1.	On cardiac auscultation,

a.	A loud 2nd heart sound at the mitral area is often heard in mitral stenosis.
b.	In this condition, the opening snap, heard best at the pulmonary area, is usually due to a heavily calcified mitral valve.
c.	A widely split and fixed 2nd heart sound is due to delayed closure of the pulmonary valve.
d.	The ejection systolic click is found in mitral regurgitation.
e.	Atrial septal defect is characterized by a split 2nd heart sound on inspiration and a loud pulmonary murmur.

Answer: C

2.	Which of the following is correct regarding the side effects of the given drugs?

a.	Pulmonary fibrosis: rifampicin.
b.	Gum hypertrophy: carbamazepine.
c.	Pulmonary eosinophilia: paracetamol.
d.	Methaemoglobinaemia: sulphonamide.
e.	Iron deficiency anaemia: azathioprine.

Answer: D

3.	Which of the following is not correct about megaloblastic anaemia?

a.	May occur during multiple pregnancy.
b.	Frequently occurs in patients with diverticulitis of the left colon.
c.	May be a manifestation of the blind loop syndrome.
d.	When present in Addisonian anaemia is due to deficiency of intrinsic factor.
e.	May result from prolonged phenytoin therapy.

Answer: B

4.	Hypercalcaemia can result from the following conditions except:

a.	Multiple myeloma.
b.	Carcinoma of the lung.
c.	Milk-alkali syndrome.
d.	Acute pancreatitis.
e.	Chronic renal failure.

Answer: E

5.	A patient complains of 4 months of loose motion following a gastric operation for duodenal ulcer. Which of the tests listed is the least useful?

a.	Serum gastrin level.
b.	Barium meal with follow-through examination.
c.	Stool fat estimation.
d.	Xylose excretion test.
e.	Serum amylase estimation.

Answer: E

6.	In patients presenting with jaundice and fever, which of the tests are useful, apart from:

a.	Mantoux test.
b.	Direct Coombs’ test.
c.	Fluorescent antibody for amoeba.
d.	Blood film for plasmodia.
e.	Sensitized erythrocyte lysis test for leptospirosis.

Answer: A

7.	Severe pyloric stenosis is associated with the following except:

a.	Aciduria.
b.	Raised Hb concentration.
c.	Low blood pH.
d.	Raised blood urea.
e.	Hypokalaemia.

Answer: C

Leads to a metabolic alkalosis.

8.	Which of the following is not correct, in SLE:

a.	Thrombocytopenia and/or haemolytic anaemia is frequently present.
b.	Acute nephritis or nephrotic syndrome manifestations usually improve with treatment.
c.	Psychotic symptoms can be due to the disease itself or to the treatment.
d.	Pericarditis and cardiac failure are usually present in terminal cases.
e.	Double-stranded DNA antibodies are usually present in high titres.

Answer: D

9.	Which of the following conditions is usually not associated with malabsorption?

a.	Tuberous sclerosis.
b.	Crohn’s disease.
c.	Multiple jejunal diverticulosis.
d.	Systemic sclerosis.
e.	Whipple’s disease.

Answer: A

10.	Cervical spondylosis:

a.	Is an acute paralytic illness due to a cervical disc prolapse.
b.	Is characterized by inversion of the biceps reflex.
c.	Has the highest incidence in the 40-50 age group.
d.	Results in progressive weakness and increased tone of the lower limbs.
e.	Is frequently associated with other congenital abnormalities like nerve deafness and optic atrophy.

Answer: D

Cervical spondylosis is a degenerative condition of the lower cervical spine that causes compression of the spinal cord or its roots.

11.	An elderly female complains of difficulty in swallowing associated with chest pain. She may be suffering from the following, except:

a.	Angina of effort.
b.	Achalasia.
c.	Plummer-Vinson syndrome.
d.	Complications of hiatal hernia.
e.	Complications of prolonged antibiotic intake.

Answer: A

12.	In supraventricular tachycardia,

a.	The heart rate is usually more than 150/min.
b.	The QRS complex is characteristically widened.
c.	The P waves are always inverted.
d.	The commonest cause is a prolonged QT interval.
e.	All the above are incorrect.

Answer: A

13.	When a patient presents with a stroke, which of the following should be seriously considered, apart from:

a.	Age.
b.	Sex.
c.	Occupation.
d.	Family history.
e.	Recent dental treatment.

Answer: B

14.	Which of the following is not correct, dementia may be caused by:

a.	Alcoholism.
b.	Hypothyroidism.
c.	Hypoglycaemia.
d.	Previous basal meningitis.
e.	Folate deficiency with megaloblastic anaemia.

Answer: E

15.	Which of the following statements is correct?

a.	Anticholinergic drugs such as opiates are used for treating constipation.
b.	Inflammatory bowel disease is due to overgrowth of bacteria in the colon.
c.	High fibre diet should be advised when patients complain of fever and watery diarrhoea.
d.	Hypothyroidism is often complicated by constipation.
e.	The commonest cause of irritable bowel syndrome is diabetes with severe autonomic neuropathy.

Answer: D

16.	Which of the following is not true?

a.	Fulminant viral hepatitis can result from either type A or type B infection.
b.	Cholestasis may be due to a hypersensitive reaction from drugs such as chlorpromazine.
c.	Autoimmune active chronic hepatitis is accompanied frequently by high titres of IgE antibodies, hyperglobulinaemia and hypercholesterolaemia.
d.	In obstructive jaundice, there is malabsorption of calcium, vitamin A and K.
e.	Liver biopsy is required usually to distinguish between chronic active from chronic persistent hepatitis due to type B infection.

Answer: C

17.	In a diabetic patient with recurrent urinary tract infection, the onset of hypotension and deterioration of the general condition suggests:

a.	Dehydration.
b.	Hypoglycaemia.
c.	Impending CVA.
d.	Onset of septicaemia.
e.	Myocardial infarction.

Answer: D

18.	Which of the following is not correct?

a.	Tight mitral stenosis may be a cause of angina pectoris.
b.	‘Heart burn’ is the most typical symptom of angina.
c.	The pain is not sharply localized in the chest, but may be referred to the left shoulder.
d.	Stress test is indicated when chest pain occurs with effort though the ECG is normal.
e.	Unstable angina is present when pain on effort progresses to pain at rest and lasts longer than previously.

19.	Which of the following complications are found in rheumatoid arthritis, hypothyroidism and acromegaly?

a.	Nephrotic syndrome.
b.	Hypercoagulable state.
c.	Hyperglobinaemia.
d.	Carpal tunnel syndrome.
e.	Xanthomatosis.

Answer: D

20.	Which of the following is not true in pericarditis?

a.	Presence of a rub over the base of the precardium.
b.	It may complicate myocardial infarction and renal failure.
c.	The prognosis depends on the etiology.
d.	Pericardial calcification is the characteristic of tuberculous pericarditis.
e.	Widespread ST depression in the ECG is usually present.

Answer: E

21.	Which of the following is not true of complete heart block?

a.	There is a low cardiac output.
b.	The intensity of the first heart sound varies from beat to beat.
c.	Stokes-Adams attacks are complications.
d.	The ECG is always diagnostic.
e.	None of the above is correct.

Answer: E

22.	The following are features of LVF except

a.	Ascites

b.	Basal crepitations

c.	Pink frothy sputum

d.	Orthopnea

e.	Nocturnal dyspnea
 
Answer: A

Ascites is a feature of right ventricular failure.

23.	Chronic diarrhea can be caused by the following except

a.	Carcinoid syndrome

b.	Inflammatory bowel disease

c.	Irritable bowel syndrome

d.	Clostridium difficule

e.	Malabsorption
 
Answer: E

24.	Features of isolated mitral stenosis are all the following except

a.	LVH on ECG.

b.	Pulmonary hypertension seen on x-ray.

c.	Small radial pulse.

d.	Parasternal heave.

e.	Accentuated 1st heart in the mitral area.

Answer: 

3. The 3rd heart sound

a.	is compatible in normal
b.	is absent in constrictive pericarditis
c.	never arise from right ventricle
d.	is a high pitch sound 
e.	is 150ms after the aortic second sound

4)Telangiectasia may be found in the following, except:
a)chronic liver disease
b)rosacea
c)basal cell carcinoma
d)osler-weber-rendu syndrome
e)henoch-scholein purpura

5) A 54 yr old man presented with the following electrolyte readings, what's 
the likely cause ?
Na 125
k  5
Cl 85
HCO3 10
Creatinine 360
a)Respiratoy acidosis
b)Mixed Respiratory and metabolic acidosis
c)metabolic acidosis
d) respiratory alkalosis and hyperchloraemic acidosis
e)respiratory alkalosis

6) Which of the following is not a cause of chronic cough?

(a)	Sinusitis
(b)	Bronchial asthma
(c)	Gastro-esophageal reflux disease
(d)	Captopril
(e)	Emphysema from 1-antitrypsin deficiency

Question 7:
What is the LEAST likely cause of diffused lymph node enlargement?
A. Toxoplasmosis
B. Chronic lymphatic leukaemia
C. Infectious mononucleosis
D. Secondary syphillus
E. Multiple myeloma

8. Dengue fever is associated with except

a.	depression
b.	loin pain
c.	moderate splenomegaly
d.	headache
e. maculopapular rash

Q13) GI bleeding, from the small bowel, can be
distinguished from the large bowel by:
A) blood mixed with faeces
B) blood separated from faeces
C) positive occult blood
D) daily output > 2L/24 hours
E) mucus

Question 14:
What to do in patient with massive upper bleeding GIT and in hypovolemic 
shock?
A. Put him on 4 hourly monitoring of pulse rate and BP
B. Upright and supine chest and abdominal X-ray
C. Resuscitate patient
D. Do emergency OGD and find cause of bleed
E. Emergency laparotomy

16. chronis subdural haematoma has the following feature except
a. headache
b. sensory ataxia
c. dementia
d. fits
e. pupillary changes

17. Ptosis is found in the following

2.	myasthenia gravis
3.	poliomyelitis
4.	tabes dorsalis
5.	dystrophica myotonica
6.	DM neuropathy

Qn 17 )    which is not a risk factor of stroke?
1) hypertension
2) AF
3) THYROTOXICOSIS
4) DM
5) rheumatic heart disease

18)In migraine, the following may be present except:
a)scintillating flashes of light
b)unilateral headache
c)homonymous hemianopia
d)horner's syndrome
e)nausea

19)The following are markers of hypoperfusion except :
a)Oliguria
b)Altered Mentation
c)Lactic acidosis
d)Hypovolemia
e)Respiratory acidosis

Question 20

The following are typical features of malignant hypertension except

(a)	Normal mental status
(b)	Diastolic blood pressure >140 mmHg
(c)	Proteinuria
(d)	Microangiopathic hemolytic anaemia
(e)	Retinal hemorrhage

Question 21:
What is the LEAST likely cause of chronic diarrhoea?
A. Carcinoid syndrome
B. Irritable Bowel Syndrome
C. Inflammatory Bowel Disease
D. Clostridium difficle
E. Malabsorption

22. Enlarged spleen is seen except

a.	liver cirrhosis
b.	myelofibrosis
c.	chronic lymphocystic leukaemia
d.	infective endocarditis
e.	idiopathic thrombotic thrombocyopenia
 
Q27)which is not a risk factor of stroke?
A) hypertension
B) AF
C) THYROTOXICOSIS
D) DM
E) rheumatic heart disease

30. The following are features of hypercapnia except
a. headache
b. somnolence
c. papilloedema
d. flapping tremor
e. peripheral vasoconstriction