Saudi Licensing Exam--Exam Prep-- Mock Exam 5 with answers

Mock Exam 5

Q1. A man came with bruising and increase time of bleeding with factor 8 deficiency :

a) Haemophilia A

b) Von Willebrand disease

Q2. An old man 65 years with Hemoglobin= 9, you will:

a) Assess Iron levels

b) Assess LDH

c) Arrange for endoscopy

Q3. In aspirin overdose :

a) Liver enzyme will peak within 3-4 hr

b) first signs include peripheral neuropathy and loss of reflexes

c) 150 mg/kg of aspirin will not result in aspirin toxicity

Q4. A man who is having severe vomiting and diarrhea and now de
veloped leg cramps after receiving 3 liters of dextrose, he is having:

a) Hypokalemia

b) hyponatremia

c) hyperkalemia

d) hypernatremia

Q5. Man who received blood transfusion back in 1975 developed jaundice most likely has:

a) Hepatitis A

b) Hepatitis C

c) Hepatitis D

d) Hepatitis E

e) Autoimmune hepatitis

Q6. Best method to prevent plague is:

a) Hand wash

b) Kill rodent

c) spray pesticide

d) give prophylactic AB

Q7. Patient come to ER with constricted pupil and respiratory compromise you will suspect:

a) Opiates “like morphine”

b) Cocaine

c) Ectasy

Q8. Management of somatization

a) Multiple phone call

b) Multiple clinic appointments

c) Refer to pain clinic

d) Antidepressant

Q9. A lot of bacteria produce toxins which are harmful. Which one of the following is useful?

a) Botulism

b) Tetanus

c) Diphtheria

d) Staph aureus

Q10. Organophosphorus poisoning, what is the antidote?

a) Atropine

b) Physostigmine

c) Neostigmine

d) Pilocarpine

e) Endrophonium

Q11. Patient using haloperidol, developed rigidity (dystonia) treatment :

a) …………………………………..

Q12. High risk factor in CLL :

a) Age

b) Smoking

c) History of breast ca

d) History of radiation

Q13. A 60 years old male was refer to you after stabilization, investigation show Hgb 8.5 g/l, hect. 64% , RBC 7.8 , WBC 15.3 & Platelet 570, Diagnosis :

a) Iron deficency Anemia

b) Hemoglobinopathy

c) CLL

d) 2ry polycythemia

Q14. A 24 years old patient. Came for check up after a promiscuous relation 1 month ago, he was clinically unremarkable, VDRL: 1/128, he was allergic to penicillin other line of management is:

a) Ampicillin

b) Amoxicillin

c) Trimethoprim

d) Doxycyclin

Q15. Cellulitis in children most common causes:

a) Group A streptococcus

b) Staphylococcal aureus

Q16. Patient with Hodgkin’s lymphoma and red strunberg cell in pathology and there is eosinophil lymphocyte in blood so pathological classification is:

a) Mixed-cellularity subtype

b) Nodular sclerosis subtype of Hodgkin's lymphoma

Q17. Therapeutic range of INR [In presence of Anticoagulant]

a) 2.5-3.5

b) 2.0-3.0

Q18. Patient had arthritis in two large joints & pansystolic murmur “carditis” Hx of URTI, the most important next step:

a) ESR

b) ASO titre

c) Blood culture

Q19. Patient with gunshot and part of his bowel spillage out and you decide to give him antibiotic for Bacteroid fragilis, so what you will give?

a) Amoxicillin

b) Clindamycin ‘Sure’

c) Erythromycin

d) Doxycycline

e) Gentamicin

Q20. Treatment of peritonitis the organism is Bacteroid fragilis

a) Clindamycin

b) Mitronidazole

c) Carbapenem

Q21. Patient with high output fistula, for which TPN was ordered , after 2 hours of the central venous catheterization, the patient become comatose and unresponsive , what is the most likely cause ?

a) Septic shock

b) Electrolytes imbalance

c) Delayed response of blood mismatch

d) Hypoglycemia

e) Hypernatremia

Q22. What is most sensitive indicator for factitious fever?

a) Pulse rate

Q23. Healthy patient with family history of DM type 2, the most factors that increase chance of DM are:

a) HTN and Obesity

b) Smoking and Obesity

c) Pregnancy and HTN

d) Pregnancy and Smoking

Q24. In diabetic retinopathy, most related factors:

a) HTN and obesity

b) HTN and smoking

c) Smoking and obesity

Q25. Patient with blood group A had blood transfusion group B , the best statement that describe the result is

a) type IV hypersensitivity

b) inflammatory reaction

c) Type II hypersensitivity

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Here are the answers with Explanation 

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Q1. A man came with bruising & increase time of bleeding with factor 8 deficiency :

a) Haemophilia A

b) Von Willebrand disease

· Hemophilia A is clotting factor VIII deficiency & is the most common form, Hemophilia B is factor IX deficiency. It is a Recessive X-linked disorders

Q2. An old man 65 years with Hemoglobin= 9, you will:

a) Assess Iron levels

b) Assess LDH

c) Arrange for endoscopy

· Anemia is a common sign of colon cancer in elderly

Q3. In aspirin overdose :

a) Liver enzyme will peak within 3-4 hr

b) first signs include peripheral neuropathy and loss of reflexes

c) 150 mg/kg of aspirin will not result in aspirin toxicity

· The early signs and symptoms of aspirin overdose include impaired hearing and ringing in the ears. Other early signs of aspirin poisoning include lightheadedness, breathing rapidly, double vision, vomiting, fever and dehydration

· The acutely toxic dose of aspirin is generally considered greater than 150 mg per kg of body mass. Moderate toxicity occurs at doses up to 300 mg/kg, severe toxicity occurs between 300 - 500 mg/kg

Q4. Man who is having severe vomiting and diarrhea and now developed leg cramps after receiving 3 liters of dextrose, he is having:

a) Hypokalemia

b) hyponatremia

c) hyperkalemia

d) hypernatremia

· K+ is secreted in stool, as he is having a diarrhea he will lose a huge amount of K+, also muscle cramp is a symptom of Hypokalemia

Q5. Man who received blood transfusion back in 1975 developed jaundice most likely has:

a) Hepatitis A

b) Hepatitis C

c) Hepatitis D

d) Hepatitis E

e) Autoimmune hepatitis

Q6. Best method to prevent plague is:

a) Hand wash

b) Kill rodent

c) spray pesticide

d) give prophylactic AB

· Plague is a deadly infectious disease that is caused by the enterobacteria Yersinia pestis. carried by rodents mostly rats

Q7. Patient come to ER with constricted pupil and respiratory compromise you will suspect:

a) Opiates “like morphine”

b) Cocaine

c) Ectasy

· Certain drugs cause constriction of the pupils, such as alcohol and opioids

· Other drugs, such as atropine, mescaline, psilocybin mushrooms, cocaine and amphetamines may cause pupil dilation

Q8. Management of somatization

a) Multiple phone call

b) Multiple clinic appointments

c) Refer to pain clinic

d) Antidepressant

· Cognitive Behavioral Therapy is the best established treatment for a variety of somatoform disorders including somatization disorder

Q9. A lot of bacteria produce toxins which are harmful. Which one of the following is useful?

a) Botulism

b) Tetanus

c) Diphtheria

d) Staph aureus

Q10. Organophosphorus poisoning, what is the antidote?

a) Atropine

b) Physostigmine

c) Neostigmine

d) Pilocarpine

e) Endrophonium

Q11. Patient using haloperidol, developed rigidity (dystonia) treatment :

a) Antihistamine and anticholinergic

· Haloperidol is a dopamine antagonist used in psychosis

· Side effects : Extrapyramidal side effects, Dystonia, Tremors, Dry mouth, Depression

Q12. High risk factor in CLL :

a) Age

b) Smoking

c) History of breast ca

d) History of radiation

· Risk factors: 1) Age. Most people diagnosed with chronic lymphocytic leukemia are over 60. 2) Sex. Men are more likely than are women to develop chronic lymphocytic leukemia. 3) Race. Whites are more likely to develop chronic lymphocytic leukemia than are people of other races. 4) Family history of blood and bone marrow cancers. A family history of chronic lymphocytic leukemia or other blood and bone marrow cancers may increase your risk. 5) Exposure to chemicals. Certain herbicides and insecticides

Q13. A 60 years old male was refer to you after stabilization, investigation show Hgb 8.5 g/l, hect. 64% , RBC 7.8 , WBC 15.3 & Platelet 570, Diagnosis :

a) Iron deficency Anemia

b) Hemoglobinopathy

c) CLL

d) 2ry polycythemia

Q14. A 24 years old patient. Came for check up after a promiscuous relation 1 month ago, he was clinically unremarkable, VDRL: 1/128, he was allergic to penicillin other line of management is:

a) Ampicillin

b) Amoxicillin

c) Trimethoprim

d) Doxycyclin

· Venereal Disease Research Laboratory [ VDRL ] test is a serological screening for syphilis that is also used to assess response to therapy, to detect CNS involvement, and as an aid in the diagnosis of congenital syphilis

· The first choice for uncomplicated syphilis is a single dose of intramuscular penicillin G or a single dose of oral azithromycin. Doxycycline and tetracycline are alternative

Q15. Cellulitis in children most common causes:

a) Group A streptococcus

b) Staphylococcal aureus

Ø Staphylococcus aureus is the most common bacteria that cause cellulitis. Ø Group A Streptococcus is the next most common bacteria that cause cellulitis. A form of rather superficial cellulitis caused by strep bacteria is called erysipelas; it is characterized by spreading hot, bright red circumscribed area on the skin with a sharp raised border. The so-called "flesh-eating bacteria" are, in fact, also a strain of strep which can -- in severe cases -- destroy tissue almost as fast as surgeons can cut it out.

Q16. Patient with Hodgkin’s lymphoma and red strunberg cell in pathology and there is eosinophil lymphocyte in blood so pathological classification is:

a) Mixed-cellularity subtype

b) Nodular sclerosis subtype of Hodgkin's lymphoma

· Classical Hodgkin's lymphoma can be subclassified into 4 Pathologic subtypes based upon

Reed-Sternberg cell morphology and the composition of the reactive cell infiltrate seen in the lymph node biopsy specimen “the cell composition around the Reed-Sternberg cells”

Name

Description Nodular sclerosing CHL Is the most common subtype and is composed of large tumor nodules showing scattered lacunar classical RS cells set in a background of reactive lymphocytes, eosinophils and plasma cells with varying degrees of collagen fibrosis/sclerosis.

Mixed-cellularity subtype

Is a common subtype and is composed of numerous classic RS cells admixed with numerous inflammatory cells including lymphocytes, histiocytes, eosinophils, and plasma cells, without sclerosis. This type is most often associated with EBV infection and may be confused with the early, so-called 'cellular' phase of nodular sclerosing CHL Lymphocyte-rich or Lymphocytic predominance Is a rare subtype, show many features which may cause diagnostic confusion with nodular lymphocyte predominant B-cell Non-Hodgkin's Lymphoma (B-NHL). This form also has the most favorable prognosis

Lymphocyte depleted

Is a rare subtype, composed of large numbers of often pleomorphic RS cells with only few reactive lymphocytes which may easily be confused with diffuse large cell lymphoma

Q17. Therapeutic range of INR [In presence of Anticoagulant]

a) 2.5-3.5

b) 2.0-3.0 “But normal range in absence if Anticoagulant is 1.8-1.2”

Q18. Patient had arthritis in two large joints & pansystolic murmur “carditis” Hx of URTI, the most important next step:

a) ESR

b) ASO titre

c) Blood culture

· The diagnosis of Rheumatic fever can be made when two of the major Modified Jones criteria, or one major criterion plus two minor criteria, are present along with evidence of streptococcal infection: elevated or rising Antistreptolysin ‘ASO’ titre or DNAase

Q19. Patient with gunshot and part of his bowel spillage out and you decide to give him antibiotic for Bacteroid fragilis, so what you will give?

a) Amoxicillin

b) Clindamycin ‘Sure’

c) Erythromycin

d) Doxycycline

e) Gentamicin

Q20. Treatment of peritonitis the organism is Bacteroid fragilis

a) Clindamycin

b) Mitronidazole

c) Carbapenem

· B. fragilis is involved in 90% of anaerobic peritoneal infections

· B. fragilis is susceptible to metronidazole, carbapenems, tigecycline, beta-lactam/beta-lactamase inhibitor combinations (e.g., Unasyn, Zosyn), and certain antimicrobials of the cephamycin class, including cefoxitin

· Clindamycin is no longer recommended as the first-line agent for B. fragilis due to emerging high-level resistance

Q21. Patient with high output fistula, for which TPN was ordered , after 2 hours of the central venous catheterization, the patient become comatose and unresponsive , what is the most likely cause ?

a) Septic shock

b) Electrolytes imbalance

c) Delayed response of blood mismatch

d) Hypoglycemia

e) Hypernatremia

· Enterocutaneous fistula is an abnormal communication between the small or large bowel & the skin.

· It is a complication that is usually seen following surgery on the small or large bowel

· Low-output fistula(< 200 mL/day), moderate-output fistula (200-500), high-output fistula ( > 500 mL/day )

Q22. What is most sensitive indicator for factitious fever?

a) Pulse rate

· Factitious fever: Fever produced artificially by a patient. This is done by artificially heating the thermometer or by self-administered pyrogenic substances. An artificial fever may be suspected if the pulse rate is much less than expected for the degree of fever noted. This diagnosis should be considered in all patients in whom there is no other plausible explanation for the fever. Patients who pretend to have fevers may have serious psychiatric problems.

Q23. Healthy patient with family history of DM type 2, the most factors that increase chance of DM are:

a) HTN and Obesity

b) Smoking and Obesity

c) Pregnancy and HTN

d) Pregnancy and Smoking

Q24. In diabetic retinopathy, most related factors:

a) HTN and obesity

b) HTN and smoking

c) Smoking and obesity

· The risk factors that increase diabetic retinopathy background are:

1) HTN

2) Poor glucose control or long case D.M

3) Raised level of fat ( cholesterol)

4) Renal disease

5) Pregnancy (but not in diabetes caused by pregnancy)

Q25. Patient with blood group A had blood transfusion group B , the best statement that describe the result is

a) type IV hypersensitivity

b) inflammatory reaction

c) Type II hypersensitivity