyrosine kinase inhibitors
B. AIDS------------HAART
C. Bronchial Asthma____Beta-2 antagonist

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D. Peptic ulcer------ proton pump inhibitors
E. Primary biliary cirrhosis----- Ursodeoxycholic acid (UDCA)
41. A 35-year old African visited our country recently, presented with attacks
of fever, headache, malaise, and diarrhea. No history of any drug intake or
any chronic illness. Clinically, he has a temperature of 39°C, pallor, and mild
tender splenomegaly.
All the followings are true, EXCEPT:
A. May has past history of recurrent attacks of fever.
B. Jaundice is a common finding.
C. Blood film examination is diagnostic.
D. Acyclovir is the treatment of choice.
E. Convulsions are known complication.
42. A 18-year old patient gives history of fatigue, headache and sore throat.
On examination: temperature of 38 Cð, congested throat with petechial rash
on palate and cervical lymphadenopathy. Peripheral blood film showed:
atypical lymphocytes, ESR: 60 mm/Ist hr.
All the followings are true, EXCEPT:
A. This condition is transmitted by droplet infection.
B. Epstein-Barr virus is the causative agent.
C. Paul-Bunnell test is positive.
D. Ampicillin is a therapeutic option.
E. Meningoencephalitis can complicate this condition.
43. A 31-year-old previously healthy woman has a one-week history of
general malaise, fever and productive cough. Her X-ray shows a left middle
lobe consolidation with increased vocal resonance in the left middle zone on
auscultation.
What is the most likely causative organism
A. Homophiles influenza
B. Streptococcus pneumonia
C. Escherichia coli
D. Mycobacterium tuberculosis
E. Pneumocystis Carinii
44. Which one of the following is correct regarding fever of unknown
origin (FUO)

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A. FUO is defined as a persistent fever within the first 24 hours
of hospitalization.
B. Malignancy accounts for more than 80% of FUO cases in
developing countries.
C. The presence of eosinophilia role-out polyarteritis nodosa.
D. Tuberculosis is one of the most common infectious causes,
E. Fever and relative bradycardia suggests infection with Cytomegalovirus.
45. All the followings are criteria for the diagnosis of rheumatoid
arthritis, EXCEPT:
A. Morning stiffness > 1 hour
B. Symmetrical arthritis
C. Positive rheumatoid factor
D. Duration of symptoms < 2 weeks
E. Subcutaneous nodules
46. The followings are true about Sjogren's syndrome, EXCEPT:
A. Is more common in female than male
B. Salivary-gland enlargement
C. Reynaud's phenomenon
D. Lymphadenopathy
E. Is Sero-negative arthritis
47. The followings are features of Bechet's disease, EXCEPT:
A. Oro-genital ulceration
B. Recurrent deep vein thrombosis
C. Blindness
D. severe pulmonary fibrosis
E. Positive pathergy test
48. Which of the following is the most frequent sit of joint involvement in
established rheumatoid arthritis (RA)
A. Distal interphalangeal joint
B. Hip
C. Knee

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D. Spine
E. Wrist
49. Recognized features of systemic sclerosis include
A. Arachnodactyly
B. Hyperhidrosis
C. Small bowel stricture
D. Reflux esophagitis
E. Hirsutism
50. Rheumatoid factor can be detected in
A. Bacterial endocarditis
B. SjÖgren syndrome
C .Systemic lupus erythematosus
D. mixed connective tissue disease
E .All of the above

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 Key answer
1 A 26 E
2 B 27 E
3 D 28 D
4 D 29 B
5 D 30 C
6 A 31 E
7 B 32 A
8 D 33 E
9 D 34 E
10 B 35 D
11 C 36 A
12 B 37 B
13 E 38 C
14 E 39 E
15 D 40 C
16 D 41 D
17 D 42 D
18 D 43 B
19 B 44 D
20 C 45 D
21 A 46 E
22 C 47 D
23 E 48 E
24 B 49 D
25 D 50 E

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