Sixth Year 2013 Medicine Exam

8/11/2019 Sixth Year 2013 Medicine Exam

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Sixth year 2013 Medicine exam (written and group A OSCE)

1-which one improves heart failure prognosis:

enalpril

2- which of the following reduce mortality after MI

a-nifidipine

2-verapamil

3-B blocker (nseet ay wa7ad)

3- case , Pt with hypercalcemia, well, ,on thiazide,the cause of his high

Ca is mostly:

-thiazide

4- ECG for inferior MI, the ischemia in due to occlusion of :

-Right coronary

5- Thrombolysis is contraindicated in :

1- Atrial fib ا) س د

aneurismاجواب ها ضورا!!

2- pregnancy .... (relative) شباوجا ةدو ي ر!

6- which of the following you will give DC shock

1-PEA

2- VF

3- asystole

4- complete heart block



7- Regarding digoxin toxicity all are true except :

-tachyarrhythmia don’t occur

8 – 3 MCQS about murmwers , I don’t remember any, رد !!

9- case with angina , hx of suddendeath in young age, murmer:

- HOCM

10-In normal physiological state ,with inspiration all true except:

-decreased JVP

-increased BP-increased pulse

- increased splitting

-soft diastolic murmer due to pulmonary vessels filling is normally

heared

11- Pt with dysnea and angina on exertion, old age, systolic ejection

murmer:

-aortic stenosis

12- which of the following is not a risk factor for DVT:

-vit C defecincy

13- case NSTEMI ,high cardiac enzymes, first management

14- case with hypokalmia , acidoses, hypothyroidism:- RTA 2 )

(!!ن

15- in hemodialysis:

-excess vit D



-osteomalacia ةدأ ش

-hypophosphatemia ضورا س

16- male with hematurea , glomuroniphritis, IgA nephropathy:

-berger dz

17- all with low complement nephropathy except:

-SLE

ش زرة ق اخرات

18- nephrotic syndrome, indications that it will respond to steroid:

-minimal change

19- dz with IgG deposition on :

- post strep

-SLE

-goodpasture

-wegner

-Alport syndrome

20- all should be treated for asymptomatic bacteria in urine except:

- old age

-pregnancy

-obstruction

-immunodeficiency

21-young pt with sore throught developed hematurea,protein in urine

<2 :

- poststrep glomuronephritis







-binucleate cells

-hypercellular bone marrow

35-pt with this dz mostly die from bleeding:

-AMPL

36- most common type of hodgken:

-nodular sclerosing

37-Aur red cells are in :

- AML

38- in polycythemia rubra vera all true except:

-Jack gene

-high erothropietin

39- ti diffrantiate limited from diffuse , best is:

-pulmonary HTN occurs more with crest

- capillary vascular proliferation

م

ت

أدة

ش

!!

40- skin necrosis with pt on warfarin :

- Protein C deficiency

41- pt did gastrectomy , neurological symptoms, no anemia:-pernicious anemia

-folate def

42- pt with neurological symp, atxia ,deficiency of:

- riboflavin



-thiamine

-vitamin B

43- in crohns, all are true except:

-mucosal and sumucosal lesion only

44- Case with bleeding tendency, anemia, abdominal mass, anal

skin tag:

- intestinal lymphoma

-crohns

45- in which case we don’t put NG tube except:

-benign or malignant esophageal strictures- foreign body in the esophagus

- esophageal vareces

46- pt with dysphagia for years , recently developed nocturnal

cough, no hoarsness :

- barret-pharyngeal pouch

47- case itching , high hemoglobin, cirrhosis, spider nevie,

pigmented skin:

- PBC ( ن

48- Case with Addison, first test:

-24 hr cortisol

-renin plasma urine ratio



49- pt with pin point pupil, Mx:

- naloxon .4 mg IV-

Naloxone 4 mg IV

50- pt with arthritis, liver cirrhosis , skin color change:

-high risk of HCC ( hemochromatosis)

51- pt with ankylosing spondelitis with crohns, all true except :

- Symmetrical poly articular arthritis in large joints

-symphesis pubis is iinvolved ?!!! ام

- not associated with crohns exacerbations

52- all are risk factors for osteoporosis except:

- early menopose

53 – blood donor ( read side effects )لاؤا ق ةرز ش

54- pt with travel hx ,has diarrhea , most common cause:

-giardia-E.coli

55- pt with watery diarrhea ,with travel hx:

-amebiasis

-giardia

56- pt with RA, most specific sign:

-subcutaneuos nodules

57- the only anti body used for dz monitoring:



-ANA and SLE

-RF and RA

-ds DNA and SLE

-sjogren and anti Ro-ss

58- pt with painfull knee, rhomboid crystal aspirated, pt may have all

except:

-narrwing of joint space

-negative biferengent !بغ

59- pt with SLE , protein urea, disease progression and death is mostly

due to:

-kidney dz

60- acromegaly pt will have all except:

- large hands

- dry thick skin (increase switing )ارو

- macrognathia

- ت

!!

ا

ن

س

61- in pseudohypoparathyroid :

-low calcium high phosphate

-low calcium low phosphateن

- high PTH

-short 3rd

and 2nd

metacarpals

62- pt on thiazied, with swalon joint, next step:

-arthrocentesis ( aspiration)





71-pt with recurrent hypoglycemia ,Blood gluc <40 , always when she

has to give reports or data at work!, her sister is on insulin, her Inv.=

high insulin , normal C , dxx:

- insolinoma-factitious insolinemia وا مو ا حر !!

72- pt with DM started on night dose glarigine (lond acting) with

preprandial short acting, some times he increase the night dose, his

blood sugar sometimes high in the morning, with headaches ,

nightmares Dxx:

- 4 am hypoglycemia with rebound hyperglycemia(I have no idea what

does that mean, but it seemed the right answer!!!!)

73- regarding DM oral drugs mechanism which is true:

- metformin decrease gluconeogenesis (not sure study them well)

و بورج ي ن تر ودا ك ن ه بورجا ش اودا ما وج

ل

ف

رت

.......وووووووردا

!

74- bad prognosis in liver cirrhosis:

- spleenomegaly ( not sure)

75- Pt with hyperthyroidism , treated with carbamazole , then had fever

76-Pt with thyroid nodule , euthyroid,first after TSH,T3 Inv.:

FNA

77- which is inappropriate in lymphoma Inv. :

-LDH level

-lymph node aspiration

-lymph node biopsy

-PET awCT nseet!



78- PT with 4 months goiter, she became febrile lately, with hyper

thyroid symp, next step:

- Iodine uptake test

80- all are causes of clubbing except :

-mesothelioma

-lung fibrosis-copd

-cealiac

-hypothyrodism

81 – all can cause generalized lymphadenopathy except:

- EBV-SLE

-lymphoma

- !اجوا

ادرو

ون

ئا

ق

ازر

قدرت

و

اخرات

قدرت زر

اه

ا

....

ت

وا

ووا : D



OSCE Cases

These are the cases that I’ve seen , I don’t know what the other

group had !

General notes: The Drs are always nice, the qyestions are mostly

easy , it’s okay if you didn’t answer ( 3*aliban bitkoon 3aref bas

btinsa ….3aaaaaaaaaaaaaadi kulna heik!) el 3lameh btin7at: 1 –

smile 2- say goodmorning 3- introduce yourself to the DR 4-

wash your hand(use alcogel ) 5- introduce yourself to pt 6- be

systematic in examination , presentation , DDx in categories 7-

mish mohem tewsal la diagnosis , el muhem el approach 8- thank

the pt and the DR

-there’s always a thyroid case bas el saneh el Pt t2a5ar ( study it

well)

-in 4th

year we had almost the same cases but with easier

questions

8 cases including one neurological case ( normally not to 4th year

students , but it was a bell’s palsy case examin, upper or lower?

Why? Bell’s phenomina ( lma ysakker 3eno eye globe is deviated

up and out so wee see white globe due to ptosis , Most common

cause:idiopathic , other causes ? Mx (steroids, acyclovir, massage,



complications? Corneal ulceration so give artificial tears and eye

patch to cover the eye when sleeping ,

so momken yjeebooha, aw yjeeboolkom reflexes aw cranial nerve

examination)

1- examine the chest with dr ibrahem hour ♥

-Didn’t ask for general examination,

- do inspection, look for cyanosis central below the tongue and in

the inner side of lip, peripheral in lips ,and increased anterior

posterior diameter(barrel shape)

- he asked me about chest expansion don’t forget to do it both ant

and post (ana nseet w tzakart bas 3l post , bas 3adi n3mlha only

post ),was it normal(decreased)? What’s the normal (3-5) cm

-do tactile vocal frimetus .

-how do you expect the heart sound of this pt?

distant due to emphysema .

-what type is this copd pt ( blue bloater or pink puffer? Mine was

obese with cyanosis , blue bloater

2- pt with RA with dr fady (makassed neurologist)

-severly -deformed hand , he asked me to do only inspection , we

all missed the muscle wasting on the left due to median nerve



injury , and we found it only in the palpation

-what do you expect the sensation difecet?

Parasthesia at 3 .5 fingers (sahleen mn el anatomy btitzakarooha

)

-raj3o el deformities( ulnar deviation ,z thumb, swan neck ,

check for subcutaneous nodules

-test for complete hand w ma titlthoo ber RA zay ma ana 3melet

!! do COMPLETE exam ,

-he also asked me if the pt has active dz and what are the signs (

swelling , redness, hotness , tenderness)

3- pt with heart murmer with DR, ra2ed aqel , kan kteer lateef ,

-tel3et AS , w 3indo carotid radiation ,

-don’t forget the maneuvers , radiation on carotid (AS) and axilla

(MR)

- auscultate mitral with left lateral position (MS) and on sitting

forward ( AR) , I didn’t detect the carotid radiation ( l2inno sma3ti

kayne msakkarah b3d ma fa7aset precordiom!! Bas 7ateli

3alameh l2ni 3melt el maneuover

-don’t forget to ask the pt to hold his breath when checking

carotid radiation and also hold breath after expiration when

leaning forward ( AR)

-and, listen with both bell and diaphragm on all areas ,

-don’t forget to count the ribs when detecting the apex beat



- be systematic don’t jump to the murmer(inspection ,palpation

apex beat thrill heave , auscultation) comment on S1 ,S2 any

added sounds, mid systolic clic

-he asked about the AAX: AS , subvalvular due hypertrophic

obstructive cardiomyopaathy , ma 3reft 3*erhom !!

mnaaaaaaaaaa7!

-He asked me where did I heared the murmer est, (aortic area,

tb3an ana smi3tha b kul el areas bas l2no AS m 2olet Aortic area

(kazabet :\)

-he asked me about the MS , what do you hear? Loud S! with middiastolic murmer , if with AR it’s called Austin flint murmer

4- case of hepato splenomegaly with external examiner examin

the abdomen

-same: be systematic , inspection blab la bla ,

-on palpation I found two masse which are most likely

hepatospleenomegaly

-do test for organomegaly , measure size with the measuring tape

(a7san)

- how to know it’s spleen (easy)

-DDx of hepatospleenomegaly ( tele3 hemochromatosis, heye w

Wilson ma tensoohomsh !! ana nseethom ( tabbaaaaaan!!) bas

3adi !



-DXX of massive spleenomegaly ( CML, leshmania, malaria,

gausher , shoofoohom min Danish !)

5- young male, inspect the upper limb with Dr majed dweik

-he had swelling in the RT upper limb with dilated veins , slightly

red

-DDx ? DVT (thrombosis -) – trauma – lymphatic obstruction w hay

el ashya2!(same as lower limb )

- He asked and if he has oral ulcers more than 3 a year with

genital ulcers and arthrirs?

( behcet dz )

-He asked me about causes of hypercoaagubility state (sahleen )

6- take hx from this young man , with some external examiner ,

-Pt had epistaxis

- he asked me how to know it’s plt disorder ( gum bleeding and

epistaxixs mostly plt , coagulation factors come with heamrthrosis

( bleeding in the joint ask about recurrent joint swelling especially

following trauma) and bleeding time increases in PLt dz , ask

about duration of bleeding after minor wound cuts ,

-he asaked me what Inv. To do? (approach to plt disorder?

plt count , bleeding time ,blood film

-DDX?



-If you suspect ITP ( which I did) , what do you see on blood film ?

( giant megakaryocyte- mish 3arfeh keeeeeef nseetha !

- kanat a5er case w kunt t3baneh w 2oltilo 5alas t3ebet!!) – lama

yi2es minni s2lni Mx of ITP ( steroid, Ig , curative spleenectomy)

-2alli ok hada 3amel spleecnectomy what are the complications?

aham eshi el overwhelming infections (pneumoccocus and H.inf )

give vaccination , especially if doing surgery . w bas

7- Case of Addison dz with an external emaminar(dr wa2el

7amoodeh♥) atyab w alaz dr momken tshoofoo !!

- This young man has hx of 6 months weight loss ,hypotention ,

nausea , vomiting ,diarrhea , take hx

-take hx for weight loss

- he didn’t let finish taking hx and showed me the pt’s mouth

which was hyperpigmented, I asked if he smokes he said know,

he also asked me to look specifically at the skin creases at the

dorsum of the hand ( hyperpigmented) I said : ahaaaaaaaaaa

Adrenal insufficiency !! (Addison dz)

- causes?

primary: 80% autoimmune (west) – TB most c\o world wide ,

other infections – hemorrhage (usually acute presentation)

- what do you expect his electrolytes would be?

Low Na high Ca high K ( Mx of hyperkalemia IMP )

hypoglycemia

-what tests do you do?

inithialy rennin-cortisol level ,

ACTH stress test ( give synthetic ACTH 250 micro gram ,



measure cortisol before and after .5h , if cortisole >550 , it’s

excluded

21-hydroxylase antibodies

(p.s ana law enni rab3a 3omor ahli ma b3rf hay el ashya2 , jawabt-ha min el pediatrics, so don’t worry they won’t ask you

same questions , w momken ma yjeebo aslant )

-MX : replace hormones: cortisole( tell the pt to increase the

usual dose in stress, exercise, surgery or OSCE :D ( hay 7ashash

3leiha!) , give aldosteron mimic(flucoti….. nseet esmo!)

- why does the pigmentation occur?ACTH increases due to adrenal faluire , and as a bi-product fi

protein bitl3 nseet esh hoo ,stimulates the melanin cells

stimulating hormone, more melanin more pigmentation (

raj3ooha)

د

م

دوااااااااااااااااااااااااااااااام

ظ:د ورص ماو دا عد يرظاو وا وا وو

د

اووب

ن

دو

ارو

–رونوو

و جل ع

Aseel Tell : D

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Sixth Year 2013 Medicine Exam