1- A 78-year-old man comes to the physician because of swelling of both ankles for

4 days. He has been taking indomethacin for low back pain for 2 weeks with
partial relief of symptoms Examination confirms the pedal edema but is otherwise
unremarkable; the bladder is not distended. His serum urea nitrogen (BUN) level
is 56 mg/dL, and creatinine level is 2.9 mg/dL; these values were previously within
normal limits. Which of the following is the most appropriate next step?
*a. Discontinuation of indomethacin
b. Prescription for a thiazide diuretic
c. Evaluation for multiple myeloma
d. Measurement of urine sodium and creatinine levels
e. Renal ultrasonography
2- A 50-year-old man with hypertension is brought to the emergency
department 30 minutes after the sudden onset of severe chest pain that
radiates to his back and arms. His blood pressure is 180/80 mm Hg in his left
arm; no pressure reading can be obtained from the right arm. Cardiac
examination shows a murmur of aortic insufficiency. Which of the following
is the most likely diagnosis?
*a. Acute aortic dissection
b. Acute myocardial infarction
c. Embolus to the right subclavian artery
d. Pulmonary embolism
e. Spontaneous pneumothorax
3- The anti-tuberculous drug that is safe in liver disease is:
a. INH
b. Rifampicin
*c. Ethambutol
d. Pyrazinamide
e. Refinah
4- One of the following is not a cause of tender hepatomegaly:
a. Viral hepatitis
*b. Typhoid fever
c. Right heart failure
d. Liver abscess
e. hepatoma
5- Anaemia of advanced renal insufficiency is best treated by:
a. blood transfusions
*b. recombinant human erythropoietin
c. pareteral iron therapy
d. folic acid
e. Parenteral B12 therapy
6- Normal sized to enlarged kidneys in a patient with chronic renal failure is
indicative of:
a. Benign nephrosclerosis
b. Chronic glomerulonephritis
c. Chronic interstitial nephritis
*d. Primary amyloidsis
e. Renal tuberculosis
7- The most common cause of Spontanous sub-arachnoid haemorrhage is:
a. rupture of an arterio-venous malformation
*b. saccular aneurysm
c. Extension form intra-cerebral haemorrhage
d. Head injury
e. Berry aneurysm
8- All the following drugs are used for treatment of ascariasis except:
a. Pyrantel Pamoate,
b. Piperazine,
c. Albendazole,
*d. DEC
e. Prazequantel
9- Bleeding time is NOT usually prolonged in:
*a. Haemophilia
b. secondary thrombocytopenia
c. scurvy
d. Von willebrand';s disease
e. ITP
10- Propranolol is indicated in the following conditions EXCEPT:
*a. Intermittent claudication
b. Portal hypertension
c. Migraine
d. Benign essential tremors
e. Hypertension
11- A 50-year-old man with hypertension is brought to the emergency
department 30 minutes after the sudden onset of severe chest pain that
radiates to his back and arms. His blood pressure is180/80 mm Hg in his left
arm; no pressure reading can be obtained from the right arm. Cardiac
examination shows a murmur of aortic insufficiency. Which of the following
is the most likely diagnosis?
*a. Acute aortic dissection
b. Acute myocardial infarction
c. Embolus to the right subclavian artery
 d. Pulmonary embolism
e. Spontaneous pneumothorax
12- A 26 year old man complains of abdominal distension . swelling of the
legs and easy fatigability . His blood pressure is 90/70 mm Hg and pulse
becomes difficult to feel on inspiration. He has oedema, ascites and tender
hepatomegaly. Precordium is quite with loud and somewhat early apical
third heart sound. The probable diagnosis is:
a. Cor Pulmonale
b. Tricuspid stenosis
*c. Constrictive pericarditis
d. Pulmonary stenosis
e. Mitral stenosis
13- One of the following markers indicates active multiplication of hepatitis
B virus:
a. HbsAg
b. HbcAg
*c. HbeAg
d. Anti Hbs
e. HbcAb
14- Infectious stage of plasmdium is:
a. Trophozoite
b. Cryptozoite
*c. Sporozoite
d. Merozoite
e. Gametocyte
15- Early onset rheumatoid arthritis with positive rheumatoid factor is more
likely to have:
a. Self limiting disease
*b. more persistent disease activity
c. less systemic involvement
d. distal inter-phalangeal involvement
e. less hand deformities
16- The earliest sensation to be list in leprosy is:
*a. Touch
b. Temperature
c. Pain
d. Vibration
e. Joint position
17- A previously healthy 30-year-old man has had fever, night sweats,
pruritus, and an enlarging lump above his left clavicle for 3 weeks.
Examination shows a 3-cm, nontender, rubbery, supraclavicular lymph
node. An x-ray film of the chest shows mediastinal lymphadenopathy.
What is the most likely diagnosis?
a. Chronic lymphocytic leukemia
b. Drug reaction
*c. Hodgkin’s disease
d. Infectious mononucleosis
e. Metastatic carcinoma
18- Anxiety neurosis is characterized by all the following EXCEPT:
*a. suicidal intent
b. panic attacks
c. multiple somatic complaints
d. over-concern
e. sleep disturbances
19- A 35 Y old male patient with pulmonary tuberculosis was discharged
from hospital on antituberculous drugs to be followed as outpatient. Three
weeks later he presented to the PHCC with nausea, vomiting and poor
appetite. On examination, he had a tinge of jaundice. The most appropriate
next step to take would be:
a. Give antiemetics and vitamins and advise him to continue
antituberculous medications.
b. Refer him to the hospital for ultrasound abdomen
*c. Immediately ask him to stop his medications and report to the
hospital.
d. Order antacid and soft diet and see him in one week.
e. Request hepatitis A virus antibodies
20. A 55 year-old lady comes to you with dry cough and shortness of breath
of 3 months. She was treated elsewhere with 2 courses of antibiotics and
syrups but did not improve. A quick physical examination at your PHCC
did not reveal anything positive. Your recommendations at this point
should be:
a. Give her another course of antibiotics.
*b. Refer her to hospital for chest x-ray
c. Prescribe salbutamol inhaler
d. Request sputum culture
e. Request ECG.
21. A 60 year-old lady was diagnosed to have pulmonary embolism and
discharged from hospital on warfarin. She came to the emergency
department 2 weeks later complaining of tarry stools of 4 days and
weakness. On examination she looked pale and had BP 90/60 mm Hg Plan
of action at this point would be to;
*a. Admit to hospital, stop warfarin and request INR
b. Give her IM vitamin K and send her home.
c. Give her iron tablets and let her continue- half the dose
of warfarin she was taking.
d. Admit her for urgent endoscopy.
e. Admit to hospital and give whole blood
22. In the first week of Typhoid fever ;
*a. Blood cultures are positive
b. Stool culture are diagnostic
c. Widal test is strongly reaactive
d. spleen is 6 cm palpable
e. The fever pattern is typically intermittent
23. Radical cure of Relapsing ovale malaria is achieved by:
a. Chloroquine phosohate.
b. Quinine
c. Fansidar (Sulphadoxine + Pyrimethanhine).
*d. Primaquine
e. Artemether
24. the most serious complications of Diabetes in the eye is:
a. Background retinopathy.
b. Maculopathy.
*c. Proliferative retinopathy.
d. Cataract.
e. Rubeosis iridis.
25. In Brucellosis all the following are true except
a. splenomegally usually indicates a chronic brucellosis
b. the gold standard investigation is blood culture
c. neuro-brucellosis may presents like multiple sclerosis
*d. spinal tenderness is uncommon
e. usually it is clinically difficult to differentiate a new infection from a
relapsing one in a patient who was treated in the past
26. Which of the following statements is true regarding Malaria?
a. the thin blood film is mainly used for rapid diagnosis
b. the thick blood film is used to identify the type of parasite
*c. mefloquin is contraindicated in epilepsy and lactation
d. severe infections should be treated with intravenous fansidar
e. steroids are useful in treating cerebral malaria in falciparum
infections
27. In Yellow fever
a. the transmission is from cows through mosquitoes
b. a long incubation period of 3-6 months
c. there is marked neutrophil leukocytosis
*d. there is poor response to lamivudine
e. the usual presentation is with fever followed by acute respiratory
distress syndrome
28. Atenolol:
a. Does not need dose modification in renal impairment
*b. reduces recurrence of events in ischemic heart disease
c. Non-cardioselective
d. safely used in cardiac failure
e. does not adversely affect lipid levels
29. A diabetic patient complained of fullness and epigastric discomfort
following meals. He has no heartburn or nocturnal pain. He was
diagnosed as having gastroparesis. Choose the most appropriate drug to
treat his symptoms.
a. A proton pump inhibitor
b. Anticholinergic agent
c. Antacids
d. H2 blocker
*e. A prokinetic drug
30. Which of the following antibiotics has negligible anti-helicobacter
pylori action?
*a. Penicillin V
b. Amoxycillin
c. Tetracycline
d. Clarithromycin
e. Metronidazole
31. A 32 year old obese lady had gestational diabetes during her last
pregnancy treated wit insulin. Two months after delivery her fasting blood
sugar was 10.5 mmol/L and HbA1c 9.3%. The best treatment for her
besides diet is:
a. glibenclamide
b. acarbose
*c. metformin
d. rosiglitazone
e. insulin
32. A 22 year old lady is admitted with fever and joint pains. Which one of
the following suggests an alternative diagnosis to rheumatic fever?
 *a. symmetrical joint arthropathy
b. raised ESR
c. erythema nodosum
d. recent group A beta haemolytic streptococcal infection
e. mid-diastolic apical murmur
33. The commonest cause of bronchiectesis in our adult population is:
a. Uncontrolled asthma
*b. Pneumoconiosis
c. immotile Cilia syndrome
d. Reccurent pneumonia
e. Tuberculosis
34. In a patient presenting with flaccid weakness and areflexia the
following features suggest the diagnosis of acute spinal cord lesion except
a. sensory level
b. sphincter involvement at presentation.
*c. abnormal gag reflex.
d. Lhermittes sign.
e. dissociated sensory loss.
35. One year after having a prosthetic heart valve a patient develops
infective endocarditis. What is the most likely causative organism?
*a. Streptococcus viridans
b. Staphylococcus aureus
c. Staphylococcus epidermidis
d. Coxiella burnetii
e. Brucella species
36. The following drug combinations are safe except:
a. mercaptopurine and allopurinol
b. rosiglutazone and metformin
c. methotrexate and folic acid
*d. sulphinpyrazone and aspirin
e. sulphadoxine and pyremethamine
37. In bronchial asthma
*a. the atopic type is commoner in young patients
b. inhaled corticosteroids significantly cause osteoporosis.
c. antibiotics prophylaxis should be given to prevent acute severe attacks
d. oxygen should be given in low concentrations.
e. the use of angiotensin converting enzyme inhibitors is contraindicated.
38. All the following are recognized features of iron deficiency anemia
except:
a. spooning of the nails
 *b. geographical tongue
c. microcytosis
d. dysphagia
e. high total iron binding capacity
39. The pathjogenesis of which one of the following infections does NOT
occur through an exotoxin?
a. Staphylococcus aureus
b. Escherichia coli
c. Clostridium botulinum
*d. Streptococcus pyogenes
e. Clostridium welchi
40- Prolonged allopurinal thearpy in a patient wiht gout is NOT indicated
for:
*a.Acute gouty arthritis
b. Tophi
c. Urate nephropathy
d. Evidence of bone/joint damage
e. Long term treatment of gout
41. In acute diarrhoea of infancy
*a. Rota virus is the causative pathogen in the majority of patients
b. Antibiotics are the first line of management
c. Hypertonic dehydration is a usual complication
d. ORT is not effective if the child is moderately dehydrated
e. Resting the bowel by stopping breast milk for 24 hours is
beneficial
42. Congenital hypertrophic Pyloric Stenosis
a. is more common in females
b. is usually associated with other GIT anomalies
c. classically presents in the first week of life
*d. leads to hypochloremic alkalosis
e. is best diagnosed by endoscopy
43. In a child with stridor the following supports a diagnosis of acute
Epiglotitis
*a. Drooling of saliva
b. Frequent brassy cough
c. Temperature of 38 C0
d. History of URT infection
e. Generalized lymphadenopathy
44. The initial drug of choice for treatment of acute bacterial meningitis in
children is
 a. Amoxicillin.
b. Gentamycin.
*c. Ceftriaxone.
d. Chloramphenicol.
e. Crystalline penicillin
45. The following hormone affects intra-uterine fetal growth
a. Fetal growth hormone
b. Maternal growth hormone
c. Fetal thyroxine
*d. Fetal insulin
e. Maternal thyroxine
46. The following is true regarding pediatric HIV infection
a. The risk of vertical transmission from infected mother to fetus is 10%
*b. ELISA & western blot tests are unreliable before 18 month of age
c. Most of HIV positive infants remain asymptomatic during childhood
d. Kaposi sarcoma is the commonest cause of death in children with
AIDS
e. The risk of transmission from mother to fetus is greatest during the 1st
trimester
47. Poor outcome in meningococcal meningitis is suggested by presence of
a. High grade fever
b. Positive Kerning sign
c. Altered sensorium
*d. Purpuric rash over extremities
e. High protein level in CSF
48. Physiologic jaundice in newborns is best characterized by:
a. Onset of clinical jaundice by 12 hours of age
b. Persistence of clinical jaundice for more than one week
c. Equal evaluation of direct and indirect serum bilirubin values
d. A drop in serum bilirubin level after discontinuation of breast-feeding
*e. A rise of serum bilirubin level of less than 5 mg/dl/day
49. The paralysis caused by polio virus infection
a. is symmetrical in distribution
b. is permanent
*c. is not associated with sensory involvement
d. Can’t occur in vaccinated children
e. usually affects the upper limbs more severely than the lower limbs
50. Appropriate developmental milestone is
a. Transferring object from one hand to another at 6 months
*b. Index finger approach at 10 months
 c. Walking like a bear at 12 months
d. Climbs on furniture at 18 months
e. Knows own gender at 2 years
51. Starting infants on solid feeds
a. should occur early if there is breast milk insufficiency
b. ideally should begin after the eruption of the first teeth
c. will improve the symptoms of infantile colic
*d. is important for the prevention of iron deficiency anemia
e. should be avoided in children with cleft palate
52. Initial management of a child with severe febrile neutropenia would be:
a. Close observation pending results of septic screening
b. Infusion of granulocyte stimulation factor
c. Bone marrow transplantation
d. Immunoglobins infusion
*e. Intravenous broad spectrum antibiotic
53. In comparison to normal human milk, cow’s milk contains more
a. Fat
b. Protein
*c. Calcium
d. Lactose
e. Vitamin A
54. A newborn is noted to have polycythemia (PCV 75%) at birth, the best
approach is to
a. increase the total fluids to 190cc/kg/day
*b. do partial exchange transfusion
c. request head ultrasound
d. ask for CT scan of the abdomen
e. repeat the test after 4 hours
55. A 4-year-old girl presents with a painful, honey-coloured, crusted lesion
on her face. The most likely diagnosis is
a. Chicken pox
b. cellulitis
*c. impetigo
d. Eczema
e. Staph aureus abcess
56. An important cause of death due to bronchial asthma is
a. Severe metabolic acidosis
b. Superadded infections
c. Use of high doses of salbutamol
d. Use of high dose of corticosteroids
 *e. Not recognising severity of the attack
57. Regarding pubertal development in girls
a. The first sign of puberty is the appearance of pubic hair
b. Breasts continue to grow to full adult size after menarche
c. The average age of Menarche in Sudan is 15 years
*d. The increment in height during pubertal growth spurt is
>20 cm
e. Puberty is described as precocious if it occurs at the age of
9 years
58. The following is true in management of diabetic ketoacidosis
*a. Insulin therapy is started 30-60 minutes after fluid therapy
b. Isotonic saline (0.9% NaCl) should not be used for children less <5
yrs
c. Potassium should not be given if serum potassium is 4.5 mmol/l
d. A blood PH of 7.25 is indication for use of sodium bicarbonate
e. Oral feeds are not allowed in the 24 hours after admission
59. Gastro-oesophageal reflux is
a. benign and self-limiting condition
b. a common cause of projectile vomiting
c. more common in patients with duodenal ulcer
d. best diagnosed by barium x-ray films
*e. usefully treated by thickening of feeds
60. The following may trigger hemolysis in children with G6PD deficiency
a. High altitude
b. Eating foods that contain artificial colours
*c. Applying Henna to the feet
d. Eating lentil (adas)
e. Treatment with amoxicillin
61. A child presents to hospital 30 minutes after ingestion of kerosene.
The best initial step of management is to
a. give syrup of ipecac to induce vomiting
b. do gastric lavage with wide bore NG tube
c. check serum hydrocarbon concentration
*d. do chest x-ray film/
e. give intravenous hydrocortisone
62. Which of the following is NOT a major criterion for diagnosis of
Rheumatic fever?
*a. Fever
b. Carditis
c. Chorea
 d. subcutaneous nodules
e. Erythema marginatum
63. On day 6 of life a baby is noticed to be oozing blood from the umbilicus.
This
a. is unimportant and mother can be reassured.
b. is evidence of severe infection.
*c. indicates the need to measure blood clotting.
d. is a sign of portal vein obstruction
e. indicates the need to check the reticulocyte count
64. The deficiency of which of the following vitamins causes peripheral
neuropathy?
a. Ascorbic Acid
b. Biotin
*c. Thiamine
d. Retinol
e. Folic acid
65. A newborn girl was found to have blood stained vaginal discharge. This
is most likely due to
a. vaginal infection
b. vesico-vaginal fistula
c. forceps delivery
*d. maternal hormones
e. urinary tract infection
66. The following is a characteristic sign of extra-pyramidal tract lesions
a. Aphasia
b. Ptosis
c. Ataxia
*d. Cogwheel rigidity
e. Absence of abdominal reflex
67. The best advice you can give to mothers to increase their milk supply is
to
a. drink more than 2 litres of milk/day
*b. increase the baby's frequency of feeding
c. eat more carbohydrates
d. rest herself by giving the baby a supplement
e. take medicine to increase her milk production
68. A recognised side effect of salbutamol treatment is
a. hypoglycaemia
b. hypocalcaemia
c. Hyponatremia
 *d. hypokalaemia
e. liver dysfunction
69. Which condition is inherited as an autosomal dominant trait?
a. haemophilia A
b. cystic fibrosis
c. phenylketonuria
*d. achondroplasia
e. albinism
70. The following is a pathognomonic sign of measles
a. maculopapular rash
b. cervical lymphadenopathy
c. conjunctivitis
*d. koplik spots
e. strawberry tongue
71. The x-ray finding that is characteristic of Necrotizing Enterocolitis is:
a. Double bubble appearance
b. Dilated loops of bowel
c. Pneumoconiosis
d. Presence of fluid levels
*e. Pneumotosis intestinalis
72. The Following is a complication of lipoid nephrotic syndrome in children
a. Congestive heart failure
b. Hypertensive encephalopathy
c. Frank haematuria
*d. Hypovolaemia
e. Renal tubular acidosis
73. The following is a normal finding in infants (no intervention needed)
a. Paralytic squint
b. Umblical hernia
*c. Mongolian spots
d. Ecchymotic patches
e. Undescended testicles
74. The 50th percentile of the standard growth chart is
a. The arithmetic mean (average)
b. The most commonly occurring value (Mode)
*c. The median
d. The geometric mean
e. The value 50% of children at that age will have
75. Wide fixed splitting of the second heart sound occurs with:
*a. Atrial septal defect
 b. Aortic stenosis
c. Pulmonary hypertension
d. Aortic incompetence
e. Right bundle branch block
76. The following indicates poor prognosis in children with ALL
a. Thrombocytopenia
b. Anemia
c. ESR of 100 mm/1st hour
d. WBCC of 50x109/Litre
*e. Paratracheal shadows on CXR
77. Which one of the following is a recognised feature of Henoch-Schonlein
purpura?
a. Strawberry tongue
*b. Rash over the buttocks
c. Thrombocytopenia
d. Cervical lymphadenopathy
e. Conjunctivitis.
78. Pneumatoceles on chest x-ray film is characteristic of:
*a. Staphylococci pneumonia
b. Mycoplasma pneumonia
c. Chicken pox pneumonia
d. Measles giant cell pneumonia
e. Pulmonary Tuberculosis
79. A 4.5 kg baby was noted to have decreased tone and power of right
upper limb. There was a history of shoulder dystocia. The most likely
diagnosis is
*a. Erb’s palsy.
b. Fractured clavicle.
c. Dislocation of right shoulder.
d. Myopathy of right upper limb.
e. Osteomyelitis of right humerous.
80. A mother is worried about the frequency of stools in her 2 weeks old
baby. Stools are yellowish, semi solid and 8-10 times per day. Baby is
exclusively breast fed. He is active and gaining weight. The most likely
diagnosis is
*a. Normal baby.
b. Breast abscess in the mother.
c. Lactose intolerance.
d. Acute gastroenteritis.
e. Milk protein allergy.