1) A 19 year male residing in a an endemic region of malaria, had never

suffered an attack of malaria he is most likely to be:

a) SS disease
b) Hemoglobin O Arab
c) Congenital spherocytosis
d) Duffy positive blood group Negative

e) Sickle cell trait AS

2) A 25 year old female patient presented with abdominal pain, fever, watery
diarrhea for 48 hours followed by blood diarrhea .The most likely cause is:

a) E. Coli infection
b) Dysenteric malaria
c) Amoebic dysentery
d) Bacillary dysentery
e) Campylobacter infection

3) A 35 year old patient with hepatosplenic schistosomiasis, the second

commonest site to be affected with schistosomiasis is:
Katayama
a) Spinal cord fever {acute
phase}
b) Lungs
c) Kidneys
d) Brain
e) Skin

4) A 20 year man presented with history of headache, high fever, nausea,

 vomiting & a bleeding tendency; was found to be positive for malaria. The
cause of his bleeding is :

a) Severe thrombocytopenia
b) Reduced anti thrombin III
c) Liver cell failure
d) Platelets dysfunction

e) Vitamin K- dependant coagulation factors defect

5) Oxamniquine: To improve schistosomiasis

Effective in both shistosomiasis
a) Is an organophosphorous derivative
b) Commonly causes convulsions
c) Is effective in S. hematobium infection
d) causes fever in the first day of treatment
e) results in elevation of alkaline phosphatase
6) A 45 year old women presented with abdominal discomfort, her stool was
examined & the result showed Entamoeba histolytica cysts ,The drug
indicated in her case is

a) metronidazole
b) tinidazole
c) diloxanate fuorate
d) albendazole
e) thiabendazole

7) The treatment of choice in brucellosis is:

a) Streptomycin +Rifampicin + doxycycline

b) Doxycycline +Rifampicin
c) Rifampicin +Co-trimoxazole Preg 2nd 3rd
 d) Streptomycin + Doxycycline
e) Doxycycline+ Ofloxacin

8) The most lethal complication of typhoid is:

a) Intestinal perforation
b) Intestinal hemorrhage
c) Myocarditis
d) Acute renal failure
e) Meningitis

9) In a patient with visceral leishmaniasis the most yielding result would be

obtained from:

a) peripheral blood
b) lymph node
c) spleen
d) liver
e) bone marrow

10) Which of the following findings favor amoebic rather than bacillary
dysentery:

a) acidic reaction of stool Amoebic acidic

b) tenesmus Favor bacillary

c) fever
d) vomiting
leukocytosis

9. 3. A 29-y-old man who lives in an area full of sandflies presented with fever
for 4 weeks. He was noted to be wasted and has a splenomegaly of 6 cm. Blood
film was negative for malaria and brucellar titer was 1: 40. He refused any
further testing and demanded treatment.
What is the most suitable treatment for this patient?

​a. Praziquantel
​b. Metrifonate
​c. Pentamidine
​d. Artesunate
+ paromomycin
​e. Sodium stebogluconate ​ ​ ​E
With Hiv amphoteracin b
1) Acute toxemic schistosomaiasis:

a) Is commonly seen in schistosoma hematobium infection

b) is not uncommon in indigenous population of endemic areas
c) presents as Swimmer’s itch
Schistosomulum
d) is diagnosed by antibodies against adult schistosme gut antigen

e) causes bloody stool

Cause daeath
2) In a patient with severe malaria:
Pul. Edema
Mc of severe is algid
a) retinal hemorrhages occur in 5% of patients
b) signs of meningeal irritation are typical of cerebral malaria
c) presence of schizonts in the peripheral blood is a poor prognostic feature
d) prolongation of APTT is not recognized
e) non cardiogenic pulmonary edema is a common association Not
common

3) Which of the following is highly suggestive of schistosomal periportal fibrosis is

a patient with portal hypertension:

a) Caput medusae
 b) Venous hum
c) Palpable left lobe of the liver
d) oesophageal varices
e) Macronodular hepatomegally

4) A 25 – year- old male presented with fever & right hypochonderial pain for two
weeks. Examination & investigation showed firm &tender hepatomegally, total
WBC 14000/µl. & high alkaline phosphatase. The most likely diagnosis is:

a) bacterial cholangitis
b) subphrenic abscess

c) amoebic liver abscess

d) right basal pneumonia
e) pyogenic liver abscess

5) In bacillary dysentery
a) fever is rare
b) Shigella shiga causes the mild form of the disease
c) Rieter’s syndrome, affects males only

d) the stool is alkaline in reaction

e) Doxycycline is the drug of choice
6) The pathogenesis of cerebral malaria is mainly due to:
a) immune complex deposition in the brain tissue
b) cerebral edema
c) cerebral anoxia
d) increased tumor necrosis factor (TNF )level

e) cerebral hemorrhage
7) The treatment of choice in a pregnant lady with brucellosis is:
a) streptomycin +doxycycline
b) streptomycin +rifampicin
c) doxycycline +rifampicin
d) rifampicin alone
e) streptomycin +cotrimoxazole

8) The most serious complication of typhoid fever is:

a) gastrointestinal hemorrhage
b) gastrointestinal perforation
c) lobar pneumonia
d) toxic psychosis
e) myocarditis

9) Which of the following drugs can be administered orally for the treatment of
visceral leishmaniasis:

a) Sodium stibogluconate
b) Pentamidine
c) Paromomycin
d) Itraconazole
e) Multefosine

10) In a patient with tetanus the CSF analysis will reveal:

a) normal contents
b) high cells , proteins and normal sugar
 c) high cells , normal proteins
d) high proteins and normal cells
e) high cells, proteins and sugar

1) A 25 year old male patient, presented with symptoms and signs of amoebic
liver abscess, which of the following is true:

a) Typically presents with fever

b) Jaundice is usual
c) Is more likely to have concomitant colitis
d) Have a clear casual relation with alcohol abuse
e) Subacute presentation is unlikely

2) Which of the following is highly suggestive of schistosomal periportal fibrosis

in a patient with portal hypertension:

a) Caput medusae
b) Venous hum
c) Palpable left lobe of the liver
d) oesophageal varices
e) Macronodular hepatomegally

3) Hemolytic uremic syndrome in a 30 year old male patient presenting with

bloody stool ,that showed microscopically the presence of leucocytes; normal
WBC count is due to:

a) E.Coli
b) Bacillary dysentery
c) Campylobacter jejueni infection
d) Clostridium difficle
e) Pseudomembranous colitis
4) Acidosis, hyperventilation and circulatory failure in severe malaria are caused
by :

a) Acute kidney injury

b) Hypoglycemia
c) Lactic acidosis
d) Hepatic failure
e) Heavy parasitemia
5) Stool analysis in a female patient ,showed the presence of both E. Histolytica
trophozoites forms & cysts forms; the drug active against both forms is

a) Metronidazole
b) Tinidazole
c) Paromomycin
d) Diloxanide fuorate
e) Albendazole

6) In cutaneous leishmaniasis ,nodular lesion will appear after the bite of sand
fly within:

a) Few minutes
b) Few hours
c) Three days
d) Three weeks
e) 2-3 months

7) A 50 year old male patient presented with skin itching, hyperpigmentation ,

skin nodules together with visual deterioration, biopsy taken from the nodule
recovered Onchocerca volvolus ; which of the following is most appropriate:

a) Micofilaria are recovered by nocturnal blood film

 b) Micofilaria invade the posterior chamber of the eye
c) Isolated skin lesions do not require treatment
d) Blindness is mainly due to optic atrophy
e) Both macro & microfilaria respond to Ivermectin Just micro

8) A farmer of 55 year old ,presented with prolonged nocturnal fever, headache

and sweating for two months, O/E he was ill, febrile with hepatosplenomegally;
the best test performed to settle the diagnosis of brucellosis is:

a) Widal test for brucellosis

b) Blood culture
c) Bone marrow culture
d) Splenic puncture
e) Imaging of sacroiliac spine

9) In typhoid fever:

a) The disease affects humans only

b) Animal reservoir is well recognized
c) Complications occur in the second week 3rd

d) Follows an attack of severe malariaShistosomiasis

e) Stool culture in the first week settles the diagnosis
10) A 45 year old male patient, with visceral leishmaniasis, received intravenous
sodium stibogluconate 20mg/kg daily for 30 days, showed no response, the
next step will be:

a) Repeat the course of sodium stibogluconate

b) Start multifosine
c) Start Liposomal amphoteracin
d) Start Paromomycin
e) Start Allopurinpl
1) A 25 year old male patient, presented with symptoms and signs of amoebic liver
abscess, which of the following is true:

a) Typically presents with fever

b) Jaundice is usual
c) Is more likely to have concomitant colitis
d) Have a clear casual relation with alcohol abuse
e) Subacute presentation is unlikely

2) Which of the following is highly suggestive of schistosomal periportal fibrosis in a

patient with portal hypertension:

f) Caput medusae
g) Venous hum
h) Palpable left lobe of the liver
i) oesophageal varices
j) Macronodular hepatomegally

3) Hemolytic uremic syndrome in a 30 year old male patient presenting with bloody
stool ,that showed microscopically the presence of leucocytes; normal WBC count
is due to:

a) E.Coli
b) Bacillary dysentery
c) Campylobacter jejueni infection
d) Clostridium difficle
e) Pseudomembranous colitis

4) Acidosis, hyperventilation and circulatory failure in severe malaria are caused by

:
 a) Acute kidney injury
b) Hypoglycemia
c) Lactic acidosis
d) Hepatic failure
e) Heavy parasitemia
5) Stool analysis in a female patient ,showed the presence of both E. Histolytica
trophozoites forms & cysts forms; the drug active against both forms is

a) Metronidazole
b) Tinidazole
c) Paromomycin
d) Diloxanide fuorate
e) Albendazole
6) In cutaneous leishmaniasis ,nodular lesion will appear after the bite of sand fly
within:

a) Few minutes
b) Few hours
c) Three days
d) Three weeks
e) 2-3 months

7) A 50 year old male patient presented with skin itching, hyperpigmentation , skin
nodules together with visual deterioration, biopsy taken from the nodule recovered
Onchocerca volvolus ; which of the following is most appropriate:

a) Micofilaria are recovered by nocturnal blood film

b) Micofilaria invade the posterior chamber of the eye

c) Isolated skin lesions do not require treatment
d) Blindness is mainly due to optic atrophy
e) Both macro & microfilaria respond to Ivermectin
8) A farmer of 55 year old ,presented with prolonged nocturnal fever, headache and
sweating for two months, O/E he was ill, febrile with hepatosplenomegally; the
best test performed to settle the diagnosis of brucellosis is:

a) Widal test for brucellosis

b) Blood culture
c) Bone marrow culture
d) Splenic puncture
e) Imaging of sacroiliac spine

9) In typhoid fever:

a) The disease affects humans only

b) Animal reservoir is well recognized
c) Complications occur in the second week
d) Follows an attack of severe malaria
e) Stool culture in the first week settles the diagnosis
10) A 45 year old male patient, with visceral leishmaniasis, received intravenous
sodium stibogluconate 20mg/kg daily for 30 days, showed no response, the next
step will be:

a) Repeat the course of sodium stibogluconate

b) Start multifosine
c) Start Liposomal amphoteracin
d) Start Paromomycin
e) Start Allopurinpl
11) A 25 year old male patient, presented with symptoms and signs of amoebic liver
abscess, which of the following is true:

f) Typically presents with fever

g) Jaundice is usual
 h) Is more likely to have concomitant colitis
i) Have a clear casual relation with alcohol abuse
j) Subacute presentation is unlikely

12) Which of the following is highly suggestive of schistosomal periportal fibrosis in

a patient with portal hypertension:

k) Caput medusae
l) Venous hum
m) Palpable left lobe of the liver
n) oesophageal varices
o) Macronodular hepatomegally

13) Hemolytic uremic syndrome in a 30 year old male patient presenting with
bloody stool ,that showed microscopically the presence of leucocytes; normal
WBC count is due to:

f) E.Coli
g) Bacillary dysentery
h) Campylobacter jejueni infection
i) Clostridium difficle
j) Pseudomembranous colitis

14) Acidosis, hyperventilation and circulatory failure in severe malaria are caused
by :

f) Acute kidney injury

g) Hypoglycemia
h) Lactic acidosis
i) Hepatic failure
j) Heavy parasitemia
15) Stool analysis in a female patient ,showed the presence of both E. Histolytica
trophozoites forms & cysts forms; the drug active against both forms is

f) Metronidazole
g) Tinidazole
h) Paromomycin
i) Diloxanide fuorate
j) Albendazole
16) In cutaneous leishmaniasis ,nodular lesion will appear after the bite of sand fly
within:

f) Few minutes
g) Few hours
h) Three days
i) Three weeks
j) 2-3 months

17) A 50 year old male patient presented with skin itching, hyperpigmentation , skin
nodules together with visual deterioration, biopsy taken from the nodule recovered
Onchocerca volvolus ; which of the following is most appropriate:

f) Micofilaria are recovered by nocturnal blood film

g) Micofilaria invade the posterior chamber of the eye

h) Isolated skin lesions do not require treatment
i) Blindness is mainly due to optic atrophy
j) Both macro & microfilaria respond to Ivermectin

18) A farmer of 55 year old ,presented with prolonged nocturnal fever, headache
and sweating for two months, O/E he was ill, febrile with hepatosplenomegally;
the best test performed to settle the diagnosis of brucellosis is:

f) Widal test for brucellosis

g) Blood culture
 h) Bone marrow culture
i) Splenic puncture
j) Imaging of sacroiliac spine

19) In typhoid fever:

f) The disease affects humans only

g) Animal reservoir is well recognized
h) Complications occur in the second week
i) Follows an attack of severe malaria
j) Stool culture in the first week settles the diagnosis
f) A 45 year old male patient, with visceral leishmaniasis, received intravenous
sodium st

20) ibogluconate 20mg/kg daily for 30 days, showed no response, the next step will
be:

g) Repeat the course of sodium stibogluconate

h) Start multifosine
i) Start Liposomal amphoteracin
j) Start Paromomycin
Start Allopurinpl11

21) A 25 year old male patient, presented with symptoms and signs of amoebic
liver abscess, which of the following is true:
k) Typically presents with fever
l) Jaundice is usual
m) Is more likely to have concomitant colitis
n) Have a clear casual relation with alcohol abuse
o) Sub acute presentation is unlikely

22) Which of the following is highly suggestive of schistosomal periportal fibrosis

in a patient with portal hypertension:
p) Caput medusae
q) Venous hum
 r) Palpable left lobe of the liver
s) oesophageal varices
t) Splenomegaly

23) A 30 year old male patient presenting with anaemia, high blood urea and
bloody stool that showed microscopically the presence of leucocytes; is due to:
a) Amoebic dysentry
b) Escherichia coli
c) Campylobacter jejueni infection
d) Clostridium difficle
e) Pseudomembranous colitis

4) In a very ill patient with malaria arterial blood gas results showed pH 7.25 (Normal 7.35
- 7.45) and bicarbonate 14 mmol/l (Normal 22 - 26 mmol/l ). The likely cause is:
k) Acute kidney injury
l) Hypoglycemia
m) Lactic acidosis
n) Hepatic failure
o) Heavy parasitemia

5) Stool analysis in a female patient showed the presence of both E. Histolytica

trophozoites & cyst forms; the drug treatment of choice is:
k) Metronidazole
l) Tinidazole
m) Mebendazole
n) Ciprofloxacine and mebendazole
o) Albendazole

6) The most serious complication of brucellosis is:

a) Depression
b) Endocarditis
c) Osteomylitis
d) Sacroillitis
e) Hepatitis
 7) A 25 – year- old male presented with fever & right hypochonderial pain for
two weeks. Examination & investigation showed firm & tender hepatomegally,
total WBC 14000/µl & high alkaline phosphatase. The most likely diagnosis is:
a) Bacterial cholangitis
b) Subphrenic abscess
c) Amoebic liver abscess
d) Right basal pneumonia
e) Pyogenic liver abscess

8) Hypereoisinophilia is encountered in the following condition:

a) Ascaris infection
b) Onchocerciasis
c) Loa loa
d) Strongoiloidis
e) Katayama syndrome.

9) In typhoid fever:
k) Stool culture in the first week settles the diagnosis
l) Animal reservoir is well recognized
m) Complications occur in the second week
n) Follows an attack of severe malaria
o) Intestinal perforation is a recognized serious and frequently fatal
complication

10) A 45 year old male patient, with visceral leishmaniasis, received intravenous
sodium stibogluconate 20mg/kg daily for 30 days showed no response. The next
step will be:
k) Repeat the course of sodium stibogluconate
l) Start multifosine
m) Start Liposomal amphoteracin
n) Start Paromomycin
o) Start Allopurinpl

2. The treatment of choice in a pregnant lady with brucellosis is:

a) Streptomycin + doxycycline
b) Doxycycline + rifampicin
c) Rifampicin + co-trimoxazole
d) Co-trimoxazole + ofloxacin
e) Ofloxacin + streptomycin
3. The best diagnostic test for typhoid fever with regard to sensitivity and
specificity is:
a) TWBC showing leukopenia
b) Blood culture
c) Widal test for somatic Ag ( IgM )
d) Widal test for flagellar Ag ( IgG )
e) Bone marrow culture

4. In a patient with bacterial meningitis the best empirical treatment is:

a) Crystalline penicillin
b) Amoxicillin
c) Chloramphenicol
d) Ceftriaxone
e) Co-trimoxazole

5. The most serious complication of brucellosis is:

f) Depression
g) Endocarditis
h) Osteomylitis
i) Sacroillitis
j) Hepatitis

6. In a patient who is responding to treatment of visceral leishmaniasis, the

following is true:
a) The lymph nodes will disappear within two weeks
b) Fever will subside in a week time
c) Splenomegly will persist for 6 months
d) Leishmanin Skin Test will remain negative for life
e) Serum albumin will return to normal in a month time.

7. Hypereoisinophilia is encountered in the following condition:

f) Ascaris infection
g) Onchocerciasis
 h) Loa loa
i) Strongoiloidis
j) Katayama syndrome.

8. Treatment of choice for hyper-reactive malarial splenomegly consists of

proguanil plus one of the following drugs:
a) Quinine
b) Fansidar
c) Mefloquine
d) Chloroquine
e) Artemesinin

9. A 19 year male residing in a an endemic region of malaria had never suffered an

attack of malaria. He is most likely to be:
a) SS disease
b) Hemoglobin O Arab
c) Congenital spherocytosis
d) Duffy positive blood group
e) Sickle cell trait AS

10. A 25 year old female patient presented with abdominal pain, fever, watery
diarrhea for 48 hours followed by bloody diarrhea .The most likely cause is:
a) Viral enteritis
b) Dysenteric malaria
c) Giardiasis
d) Bacillary dysentery
e) Drug induced (antibiotics)

11. A 35 year old patient with hepatosplenic schistosomiasis, the second

commonest site to be affected with schistosomiasis is:
a) Spinal cord
b) Lungs
c) Kidneys
d) Brain
e) Skin
 12. A 20 year-old man presented with history of headache, high grade fever,
nausea, vomiting & a bleeding tendency; was found to be positive for malaria.
The cause of his bleeding is:
a) Severe thrombocytopenia
b) Reduced anti thrombin III
c) Liver cell failure
d) Platelets dysfunction
e) Vitamin K- dependant coagulation factors defect

13. Which of the following is highly suggestive of schistosomal periportal fibrosis

in a patient with portal hypertension:
f) Caput medusae
g) Venous hum
h) Palpable left lobe of the liver
i) Oesophageal varices
j) Macronodularhepatomegaly

14. A 25 – year- old male presented with fever & right hypochonderial pain for
two weeks. Examination & investigation showed firm & tender hepatomegally,
total WBC 14000/µl & high alkaline phosphatase. The most likely diagnosis is:
f) Bacterial cholangitis
g) Subphrenic abscess
h) Amoebic liver abscess
i) Right basal pneumonia
j) Pyogenic liver abscess

15. A 35-year-old woman developed bilateral optic neuritis with partial recovery. MRI of
brain was normal. One year later, she developed paraparesis and incontinence. She was
given intravenous methylprednisolone followed by oral prednisolone, but continued to
deteriorate. Investigations showed:
ESR 7 mm/1st hr, antinuclear antibodies negative. MRI scan of spine: high-signal
lesion from C6 to T10. Cerebrospinal fluid: white cell count 12/ cu mm , negative
oligoclonal bands. What is the most likely diagnosis?

a) Acute disseminated encephalomyelitis

b) Multiple sclerosis
c) Sjogren's syndrome
d) Systemic lupus erythematosus
Neuromyelitis optica
 1. A 25 year old gentleman presented with a seven month history of low grade
fever, occurring daily associated with dry cough, diarrhea 3-4 motions per day,
watery & lately became blood stained.
O/E He looks ill, pale not jaundiced, there were cervical lymph nodes, firm, discrete, not
tender. Abdomen revealed a firm non tender spleen of 8 cm below the left subcostal
margin. Rest of physical examination was unremarkable.
The most probable diagnosis is:-
a. HIV Disease
b. Lymphoma
c. Visceral leishmaniasis
d. Chronic lymphocytic leukemia
e. Tuberculosis

2. A 30 year old lady presented to the ER (Emergency Room), complaining of one

week duration of fever, frontal headache & joint pains . Her symptoms increased
in severity in the last two days, as she noticed reddish urine, there is associated
nausea and sometimes vomiting. Examination showed a febrile lady with lemon
tinge yellowish discoloration of the sclera.
3
Investigations: Blood film for malaria negative, total WBCS count 3.5 x10 /µL (3.6-11),
3
platelets count is 75 x10 /µL (150–350); urine showed increased uroblinogen.
The diagnosis is:-
a. Infective hepatitis
b. Typhoid fever
c. Malaria
d. Acute brucellosis
e. Yellow fever

3. A 28 year old gentleman, working as an irrigation canal cleaner, presented six

months earlier to the medical department, where he received Praziquantel
tablets for intestinal schistosomaisis. Assessment for achievement of cure is
based on:
a. Negative stool analysis for schistosoma ova
b. Negative ELISA test
c. No demonstrable antibodies to adult gut antigen
d. Positive schistosoma ova in stool examination, with negative hatching test
e. Normalization of pre-treatment eosinophilia

4. A 42 year old lady, hypertensive on amilodipine 5mg daily, presented for regular
checkup. Among other tests carried out on her, peripheral blood picture showed
banana shaped gametocytes. The appropriate drug indicated in her case to
eradicate these gametes is:-
 a. Artesunate
b. Mefloquine
c. Quinine
d. Primaquine
e. Halfantrine hydrochloride

5. A 20 year old gentleman presented with three days history of fever, followed by
diarrhea, small amounts, 8-10 times per day, associated with blood , lower
abdominal pain as well as tenesmus. Examination is unremarkable.
Investigations showed blood urea 75 mg/dl (20-40), serum creatinine 2.8 mg/dl
(0.7–1.3), stool analysis showed fecal leucocytes and RBCs. Peripheral blood
picture showed fragmented RBCs.
The diagnosis is:-
a. Clostridium Difficuile colitis
b. Amebiasis
c. Campylobacter jejunei
d. Escherichia coli inection
e. Salmonellosis

6. A 20 year-old man presented with history of headache, high grade fever, nausea,
vomiting & a bleeding tendency; was found to be positive for malaria. The cause
of his bleeding is:
a. Severe thrombocytopenia
b. Reduced anti thrombin III
c. Liver cell failure
d. Platelets dysfunction
e. Vitamin K- dependant coagulation factors defect

7. In a patient who is responding to treatment for visceral leishmaniasis, the

followings are true:
1. The lymph nodes will disappear within two weeks
2. Fever will subside in a week time
3. Splenomegly will persist for 6 months
4. LST (Leishmanin Skin Test) will remain negative for life
5. Serum albumin will return to normal in a month time

8. Wound debridement and antibiotics are essential for preventing further release
of C. tetani from the wound. The antibiotic of choice is:
a. Penicillin
b. Cephtriaxone
c. Gentamycin
 d. Metronidazole
e. Chloramphenicol

9. A 54 years old man presents with prolonged fever and right upper subcostal pain
and tenderness. Abdominal ultrasound scan revealed a 6✕
✕6 cm cystic lesion in
right lobe of liver.
Expected findings on further assessment include:
a. A raised blood alkaline phosphatase and neutrophil leucocytosis
b. Anormal alkaline phosphatate but raised serum bilirubin level
c. Markedly raised serum aphafetoprotein level
d. A normal CXR
e. Raised Ca 19.9 tumour marker

10. On a busy night in the ER the on call team received three patients from a
village in Algezira referred with febrile illness associated with variable
symptoms of headache, muscle pains, vomiting of blood and bruising under the
skin.
Which of the following next step is most appropriate?
a. They should all be referred to the Bleeding Centre for urgent endoscopy
b. They should be treated with intravenous quinine
c. The Public Health Department should be immediately notified
d. They should be treated with intravenous antibiotics
e. Commence intravenous omeprazole and observe
3
11. A 44 year old male with advanced HIV/AIDS, CD4 count of 4 cells/mm (400-1200)
presented to the ER complaining of a headache for the last 14 days. He also complained
of intolerance to light and neck stiffness. He vomited 3 times over the last 3 days. He
denied any fever or night sweats. CSF examination revealed: WBC 46 cells/µl (0 - 5),
lymphocytes 83%. Protein 147 mg/dl (12 - 60). Glucose 28 mg/dl (40 - 80). Blood glucose
117. CSF microscopy: Yeasts seen.
What is the best course of action?
a. Start Ceftriaxone and Vancomycin
b. Start intravenous Dexamethasone
c. Start Amphotericin B and Flucytosine
d. Start antituberculous therapy with 4 drugs
e. Start Acyclovir

12. A patient with HIV and CD4 count of less than 200 cells/mm presents with
3

fever, night sweats, cough and profound weight loss. You suspect tuberculosis
coinfection. Which of the following statements is correct?
a. Extrapulmonary TB is less likely than in HIV negative patients
b. Sputum smear for acid and alcohol fact bacilli is always positive
c. CXR will be abnormal in most patients
d. Mantoux test is often strongly positive
 e. Antituberculous treatment should be started before antiretroviral therapy

24) A 25 year old male patient, presented with symptoms and signs of amoebic
liver abscess, which of the following is true:

p) Typically presents with fever.

q) Jaundice is usual
r) Is more likely to have concomitant colitis
s) Have a clear casual relation with alcohol abuse
t) Sub acute presentation is unlikely

25) Which of the following is highly suggestive of schistosomal periportal fibrosis

in a patient with portal hypertension:

u) Caput medusae
v) Venous hum
w) Palpable left lobe of the liver
x) oesophageal varices
y) Macronodular hepatomegally

26) Hemolytic uremic syndrome in a 30 year old male patient presenting with
bloody stool that showed microscopically the presence of leucocytes; normal
WBC count is due to:

k) E.Coli
l) Bacillary dysentery
m) Campylobacter jejueni infection
n) Clostridium difficle
 o) Pseudomembranous colitis

27) Acidosis, hyperventilation and circulatory failure in severe malaria are

caused by :

p) Acute kidney injury

q) Hypoglycemia
r) Lactic acidosis
s) Hepatic failure
t) Heavy parasitemia

28) Stool analysis in a female patient showed the presence of both E. Histolytica
trophozoites forms & cysts forms; the drug active against both forms is

p) Metronidazole
q) Tinidazole
r) Paromomycin
s) Diloxanide fuorate
t) Albendazole

29) In cutaneous leishmaniasis ,nodular lesion will appear after the bite of sand
fly within:

k) Few minutes
l) Few hours
 m) Three days
n) Three weeks
o) 2-3 months

30) A 50 year old male patient presented with skin itching, hyperpigmentation ,
skin nodules together with visual deterioration, biopsy taken from the nodule
recovered Onchocerca volvolus ; which of the following is most appropriate:

k) Micofilaria are recovered by nocturnal blood film

l) Micofilaria invade the posterior chamber of the eye

m) Isolated skin lesions do not require treatment
n) Blindness is mainly due to optic atrophy
o) Both macro & microfilaria respond to Ivermectin

31) A 55 year old farmer with prolonged nocturnal fever, headache sweating and
hepatosplenomegally; the best test performed to settle the diagnosis of
brucellosis is:

k) Widal test for brucellosis

l) Blood culture
m) Bone marrow culture
n) Splenic puncture
o) Imaging of sacroiliac spine

32) In typhoid fever:

 p) The disease affects humans only
q) Animal reservoir is well recognized
r) Complications occur in the second week
s) Follows an attack of severe malaria
t) Stool culture in the first week settles the diagnosis

33) A 45 year old male patient, with visceral leishmaniasis, received intravenous
sodium stibogluconate 20mg/kg daily for 30 days showed no response. The next
step will be:

p) Repeat the course of sodium stibogluconate

q) Start multifosine
r) Start Liposomal amphoteracin
s) Start Paromomycin
t) Start Allopurinpl

CASE 1:
A 45 year-old man presented to the medical outpatient
department complaining of fever for the last three months, the
fever is of low grade, occurs mostly at the evening, associated
with nocturnal sweating, and had anorexia and weight loss. He
also complained of dry cough, there was no abdominal pain, he
had diarrhea about three motions per day, and the stools contain
no blood. He sought medical advice and received various
medications with no response.

OE: looks ill, pale, not jaundiced, afebrile.

Pulse , blood pressure were normal, neck examination showed a
group of posterior triangle lymph nodes, firm, discrete, not
tender , there were no epitrochlear nodes, but there were
inguinal lymph nodes bilaterally. Both chest and cardiovascular
examinations were normal.
Abdominal examination, showed palpable spleen, of 10 cm,
below the left subcostal region, firm non tender, liver span is 12
cm. No venous hum or splenic rub.

Investigations revealed normal WBC count, total and

differential, Hb 9.6 g/dl. Ultrasound showed normal portal vein
diameter and liver and spleen were of coarse texture and the
kidneys were normal.

1) State THE MOST LIKELY diagnosis

----------------Lymphoma------------(8)

2) State TWO OTHER possible diagnoses

------------Tuberculosis---(4)---VL—(4)
------------HIV Disease--(4)-----Brucellosis—(4)

3) State ONE investigation to establish the diagnosis

-----------lymph node biopsy -----(2)----Other relevant
investigation ---(1)

4) What is the appropriate treatment modality

Radiotherapy +
----------------CHEMOTHERAPY---------(2)-----other
relevant treatment---(1)

CASE 1:
A 26 year old male from Kosti presented to the outpatient clinic
with a four week history
of upper abdominal pain and high grade fever which was
 accompanied with rigors. He also has
mild cough and anorexia. He has no past history of significance.
On examination he looks ill, febrile temp 39. Cardio-respiratory
and neurological examinations were normal. Abdominal
examination revealed tender hepatomegaly 9 cm below costal
margin. Spleen not palpable and no ascites.
Investigations showed: TWBC 18500 x10 /µL (3.6-11) with
3

85% Neutrophils. Blood film and ICT were negative for malaria.

a) What is the most likely diagnosis ?

Amoebic OR Pyogenic liver abscess ​(6)

​ ​Other causes ​2

b) Mention TWO other differential diagnoses?

Any two of: Pyogenic or Amoebic liver abscess, ​

Acute hepatitis (any cause), Cholangitis, Infected
hydatid, cholecystitis ​(6)
​
Three marks for each

c) Mention THREE investigations that help in

reaching a diagnosis?

Any three of: U/S, CT, LFTs, Hepatitis serology,

H5 agAmoebiasis serology, blood culture ​ ​ ​ ​
Two marks for each
​ ​ ​ ​ ​ ​ ​ ​(6)

d) What treatment is indicated in this case ?

 1. Antibiotics ​(1)

2. Aspiration ​(1)

Case 3:

A 50 year old male Sudanese patient, presented to the outpatient

clinic complaining of fever ,headache & general body pains for
the last two months, there was also feeling of fatigue &
weakness. The patient sought medical advice, received various
courses of antibiotics and antimalarial without response.
Recently he started to complain of abdominal pain, constipation
and diarrhea as well. He had a past history of schistosoma
mansoni for which he received some form of treatment. Since
then he had no complains related to this.
O/E: he looks ill, pale, not cyanosed, febrile .Pulse 65 beats
/minutes, BP 110/60 mmHg .Chest ,cardiovascular & nervous
system were normal
Abdomen: Spleen palpable 6cm below the left subcostal region,
firm not tender .Liver palpable 4cm, below the right subcostal
region; firm not tender. No ascites or palpable lymph nodes
Investigations: Hb 8g/dl; WBC count 3300; ESR 75 mm in 1 st

hour. AST 60 IU/DL; ALT 70 IU/DL

Ultrasound showed: splenomegally. Hepatomegally ; with
discrete para-aortic lymph nodes.

a) Mention THREE differential diagnosies:

Brucellosis
1. -------------------------------------------------------------------------------------
------
HCC
2. -------------------------------------------------------------------------------------
------
Typhoid , kalazar
3. -------------------------------------------------------------------------------------
------
b) List THREE investigations for the definitive diagnosis (one for each
differential)
BM aspiration and culture
1. ---------------------------------------------------------------------------
-----
Triphasic CT
2. ------------------------------------------------------------------
--------------------------------------------------
Duedenal aspirate
------------------------------------------------------------------------------
--------------------------------------