All questions to be answered: I. Choose the correct answer for the following: (20 marks)

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(1)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 1 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

All questions to be answered:

I.

Choose the correct answer for the following: (20 marks)

1- The abnormal muscle tone in pyramidal tract lesion is typically described as:

a. Clasp Knife b. Cog wheel c. Lead pipe d. Hypotonia

2- Joint swelling may be due to a) hypertrophy of bone

b) inflammation of the synovial lining

c) swelling of the structures surrounding the joint. d) all of the above

3- A lesion of left twelfth cranial nerve produces:

a. Deviation of tongue to the right and expressive aphasia. b. Deviation of uvula to the left and expressive aphasia. c. Deviation of tongue to the left and expressive aphasia. d. None of the above

4- proximal interphalangeal joint hyperextension with concurrent distal Interphalangeal

joint flexion is

a. Swan neck deformity b. Boutonnière deformity c. Dupuytren contracture d. none of the above

(2)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 2 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

5- Cardiovascular causes of cough include : a-Pulmonary congestion due

b-pulmonary embolism

c-Pressure on a bronchus by aortic aneurysm d-All of the above.

6- Systemic disease that can cause severe abdominal pain: a. Diabetic ketoacidosis,..

b. familial meditranian fever, c. sickle cell crisis

d. All of the above

7- The characteristic features of the hands in patients with rheumatoid arthritis include

all of the following except

a) subluxation of the metacarpophalangeal joints b) radial deviation of the wrist joint

c) ulnar deviation of the fingers d) Heberden's nodes

8- Quantitative evaluation of flexion of the lumbar spine is done using

a. Straight leg raising test b. Bowstring test

c. Schober's test d. Heel-knee chin test

(3)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 3 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

9- Patients with barrel shaped chest may have one of the following except:

a. COPD

b. bronchial asthma developed early in life. c. Interstitial pulmonary fibrosis

d. increase in antero-posterior diameter

10- All of the following is true about Heberden's nodes except

a. caused by formation of calcific spurs of the articular cartilage b.can develop in the distal interphalangeal joints

c.less common than Bouchard's nodes d.affects patients with osteoarthritis

11- Articular pain is characterised by

a) Being localized

b) Painful active movements but painless passive movements c) Being deep or diffuse

d) physical findings are remote from joint capsule

12- The following gastrointestinal diseases can cause clubbing except:

a) Ulcerative colitis, b)Crohn’s disease, ,

(4)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 4 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

c) leiomyoma of the esophagus d) Duodenal ulcer

13) In vright ventricular enlargement, the apex is shifted

a-outward and downward b-Inward and and downward c-outward only

d-downward only

14)The presence of fasciculations may signify:

a. Upper motor neuron lesion b. Lower motor neuron lesion c. Cerebellar lesion

d. Extrapyramidal lesion

15) Coarse rest tremors are characteristic of:

a. Thyrotoxicosis b. Anxiety c. Parkinsonism

(5)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 5 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

d. Cerebellar disease

16) Unilateral upper motor neuron facial paralysis:

a. Affects the upper face and spares lower face b. Affects the lower face and spares the upper face

c. Affects the whole face but spares the emotional expression d. Affects voluntary as well as involuntary movements

17) Thrill over the second right intercostal space is due to

a. Mitral stenosis

b. Ventricular septal defect c. Organic aortic stenosis d. Pulmonary stenosis

18) Increase lymphocytic count in ascetic fluid analysis signifies

a. Tuberculous peritonitis b. portal hypertension c nephrotic syndrome d. Primary mesothelioma

(6)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 6 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

19) Causes of massive splenomegaly include:

a. Chronic lymphocytic lymphoma

b. Myelofibrosis with myeloid metaplasia c. Chronic malaria

d. All of the above

20) Epigastric pulsations could originate from:

a-Right ventricular enlargement b-hepatic congestion

c-Aneurysm of abdominal aorta d-All of the above

II- Put True or False in front of each sentence: (10 marks)

1- Trachea is shifted to the same side of lesion in case of massive pleural effusion or tension pneumothorax. ( )

2- Litten’s sign is absent in pleural effusion. ( )

3- Deep sensations include pressure sense and vibration sense ()

(7)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 7 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

5- Right upper quadrant Abdominal pain could be due to pneumonia ()

6- Acanthosis nigricans is seen in patients with inflammatory bowel disease.( ) 7- Increased tactile vocal fremitus occurs in cases of pneumothorax. ( )

8-Inability to rotate the head to one side nay arise from a lesion of the cranial nerve number 12 () 9- Ascites is infrequent in patients with cirrhosis unless both portal hypertension and

hypoalbuminemia are present ( )

10-Bronchial breathing may be heard at the upper level of pleural effusion. ( )

III- Complete the following sentences: (10 marks)

1-

A wave in jugular venous pulse represents ……… ……….it is absent in …… ………….…(2 marks)

2-

Causes of enlarged cervical lymph nodes in chest diseases include …………..,…&………..(2 marks)

3-

Rapid and deep breathing is called ……….. which occurs in

………(2 marks)

4-Normal respiratory movement in males is ………..…, while in females it is ……….(2 marks)

5-Virchaw lymph node signifies……… ……….While Cullen’s sign – bruising surrounding umbilicus – signifies ……… (2 marks)

IV- Short questions: ( 20 Marks)

(8)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 8 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

……… ……….. ………. ……….

2- Enumerate Four signs of Horner`s syndrome. (2 marks)

……… ………..

3- Enumerate Four criteria of splenic dullness. (2 marks)

……… ……… ……….. ………

4-

Enumerate Four tests used to examine co-ordination of mmovements. (2 marks)

…… ……….. ……… ………. ………

(9)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 9 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

5-

Tabulate the differences between inflammatory and non inflammatory joint pain. (4 marks)

Feature Inflammatory Noninflammatory

……… ………. ……….. ……….. ……… ………. ……….. ……….. ……… ………. ………. ……….. ……… ……….. ………...

6-

Enumerate signs of liver cell failure(4 marks)

Foetor hepaticus

(10)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 10 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

Palmer erythema Spider naevi Finger clubbing Dark complexion Jaundice Gynecomastia

Feminine distribution of pubic hair , testicular atrophy Peripheral oedema

7-

Tabulate differences between cardiac and esophageal pain(4 marks)

Cardiac pain Esophageal pain Radiation: left Radiation : back

(11)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 11 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

Type: pressing, constricting Aggravating factors

:

physical activity, stress

Relieving factors : nitrates Associated symptoms : dyspnoea, sweatin g Type:burning, spasmodic Aggravating factors : body position, eating

Relieving factors : antacid Associated symptoms : dysphagia,regurgitation

End of questions Good Luck

(12)

Alexandria University

Medical Research Institute

Hematology Department

Master Degree

Course title: Internal Medicine

Course code: 1715721

Page 12 of 10

Student name:

Final exam

Semester: Fall

Academic year: 2019 – 2020

Time allowed: 60 minutes

Date: 09/ 01 / 2020

Total Marks : 60

End of questions

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