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A 52-year-old man presents with bright red blood وه
دم52 ر D
per rectum. He states that he has been bleeding "ة# ف%& *" أد أ) آن.أ
اج
heavily for a couple of hours. In the ER, his pulse is ه/.& ا،ارئ2 ا345 6 .ت, -.
110beats/min, blood pressure is 90/50mmHg, he is >? و،@.A ز3C 50/90 ا"م ه:;< ، د/110
cool and clammy appearing, and he has blood DC ،از. اEF 6 >ر دمG - ،رد و"ي#
present on rectal examination, although he does not I5 ا6 ف%& )) أJC "و. K ) أ3Lا
appear to be bleeding at the present. Which of the :؟N اOJوNة ا2P ا6 ه6Q أي ا.<Fا
following is the best initial next step ? . ا*نJ?& .A
A. Colonoscopy . ن6&J, J?& .B
B. Flexible sigmoidoscopy ."يS 6Tب أ. أ-< و.C
C. Place a nasogastric tube .6FC * ور"يF# "ء. ا.D
D. Start an of IV normal saline 9% .6.C, O OW * دم.E
E. Give a transfusion of type O-negative blood
1A
3. A 56-year-old man with known chronic kidney ،% يC>ب آQ ا6S 56 ر B
disease presents with a 3-day history of shortness زدة6 O, وaT [5 وه
of breath and rapid weight gain. On examination, DC -4Q ا،EFT &" ا. أم3 b& ازن
you are able to ausculate an S3, hear crackles at the :,Q خTQ اO ورؤ،" ا*ا6 ع آاآ, ،S3
bases, and see moderate jugular venous distension OJQة ا2P ا6 ه6Q أي ا.6 ار" ادا6
(JVD). Which of the following is your next step in :؟3JJ*QQ ا6
evaluation? .gC*"ى اi :J2P إاء.A
A- Perform an echocardiogram .["رC OJ&J, OSj إاء أgC\ .B
B- Order a chest x-ray
JjQ"ل اS ب4F J&س اJ5 .C
C- Measure a creatinine to calculate renal .6.J.ا
glomerular filtrate .OJ.C* اAP*@ اFQ ا.D
D- Check for cardiac enzymes
2A
5. A 45-year-old woman with type 2 diabetes presents ،2 : ي, داء6S 45 اأة ه A
to the clinic with decreased vision in the left for 1 6 E5& >" أنJ. qJ دةJS اDت إ
year, 1 + proteinuria, a baseline creatinin of ،1+ Jو. اOCJ# ،O&, b& ى4J اJS ا6 Oاؤ
1.6mg/dL, a low-density lipoprotein (LDL) of 135 ذات6F اJو. ا،, د/sC 1.6 J&آ
mg/dL, blood pressure of 145/92mmHg, and ا"م:;< ،, د/sC 135 OTP& اO]ا
occasional chest pain for the past 2 months. Which > ا6 -2*Q "ريi 3 وأ،@.A ز3C 92/145
of the following is the best medication to start the )# "أ. ه أ دواء6Q أي ا.JXNا
patient on at this time ? :ن؟t اb& Oا
A. ACE inhibitor .O.C*& اJ4&lNة اJX :.] .A
B. β-blocker .QJ# g .B
C. Oral nitrate .3Tات \@ اQ .C
D. Thiazide diuretic .ز"يJ "ر.D
3A
6. A 30-year-old woman with no past medical history OJ< ةJ, >" aJ 30 اأة ه D
presents with a productive cough of 2-week ةQ b& uQ& لS, 6 ت وه،O*#,
duration. She states she also has a runny nose,body نvJ, أ6S >w# *" أدت.J.,أ
aches, congestion, and fevers for the past week. In ع ارةT*ن وارQ إ،>4 ءF أ6 مKx ،6Tأ
office she is normotensive, with a normal pulse, ،6SJ.\ :;دة آن اJS ا6 .6<ع ا.,N اb&
and temperature of 38.3°C. Her physical EFT اJ. .س°38.3 ارةF وا،6SJ.\ /.&ا
examination is significant for sinus tenderness, OJTNرة اF ا،OJTNب اJl ا6 مvي إ4ا
congested nasal turbinates, and crackles in the left 6CT4 ا4N اET *ل ا6 وآاآ،OJS*&Q4
lower lobe lung fields. Which one of the following 6 N اDوNة ا2P ا6 ه6Q أي ا.OAC
is the best initial step in management ? :؟6vS اJ#"Qا
A. Reassure the patient that she likely has a
رN اDC >Q#iن إw# O اOw\ .A
viral infection and it will resolve on its own .>4T *ءC DTQ, وOJ,وJ
B. Order a rapide strep test and treat if positive *"تS ا-, يF EF gC\ .B
C. Prescribe amoxicillin for a likely bacterial .OJ#l إOlJQ& اI إذا آOlSوا
infection O#i{
اJ g.4# JCC4J4 أآni و.C
D. Order chest x-ray to rule out possible .OJ|lا
pneumonia دS.Q,K ["رC OJ&J, OSj إاء أgC\ .D
.يA>ب رQ# O#i{ل اQا
Une femme de 30 ans sans antécédents médicaux
présente une toux productive qui date de 2
semaines. Elle déclare avoir également un nez qui
coule, des courbatures, une congestion et de la
fièvre au cours de la dernière semaine. Au bureau,
elle est normotendue, avec un pouls normal et une
température de 38.3 ° C. Son examen physique
révèle une sensibilité des sinus, des cornets nasaux
congestionnés et des crépitements dans les champs
pulmonaires du lobe inférieur gauche. Laquelle des
propositions suivantes est la meilleure première
étape dans la prise en charge de la patiente?
A- Rassurer la patiente qu'elle a probablement
une infection virale et qu'elle se résoudra
d'elle-même
B- Commander un test streptococcique rapide
et traiter si positif
C- Prescrire l'amoxicilline pour une infection
bactérienne probable
D- Demander une radiographie pulmonaire
pour exclure une éventuelle pneumonie
4A
7. A 35-year-old G2P1 at 11 weeks’gestational age 11 ع.,N ا6 G2P1 35 اأة ه A
presents with complaint of palpitations, weight رة4X ،*نTX 6 ت وه،F ا
loss, nervousness and tremor. She denies prior *#, ><S IT "* .فlاب وار2< ا،وزن
history of thyroid problems. Laboratory studies TSH أنO.Pت ا, أآ"ت ا"را.OJ5آ در
confirm that TSH is severely suppressed. Which of b> جv ه أ6Q أي ا."ة# E5&Q
the following is the best treatment for this patient at :؟I5ا اb ه6 Oا
this time ? .PTU .A
A. PTU .QJ# ت. .B
B. β-blockers .J4وآJTJ .C
C. Levothyroxine .زولJQ .D
D. Methimazole
5A
9. A 5-year-old child is brought into a pediatrician’s لT\N اgJ.\ دةJ D&ات إ, 5 T\ أ D
office for immunization and physical examination. )" *" أدت وا.ي4 اEFT
واJ*CQ أ ا
The mother is concerned. Which of the following is أي.vJC5 "a*2 اJ|w IF " > هCT\ نw#
a contraindication to vaccinating the child ? :؟T2ا اb
هJ*CQ ب.2Q, ه د ا6Qا
A. Acute otitis media with a temperature of س°38 ارة- دD2,>ب أذن وQ ا.A
38°C requiring antibiotic therapy .يJ د# جv gC2Q يbوا
B. Previous vaccination reaction that consisted ارةnwQ @#, 6* S رد.B
of fever and fussiness that lasted for 2 days .J ةQT ج "وم%وا
C. History of an allergic reaction to penicillin .JCCJ4&. اDC a4FQ ا.C
D. Previous vaccination reaction that consisted % أزnwQ @#, 6* S رد.D
of wheezing and hypotension .:;< ضTPوا
6A
11. Which of these is the most common etiology of A
chronic pericarditis? >بQK Jj ]آN اg.4 ه ا6Qأي ا
A. Neoplastic :؟%ر اQا
B. Viral .6 ور.A
C. Autoimmune .6,وJ .B
D. Uremic .6 ذا6& .C
E. Post-myocardial infarction .6 ر.D
.OJ.C5 OC ءQ" اS# .E
Laquelle des propositions suivantes est l’étiologie
la plus fréquente d’une pericardite chronique ?
A. Néoplasique
B. Virale
C. Auto-immune
D. Urémique
E. Post-infarctus du myocarde
12. You are taking charge of a 48-year-old patient with B
no cardiovascular risk factor for whom the lipid OJA وOJ.C5 دون ا، 48 /
profile showed a LDLc of 2.3g / L. What are you ه.ل/غ2.3 =LDL ) أنCJF >تG أ،>"دة
doing ? :؟Sا
A. Simple monitoring .O.5 اا.A
B. Health and diet rules .OJFi – OJAاbL OJ .B
C. Prescription of ezetimibe .gJJQ إزni و.C
D. Prescription of a statin .JQ, ni و.D
E. Prescription of a fibrate .ات.J ni و.E
8A
17. Which of these is the main cause of orthostatic C
hypotension in case of normal autonomic nervous Qض اTPK 64JA اg.4 ه ا6Qأي ا
system? 6.[S>ز اlC 6SJ.2 ا-< اO 6 6#[Q{ا
A. Severe hypovolemia :؟6اbا
B. Severe venous insufficiency .""j دم3l E* .A
C. Iatrogenic drug .""j [ر ور"ي5 .B
D. Endocrine .6vSب ا.2Q,K ا.C
E. Shy-dragger syndrome .3[ ا;"د ا6 لvQ ا.D
. درا-6j OزvQ .E
Parmi les propositions suivantes quelle est la
principale cause d’hypotension orthostatique au cas
où le système nerveux autonome est normal ?
A. Hypovolémie severe
B. Insuffisance veineuse sévère
C. Iatrogènie médicamenteuse
D. Endocrinopathies
E. Syndrome de Shy-dragger
9A
18. A 59-year-old man undergoes coronary bypass 62 أ.OJCJC إآOCFQ -X ، 59 ر C
surgery. He receives vancomycin prophylactically -,Qم اJ ا6 .O, 24 "ةJA5 وJ4 )
for 24 hours. On the ninth postoperative day, he - م°39.8 D[ إQ ) ارIST ارOJCS" اS#
develops a fever of 39.8°C with a heart rate of 115 3C 65/105 دم:;< د و/O. 115 gC5 O,
beats/min and a blood pressure of 105/65mmHg. " دون اارJ # 3WQC 6اl ا-5 ا.@.Aز
The surgical site is healing well with no redness or ³3/14000 ءJ."اد آت ا"م اS .uJl أو
discharge. His white blood cell count is J. .ءJ# ل "ة آت دم. اJCF 6 >?و
14,000/mm³ and urinalysis reveals many white ا;ام ذاتOJ.C, تJ[ ل. زرع ا"م وا
blood cells per high-power field. Blood and urine أي.زQآv ةP JL "ازJ4ة أوآJX
cultures grow a non-lactose-fermenting oxidase- bج هvS N ه اOJQ اOJFادات ا
positive gram-negative rod. Which of the following :؟O#i{ا
antibiotics is most appropriate to treat this .J,4آCTJ4 آ.A
infection? .ن4آQT, .B
A. Moxifloxacin .3&J.J إ.C
B. Ceftriaxone .زول4آQTC,-3#Q .D
C. Imipenem .JCJ4;J .E
D. Trimethoprim-sulfamethoxazole
E. Trigecycline
10 A
19. A family of four presents to the emergency room 345 D ت إ، أادOS# أرO OCA A
with sudden-onset abdominal cramps, and ،OJ&2# تl&Q T "ء# 6ارئ وه2ا
vomiting. None of them has fever or diarrhea. Four .5 .>ل, ارة أو إ6S 3>& "أK .ءJ5وا
hours earlier, they had lunch at a roadside 3S2 6 &ول ا;"اءQ ة,N اI آ،ت, -#أر
restaurant. They ate a variety of grilled meats, fried ،O&Q O مF I *" &و.@2 اg DC
rice, and seasoned vegetables. What is the most ]آN اOJt ا6 ه.OJ, رX و،6C* وأرز
likely mechanism of their symptoms ? :اض؟N اCQ FJ
A. Ingestion of preformed toxins .*.4 O م, &ول.A
B. Bacterial invasion of stomach and small ءS{"ة واS"ار اl 6| و%L .B
intestine wall .O*J5"ا
C. Proliferation of ingested bacteria with @vQ جQ ا- OSCQ. ا3J|اlر اQ ا.C
subsequent production of toxin active ءS{ اOJ\P vX l اO2j&م ا4C
against small bowel mucosal cells .O*J5"ا
D. Bacterial invasion of large intestine wall .O?JC;ء اS{"ار اl 6| و%L .D
E. Secondary malabsorption caused by the 6 ) زدة.., [ص |يQء ا, .E
pathogen’s overgrowth in the proximal O*J5"ء اS{ ا6 O<ا اSا
small intestine .O.*ا
11 A
20. An 18-year-old woman presents with a 2-day 6 ت وه، 18 اأة ه C
history of sore throat. Which of the following Ol أي.J b& @CF ا6 >بQا
constellation of symptoms and signs is most - 54آ] اN ا6 هOJQرات اj{اض واNا
consistent with group-A streptococcal pharyngitis ? : أ؟Ol*"ت اS# مSC.>ب اQا
A. Fever, anorexia, dysphagia and hoarseness .OF# و،-C# 4 ،OJ>j *"ان، ارة.A
B. Fever, runny nose, cough, myalgia and poor ،6C 3 أ،لS, ،6Tن أvJ, ، ارة.B
appetite .OTJS< OJ>jو
C. Fever, no cough, tonsillar exudates, and ،O إازات ز،لS, "ون# ، ارة.C
tender anterior cervical lymphadenopathy O.5 ا6 OJN اOوTCل ا;"د اvQوا
D. Fever, cough, pharyngeal erythema and .>Pو
dysphagia .-C# 4م وSC. اار ا،لS, ، ارة.D
E. Fever, trismus, dysphagia and neck swelling .O.5 ورم ر-C# 4 ،ز%< ، ارة.E
12 A
21. A 49-year-old man has a history of athlete’s foot "اء ا*"م# O#i{# ةJ, )" ، 49 ر C
but is otherwise healthy when he develops sudden 6S "أ# ةwl ."ةJ OF[# -QQ )& و6<ا
onset of fever and pain in the right foot and leg. On >Gأ.D&Jق وا*"م ا4 ا6 3ع ارة وأTار
physical examination, the foot and leg are fiery red ق ذات ن أ4ي أن ا*"م وا4 اEFTا
with a well-defined indurated margin that appears 35TQ يb وا<
"ا واgC[ ه- ري
to be rapidly advancing. There is tender inguinal .OJ# ا{رOJTC*" اS ا6 3P ه&ك.-, #
lymphadenopathy. Which organism is the most :؟O#i{ اb> FJ ]آN اg.4 اSه ا
likely cause of this infection ? .Oو. اO&*دS ارات ا.A
A. Staphylococcus epidermidis . ا*"مOTS, .B
B. Tineapedis .OFJ* اO"*S ارات ا.C
C. Streptococcus pyogenes .O2CQP تJAهاK .D
D. Mixed anaerobic infection .Tأ-OJvF اO"* رات.E
E. Alpha-hemolytic streptococci
13 A
23. A 27-year-old man has fever, macular rash, and "يC
T\ ، ارة6S ، 27 ر B
lymphadenopathy. He had unprotected sex with a JL O5v *" رس.OJTC*" اS ا3P و،6S*#
male partner 2 weeks before the onset of these b"ء ه# .5 J., أb& ذآj - Ow
symptoms and has just learned that the partner is وسJT# ) [بj نw# QC 3C "* و،اضNا
infected with human immunodeficiency virus EF / *" أى ا.O.4Q اO& اE*
(HIV). The patient’s rapid HIV test is negative. ر.QX ه أ إ.OJ.C, OlJQ& اI وآ-, أ"ز
What is the best test to evaluate this patient for HIV "& O.4Q اO& اE* وسJT# O#i{ ا3JJ*Q
infection ? :؟/ا اbه
A. HIV Enzyme Linked Immunosorbent Assay 3%w# :. ا6& ا%Qة اS .A
(ELISA) .(ا%Jا{"ز )إ
B. PCR for HIV RNA . HIV RNAاز لJJ. اOC4C, T .B
C. Western blot testing .تC# نQ,ر و.QX ا.C
D. Glycoprotein 120 Elisa testing .ي, Jو# 120 ا%Jر ا.QX ا.D
E. PCR for HIV DNA .HIV DNA از لJJ. اOC4C, T .E
14 A
24. An 18-year-old high school student presents to the 345 D إ، 18 O, "رg\ A
emergency room with a 1-day history of right knee O. اآ6 3 م وا" أb& ارئ وه2ا
pain, swelling, and redness. He is quarterback on @ آة6 دعgK ه. رم واار،D&Jا
the school’s football team. He remembers falling ) أ|&ءQ. رآDC -5آ أ) وbQ ) إ.O,"م ا"ر5
on the knee while practicing 2 days ago. The knee 15 , وأرO.آC ل%# *" أي.J b& g"رQا
is tapped and 15mL of cloudy fluid is sent for cell .رع%ام واL OX2 ،vP"اد اSQ A4 ا
count, gram stain, and culture. The Gram stain OJ#lت رات إl امL OX2 >تGأ
shows gram-positive cocci in clusters. Which of the :؟SC ر4 ه أ6Q أي ا.ا;ام
following is the best course of action ? Oرة اQ, واJ4T# "ء. ا.A
A. Start vancomycin and consult orthopedic .?مSا
surgery .?مS اOرة اQ, ا.B
B. Consult orthopedic surgery .رع% اuAQ ?رQ# "Jو%J&JC# "ء. ا.C
C. Start linezolid awaiting culture results .ن4آQT4# "ء. ا.D
D. Start ceftriaxone 64J\&; J رgC\ وJ4vJQ# "ء. ا.E
E. Start telavancin and order MRI of the knee .O.آC
15 A
25. A 45-year-old woman has pain in her fingers on "& >S#i أ6 3 أ45 اأة ه B
exposure to cold, arthralgias and difficulty مS2 ا-C# 6 O#Si وiT 3 أ،د.C ضSQا
swallowing solid food. She has a few "ون# ا["رDC JC5 اتJSj -, >" .gC[ا
telangiectasias over the chest but no erythema of ه&ك.O24.&ح ا24 اDC ا) أو6 اار
the face or extensor surfaces. There is slight ه.عblذرع واN ا،"J" اC 6 OT.T\ Oآ,
thickening of the skin over the hands, arms and :؟6[JP أ إاء
torso. What is the best diagnostic workup ? .CCP-<"اد ادةNي واJ| اS ا.A
A. Rheumatoid factor and anti-CCP antibodies وأ<"اد70-Scl- د، د وي.B
B. Antinuclear, anti-Scl-70 and anticentromere .ي% اآ3J4*C دة
antibodies زQJQ&J4C &ز وأ<"اد دةJ آJ آ.C
C. Creatinine kinase (CK) and antisynthetase .(1-Jo-)] د
antibodies (such as anti-Jo-1) .J& وآBUN .D
D. BUN and creatinine "J اa;# اض وا?اهNج اQ&Q, ا.E
E. Reproduction of symptoms and findings by .رد.ء ا#
immersion of hands in cold water
16 A
26. A 20-year-old man complains of arthritis and eye uJ> وiT >بQ ا20 ر C
irritation. He has a history of burning on urination. J. .ل.Qة @ &" اJ, )" .JS ا6
On examination, there is a joint effusion of the D&J اO. اآ6 6C[T ب.[ أن ه&ك اEFTا
right knee and a rash of the glans penis. Which of 6Q أي ا.gJ* اOT DC "يC
T\و
the following is correct ? :
؟JFi
A. Neisseria gonorrhoeae is likely to be OT OJ&# تJ4 ا
زرع.A
cultured from the glans penis .gJ*ا
B. The patient is likely to be rheumatoid يJ| ") ر/ ا
أن ا.B
factor-positive .6#lإ
C. An infection process of the gastrointestinal g.4 أن6>>ز اl ا6 O#i إ.C
(GI) tract may precipitate this disease .ا اضbه
D. An ANA is very likely to be positive .6#l ا
"ا أن ن إANA .D
E. Creatinine kinase will be elevated .-T ف, &زJ آJ آ.E
17 A
27. A 35-year-old-right-handed construction worker ،D&J" اJ# S 35 &ء# C
presents with complaints of nocturnal numbness .D&J " اQ 3 وأ6CJ "رX وه
and pain involving the right hand. Symptoms wake ه&ك." %># ول% 3| وm*JQ4 )CSl اضNا
him and are then relieved by shaking his hand. .OJ#l إJ&J Ov .OT اا6 ار/S#
There is some atrophy of the thenar eminence. :؟/ا اb> OFJ[ أ6ه
Tinel sign is positive. What is the best advise for )"اS DC OF )Q.5 أنAآ" داwQ ا.A
this patient ? أن ذqJ ،&ء. ا-5 6 Sأ|&ء ا
A. Always ensure he has a firm grip on his .:,Q اg[S اDC :; اnTPJ,
equipment while working on the "S# ء4 [) آS DC "JCl@ اJ.2 .B
construction site as this may relieve .دQS) اCS )Aأدا
pressure on the median nerve .5 OJA"# OlS آvJ 3[S ةJ. -< و.C
B. Apply ice to his wrist each evening after .Oاl# ا*ارbXأ
performing his usual work 6A%JTج اvS اD إ/ اF .D
C. Wear a wrist splint ar night as initial .3N اnJTPQ {اء ر
therapy prior to considering surgery
D. Refer the patient to physical therapy for
exercises to alleviate the pain
18 A
28. A 35-year-old man who has been incarcerated for 3 ،&ات, 3 ةQT l4 آن، 35 ر C
years develops slowly progressive back pain >? ا6 3ء أ:.# وJlر ") "ر2Q "5و
eventually accompanied by fatigue, intermittent رة4X ،6CJ قS ،OS2*Q D ،gS - #F[
fevers, night sweats, weight loss, and pain in the 6 nS< Dر إ2 D&J ا*"م ا6 3 وأ،وزن
right foot that progresses to weakness of the right تFJT[ء واJ."اد ات اS .D&Jق ا4ا
leg. His WBC count and platelet count are normal 6SJ.\ ،vP ا6SJ.\ و ") * دم،6SJ.\
but he has a normochromic, normocytic anemia. ه.OJSJ.\ O". واOC اnAG ا.غ.[ا
Renal and hepatic functions are normal. What is the :؟FJ ]آN اEJPQا
most likely diagnosis ? ."دSQ ?م6* ورم.A
A. Multiple myeloma .ض دم *ي دJ# ا.B
B. Acute myeloid leukemia (AML) .(ت# ع )داءP& ا, .C
C. Spinal tuberculosis (Pott disease) .ضSQ4ع اP&>ب اQ ا.D
D. Transverse myelitis .O*رT اiTل اvQ ا.E
E. Spondyloarthropathy
19 A
29. A 64-year-old woman presents with 6 weeks of 6S 6 ت وه، 64 اأة ه A
fatigue, dyspnea, and night sweats. She lost 5kg. "* .-J#, أ6 b& 6CJ قS و،aT& @J< ،gS
she has no history of trauma, has never had surgery, "> رaJ .>ام وزLCJ آO4X ت4X
and takes no medications. Chest x-ray reveals a >تG أ.O&ول أدوQ K و،Oاl -P 3 ،O<
large right-sided pleural effusion. Thoracentesis DC J. آ6.& ب.[["ر اC OJ&J4 اOSjNا
yields pleural fluid that appears milky. Pleural fluid DC 6.& A, ل ا["ر%# uQ .N اglا
triglyceride level is 500mg/dL. Which of the 6.&l اA4 ا6 "J4JC; ىQ4 .6.JC j
following disorders is most likely in this patient ? 6 هOJQت ا#ا2<K أي ا.,د/sC500 ه
A. Lymphoma :؟O اb &" هFJ ]آNا
B. Congestive heart failure .ويT ورم.A
C. Pulmonary embolism .6*Q اgC5 [ر5 .B
D. Pneumonia .يA ا[م ر.C
E. Systemic lupus erythematous .OA ذات ر.D
.O >زOJ O.A ذ.E
Une femme de 64 ans se plaint de fatigue, de
dyspnée et de sueurs nocturnes qui datent de 6
semaines. Elle a perdu 5kg. Elle n'a aucun
antécédent de traumatisme, n'a jamais subi
d'intervention chirurgicale et ne prend aucun
médicament. La radiographie thoracique révèle un
large épanchement pleural droit. La thoracentèse
produit un liquide pleural qui semble laiteux. Le
niveau de triglycérides liquides pleuraux est de 500
mg / dL. Lequel des troubles suivants est le plus
probable chez ce patient?
A- Lymphome
B- Insuffisance cardiaque congestive
C- Embolie pulmonaire
D- Pneumonie
E- Lupus érythémateux systémique
20 A
30. A 40-year-old woman has had increasing fatigue @J< وgSQا" &"ه ا%Q 40 اأة ه A
and shortness of breath for 6 months. Physical تv ي4 اEFT> اG أ.>j أ6 b& aT&Qا
examination reveals normal vital signs and a resting .O &" اا%97 Jl4ع أوآ.j وإOJSJ.\ OJ
O² saturation of 97%. Her lungs are clear without EF >G أ.%ة أو أزXX "ون# وOF< واOAا
rales or wheezing. Cardiac examination shows a OPT و6| gC5 رز [ت# يA ن رgC*ا
prominent pulmonary component of the second "ل.Q 6Qى وا4J اE* اO 6 O OJ<.*ا
heart sound (P²) and a soft systolic murmur at the .رزة# v O O.5 ?> أوردة ا.aT&Q ا-
left sternal border trhat varies with respiration. Her N اJ2. ا3P OJ&J4 ا["ر اOSj>ت أGأ
neck veins show a prominent v wave. Chest x-ray .O% اآOA اJ اا-,و
shows right ventricular hypertrophy and b> EJP -< N اOJQة ا2P ا6 ه
enlargement of the central pulmonary arteries. :؟Oا
What is the best next step in establishing a .gC*"ى اi :J2P .A
diagnosis in this patient ? ر أولQ"رة ا5 سJ5 - aT&Qس اJ5 .B
A. Echocardiogram .3FT" اJ4أوآ
B. Spirometry with measurement of diffusing .">lر ا.QX ا.C
capacity of carbon monoxide .1– T أJ4# ى دQ4 .D
C. Exercise stress test .N اgC*ة ا245 .E
D. Alpha-1 antitrypsin level
E. Right heart catheterization
21 A
31. A 65-year-old man with mild congrestive heart 6*Q اgC5 [ر5 6S 65 ر C
failure is scheduled to receive total hip K .ركC "ال آ.Q, اDC [لF? اQ& وnJTX
replacement. He has no other underlying disease عTر# ") رaJى وX أاض أ6S
and no history of hypertension, recent surgery, or أي.6% اب2< أو ا،O]" O ا،:;<
bleeding disorder. Which of the following is the [مK اO5C N ه ا{اء ا6Qا
best approach to prevention of pulmonary embolus :؟/ا اbي &" هAا
in this patient ? .م/sC75 J., أ.A
A. Aspirin 75mg/d .م/sC25 J., أ.B
B. Aspirin 25mg/d J "Cl اIF sC30 ر#4 إآ.C
C. Enoxaparin 30mg subcutaneously bid .J
D. Early ambulation .. فS, إ.D
E. Graded compression elastic stocking .O O2L< ارب.E
22 A
33. A 57-year-old man presents with hemoptysis and ا"مqT وه، 57 ر C
generalized weakness. His symptom begans with J;i ا"مqT&# اضN"أت ا# .3S nS<و
small-volume hemoptysis 4 weeks ago. Over the ،JJ< اJ.,N "ى اDC .-J#, أ4 b& 3lFا
past 2 weeks, he has become weak and feels “out of جX")S<ن وw# S وTJS<
.iأ
it”. His appetite has dismished, and he has lost 4.5 s آ4.5 "* و،مS2 اDC )QJ>j I[5& ."ة2J4ا
kg of weight. He has a 45-pack-year history of .&, O.C 45 6 هJX"Q ا6 )J, .) وز
cigarette smoking. Physical examination is صFT>ت اG أ.WJj mFC 3 ي4 اEFTا
unremarkable. Laboratory studies reveal a mild 118 [دم اi OJ5 وnJTX * دمO.Pا
anemia and a serum sodium value of 118Eq/L. 6 OCQ آOJ&J4 ا["ر اOSj>ت أG أ. ل/ 6CC
Chest x-ray shows a 5cm left mid-lung field mass ،n[& ع4 ا- 3, 5 ى4J اOA اn[Q& *
with widening of the mediastinum suggesting J ا.OJT[& اOJTC*" اS ا3P D إJ
mediastinal lymphadenopathy. MR scan of the ]آN اg.4 ه ا.WJj mFC 3 "غC 64J\&;ا
brain is unremarkable. What is the most likely :اض؟N اb> FJ
cause of his symptoms ? .OJA ا>اgS\ن ا, .A
A- Bronchial carcinoid .OA ا6 O"L O\, .B
B- Adenocarcinoma of the lung .OAة اJ;[ اOJCP اO\, .C
C- Small cell carcinoma of the lung .يAاج رX .D
D- Lung abcess .يAت اJjj ورم ا.E
E- Pulmonary aspergilloma
23 A
34. A 60-year-old obese man complains of excessive س >ريS ، 60 "# ر E
daytime sleepiness. He has been in good health :;< عT]&ء ارQ,# "ةJ OF[# -QQ ه.طT
except for mild hypertension. He drinks alcohol in O *" أدت زو."الQ# لF إ) ب ا.nJT\
moderation. The patient’s wife states that he snores EF . "ة اتm*JQ4 وvJ P ) أ/ا
at night and awakens frequently. Examination of :؟g4N ا6 هOJQت ا, أي ا"را.6SJ.\ مSC.ا
the oropharynx is normal. Which of the following . أط ا&م3JJ*Q 6A#> دغ آ:J2P .A
studies is most appropriate ? .aT&Q@ اJ< يFQC O>Q ا: .B
A. Electroencephalogram (EEG) to assess .6 اO2 ع.j إ.C
sleep patterns . أ|&ء ا&مaT&Qت اv O, درا.D
B. Ventilation pattern to detect apnea . ا&مO, درا.E
C. Arterial O² saturation
D. Study of muscles of respiration during sleep
E. Polysomnography
24 A
35. A 72-year-old man comes to the office with 6S دة وهJS اD إ72 ر A
intermittent symptoms of dyspnea on exertion, ،">l &" اaT&Q@ اJ OS2*Q أاض
palpitations, and cough occasionally productive of ،6.C* ا-4Q &" ا.J"م أC uQ& لS, و،*نTX
blood. On cardiac auscultation, a low-pitched DC OQX OJ\4. هدرة اOPT /JTX # IS,
diastolic rumbling murmur is faintly heard at the :؟OPT& اb> FJ ]آN اg.4 ه ا.O*ا
apex. What is the most likely cause of the murmur? .ب. اOC 6 OJ| رD .A
A. Rheumatic fever as a youth ."JS# " أb& :;< عT ار.B
B. Long-standing hypertension O&4ل اvX OQi OJ.C5 OC ءQ ا.C
C. A silent MI within the past year .OJ<ا
D. A congenital anomaly .6*CX gJ .D
E. Anemia from chronic blood loss .O&% رة دم4X u * دم.E
26 A
38. A 23-year-old man complains of persistent mK "* .3A"اع داi 23 ر A
headache. He has noticed gradual increase in his DC اءb سJ5) وX سJ5 6 OJlزدة "ر
ring size and his shoe size over the years. On تi )" آن،ي4 اEFT &" ا.J&4ا
physical examination, he has a peculiar deep, *F اEF J .3*@ أف و أJ gL
hollow-sounding voice and a prognathic jaw. 6 ه.JJL"[ اJ* اD D[ي إ.ا
Bedside visual field testing suggests bitemporal :؟O#C2 اOJوNت ا,ا"را
hemianopsia. What initial studies are indicated ? 6C[ J4v )# .A
A. Serum insulin-like growth factor (IGH-1) .JQآKو.ت اQ4و
and prolactin levels .6.[ت هن ا& اQ4 .B
B. Morning growth hormone levels زونQ4"آ# ح.ول ا%Jى ارQ4 .C
C. Overnight dexamethasone-suppressed . >راvJ
cortisol level ج4س اJ5 3JJ*Q OllC 6. رةi .D
D. Lateral skull film to assess sella turcica size .6آQا
E. GHRH-stimulated growth hormone level .&ر >ن اFى ا>ن اQ4 .E
27 A
39. A patient with small cell carcinoma of the lung ،OA ا6 ةJ;[ اvP اO\, 6S / C
develops increasing fatigue but is otherwise alert ).&Q هb vX ، "ا%Q gS )" ر2Q
and oriented. Serum electrolytes show serum ارد ا[ ?> أن ا[دمj EF .)Qو
sodium 0f 118mEq/L. there is no evidence of ضTP ا،O ذJ " دK . ل/ 6CC118
edema, orthostatic hypotension, or dehydration. OJ, ذات أ%ل آ. ا.فTl أو،6#[Q ا
Urine is concentrated with an osmolality of J& ا،[ اBUN .ل/ ل6CC550
550mmol/L. serum BUN, creatinine, and glucose 6 ه6Q أي ا.6SJ.2ل اl ا6 آزC;وا
are within normal range. Which of the following is :؟g4Nة ا2Pا
the next appropriate step ? .Qدل اS 6FC لCF# 3J*CQ ا.A
A. Normal saline infusion .ل. إدرار ا.B
B. Diuresis .Aا4# "JJ*Q ا.C
C. Fluid restriction .JCJ,C د.D
D. Demeclocycline .Q ا6 6FC لCF# 3J*CQ ا.E
E. Hypertronic saline infusion
28 A
40. A 30-year-old man is evaluated for a thyroid "* .OJ5"ات درJ*S 30 ر3JJ* 3 "* C
nodule. The patient reports that his father died from \ن ا"رق وأن, g.4# D " أن وا/أد ا
thyroid cancer and that a brother had a history of %J آ.رةQ OCت آJ[ 6S *) آنJ*j
recurrent renal stones. Blood calcitonin 5 أ6SJ.2 )ا/امLJ#2000 ا"مJQJ4آ
concentration is 2000pg/mL (normal is <100) ; [ ا6 تT,Tم واJ4ت اQ4 ،(100
serum calcium and phosphate levels are normal. EQP احgJ.\ "& /ل ا, إر3 .OJSJ.\
The patient is referred to a thyroid surgeon. Which أ6;.& OJQت ا, أي ا"را.OJ5 ا;"ة ا"ر6
of the following studies should also be obtained ? :>؟JC [لFا
A. Obtain a liver scan .".C
4 DC [لF ا.A
B. Measure parathormone level .ى هن رات ا"رقQ4 سJ5 .B
C. Measure urinary metanephrines .ل. اTQ سJ5 .C
D. Administer suppressive doses of thyroxine سJ5 وJ4وآJ]C O2.] ء ت2 إ.D
and measure levels of thyroid-stimulating- ."رقC ضFى ا>ن اQ4
hormone .-د اJ# / اOlS .E
E. Treat the patient with radioactive iodine
29 A
41. A 40-year-old man complains of slowly ر2Q 3S nS< 40 ر C
progressive generalized weakness, weight loss, 3[S ا6 3 وأ،2. ا6 3 أ،رة وزن4X ،ء:.#
abdominal pain, and wrist and knee pain over the 6 ) J5 .OJ< اOCJC*> اjNل اvX O.واآ
past several months. He was told at an urgent care ا*"ارvJC5 -T ا"م, "لS ارئ أن2ا
visit that his blood sugar was a little higher than O> "ي. ض آOJCA ةJ, ه&ك.6SJ.2ا
normal. There is a family history of liver disease on ط6S / أن اJ. ،EFT &" ا."وا
his father’s side. On examination, the patient has m آ.". اO DC س4l وQ& s.[
diffuse hyperpigmentation and palpable liver edge. J[S ا6 nJT\ "دSQ iT >بQأ ا
Mild polyarthritis of the wrists and أوEF ه أ.OJv4 اOJS&4 اiTوا
metacarpophalangeal joints is also noted. What is اb هOC EJP DC "ة4C صFT اOl
the best test or combination of tests to help you :؟/ا
diagnose this patient’s problem ? @ و"ولTQ ا- "اد دم آS .A
A. Complete blood count with differential and .ب اv*Q,Kا
a comprehensive metabolic panel HbA1C .B
B. Hemoglobin A1C ،""Fط ا.رK OC ا*"رة ا،""F ا.C
C. Iron, total iron-binding capacity, and ferritin .JTوا
D. Alpha-1 antitrypsin level .1– T أJ4# ى دQ4 .D
E. Liver-spleen scan .".آ-لF\
4 .E
30 A
42. A 32-year-old woman complains of abdominal pain n5Q 2. ا6 3 ا، 32 اأة ه A
off and on since age of 17. She notices abdominal خTQ# S 6 ه. 17 آن هb& دS 3|
bloating relieved by defecation as well as ك4>ل وا, ه&ك اb;ط آQ# ول% 6&2#
alternating diarrhea and constipation. She has no ،6 هn% ،رة وزن4X 6S K .&وبQ
weight loss, GI bleeding, or nocturnal diarrhea. On مv أن "> إEFT &" اJ. .6CJ >ل,أو ا
examination, she has slight LLQ tenderness and .2.C 6CT4 ا4N ا-# ا6 زيL 2# خTQوا
gaseous abdominal distension. Laboratory studies, "اد آS Q 6Q وا،O.Pص اFTا
including complete blood count, are normal. Which 6وN ه ا{اء ا6Q أي ا.OJSJ.\ ،تC
of the following is the most appropriate initial :؟g4Nا
approach? u& د،OJAاb;ف اJNدة ا%# OJi .A
A. Recommend increased dietary fiber, .>j "S# EFT اOS#Q و،وم%C&" ا
antispasmodics as needed, and follow up أ ااءOJ هgJ.\ OS ا.B
examination in 2 months . ا*نJ?&
B. Refer to gastroenterologist for colonoscopy .J.,ة أQT 3T \@ اJC,اQ .C
C. Two weeks of oral tetracycline - OC OJت ه, دراOC4C, gC\ .D
D. Order UGI series with small bowel follow- .O*J5"ء اS{ اO, دراOS#Q
through .O*J5"ء اS{ اO%X bX أgC\ .E
E. Order small bowel biopsy
31 A
43. A 55-year-old white woman has had recurrent 6S ، 55 ه،/J#Nق اSاأة ا A
episodes of alcohol-induced pancreatitis. Despite .لF# ضF &س# >بQK رةQ ت#
abstinence, the patient develops postprandial O ن ا،اف,{ "م ا3L اDC
abdominal pain, bloating, weight loss despite good رة4X ،OPT ،مS2" &ول اS# 2. ا6 3 أ
appetite, and bulky, foul-smelling stools. Kidney, ةJ. آOCQاز ذات آ# ،"ةJl> اQJ>j 3L# وزن
ureter, bladder (KUB) x-ray shows pancreatic ،gF ا،OJCC OJ&J4 اOSjN>ت اG أ.OWJ, OFAورا
calcifications. In this patient, you should expect to gl 6Q أي ا.6,&# aC ود،O]ا
find which of the following ? :؟O اb) &" هS5
A- Diabetes mellitus .ي4 داء ا.A
B- Malabsorption of fat-soluble vitamins D and 3,"# OCF&&ت اJQJTC [صQء ا, .B
K . ع د و ك
C- Positive fecal occult blood test .6#lاز إ. ا6 6TP ا"م اEF .C
D- Courvoisier sign .) آرازOv .D
E- Markedly elevated amylase .ظFC زvJع أT ار.E
32 A
45. Serum elevation of gamma GT may occur in the آ6 OJC[ اGT L 6 "ث زدةF أن B
following situations except one: : "اOJQت اKFا
A - Liver cancer .".\ن ا, .A
B - Gilbert's disease
.ت.C داء.B
C - During alcoholism
D - Cancer of the pancreas head .لF ا6\S أ|&ء.C
E - During a phenobarbital treatment .&س. اO5 \ن, .D
.لQJ#ر#&JT# جvS أ|&ء ا.E
Une élévation du taux sérique de la gamma GT
peut s'observer dans les situations suivantes, sauf
une. Laquelle ?
A - Au cours des cancers du foie
B - Au cours de la maladie de Gilbert
C - Au cours de l'alcoolisme
D - Au cours d'un cancer de la tête du
pancréas
E - Au cours d'un traitement au
phénobarbital
46. A 44 y old male complains of erectile dysfunction. OTJG و6 CX 44 ر C
He is treated for hypertension and for a psychiatric و ض:;ع اT ارuS ه.[بQKا
disease. Which is the least likely medication he is 5&و> ه أQ يb اOJQ اOدوN أي ا.64T
taking that could be responsible for this problem:
:؟OC اb هKو4 أن نFJ
A. Propranolol
B. Metoclopramide .ال#و# .A
C. Furosemide ."Jا#CQ .B
D. Domperidone ."JJ,وJ .C
E. Neuroleptics ."ون. دو.D
. دات ذهن.E
Un homme de 44ans se plaint de problèmes
érectiles. Il est traité pour hypertension et pour une
maladie psychiatrique.Parmi tous ces médicaments,
lequel serait le moins responsable de ce problèmes :
A. Propranolol
B. Metoclopramide
C. Furosemide
D. Domperidone
E. Neuroleptiques
33 A
47. Which artery is MOST likely to be diseased in a 67 &" رO#i <S ]آNن ه اj أي B
year old, male patient , non-smoker and م ا"مFj اب2< ") ا،X" K ، 67
dyslipidemic, who suffers a syncopal episode :؟OJL دO وE*& OJ 6L ب6Sو
secondary to cerebral ischemia?
.6.4 ان ا.A
(A) Carotid
(B) Vertebrobasilar .*ري ا*"يT ان ا.B
(C) Anterior communicating artery .6N اi ان ا.C
(D) Anterior cerebral artery .6N ا6L" ان ا.D
(E) Posterior communicating artery .6TCP اi ان ا.E
34 A
49. A 25-year-old man complains of pain and "J ا6 ورم3 أ25 ر D
swellingin the hand and forearm, perioral ك4 )QوF "S# ءJ5 وا،3T"ر ل اX ،"4وا
numbness, and vomiting after trying to catch a آ.@.A ز3C 60/90 ا"م:;< .OClCl اDSw#
rattlesnake. Blood pressure is 90/60 mm Hg. All of
: "اg,& جv ه6C
the following are appropriate therapies EXCEPT
A. fluid resuscitation .Aا4# شS{ ا.A
B. administration of 10 vials of antivenin .DSN ا34 * د10 ء2 إ.B
C. measurement of coagulation factors and .تFJT[] واPQس ا اJ5 .C
platelets .راعbC ريOT -# .D
D. immediate fasciotomy of the arm .3N اOlS .E
E. pain medication
35 A
51. Which of the following statements is TRUE 6 فvQXv O.4&# OFJFi OJQرات ا.S أي اE
regarding radiographic differences in appearance :؟O?JC; واO*J5"ء اSN اJ# 6Sا?> ا
between the small and large bowels? ز. 6Q اO<SQ4 اOJ2P ا]ت ا.A
A. Transverse linear densities that arise from the
" هnlQ اD*> إ2# "Qء وSN"ار ا
bowel wall and extend part way into the lumen
are characteristically seen in the small intestine .O*J5"ء اSN ا6 %J #
B. Haustrae are the transverse linear densities O<SQ4 اOJ2P ا]ت ا6ت ه.J.* ا.B
found in the small intestine .O*J5"ء اSN ا6 ادة
C. Transverse linear densities that extend # "Q 6Q اO<SQ4 اOJ2P ا]ت ا.C
completely across the bowel lumen are found 6 دة6ء هSK اnl . آ
inthe colon .ا*ن
D. Plicae circulares are the transverse linear
OJ2P ا]ت ا6 هOAت ا"اJ&] ا.D
densities found in the colon
E. Haustrae are less numerous and situated farther . ا*ن6 ادةO<SQ4ا
apart than plicae circulares >S# "اJS# -<Q "دا و5 أ6ت ه.J.* ا.E
.OAت ا"اJ&] أآ] ا/S.ا
Laquelle des affirmations suivantes est VRAIE
concernant les différences radiographiques entre le
grele et le colon?
A. Les densités linéaires transversales qui
proviennent de la paroi intestinale et
s'étendent à mi-chemin dans la lumière sont
caractéristiquement visibles dans l'intestin
grêle
B. Les haustrae sont les densités linéaires
transversales trouvées dans l'intestin grêle
C. Les densités transversales linéaires qui
s'étendent complètement à travers la lumière
de l'intestin se trouvent dans le côlon
D. Les plicae circulaires sont les densités
linéaires transversales trouvées dans le
côlon
E. Les haustrae sont moins nombreux et situés
plus éloignés que les plicae circulaires
52. A 38 year old male presents with severe abdominal 6 3 وه أ38 ر A
pain, diagnosed as pancreatitis. Which of the .&س د# >بQ# )[JP 3 qJ ،""j 2.ا
following drugs is NOT associated with acute &س.>ب اQ ا- @اQ K OJQ اOدوNأي ا
pancreatitis?
:د؟Fا
(A) Heparin
(B) Furosemide .ر. ه.A
(C) Rifampin ."JJ,وJ .B
(D) Salicylates .J.T ر.C
(E) Warfarin .تvJ4JC, .D
. وارر.E
Un homme de 38 ans présente une douleur
abdominale sévère, diagnostiquée comme une
pancréatite. Lequel des médicaments suivants n'est
pas associé à une pancréatite aiguë?
(A) Héparine
(B) Furosémide
(C) Rifampine
(D) Salicylates
(E) Warfarine
36 A
53. Which of the following is NOT a predisposing :@؟QTر ا2Q WJ> v aJ 6Qأي ا B
factor for the development of a hernia? .*ء4Q,K ا.A
(A) Ascites .O&4 ا.B
(B) Obesity
.64J آnJC .C
(C) Cystic fibrosis
(D) Chronic obstructive pulmonary disease .%ي اA"اد ا4K داء ا.D
(E) Peritoneal dialysis .65Ti دل.E
37 A
55. Mr Farid is diagnosed with stomach cancer; his أنgl ،" "J4C "ةS \ن, EJP 3 "* E
symptoms should include everything except: : "ا6C أا<) آQ
A - Epigastric pains .OJ,j مKx .A
B - Vomiting food
.مS2ء ا6* .B
C - Hematemesis
D - recurrent phlebitis .ء دم6* .C
E - Constipation .رQ ]ريX >بQ ا.D
.ك4 إ.E
Mr Farid est diagnostiqué d’un cancer de
l'estomac ; ses symptomes devraient inclure tout
sauf :
A - Douleurs épigastriques
B - Vomissements alimentaires
C - Hématémèse
D - Phlébites récidivantes
E - Constipation
56. All these markers are associated with a severe ""j Ll, داء- @اQ تvS اb ه-J A
Sjögren with poor prognosis except: : "اJ, EJP ذات
A- Blepharitis .Tl>ب اQ ا.A
B- Hypocomplementemia
. ا"م6 OQ اE* .B
C Purpura
D-Raynaud with digital ulcerations .O .C
E-Cryoglobulinemia .-#iN ا6 *ت- ر&د.D
. ا"م6 Oد.&ت اJ#C; ود ا.E
Tous ces marqueurs sont associés à un Sjögren
grave avec mauvais pronostic sauf :
A- Blépharite
B- Hypocomplémentémie
C- Purpura
D- Raynaud avec ulcérations digitales
E- Cryoglobulinémie
57. The epididymis is responsible for everything : "ا6C ول آ4 #.ا E
except: .O&ات اJF * ا.A
A. Sperm transport .O&ات اJF اO ج آ.B
B. Maturation of sperm mobility
.O&ات اJF اO#[X ج.C
C. Maturation of sperm fertility
D. Sperm storage .O&ات اJF ا%P .D
E. Secretion of 70% of the ejaculate liquid .فb* اA, %70 إاز.E
38 A
58. Which of the following is NOT a complication of >بQت اT aJ ه6Qأي ا D
acute pancreatitis? :د؟F&س ا.ا
A. Adult respiratory distress syndrome .J;. &" اOJ4T&Q اO*A اOزvQ .A
(ARDS)
.6.C5 6C :J.] .B
B. Myocardial depression
C. Disseminated intravascular coagulopathy .Q& ]ري ور"يX لvQ ا.C
(DIC) .[صQء ا, .D
D. Malabsorption .OJ,&# O# آذO4J آ.E
E. Pancreatic pseudocyst
39 A
60. Clostridium tetani is the organism responsible for ول4 ا6|l اS ا6 هOاز% اOJ]2ا B
causing tetanus. All of the following statements از%C O.4&# OJQرات ا.S آ ا.از%داء ا
regarding tetanus are TRUE EXCEPT : "اOFJFi
A. tetanospasmin, an exotoxin produced by
)lQ& 6رX نT ه ذ،J,.,Q .A
C.tetani, is responsible for the clinical
manifestations of tetanus ول4 وه،Oاز% اOJ]2ا
B. tetanospasmin is released into the CNS after .از% "اء اO4ا?ه ا
C. tetani crosses the blood–brain barrier >زl اX داD إJز.,Q رFQ .B
C. clinical manifestations of tetanus include OJ]2ر ا. "S# ي% اآ6.[Sا
generalized muscular rigidity, violent . ا"ي6L" ا%FC Oاز%ا
muscular contractions, and instability of the از% "اء اO4 ا?ه اQ .C
autonomic nervous system
،nJ& 6C EC* ،3S 6C gC[
D. the most common presenting complaint of
patients with generalized tetanus is pain and .إراديv ا6.[S>ز اl ا6 *ارQ,"م ا
stiffness in the masseter muscle "& Jj ]آNرزة ا. إن اى ا.D
E. tetanospasmin prevents the release of 6 ه3Sاز ا%"اء ا# J#[ اD<ا
GABA and glycine from presynaptic nerve .O;< اOCS ا6 gC[ و3أ
terminals GABA رF -& J,.,Q .E
.5 [بN >ت اJ4JCLو
Clostridium tetani est l'organisme responsable du
.OJ.ا
tétanos. Toutes les affirmations suivantes
concernant le tétanos sont VRAIES SAUF
A. la tétanospasmine, une exotoxine produite
par C. tetani, est responsable des
manifestations cliniques du tétanos
B. la tétanospasmine est libérée dans le SNC
après C. tetani se retrouve dans le sang
C. les manifestations cliniques du tétanos
incluent la rigidité musculaire généralisée,
les contractions musculaires violentes et
l'instabilité du système nerveux autonome
D. la plainte la plus fréquente des patients
atteints de tétanos généralisé est la douleur
et la rigidité dans le muscle masséter
E. La tétanospasmine empêche la libération de
GABA et la glycine des terminaisons
nerveuses présynaptiques
61. Which of the following animals is NOT a potential "اءaJ هOJQات اJFأي ا D
carrier of rabies? :؟gCا
(A) Dogs .بv ا.A
(B) Bats
.JTP ا.B
(C) Skunks
(D) Squirrels .ن#? ا.C
(E) Cows .g&4 ا.D
.*. ا.E
Lequel des animaux suivants N'EST PAS un
potentiel porteur de la rage?
(A) Chiens
(B) Chauves-souris
(C) Mouffettes
(D) Écureuils
(E) Vaches
40 A
62. What is the least likely reason for epigastralgia أ|&ء6, ا3 FJ 5N اg.4 ه ا B
during pregnancy :؟Fا
A. Decreased lower oesophageal sphincter tone .OJCT4 [ة ايء اO* 6 E5& .A
B. Decreased secretion of gastrin
.Q,; إاز ا6 E5& .B
C. Mechanical pressure due to the size of the
uterus .3 ا3l u 6JJ :;< .C
D. Decreased gastric emptying ."يS ا{اغ ا6 E5& .D
E. Increase in gastroesophageal reflux .6W"ي اSع اlرK زدة ا.E
41 A
64. For a 40 y old patient with an acute necrotizing &س# >بQ ا6S 40 / A
pancreatitis of biliary origin, what is the best ه أ،اويTi ي د ذات ["رP
therapeutic proposal? :ج؟vSC احQ5ا
A. The drainage technique of choice is
J?&Q ا6رة هQP اn[Q اOJ&* .A
endoscopic retrograde
cholangiopancreatography when it is 6,&.[ اQ اO*2# 6CXا"ا
available. ..اQ &" ن-اوي ااT[ا
B. Surgical treatment should be preferred as . |ن:P آOCT 6 هOJاl اOlS ا.B
second line. D*. 6"Qم اl> ذات اn[Qت اJ&* .C
C. Minimally invasive drainage techniques .لSQ,K اOCJC5
remain poorly used. 6 ه6"Qم اl> ذات اn[Qت اJ&* .D
D. Minimally invasive drainage techniques are
.bJT&Q اO.Si
difficult to implement
42 A
66. A 49-year-old woman is admitted for an evaluation رS اg.4# 3JJ*Q ISX ، 40 اأة هD
of weakness. She complains of fatigue with - ،تvS"ام اPQ, ا- gS 6 ه.ه#
repetitive muscle use, with significant fatigue and " "5 gSQا اb ه.مJ اO> 6 -C# 4 وJ. آgS
dysphagia by the end of the day. Her activities have
6l2< اaT @J< وه&ك،>\ رز# #
been significantly limited due to her fatigue, and
there is significant orthopnea.During her 137 دمi :ي.P اJCFQ> اG أ،3JJ*Q أ|&ء ا.رز#
evaluation, laboratory analysis reveals: Sodium 137 "رC آ، ل/ 6CC 3.8 مJ,# ، ل/ 6CC
meq/L, potassium 3.8 meq/L, chloride 94 meq/L, . ل/ 6CC 31 تF 6| ، ل/ 6CC 94
bicarbonate 31 meq/L. An arterial blood gas shows 3C 60 PaCO2 ،PH 7.33 >G أ6ز ا"م اL
pH of 7.33, PaCO2 60 mmHg, and PaO2 65 OJ&J4 ا["ر اOSj * أ.@.A ز3C 65 PaO2 و،@.Aز
mmHg. A chest x-ray is interpreted as “poor %92 هJl4وآNع ا.j إ."6*J>>" اl اnS< " ه
inspiratory effort.” The oxygen saturation is 92%
.OJSJ.\ O ه وOوQا-O>Q اEF .O; ا6
on room air. A ventilation-perfusion scan has
normal perfusion. Which of the following tests will g., nS 6 FJ ]آN ه اOJQص اFTأي ا
most likely identify the cause of this patient’s :؟O اb &" ه64T&Q اFQا
respiratory acidosis? ."غC ريF 6*.\
4 .A
A. CT scan of the brain .3FT" اJ4ول أوآN رQK"رة ا5 .B
B. Diffusing capacity for carbon monoxide . ايءJ?& .C
C. Esophagoscopy *ءCQ,K اOJS< و6) O4* اOJF ا*"رة ا.D
D. Forced vital capacity (supine and upright)
.(O*Q,K اOJS< و6و
E. Pulmonary angiogram
.OA رOJAرة وi .E
Une femme de 49 ans est admise pour une
évaluation de faiblesse. Elle se plaint de fatigue
musculaire, avec une fatigue importante et une
dysphagie en fin de la journée. Ses activités ont été
considérablement limitées en raison de sa fatigue,
et il y a une orthopnée significative. Au cours de
son évaluation, l'analyse en laboratoire révèle:
Na 137 meq / L, potassium 3,8 meq / L, chlorure 94
meq /L, bicarbonate 31 meq / L. Un gaz du sang
artériel montre un pH de 7,33, PaCO2 de 60 mmHg
et PaO2 de 65 mmHg. La radiographie thoraxest
interprétée comme un «mauvais effort
inspiratoire». La saturation d'oxygène est de 92% à
l'air ambiant. Un Scan de ventilation-perfusion est
normal. Lequel des tests suivants sera très
probablement necessaire pour identifier la cause de
l’acidose respiratoire ce patient?
A. Scanner cérébral
B. Capacité de diffusion du monoxyde de
carbone
C. Oesophagoscopie
D. Capacité vitale forcée (en décubitus dorsal
et en position verticale)
E. angiographie pulmonaire
43 A
67. A 75-year-old smoking man with a history of ةl& \ن4 ةJ, - 75 X" ر C
laryngeal cancer treated by surgical resection and جv و6[ل اWQ,# )QlS I qJ
radiotherapy presents for thirst with a feeling of رS وا2S وه ا،OSjN#
sticky tongue. He has noticed this for a few months
>ر وj OS# b& ذmK "* .ج% ن4C#
but his condition is currently worsened after an
angina treated by antibiotic therapy. All these J>ب زQK )<S "S# )Q ءت, أنq.
measures are effective to improve his condition JS اb آ ه.يJ د# OlS اI qJ
except: :) "اQ J4F 6 OS 6ه
A- Prescribe antimycotics .ت2 دni و.A
B- Make the HbA1C test .HBA1C EF إاء.B
C- Make a biopsy of the salivary glands .OJ#SC ا;"د اO%X bX أ.C
D- Drink a lot of water
. اءJ]ب اj .D
E- Start a PPI and stop smoking
n5Qون وا. اOP :.]# "ء. ا.E
Un homme de 75 ans, tabagique avec antécédent de .JX"Qا
cancer du larynx traité par résection chirurgicale et
radiothérapie, se présente pour soif avec langue
collante. Il a remarqué ceci depuis quelques mois
mais son état est majoré actuellement après une
angine traitée par antibiothérapie. Toutes ces
mesures sont efficaces pour améliorer son état
sauf :
A- Prescrire des antimycotiques
B- Faire le dosage de HbA1C
C- Faire une biopsie des glandes salivaires
D- Boire beaucoup d’eau
E- Débuter un IPP et arrêter le tabac
68. A 40-year-old woman, working as a cook in a ،3S2 6 OX.\ S ، 40 اأة هD
restaurant, complains of burning eyes, especially at O - ء4 ا6 S أ|&ء اOiX ،>J&J 6 @
work in the evening with pruritus and redness. ء# 4; &" اQ5 اضN اb >"أ ه.واار
They are temporarily quenched by the application
: "ا؟K.* .QS EJP 6C آ.رد.ا
of cold water. All these diagnoses are possible
except: .ت,"S اg.4# PQ# OFQC >بQ ا.A
A- Conjunctivitis by irritation because of ..2 ارة اg.4# PQ# OFQC >بQ ا.B
lenses .Ll, داء.C
B- Conjunctivitis by heat irritation of .OJ*>ب اQ ا.D
cooking .ول%S J فT .E
C- Sjögren's disease
D- Keratitis
E- Isolated eye dryness
44 A
69. A 52-year-old alcoholic man presents to a local 345 D إ،لF اDC " ، 52 رD
emergency room with purulent, productive cough, 6 @J< ،""يi uQ& لS, 6S ارئ وه2ا
shortness of breath, right-sided chest pain, and عT وار، ا["رN اgl اDC 3 أ،aT&Qا
fever. He thinks his symptoms started a few days
"& . أمOS# b& "أت# )<*" أن أاQS ) إ.ارة
ago. On examination, he has a temperature of
38.8°C, heart rate of 96 beats/min, respirations of 96 gC*ت ا#< "لS ،م°38.8 ) ارI آ،EFTا
22 breaths/min, oxygen saturation of 85% on room %85 Jl4وآNع ا.j إ، د/ aT 22 aT&Q ا، د/ O.
air, and a blood pressure of 115/92mmHg. He has )&, أ.@.A ز3C 92/115 ا"م:;< و،O; ا6
poor dentition and fetid breath. There is dullness to *F اDC &" ا*عOJi ه&ك أ.Q aT& واOWJ,
percussion over the right lower lung field, and rales .gl اOJA&| ةXX -4 و،N ا6CT4ي اAا
are auscultated bilaterally. A chest radiograph 34* ا6 N اgl ا6 OQ ا["رOSj?> أ
shows a right-sided opacity in the superior portion
-A, ىQ4 ود- N اT,N اETC يCSا
of the right lower lobe with an air-fluid level
present. There appears to be right-sided .N اgl اDC 6&Q "C[ "و. DC ه&ك.6Aها
parenchymal consolidation as well. Which of the &داQ, ا،FJ ]آN اg.4 اS ه ا6Qأي ا
following is the most likely etiologic organism :ض؟Sا اb>
based on this presentation? .ء4Cت اJ. ا.A
A. Candida glabrata .ا%CT{وس اJ .B
B. Influenza virus .OJC4ات ا2TQ ا.C
C. Mycobacterium tuberculosis
.OJ> اO"*S ارات ا.D
D. Peptostreptococcus
E. Streptococcus pneumonia .OA*"ت اS ا.E
45 A
70. A 30-year-old female with end-stage renal disease )QC 6 يC داء آ6S 30 هD] أE
who receives her dialysis through a tunneled ،>TQ آ6 )J*T ة245 . لFQ -P وOJA>&ا
catheter in her shoulder presents with fever and .>? اT, أ6 ""j 3 ارة وأ6ت وه
severe low back pain. On examination, she is
و،)5SQ وO JL I آ،EFT&" ا
uncomfortable and diaphoretic but
hemodynamically stable. She has a soft 2/6 early )J<.* "@ اOPT >" .*ةQ4 O"> اQJJ&د
systolic flow murmur. Her line site is red and warm أ ودا دون إازاتg*] ا-5 .6/2 O ة.
with no pustular exudates. She is very tender over .>هG T, أDC al"" &" اj 3w# S 6 ه.O]#
her lower back. Neurologically, she is completely تt J " دK . OJC, 6 ه،OJ.[S اOJ& ا
intact. There is no evidence of Janeway lesions, "اد آت ا"مS . روث-*# أو،C, *" أو،اي
Osler nodes, or Roth spots. Her white count is آQ أنgl ريT ا3JJ*Q ا.16700 ءJ.ا
16,700. Immediate evaluation should include all of
: "ا6C
the following except:
A. MRI of the lumbar spine .OJ&2**ات اTC 64J\&; J ر.A
B. removal of her dialysis catheter .لFQة ا245 O إزا.B
C. transthoracic echocardiogram . ا["ر. gC*"ى اi :J2P .C
D. two sets of blood cultures followed by v J4 >JC رع ا"م% نQl .D
vancomycin as well as gram-negative . ا;امOJ.C, )J2;
coverage .2.C ريF 6*.\
4 .E
E. Abdominal CT scan
46 A
71. A 78-year-old male presents to the clinic Cدة وه أ) آJS اD إ78 رD
complaining that every time he shaves with a .6 اgJ; ،3J*Q4 اO5vFس ا# )&5@ ذCF
straight razor, he passes out. His symptoms have /S# 6 .JJ< ا> ا6 اضN اb ) هI|"
been occurring for the last 2 months. Occasionally,
.b آ6 اgJ; ،O*J< O5 &" "ي،نJNا
when he puts on a tight collar, he passes out as
well. The loss of consciousness is brief, he has no ،O*اQ ادر# )" aJ و،%J و6ب اJ;ا
associated prodrome, and he feels well afterward. mFC O"* اOJ<) اJ, ." ذS# "J )w# Sو
His past medical history is notable for hypertension ) هv .ول ا"مQ4 وط آ:;< عTار
and hypercholesterolemia. His only medication is I آ،ي4 اEFT &" ا.:* "زJرC"روآJه
hydrochlorothiazide. On physical exam his vital ]&ءQ,# 6SJ.\ gC* اEF و،OJSJ.\ OJFرا) اjإ
signs are normal, and his cardiac exam is normal 6[JPQ اEFT ه ا6Q أي ا.-# ااgC*ت اi
with the exception of a fourth heart sound. Which
:؟g4N ا6Qا
of the following is the most appropriate next
diagnostic test? . ا{>ديgC*"ى اi :J2P .A
A. Stress echocardiography .مJQد&ز اw# [Q ا.B
B. Adenosine thallium scan .O.5C ريF 6*.\ [ .C
C. Computed tomogram of the neck .6.4 اgJl اJ" .D
D. Carotid sinus massage .EFT اO \وO إ.E
E. Tilt table test
47 A
72. A 42-year-old woman presents to the emergency room "ء# - ارئ2 ا345 D ت إ42 اأة هE
with acute onset of shortness of breath. She recently had رجX >" زرة ا6 اX I آ.aT& @J د
been to visit her parents out of town and rode in a car
for about 4 h each way. Two days ago, she developed a "S# .l آ ا6 ت, 4 6اF رةJ4دت ا5 وO&"ا
mild calf pain and swelling, but she thought that this *"تQ و&> ا،OC# ا6 ورم:J4# 3w# تSj ،J
was not unusual after having been sitting with her legs DC دQKس واCl" اS# ديJL أا3 اbأن ه
dependent for the recent trip. On arrival to the ،ارئ2 ا345 D> إi &" و.OC اC 6 >JCر
emergency room, she is noted to be tachypneic. The
vital signs are: blood pressure 98/60 mmHg, heart rate :;< :OJFرات اj{ ا.aT ع4 O 6 > أm
114 beats/min, respiratory rate 28 breaths/min, SaO2 114 gC*ت ا#< "لS ،@.A ز3C 60/98 ا"م
92% on room air, weight 89 kg. The lungs are clear 6 %92 SaO2 ، د/aT 28 aT&Q اO, ،د/O.
bilaterally. There is pain in the right calf with ه&ك.J.l ا6 OF< واOA ا.s آ89 ازن،O;ا
dorsiflexion of the foot, and the right leg is more
swollen when compared to the left. An arterial blood gas وا،*"مC 6>اG ا]&ء- D&J اOC# ا6 3أ
measurement shows a pH of 7.22, PaCO2 18 mmHg, سJ5 >G أ.ى4J ا ا. أآ# OرQ D&Jا
and PaO2 68 mmHg. Kidney and liver function are ،@.A ز3C18 PaCO2 ،7.22 PH 6ز ا"م اL
normal. A CT scan is performed and confirms a "* .OJSJ.\ OJC" وا. اOTJG و.@.A ز3C 68 PaO2
pulmonary embolus. All of the following agents can be
used alone as initial therapy in this patient except: .OA رOi آ" ودwري وF 6*.\ [Q ISX
A. enoxaparin, 1 mg/kg SC twice daily )JA"# OlS"ا> "ه آPQ, اOJQا اSآ ا
B. fondaparinux, 7.5 mg SC once daily :]&ءQ,# O اb&" ه
C. tinzaparin, 175 units/kg SC once daily J "Cl اIF sآ/sC 1 ،ر#4 إآ.A
D. unfractionated heparin IV adjusted to maintain .J
activated partial thromboplastin time (aPTT)
two to three times the upper limit of normal " ة وا"ةCl اIF sC 7.5 ،aر&آ# "ا.B
E. warfarin, 7.5 mg PO once daily to maintain INR .J
at 2–3 " ةCl اIF s آ/ و"ة175 ،ر#ا%&J .C
.J وا"ة
Une femme de 42 ans se présente à la salle d'urgence
avec un début d'essoufflement aigu. Elle a récemment
6 )Q "لS "أ ور%l JL ر. ه.D
rendu visite à ses parents en region et a roulé dans une 6A%l اJQ,v#. ز وOJi
voiture pendant environ 4 heures à chaque fois. Il y a .6SJ.2" اF اDC أJ ل ة أوSTا
deux jours, elle a développé une légère douleur au ة وا"ة3T \@ ا- 7.5 ، وارر.E
mollet et un gonflement, mais elle pensait que ce n'était
pas inhabituel après avoir été assise avec ses jambes .3-2 DC INR OJ[ J
pendantes lors du récent voyage. À son arrivée à la salle
d'urgence, elle est notée tachypnéique. Les signes vitaux
sont: tension artérielle de 98/60 mmHg, fréquence
cardiaque de 114 battements / min, fréquence
respiratoire de 28 respirations / min, SaO2 de 92% dans
l'air ambiant, poids de 89 kg. Les poumons sont dégagés
bilatéralement. Il y a une douleur dans le mollet droit
avec dorsiflexion du pied, et la jambe droite est plus
enflée par rapport à la gauche. Une mesure des gaz du
sang artériel montre un pH de 7,22, PaCO2 18 mmHg,
et PaO2 68 mmHg. La fonction rénale et hépatique est
normale. Un scanner hélicoïdal est réalisé et confirme
une embolie pulmonaire. Tous les agents suivants
peuvent être utilisés seuls comme traitement initial chez
elle sauf:
A. énoxaparine, 1 mg / kg SC deux fois par jour
B. Fondaparinux, 7,5 mg SC une fois par jour
C. tinzaparine, 175 unités / kg SC une fois par jour
D. héparine IV non fractionnée ajusté pour
maintenir le temps de céphaline activée (TCA)
deux à trois fois la limite supérieure de la
normale
E. warfarine, 7,5 mg PO une fois par jour pour
maintenir l'INR à 2-3
48 A
73. A 31-year-old woman presents to your clinic 6دة وهJS اD ت إ، 31 اأة هE
complaining of painful arthritis that is worse in the "& ح.[ &" ا35TQ يb وا3 iT >بQ ا
mornings when she wakes up. She was recently >بQK نJ gJ.\ "& اX >JJ* *" ى.m*JQ4
evaluated by an ophthalmologist for uveitis in her
ي.P اEFT> * اG أ.D&J&> اJ 6 OJ%*ا
right eye. A recent laboratory report shows an
erythrocyte sedimentation rate of 48 mm/h. Which 6Q أي ا.O, / 3C 48 ا"مT] O, ،JXNا
of the following will be helpful in distinguishing a ا&آn>ب ا;رQ@ اT DC "4 ف,
relapsing polychondritis from rheumatoid arthritis : او"ي؟iT>ب اQا
(RA)? iT >بQ ا- @اQ iT >بQ ا.A
A. Arthritis associated with RA is nonerosive. .آQ JL رو"ي
B. Eye inflammation is absent in relapsing n>ب ا;رQ ا- @اQ K JS>ب اQ ا.B
polychondritis.
.aا&آ
C. Relapsing polychondritis will not present
with vasculitis. >بQ ا- @اQ K a ا&آn>ب ا;رQ ا.C
D. Relapsing polychondritis will present with .OJوNا
high-titer of rheumatoid factor. - @اQ a ا&آn>ب ا;رQ ا.D
E. The arthritis of relapsing polychondritis is .6 رJS رو"ي ذات
asymmetric. JL هn>ب ا;رQ ا6 iT>ب اQ ا.E
.G&Q
Une femme de 31 ans se présente à votre clinique
pour une arthrite douloureuse qui s'aggrave le matin
quand elle se réveille. Elle a récemment été évaluée
par un ophtalmologiste pour une uvéite dans l'œil
droit. Un rapport de laboratoire récent montre un
taux de sédimentation des érythrocytes de 48 mm /
h. Lequel des éléments suivants sera utile pour
distinguer la polychondrite récidivante de la
polyarthrite rhumatoïde (PR)?
A. L'arthrite associée à la polyarthrite
rhumatoïde est non érosive.
B. L'inflammation des yeux est absente dans la
polychondrite récidivante.
C. La polychondrite récidivante ne présentera
pas de vascularite.
D. La polychondrite récidivante présentera
avec le titre élevé du facteur rhumatoïde.
E. L'arthrite de la polychondrite récurrente est
asymétrique.
49 A
74. A 44-year-old woman seeks evaluation for irregular JL O> "ور> اJJ* gC2 44 اأة هA
menstrual cycles with heavy menstrual bleeding. نw# *" أدت.""j /J n% - O*اQ واO?Q&ا
She reports that her menses had been regular with &تS اA أواb& 28 "ورة# JSJ.\ > آنJ
28-day cycles since her early twenties. However,
> دور،OJ< اOQ4> اjN ا6 ، و. ه
for the past 6 months, her cycles have been 22–25
days with heavy associated bleeding that is unusual ديJL ""j n% - O.[Q و25-22 Iآ
for her. She has had rare hot flashes and sleep اب2< واO&X, ت."ث > هF درا.> O.4&#
disturbance. She is requesting assistance in b هDC ة2J4C "ة4 اgC2 6 ه. ا&م6
controlling these symptoms. You suspect she is ع2* ا.5 ةQT ا6 >*"ت أQ *" ا.اضNا
perimenopausal, and hormonal testing on day 2 of "> أآJF 6]م اJ ا6 6> اEFT وا،q2ا
her menses confirms this suspicion. You are ي-# جv حQ* I أ.اb*دك هQ ا
considering treatment with oral contraceptives for
JL > "وثQ5 أا<> وDC ة2J4C
control of her symptoms and to protect against
unintended pregnancy. Which of the following ب.2Q, د ا.QS ف, 6Q أي ا.*[د
would be considered a contraindication to use of :؟OT اF ا-& ب. "امPQ,K
oral contraceptive pills: . ه.A
A. Her age .q2ارة ا%L .B
B. Menorrhagia .ةJ[* ا"ورات ا.C
C. The short cycles .رقN ا.D
D. Insomnia
.O&X4ت ا.> ا.E
E. Hot flushes
50 A
75. About knee trauma, all of the following statements OFJFi OJQرات ا.S آ ا،O. اآO< O.4&# C
are correct EXCEPT ONE. Which ? :"ا
A. A sprained knee may be accompanied by a .OJv هOx - O. اآ6|ا@ وQ أن.A
meniscal lesion
.OJv> اOt) ا.., أن ن°15 6&] ا.B
B. A 15 ° flessum can be caused by a meniscal
lesion " K ،Oو%S اOJv>ت اt ا6 .C
C. In isolated meniscal lesions, no effusion is .ب.[ا
found Ox أن ه&ك6&S ريOJ#l{ اOvS ا.D
D. A positive sign of McMurray means there is .OJvه
a meniscal lesion O"i g.4 أنJ2P اO. اآ6| و.E
E. Serious sprained knee can cause patella .OT<ا
shock
51 A
77. A 37-year-old woman has significant nocturnal O*2& 6 J. آ6CJ 3 أ6S 37 اأة هD
pain in the scapular area as a result of work at her لS # >Ql "* .>%& 6 S اu nQا
home. You treat it effectively for a calcification "* .O ق اآOCS و ا6 -<Q اaCQ ا
located in the tendon of the supraspinous muscle.
-J#," "ة أS# ىX ة أS ورQC ت
She consults you again a few weeks after this
episode for a difficulty in mobilizing the shoulder. "* .nQ اF 6 O#Si g.4# ا&بC "وث
You notice a limitation of passive mobility on .ي4 اEFT"ودة &" اF OCST& O آI?K
clinical examination. What is the most likely :؟FJ ]آN اEJPQه ا
diagnosis? .Oق ا ق اآ% .A
A. Rupture of the supraspinatus tendon .iاQ O>ب و ق اآQ ا.B
B. Unbroken tendonitis of the supraspinatus .aC *# .C
C. Residual calcification
.gF4C #5 O?TF >بQ ا.D
D. Retractable Capsulitis
E. Symptomatic Chondrocalcinosis .6<S اnس ا;رv آ.E
52 A
79. A 26 y old female complains of dyspnea. >G أ.aT& @J< 26 هD]أ C
Ultrasound reveals mitral stenosis. Which of the اتJJ;Q أي ا.6 @J ق ا[ت
following pathological change does not occur in :؟6Q@ اJQ ا6 "ثF K OJQ اOJ<ا
mitral stenosis .4Nذ اN ا:;< زدة.A
A) Increased left atrial pressure .4Nذ اN ا-, .B
B) Left atrium dilatation .6&J2# 3P .C
C) Ventricular hypertrophy .]اتP ا[م ا.D
D) Embolisation of clots
.OFJFi v أO#N آ ا.E
E) All of the above
53 A
80. Which of the following patients is MOST likely to "JTQ4 أنFJ ]آN ه اD<ء اK أي هC
benefit from antibiotic therapy in addition to n[@ وj D إO< إOJFدات ا# جvSا
abscess incision and drainage? :اج؟Pا
A. A previously healthy female with a
"ةL 6 اجP# O#[* و#, OJC, D] أ.A
Bartholin’s gland abscess and no history
suggesting a high risk for STD OJ \P D إJ ةJ, K وJ#
B. A healthy 25-year-old male with recurrence .J4& O*& اضN
of a pilonidal abscess that first occurred 2 اجP ار ا6S 25 ر.B
years previously .JQ&, b& ي "ث أول ةbي واSا
C. A febrile 50-year-old female with NIDDM ع ارةT ار50 هD] أ.C
and recurrence of axillary hydradenitis DC "QS JL ي, داء6S 6وه
suppurativa
6FJ* اOJ2#{ اOJ5S>ب ا;"د اQ واJ4{ا
D. A 35-year-old male with a sebaceous gland
cyst that has been present for 2 years and .رQا
has now become infected O"L O4J آ6S 35 ر.D
E. An intravenous drug user without fever or IF.iن أt واJQ&, b& تw 6Q واOJزه
tachycardia presenting with a 2-cm2 deltoid .O|lQ
abscess that developed 7 days after “skin "ون# * ار"يF"رات \@ اP " .E
popping” OJ ا"ا6 اجX gC5 رع4 ارة أو
"ClQ أم "ا7 "S# w يb وا² 3, 2
Lequel des patients suivants est le plus susceptible
de bénéficier d'un traitement antibiotique en plus de .""يClا
l' incision et drainage d’un abcès?
A. Une femme auparavant en bonne santé avec
un abcès de Bartholin et aucun antécédent
suggérant un risque élevé de MST
B. Un homme de 25 ans en bonne santé avec
récidive d'un abcès pilonidal survenu 2 ans
auparavant
C. Femme fébrile âgé de 50 ans avec DNID et
récidive d'hydraénite axillaire suppurée
D. Un homme de 35 ans avec un kyste de
glande sébacée présent depuis 2 ans et est
maintenant infectée
E. Un utilisateur de drogue par voie
intraveineuse sans fièvre ou tachycardie
présentant un abcès de 2-cm2 du deltoïde
qui s'est développé 7 jours après une
«abcedation cutanee»
54 A
81. A female patient reports a recent sexual contact O5v DC اX I> آw# D] أO *" أدتE
with a partner who has just been treated for a ض# )Q#i إ.Qj) اv 3 j - OJ4&
suspected STD. During the examination, a urine .J#l آن إFر ا.QX إ،EFT أ|&ء ا.J4& &*ل
test for pregnancy is found to be positive. Which of
O اF .5 )Ti وtي اJFه اد ا
the following antibiotics is safe to prescribe before
referring the patient to an obstetrician for prenatal :دة؟K ا.5 O&SC "J وOJA4 gJ.2
care? .JCJ, أ.A
(A) Acyclovir .J4وQ أز.B
(B) Azithromycin .3J4JT, .C
(C) Cefixime ."ازولJوQ .D
(D) Metronidazole .OFJFi v أO#N آ ا.E
(E) All of the above
55 A
82. All of the following statements about OFJFi ط ا"رقE* لOJQرات ا.S آ اB
hypothyroidism are TRUE EXCEPT :"ا
A. prevalence is greater in women than in men .ء أآ] ال4&ر &" اQ ا.A
B. amiodarone and lithium may mask the
OJQاض اKن اJTP "5 مJ]JCدارون واJ أ.B
presentation secondary to elevation of
thyroid hormone levels .65ى ا>ن ا"رQ4 عTرK
C. in secondary hypothyroidism, thyroid- ى ا>نQ4 ، ط ا"رق ا]يE* 6 .C
stimulating hormone (TSH) levels are . دة/TP& ( نTSH)"رقC ضFا
usually low "& -Aj ط ا"رق هE* أن3L# .D
D. although hypothyroidism is common in "5 اضN ن "رة ا، 60 . أآ3 ه
those older than 60 years, a paucity of ..Si EJPQ اSl
symptoms may make the diagnosis difficult
طE* u ط ا"رقE* "S# .E
E. postablation hypothyroidism is a cause
ofprimary hypothyroidism .6A".ا"رق ا
56 A
84. Regarding trauma of the abdomen in a patient with دثF ضS / OJ&2.<ت اC O.4&# C
a car accident , the viscera most commonly affected :؟6 هJj ]آN|ة اwQء اN ا،رةJ,
is: .". ا.A
A. The liver
."ةS ا.B
B. The stomach
C. The spleen .لF2 ا.C
D. The intestine .ءSN ا.D
E. The colon . ا*ن.E
57 A
86. Each of the following cardiac conditions is OJ O.A ذ- @اQ OJQ اOJ.C*ت اKF ا-J B
associated with systemic lupus erythematosus : "ا؟O>ز
(SLE) EXCEPT .رQ>ب اQ ا.A
(A) pericarditis .>#N@ اJ .B
(B) aortic stenosis .&قP ا.C
(C) angina .6وL 6SC< >بQ ا.D
(D) costochondritis .gC* اOC >بQ ا.E
(E) myocarditis
59 A
91. A 65-year-old man undergoes a technically difficult OJ&* ذات6&2# 6l Q. -P ، 65 رC
abdominoperineal resection for a rectal cancer OJCSل اvX D*CQ qJ ،3J*Q4 \ن, g.4# O.Si
during which he receives three units of packed red 4 " ورS# .اءFث و"ات آت ا"م اv|
blood cells. Four hours later in the intensive care "ة# ف%& هO*AT اO&S ا6 ت د,
unit he is bleeding heavily from his perineal ز،OCS] اPQت ا,>ت دراG أ.6lSح اlا
wound. Emergency coagulation studies reveal ،ف%& وز ا6A% JQ,v#. ز و،J.وو#
normal prothrombin, partial thromboplastin, and وOST JL .JTب اP تlQ& .OJSJ.\ >Cآ
bleeding times. The fibrin degradation products are "ادS و/TP& .JTى ا[ " اQF
not elevated but the serum fibrinogen content is FJ ]آN اg.4 ا.QJ وJ/70000 تFJT[ا
depressed and the platelet count is 70,000/µL. The : هn%&C
most likely cause of the bleeding is . * ا"مS رد6 JXw .A
a. Delayed blood transfusion reaction .6 ذا6& .J CF .B
b. Autoimmune fibrinolysis .6اl* اF ا6 وء دي زف.C
c. A bleeding blood vessel in the surgical .VIII S ز ا.D
field .ارةFض اTP اu ]يP لvQ إ.E
d. Factor VIII deficiency
e. Hypothermic coagulopathy
60 A
92. A victim of blunt abdominal trauma requires a OJ&2# O< رOJF ".ء ا% [لWQ, إاء اgC2Q C
partial hepatectomy. He is rapidly transfused with 8 "* .& ا"م# ) و"ات ا"م8 * 3 "* .OCJCآ
units of appropriately crossmatched packed red ل%. ا-5ف ا%& )w# شS{ اOL 6 )JC m
blood cells from the blood bank. He is noted in the ا
أن ن.6اlار"ي و ا@ ا
recovery room to be bleeding from intravenous ت ا"مFJTi E* u "& ]ريPل اvQKا
puncture sites and the surgical incision. His :؟OJQ] اPQ أي ا ا6 وز
coagulopathy is likely due to thrombocytopenia and .:* II .A
deficiencies of which clotting factors? .VII وII .B
a. II only .VIII وV .C
b. II and VII .X وIX .D
c. V and VIII .XII وXI .E
d. IX and X
e. XI and XII
61 A
93. An elderly diabetic woman with chronic steroid- % 6.[5 u&ي و4"اء ا# O#[ O&4 اأةC
dependent bronchospasm has an ileocolectomy for )JTAT O أرLT ISX ،"وJQ4 اDC "QS
a perforated cecum. She is taken to the ICU ة% اآO&S و"ة اD إICX *" أد.رN ا]*ب اg.4#
intubated and is maintained on broad-spectrum J# دو،nJ2 ا-,ي واJ د# OJi - gJ.&Q#
antibiotics, renal-dose dopamine, and a rapid 6]م اJ" اS# .-, J|w و" ذاتJQ, و،OC آOl#
steroid taper. On postoperative day 2 she develops ،(ف°102) م°39.2 ارةF# عT "ث > ارOاlC
a fever of 39.2ȃC (102.5ȃF), hypotension, E* O.P ا3J*>ت اG وأ،ت., ،:;< ضTPا
lethargy, and laboratory values remarkable for ]آN اEJPQ إن ا.م ا"مJ,# عT ا"م وار,
hypoglycemia and hyperkalemia. The most likely :د هF"ث اFا اb> FJ
diagnosis of this acute event is . دمuX .A
a. Sepsis . ا"م3l E* .B
b. Hypovolemia .?"ة اL [ر5 .C
c. Adrenal insufficiency . د6.J. P& .D
d. Acute tubular necrosis .ي, 6CX F .E
e. Diabetic ketoacidosis
62 A
95. Concerning mammography ,all the following are
JFi 6C آ،6S[ ا]"ي اQ# @CSQ J C
true except : :"ا
A. frequently coupled with ecchography . ا["ى:J2P - نQ* اJ] آ.A
B. It is the best screening way for breast cancer .\ن ا]"ي, يFQC O*\ ه أ.B
C. It is more sensitive in young compared to ء4&# Oت *ر# &" اOJ,4 ] ه أآ.C
older women .&, .آNا
D. It will detect stellar opacity .OJl& اOQSى اFQ ف, ه.D
E. It will detect microcalcifications .>يl اaCQى اFQ ف, ه.E
63 A
98. A 70 year old man has on a regular XRay دكOدS اOJ&J4 اOSjN>ت اG أ، 70 رD
vertebral narrowing at D12-L2 level.Among the K OJQص اFT أي ا.D12-L2 ىQ4 6 *ري
following tests ,which one has no utility in the :؟O]?م اS اOj ه- 6*TQ اEJPQ ا6 "JT
differential diagnosis with secondary osteoporosis .م ا"مJ4 آ.A
A- Calcemia .لST اC Jو# .B
B- C reactive protein .6&25->يG 64J\&; J ر.C
C- Dorso-lombar MRI .3?S اO]س آJ5 .D
D- Osteodensitometry .6C[ اJو.C 6A#>ن اv ا.E
E- Protein electrophoresis
64 A
100. Which of the following is not seen in functionnal 6TJGي اC ا*[ر ا6 " هK 6Q أي اD
acute renal insufficiency : :د؟Fا
A- Fraction excretion of sodium <1 .1 ȃ اح ا[دم2ء ا% .A
B- Urinary density >1020 .1020 ȃ ل. اO] آ.B
C- Urinary sodium < 10 .10 ȃ ل.دم اi %J آ.C
D- Urea over cratinine ratio < 20 .20 ȃ زv. اJ&آ/O. اO.4 .D
E- Urinary sodium (mosm/kg H2O) >500 DC( أmOsm/ Kg H2O) OJ. اOJ,وN ا.E
.500
Les critères biologiques suivantes sont retrouvées
au cours d’une insuffisance rénale aigue
fonctionnelle sauf :
A- Fraction d’excrétion du sodium < 1.
B- Densité urinaire > 1020.
C- Concentration urinaire en sodium < 10
mmol/l.
D- Ratio urée / créatinine plasmatique < 20.
E- Osmolalité urinaire ( mOsm/ Kg H20) >
500
101. A 55 year old patient is suffering from diabetes for .JQ&, b& ي, داء6S ، 55 / B
the last 2 years.He has uncontrolled hypertension.In اb> حQ* أن.:.& JL :;< عT") ار
this patient ,you would suggest : :/ا
A- Calcium antagonists .مJ4ات آi .A
B- Angiotensin converting enzyme inhibition .O.C*& اJ4&JlNة اJX ت2.] .B
C- Diuretics . "رات.C
D- Vasodilators .OJت أوS, .D
E- Beta blockers .QJ# ت. .E
65 A
102. A patient is having recurrent renal colics.His renal ا["ى:J2P .رQ يC آE; 6S / B
ecchography and a regular XRay do not reveal any .OCت آJ[ أيn K OدS اOJ&J4 اOSjNوا
renal calculi.He is known to have very poorly )JC 2J4 O&, 15 b& ي, وف أن ") داءS ه
controlled diabetes for the last 15 year.His renal : u ي هC إن ;[) ا. "اJ, #
colics are due to : .OSj OTJTj تJ[ .A
A- Radiolucent calculi .6JC P& .B
B- Papillary necrosis .دF اOJC واOF>ب اQ ا.C
C- Acute pyelonephritis .رQ "اد4 ا.D
D- Recurrent obstruction .gF@ اJ .E
E- Ureteral stenosis
66 A
105. The two factors that should let us fear a rupture of ق أم ا"م% فP &CSl اS اJ&| ه&ك اA
an aortic aneurysm is : :O>#Nا
A- Abdominal pain + Aneurysm diameter . أم ا"م25 + 6&2# 3 أ.A
B- Increase aneurysm diameter + angor .&قX + أم ا"م25 ازدد.B
C- Blue toe +Iliac thrombosis .6T5 ]P + أزرق-.i إ.C
D- Abdominal pain + peripheral emboli .62JF ا[م+ 6&2# 3 أ.D
E- Ureteral compression + recurrent emboli .رQ ا[م+ 6. :;< .E
107. which of the following lesions are not seen in :ب؟. اg 6 " هK OJQت اt أي اC
acnea: . زؤان.A
A- comedon .O\2 .B
B- Papules .OC[ .C
C- Vesicule .]ة# .D
D- Pustule ."ةJ* .E
E- Nodule
67 A
108. The manifestations of secondary syphilis include : : ا]يaJCJT4 ?ه داء اE
A- Erythematous macules of the trunk .عbl اDC OJ -*# .A
B- Papules at the palms and the feet .J"* اDC" وJ اO راDC \ت2 .B
C- Fever + arthralgias .iT 3 أ+ ارة.C
D- Incomplete alopecia . آJL -Ci .D
E- All the answers are true .OFJFi v أO#N آ ا.E
68 A
110. Concerning snake bites ,which of the following is :
؟JFi 6Q أي ا،J#S]ت اL"C O.4&# C
true : .لT\Nرة &" ا2X 5 أ6 هJ#S]ت اL" .A
A- Snake bites are less serious in children "& رة2X 5 أ6 هJ#S]ت اL" .B
B- Snake bites are less dangerous when face .عblا) وا
and trunk are involved راتj إ6 ه:;ض اTPارة واFع اT ار.C
C- Fever and hypotension are clinical signs and .ةJ2X ة واJ2X O,
factors of poor prognosis OS#Q "& OJ > أهaJ OJS<رات اj{ ا.D
D- Local signs are not important in the follow .DTQ4 ا6 /ا
up of inpatients .34C 644F T Ol ات.F ا.E
E- Petechias are due to allergic reaction to the
venin
69 A
112. A 22-year-old man is brought by his family to the ارئ2 ا345 D) إQCA ) أ، 22 رD
Emergency room for severe headache and fever of و،O, 12 b& ع ارةT"" وارj "اعi g.4#
12 hours duration for which he took eryhtromycin. 6 ك#) ا{رJC "ا# .J4وQأ ذ &ول إر
He started to be confused over the last 2 hours and 6 ."يC
T\ >رG m وJQJ< اJQ4ا
a rash is noted. On physical examination the rash - @L ن أC#
T2> اG ي4 اEFTا
appears dark red with petechias all over his body. : 6S /ا اb ه.)4 ءF أA, 6 ات.
This patient has: . دةO >زOJ O.A ذ.A
A- Acute systemic lupus erythematosis .يJF اد اDC a4F .B
B- Allergic reaction to the antibiotic .OJTJ D .C
C- Typhoid fever . دF, >بQ ا.D
D- Acute meningitis ."ةA"ر زاP O .E
E- Narcotic overdose
70 A
114. What is the MOST common long-term sequela of F, >بQK Jj ]آN اN اOC\ J#*S ا6 هC
bacterial meningitis in a child? :ل؟T\N &" ا6|
A. Seizure disorder .OJi ب.A
B. Intellectual disability .O O5 إ.B
C. Hearing loss .-4 *"ان ا.C
D. Hemiparesis .6*j ل%X .D
E. None of the Above .OFJFi JL v أO#N آ ا.E
71 A
116. 3. Which statement regarding genetic disorders of OJ| اراOJ#v*Q,Kت ا#ا2<Kن اw# OJQرات ا.S أي اA
metabolism is NOT true? :؟w2X
A. In severe disorders, the affected infant may be ا[بT2 ا،ت ا""ة#ا2<K ا6 .A
sick at birth .دةKر &" اQ "5
B. Most genetic metabolic diseases are treatable OJ| اراOJ#v*Q,Kاض اK ا3?S .B
C. The majority of genetic metabolic disease have .>QlS
autosomal recessive inheritance 3>" OJ| اراOJ#v*Q,Kاض اN اOJ.CL أ.C
.6F&Q 6|"ي ورا4 6;.i
D. Early diagnosis is crucial to good prognosis for
EJPQ أ ا3> . اEJPQ ا.D
most disorders
.ت#ا2<K ا3?S "Jlا
Quelle proposition concernant les troubles
génétiques du métabolisme n'est PAS vraie?
A. Dans les formes sévères, le nourrisson atteint
peut être malade à la naissance
B. La plupart de ces maladies sont traitables
C. La majorité des maladies métaboliques
génétiques ont une transmission autosomique
récessive
D. Un diagnostic précoce de la plupart de ces
troubles est crucial pour un bon pronostic
117. 4. The diagnosis of cystic fibrosis is usually :؟64J اnJCQ اEJP آ" دة6Q أي اA
confirmed by the finding which of the following? .قSر" اCع آT ار.A
A. Elevated sweat chloride .قSر" اCض آTP ا.B
B. Decreased sweat chloride .[ر" اCع آT ار.C
C. Elevated serum chloride .[ر" اCض آTP ا.D
D. Decreased serum chloride .OFJFi JL v أO#N آ ا.E
E. None of the Above
72 A
119. Which statement about rhinovirus is false? :؟w2X OJTNوس اJT O.4&# OJQرات ا.S أي اC
A. Rhinovirus is the most common cause of the Jj ]آN اg.4 ه اOJTNوس اJ .A
common cold .آم%C
B. Antibiotic treatment is not routinely indicated )J ر إK يJFد ا# OlS ا.B
for upper respiratory tract infections .JCS اOJ4T&Qق ا2ت ا#i{ "JC*
C. Over-the-counter remedies are safe and effective O&x 6 هOJ.\ OTi دون وOدوw# OlS ا.C
for treatment of rhinovirus in infants .لT\N &" اOJTNوس اJ جvS
D. Human rhinovirus infection may be life أنO. اOJTNوس اJT# O#i{ ا.D
)" / "& ةJFC ن >"دة
threatening in an immunocompromised person
.OJ& ت#ا2<ا
E. Rhinovirus are the major infectious trigger for
OJ4JAت ا#i{ ه اOJTNوس اJ .E
asthma in school-aged children .ل ا"ارسT\ &" أ#C ة%TFا
73 A
121. The initial treatment of choice for a symptomatic - O#F[ ") أاض/ جv 6 ولNر اJP اC
patient with isolated pulmonic stenosis is: :ول ه%S يA@ ررJ
A. Closed surgical blade valvotomy .@C; ا6اl ا[م ا-# .A
B. Open surgical valvotomy .حQT ا6اl ا[م ا-# .B
C. Balloon catheter valvuloplasty .ة245 ن.# راب ا[م.C
D. Blalock-Taussig shunt .s&J,-كv# OCF .D
E. Valve replacement .مi "ال.Q, ا.E
74 A
123. A 3-month-old infant has had upper respiratory OS# b& OC OJ4T& أاض6S >j أ3 T\ A
symptoms for a few days and presents to the ،OJ4T& O*A< O 6 ارئ وه2 ا345 Dأم وأ إ
emergency department with respiratory distress, .ت.J[*>ب اQ# >[JP 3 "* .Ol4 أآE* و،%أز
wheezing, and hypoxia. You diagnose :؟Jj ]آN اg.4ه ا
bronchiolitis. What is the most common cause? .ويvP ا64T&Qوس اJ .A
A. Respiratory syncytial virus .ا%CT{ة اJ? وسJ .B
B. Parainfluenza virus .OC\S اvPوس اJ .C
C. Cytomegalovirus .ا%CT{وس اJ .D
D. Influenza virus .OA>ب اQK 6Qوس اJ .E
E. Human metapneumovirus
75 A
125. You see a baby of 15 months for a seizure. He had aJ .OJi ت#&# >ا [بj 15 T\ S أنD
no personal or family history of seizure. The )w# )" *" أدت وا.OJi OJCA أوOJ[Pj ةJ, )"
mother tells you he was febrile since the morning. ) "ث.ةwl O#& "ث ا.ح.[ اb& ع ارةTر# gJiأ
The crisis came suddenly. He first extended all 4 )"أت أ\ا# 3| و6 |ا-. OS#رN\ا) اw# "دKأو
members for a few seconds and then presented ي4 اEFT اJ. .@A5 د5 D إ4 ةQT از%QهK#
. دD& D2,>ب أذن وQ ود اITQ واآ.م°39.5 ارة
members shaking for 4 to 5 minutes. Clinical
.JSJ.\ آن6.[S اEFTا
examination found a temperature to 39.5 ° C. You :؟OF اb> EJPQ ه ا
find a right acute otitis media. The neurological .F, >بQ ا.A
examination was normal. .عi .B
What diagnosis do you mentioned? .qJ.X 6T\ ع ارةT ار.C
A. Meningitis. .Oت ورvQX ا.D
B. Epilepsy .6AF, 6L>ب دQ ا.E
C. Malignant hyperthermia infant
D. Febrile convulsion
E. Meningo-encephalitis
76 A
127. A 4-year-old boy squeals and cries but uses no ) إن >را.3CQ دون أنgFQ& و6. &ات, 4 6.i B
words. His gross and fine motor skills are well Kء وJjN# ;& ه."J # رة2Q OJ4l واOJآFا
developed. He is preoccupied with objects and does "و. ات وi 6SJ.\ # gJlQ4 .لT\N ا- gSC
not play with other children. The child responds : هFJ ]آN اEJPQ ا.i ودون ا3Q> JL
normally to sounds but appears disinterested and .%JآQ اE* وOآFاب ط ا2< ا.A
detached. The most likely diagnosis is: .اب "ي2< ا.B
A. Attention-deficit/hyperactivity disorder .-, *"ان.C
B. Autistic disorder .6.[ 64& اب2< ا.D
C. Hearing loss .6C* nCP .E
D. Neurodegenerative disorder
E. Mental retardation
77 A
129. All of the following statements concerning the "& T ات اOزvQ O|دF O.4&# OJQرات ا.S آ اD
incidence of the sudden infant death syndrome : "ا،OFJFi لT\Nا
(SIDS) are correct, except: S ا6 O#iآ] إN ا6 هO|دF اb ه.A
A. The incidence of SIDS is the highest at the age .>j أ5-4 J#
of 4-5 months ت ذويvAS &" اJj ] أآ6 ه.B
B. It is more frequent in families with poor social .ةJ*T اOJJSت اKFا
conditions *ءjN اJ# |آ] "وN ا6 هO|دF اb ه.C
.ا اضb هF<
C. The incidence is higher among siblings of SIDS
.&ت.آ] &" اN ا6 هO|دF اb ه.D
victims
D. The incidence is higher among girls
78 A
131. In hemophilia A, which one of the following JL هOJQ اO.Pص اFT أي ا،A JCJJ> ا6 D
laboratory exam is abnormal? :؟6SJ.\
A. Bleeding time .ف%& ز ا.A
B. Platelet count .تFJT["اد اS .B
C. PT (Prothrombin Time) .J.وو. ز ا.C
D. PTT (Partial Thromboplastin Time) .6A%l اJQ,v#.وQ ز ا.D
E. Fibrinogen .JTJC " ا.E
79 A
134. Diagnostic criteria established for the diagnosis of ]آN ارة "وم6 ه6آ, ض آواOJ[JPQ اJS اC
Kawasaki Disease are fever lasting longer than 5 : "اOJ4JA اO4 ا?ه ا6Q أم وا5
days and the following main clinical features @&S ا6
J*Q JL دOJT "* 3P .A
except: .3, ١.5 . أآOJT *"ة25 -
A. Acute nonpurulent cervical lymphadenopathy .Oن او4 .B
with lymph node diameter greater than 1.5 cm .
J*Q OFQC >بQ ا.C
B. Strawberry Tongue .لjN"د اSQ
T\ .D
C. Purulent Conjonctivitis .OJ2JF\اف اN ا6 اتJ; .E
D. Polymorphous Rash
E. Changes in the peripheral extremities
80 A
136. A newborn infant presents with cyanosis and mild aT ع4ق و5 ازر6S دة وهK اq" T\ أB
tachypnea at about 6 hours of life. The infant is 6 -J< ا-< و.دةKت ا, 6 6" اS# nJTX
placed in 100% oxyhood (100% oxygen) and ه6Q أي ا.ع.j{ ا-J.2 و%100 Jl4 أوآOS&*
saturations normalize. Which of the following is :؟T2ا اb> FJ ]آN اEJPQا
the most likely diagnosis in this infant? .655 ازر6*CX gC5 ض.A
A. Cyanotic Congenital Heart Disease .يA ض ر.B
B. Lung Disease .ي% اآ6.[S>ز اl ا6 ض.C
C. Central Nervous System Disease .واح ا["رQ, ا.D
D. Pneumothorax . ا"مJ#CLJ>Q .E
E. Methemoglobinemia
81 A
139. An 8 yr. old female child following Upper OJ4T&Qق ا2ن اQ# >Q#i" إS# ،&ات, 8 هD] أC
Respiratory Tract Iinfection developed DC Q& وT اDC 6\2 6S*#
T\ >" w OCSا
maculopapular rash on the jaw spreading onto the "* 3P وn, "ون# q]م اJ ا6 Djv يbع واblا
trunk which cleared on the 3rd day without : هEJPQ ا.ذنN اnCX OJT
desquamation and tender post auricular and .6آ, داء آوا.A
lymphadenopathy. The diagnosis is .OJ O#i إ.B
A. Kawasaki disease .اءJF ا.C
B. Erythema infectiosum .O.[F ا.D
C. Rubella .OFJFi JL v أO#N آ ا.E
D. Measles
E. None of the Above
82 A
141. A 7-year-old presents to the ER after three days of أمO|v| "S# ارئ2 ا345 D أ إ،&ات, 7 T\ A
worsening, unsteady gait. Among the following, the >? ا،6Q < ا.OWJ, O ذاتOQ#| JL OJ
finding most typical of Guillain-Barré syndrome is: :ر) ه#-نvJL OزvQ 62&ا
A. Absent deep tendon reflexes. .O*JS اOت ا4S&ب اJL .A
B. Urticaria .ىj .B
C. Proximal weakness. .O.*ت اvS وه ا.C
D. Ptosis. .6" .D
E. None of the above .OFJFi JL v أO#N آ ا.E
83 A
143. A 85-year-old man is being evaluated for gait 6 O#Si g.4# )JJ* يl 85 ر E
difficulties. On examination, it is found that joint @JS اaF*"ام اQ,ب اJL J. ،EFT &" ا.)QJ
proprioception is absent in his toes. People with نS bص اPjN ا.)J"5 6 6C[Tا
impaired position sense will usually fall if they
"& <ن أرS* ف, )Qس ا4 إ6 nS<
stand with their feet together and do which of the
following ? وأيg& D إ.& 3>J"5 QC# ف5 اOوF
A- Flex the neck :)؟# مJ*وض اT ه ا6Qا
B- Extend their arms in front of them .O.5 ا6&| -A
C- Flex the knees .مN اD إJراb " ا-B
D- Turn the head .JQ. اآ6&| -C
E- Close their eyes . "و اأس-D
.3>&Jق أvL إ-E
Un homme de 85 ans est évalué pour des difficultés
de marche. A l'examen, on constate que la
proprioception des articulations est absente dans
ses orteils. Les personnes ayant un mauvais sens de
position tombent généralement si elles se tiennent
debout avec les pieds joints et font laquelle des
propositions suivantes?
A- Plier le cou
B- Étendre les bras devant eux
C- Fléchir les genoux
D- Tourner la tête
E- Fermer les yeux
144. A 22-year-old woman reports a scotoma OQ 6S >w# "JT 22 اأة ه C
progressing across her left visual field over the 30 "ىDC 4N[ي ا.> اl . "رجQ
course of 30 minutes, followed by left hemicranial ،نJ]L ،4N اnF*@ اj 6 /# 3> أJC ،O*J5د
throbbing pain, nausea, and photophobia. Her
>" >"ه وواX *" أدت أن أ.ورهب اء
brother and mother have similar headaches. Which
of the following is present in this patient’s b هO 6 ه د6Q أي ا.| "اعi
condition but not in common migraine ? :؟6T[& ا["اع ا6 SAj aJ وOا
A. Photophobia . رهب اء-A
B. Familial pattern .6CAS ا:& ا-B
C. Visual aura .O[ر# أورة إ-C
D. Hemicranial pain .nF*@ اj 6 3 أ-D
E. Nausea
.نJ]L -E
Une femme de 22 ans rapporte un scotome
progressant dans son champ visuel gauche sur une
période de 30 minutes, suivi d'une douleur
lancinante hémicrânienne gauche, de nausées et
d'une photophobie. Son frère et sa mère ont des
maux de tête similaires. Lequel des éléments
suivants est présent chez ce patient mais pas dans la
migraine courante?
A. Photophobie
B. Predisposition familiale
C. Aura visuelle
D. Douleur hémicrânienne
E. Nausées
84 A
145. A 32-year-old woman is being evaluated for "أ# "* .["اعC JJ* أت32 اأة ه A
headaches. They started about 6 months ago and و"وم،ع.,N# ات-# "ثF> وj أ6 b&
occur a few times per week, lasting until she falls ء%l ا6 % وآI#| 3N ا. ا&م6 أن ;قDإ
asleep. The pain is constant and focused at the front
O5v ) aJ 3N ا. اأس6TCP وا6Nا
and back of the head. The pain is unrelated to
position and tends to be worse later in the day. 6A< ه&ك رهب.مJأ أ|&ء ا, J وl{#
There is mild photophobia. Which of the following :ر
؟N ا6 هOJQ أي ا?ه ا.nJTX
findings is most likely ? مv وإO.5 اOق آ2 6 JW< - ا-A
A. Slightly reduced neck range of motion and .@&SC ورl
paracervical tenderness .تJC O وذ-B
B. Papilledema .6SJ.\ JL "غC 64J\&; اJ ا-C
C. Abnormal brain MRI
JL "غC ريF ا6*.2[ اQ ا-D
D. Abnormal brain CT
E. Abnormal EEG .6SJ.\
.6SJ.\ JL 6A#> ا["ى ا:J2P -E
Une femme de 32 ans est évaluée pour des maux de
tête. Ils ont commencé il y a environ 6 mois et se
produisent quelques fois par semaine, jusqu'à ce
qu'elle s'endorme. La douleur est constante et
concentrée à l'avant et à l'arrière de la tête. La
douleur n'est pas liée à la position et tend à être pire
plus tard dans la journée. Il y a une légère
photophobie. Lequel des résultats suivants est le
plus probable?
A. Amplitude du cou légèrement réduite et
sensibilité paracervicale
B. Œdème papillaire
C. IRM cérébrale anormale
D. Tomodensitométrie cérébral anormal
E. EEG anormal
146. A 39-year-old man was treated 1 year ago for a اجCX O&, b& u 39 ر C
brain abscess. He has largely recovered, but still )" و&) زال،J. آ# 6Tj "* .6Lد
has occasional word-finding difficulties. Which of ه6Q أي ا.Jت أC*ء اQ ا6 O#Si
the following is the most common symptom in
ن#[ اD< &" اJj ]آNض اSا
patients with brain abscess ?
A- Nausea and vomiting :؟6Lاج دP#
B- Ataxia .ءJ5ن وإJ]L -A
C- Headache .
ر-B
D- Neck stiffness ."اعi -C
E- Seizures .O.5 رgC[ -D
.OJi ت# -E
Un homme de 39 ans a été traité il y a 1 an pour un
abcès cérébral. Il s’est largement rétabli, mais a
toujours des difficultés occasionnelles à trouver ses
mots. Lequel des symptômes suivants est le plus
fréquent chez les patients présentant un abcès
cérébral?
A- Nausées et vomissements
B- Ataxie
C- Maux de tête
D- Rigidité du cou
E- Convulsions
85 A
147. A 37-year-old man presents with visual تT وه37 ر D
impairement. Examination reveals a bitemporal J* اD صFT>ت اG أ.O اؤ6
hemianopsia. Which of the following tumors is FJ ]آN ه اOJQورام اN أي ا.JJL"[ا
most likely responsible for this finding ?
: ا?هة؟b هKو4 أن ن
A. Optic glioma
B. Occipital astrocytoma .[ي# 6*# ورم د-A
C. Brainstem hemorrhage .6اb5 6l ورم-B
D. Pituitary adenoma .ع ا"غb 6 n% -C
E. Sphenoid wing meningioma .OP&"ة اL 6 ورم-D
. ا"ي3?S &ح ا6 6AF, ورم-E
Un homme de 37 ans se présente avec des troubles
visuels. L'examen révèle une hémianopsie
bitemporale. Laquelle des tumeurs suivantes est
probablement responsable de cette observation?
A. Gliome optique
B. Astrocytome occipital
C. Hémorragie du tronc cérébral
D. Adénome hypophysaire
E. Méningiome de l'aile sphénoïde
148. A 72-year-old woman has a head CT performed 6*.\ [ > أي72 اأة ه A
because of headaches. It is significant for a left 6 OCQ >رG ه&ك. ا["اعg.4# أسC ريF
hemisphere mass with an overlying hyperostosis of DC 6 ه.OllC 3?S طT# ة2; 4Nا@ ا
the skull. She most likely has which of the
:؟6Q أي ا6S
رNا
following ?
A. Meningioma .6AF, ورم-A
B. Pituitary adenoma .OP&"ة اL 6 ورم-B
C. Astrocytoma .6l ورم-C
D. Schwannoma .6Tj ورم-D
E. Hemangioblastoma .6A و6 ورم أرو-E
86 A
149. A 15-year-old boy has multiple angiomatoses of the 6 "دSQ 6Aرم و# [ب15 DQ C
retina and cysts of the kidney and pancreas. Which أي.&س. واOJC ا6 ت4J وآOJ.ا
of the following brain tumors is most likely to w& أنFJ ]آN ا6 هOJQ اOJL"ورام اNا
develop in this child ?
:؟DQTا اb&" ه
A. Glioblastoma multiforme
B. Meningioma .لjN"د اSQ 6*# د6 ورم أرو-A
C. Hemangioblastoma .6AF, ورم-B
D. Ependymoma .6A و6 ورم أرو-C
E. Pinealoma .6.[ 62# ورم-D
.O#&[ ورم ا;"ة ا-E
Un garçon de 15 ans a de multiples angiomatoses
de la rétine et des kystes du rein et du pancréas.
Laquelle des tumeurs cérébrales suivantes est la
plus susceptible de se développer chez cet enfant?
A. Glioblastome multiforme
B. Méningiome
C. Hémangioblastome
D. Ependymome
E. Pinéalome
150. A 30 y male operated for appendicitis one month >j b& OJ اOJC ) I أO&, 30 / D
ago presents for abdominal pain and bloating. All OPT و3 وه أ،O"ة دودA>ب زاQ اg.4#
of the following would make you suspect ،"اد4{# CSl ف, 6C آ.2. ا6
occlusion, except : :"ا
a. Severity of the pain .3N"ة اj .A
b. Eructation .lQ ا.B
c. Absence of gaz emission .ق ا;زاتv2ب اJL .C
d. Petechia ..F ا.D
e. Similar transient episodes during this .>ا اbل هvX ة# O># ب.E
month
87 A
151. You are asked to see a 65 year old unconscious 6 6C "5 O&, 65 / O&S & gC\ "* C
patient in the emergency room. He was brought in .فS,رة إJ4# DTQ4 اD أ إ.ارئ2 اOL
by ambulance. He looks pale and his peripheries أنEFT اJ. .O.\ردة ور# ) وأ\ا.j "و.
are cold and clammy. On examination his pulse ع.j{ وا45/70 ا"م:;< ، د/ ن60 /.&"ل اS
rate is 60 bpm, BP 70/45 and saturations are 96% ي% ار"ي اآ:; ا.JlJ4 أوآQJ 4 DC %96
on 4 L of oxygen. His Central Venous Pressure : هFJ ]آN اEJPQ إن ا.(H2O 3, 14) -T
(CVP) is raised (14 cm of H2O.) The most likely .OJQ{ اO"[ ا.A
diagnosis is .JA اآ6\S .B
a) Septic shock .6.C5 w& ذاتO"i .C
b) Cocaine abuse .OJ5w O"i .D
c) Cardiogenic shock . ا"م3l E* Ol O"i .E
d) Anaphylactic shock
e) Hypovolemic shock
88 A
152. A 20 year old man who was involved in a road )JC ] "5 و،J, دثF ضS O&, 20 رC
traffic collision is found to be in respiratory &ع5 ) -<) وو.J.& 3 "* .OJ4T& O*A< O 6 وه
distress. He is intubated and is bag valve masked. ج *ة أQF )" أPQ اgJ.\ ك.X أ.O>Qا
The anaesthetist tells you that he has to use a lot of 6 - أن ه&ك ا-4Q &" اJ. ./ اO>
force to ventilate the patient. On auscultation there O.[* ا. ا["ر4N اgl اDل ا>اء إXد
is reduced air entry on the left hand side of the ه6Q أي ا.N اgl اF OF& OJAا>ا
chest. The trachea is deviated to the right hand side. :؟/ا اb> OAv ]آN اJ#"Qا
Which one of the .["رC OJ&J4 اOSjN ا.A
following is the most appropriate management .OJA ا>اO.[*C OJS2* رةi .B
option for this patient? .ر4J اDC ةJ. آOJ&5 "امPQ,# :; اnJTP .C
a) A chest X-Ray .JJ اDC ةJ. آOJ&5 "امPQ,# :; اnJTP .D
b) A CT thorax .["رC n[ إاء.E
c) Decompression using a large bore
cannula on the left
d) Decompression using a large bore
cannula on the right
e) Insert a chest drain
89 A
153. A 73 year old man is admitted with severe 6S وهDTQ4ى اN إX أدO&, 73 رB
abdominal pain. His abdomen is soft with )J, Q .3S مv إ- J )&2# .""j 6&2# 3أ
generalised tenderness. His past medical history OرT5ت إ#ري وT5 إgC5 ضOJ< اOJ<ا
includes ischemic heart disease and transient )iF .)اj - g,&Q K )< إن أا.ة#
ischemic attacks. His symptoms are out of ،113 CRP ،21.5 ءJ. آت ا"م ا:6 هO"ا
proportion to his signs. His blood tests are: ،187 J& ا،13 O. ا،13.5 J#CLJ>ا
WBC 21.5, CRP 113, Hb 13.5, Urea 13, Creatinine .5.1 مJ,. ا،139 ا[دم
187, Na 139, K 5.1. ،98 PO2 ،7.32 PH :6Q ه آ6ز ا"م اL
His arterial blood gas is as follows: PH 7.32, PO2 EJPQ إن ا.14.1 HCO3 ،15.9 BE ،3.1 PCO2
98, PCO2 3.1, BE -15.9, HCO3 14.1. The diagnosis : هQFا
is probably: .6#v*Q, اF .A
a) Metabolic acidosis .64T& /S - 6#v*Q, اF .B
b) Metabolic acidosis with respiratory .64T& F .C
compensation .6#v*Q, ا/S - 64T& F .D
c) Respiratory acidosis ."راتP 6\S .E
d) Respiratory acidosis with metabolic
compensation
e) Drug abuse
90 A
154. A 48-year old obese lady presents to the ER with 3 أ6S 6 وهO&, 48 هO&"# "ةJ, تA
severe colicky RUQ pain associated with nausea نJ]L - @اQ Nي اCS ا-# ا6 E;# )J.j
and 2 episodes of vomiting. On examination there "م ود * دم أوEFT &" اJ. .J*Q اJQ#و
is no anaemia or jaundice. She has a temperature of مv إ6S 6 ه.OW°38 > ارO در.ن5
38C. She has rebound tenderness and guarding in يCS ا-# ا6 2.ت "ار اv 6 u& و-را
the RUQ. WBC – 13.1, CRP 20 and liver function صF و20 CRP ،13.1 ءJ. آت ا"م ا.Nا
tests are normal. What is the most likely diagnosis? .OJSJ.\ ". اOTJGو
a) Acute cholecystitis :؟FJ ]آN اEJPQ ه ا
b) Cholelithiasis .>ب ارة دQ ا.A
c) Biliary colic .OاوTi تJ[ .B
d) Cholangitis .اويTi E; .C
e) Diverticulitis .OاوT[>ب ا*&ة اQ ا.D
.u>ب اQ ا.E
Une dame de 48 ans obèse se présente aux urgences
avec de graves douleurs au QSD à type de
coliques associées à des nausées et 2 épisodes de
vomissements. À l'examen, il n'y a pas d'anémie ou
d’ictere. Elle a une température de 38C. Elle
presente une douleur à la decompression
abdominale et une defense dans le QSD. WBC -
13.1, les tests de CRP 20 et la fonction hépatique
sont normaux. Quel est le diagnostic le plus
probable?
A.Cholécystite aiguë
B. Cholélithiase
C. Colique biliaire
D. Cholangitis
E. Diverticulite
91 A
155. A 69 year old lady who is on Ibuprofen and Jو#.# جvS -P O&, 69 "ة هJ, C
dexamethasone for rheumatoid arthritis presented "* .يJ| رiT >بQ# >Q#i إg.4# زونQJ4ودآ
to the E R with sudden onset severe epigastric pain 3N T "ء# g.4# ارئ2 ا345 Dت إ
and vomiting. On examination her abdomen was &J &> آن2# أنEFT اJ. .J*"" وj 6,j
soft with mild tenderness in the epigastrium and 3 .Nي اCS ا-#ف ا, ا6 :J4# مv إ-
RUQ. There was no guarding or rigidity. Bowel آن ه&ك.O#vi أو2.ت اv 6 تl& "
sounds were decreased. What is the single most OJآ] أهNي اFQ ه ا.ءS{ات اi أ6 E5&
important investigation you should request for this :؟/ا اb> ).C\ gl يbا
patient? .2.C 64J\&; J ر.A
a) MRI of the abdomen .ءJ."اد آت ا"م اS .B
b) WBC count .O.[Q& ["رC OJ&J, OSj أ.C
c) Erect Chest X-Ray .2.C OJS2* رةi .D
d) CT scan of the abdomen 6W J?& / يC 6 ه6CX داJ?& .E
e) Upper GI endoscopy / OGD . ي6&|"ي اS
(OesophagoGastroDuodenoscopy)
92 A
157. A 22 year old unmarried man complains of OS# b& OX دوO&, 22 ر زبD
dizziness for several weeks with nausea and EFT اJ. .ن و"م ازنJ]L - O*اQ -J#,أ
imbalance. A neurological examination reveals a ) >را.هتl{ ا-J 6 ود رأرأة6.[Sا
nystagmus in all directions. Motor skills and – O) ا4S& وأ،OJSJ.\ ),4 وإOJآFا
sensitivity are normal, as are osteo-tendinous :;< - O"C ;ت.[ مS اEFT> اG أ.OJ?Sا
reflexes. The general examination reveals ه.OW O در37 ارةO ودر،7/12 6j
pigmented skin lesions along with a blood pressure :؟EJPQ# "ء.C اQ5إ
of 12/7, a temperature of 37 degrees Celsius. What .6S, :J2P .A
do you suggest for attaining a diagnosis? .O.5C OSjرة أi .B
a) Audiogram .6&25 ل%# .C
b) cervical Radiology ."غC 64J\&; J ر.D
c) Spinal Tap .OllC OSjرة أi .E
d) MRI
e) Radiology of the skull
93 A
158. A 56-year-old woman with no particular history ت،"دةF OJ.\ ةJ, دون،O&, 56 "ة هJ, B
presents a recent abdominal bloating. The ق ا[تT# "آwQ ا3 .]" 6&2# خTQ ا6وه
ultrasound confirmed the presence of ascites and a - 3,15 N ا/J. اDC O4J*ء وآ4Q, ود ا
right ovarian cyst of 15 cm with thick wall and with D إ2 OJCXت دا4J "دةSQ I# ا- "ارOآ,
multiple intra-cystic vegetations of 2 to 3 cm يb\ن ا4 ه ا،O ر اbX أ|&ء أ.3,3
.During history taking, what type of cancer would :>؟QCA ر6 )& qF.Q,
you search in her family history (one answer) .3 اO2# ا["ر و.A
A. Breast and endometrial ./J. ا["ر وا.B
B. Breast and Ovarian .3 اO2# و/J. ا.C
C. Ovarian and endometrial ./J. واO] ا.D
D. Bladder and ovary .3 اO2# وO] ا.E
E. Bladder and endometrial
94 A
160. A 1 month old infant presented, at rest, an ،ق هم5 ازرO &" اا6S "> واj T\ C
important cyanosis, which increased when he cried :O4 ا?ه ا.(""j ق5ء )ازر." &" ا% يbوا
(severe cyanosis). Physical findings: No dyspnea or DC
أ.[ OPT& ا،aT رع4 أوaT @J< "م ود
tachypnea, murmur loudest at the upper left sternal 6S[ اQ ا.4Nي اCS اE* اO "&
border. Chest Radiogram: decreased pulmonary .OA اOJAرات اj{ ا6 E5& :["رC
vascular markings. : هFJ ]آN اEJPQإن ا
The most likely diagnosis is: .>ي#N@ ا[م اJ .A
A. Aortic valve stenosis .u4&Q اE5 4N اgC* اOزvQ .B
B. Hypoplastic left heart syndrome . OJ# ر.C
C. Tetralogy of Fallot ""j عT ار- 6&J2. ا%F ا6 J. آgJ .D
D. Large ventricular septal defect with severe .يA ا:; ا6
pulmonary hypertension
95 A
161. A 64 year old woman with known type 2 diabetes عT ار،2: ي, داء6S O&, 64 "ة هJ, B
mellitus, hypertension and chronic atrial 6 ت وه،% 6&ن أذT ور:;<
fibrillation presents for anorexia, nausea and ت2.] ،J4{# uSQ .ءJ5ن واJ]L ،OJ>j *"ان
vomiting. She has been treated with insulin, ACE >w# أدت.] يP ودO.C*& اJ4&Jlة أJX
inhibitors and oral anticoagulant. She reports ا"م, ط. هg.4# اX J4{ ت اICC5
decreasing her insulin doses lately because of :;< 6 ط. هg.4# :;C /P ا"واء اIT5وأو
hypoglycemia and has stopped her HCT و12.8 HB :ص ا"مF >تG أ.ا"م
antihypertensive medication because of low blood : هFJ ]آN اEJPQ ا.5=K و132=Na،%40
pressure. Her blood tests show :Hb of 12.8 and . دOJ.C5 OC ءQ ا.A
HCT of 40% ; Na= 132 and K= 5. The MOST .O? ا;"ة ا6 [ر د5 .B
LIKELY diagnosis is : . دةOA رO وذ.C
A. Acute myocardial infarction . د6L د6A وn% .D
B. Acute adrenal failure .6 هn% .E
C. Acute pulmonary edema
D. Acute cerebrovascular bleed
E. Gastrointestinal bleed
96 A
162. A 25-year-old male patient, smoker, presents with "ريi 3 أ،X" ،O&, 25 / رC
chest pain of 3-hours duration, relieved ة2P ا.&ء مF{ &" ا4FQ ،ت, 3 b& Q4
by leaning forward. The next step in management :6 هOlS ا6 OJQا
is:
A. Administer NSAID’s and send home O"JAوJQ, JL >بQء دات ا2إ .A
B. Request ventilation perfusion scans .ل%& اD) إ,وإر
C. Request echocardiography .OJF& اO>Q اqF. اgC\ .B
D. Administer sublingual nitroglycerin and .gC*"ى اi :J2P gC\ .C
reassure patient Ow\ن و4C اIF J4JCLوQ ء2إ .D
E. Advise psychiatric evaluation ./ا
.64T 3JJ* gC\ .E
Un homme âgé de 25 ans fumeur, se présente pour
une douleur thoracique qui dure depuis 3 heures,
soulagée par la position penchée en avant. La
prochaine étape dans la conduite à tenir est :
A. Administrer des antiinflamatoires non
stéroîdiens et renvoyer le patient
B. Demander une scintigraphie ventilation
perfusion
C. Demander une échographie cardiaque
D. Administrer de la nitroglycémie sublinguale et
rassurer le patient
E. Conseiller une evaluation psychiatrique
163. A 75-year-old woman presents to the emergency 6ارئ وه2 ا345 D ت إO&, 75 "ة هJ, B
room with abrupt onset of left-sided weakness that gl ا6 nS# T "ء# O, b& 6S
began 1 hour ago. Assuming all imaging tests are ةQ 6 هOJSر اi ا-J اض أنQ ا- .4Nا
immediately available and there are no [Q@ اAا2 ب.2Q, ه&ك دات اaJرا و
contraindications to the following imaging O# O"ا. ا6 ااؤgl يb اEFT ه ا،OJQا
modalities, which test should initially be :؟OJ&J اوO4 اOا
performed in routine clinical care? .O.5 اأس واOJوN 6S2* [ .A
A. CT angiogram of the head and neck .OSj"ون أ# أسC 6S2* [ .B
B. CT scan of the head without contrast ."غC 64J\&; J ر.C
C. Magnetic resonance image (MRI) of the 64J\&; Jأس ورC 64J\&; J ر.D
brain .O.5 اأس واOJوN
D. MRI of the brain and magnetic resonance .OSj أ- أسC 6S2* [ .E
angiogram (MRA) of the head and neck
E. CT scan of the head with contrast
97 A
164. A 20-year-old sportsman presents with pain and 6 ورم3 أO&, 20 6< ر رA
swelling of he knee following a rotational trauma in ة# gSC اOl O"ارQ, اOF< 6 O.اآ
football. X-Rays are normal. The most probable FJ ]آN اEJPQ ا.OJC, OJSا[ر ا.ا*"م
diagnosis would be :ه
A. A tear of the medial meniscus .OJ4{ اOv> ا6 ق% .A
B. A tear of the lateral meniscus .OJ اOv> ا6 ق% .B
C. A tear of the anterior cruciate ligament .6N ا6.[Qط ا# ا6 ق% .C
D. A tear of the posterior cruciate ligament .6TCP ا6.[Qط ا# ا6 ق% .D
98 A
166. One of the more common pathogens responsible of رع% OJQ اOAت اQKول ا4 اض اS إن اE
pulmonary infections in immunocompromised : ه6&ز اS اD< "& ءNا
patients following transplantation is: .Oو. اO&*دS ارات ا.A
A. Staphylococcus epidermidis .OJ%&ت اJ"Q4 ا.B
B. Haemophilus influenzae .OJ*Jjت اJ]2 ا.C
C. Clostridium Botulinum .OA اO"*S ارات ا.D
D. Streptococcus Pneumoniae .OJ& ارOA اO4JQ ا.E
E. Pneumocystis Carinii
99 A
168. A 52-year-old woman attends the general qJ OS اOF[ اgJ.\ "& تO&, 52 إأة هA
practitioner saying that she last had a period many آ"ةwQ JL 6 ه.>j "ة أb& I آO>j دةXx أدت أن
months ago. She is not sure if she has undergone . أاض6S K >N q2ع ا2*ة اQT# ICX> دw#
the menopause as she has no symptoms. A serum EJPQ ا6 "4 ي أنb ا6C[ اEFTه ا
test of which of the following could aid a clinical :؟q2ع ا2*K ي4ا
diagnosis of menopause ? (FSH).glC ).& ا>ن ا.A
(HCG).ي. اOJ هن ا.B
A- Follicle-stimulating hormone (FSH)
.C ا>ن ا.C
B- Human chorionic gonadotrophin (HCG)
.JوQ, إ.D
C- Luteinizing hormone
.ونJQ4و# .E
D- Oestrogen
E- Progesterone
Une femme de 52ans se présente chez le médecin
généraliste en disant qu'elle avait eu une
menstruation il y a plusieurs mois. Comme elle n'a
pas de symptômes, elle ne sait pas si elle a eu la
ménopause. Un test sérique qui pourrait aider au
diagnostic clinique de la ménopause?
A-Hormone stimulante folliculaire (FSH)
B- La gonadotrophine chorionique humaine (HCG)
C-Hormone lutéinisante
D- Oestrogène
E- Progesterone
169. An 18-year-old man is brought to the emergency حg.4# ارئ2 اOL D أ إ، 18 بj A
department with a stab wound just to the right of -C اJ# O4 ا6 E* اJ DC O&S\ u
the sternum in the sixth intercostal space. His blood OQX gC5 اتi أI? .@.A ز3C 80 ا"م:;< .دس4ا
pressure is 80 mm Hg. Faint heart sounds and D&J اO>l ا6 -4Q اJ. . O5&Q ت.و
pulsus paradoxus are noted. Auscultation of the أن نgl 6Q أي ا.aT&ت اi 6 E5& ا["ر
: ؟/ا اb> 6A". ا6vS اJ#"Qه ا
right chest reveals decreased breath sounds. The
. Nف ا["ر اl nj ر.A
initial management of this patient should be which
. * دم.B
of the following?
.["رC ريF 6*.\ [ .C
a- Aspiration of the right chest cavity
. ا["ر-# .D
b- Transfusion
. ا["رJ?& .E
c- CT scan of the thorax
d- Thoracotomy
e- Thoracoscopy
Un jeune de 18 ans est amené aux urgences avec un
coup de couteau juste à droite du sternum dans le
sixième espace intercostal. Sa tension artérielle est
de 80 mm de Hg. Les bruits cardiaques sont
inaudibles et un pouls paradoxal sont notés.
L’auscultation pulmonaire révèle une diminution
du murmure vésiculaire du coté droit. La prise en
charge initiale de ce patient doit être:
a- Aspiration de la cavité pleurale
droite
b- Transfusion
c- Tomodensitométrie du thorax
d- Thoracotomie
e- Thoracoscopie
100 A
170. A 65 year old man presents with dysphagia. He has >j b& mK "* . -C# 4 6S 65 رE
noticed a 2 month history of indigestion and post >j b& و، آN" اS# ءvQ{# س4 وإ6 ه4S# )Q#iإ
prandial fullness and a one month history of nausea :؟Nج اvS ه ا.زنC ن و*"انJ]L "وثmv "أ#
and weight loss. What is the best management: .2.C ق ا[ت.A
a- Abdominal ultrasound .رم# OSC# .B
b- Barium swallow . وا["ر2.C ريF 6*.\ [ .C
c- CT abdomen and thorax 6CX داJ?& .D
d- Endoscopy O%X و6CX داJ?& .E
e- Endoscopy and biopsy
Un homme de 65 ans se présente avec une
dysphagie. Il signale une histoire de 2 mois
d'indigestion et de plénitude postprandiale, une
histoire d’un mois de nausée et de perte de poids.
Quelle est la meilleure conduite:
a- Echographie abdominale
b- Repas baryté
c- CT scan abdominal et thoracique
d- Endoscopie
e- Endoscopie et biopsie
171. Which of the following findings of chest x-ray is ] أآ6 هOJ&J4 ا["ر اOSjN OJQأي ا?ه ا A
most consistent with the diagnosis of chronic :؟%ي اA"اد ا4{ داء اEJP - *#2
obstructive pulmonary disease (COPD)? .OJ.J[5 Oآ, ،خTQ ط ا.A
A. Hyperinflation, bronchial thickening .J*& ا:JF 6 OTXت رj ر.B
B. Perihilar fluffy infiltrates . ب6J آ:X، 6.& ب.[ ا.C
C. Pleural effusion, Kerley B lines .ةQ& O"* OQ .D
D. Diffuse nodular opacities .OJCT, OJل زvG .E
E. Ground glass shadowing
102 A
175. A 78 y.o. male presents with a hand tremor at rest, ،ن4" &" اJ ا6 O ر78 رD
shuffling gait, and difficulty getting started O#vi >? ) آ أ.6# "ء. ا6 O#Si و،OC5]Q OJ
walking. He also exhibits rigidity with passive ،EJPQآ" اwQC .OCS\اف اN ا6 OCST& O آ-
motion of his upper extremities. To confirm the :؟gC2 ف,
diagnosis, you would do: .62JF اg[SC O%X .A
A. Peripheral nerve biopsy .6.[S اJiQ اO, درا.B
B. Nerve conduction study .EEG .C
C. EEG .صFT" ا% "م إاء.D
D. No further testing .6TAG و64J\&; اJ# [ .E
E. Functional MRI
103 A
177. A 32 y.o. woman is brought to the ER having "J" أS# ارئ2 ا345 Dت إC أ32 اأة اE
reportedly taken a large dose of heroin. She is >" ،gJlQ4 K 6 ه.JAوJ>ة اJ. آO > &و
unresponsive, has small pupils and has a respiratory gl 6Q أي ا.O*J5 د/ aT 6 aT&Q اO, وO5" @J
rate of 6 breaths/min. Which of the following :ؤ؟2ا
should be administered? .J# أو.A
A. Atropine .لQ إ.B
B. Ethanol .J&زC .C
C. Flumazenil .JWQ4J, JQ,أ- ن.D
D. N-acetylcysteine .ن4 آ.E
E. Naloxone
104 A
179. A 48 year old man presents with epigastric pain. It "أ# "* .6,j 3 وه أ48 رC
began suddenly, and reached a constant ache which *" أد.>? اF nQC I#| 3 أD إi وDQ ،ةwl
radiates through to the back. He reports nausea, OF# ) أ) آنQCA *" أدت.>ل, وإJ5 ،نJ]L "وث
vomiting and has diarrhoea. His family noted he "& .I>Q" ا5 OF اb أن هJ. و، أم3 b& ن5
was jaundice 3 days ago, but this appears to have .6,j 3 وأ،ت,S ا،ارةF# عT آن ") ارEFTا
: ر
هN اEJPQ ا.## O"5 OJ< ةJ, )"
resolved. On examination he is pyrexial, is
. دO"ة دودA>ب زاQ ا.A
guarding, and has epigastric tenderness. He has a
.>ب ارة دQ ا.B
past medical history of Asthma. What is the most
.&س د# >بQ ا.C
probable diagnosis
.u>ب اQ ا.D
a- Acute appendicitis
.gC* اOC ءQ ا.E
b- Acute cholecystitis
c- Acute pancreatitis
d- Diverticulitis
e- Myocardial infarction
105 A
180. A 25-year-old male presents to the clinic for ةJ, )" .3*S ا3JJ*Q دةJS اD إ25 رC
evaluation of infertility. He has a life-long history "& .رةQ اOAت اQ{ واuQ&ل اS4 اOC\ ةJ
of a productive cough and recurrent pulmonary ،>ل, إ،6&2# 3 أ- O&% آDر إj أا<) أOSا
infections. On his review of symptoms he has .ي, داء6S ه أ. ازنg4 آ6 O#Siو
indicated chronic problems with abdominal pain, EJPQ ه ا.ت.[5 -, حQ* OJS"ر اi رةi
:؟FJ ]آNا
diarrhea, and difficulty gaining weight. He also has
.% يA"اد ر4 ا.A
diabetes mellitus. His chest x-ray suggests
.يC 64T& ن >زQ ا.B
bronchiectasis. Which is the most likely diagnosis?
.64J آnJC .C
a. COPD
.6CXي داA رn% .D
b. Upper respiratory infections
.# ر.E
c. Cystic fibrosis
d. Intrapulmonary hemorrhage
e. Asthma
106 A