T- DHA 9-4-2017 SUNDAY

1. A practitioner wants to close a wound .The steps followed are :

a. Clean, drape, irrigate, antiseptic
b. Irrigate, clean, drape, antiseptic
c. Irrigate, drape, clean, antiseptic
d. drape, Irrigate, clean, antiseptic
2. A male patient chronic smoker, eats spicy food , complains of epigastric pain since few days ,
aggravated when he feels hungry . Urea breath test positive, biopsy showed color change. What
could be the cause of it?
a. H-pylori
b. Gastric carcinoma
c. campylobacter
d. Yersinia

3. Old lady known HTN , DM , presented with epigastric pain radiating to the back and heart
burn for past 2 months, not relieved by antacids (ranitidine) otherwise she looks healthy no
abdominal tenderness vitals BP 150/90 . ECG given:

a. aortic dissection
b. perforated peptic ulcer
c. myocardial infarction
d. Prinzmetal angina

4. Patient with codeine phosphate over dose. Manifestation includes:

a. Insomnia and irritability

b. Respiratory depression and small pupil
c. Somnolence and irritability
d. Constipation and abdominal pain

5. A child complains of ear pain from past few days. On otoscopy pieces of paper deep inside
the ear. What to do next:

a. Irrigation and remove by forceps

b. Suction
c. Refer to ENT for otoscopy
d. antibiotics

6. A female known case of Sickle cell anemia , complaining of fatigue and shortness of breath
.History of taking co-trimoxazole before 2 days . Lab findings of anemia .

a.G6PD deficiency
b. Sickle cell crisis
c. iron deficiency
d. hereditary spherocytosis
7.18 years old complaing of sudden onset of chest pain and dyspnea. On examination right side
decrease breath sounds. Chest x ray : pneumothorax . What to do next

a. do blood culture
b.give antibiotics
c.Call 911 for emergency transferal

8.Long scenario : A 68 years old male complaining of shortness of breath on exertion , fatigue
and weakness . On examination lung crackles, point of maximal impulse, pan systolic murmur-
apex, jugular venous distention.
Which non – invasive test is the best to do to see these findings .

a. X ray
b. ECG
c. Echocardiogram
d. 24 hr holter monitoring

9.A man complaining of eye pain , redness , photophobia after he woke up from sleep today .
He is a chronic user of contact lenses and sometimes sleeps wearing them , What to do next .

a. Topic antibiotics
b. Refer to ophthalmology
c. Fluorescein eye test

10. A child known case of mild intermittent asthma prescribed with b2 agonist. Now complaining
of symptoms for 4 days a week and increase use of b2 agonist inhaler. What to add for his
treatment

a.low dose steroids

b.LABA –salmetrol
c.systemic steroids
d.theophylline

11. 30 years old female was screened with pap smear and was normal 6 months ago. Her
mother was diagnosed with cervical cancer when she was 40 years old.
How often should the 30 year old female be screened with pap smear ?

a. 6 months
b. Every year
c. 5 years
d. 10 years

12. Screening for cervical cancer for a 35 years old female with multiple sexual partners. No
other complain.

a.every 5 years
b . every 1 year
c. 3 months
d . 6 months
13 .A 16 year old boy diagnosed with DM type before 1 year . His recent eye exam was normal
.When should he be screened for diabetic retinopathy.

a. Every year
b. 5 years after he got diagnosed
c. Every 6 months
d. Every 3 months

14. Glaucoma is due to :

a.Iris & pupilary muscle narrowing the trabecular formation of the aqueous duct (acute)
b. Microscopical changes of the trabecular formation of the aqueous duct. (chronic)
c.Vitreous abscess.

15. 40 years old patient diagnosed with pancreatic carcinoma , what is the pathophysiology
of pancreatic carcinoma :

a. Inactivation of proteins
b. Deactivation of cytokines
c. Inhibition of trypsin
d. over secretion of trypsin

16. Starting a patient on Glyburide what is the most important side effect you need to inform
him:

a. Hyperlipidemia
b. Hypoglycemia
c. Weight gain
d. Vomiting

17. Glipizide mode of action :

a.Increase secretion of insulin from pancreas

b.Increase sensitivty of cells to insulin
c.Gluconeogenesis

18. Man diagnosed with DM , BMI : normal . Which medication should he be start on ?

a.Metformin
b.Thiazoladinedione
c.incretins
d.Repaglinide

18. A picture to identify with scenario

19 . A young boy complaining of itching of feet with a picture : scabies

20. A child with bowed legs, multiple fracture with a x ray: osteogenesis imperfecta

21.A 35 years old women complaining of hand pain and stiffness mostly in the morning lasting
for about 1 hr. Labs : RF: -ve Anti CCP +ve ESR : increased . Diagnosis

a. Rheumatoid arthritis
b. Osteoarthritis
c. Osteoporosis

22. Patient with decreased level of estrogen, what is she likely to develop the most due to
decreased estrogen?

a. amenorrhea only
b. amenorrhea and obesity
c. amenorrhea and osteoporosis
d. Ca breast

23. Patient with DM mellitus which of the following are most important risk factors for him to
develop diabetic retinopathy.

a.Obesity and hypertension

b.obesity and smoking
c.hypertension and smoking
d.hyperlipidemia and hypertension

24.A Saudi 40 years old male came for routine check up . What are the risk factors he should be
checked for .

a. Obesity , HTN , DM
b. Obesity , smoking
c. Hyperlipidemia , HTN
d. DM , smoking

25. A 30 years old male with indirect inguinal hernia with pulse . Mechanism of hernia

a. muscle defect causing it to pass through internal inguinal ring then external
b. congenital defect opening in the the abdominal wall

26 .Which milk is best used to prevent from allergy and other symptoms ?

a.lactose free
b.partially hyrdrolysed
c.soya milk

27.Which of the drug should avoided with sexual dysfunction of SSRI :

a.propanalol
b.yohimbine

28. The following drugs :phosphodiesterase 5 inhibitors, Yohimbine and L-arginine are given for
:
a.Male impotence
b.Male azoospermia
c.Female arousal
d.Female Orgasm

29.Child 7 months years old . milestone

a.can drink from a cup without help

b.get scared of strangers
c.can say mama dada
d.can copy some sounds made by adults

30. A 3 year old boy was brought by his mother because of not using the washroom in his new
house.Despite of all efforts by his mother he prefers to wear pampers. On examination : hard
mass felt on palpation . What to advice

a. Wait for him to adapt to the new surroundings

b. Make him flush the toilet and let him see it

31.A 40 years old female complaining of a breast mass about 1 cm . It had been persistent for 2
cycles , no discharge . Mammography US normal . What to do next ?

a. Ask her to come back after 2 cycles

b. Do monthly BRCA1 test
c. Tissue studies

32. Psoriatic patient beside medical treatment what to advice.

a. Avoid sun exposure

b. Avoid trauma
c. Frequent baths

33. 2 workers recently exposed to radiation after a blast in nuclear power plant,but they look
normal no sign of specific finding after examination what is the management.

a.keep them isolated and reassure them

b.discard their clothes immediately
c.only reassure them
d.give 2 asprin and discharge

34. Case of trichomoniasis asking for treatment: Oral metronidazole

35. Case of chlamydia: discharge, neutrophils

36. Case of bacterial vaginosis: clue cells, fishy odor

37. In which condition the amount of hemoglobin saturated with oxygen is decreased.

a. carboxy Hemoglobin
b.ethanol
c.methanol
d.lead

38. Flavivirus prevention?

a.eradication of animal reservoir

b.eating proper cooked food
c.improving sanitation

39. Patient with complaining of sweating, palpitations before giving a speech in meeting. He is
doing well in his job. Diagnosis:

a.Generalised Anxiety disorder

b.Agoraphobia
c.Performance anxiety
d.Specific phobia

40. A women with 5 cm axillary mass . what to do next

a.incision and drainage under local anaesthesia

b.incision and drainage under GA
c.antibiotic

41. Thin patient living in very crowded area, xray showed fibrous patch in upper rt lobe n there is
cough n wheezing what to give to the contacts.

a.BCG
b.h influenza vaccine
c.meningococcal
42. A G2P0 patient came to you because she is worried her last pregnancy ended up in first
trimester , she is now BHCG+ve .Asking for a vaccine , what can be given now ?

a.Rubella
b.measles
c.influenza
d.varicella

43. A old patient with exophthalmous , propotosis with pulsation felt on the eye .

a. Carotid cavernous fistula

b.carotid thrombosis
c,goiter

44. Younger diabetic patient came with abdominal pain, vomiting and ketones smelled from his
mouth. What is frequent cause:

a. Insulin mismanagement
b. Diet mismanagement
c.infection

45. A young boy complaining of abdominal pain, diarrhea and smelly flatus. What is the cause ?

a. Giardiasis
b. Entamoeba
c. E coli
d. Cholera

46. A man complaining of headache, dizziness and weakness ( polycythemia ) Labs : high hb
high hct .check for : serum erythropoietin level

47. A 5 years old not eating well, growth chart given, MCV , HB : LOW , deficiency ?

a. iron deficiency
b. thalassemia
c. vit b12

47. Patient came to you complaining of lower back pain, you asked him about duration because:

a. Short onset is important for biological origin.

b. Location and onset is important for the biological origin
c.Location and onset are important for the outcome

48, What is true about child maltreatment?

a. Benefit outweighs harm

b. Harm out weights benefit
c. Strong evidence that early counseling help
49. A man who lost his wife presented with depressed mood, sad and sleep
disturbance for 2 months. What is your diagnosis

a.bereavement
b. Depression

50. A pregnant women complaining of urine dribbling with coughing and sneezing. She tried to
squeeze but doesn’t help. What management to do initially?

a. Anti cholinergic
b. Pelvic floor strengthening
c. Surgery

51. A child developed diarrhea after being treated with some antibiotic. What to give him now?

a. Cephalosporin
b. Linezolid
c. Vancomycin
d. Penicillins

52. A sexually active women ( multiple sexual partners) complaining of left knee pain . Erythema
redness and warm . What is the cause :

a. septic arthritis
b. RA
c. OA
d. osteopororis

53. Most common finding in a new born which doesn’t need to be investigated.

a. fused labia
b. perforated hymen
c. mucopurulent discharge

54. Man present with painless ulcer in his penis with indurate base and everted edge .The
diagnosis is?

a. syphilis
b. gonorrhea
c. chancroid
d. HSV

55. A diabetic man presented with severe dehydration & fatigue. Lab Na: 150 K: normal Cl:
normal
RBS : 50 mmol

What does he need initially?

a. 0.45 % Saline
b. Insulin
c. Antibiotics
d. Bicarbonate

56 . A 45 years old female who does strenuous exercise 3 days a week, mammogram and pap
smear normal. What should you advice her ?

a. doesn’t need regular pap test or mammography

b. Bone scan and early osteoporosis prophylaxis

57. A male patient with difference in BP in both upper and lower extremity. Diagnosis

a. Coarctation of aorta
b. Aortic aneurysm
c. Aortic dissection
d. Vsd

58. A diabetic woman of 50 yrs develop hypernatremia and central obesity with blue purple stria
on body which test you will require?

a.ACTH
b.24 hr cortisol (urine)
c.blood culture

59. 31 years old autopsy shows bulky vegetation’s on aortic and mitral valves, what is the
diagnosis?

a. Infective endocarditis
b. libman sacks endocarditis
c.rheumatic heart disease

60. The best drug used in treating schizophrenia, mania and schizophreniform disorders is:

a. Risperidone
b. Amitriptyline
c. Olanzapine
d. Paroxetine

61. A child after consuming some toxic compound complaining of urinary incontinence ,
increase lacrimation, emesis, miosis , bradycardia . What should be given to him?

a. Atropine
b. Pralidoxime
c. Nalaxone
d. Benzodiazepine

62. A patient complains of vertigo after taking anti-tb medication. Which one causes it?

a. Rifampin
b. Pyridoxine
c. Streptomycin
d. Isoniazid
63. 28 year old male patient with symptoms of Ulcerative Colitis+ anemia related to UC.
Sigmoidoscopy revealed multiple polyps, Biopsy of polyps Carcinoma in situ. What is the most
definitive therapy that will be effective in the long-term.

a. Correct Anemia
b. Left hemicolectomy and Colostomy
c. Total Colectomy and Ileotomy
d. Removal of all polyps by Colonoscopy

64. A female with no complains came for routine check up.

Labs: TSH: high T3: normal T4: normal.
What is the diagnosis?

a.Primary hyperthyroidism
b. Secondary hyperthyroisim
c.Subclinical hypothyroisim
d.Primary hypothyroidism

65. What advice do you give to a women with mastitis?

a. continue breast feeding

b do not breast feed
c.warm compression

66. A case of VIT B12 deficiency

67. Adolescent female counselling on fast food. What you should give her?

a. Ca + folic acid
b. Vitamin C & folic acid
c. Zinc & folic acid
d. Zinc & Vitamin C

68. Patient wants to quit smoking, you told him that symptoms of nicotine withdrawal peaked
after:

a. 1-2 days
b. 2-4 days
c. 5-7 days
d. 8- 10 day

69. Alcohol withdrawal, delirium tremens begins:

a.2-4 Days
b.5-7 Days
c.7-10 Days
d-9-11 Days

70. A boy complaining of cough, fever , and ear pain . On examination bulged tympanic
membrane .What to give him initially?
a. Oral amoxicillin
b. Cephalosporin
c. Gentamicin

71. Treatment of mania in chronic hepatitis patient .

a.lithium
b.MOA inhibitor
c.Sertaline
d.Benzodiazepine

72.Which symptom will a patient with chronic kidney disease present in future?

a.diarrhea
b.headche
c.oliguria

73. A picture

Which organism causes it ?

a) group A beta hemolytic streptococci

b) Haemophilus influenzae type B
c) group B beta hemolytic streptococci
d) pseudomonas

74. Pt with pain in Rt iliac fossa while you are doing palpation he developed vomiting and
nausea what is your diagnosis :

a) crohn’s disease
b) appendicitis
c) diverticulitis

75. An old man with knee effusion. what to do next ?

76. More cases on Osteoarthritis, Rheumatoid Arthritis

77. Odds radio and relative risk.