1
INTERNAL MEDICINE, PEDIATRICS, SURGERY,
GYNECOLOGY & PSYCHIATRICS ALL
COMBINED EXAM WITH QUESTIONS AND
CORRECT ANSWERS
Internal Medicine
1) A 64 year old male, 3 days after urgent surgery for colon adenocarcinoma,
develops worsening dyspnea and hypoxemia. On examination –room saturation
92%, blood pressure 120/80, pulse 105/min, creatinine 0.9 mg/dl, with no other
abnormal clinical findings. What is the most appropriate next diagnostic step?
A) Abdominal CT
B) Lung CT angiography
C) MRCP
D) Pulmonary function test
E) Cardiac thallium scan
2)A 63 years old male complains of gradual onset of malaise and weight loss on
examination-splenomegaly ,cytogenetic analysis BCR/ABL 1 gene . which of the
following is correct ?
A. Bone marrow fibrosis rules out the diagnosis
B. On CBC -25% of WBC will be blasts
C. Treatment includes tyrosine kinase inhibitor (TKI) imantinib mesylate (Gleevec)
D. Leukopenia is probable finding
E. Allogenic stem cell transplantation (SCT) is contraindicated in this disease
3) 60 years old female is diagnosed with chronic lymphocytic leukemia(CLL) stage 0
she is admitted due to dyspnea . General malaise and dizziness. On examination-mild
splenomegaly without lymphadenopathy with no other abnormal findings labs
hemoglobin 8.0g/ dl reticulocytes 4% ,platelets 250,000, total bilirubin 6mg/dl ,direct
bilirubin 2mg /dl ,lactate dehydrogenase (LDH) 356mg/dl(norm <250). What is the
most likely etiology of the anemia?
A. Hypersplenism
B. Autoimmune hemolytic anemia (AIHA)
C. Thrombotic thrombocytopenic purpura
, 2
D. Iron deficiency anemia
E. Immune thrombocytopenic purpura
4) A 31 years old male arrive to ER complaining of fever with pain and erythema of
the eyes. In the past month he complains of painful genital and oral ulcers Knee pain
and Fever. In the past week bilateral eye pain and erythema with photophobia. On
examination fever 38c eye slit lamp bilateral WBC at the anterior chamber. Oral and
genital ulcers , swelling and erythema of knees. With no other abnormal findings .
Which of the following most likely diagnosis?
A- Bechet D.
B- crohn's D
C- Sarcoidosis
D- Systemic lupus erythematosus
E- Systemic herpes simplex infection
5) A 72 year old male status post anterior wall myocardial infraction 10 years ago. He
now complains of increasing dyspnea and is treated with bisoprolol and aspirin on
examination normal vital signs. Rales over the lung bases . echocardiography – left
ventricular ejection fraction (LVEF) 38%. Labs normal CBC , creatinine 0.9mg/dl , urea
35 mg/dl , sodium 136 , potassium 4.5.
Which of the following is the most appropriate treatment ?
A. Implant cardiac re-synchronization treatment (CRT)
B. Add digoxin
C. Automatic implantable cardiac defibrillator (AICD)
D. Add furosemide and ACE inhibitor
E. Add spironolactone
6) A 75 year-old female is admitted to evaluate an episode of syncope during her
morning walk. She has hyperlipidemia and is treated with simvastatin alone. Below is
the ER ECG. What is the most appropriate next step?
✓ Admit and refer to pacemaker implantation ASAP.
, 3
Refer to 24 hours Holter test.
Recommend 30-day heart monitoring by implantable monitor.
Refer to Tilt test.
Admit for observation alone.
7. A 35 years old female complains of fatigue weight gain despite attempts to avoid
it. Losing hair change of voice and hand tingling . Which of the following can explain
her symptoms ?
A- normal tsh high t4 high t3
B- d high t4 high t3
C-low tsh hight t3 hight t4
D- normal tsh low t3 normal t4
E- high tsh low t3 low t4
8. An 82 years old male with decreased cognitive status , ischemic heart disease ,
diabetes, hypertension . He fell at home and was found after a day laying on the
floor. Labs creatinine 2.5mg/dl (it was 1.3 year ago ) , urea 70mg/dl.
Urinary stick is positive for hemoglobin but sedimentation demonstration only
low amount of RBC.
Which of the following will support the diagnosis ?
A- FeNa 2.5%
B- Dysmorphic RBC on urine sedimentation
C- Numerous urinary granular casts.
D- Elevated serum creatinine phosphokinase
E- Elevated serum lactate dehydrogenase.
9)Which of the following symptoms is suggestive of ischemic heart disease?
A) Lower and middle abdominal pain
B) Epigastric pain that worsens with mild exercise
C) Stabbing pain radiating to the trapezius
D) Dyspnea that improve while climbing steps
, 4
E) Upper jaw pain
10) Which of the following is the most early symptoms of patient with pulmonary
hypertension?
A) Cough
B) Exercise dyspnea
C) Syncope
D) Chest pain
E) Peripheral edema
11 )A 21 year old male had fever and throat pain 3 weeks ago. He now complains
of general malaise , headache and weight loss , his blood pressure is high and he
has leg edema . Labs – creatinine 2.4 mg/dl , increased anti- streptolysin O
(ASLO) , low C3 complement level , positive rheumatoid factor (RF) , urinary stick
– WBC ++ , protein ++ , RBC ++ , and RBC casts on microscopy.
What is the next step in management?
A) Cyclophosphamide
B) Enalapril
C) Penicillin
D) Dialysis
E) Cyclosporin
12) 48 years female undergoes evaluation for increase dyspnea in the past 3
months , four years ago she was diagnosed with limited cutaneous systemic
sclerosis and Raynaud phenomenon and Gastroesophageal reflux disease , she is
Treated with Nifedipine and Omperazole .
On examination bilateral equal breathing without wheezes or rales
Heart sound : wide split S2 : accentuated P2
Chest x-ray :no abnormal finding , what is the most likely etiology of this
symptoms ?
a)interstitial lung disease
b)myocardial fibrosis
INTERNAL MEDICINE, PEDIATRICS, SURGERY,
GYNECOLOGY & PSYCHIATRICS ALL
COMBINED EXAM WITH QUESTIONS AND
CORRECT ANSWERS
Internal Medicine
1) A 64 year old male, 3 days after urgent surgery for colon adenocarcinoma,
develops worsening dyspnea and hypoxemia. On examination –room saturation
92%, blood pressure 120/80, pulse 105/min, creatinine 0.9 mg/dl, with no other
abnormal clinical findings. What is the most appropriate next diagnostic step?
A) Abdominal CT
B) Lung CT angiography
C) MRCP
D) Pulmonary function test
E) Cardiac thallium scan
2)A 63 years old male complains of gradual onset of malaise and weight loss on
examination-splenomegaly ,cytogenetic analysis BCR/ABL 1 gene . which of the
following is correct ?
A. Bone marrow fibrosis rules out the diagnosis
B. On CBC -25% of WBC will be blasts
C. Treatment includes tyrosine kinase inhibitor (TKI) imantinib mesylate (Gleevec)
D. Leukopenia is probable finding
E. Allogenic stem cell transplantation (SCT) is contraindicated in this disease
3) 60 years old female is diagnosed with chronic lymphocytic leukemia(CLL) stage 0
she is admitted due to dyspnea . General malaise and dizziness. On examination-mild
splenomegaly without lymphadenopathy with no other abnormal findings labs
hemoglobin 8.0g/ dl reticulocytes 4% ,platelets 250,000, total bilirubin 6mg/dl ,direct
bilirubin 2mg /dl ,lactate dehydrogenase (LDH) 356mg/dl(norm <250). What is the
most likely etiology of the anemia?
A. Hypersplenism
B. Autoimmune hemolytic anemia (AIHA)
C. Thrombotic thrombocytopenic purpura
, 2
D. Iron deficiency anemia
E. Immune thrombocytopenic purpura
4) A 31 years old male arrive to ER complaining of fever with pain and erythema of
the eyes. In the past month he complains of painful genital and oral ulcers Knee pain
and Fever. In the past week bilateral eye pain and erythema with photophobia. On
examination fever 38c eye slit lamp bilateral WBC at the anterior chamber. Oral and
genital ulcers , swelling and erythema of knees. With no other abnormal findings .
Which of the following most likely diagnosis?
A- Bechet D.
B- crohn's D
C- Sarcoidosis
D- Systemic lupus erythematosus
E- Systemic herpes simplex infection
5) A 72 year old male status post anterior wall myocardial infraction 10 years ago. He
now complains of increasing dyspnea and is treated with bisoprolol and aspirin on
examination normal vital signs. Rales over the lung bases . echocardiography – left
ventricular ejection fraction (LVEF) 38%. Labs normal CBC , creatinine 0.9mg/dl , urea
35 mg/dl , sodium 136 , potassium 4.5.
Which of the following is the most appropriate treatment ?
A. Implant cardiac re-synchronization treatment (CRT)
B. Add digoxin
C. Automatic implantable cardiac defibrillator (AICD)
D. Add furosemide and ACE inhibitor
E. Add spironolactone
6) A 75 year-old female is admitted to evaluate an episode of syncope during her
morning walk. She has hyperlipidemia and is treated with simvastatin alone. Below is
the ER ECG. What is the most appropriate next step?
✓ Admit and refer to pacemaker implantation ASAP.
, 3
Refer to 24 hours Holter test.
Recommend 30-day heart monitoring by implantable monitor.
Refer to Tilt test.
Admit for observation alone.
7. A 35 years old female complains of fatigue weight gain despite attempts to avoid
it. Losing hair change of voice and hand tingling . Which of the following can explain
her symptoms ?
A- normal tsh high t4 high t3
B- d high t4 high t3
C-low tsh hight t3 hight t4
D- normal tsh low t3 normal t4
E- high tsh low t3 low t4
8. An 82 years old male with decreased cognitive status , ischemic heart disease ,
diabetes, hypertension . He fell at home and was found after a day laying on the
floor. Labs creatinine 2.5mg/dl (it was 1.3 year ago ) , urea 70mg/dl.
Urinary stick is positive for hemoglobin but sedimentation demonstration only
low amount of RBC.
Which of the following will support the diagnosis ?
A- FeNa 2.5%
B- Dysmorphic RBC on urine sedimentation
C- Numerous urinary granular casts.
D- Elevated serum creatinine phosphokinase
E- Elevated serum lactate dehydrogenase.
9)Which of the following symptoms is suggestive of ischemic heart disease?
A) Lower and middle abdominal pain
B) Epigastric pain that worsens with mild exercise
C) Stabbing pain radiating to the trapezius
D) Dyspnea that improve while climbing steps
, 4
E) Upper jaw pain
10) Which of the following is the most early symptoms of patient with pulmonary
hypertension?
A) Cough
B) Exercise dyspnea
C) Syncope
D) Chest pain
E) Peripheral edema
11 )A 21 year old male had fever and throat pain 3 weeks ago. He now complains
of general malaise , headache and weight loss , his blood pressure is high and he
has leg edema . Labs – creatinine 2.4 mg/dl , increased anti- streptolysin O
(ASLO) , low C3 complement level , positive rheumatoid factor (RF) , urinary stick
– WBC ++ , protein ++ , RBC ++ , and RBC casts on microscopy.
What is the next step in management?
A) Cyclophosphamide
B) Enalapril
C) Penicillin
D) Dialysis
E) Cyclosporin
12) 48 years female undergoes evaluation for increase dyspnea in the past 3
months , four years ago she was diagnosed with limited cutaneous systemic
sclerosis and Raynaud phenomenon and Gastroesophageal reflux disease , she is
Treated with Nifedipine and Omperazole .
On examination bilateral equal breathing without wheezes or rales
Heart sound : wide split S2 : accentuated P2
Chest x-ray :no abnormal finding , what is the most likely etiology of this
symptoms ?
a)interstitial lung disease
b)myocardial fibrosis
