This document appears to be an exam answer sheet for a final exam in internal medicine for dental students. It contains 40 multiple choice questions with answers in parts 1 and 2. Part 1 focuses on cardiovascular, endocrine, and infectious diseases. Part 2 correlates clinical presentations with conditions. Part 3 contains extended matching questions linking clinical scenarios to specific diseases. The document provides high-level information on the content and format of the exam through its organization of medical multiple choice and matching questions across various topic areas in internal medicine.

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Al Azhar University-Gaza
Faculty of Dr. H .Abdulshafi Of Dentistry
Name:………………………… Date : 6 June, 2011
Time : 2 Hours
Student No : ………………...
Final Exam
Internal Medicine (Practical)
Second Semester 10-11
Answer Sheet
Question Answer Question Answer
1 A 21 D
2 E 22 E
3 A 23 E
4 E 24 C
5 C 25 A
6 E 26 C
7 B 27 C
8 C 28 E
9 B 29 E
10 C 30 B
11 E 31 E
12 A 32 E
13 C 33 B
14 A 34 D
15 C 35 A
16 A 36 D
17 B 37 D
18 B 38 A
19 C 39 D
20 A 40 D

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Part I Examination (MCQ’s)
Select the best answer (Only ONE Answer)
(1) All of the followings are symptoms and signs of cardiovascular diseases Except :
A) Hot and pale extremities
B) Chest pain
C) Lower limbs swelling
D) cough
E) Dyspnea
(2) All of the followings are presentation of ischaemic heart disease Except
A) Unstable angina
B) Cardiac arrhythmia
C) Heart failure
D) Sudden death ( cardiac arrest, ventricular fibrillation )
E) Pulmonary embolism
(3) All of the followings are major symptoms and signs of hypertension Except :
A) Severe Headache
B) Blurring of Vision
C) Dizziness/ Sweating
D) Palpitation
E) Chest pain
(4) Clinical picture of hyperthyroidism include all of the followings Except :
A) Nervousness
B) Tremors
C) Excessive sweating
D) Weight loss and increased appetite
E) Cold intolerance
(5) Which one of the followings is the cardinal symptom in cardiology
A) Dyspnea
B) Sputum production and haemoptysis
C) Chest pain
D) Cough
E) Cyanosis
(6) In hypertensive urgency , all of the followings are true Except :
A) Diastolic blood pressure > 120-130
B) Associated with end organ damage
C) Lower down the blood pressure within 24 hours
D) Can be treated with oral drugs
E) Not associated with end organ damage
(7) All of the followings are major Dukes criteria for diagnosing infective endocarditis Except :
A) Positive Blood cultures with appropriate organism
B) Immunologic phenomena ( Oslers nodse, Roth spots )
C) Evidence of Coxiella burnetii infection
D) New Valvular regurgitation
E) Positive Echocardiographic findings

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(8) Rheumatic fever , all of the followings are true Except :
A) Rare below three years age
B) Common age between 5 – 18 years
C) Common in developed countries
D) Common in developing countries
E) Overcrowding and poor hygiene and sanitation
(9) All of the followings are systemic complication of diabetes mellitus Except
A) Retinopathy
B) Arthritis
C) Skin lesions
D) Delayed wound healing
E) Increased susceptibility to infection
(10)Clinical picture of hypothyroidism include all of the followings Except :
A) Hypothermia
B) Bradycardia
C) Diarrhoea
D) Hypoventilation
E) Poor mentation
(11)The major clinical diagnostic criteria for the diagnosis of Behcet’s disease include all of the
followings Except :
A) Recurrent oral ulcerations (aphthae)
B) Recurrent genital ulcerations
C) Ocular lesions (conjunctivitis, reduced visual acuity
D) Skin lesions (papules, pustules,ulcers)
E) It is more common in females
(12)Diabetes Insipidus ,all of the followings are true Except
A) The only cause of diabetes insipidus is posterior pituitary destruction
B) Polyurea
C) Polydepsia
D) Excessive thirst
E) Pale urine in immense amounts (2-24L/day)
(13)All of the following valvular heart disease cause systolic murmur Except
A) Aortic valve stenosis
B) Pulmonary valve stenosis
C) Aortic valve regurgitation
D) Mitral valve regurgitation
E) Pulmonary valve regurgitation
(14)Angina pectoris, which one of the following is false ?
A) Mainly due to decrease coronary blood supply
B) Mainly due to increase myocardium demand for oxygen
C) It is a symptom not a disease
D) Chest pain relieved by rest
E) Chest pain relieved with sub lingular nitrate

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(15)All of the followings are clinical and biochemical features of haemolytic anaemia except :
A) Rapid fall of hemoglobin
B) Splenomegaly
C) Jaundice due to increased direct ( Conjugated ) Bilirubin
D) Pigment Gall stones
E) Leg ulcers
(16)The cardinal manifestation of Gastroesophageal disease ( GERD ) is :
A) Heart burns ( Hyperacidity )
B) Epigastric pain
C) Dysphagia
D) Early Satiety
E) Nausea and vomiting
(17)All of the followings are early signs of syncope except :
A) Pallor
B) Bradycardia
C) Heavy perspiration
D) Blood pressure approximately baseline
E) Nausea
(18)Which one of the following bleeding disorder is inherited?
A) Liver disease
B) Von Willebrands disease
C) Vitamin K deficiency
D) Warfarin overdose
E) DIC(Disseminated Intravascular Coagulation)
(19)Medical & Dental Management of systemic lupus erythematosis , include all
of the followings except :
A) Avoid excessive exposure to sunlight
B) NSAIDS for mild active disease with antimalarial drugs
C) Systemic corticosteroids for mucocutaneos lesions
D) Assess adrenal function for possible suppression
E) Consult with physician regarding systemic manifestation
(20) Sjogren Syndrome , all of the followings are correct except :
A) 10% of the population and in 30-45% of RA patients
B) 9:1 Female :Male preponderance
C) Age of onset 40-60 years
D) Dry mouth, skin, eyes, nose and vagina
E) Tongue becomes fissured and exhibits atrophy of the papillae
(21)All of the followigs are causes of Macrocytic Anaemia ( MCV > 100 ) except :
A) Alcohol abuse
B) Folic acid deficiency
C) Vegetarians
D) Hyperthyroidism
E) Bone marrow infiltration

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(22) Which one of the followings is extra articular manifestation of rheumatoid arthritis
A) Rheumatoid nodule
B) Cardiovascular
C) Pulmonary
D) Hematological
E) All of the above
(23)Which one is correct regarding the cause (causes) of Iron deficiency anaemia.
A) Malabsorption
B) Pregnancy
C) Chronic blood loss
D) Inadequate dietary intake of iron
E) All of the above
(24)Vitamin K and related disorders , all of the followings are correct except
A) Source of vitamin K is vegetables
B) Synthesized by intestinal flora
C) Required for synthesis of coagulation factors ( II , VII , VIII , IX ,X)
D) Antibiotics therapy leads to vitamin K deficiency
E) Vitamin K deficiency treated by Fresh Frozen Plasma
(25)Hepatitis B Vaccine , all of the followings are correct except
A) Effective in preventing hepatitis B ( 50% develop immunity)
B) 3-dose vaccination series (0-1-6 months )
C) May be given to Pregnant woman
D) Test for Antibodies to HBsAg 1 to 2 months after 3-dose vaccination series completed.
E) Re-vaccinate who do not develop adequate antibody response.
(26)Head and Neck Manifestations of scleroderma, include all of the followings except
A) Dysphagia most common initial complaint
B) Tight, thin lips with vertical perioral furrows
C) Trismus secondary to tempromandibular joint pathology , not to tight skin
D) Xerostomia, xerophthalmia,
E) Transition zone around dental roots
(27)Behcet’s Disease , all of the followings are correct except
A) Vasculitis with triad of oral and genital ulcers and uveitis or iritis
B) Aphthous like ulcers, covered in pale pseudomembrane
C) Painless ulcers on lips, gingiva, buccal mucosa, tongue and palate
D) Genital ulcers similar in appearance
E) Heal in days to weeks with scarring
(28)All of the followings are blood borne pathogens except
A) HIV ( Human Immunodeficiency Virus )
B) HBV ( Hepatitis B Virus )
C) HCV ( Hepatitis C Virus )
D) HDV( Hepatitis D Virus )
E) HEV( Hepatitis E Virus )
(29)Liver cirrhosis and natural history of cirrhosis ( Cause of death ) , all of the followings
are correct except
A) Cirrhosis from any cause can lead to hepatocellular carcinoma
B) Complicated by impaired coagulation

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C) Complicated by liver failure
D) Complicated by renal failure
E) Defined by liver fibrosis only
(30)Red flags (serious conditions ) in rheumatology practice include all of the followings except
A) Fractures
B) Day pain
C) Septic arthritis
D) Gout /Psedogout
E) Fever or unexplained weight loss
(31)Dental management of Sjogrens syndrome , include all of the followings except
A) Prevention of caries
B) Enhance salivary output
C) Treatment of oral candidiasis
D) Pain control for enlarged salivary glands
E) All of the above
(32)Diseases transmitted in dental settings by which one of the following :
A) From the patient to the dental worker
B) From the dental worker to the patient
C) From one patient to another
D) From the dental office to the community
E) All of the above
(33)All of the followings are indications for gastroscopy except :
A) Upper Gasrointestinal Bleeding
B) To assess reflux symptoms that respond to medical management
C) Dysphagia
D) Hematemesis
E) Atypical chest pain
(34)All of the followings are symptoms and signs of hyperglycaemia Except
A) Vomiting
B) Hyperventilation
C) Acetone breath
D) Profuse sweating
E) Dry mouth and skin
(35)All of the followings are indication for infective endocaditis prophylaxis Except :
A) Cardiac catheterization and stent insertion
B) Prosthetic cardiac valve
C) Previous infective endocarditis
D) Cardiac transplants with valvulopathy
E) Congenital Heart Disease
(36)All of the followings are symptoms and signs of respiratory diseases Except :
A) Cough
B) Chest pain
C) Clubbing
D) Small volume pulse
E) Bounding pulse

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(37)Definitive diagnosis of acute rheumatic fever need :
A) Two major criteria without evidence of recent streptococcal infection
B) One major criteria plus two minor criteria without evidence of recent streptococcal infection
C) Three minor criteria plus evidence of recent streptococcal infevtion
D) One major criteria and two minor criteria plus evidence of recent streptococcal infection
E) Four major criteria
(38)All of the followings are symptoms and signs of hypoglycaemia Except :
A) Dehydration and dry skin
B) Dilated (reacting) pupils
C) Anxiety, tremor, aggression
D) Confusion
E) Loss of consciousness
(39)Complications of obesity include all of the followings Except :
A) Hypertension
B) Coronary artery disease
C) Cerebrovascular accident
D) Type I diabetes mellitus
E) Hyperlipidaemia
(40)Route of Transmission of HBV include all of the followings except
A) Sexual
B) Perinatal
C) Percutaneous
D) Oral
E) Intra venous drug users ( IVUD )

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Part II Examination
Correlate clinical presentation with the relevant clinical condition
(Choose from available options)
1. Correlate the signswith the relevant endocrine condition ( Acromegaly, DiabetesInsipidus, Hypothyroidism,
Addison’s disease, Cushing’sdisease ,Hyperthyroidism, Diabetesmellitus)
Signs Condition
Buccal/palmar crease hyperpigmentation, postural hypotension Addison’s disease
Moon-shaped’ face, centripetal obesity, proximal myopathy, purple striae,
hypertension, diabetes mellitus
Cushing’s disease
Bradycardia, dry thin hair, goitre, loss of outer third of eyebrow, slowly relaxing
reflexes
Hypothyroidism
Tachycardia, goiter, atrial fibrillation, lid lag Hyperthroidism
2. Correlate the classic presentation with the relevant clinical problem (Abdominal aortic aneurysm, Acute
pancreatitis, Biliary colic ,Ascitis, Ureteric colic ,Acute appendicitis, Ectopic pregnancy)
Classic presentation Problem
Colicky loin pain radiating to groin Ureteric colic
Jaundice and constant right upper quadrant pain Biliary colic
Severe epigastric pain radiating to back associated with vomiting Acute pancreatitis
Periumbilical pain radiating to right iliac fossa Acute appendicitis
Central abdominal pain, expansile, pulsatile mass Abdominal aortic
aneurysm
Part III Examination
(Extended Matching Questions (EMQ’s)
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
Question (I)
A polymyositis
B Behçet’sdisease
C polymyalgia rheumatica
D primary Raynaud’sdisease
E ankylosing spondylitis
F systemic sclerosis
G rheumatoid arthritis
H Sjögren’ssyndrome
(1) A 45-year-old woman complains of cold numb fingers and difficulty in swallowing.On examination she has tight skin,
thickening of the fingers and telangiectasia. F

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(2) A 51-year-old woman complains of weakness in her shoulders and thighs. She has a significantly raised creatine
kinase (CK) level A.
(3) A 25-year-old man has been referred to rheumatology clinic with multiple painful stiff joints and uveitis. He also
complains of ulcers on his penis and mouth. B
(4) A 45-year-old woman presents with dryness in the eyes and mouth. Her Schirmer’s test is positive H.
Question (II)
A autoimmune hepatitis
B hepatitis C
C hepatitisA
D iatrogenic hepatitis
E primary biliary cirrhosis
F hepatocellular carcinoma
G Wilson’sdisease
H haemochromatosis
I Dubin–Johnson syndrome
J haemolytic anaemia
H primary sclerosing cholangitis
(1) A 24 year old presents with nausea, malaise and jaundice. He returned 3 weeks ago from a holiday abroad. On
examination he has a moderate hepatosplenomegaly and tender cervical lymphadenopathy. He has dark urine and
pale stools C.
(2) A 35-year-old woman presents with fever, malaise and jaundice. On examination she has moderate hepatomegaly.
She is anti-smooth muscle antibody and antinuclear antibody positive. A
(3) A 4-year-old patient presents with anaemia and mild jaundice. Hb 7 g/dl, reticulocytes 14 per cent. Electrophoresis
result pending J.
(4) A 45-year-old man with ulcerative colitis presents with jaundice, pruritus and abdominal pain. Alkaline phosphatase
(ALP) is raised and anti-mitochondrial antibodies negative. H
Question (III)
A pulmonary embolus
B pneumothorax
C lobar pneumonia
D atrial fibrillation
E infective endocarditis
F aortic dissection
G cardiac tamponade
H herpeszoster infection
I pericarditis
J angina
(1) A 63-year-old man with a history of high blood pressure presents in A&E with
sudden-onset tearing chest pain radiating to the back. F
(2) A 40-year-old woman develops sudden-onset dyspnoea at rest following hip
replacement surgery. On examination she is tachycardic and her electrocardiogram
(ECG) shows right axis deviation. A
(3) A 60-year-old businessman complains of central crushing chest pain radiating to
both arms after running to catch a bus. Pain was relieved by rest and his ECG
recording 1 h later was unremarkable. J
(4) A 21-year-old high-jumper presents with acute-onset dyspnoea and right-sided
pleuritic chest pain. Examination reveals increased resonance and reduced
expansion on the right side B.

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GoodLuck
Dr.Suhail Kishawi