Exam

‫امتحان الهندية‬
• Depression can co-exist with

Mania.
OCD.
Major depression
Schizophrenia
2-Major symptoms associated anxiety
-decreased concentration
-tachcardia.
-Palpitation
-………
3-picture thyroid acropachy
Clubbing * imased
4-diabetic neuropathy:
-Distal symmetrical mononeuropathy
-Distal symmetrical po;yneuropathy

-proximal symmetrical mono neuropathy
-proximal symmetrical polyneuropathy
5-Drus causing pancytopenia

-chloraamphenicol
-……………..
-……………..
-………………..
6-Screening tests :
-Is for common diseases
-diseases with long ……..period.

-……………….
Wilson and Jungner classic screening criteria1
1. The condition sought should be an important health problem.

2. There should be an accepted treatment for patients with recognized disease.
3. Facilities for diagnosis and treatment should be available.
4. There should be a recognizable latent or early symptomatic stage.

5. There should be a suitable test or examination.
6. The test should be acceptable to the population.
7. The natural history of the condition, including development from latent to

declared disease, should be adequately understood.
8. There should be an agreed policy on whom to treat as patients.
9. The cost of case-finding (including diagnosis and treatment of patients

diagnosed) should be economically balanced in relation to possible expenditure on
medical care as a whole.
10. Case-finding should be a continuing process and not a “once and for all”
project.
a)234 b)123 C)134

7-Matching question:
-Sidroplastic
-Alcohol
-……………
-niacin
-B1
-Thyamine
aving enough niacin, or vitamin B3, in the body is important for general good
health. As a treatment, higher amounts of niacin can improve cholesterol levels and
lower carThiamine is a vitamin, also called vitamin B1. Vitamin B1 is found in
many foods including yeast, cereal grains, beans, nuts, and meat. It is often used in
combination with other B vitamins, and found in many vitamin B complex
products. Vitamin B complexes generally include vitamin B1 (thiamine), vitamin
B2 (riboflavin), vitamin B3 (niacin/niacinamide), vitamin B5 (pantothenic acid),
vitamin B6 (pyridoxine), vitamin B12 (cyanocobalamin), and folic acid. However,
some products do not contain all of these ingredients and some may include others,
such as biotin, para-aminobenzoic acid (PABA), choline bitartrate, and inositol.
People take thiamine for conditions related to low levels of thiamine (thiamine
deficiency syndromes), including beriberi and inflammation of the nerves (neuritis)
associated with pellagra or pregnancy.
Thiamine is also used for digestive problems including poor appetite, ulcerative
colitis, and ongoing diarrhea
Thiamine is also used for AIDS and boosting the immune system, diabetic pain,
heart disease, alcoholism, aging, a type of brain damage called cerebellar
syndrome, canker sores, vision problems such as cataracts and glaucoma, motion
sickness, and improving athletic performance. Other uses include preventing
cervical cancer and progression of kidney disease in patients with type 2 diabetes.
Some people use thiamine for maintaining a positive mental attitude; enhancing
learning abilities; increasing energy; fighting stress; and preventing memory loss,
including Alzheimer's disease.
Healthcare providers give thiamine shots for a memory disorder called Wernicke's
encephalopathy syndrome, other thiamine deficiency syndromes in critically ill
people, alcohol withdrawal, and coma.diovascular risks.
8-Wound inversion
Primary inversion by suturing/surgery
Secoandry inversion leave woun alone eg ulcer
Tertiary inversion
Close appearance
Reopen
Re open and then closure
9-Anti Parkinson causing tardive dyskinesia
-Levo dopa
Choices are not clear
10-Which
-Lichen
Lichen sclerosis
Lichen planus
Lichen sclerosus (LIE-kun skluh-ROW-sus) is an uncommon condition that creates

patchy, white skin that's thinner than normal. Lichen sclerosus can affect skin
anywhere on your body. But it most often involves skin of the vulva, foreskin of the
penis or skin around the anus.Anyone can get lichen sclerosus but postmenopausal
women have a high risk
Lichen planus (LIE-kun PLAY-nus) is an inflammatory condition that can affect the
skin, hair, nails and mucous membranes. On the skin, lichen planus usually appears
as purplish, often itchy, flat-topped bumps, developing over several weeks. In the
mouth, vagina and other areas covered by a mucous membrane, lichen planus forms
lacy white patches, sometimes with painful sores.Most people can manage typical,
mild cases of lichen planus at home, without medical care. If the condition causes
pain or significant itching, you may need prescription drugs.
11-Guilaie psoriasis after which organism
HSV
HIV
Strepto
staph
Guttate psoriasis. Red drop-like lesions are found on the skin. This type of psoriasis
usually occurs after a streptococcal (bacterial) infection. Image courtesy of Hon
Pak, MD.
HIV: Psoriasis may worsen after an individual has been infected with HIV.
However, psoriasis often becomes less active in advanced HIV infection.
Drugs: A number of medications have been shown to aggravate psoriasis. Some

examples are as follows:
Lithium: Drug that may be used to treat bipolar disorder
Beta-blockers: Drugs that may be used to treat high blood pressure
Antimalarials: Drugs used to treat malaria, arthritis, and lupus
NSAIDs: Drugs, such as ibuprofen (Motrin and Advil) or naproxen (Aleve), used to
reduce inflammation
Emotional stress: Many people note an increase in their psoriasis when emotionally
stressed.
Smoking: Cigarette smokers have an increased risk of chronic plaque psoriasis.
Alcohol: Alcohol is considered a risk factor for psoriasis. Even moderate intake of
beer may trigger or worsen psoriasis.
Hormone changes: The severity of psoriasis may fluctuate with hormonal changes.
Disease frequency peaks during puberty and menopause. During pregnancy,
psoriatic symptoms are more likely to improve. In contrast, flares occur in the
postpartum period
12-matching:
Preeclampsia
Eclampsia
Gastetional diabetes
Secizure
Proteinuria
After 20 weeks
13-histopic with senrio of PAS +VE Mesophage :
-whipple
-tropical sprue
-celiac
-lymphoma
14-which malignancy metastasis to to adrenal gland:
-breast
-lung
-lymphoma
-……………..
15-bone frmationin muscle fascia after trauma to elbow:
-myositis ossifican
16-bladder pain syndrome:

-common in women
-no sign of inflammation
-………..
-…………..
A)1,2,3 B)3,4 C)2,3,4
17-pseudo
-osteoprosis
-osteomalacia
-osteopiosis
-……………..
18-Sleep apnea………(causes) * respiratory
(the answer was all except alcohol).
Causes of obstructive sleep apnea — Most patients have OSA because of a small
upper airway. As the bones of the face and skull develop, some people develop a
small lower face, a small mouth, and a tongue that seems too large for the mouth.
These features are genetically determined, which explains why OSA tends to cluster
in families. Obesity is another major factor. Tonsil enlargement can be an important
cause, especially in children.
SLEEP APNEA SYMPTOMS
The main symptoms of OSA are loud snoring, fatigue, and daytime sleepiness.
However, some people have no symptoms. For example, if the person does not
have a bed partner, he or she may not be aware of the snoring. Fatigue and
sleepiness have many causes and are often attributed to overwork and increasing
age. As a result, a person may be slow to recognize that they have a problem. A bed
partner or spouse often prompts the patient to seek medical care.
Other symptoms may include one or more of the following:
●Restless sleep
●Awakening with choking, gasping, or smothering

●Morning headaches, dry mouth, or sore throat
●Waking frequently to urinate
●Awakening unrested, groggy
●Low energy, difficulty concentrating, memory impairment
Risk factors — Certain factors increase the risk of sleep apnea.
●Increasing age. OSA occurs at all ages, but it is more common in middle and older
age adults.
●Male sex. OSA is two times more common in men, especially in middle age.
●Obesity. The more obese a person is, the more likely they are to have OSA
●Sedation from medication or alcohol interferes with the ability to awaken from
sleep and can lengthen periods of apnea (no breathing), with potentially dangerous
consequences.
●Abnormality of the airway.
SLEEP APNEA COMPLICATIONS
19-micro pic gram –ve cocci (gram stain )
N meningitis
Campylobacter
-…………………
Gram –ve
20-……………………
21-which SSRI not P450 inducers
-sertaline
Fluxitinn
Escitalopram
No 22 Ques
23-Dystrophic calcification causes:
Dystrophic calcification (DC) is the calcification occurring in degenerated or

necrotic tissue, as in hyalinized scars, degenerated foci in leiomyomas, and caseous
nodules.Caseous necrosis in T.B. is most common site of dystrophic
calcification.Liquefactive necrosis in chronic abscesses may get calcified.
Fat necrosis following acute pancreatitis or traumatic fat necrosis in breasts results
in deposition of calcium soaps.
Infarcts may undergo D.C.
Thrombi, especially in veins, may produce phlebolithis.
Haematomas in the vicinity of bones may undergo D.C.
Dead parasites like schistosoma eggs may calcify.
Congenital toxoplasmosis, CMV or rubella may be seen on X-ray as calcifications

in the brain.
Density-Dependent Colour Scanning Electron Micrograph SEM (DDC-SEM) of

cardiovascular calcification, showing in orange calcium phosphate spherical
particles (denser material) and, in green, the extracellular matrix (less dense
material).[2]
Calcification in degenerated tissue[edit]
Dense scars may undergo hyaline degeneration and calcification.
Atheroma in aorta and coronaries frequently undergo calcification.[2][3]
Cysts can show calcification.
Calcinosis cutis is condition in which there are irregular nodular deposits of

calcium salts in skin and subcutaneous tissue.
Senile degenerative changes may be accompanied by calcification.
The inherited disorder pseudoxanthoma elasticum may lead to angioid streaks with
calcification of Bruch's membrane, the elastic tissue below the retinal ring.
24-Achlohydria predispose with organisms:
H. pylori
…….
……….
…………
Risk of particular infections, such as Vibrio vulnificus (commonly from seafood) is

increased. Even without bacterial overgrowth, low stomach acid (high pH) can lead
to nutritional deficiencies through decreased absorption of basic electrolytes
(magnesium, zinc, etc.) and vitamins (including vitamin C, vitamin K, and the B
complex of vitamins). Such deficiencies may be involved in the development of a
wide range of pathologies, from fairly benign neuromuscular issues to life-
threatening diseases.
he slowing of the body's basal metabolic rate associated with hypothyroidism

Pernicious anemia where there is antibody production against parietal cells which
normally produce gastric acid.
The use of antacids or drugs that decrease gastric acid production (such as H2-
receptor antagonists) or transport (such as proton pump inhibitors).
A symptom of rare diseases such as mucolipidosis (type IV).
A symptom of Helicobacter pylori infection which neutralizes and decreases

secretion of gastric acid to aid its survival in the stomach.[2]
A symptom of atrophic gastritis or of stomach cancer.
Radiation therapy involving the stomach.
Gastric bypass procedures such a duodenal switch and RNY, where the largest acid
producing parts of the stomach are either removed, or blinded.
VIPomas (vasoactive intestinal peptides) and somatostatinomas are both islet cell
tumors of the pancreas.
Pellagra, caused by niacin deficiency.
Chloride, sodium, potassium, zinc and/or iodine deficiency, as these elements are
needed to produce adequate levels of stomach acid (HCl).
Sjögren's syndrome, an autoimmune disorder that destroys many of the body's

moisture-producing enzymes
25- patient came for EC stress test
Characteristic of global left heart failure:

Hypotension
Increase HR
………….
On physical examination, patients with decompensated heart failure may be

tachycardic and tachypneic, with bilateral inspiratory rales, jugular venous
distention, and edema. They often are pale and diaphoretic. The first heart
sound usually is relatively soft if the patient is not tachycardic. An S3 and often
an S4 gallop will be present. Murmurs of mitral or tricuspid regurgitation may
be heard. Paradoxical splitting of S2 may be present because of delayed
mechanical or electrical activation of the left ventricle. Patients with
compensated heart failure will likely have clear lungs but a displaced cardiac
apex. Patients with decompensated diastolic dysfunction usually have a loud S4
(which may be palpable), rales, and often systemic hypertension.
26-which is not characteristic of ……addison
Hypoglycemia
Hypotension
Hyperkalemia #
Vascular collapse
27-polyglandular syndrome one organism with Addison
Answer is candida.
28-Drug used in renal fibrosis
(chec the link in whatsapp group)
29-SLE immune complex deposit :
subepithial
sub endothelial
Mesengial
…………
30-SLE with type of mesangial prolifrative nephropathy
Type I
TypreII
TypreIII
Type VI
31-Alcoholic withdrwal syndrome tyes
Siple partial
Complex partial
Generalized
Myoclonic
32-Drug useful in alcohol withdrawal /or with alcoholic sympt with psychotic symptoms as
well
Phynotoin
Valporic
Chlorapamazapin
Carbamazapine
33- 1 gm of fat contains
4
12
34-Picture of chorn's disease ====sling sign
35-Fundus picture (haemorrhage )large
Q hall mark of disease === retinopathy
-exudese
-Doi beri haemorrhage
-neovascularization
36-Match
Charcot joint !!!
Tabes dorsalis
Sacrolitis
Primary syphilis
Secoandry syphilis
Tertiary syphilis
Secondary syphilis occurs approximately four to ten weeks after the primary infection.[3]
While secondary disease is known for the many different ways it can manifest, symptoms
most commonly involve the skin, mucous membranes, and lymph nodes.[16] There may be
a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the
palms and soles.[3][17] The rash may become maculopapular or pustular. It may form flat,
broad, whitish, wart-like lesions known as condyloma latum on mucous membranes. All of
these lesions harbor bacteria and are infectious. Other symptoms may include fever, sore
throat, malaise, weight loss, hair loss, and headache.[3] Rare manifestations include liver
inflammation, kidney disease, joint inflammation, periostitis, inflammation of the optic
nerve, uveitis, and interstitial keratitis.[3][18] The acute symptoms usually resolve after
three to six weeks;[18] about 25% of people may present with a recurrence of secondary
symptoms. Many people who present with secondary syphilis (40–85% of women,
20–65% of men) do not report previously having had the classic chancre of primary
syphilis.
37-compartment syndrome :
-nerve injury
-muscle edema
-arterial injury
-soft tissue odema
Acute compartment syndrome occurs when the tissue pressure within a closed muscle
compartment exceeds the perfusion pressure and results in muscle and nerve ischemia. It
typically occurs subsequent to a traumatic event, most commonly a fracture.
Compartment syndrome develops when swelling or bleeding occurs within a compartment.

Because the fascia does not stretch, this can cause increased pressure on the capillaries,
nerves, and muscles in the compartment. Blood flow to muscle and nerve cells is disrupted.
Without a steady supply of oxygen and nutrients, nerve and muscle cells can be damaged.
In acute compartment syndrome, unless the pressure is relieved quickly, permanent

disability and tissue death may result. This does not usually happen in chronic (exertional)
compartment syndrome.
Compartment syndrome most often occurs in the anterior (front) compartment of the lower
leg (calf). It can also occur in other compartments in the leg, as well as in the arms, hands,
feet, and buttocks.
38-common site compartment syndrome
-forearm
-……………….
39-not available
40Thigh
41-PID
43-FEV/FVC ratio * respiratory
44-causes common of………….
‫امتحان ريم‬
1-regarding (ARDS) which is correct:
-bilateral alveolar-infiltration
-Pulmonary vascular congestion
-can cause pleural effusion.
-All the above is right
2-Regardin mechanical ventilation for ARDS:
a-Can treat patient from sever hypoxia
b-To avoid muscle fatigue.

c-,,,,,,,,,,,,,,,,,,,,,,,
d-None of th above.
A,b a, b, c a-d
3-post op pt developed cough dyspnea after one day the least complication is :
-pneumonia - hypoxemia - hypotension -Atalactesia

4-Obesity in PFT what marker affected
-↑FRC (functional residual capacity) decrease in obese patients *
-↓TLC
-↑FVC
-↑ERV Reduced in obese patients**
**(Based on our results, we can conclude that obesity causes significant changes in
respiratory function, as is evidenced by the highlighted changes in the components of the
VC (IRV and ERV). These findings suggest deleterious effects on ventilatory mechanics
caused by obesity, due to probable lung compression (reduction in the ERV), leading to a
compensatory increase in the IRV in an attempt to maintain a constant VC. Harming the
ventilatory mechanics associated with ERV reduction may have contributed to the
reduction in the MVV. However, these changes were not sufficient to cause obstructive or
restrictive pulmonary disorders by spirometry or significant breathlessness complaints in
2
obese women with a BMI between 35 and 49.99 kg/m .) , However, obese individuals
showed a reduction in the ERV, possibly offset by the increase in the IRV, thus keeping the
VC unchanged. MVV maximum voluntary ventilation , VC vital capacity.
revealed that FVC, FEV1, and TLC were significantly lower in the patients with
upper body fat distribution.
‫مختصر مفيد‬
All the volumes are decreased in obese patients.
4-Pt diagnosed as hashimoto thyroditis
Which test ……about:
-Dermatitis herpatoformis
-Type 1 DM
-……………………….. -…………………..
Having another autoimmune diseases is a risk factor to develop Hashimoto’s thyroiditis,

and the opposite is also true.[1] Autoimmune diseases most commonly associated to
Hashimoto’s thyroiditis include celiac disease, type 1 diabetes, vitiligo and alopecia.[14]
5-Same pt developed goiter characteristic :
-firm regular
-firm irregular
-soft irregular
Soft regular
clinical findings of hashimoto:
painless goiter not alwayes symmetrical rubbry not tender on examination
6-same above question
Matching
-damage thyroid tissue
-Thyroniate
-,,,,,,,,,,,,,,,,,
-decrease iodination
-,,,,,,,,,,,,,,,,,,,,,,,
-radioisotope iodination
7-regarding MODY:
-MODY 1
-MODY2
-MODY3
-glucokinase
-NFM
-……………………
8-Patient with history of DKA, which fluid replacement=====N.S
9-which thyroid cancer ass with anti thyroglobulin antibody
-papilary –follicular – molecular-lympho
10-hemepiosis in first trimesterfrom 1—6 weeks :
-placenta
-corpus collosum
-,,,,,,,,,,,,,,,,,,,,,,, -,,,,,,,,,,,,,,,,,,,,,,,,,,
human meamopaiosis starts in the yolk sac in the third week of intra uterine life.
11-hemepiosis in adults occurs in
-liver
-spleen
-bone marrow
12-Organ secret erythropiotin====Kidney
13-picture of exophosmus ====diagnosis
14-bone tumor ass with Codman diagnosis

osteosarcoma
Many patients first complain of pain that may be worse at night, may be
intermittent and of varying intensity and may have been occurring for some
time. Teenagers who are active in sports often complain of pain in the lower
femur, or immediately below the knee. If the tumor is large, it can present as
overt localised swelling. Sometimes a sudden fracture is the first symptom,
because affected bone is not as strong as normal bone and may fracture
abnormally with minor trauma. In cases of more deep-seated tumors that are
not as close to the skin, such as those originating in the pelvis, localised
swelling may not be apparent
Family physicians and orthopedists rarely see a malignant bone tumor (most
bone tumors are benign). The route to osteosarcoma diagnosis usually begins
with an X-ray, continues with a combination of scans (CT scan, PET scan,
bone scan, MRI) and ends with a surgical biopsy. A characteristic often seen
in an X-ray is Codman's triangle, which is basically a subperiosteal lesion
formed when the periosteum is raised due to the tumor. Films are suggestive,
but bone biopsy is the only definitive method to determine whether a tumor is
malignant or benign.
15-Regarding osteogenesis imperfection
-hypermobily
-sensory deafness
-lower bone d……
-……..
One of the most consistent features of the skeletal defect in OI is low bone density, a major
reason for excess skeletal fragility and fractures in this disorder. Densitometry can be
helpful in assessing skeletal development in children with OI and determining the
likelihood of fractures. It can also be useful to assess the possible deleterious effects of
injuries, illness and/or medications in patients with OI. This technology allows physicians
to assess the effects of treatments designed to build up bone mass or prevent bone loss.
Bone mineral density, as measured with dual-energy radiographic

absorptiometry (DRA), is generally low in children and adults with
osteogenesis imperfecta. However, there is wide variation in the bone density
of patients with OI. Still, normal bone density in a patient whom osteogenesis
imperfecta is being evaluated should prompt consideration of alternate
diagnoses
16-Some type of cardiomyopathy …………….ass:
-…………….. -………………… -…………………….
17-pt With HOCM
-lt vent hypertrophy
-rt vent hypertrophy

-half of patient is autosomal dominant
-……….
hocm more than 50 to 60 % AD
ab bcd abc
18-
19-
20-pancreatic pseudo ass with :
-epithelia surrounding very thin
-full of necrotic debris and hemorrhage
-full of pancreatic enzyme
-…………………………
full of amylase /pancreatic pseudocysts are sometimes called false cysts because they do
not have an epithelial lining.The wall of the pseudocyst is vascular and fibrotic,
encapsulated in the area around the pancreas.Pancreatitis or abdominal trauma can cause its
formation.[5] Treatment usually depends on the mechanism that brought about the
pseudocyst. Pseudocysts take up to 6 weeks to
21-matching :
-amilord
-frusimide
-ARBs
-hypokalemia
-hyperkalemia
-………………………..
ARBS class of drugs is usually well tolerated. Common adverse drug reactions (ADRs)
include: dizziness, headache, and/or hyperkalemia. Infrequent ADRs associated with
therapy include: first dose orthostatic hypotension, rash, diarrhea, dyspepsia, abnormal
liver function, muscle cramp, myalgia, back pain, insomnia, decreased hemoglobin levels,
renal impairment, pharyngitis, and/or nasal congestion.
amiloride anti hypertension cuz hyperkalemia/ contra indicated in addisson d or high K
21-which cause irreversible damage :
-Alcoholic hepatitis
-Fatty liver
-Liver fibrosis
-Stetosis
22-karena syer syndrome ass with :

-ophothalmoplegia.
-retenal pigmentosis
-AV block
-………………………..
21-after operation how can sterile instruments
-procid iodine
-propyl alcohol
-………………………….. -………………………………
22-most common suture cause infection ;
-uremyl
-prolen
-………………………..
-………………………………….
mono filaments are slippery but minimize infection and give less reaction.
braided sutures provide secure knotes but they allow infection to occure between thier
plaited strands.
braided:
vicrylepolyglictan/ absorbable,tying pedicles or bowel anastam. or subcutanous closure
dexon / poly glycolic acid/absorbable similar uses as viryle
mersilk non absorbablesecuring drains
monofilament
monocryle absorbable subcuticular skin closure
polydioxanon pds closing abdominal wall
ethilon closing skin wounds
prolene arterial anasamosis
metal skin wounds / sternotomy

23-Regarding abnormal position :
-antreiocehalic
-posterior cephalic
-face
-brow
Thus the various presentations are:
cephalic presentation (head first):
vertex (crown) — the most common and associated with the fewest complications
sinciput (forehead)
brow (eyebrows)
face
chin
abnormal /breech presentation[1] (buttocks or feet first):
complete breech
footling breech
frank breech
shoulder presentation:/abnormal
arm
shoulder
trunk
24-regarding oxytocin , is not causing :
-hypotension
-dehydration
-utrine contraction
-utrine hyperactivity
in the physiology of laboure the increasing frequency of contractions is associated with

formation of gap junctions between myometrial cells.events related to high levels of
oxytocin and prostaglandins
Methods of inducing labor include both pharmacological medication and

mechanical or physical approaches.
Mechanical and physical approaches can include artificial rupture of
membranes or membrane sweeping. The use of intrauterine catheters are also
indicated. These work by compressing the cervix mechanically to generate
release on prostaglandins in local tissues. There is no direct effect on the
uterus.
Pharmacological methods are mainly using either dinoprostone (prostaglandin
E2) or misoprostol (a prostaglandin E1 analogue)
Medication
Intravaginal, endocervical or extra-amniotic administration of
prostaglandin, such as dinoprostone or misoprostol.[ HYPERLINK
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Prostaglandin E2 is the most studied compound and with most
evidence behind it. A range of different dosage forms are available
with a variety of routes possible. The use of misoprostol has been
extensively studied but normally in small, poorly defined studies.
Only a very few countries have approved misoprostol for use in
induction of labor.
Intravenous administration of synthetic oxytocin preparations. A
high dose does not seem to have greater benefits than a standard
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Use of mifepristone has been described but is rarely used in practice.
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Relaxin has been investigated,[ HYPERLINK "/l" HYPERLINK
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commonly used.
mnemonic; ARNOP: Antiprogesterone, relaxin, nitric oxide donors,
oxytocin, prostaglandins
25_septic shock ass with increase with :
-INF
-TNF
-Lactate
-phosphokinase
22-Pigment stone are treated by :

-uredeoxycholic acid.cholesterol stone
-laproscopy
-labrotomy
-all the above
23-pigment stone form mainly by:
-cholesterol
-Ca phosphate
-………………….
-……………………
bile
24-Ankylosis spondylitis not responding to NSAID's , what is the appropriate ttt:
-infliximab
-Etracept
-………………………
-……………………….
25-Most common joint affected in the patient above:
-lumbar
-thoracic
-lumbosacral
-sacral
26-treatment of basal cell carcinoma
surgery
27-which is a contraindication of liver transplantation :
-hepatic vein thrombosis this is relative contraindication c the other choices if contain absolute 1
-severe malnutrition
-………………….
-………………
bsolute contraindications
Severe cardiopulmonary disease
Extrahepatic malignancy (oncologic criteria for cure not met)
Active alcohol/substance abuseAcute alcoholic hepatitis
Active infection/uncontrolled sepsis
Lack of psychosocial support/inability to comply with medicaltreatment
Brain death
Relative contraindications
Advanced age
Acquired immune deficiency syndrome
Cholangiocarcinoma
Diƈuse portal vein thrombosis
28-
29-
30-about septic shock
31-lithium side effect:
32-congenital adrenal hyperplasia matching :;
-hydrolase def:===defect in utilization
-non classical……………..
33-matching:
-FSH
-LH
-IMH
-DORMNANAT OVUALATION
-ovulatory
-…………………………………
34-what is goitergenic in diet:
-gabbage
-bean
-………………………………
-……………………………
Top 11 Harmful Goitrogenic Foods
Bok Choy.
Broccoli.
Brussel sprouts.
Cabbage.
Cauliflower.
Kale.
Kohlrabi.
Mustard and Mustard greens.
35-causes of neurovascular as expected:
-FMD
-Athersclesosis
-Obstruction uropsthy
-…………………………………
36-which one is not ass with febrile convulsion?
-ass with tonic clonic seizure.
-ass with children less than 5 years
-from intracranial infection
-there is some FH of FC
febrile convulsions are generalized tonic clonic ass e rapid rise in body temp.due to viral or
bacterial non cns infections and are the commenest form of seizers / 6m to 5 yrs age
37-which is poorer prognosis in germ cell centre:
-embrogel
-serminoma
-yolk sac
-terafora
Yolk sac tumors, formerly called endodermal sinus tumors, make up approximately
10–20% of ovarian germ cell malignancies, and have the worst prognosis of all ovarian
germ cell tumors
Choriocarcinoma can occur as a primary ovarian tumor developing from a germ cell,
though it is usually a gestational disease that metastasizes to the ovary. Primary ovarian
choriocarcinoma has a poor prognosis and can occur without a pregnancy. They produce
high levels of hCG and can cause early puberty in children or menometrorrhagia (irregular,
heavy menstruation) after menarche.
38-Osteoarthritis affect DIP-PID called :
-erosine
-generalized
-………………………………
-…………………………….
Erosive osteoarthritis is considered a subtype of osteoarthritis and it is usually seen in the

joints of the hand and fingers. It often strikes women around the time of menopause, which
leads to the suspicion that hormones and genetics play a role in its progression.
39-marker for germ cell tumor is:
-HCG
- α fetoprotein
-PSD
-all of the above
Germ cell cancers can elevate blood levels of the tumor markers human chorionic
gonadotropin (HCG), alpha-fetoprotein (AFP), and/or lactate dehydrogenase
(LDH). If the blood levels of these are elevated before treatment starts, they are
rechecked during chemo (usually before each cycle). If the chemo is working, the
levels will go down to normal. If the levels stay up, it can be a sign that a different
treatment is needed.
40-Question about congenital hypothyroidism
41- Question about storage DS.
42- acanthosis nigrican
Diagnosis and what test ?
dm
43- Question about acute phase protein in renal failure?
crp
44-post operation complication of inguinal hernia?
Only a small percentage of patients who undergo hernia repair surgery have
postoperative complications, which include: Black and blue scrotum and shrunken
testicles in men following an inguinal hernia repair. Bleeding. Inability to urinate
45- Question about bipolar disease poor prognosis
Of the various types of the disorder, rapid cycling (four or more episodes in one
year) is associated with the worst prognosis due to higher rates of self-harm and
suicide.[22] Individuals diagnosed with bipolar who have a family history of bipolar
disorder are at a greater risk for more frequent manic/hypomanic episodes.[109]
Early onset and psychotic features are also associated with worse outcomes,as
well as subtypes that are nonresponsive to lithium
47-matching
-hydrolizine
Intracranial
-na nitroprusside
Sodium nitroprusside is intravenously infused in cases of acute hypertensive

crises.[9][10] Its effects are usually seen within a few minutes.
Nitric oxide reduces both total peripheral resistance and venous return, thus
decreasing both preload and afterload. So, it can be used in severe congestive
heart failure where this combination of effects can act to increase cardiac output.
In situations where cardiac output is normal, the effect is to reduce blood pressure.
[9][11] It is sometimes also used to induce hypotension (to reduce bleeding) for
surgical procedures (for which it is also FDA, TGA, and MHRA labelled).[9][10][12]
This compound has also been used as a treatment for aortic valve stenosis,[13]
oesophageal varices,[14] myocardial infarction,[15] pulmonary hypertension,[16]
[17][18] respiratory distress syndrome in the newborn,[19][20] shock,[20] and ergot
toxicity.[21
-HTN pregnancy
48-ECG st elevation ass with
-pericarditis
-MI
-PE -…………………
ECG mimics of acute myocardial infarction, which include left ventricular

hypertrophy, left bundle branch block, paced rhythm, early repolarization,
pericarditis, hyperkalemia, and ventricular aneurysm
49- Question about treatment of ischemic vascular disease (picture) dupler in L.L
50 PICTURE OF RENAL ARTERY WITH BEADING SIGN ========FMD
51-after chemotherapy which type of hair loss it occur?
-alopecia eraiata autoimmune good responce to steroids
-Teligen affulium post partum / stress induced / diet ...responde to cuz correction
Anagen effluvium is the pathologic loss of anagen or growth-phase hairs.

Classically, it is caused by radiation therapy to the head and systemic
chemotherapy, especially with alkylating agents
52-drug contraindicated in breast feeding:
Phynotoin
-lithium
……………………
……………………
Teratogenic drugs: A teratogen is an agent that can disturb the development of the embryo
or fetus. Teratogens halt the pregnancy or produce a congenital malformation (a birth
defect). Classes of teratogens include radiation, maternal infections, chemicals, and drugs.
Drugs that are capable of acting as teratogens include:
ACE (angiotensin converting enzyme) inhibitors such as:
benazepril (Lotensin),
captopril (Capoten),
enalapril (Vasotec),
fosinopril sodium (Monopril),
lisinopril (Zestril, Prinivil),
lisinopril + hydrochlorothiazide (Zestoretic, Prinzide),
quinapril (Accupril) and
ramipril (Altace).
Acne medication isotretinoin (Accutane, Retin-A).
Alcohol ingested chronically or in binges.
Androgens (male hormones).
Antibiotics tetracycline (Achromycin), and doxycycline (Vibramycin), and
streptomycin.
Anticoagulant (blood-thinner) warfarin (Coumadin).
Anticonvulsants (seizure medications) such as:
phenytoin (Dilatin),
valproic acid (Depakene, Valprotate),
trimethadione (Tridione),
paramethadione (Paradione), and
carbamazepine (Tegretol).
Anti-depressant drug lithium (Eskalith, Lithob).
Antimetabolite/anticancer drugs methotrexate (Rheumatrex) and aminopterin.
Antirheumatic agent and metal-binder (chelator) penicillamine (Ciprimene,
Depen).
Antithyroid drugs such as:
thiouracil/propylthiouracil and
carbimazole/methimazole.
Cocaine.
DES (diethylstilbestrol), a hormone.
Thalidomide (Thalomid) which was approved by the FDA for the treatment of a
complication of leprosy (erythema nodosum leprosum
53-most common investigation for mediastinm lymph node

-CXR
-CT
-Endoscopy
54-chagas DS caused by
Typnosma cronzi
he cause of Chagas disease is the parasite Trypanosoma cruzi, which is

transmitted to humans from a bite from an insect known as the triatomine bug.
These insects can become infected by T. cruzi when they ingest blood from an
animal already infected with the parasite
55-Also mody DS which one respond to sulfornylurea
-mody 1
-mody2
-Mody3
Mody3/4
MODY 3 (also known as HNF1A-MODY) is caused by mutations of the HNF1-

alpha; gene, a homeobox gene on chromosome 12. This is the most common type
of MODY in populations with European ancestry,[1] accounting for about 70% of all
cases in Europe. HNF1α is a transcription factor (also known as transcription
factor 1, TCF1) that is thought to control a regulatory network (including, among
other genes, HNF1α) important for differentiation of beta cells. Mutations of this
gene lead to reduced beta cell mass or impaired function. MODY 1 and MODY 3
diabetes are clinically similar. About 70% of people develop this type of diabetes
by age 25 years, but it occurs at much later ages in a few. This type of diabetes
can often be treated with sulfonylureas with excellent results for decades.
However, the loss of insulin secretory capacity is slowly progressive and most
eventually need insulin.
This is the form of MODY which can most resemble ordinary type 1 diabetes, and
one of the incentives for diagnosing it is that insulin may be discontinued or
deferred in favor of oral sulfonylureas. Some people treated with insulin for years
due to a presumption of type 1 diabetes have been able to switch to pills and
discontinue injections. Long-term diabetic complications can occur if the glucose is
not adequately controlled.
High-sensitivity measurements of CRP may help to distinguish between HNF1A-

MODY and other forms of diabetes
56— pt with ovarian cancer and want disclose and her family refuse what is your
action ?
60-patient with lt testicular carcinoma metastesis to which L.N ?
-para-aortic
-preaortic
-femoral
-mediastial With the exception of spermatocytic seminoma, germ cell tumor types usually
develop retroperitoneal lymph node metastases. Tumors from the right testis spread to the
interaortocaval, precaval, and paraaortic region with crossover to the left-sided lymph
nodes. The left testis drains into the paraaortic and preaortic regions
61-patient fomeral pt with varicose vein ………………..
62- Question about differance between osteogenesis imperficta and

achondroplasia.
Achondroplasia is a common cause of dwarfism. It occurs as a sporadic mutation in

approximately 80% of cases (associated with advanced paternal age) or it may be inherited
as an autosomal dominant genetic disorder.People with achondroplasia have short stature,
with an average adult height of 131 centimeters (52 inches) for males and 123 centimeters
(48 inches) for females. Achondroplastic adults are known to be as short as If both parents
of a child have achondroplasia, and both parents pass on the mutant gene,
These genetic changes reduce the amount of type I collagen produced in the body, which
causes bones to be brittle and to fracture easily. The mutations responsible for most cases
of osteogenesis imperfecta types II, III, and IV occur in either the COL1A1 or COL1A2
gene.Jan 10, 2017
63-drug used in pt with smoking cessation:
-burpioion
66- Question about epicarditis tennis elbow
-affect extision muscle
-………………………………..
Pain on the outer part of the elbow (lateral epicondyle) Point tenderness over the lateral
epicondyle—a prominent part of the bone on the outside of the elbow Pain from gripping
and movements of the wrist, especially wrist extension[citation needed] and lifting
movements Pain from activities that use the muscles that extend[citation needed] the wrist
(e.g. pouring a container of liquid, lifting with the palm down, sweeping, especially where
wrist movement is required)
‫امتحان ابتهاج‬
1-pancoratitis, what drug cause it ?
=azathioprine
2-commonesr cause of chronic pancreatitis and lead to ca pncrease
-Alchol
-familiar
-Gall stone
3-enzyme responsible for pancreatitis :
lipase
amylase elevated too but lipase more specific
4-commonest cause of acute pancreatitis?
Gall stone
5-hemolytic uremic syndrome (HUS) Causative organism :
E. coli
6-HUS, newly effect, causative organism :
N. menigititis , strepto pneumonia , staph
7-female with fever and haemoptysis , lower grade fever , if there is frank haemoptysis
what is the golden investigation to diagnosis?
-broncoscopy
-CXR
-CT
-MRI
TIP :
Golden investigation bronscopy
Initial investigation CXR
8-Same case above:if the sputum is foul smell the answer is bronchiactasis.
9-what is the causative organism of the above case if the cough lasts for 3-8 weeks with
distinguish pattern the answer would be be ====pertusis
10-…………………
11-what is true about synovian syndrome?
-occur in small joint
-occur more commonly in tissues around joint -……………..-…………………..
12-LSD????
13-Cord prolapsed what is the most mode of delivery if cervix is fully dialated:
-V.D
-Assissted V.D
-C/S
-Forecep
14-commonest presentation with cord prolapsed:
-cephalic
-transverse
-shoulder
-face
15-child presented with cyanosis ass with crying , there is history of cyanosis , normal
growth :
ASD
VSD
PDA
Pattern foramen ovale
16-Reactive arthritis:
17- Reactive arthritis if the cause is gynococcal ass with :
-eye problem
18-Alcohol affect which pathway
-GABA
-Glutamin
19-Alcohol patient with military wiss body his ttt include of the following except :
Benzodiazipam
Thiamin
IV fluid
Anhphysotic
20-question about Alcohol.
21-couple came to yor clinic to discuss contraception , what is the method ass with ectopic
IUCD
22-If the female is having high androgen , which method is contraindicated for her ?
23-Fibrinomyalgia:
-ass with physcotic symptoms

-work insufficiency
-------. ----------------------------------
24-Glibret syndromw
Female with high unconjucated bilirubin
25-Charcot joint :………………….
26-tertiary hyperparathyrodim
Postrenal
CRF
27-Drug causes TTP=== QUININ

28-mechanism of TTP
Von will brand factor
29-schizophrenia
30-personality disorder:
Paranoid
Shezoid
Histroinic
31-type of material in vessel suturing
Nylon silk
32-worm bag in testis=variocelle

33-Sleep apnea
Narcolepsy
34-Androstenodion
35-EAA extrisnsic alleric allveolitis:
-Neutrophilia
-eosinophilia
36-MVD=ALS
37-Small cell lung carcinoma case
39-small cell lung carcinoma
40squamouse cell carcinoma = précis posing ulcer
41-
42-Steroid potency
43-Psoriasis ass with itching ===flexo….!!!!!
44-
45-Lichen psoriasis
Not invasive mouth
46-drug causes renal artery vasodilatation
47-filtration of glucose occur in
DCT
PCT
Loop of Hennle
Collecting duct
48-panic disorder occur mostly (acyropphdia)
49-15 years old , you want him to participate in research , consent form :
-Him
-parent
-older brother
-……………..
50-Kupffer cell:
-sinusidal
-portal
51-rectal αurethrocele
‫) إمتحان وئام )مكتوب باللون االسود‬
1-Hormon maintains BMR in body

Ans::Thyroid
2-Hormon inhibits apptite centre
Ans: leptin
3-in DKA which is predominant keton body
Ans:β – hydroxybutyrate
4-symptoms of DKA does not appear until β-cell are destroyed
-10-20 %
-30-40%
-40-50%
-70-80%
5-DKA symptoms occur due to:
-↑FFA LEVEL
-excess glucagon
6-Regarding sweat glands match the following:
No available options
5 questions about vitamin D
7-pic of bowing sign (legs)
Which disease ans: rickets
8-same pic asking cause of pseudo – fractures
-rickets
-osteoporosis
-osteomalacia
-osteopetrosis
Osteomalacia is the softening of the bones caused by impaired bone metabolism primarily
due to inadequate levels of available phosphate, calcium, and vitamin D, or because of
resorption of calcium. The impairment of bone metabolism causes inadequate bone
mineralization. Osteomalacia in children is known as rickets, and because of this, use of
the term "osteomalacia" is often restricted to the milder, adult form of the disease. Signs
and symptoms can include diffuse body pains, muscle weakness, and fragility of the bones.
In addition to low systemic levels of circulating mineral ions necessary for bone and tooth
mineralization, accumulation of mineralization-inhibiting proteins and peptides (such as
osteopontin and ASARM peptides) occurs in the extracellular matrix of bones and teeth,
likely contributing locally to cause matrix hypomineralization (osteomalacia).[
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The most common cause of osteomalacia is a deficiency of vitamin D, which is normally
derived from sunlight exposure and, to a lesser extent, from the diet.[ HYPERLINK "/l"
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deficiencies of vitamin D or phosphate (which would typically be identified in childhood)
or malignancy
9-same pic :if the patient has normal 250H vit D level and hyperthyroidism
which organ affected:
-skin
-liver
-kidney
-bone
10-patient has def of vit D along with vit D supplement what you will add
-zinc
-magnisium
-phosphorous
-Ca-phosphate
Vitamin D and calcium supplements are measures that can be used to prevent and treat
osteomalacia. Vitamin D should always be administered in conjunction with calcium
supplementation (as the pair work together in the body) since most of the consequences of
vitamin D deficiency are a result of impaired mineral ion homeostasis
11-match the following (pic was giving )
SA node
AV node
Buddle of His
Rt atrium
Sulcus terminalis
Anteroventiricular septum
12-Regarding : T.b arthritis
-it is usually monoarticuular
-involves small non-weight bearing joint
-aspiration of synovial fluids doesn't show myobacteria
-systemic symptoms are rare.
Ab bd abd
The most common form of articular tuberculosis is spondylitis followed by arthritis of
6
weight bearing joints (especially knee and hip ). The spine is the most common site
followed by the hip joint which constitutes approximately 15% of all cases.
Tubercular arthropathy can affect any joint but frequently reported in knee, ankle,
sacroiliac joint, sternaoclavicular joint, shoulder, elbow and wrist. Tubercular arthropathy
is usually monoarticular
Initial acid-fast bacilli smears are often negative and synovial culture is positive in ~80%
6
of cases
13-what will be the rate of a patient with atrial fibrillation and strong vagal
tone:
-140-160
-‹100
-160-200
-more than 200
14-patient with ECG done shows atrial fibrillation which during u will give :
-Esmol
-adenosine
-flecainide
-sotalol
15-pt came with complaing of : weight gain and fatigue , lab shows abnormal TSH and T4
, Which drug drug he is taking
Ans :amiladorone
Medicines. Some medicines can interfere with normal production of thyroid hormone.
Lithium is one of the most common medicines that causes hypothyroidism. Others include
amiodarone (such as Cordarone or Pacerone) and interferon alfa (such as Intron A or
Roferon A).
16-what will be treatment of choice for patient with pleaurl thickness like given ›10
mm……!!!!
-Thoracocentesis
-Decortication (An operation done by surgeon to strip the connective tissue fron lung
parenchyma).
-lung biopsy and transplantation
Pleural thickening commonly occurs after a patient suffers pleural effusion, an

excessive buildup of fluid in the pleural space
long term complication of asbestosis
17-patient came c/o dyspnea and cough he was admitted after 1 day he suddenly
developed shortness of breath x rays was given , what is diagnosis
-pneumonia
-COPD
-atelactasis
-pneumothorax
18-
19-Idiopathic pulmonary fibrosis characterized by:
-Normal ↑FEV/FVC
-↓TLC
-↑R.V
-↓FEV/FVC
19-patient chain smoker presented with SOB spirometery done what parameter will be
affected :
-↓FEV
-↑FEV/FVC
-↓TLC
20-Pt long chain smoker came to Dr. what factor will be important in prognosis
-smoking cessation
-ipratrobium
-LABA
-Salbutamol
21-which of the following causes of trasduate pleaural effusion
-T.B
-Malignancy
-Cirhosis of liver
-Pneumonia
21-pleaural fluid will be trasudate if :

-pleural fluid protein ›0.5
-pleural fluid LDH›0.6
-pleural fluid LDH›2/3 of serum

-none of the above.
Lights criteria (High protein and LDH = exudate), determines presence of exudate with
protein and LDH levels
Pleural fluid protein to serum protein ratio >0.5
Pleural fluid LDH to serum LDH ratio >0.6
Pleural fluid level >2/3 of upper value for serum LDH
Additional criteria – Confirm exudate if results equivocal
Serum albumin – pleural fluid albumin <1.2g/dL
21-regarding patient autonomy :
-maintains confidentaly
-providing medical care acting in best s…… of patient;
-informed consent
Ac true c d true acd are true
n medical practice autonomy is usually expressed as the right of competent adults to make
informed decisions about their own medical care. The principle underlies the requirement
to seek the consent or informed agreement of the patient before any investigation or
treatment takes place
Definition: Autonomy is the “personal rule of the self that is free from both controlling
interferences by others and from personal limitations that prevent meaningful choice.”
Autonomous individuals act intentionally, with understanding, and without controlling
influences.
Clinical Applications: Respect for autonomy is one of the fundamental guidelines of

clinical ethics. Autonomy in medicine is not simply allowing patients to make their own
decisions. Physicians have an obligation to create the conditions necessary for autonomous
choice in others. For a physician, respect for autonomy includes respecting an individual’s
right to self-determination as well as creating the conditions necessary for autonomous
choice.
Individuals come to doctors for guidance in making choices because they do not have the
necessary background or information for making informed choices. Physicians educate
patients so that they understand the situation adequately. They calm emotions and address
fears that interfere with a patient’s ability to make decisions. They counsel patients when
their choices seem to be disruptive to health and well-being. Respect for autonomy also
includes confidentiality, seeking consent for medical treatment and procedures, disclosing
information about their medical condition to patients, and maintaining privacy.
Examples of promoting autonomous behavior: Presenting all treatment options to a patient,

explaining risks in terms that a patient understands, ensuring that a patient understands the
risks and agrees to all procedures before going into surgery.
Beneficence:
Definition: Beneficence is action that is done for the benefit of others. Beneficent actions
can be taken to help prevent or remove harms or to simply improve the situation of others.
Clinical Applications: Physicians are expected to refrain from causing harm, but they also
have an obligation to help their patients. Ethicists often distinguish between obligatory and
ideal beneficence. Ideal beneficence comprises extreme acts of generosity or attempts to
benefit others on all possible occasions. Physicians are not necessarily expected to live up
to this broad definition of beneficence. However, the goal of medicine is to promote the
welfare of patients, and physicians possess skills and knowledge that enable them to assist
others. Due to the nature of the relationship between physicians and patients, doctors do
have an obligation to 1) prevent and remove harms, and 2) weigh and balance possible
benefits against possible risks of an action. Beneficence can also include protecting and
defending the rights of others, rescuing persons who are in danger, and helping individuals
with disabilities.
Examples of beneficent actions: resuscitating a drowning victim, providing vaccinations

for the general population, encouraging a patient to quit smoking and start an exercise
program, talking to the community about STD prevention.
Balancing Autonomy and Beneficence:
Some of the most common and difficult ethical issues to navigate arise when the patient’s
autonomous decision conflicts with the physician’s beneficent duty to look out for the
patient’s best interests. For example, a patient who has had bypass surgery may want to
continue to smoke or a patient with pneumonia may refuse antibiotics. In these situations
the autonomous choice of the patient conflicts with the physician’s duty of beneficence and
following each ethical principle would lead to different actions. As long as the patient
meets the criteria for making an autonomous choice (the patient understands the decision at
hand and is not basing the decision on delusional ideas), then the physician should respect
the patient’s decisions even while trying to convince the patient otherwise.
22-opening snab is seeing in :
Ans : mitral stenosis
23-Drugs used for acne causes hypertriaglycemia
retinoids
24-which of the following is x-linked recessive lysosomal storage disease
Ans: fabry's disease
2 ques on Acnevalgaris
2 ques on psoriasis
29-most common cause of impetigo :
-streptpyogens
-staph aerus
30-Pic of skin given asking which striae is seen in /
Ans: lichen planus
31-drug of choice of patient with HTN and renal arterystenosis
Fluid retention
CC/AHA, ESC and SCAI all prefer medical therapy as the first-line treatment for RAS.
[44, 45, 46] ACC/AHA and ESC recommend ACE inhibitors, ARBs, and calcium channel
blockers for unilateral RAS, [44, 45] but ESC finds ACE inhibitors and ARBs
contraindicated for the treatment of bilateral severe RAS and in the case of a single
functional kidney. [45] ACC/AHA also recommends beta-blockers for treatment of
hypertension associated with RAS.
Medical therapy remains the cornerstone of treatment for renal-artery stenosis (15). ACE
inhibitors, angiotensin II receptor blockers and calcium channel blockers are effective in
the treatment of hypertension in the presence of unilateral RAS and may lead to slowing of
the progression of renal disease (class I, level B).
The major risk of current pharmacologic therapy resides in the decline of renal function, a
clinical situation often encountered when introducing an ACE inhibitor or ARB. These
drugs are efficient antihypertensives in 86-92% of RVH patients, usually in combination
with a calcium antagonist and a diuretic. ACEIs and ARBs are generally well tolerated,
with only 5% of cases requiring cessation during the first three months. A significant (over
30%) fall in GFR (or an over 0.5 mg/dL rise in serum creatinine) may be an indication to
consider renal revascularisation.
ACE inhibitors and ARBs are contraindicated in the case of bilateral RAS and when this
lesion affects a single functional kidney.
There is evidence that thiazides, hydralazine, and beta-blockers are also effective in
achieving target blood pressure in individuals with RAS (1
32-Drug used to decrease proteinuria in D.M.
Ans: ACE Inhibitor (lisinopril).
33-Drug used for alcohol withdrawal
Ans:diazepam
34-pt had removed terminal ilium , which thing will be deficient
Ans :vit B 12
35-alcohol decrease absorption of :
Ans :vit B 12
36-regarding delirium tremens :
-seziures occur after 2 weeks
-phenytoin has no role
-occur in chronic alcoholic patient
A c true abc true ade true none
37-following is responsible for maturation of RBC
Ans:folic acid
38-pt presented with loose motion and bloody diarrhea ,string sign scan of xray diagnosis
Ans. Chron's disease
39-case control study :
-To know risk factors
-To see disease prevelance
-. ….. . . .
Ab true adc
A case-control study is a type of observational study in which two existing groups differing
in outcome are identified and compared on the basis of some supposed causal attribute.
Case-control studies are often used to identify factors that may contribute to a medical
condition by comparing subjects who have that condition/disease (the "cases") with
patients who do not have the condition/disease but are otherwise similar (the "controls").
[1] They require fewer resources but provide less evidence for causal inference than a
randomized controlled trial.
Porta's Dictionary of Epidemiology defines the case-control study as: an observational
epidemiological study of persons with the disease (or another outcome variable) of interest
and a suitable control group of persons without the disease (comparison group, reference
group).[2] The potential relationship of a suspected risk factor or an attribute to the disease
is examined by comparing the diseased and nondiseased subjects with regard to how
frequently the factor or attribute is present (or, if quantitative, the levels of the attribute) in
each of the groups (diseased and nondiseased)."[2]
40-marfan syndrome characteristic by:
Ans :defect in fibrilin gene
41-Syphilis matching
Tertiary syphilis
Charcot joint
Specific kind of arthritis
Tabes dorsalis
ny condition resulting in decreased peripheral sensation, proprioception, and fine motor

control:
Diabetes mellitus neuropathy (the most common in the U.S. today, resulting in destruction
of foot and ankle joints), with Charcot joints in 1/600-700 diabetics. Related to long-term
poor glucose control.
Alcoholic neuropathy
Cerebral palsy
Leprosy
Syphilis (tabes dorsalis), caused by the organism Treponema pallidum
Spinal cord injury
Myelomeningocele
Syringomyelia
Intra-articular steroid injections
Congenital insensitivity to pain
Peroneal muscular atrophy
Primary stage: After the initial infection (direct sexual contact with affected individual), the
bacterium spreads all over the body using the blood vessels and lymphatic system, and
multiply rapidly. Primary lesions form within a few hours after infection, which contain
large quantities of the Treponema bacteria.
Secondary stage: The bacterium invades tissues, cerebrospinal fluid, skin, and mucus
membranes. It causes inflammatory rashes on the body (secondary lesions), within 4-12
weeks after the primary stage. This continues till a stage of dormancy is reached; after
which multiple relapse or remissions take place (for the next 1-2 years).
Tertiary stage: After the secondary stage, there is a period of latency, which could last for
many years. A third of all infections, then gradually progresses to Tertiary Syphilis. In this
stage, the central nervous system is affected and several vital organs (heart, liver) may
develop infections. This may take place after 3 years or sometimes even after 20 years.
Tertiary Syphilis is classified into three key types, principally based on the infestation
location. These are: Neurosyphilis, Cardiovascular Syphilis, and Gummatous Syphilis
Neurosyphilis occurs when the infection affects the central nervous system. It is grouped
into six principal types; Neurosyphilis – Tabes Dorsalis is one among them
Tabes Dorsalis is a rare form of Neurosyphilis, in which the brain, spinal cord, and several
muscles of the gastrointestinal/digestive system are involved. It occurs many years after the
individual first contracts Syphilis
Who gets Tabes Dorsalis Neurosyphilis? (Age and Sex Distribution)
Sexually mature men and women who are infected by Treponema bacteria contract
Syphilis. Occasionally, even teenagers (as young as 15 years) are affected by this infectious
condition
No gender preference or racial predilection is observed. However, according to a CDC

report (CDC.gov release, 2006) the male-female incidence for Syphilis - Primary &
Secondary, stands at 6:1. The male-female ratio for an untreated Syphilis developing to
Tertiary Syphilis is around 2:1
In certain geographical regions with lower socio-economic standards and insufficient

access to proper healthcare (such as central African regions); it is found that the general
incidence of sexually transmitted diseases (STDs), including Syphilis is higher
42-water house fluidride syndrome is caused by :
Ans :nieseria meningitides
43-addison disease, auto immune type I which infection is common ?
Ans :candida
44-central addision disease characterized by all except:
-hyponatremia
-hypoglycemia
-hyperkalemia
-vascular collapse
45-drug used to decrease water retention in CHF
-Frusemide
-spironolactone
-ACE I
-β-blocker
46-Gout
Match the following in espect of side effect :
-alloprinol====hypersensitivity reaction
-Cholichine –blood diarrhea

-preobenecid====water retition
preobenecid/ Dizziness; flushing; hair loss; headache; loss of appetite; nausea; sore gums;
vomiting.
side effects occur when taking colchicine:
More common:
Diarrhea
nausea or vomiting
stomach pain
Rare
Black, tarry stools
blood in the urine or stools
burning, "crawling", or tingling feeling in the skin
difficulty with breathing when exercising
fever with or without chills
headache
large, hive-like swellings on the face, eyelids, mouth, lips, or tongue
muscle weakness
numbness in the fingers or toes (usually mild)
pain
peeling of the skin
pinpoint red spots on the skin
redness
skin rash or hives
sores, ulcers, or white spots on the lips or in the mouth
sore throat
swelling
tenderness
unusual bleeding or bruising
unusual tiredness or weakness
Most people on allopurinol don’t experience side-effects. However, some possible side-
effects include:
skin rashes
drowsiness, dizziness or headaches
feeling sick (nausea) or vomiting
taste disturbance
47-match the following with respective side effect:

-aminoglycoside====focal glomulular necrosis
-graft rejection====tubular cells
-SLE======red cell in urin
-…………………………………………………………………………………..
he kidney is the most commonly involved visceral organ in SLE. Although only
approximately 50% of patients with SLE develop clinically evident renal disease, biopsy
studies demonstrate some degree of renal involvement in most patients. [80] Therefore, it
is important to correctly classify the extent of renal involvement in SLE to improve the
correlation between histologic findings and the prognosis of the renal disease (see Biopsies
and Histologic Features under Workup).Glomerular disease usually develops within the
first few years of SLE onset and is often asymptomatic.
Acute or chronic renal failure may cause symptoms related to uremia and fluid overload.
Acute nephritic disease may manifest as hypertension and hematuria. Nephrotic syndrome
may cause edema, weight gain, or hyperlipidemia.
Rejection is an adaptive immune response via cellular immunity (mediated by killer T cells
inducing apoptosis of target cells) as well as humoral immunity (mediated by activated B
cells secreting antibody molecules), though the action is joined by components of innate
immune response (phagocytes and soluble immune proteins). Different types of
transplanted tissues tend to favor different balances of rejection mechanisms.
Immunization[edit]
An animal's exposure to the antigens of a different member of the same or similar species
is allostimulation, and the tissue is allogenic. Transplanted organs are often acquired from a
cadaver (usually a host who had succumbed to trauma), whose tissues had already
sustained ischemia or inflammation.
Dendritic cells (DCs), which are the primary antigen-presenting cells (APCs), of the donor
tissue migrate to the recipient's peripheral lymphoid tissue (lymphoid follicles and lymph
nodes), and present the donor's self peptides to the recipient's lymphocytes (immune cells
residing in lymphoid tissues). Lymphocytes include two classes that enact adaptive
immunity, also called specific immunity. Lymphocytes of specific immunity T cells
—including the subclasses helper T cells and killer T cells—and B cells.
The recipient's helper T cells coordinate specific immunity directed at the donor's self
peptides or at the donor's Major histocompatibility complex molecules, or at both
onoliguric acute kidney injury — Acute kidney injury from aminoglycoside exposure
typically manifests after five to seven days of therapy. The nonoliguric aspect of the renal
failure is secondary to a loss in renal concentrating ability believed to be the result of distal
tubular damage.
The acute tubular necrosis that occurs from aminoglycoside exposure is rarely severe, with
incremental increases in the plasma creatinine that are usually mild (0.5 to 2.0 mg/dL [44
to 177 micromol/liter]) [6]. However, aminoglycosides can result in toxicity, mandating
renal replacement therapy in patients who already have chronic kidney disease (CKD). The
urine sediment most commonly shows mild proteinuria, hyaline, and granular casts. The
fractional excretion of sodium is generally above 1 percent (calculator 1) or, for standard
units, (calculator 2). (See "Fractional excretion of sodium, urea, and other molecules in
acute kidney injury (acute renal failure)".)
https://www.niddk.nih.gov/health-information/kidney-disease/glomerular-diseases
48-patient with threated abortion how to know vailability of the fetus :
Ans:U/S
49-match the following :

-meune alleght syndrome===osteoporosis
All the options was syndromw first time to hear about
50-patient presented with cough , sore throat , organism isolated pic was given , which of
the following is G-ve rods
-clostriduium g+ve rod
-neiserriad-ve cocci
-bacillus
-corynebacter diphtheriag+ve rod
51-Drug inhibits epithelial sodium channel on collecting ducts
Ans:amiloride
Common side effects include high blood potassium, vomiting, loss of appetite, rash, and
headache.[1] The risk of high blood potassium is greater in those with kidney problems,
diabetes, and those who are older.[1] Amiloride is in the potassium-sparing diuretic family
of medications.[1] It works by increase the amount of sodium and decreasing the amount
of potassium released by the distal tubule of the kidney
52-Drug which decrease risk of TIA in atrial fibrillation
Ans: warafarin
53-regarding GH & IGH match the following :
-somatostatin ====↓IGH
-………….
-……………
-……………..
Somatostatin, also known as growth hormone–inhibiting hormone (GHIH) or by several

other names, is a peptide hormone that regulates the endocrine system and affects
neurotransmission and cell proliferation via interaction with G protein-coupled
somatostatin receptors and inhibition of the release of numerous secondary hormones.
Somatostatin inhibits insulin and glucagon secretion.
Somatostatin is produced by neuroendocrine neurons of the ventromedial nucleus of the

hypothalamus. These neurons project to the median eminence, where somatostatin is
released from neurosecretory nerve endings into the hypothalamo-hypophysial system
through neuron axons. Somatostatin is then carried to the anterior pituitary gland, where it
inhibits the secretion of growth hormone from somatotrope cells. The somatostatin neurons
in the periventricular nucleus mediate negative feedback effects of growth hormone on its
own release; the somatostatin neurons respond to high circulating concentrations of growth
hormone and somatomedins by increasing the release of somatostatin, so reducing the rate
of secretion of growth hormone
54-AIDS ↓
CD 4 CELLS
HIV-1 uses CD4 to gain entry into host T-cells and achieves this through its viral envelope
protein known as gp120.[13] The binding to CD4 creates a shift in the conformation of
gp120 allowing HIV-1 to bind to a co-receptor expressed on the host cell. These co-
receptors are chemokine receptors CCR5 or CXCR4. Following a structural change in
another viral protein (gp41), HIV inserts a fusion peptide into the host cell that allows the
outer membrane of the virus to fuse with the cell membrane.
HIV infection leads to a progressive reduction in the number of T cells expressing CD4.
Medical professionals refer to the CD4 count to decide when to begin treatment during
HIV infection, although recent medical guidelines have changed to recommend treatment
at all CD4 counts as soon as HIV is diagnosed. A CD4 count measures the number of T
cells expressing CD4
55-Drug causes abortion by antagosing progression receptors on utrus:
-mifepristone……..
-misoprostol
-gemprost
-all of the above.
rogesterone receptor antagonists work as antiprogestins. The main example is mifepristone.

Selective progesterone receptor modulators may also have more or less antagonist activity.
Additional PR antagonists include: onapristone (ZK98299), lonaprisan (ZK230211,
BAY86-5044), APR19, EC304, WAY-255348, ORG31710, asoprisnil (J867), telapristone
(Proellex, CDB-4124), and CDB-2914 (ulipristal acetates).[19
56-patient with road traffic accident complain of decrease abduction of arm which nerve
affected
Ans:axillary nerve.
jury of axillary nerve (axillary neuropathy) is a condition that can be associated with a
surgical neck of the humerus fracture.
It can also be associated with a dislocated shoulder [1] or with traction injury to the nerve,
which may be caused by over-aggressive stretching or blunt trauma that does not result in
fracture or dislocation.[2] One form of this injury is referred to as axillary nerve palsy.
Injury most commonly occurs proximal to the quadrilateral space.
Injury in this nerve causes paralysis (as always) to the muscles innervated by it, most
importantly deltoid muscle. This muscle is the main abductor of the shoulder joint from 18
to 90 degrees (from 0 to 18 by supraspinatus). Injury can result in a reduction in shoulder
abduction.[4] So a test can be applied to a patient with injury of axillary nerve by trying to
abduct the injured shoulder against resistance
57-regarding bells palsy:
-most cases of fascial palsy are bilateral
-there is swelling of ganglion in Ext auditory canal
-patient completely recover
-………………………
58-1 ques of T.B
59-1 ques of Pneumonia
60-one ques on UTI
61-Stab wound on chest , pt came with SOB there is equilibration of pressure in all
chamber of heart , what is the diagnosis :
Ans cardiac temponade
62-one question on SLE.

63-1 ques on costidal
64-1 ques on thyroid acropachy
Pic was given pic indicates
Ans:clubbing
65-drug increase sensitivity of insulin
Ans:metformin
‫امتحان البت النجحت‬
1-Amphetamine used to treat:
narcolepsy ,
Obesity
,HIV
2-Which drug is not used in treating heat stroke ?
treated by cooling the pt , fanning.ac, ic bath or bpacks
no iced iv saline will stop the heart
3-Which of the following is not a feature of heat stroke ?
caracterized by elevated body temp due to high temp outside
dehydratio dry skin
hyperkaleamia
high ALP
confusion
arrhythmias
4-Which part slows down conduction in the heart ?
AV node?
Purkinjie?
bundle of his
AV node briefly slows down the electrical signal, giving the ventricles time to
receive the blood
5-Which inv to rule out hemorrhage in stroke ? CT
6-Which imaging test to rule out infiltrating disease in heart ?
Two dimensional echocardiography

Echocardiography is the first line investigation for evaluation of patients with
suspected cardiac sarcoidosis. Echocardiographic appearances are variable and
may show regional wall motion abnormalities and thickening of the interventricular
septum, with bright shadows consistent with infiltration. Alternatively the ventricles
may appear thinned, with global dysfunction and aneurysm formation. Diastolic
dysfunction is seen on initial interstitial inflammation, when systolic function may
still be normal. Subsequent injury and fibrosis causes systolic
abnormalities.21,22,23 As most of these features are also common in ischaemia,
coronary artery disease will require exclusion.
-Radionucleotide scintigraphy studies
201Thallium scintigraphy myocardial perfusion studies typically show segmental

areas of decreased uptake in the ventricular myocardium that disappear or
decrease in size during stress or after intravenous administration of
dipyridamole.24,25 However, this reverse distribution is not specific for cardiac
sarcoidosis as it may also occur in other cardiomyopathies.
7-Picture of Cushing's syndrome what is the cause ?
Adrenal nodule
, adrenal carcinoma
, pituitary Adenoma,
ectopic ACTH .
cushing syndrome is of any cuz /cushing syndrome due to pitutary adenoma & is
ass e androgen excess n bilateral adrenal hyper plasia . androgen excess
(hirsutism) absent in iatrogenic cushing as exogenous steroides suppress
androgens secrition by adrenal glands
Pituitary adenomas cause most cases of Cushing's syndrome. They are benign, or
non-cancerous, tumors of the pituitary gland which secrete increased amounts of
ACTH, (adrenocorticotropin), a hormone that stimulates the adrenal glands
a pituitary adenoma are known as Cushing's disease. It is the second most

common cause of Cushing's syndrome after medication
8-Match the respective antibody with its cause
hashimoto / antithyroglobulin
1 biliary chirosis / antimitocondrial

9-Which drug can cause hypercalcemia and stones ?
Lithium
10-Which vertebra correspond to the spinal cord level at same level.
first two cervical cord segments roughly match the first two cervical vertebral
levels.
C3 – C8 segments of the spinal cords are situated between C3 through C7 bony

vertebral levels.
Likewise, in the thoracic spinal cord, the first two thoracic cord segments roughly
match first two thoracic vertebral levels.
However, T3 through T12 cord segments are situated between T3 to T8. The
lumbar cord segments are situated at the T9 through T11 levels while the sacral
segments are situated from T12 to L1. The tip of the spinal cord or conus is
situated at L2 vertebral level. Below L2, there is only spinal roots, called the cauda
equina.
A rough calculation can be done as follow to obtain a relation between vertebral

and segmental level.
From C2-C6 vertebra add 1 to obtain the spinal segment level
From T1-T6 vertebra add 2 to obtain the spinal segment level
From T7-T9 vertebrae add 3 to obtain the spinal segment level

T10-T12 vertebrae have whole of lumbar segments
L1 vertebra has sacral & coccygeal segments
L2 onwards is cauda equina
11-Bladder innervation nerve roots ?
12-Cervical vertebral most common site of compression56
13-most common site of ectopic pregnancy ? Ampulla
14-most common site of rupture ectopic and shock ? Isthmus
Most Common site: Ampulla
Most common site for rupture: Isthmus -because it has a thick muscularis, is
narrow, inflexible and rigid.
97% of ectopic pregnancies occur in the Fallopian tube. 80% of these occur in the
ampulla region of the tube. About 10% occur in the isthmus region and about 5%
in the infundibulum region. Only about 3% occur in the interstitial portion of the
Fallopian tube.
www.obgyn.net/displayarticl...projects/ectopic-pregnancy
The most frequent type of ectopic pregnancy is the tubal variety, which can be
particularly dangerous to the mother if it involves implantation in the narrow portion
of the tube near the uterus called the isthmus, rather than the larger, more
expandable ampulla or infundibulum. This is because as the fertilized egg attempts
to grow and divide, the isthmus attempts to stretch but is so narrow and inflexible
that it soon ruptures, causing profuse internal hemorrhaging that can lead to death.
Tubal rupture may also occur when the ovum is implanted in other regions of the
uterine tube, but at a lower rate of incidence since the longer amount of time it
takes to occur means that there is a better chance that the condition will be
recognized before the tube becomes physically damaged.
15-if cervical spondylitis with no radiculopathy, how to treat ?
exercise and careful mobilization ) ,
Treatment is usually conservative in nature. Patient education on lifestyle

modifications, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy
and chiropractic care are common forms of manual care that help manage such
conditions[citation needed]. Other alternative therapies such as massage, trigger-
point therapy, yoga and acupuncture may be of limited benefit[citation needed].
Surgery is occasionally performed.
16-cervical spondylitis with radiculopathy how to manage ?
Surgery
Candidates for Surgery
Candidates for surgery include patients who have progressive neurologic changes
with signs of severe spinal cord compression or spinal cord swelling. These
neurologic changes may include:
Weakness in the arms or legs
Numbness in the hands
Fine motor skill difficulties
Imbalance issues
Gait changes
Patients with severe or disabling pain may also be helped with surgery.
Patients who experience better outcomes from cervical spine surgery often have
these characteristics:
Younger age
Shorter duration of symptoms
Single, rather than multiple, areas of spinal cord involvement
A larger area available for the spinal cord
17-Narcolepsy differentiate from OSA? Different features written I chose non .
18-OSA duration of apnoea? How many seconds ? Less than 5, 10-20?
19-side effect of CPAP?
Dry airways
CPAP machine. This device includes a mask that you wear over your nose or
mouth, or both. An air blower forces constant and continuous air through the nose
or mouth. The air pressure is just enough to keep the upper airway tissues from
collapsing during sleep. Other types of positive airway pressure devices are also
available, including the BPAP, which has two levels of air flow that vary with
breathing in and out
20-Eosinophilia is not a feature of :
allergic bronchipulmonary asperigollisis
, lofflers syndrome
, parasitic infections
, extrinsic allergic alveolitis(hypersensitivity pneumonitis(nutrophilia}
21-from which cells arise carcinoid tumour ?

neuroendocrine cells
22-Which drug with extensive first pass metabolism given after mi with high dose ?
Nitrate
?aspirin ?
Mode of Action
In the tissues , isosorbide dinitrate is denitrated and nitrous oxide (NO) is released.
It acts on vascular smooth muscle and is a potent vasodilator . Venous smooth
muscle is more sensitive than arterial smooth muscle. This results in a peripheral
pooling of blood, decreased venous return in the hear and also a decrease in the
peripheral arterial resistance (reduces preload and after load ). Coronary
vasodilatation is also produced. All these effects results in decreased myocardial
oxygen demand and relief of anginal symptoms. In congestive cardiac failure, its
reduces preload and ventricular filling pressures, hence reducing symptoms and
increasing exercise capacity in congestive cardiac failure patients. It also
decreases platelet aggregation.
Pharmacokinetics:
It is absorbed from the GIT but due to extensive first passmetabolism,

bioavailability is as low as 10 % . Hence usually it is administered sublingually,
which bypasses the first pass effect and bioavailability increases by 50 % . Onset
of action is few minutes after administration. Duration of effect is 15 –30 minutes.
When longer duration of action is needed, transferal or buccal routes do
administration or slow release preparations can be used. It is excreted as
glucuronide conjugates in the urine.
23-Which is commonest site of fluid and electrolyte absorption ?
Jejenum
, ileum ,
first half or second half of deudenun
Because of differences in structure and in absorptive and secretory mechanisms,

the various parts of the gut perform different functions. In the jejunum, transport
activity is extensive and the rapid equilibration of its content provides the optimal
absorptive mixture. Functionally, the ileum and colon are similar; compared with
the jejunum, they have greater absorptive capacity for electrolytes and generate
significantly higher transmural electrical potentials. In the colon, some transport
mechanisms are potentiated by adrenocortical steroids. 3. Water and electrolyte
absorption and secretion are the end-products of bidirectional fluxes across the
intestinal wall that are several times greater than net movement in either direction.
Secretion is the surplus of negative flux (into the lumen) and absorption the
surplus of positive flux (out of it). 4. Many electrolyte transport mechanisms require
the absorption of other electrolytes or non-electrolytes, and some are concerned
with electrolyte exchange. Water transport is always passive, in the direction of
solute flow, but its solvent drag can move solutes across the intestinal membrane.
24-
Central precocious puberty is associated with which of those ?
prader wili syndrome ,
Mcune Albright syndrome

, congenital adrenal hyperplasia
, klinfelters
McCune-Albright syndrome is a disorder that affects the bones, skin, and several
hormone-producing (endocrine) tissues.
People with McCune-Albright syndrome develop areas of abnormal scar-like

(fibrous) tissue in their bones, a condition called polyostotic fibrous dysplasia.
Polyostotic means the abnormal areas (lesions) may occur in many bones; often
they are confined to one side of the body. Replacement of bone with fibrous tissue
may lead to fractures, uneven growth, and deformity. When lesions occur in the
bones of the skull and jaw it can result in uneven (asymmetric) growth of the face.
Asymmetry may also occur in the long bones; uneven growth of leg bones may
cause limping. Abnormal curvature of the spine (scoliosis) may also occur. Bone
lesions may become cancerous, but this happens in fewer than 1 percent of
people with McCune-Albright syndrome.
In addition to bone abnormalities, affected individuals usually have light brown

patches of skin called café-au-lait spots, which may be present from birth. The
irregular borders of the café-au-lait spots in McCune-Albright syndrome are often
compared to a map of the coast of Maine. By contrast, café-au-lait spots in other
disorders have smooth borders, which are compared to the coast of California.
Like the bone lesions, the café-au-lait spots in McCune-Albright syndrome often
appear on only one side of the body.
Girls with McCune-Albright syndrome usually reach puberty early. These girls
usually have menstrual bleeding by age two, many years before secondary sex
characteristics such as breast enlargement and pubic hair are evident. This early
onset of menstruation is believed to be caused by excess estrogen, a female sex
hormone, produced by cysts that develop in one of the ovaries. Less commonly,
boys with McCune-Albright syndrome may also experience early puberty.
25-Toxic hormone to heart muscle ?renin , angiotensin ?
26-most common cause of death post mi if untreated :
heart failure
VF
27-diabetes insipidus interpretation of results :-water deprivation test done and

urine became concentrated , which of the following can be eliminated ? Primary
polydypsia , partial nephrogenic DI, partial neurogenic DI, severe ADH deficiency ?
28-what is the commonest inheritance pattern in DI?
29-post streptocal GN , what kind of antibody in blood ? ASO.
30-which is not a modality of treatment in Post strep GN ?
steroids , antibiotics , dialysis , antihypertensives..
. 31-irreversible complication of chirrois? spider naevi, encephalopathy ,portal

HTN,
32-which is a feature of hyperoestergenemia : palmar eythema , ...spider naevi or

non of the above ? ( gynecomastia and loss of chest and axillary hair wasn't
included in the options so I chose non ) Skin :
33-picture of Focceps syndrome? Don't know spelling , where does it arise from ? I
chose sebaceous glands .
34-picture of roseaca? Which is not a feature of it ? I chose pustules randomly
forehead,nose n cheecs become red, looks like acne buut no comedone. o/e:
erythema ,telangictasia, papule, postule, in sever cases greasy thickness pulpous
apperance called rhinophyma.
to decrease the condition avoid alcohol and hot bevearges, sun exposture,
emotional stress. rx:topical metronidazol, tetracyclin for maintenance or retinoids
for sever cases
.35-Schizophrenia that has good mental capacity,type?
Catatonic ,
residual ,
Patients who meet the criteria for residual schizophrenia are still showing some signs of
their illness, but they don't have any prominent positive symptoms. Positive symptoms of
schizophrenia include hallucinations, delusions, catatonic behavior, severely disorganized
behavior, or disorganized speech
35-Residual shizophrenia ( wats not a feature of it ?
36-match:-metyrapone test , TRH test , L dopa test with respective pituitary

hormone
The L-Dopa stimulation test was designed as a simple test to perform in the initial
diagnostic workup (ie, screening) of a patient with suspected growth hormone deficiency.
... Testing of the GH axis should always be performed after an overnight fast
37- how to treat nodulocystic acne,
isitrniin
, acutirinon
Treatment of nodulocystic acne can be challenging and may require a combination of

medicines. Topical treatment is usually ineffective.
The recommended treatment for nodulocystic acne is isotretinoin, which should be
commenced early to prevent scarring. The treatment is required for at least five months,
and further courses are sometimes necessary.
Patients with acne conglobata often need additional treatments, such as:
Oral antibiotics
Intralesional steroids
Systemic steroids
Hormonal therapy in women
38-amputated limb phenomenon Which pain killer used with easy dosing ?
pregabalin
amytryptaline
39-hypothyroidism symptoms given with normal TSH level ..cause? hashimoto,
iodine deficiency
Reidel's thyroiditis
40-Picture of pneumothorax in 35 yr old male , wats the commonest cause ?

Primary , secondary , traumatic , tension ,,
41/picture of pellagra in alcoholic which vit is deficient ? c.

42-matching :-interpret result of high dose dexamethasone suppression test .
43-what's not a feature of hypomania? ,
44-wats the functions of the peritonenum ?
45-X ray of legs in hyperpatathroidsm : osteitis fibrosa cystica, osteomalacia ,

adynamic bone disease..??
46-x ray of painful hip in a small girl , wats commonest cause : slipped capital
femoral epiphysis, , acetabular dysplsia, non , legg Perth disease,
/47-neurotransmitter in euphoria ? Epinephrine , norepinephrine , GABA,,
48-autoimmune polyglandular syndrome type 1 associated with which disease ?

Hypoparathyroidsm and mucocutaneous candida
49-where is congenital kidney disease with retinitis pigmentosa occurring ? NPHP

, medullary sponge kidney ,polycystic kidney disease .
50- secondary causes of osteoporosis :-thyrotoxicosis, other options , non .
51-how to treat ectopic with hcg 2500 ? Laparotomy , oral methotrexate
52-spared muscles in Dermatomyositis and polymyositis
53-male sperm count less than 10 million , IVF or IUI.?
54-Which part of the skin has no sweat glands ? Lips .
55-Young man with ulcerative colitis , cause of severe lower tender abdomen ?
Perforation , fistula, stricture ,
,56-picture of KOH stain vaginal discharge ? Cause ? Candida .

57-Which of the following is an indirect risk factor for heart disease? Obesity ,
hypertension , diabetes , smoking , hyperlipidemia
.58- pt given ace inhibitor and thiazides , what blood test to monitor? Creatinine .
59- COPD , which r the measures which improve long term outcome in pts ? Long
term o2 therapy , lung reduction surgery , steroids ,stop smoking ..
60- most common organism / infection in cystic fibrosis ? Pseudomonas .
61- what is the most common indication for lung transplantation ? I chose Cystic
fibrosis , can't recall other options .
62- most common organism / infection in sicklers ? I chose staph aureus.

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‫امتحان الهندية‬

• Depression can co-exist with

2-Major symptoms associated anxiety

-Distal symmetrical po;yneuropathy

-proximal symmetrical polyneuropathy

5-Drus causing pancytopenia

-Is for common diseases

-diseases with long ……..period.

Wilson and Jungner classic screening criteria1

1. The condition sought should be an important health problem.

4. There should be a recognizable latent or early symptomatic stage.

6. The test should be acceptable to the population.

7. The natural history of the condition, including development from latent to

9. The cost of case-finding (including diagnosis and treatment of patients

a)234 b)123 C)134

Primary inversion by suturing/surgery

Secoandry inversion leave woun alone eg ulcer

Re open and then closure

9-Anti Parkinson causing tardive dyskinesia

Choices are not clear

Lichen sclerosus (LIE-kun skluh-ROW-sus) is an uncommon condition that creates

11-Guilaie psoriasis after which organism

Drugs: A number of medications have been shown to aggravate psoriasis. Some

Antimalarials: Drugs used to treat malaria, arthritis, and lupus

Smoking: Cigarette smokers have an increased risk of chronic plaque psoriasis.

13-histopic with senrio of PAS +VE Mesophage :

14-which malignancy metastasis to to adrenal gland:

15-bone frmationin muscle fascia after trauma to elbow:

16-bladder pain syndrome:

-no sign of inflammation

A)1,2,3 B)3,4 C)2,3,4

18-Sleep apnea………(causes) * respiratory

(the answer was all except alcohol).

SLEEP APNEA SYMPTOMS

Other symptoms may include one or more of the following:

●Awakening with choking, gasping, or smothering

●Waking frequently to urinate

●Awakening unrested, groggy

●Low energy, difficulty concentrating, memory impairment

Risk factors — Certain factors increase the risk of sleep apnea.

SLEEP APNEA COMPLICATIONS

19-micro pic gram –ve cocci (gram stain )

21-which SSRI not P450 inducers

23-Dystrophic calcification causes:

Dystrophic calcification (DC) is the calcification occurring in degenerated or

Infarcts may undergo D.C.

Thrombi, especially in veins, may produce phlebolithis.

Haematomas in the vicinity of bones may undergo D.C.

Dead parasites like schistosoma eggs may calcify.

Congenital toxoplasmosis, CMV or rubella may be seen on X-ray as calcifications

Density-Dependent Colour Scanning Electron Micrograph SEM (DDC-SEM) of

Dense scars may undergo hyaline degeneration and calcification.

Atheroma in aorta and coronaries frequently undergo calcification.[2][3]

Cysts can show calcification.

Calcinosis cutis is condition in which there are irregular nodular deposits of

Senile degenerative changes may be accompanied by calcification.

Risk of particular infections, such as Vibrio vulnificus (commonly from seafood) is

he slowing of the body's basal metabolic rate associated with hypothyroidism

A symptom of rare diseases such as mucolipidosis (type IV).

A symptom of Helicobacter pylori infection which neutralizes and decreases

A symptom of atrophic gastritis or of stomach cancer.

Radiation therapy involving the stomach.

Pellagra, caused by niacin deficiency.