Facebology 4th year exam notes by Facebology

Facebology Fourth Year Exam Notes

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‫ميحرلا نمحرلا هللا مسب‬ ‫يقدم لكم فريق ‪ Facebology‬مذكر ة أسئلة أمتحانات ألسنوأت ألسابقة للفرقة ألرأبعة في موأد‪:‬‬ ‫‪Public Health, Forensic Medicine & Clinical Toxicology, Ophthalmology and‬‬ ‫‪Ear, Nose & Throat‬‬ ‫تحتوي ألمذكرة على طريقتين لعرض ألسئلة ألولى ألمتحان كامل وألثانية على شكل تجميعات‬ ‫للسئلة أللتي تكررت في كل أمتحان لكل فرع من ألمادة ‪.‬‬ ‫نتمنى أن ينال هذأ ألعمل رضاكم فقد أمضى عليه ألفريق من ألوقت وألجهد حتى يسهل على‬ ‫ألطالب ألوصول للمعلومة وعرض ألمتكرر من ألسئلة باك ثر من طريقة لتعم ألفائدة للجميع ‪.‬‬ ‫زملؤنا ألعزأء ‪ ...‬إن دأئما ما يشغل تفكيرنا هو أنتم وألوصول بكم لتحقيق أعلى درجات ألنجاح‬ ‫وتحقيق ألمهارة وألك فاءة ألعلمية لكافة أفرأد دفعتنا ومن ياتوأ بعدنا فادرس وأجتهد وأعمل ودع‬ ‫ألنتائج على هللا ‪.‬‬ ‫ّ‬ ‫لقد ّ‬ ‫شرفنا هللا وكلفنا باسمى ألمهن فل تدرس للمتحان فقط وضع دأئما في ذهنك أنك ستتخرج‬ ‫وتصبح طبيبا تقع بين يديه حياة ألبشر ‪.‬‬

‫‪‬‬ ‫تفضلوأ بزيارة صفحتنا على ‪: Facebook‬‬ ‫‪https://www.facebook.com/Facebology‬‬ ‫‪Facebology Team‬‬ ‫‪2‬‬ ‫‪3‬‬

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Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam. For the 4th academic year Medical Students (July, 2014) Time: (3) Hours.

Total Marks: (150)

All Questions should be attempted (5 Sections in 2 pages).

I-Mention: 1- Recommended immunization for adolescents. 2- Screening tests for school children. 3- Health hazards related to exposure to ionizing radiations. 4- Etiology of: a- Iron deficiency anemia. b- Mental handicapping. 5- Sources of infection and modes of transmission of: a- Avian Influenza (Bird Flu.). b- Brucellosis. c- Tetanus. d- Yellow fever. 6- Prevention of:a- Rabies. b- Diabetes Mellitus. c- Vitamin â&#x20AC;&#x153;Aâ&#x20AC;? deficiency among children. d- Heat cramps.

(4 Marks) (4 Marks) (4 Marks) (3 Marks) (3 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks)

II-Enumerate: 1- Three of the health services to achieve safe motherhood. 2- Five of the individual factors behind mental disorders. 3- Two of the factors influencing nutritional status of elderly. 4- Three of the diseases possibly transmitted in swimming pools. 5- Risk factors of: a- Coronary heart disease. b- Hepatocellular carcinoma. 6- Three of the health risks related to international travel.

(4 Marks) (3 Marks) (3 Marks) (3 Marks) (4 Marks) (4 Marks) (3 Marks)

III- Explain the following (Give reasons): 1- Pulmonary Tuberculosis is considered a social disease. (4 Marks) 2- Communicable diseases are common among school children. (4 Marks) 3- The wide base and narrow apex of the pyramid representing age distribution of the population in developing countries. (4 Marks) 4- Nosocomial infection have a significant Public Health burden. (4 Marks) 5- Occupational exposure to small-sized dust particles (1-5 microns) can cause pneumoconiosis (fibrotic lung disease). (4 Marks) 6- Higher rates of natural increase in developing countries. (4 Marks)

IV- Give definition and (2) examples for each of the following: 1- Zoonotic diseases. 2- Emerging infectious disease. 3- Psychoactive substance abuse. 4- Food intoxication. 5- Health education.

(3 Marks) (3 Marks) (3 Marks) (3 Marks) (3 Marks)

V- Give a brief account on each of the following: 1- General measures for prevention of occupational diseases. 2- Diagnosis and health effects of obesity. 3- Steps of health program planning. 4- Characteristics of water-born epidemics.

(10 Marks) (10 Marks) (10 Marks) (10 Marks)

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam. For the 4th academic year Medical Students (September, 2014) Time: (3) Hours.

Total Marks: (150)

All Questions should be attempted (5 Sections in 2 pages).

I-Mention: 1- Activities for implementation of health programs. 2- Clinical forms of infectious disease cases. 3- Recommended immunization for adolescents. 4- Etiology of: a- Iron deficiency anemia. b- Mental handicapping. 5- Sources of infection and modes of transmission of: a- Mumps (Epidemic Parotitis). b- Typhoid fever. c- Rift valley fever. d- Rabies. 6- Prevention of:a- Tetanus. b- Essential hypertension. c- Obesity. d- Heat cramps.

(4 Marks) (4 Marks) (4 Marks) (3 Marks) (3 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks)

II-Enumerate: 1-Two general measures to insure safe motherhood. 2- Two of the primary measuresto prevent mental disorders. 3- Three of the factors influencing nutritional status of elderly. 4- Two of the health hazards related to noise. 5- Three preventable risk factors for each of the following: a- Coronary heart disease. b- Breast cancer. 6- Two of the health risks related to international travel.

(3 Marks) (3 Marks) (3 Marks) (3 Marks) (3 Marks) (3 Marks) (3 Marks)

III- Explain the following (Give reasons): 1- DOTS strategy is recommended by WHO for management of TB. 2- Some of the communicable diseases may re-emerge. 3- Prematurity has a significant Public Health burden. 4- Importance of school health services 5- Occupational exposure to small-sized dust particles (1-5 microns) can cause pneumoconiosis (fibrotic lung disease). 6- Higher rates of natural increase in developing countries.

(4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks) (4 Marks)

IV- Give definition and (2) examples for each of the following: 1- Pneumoconiosis. 2- Nosocomial infection. 3- Drug addiction. 4- Sexually Transmitted Diseases (STDs). 5- Zoonotic disease.

(3 Marks) (3 Marks) (3 Marks) (3 Marks) (3 Marks)

V- Give a brief account on each of the following: 1- Etiology and clinical forms of occupational dermatitis. 2- Goals and general lines of dietary management in renal diseases. 3- Standard chemical characteristics of potable water. 4- Population census.

(10 Marks) (10 Marks) (10 Marks) (10 Marks)

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam. For the 4th academic year Medical Students Time: (90) Minutes.

Total Marks: (50) All Questions should be answered

I-Enumerate:

(12 Marks)

1- Modes of transmission of communicable diseases. 2- Occupational diseases related to mineral (inorganic) dust exposure. 3- Effects of Global warming. 4- Uses of population census data. 5- Environmental factors behind emerging and re-emerging of infectious diseases. 6- Complications of Pertussis (Whooping Cough).

II-Give reasons for the following:

(10 Marks)

1- Carriers of infectious diseases is the most important potential reservoir of infection. 2- Fibrotic lung diseases (Pneumoconiosis) are mostly related to small sized dust particles (1-5 microns). 3- Low fluoride content of potable water is as hazardous as high fluoride content. 4- Higher rates of natural increase in developing countries. 5- Nitrites should be nil in potable water samples.

III-Give (2) examples for each of the following: 1- Vehicles of infection. 2- Vectors transmitting infections to human. 3- Bimodal transmission of infectious diseases. 4- Occupational infection 5- Clinical forms of occupational dermatosis.

(10 Marks)

IV-Choose the correct answer:

(6 Marks)

1- Infants may be borne with temporary trans placental immunity to the following diseases except: a- Measles. b- Diphtheria. c- Mumps. d- TB. 2- Which of the following might be related to STDs, in females: a- Pelvic inflammatory disease. b- Ectopic pregnancy. c- Increased risk of cervical cancer. d- All of the above. 3- The following disease causes a curable ulcer mostly on genetalia: a- Syphilis. b- Herpes simplex type II. c- HIV/AIDS. 4- The following can be transmitted by direct droplet infection except: a- Mumps. b- Varicella. c- Measles. d- Yellow fever. 5- The following are manifestations of chronic lead poisoning except: a- Anorexia. b- Blue gray line on gums. c- Peripheral neuritis. d- Bilateral Wrist and foot drop. 6- Acute effects (hazards) of chemical air pollution include the following except: a- Carbon monoxide poisoning. b- Hypersensitivity reactions of respiratory passages. c- Lead and mercury poisoning.

III-Give short accounts on: 1- Active immunization. 2- Significance of nasopharyngeal swabbing for meningococcus. 3- Control of mumps. 4- Public health significance of sexually transmitted infections.

(12 Marks)

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam (Old System) for the 4th academic year Medical Students (Feb, 2014) Time: (3) Hours.

Total Marks: (150) Answer the following Question:

1. Mention risk factors and preventive measures for iron deficiency anemia. (15 marks) 2. Define maternal mortality & discuss causes & how to control. (15 marks) 3. Analyze the relation between work environment and the occurrence of occupational accident. (14 marks) 4. Enumerate: (20 marks) a. Screening tests for school children. b. Causes of neonatal mortality. c. Hazards associated with prematurity. d. Objectives of premarital care. 5. Compare between population pyramids of developed and developing countries; analyze causes of differences.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2013) Time: (3) Hours.

Total Marks: (150)

Number of questions: 6 questions in 5 pages

I-Answer the following questions:

(60 Marks)

1. Discuss: common nutritional problems among pregnant mothers and 2. 3. 4. 5. 6.

how to prevent. Give short account on preventive measures of communicable diseases in schools. Mention uses of tuberculin testing & significance of its negative reaction. Self-care and patient education messages for diabetic patients. Discuss causes of emergence and re-emergence of infectious diseases. Discuss types and public health importance of carriers.

II-Mention:

(20 Marks)

1. 2. 3. 4.

Determinants of priority in health program planning. Characters of morons. How to know that tuberculosis has complicated silicosis. Specific preventive measures for: a. Influenza. b. HBV infection. 5. Mode(S) of transmission and reservoir of infection of: a. Brucellosis. b. Meningitis.

II-Enumerate:

(20 Marks)

1. Two behavioral problems among adolescents. 2. Two causes of social problems among elderly. 3. Two occupations in which workers are at risk of exposure to lead.

4. Two indications for low salt diet. 5. Two indications of high protein diet. 6. Two causes of infant mortality. 7. Two rates that measure fertility. 8. Two vaccines used against rabies. 9. Two chemical hazards due to defects of potable water quality. 10. Two mandatory vaccines for international travelers. II-Define: 1. 2. 3. 4. 5.

Premature infant. Maternal mortality. Epidemiology. Endemic disease. Pneumoconiosis.

II-Explain why: 1. 2. 3. 4.

(10 Marks)

(20 Marks)

Mental illness among homeless adults and children are high. The allergic theory is more accepted in development of byssinosis. Pneumonic plague is the most serious type. Population pyramid of developed countries is characterized by narrow base. 5. Complex carbohydrate is preferred for diabetic patients. 6. Coliform bacteria are the organisms of choice to indicate fecal examination in the routine water examination. 7. Periodic medical examination is important for industrial workers. 8. Infants after six months of life are at risk of iron deficiency anemia. 9. Adolescent females suffering from goiter are indicators for magnitude of problem of iodine deficiency in a community. 10. Decline of death rate in Egypt.

II-Choose the correct answer from the followings:

(20 Marks)

1. Impact evaluation of health program refers to:

a. The extent to which the program implementation complies with program plan. b. The long term outcome of the program. c. Assessment of the obtained results. Delayed puberty should be evaluated if there is no sign of puberty by the age of: a. 14 years. b. 16 years. c. 20 years. Lung cancer is more frequent with occupational exposure to: a. Free silica dust. b. Asbestos. c. Coal dust. Direct hand to mouth infection is rare to occur in: a. Staphylococcal food poisoning. b. E-Coli infection. c. Salmonella fool poisoning. d. Poliomyelitis. Egypt considered receptive area for yellow fever because: a. Absence of virus. b. Presence of vector. c. Both a&b. The most common hospital acquired infection is: a. Surgical site infection. b. Urinary tract infection. c. Lower respiratory tract infection. d. Skin infection. The following cancer is mostly associated with air pollution: a. Lung cancer. b. Breast cancer. c. Colon cancer.

8. The cut of point of Hg for diagnosis of anemia among pregnant female is: a. 11 gm./dl

b. 12 gm./dl c. 13 gm./dl 9. Which of the following is not a leading cause of maternal mortality in Egypt: a. Maternal hemorrhage. b. Toxemia of pregnancy. c. Cancer. d. Puerperal sepsis. 10. Which of the followings is reversible eye manifestation of vitamin “A” deficiency: a. Bitot’s spots. b. Night blindness. c. Xenophthalmia. 11. The following form of food poisoning is considered infection not intoxication: a. Salmonella food poisoning. b. Staphylococcal food poisoning. c. Botulism. 12. Which of the followings is considered a constrain of the health care system in Egypt: a. High infant mortality rate. b. Egypt has too many specialists. c. Health infrastructure is mal-distributed. d. All of the above. 13. Recurrent attack of rheumatic fever is usually due to: a. Repeated attacks of streptococcal infections. b. Improper chemotherapy of streptococcal disease. c. Inadequate dosage may also play a role. d. All of the above. 14. The international incubation period for cholera is: a. 5 days. b. 6 days. c. 2-5 days. 15. Optimum relative humidity for human is: a. From 20-60%. b. From 60-80%. c. Above 80%.

16. For prevention of puerperal sepsis the following should be done: a. Good antenatal care. b. Sanitary environment for delivery. c. Chemoprophylaxis. d. All of the above. 17. Planning is defined as: a. Deciding what to do and how to do it before action is required. b. Deciding what to do and how to do it after the action has been done. c. None of the above. 18. The psychoactive component in tobacco is: a. Carbon monoxide. b. Tar. c. Nicotine. d. All of the above. 19. Vomitus of a patient treated with cytotoxic drugs is considered: a. Biological waste. b. Genotoxic waste. c. Non-hazardous waste. 20. Naser Institute for open heart surgery is a good example of: a. Primary health care service. b. Secondary health care service. c. Tertiary health care service.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (August, 2013) Time: (3) Hours.

Total Marks: (150)

Number of questions: 6 questions in 5 pages

I-Answer the following questions:

(60 Marks)

1. Discuss: common nutritional problems among pregnant mothers and 2. 3. 4. 5. 6.

how to prevent them. Give short account on methods of population estimation. Mention patterns of spread of communicable diseases. Discuss risk factors and nutrition education messages for patients with cardiovascular disease. Discuss hazards of exposure to high atmospheric humidity and temperature. Discuss primary and secondary preventive measures of cancer.

II-Mention:

(20 Marks)

1. 2. 3. 4.

Characters of healthy classrooms. Characteristics of idiots. General preventive measures for occupational diseases. Specific preventive measures for: c. Mumps. d. Typhoid fever. 5. Mode(S) of transmission and reservoir of infection of: c. Human deficiency virus (HIV). d. Varicella (chickenpox).

II-Enumerate: 1. Two values for notification of infectious diseases

(20 Marks)

2. Two risk groups that should be screened for diseases. 3. Two types of hazardous medical waste. 4. Two occupations in which workers are at risk of exposure to silica. 5. Two indications for clear liquid diet. 6. Two indications for low protein diet. 7. Two laboratory findings indicating high risk pregnancy. 8. Two motives for low fertility. 9. Two disinfectants for potable water. 10. Two emerging diseases. II-Define: 1. 2. 3. 4. 5.

Quarantine. Crippled child. Outbreak. Current smoker. Herd immunity.

II-Explain why: 1. 2. 3. 4. 5.

(10 Marks)

(20 Marks)

Egypt is considered a receptive area for yellow fever. Drug addiction is considered an important public health problem. The risk of smoking is more serious among pregnant women. Pneumonic plague is the most serious clinical type of plague. Population pyramid of developed countries is characterized by narrow base. 6. Physical activity is important in prevention of non-communicable diseases. 7. Coliform bacteria are the organisms of choice to indicate fecal examination in the routine water examination. 8. Pre-placement medical examination is important in industrial workers. 9. Premature infants are at risk of iron deficiency anemia. 10. People living in oasis are suffering more from iodine deficiency disorders.

II-Choose the correct answer from the followings:

(20 Marks)

1. Impact evaluation of health program refers to:

a. The extent to which the program implementation complies with program plan. b. The long term outcome of the program. c. Assessment of the obtained results. Delayed puberty should be evaluated if there is no sign of puberty by the age of: a. 14 years. b. 16 years. c. 20 years. Lung cancer is more frequent with occupational exposure to: a. Free silica dust. b. Asbestos. c. Coal dust. The most common hospital acquired infection is: a. Surgical site infection b. Urinary tract infection. c. Lower respiratory tract infection. d. Skin infection. The cut-of point of Hg for diagnosis of anemia among pregnant female is: a. 11 gm./dl b. 12 gm./dl c. 13 gm./dl Which of the followings is reversible eye manifestation of vitamin “A” deficiency: a. Bitot’s spots. b. Night blindness. d. Xenophthalmia. The following food poisoning is caused by infection: e. Salmonella food poisoning f. Staphylococcal food poisoning. g. Botulism. The international incubation period for cholera is: a. 5 days. b. 6 days.

c. 2-5 days. 9. For prevention of puerperal sepsis the following should be done: a. Good antenatal care. b. Sanitary environment for delivery. c. Chemoprophylaxis. d. All of the above. 10. The psychoactive component in tobacco is: a. Carbon monoxide. b. Tar. c. Nicotine. d. All of the above. 11. The most common complications of pertussis result from: a. Toxemia. b. Secondary bacterial infections. c. Increased intracavitary pressure. d. Repeated vomiting. 12. All of the followings are advantages of the health care system in Egypt EXCEPT: a. An extensive infrastructure of physicians, clinics and hospitals. b. 40% of the population has formal coverage. c. Physical accessibility to health care is available to all citizens. d. Availability of immunizations and medical technology. 13. The commonest route of entry of tetanus in newborn is: a. Injury. b. Umbilical cord. c. Ear. d. All of the above. 14. The skin rashes are infectious in case of: a. Measles. b. German measles. c. Chickenpox. 15. Which of the following persons are most at risk for AIDS infection: a. Street children. b. Injecting drug abusers. c. Infants born to infected mother. 16. The main source of meningococcal meningitis is: a. Carriers.

b. Clinical cases. c. Inanimate sources. 17. Testing blood donors is important for prevention of: a. Hepatitis B virus infection. b. Hepatitis C virus infection. c. HIV/AIDS infection. d. All of the above diseases. 18. The most serious complication of mumps in adolescents: a. Orchitis. b. Myocarditis. c. Aseptic meningitis. 19. Hepatitis A vaccine is recommended in all types of the following groups EXCEPT: a. Children prior to 1 year of age. b. Day care providers. c. Food handlers. d. Travelers to an endemic area. 20. The objectives of geriatric health program is: a. Add years to life. b. Add healthy life to the years. c. Both (a) and (b). d. None (a) none (b).

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Malaysian Students (September, 2013) Time: (3) Hours.

Total Marks: (150)

Number of questions: 6 questions in 5 pages

I-Answer the following questions:

(60 Marks)

1. 2. 3. 4.

Mention types and public health importance of carriers. Discuss causes of maternal mortality and how to control. Give short account about methods of population estimation. Discuss risk factors and nutritional education messages for patients with diabetes mellitus. 5. Discuss hazards of exposure to ionizing radiation. 6. Discuss risk factors of cancer.

II-Mention: 1. 2. 3. 4.

Types of screening tests for school children. Characteristics of morons. General preventive measures for occupational diseases. Specific preventive measures for: e. Measles. f. Typhoid fever. 5. Mode(S) of transmission and reservoir of infection of: e. Human deficiency virus (HIV). f. Meningitis.

(20 Marks)

II-Enumerate:

(20 Marks)

1. Two benefits for notification of infectious diseases. 2. Two risk groups for hypertension. 3. Two common sites for nosocomial infection. 4. Two occupations in which workers are at risk of exposure to silica. 5. Two indications for full liquid diet. 6. Two indications for high protein diet. 7. Two personal factors indicating high risk pregnancy. 8. Two motives for high fertility. 9. Two characters of safe food. 10. Two re-emerging diseases. II-Define: 1. 2. 3. 4. 5.

Quarantinable disease. Crippled child. Epidemic. Ex-smoker. Herd immunity.

II-Explain why: 1. 2. 3. 4. 5.

(10 Marks)

(20 Marks)

Elderly are considered vulnerable group. Isolation of cases of brucellosis is not needed. Drug addiction is considered a social problem. Pneumonic plague is the most serious clinical type of plague. Population pyramid of developing countries is characterized by narrow apex. 6. Physical activity has an important role in prevention and management of obesity. 7. Global warning may carry both benefits and hazards to human being. 8. Pre-placement medical examination is important for industrial workers. 9. Premature infants are at risk of iron deficiency anemia. 10. Prevalence of goiter among adolescent females is used as indicator for iodine deficiency disorders.

II-Choose the correct answer from the followings:

(20 Marks)

1. Factors affecting planning are:

a. Public opinion and attitude. b. Needs and demands. c. Availability of resources. d. All of the above. The adolescent mortality rate has been closely linked to: a. Injuries and cancer. b. Cardiovascular diseases and diabetes. c. Sex related diseases. Fibrotic diseases of the lung include all the following EXCEPT: a. Silicosis. b. Bysinosis. c. Asbestosis. d. Anthracosis. Severe muscle wasting is evident more in the case of: a. Marasmus. b. Kwashiorkor. c. Stunting. The cut-of point of Hg for diagnosis of anemia among pregnant female is: a. 11 gm./dl b. 12 gm./dl c. 13 gm./dl Which of the followings is reversible eye manifestation of vitamin “A” deficiency: a. Bitot’s spots. b. Night blindness. d. Xenophthalmia. The following food poisoning is caused by infection: a. Salmonella food poisoning b. Staphylococcal food poisoning. c. Botulism. The international incubation period for cholera is: a. 5 days. b. 6 days. c. 2-5 days.

9. For prevention of puerperal sepsis the following should be done: a. Good antenatal care. b. Sanitary environment for delivery. c. Chemoprophylaxis. d. All of the above. 10. The psychoactive component in tobacco is: a. Carbon monoxide. b. Tar. c. Nicotine. d. All of the above. 11. The most common complications of pertussis result from: a. Toxemia. b. Secondary bacterial infections. c. Increased intracavitary pressure. d. Repeated vomiting. 12. All of the followings are advantages of the health care system in Egypt EXCEPT: a. An extensive infrastructure of physicians, clinics and hospitals. b. 40% of the population has formal coverage. c. Physical accessibility to health care is available to all citizens. d. Availability of immunizations and medical technology. 13. The commonest route of entry of tetanus in newborn is: a. Injury. b. Umbilical cord. c. Ear. d. All of the above. 14. The skin rashes are infectious in case of: a. Measles. b. German measles. c. Chickenpox. 15. Which of the following persons are most at risk for AIDS infection: a. Street children. b. Injecting drug abusers. c. Infants born to infected mother. 16. The main source of meningococcal meningitis is: a. Carriers. b. Clinical cases.

c. Inanimate sources. 17. Testing blood donors is important for prevention of: a. Hepatitis B virus infection. b. Hepatitis C virus infection. c. HIV/AIDS infection. d. All of the above diseases. 18. The most serious complication of mumps in adolescents: a. Orchitis. b. Myocarditis. c. Aseptic meningitis. 19. Hepatitis A vaccine is recommended in all types of the following groups EXCEPT: a. Children prior to 1 year of age. b. Day care providers. c. Food handlers. d. Travelers to an endemic area. 20. The objectives of geriatric health program is: a. Add years to life. b. Add healthy life to the years. c. Both (a) and (b). d. None (a) none (b).

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students Time: (90) Minutes.

Total Marks: (50) All Questions should be answered

I-Enumerate: 1. 2. 3. 4. 5.

(5 Marks)

Patterns of spread of communicable diseases. Occupational diseases related to organic dust exposure. Effects of Global warming. Using of population census data. Morbidity rates (Statistics).

II-Give reasons for the following:

(5 Marks)

1. Mild infectious disease cases might be hazardous compared to severe cases. 2. Fibrotic lung diseases (Pneumoconiosis) are mostly related to small size dust particles (1-5 microns). 3. Low fluoride content of portable water is as hazardous as high fluoride content. 4. Birth rates are usually high in developing countries. 5. Nitrites should be nil in potable water sample.

III-Give (2) examples for each of the following: 1. Vehicles of infection. 2. Vectors transmitting infections to human. 3. Bimodal transmission of infectious diseases. 4. Reservoirs of infection. 5. Herd immunity. 6. Occupational infection. 7. Occupational hazards related to exposure to wool dust. 8. Artificial immunization. 9. Water-borne viral infections. 10.High fertility moves.

(10 Marks)

IV-Choose the correct answer:

(10 Marks)

Infants may be borne with temporary trans-placental immunity to the following diseases EXCEPT: a. Measles. b. Diphtheria. c. Mumps. d. TB. 2. Attacks of one of the following infectious diseases lead to solid immunity EXCEPT: a. Measles. b. Gonorrhea. c. Smallpox. d. Mumps. 3. The following can be transmitted with direct droplet infection EXCEPT: a. Mumps. b. Varicella. c. Measles. d. Yellow fever. 4. The following manifestations of chronic lead poisoning EXCEPT: a. Anorexia. b. Blue grey line on gums. c. Peripheral neuritis. d. Bilateral wrist and foot drop. 5. Acute effects (hazards) of chemical air pollution include the following EXCEPT: a. Carbon monoxide poisoning. b. Hypersensitivity reactions of respiratory passages. c. Lead and mercury poisoning.

V-Give short accounts on:

(15 Marks)

1. Naturally acquired immunity. 2. Significance of nasopharyngeal swapping for meningococcus. 3. Control of mumps.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students 1st group & Group A Malaysian Students 25/5/2013 Time: (90) Minutes.

Total Marks: (50) All Questions should be answered

I-Answer the following questions:

(20Marks)

1. Discuss: indirect modes of disease transmission. 2. Discuss: prevention measures applied to contacts of infectious case to prevent spread of infection. 3. Give short notes on objectives and items of tuberculosis survey. 4. List vaccines against typhoid fever and mention efficacy of each of them and indications for vaccination. 5. Explain why sexually transmitted diseases constitute a major public health problem of special priority.

II-Mention: 1- Reservoir (s) of infectious and mode (s) of transmission of the following diseases: (6 marks) a. Yellow fever. b. Rift valley fever. c. Brucellosis. d. Swine influenza. 2- Period of infectivity of: (4 marks) a. Hepatitis B virus infection. b. Measles. c. Chickenpox. d. Hepatitis A virus infection.

III-Choose the correct answer:

(20 Marks)

1. Reservoir of infection of measles is: a. The case. b. The carrier. c. Both case and carrier. 2. Solid immunity is acquired after vaccination against: a. Measles. b. Poliomyelitis. c. Typhoid fever. 3. The most dangerous complication of German measles is: a. Encephalitis. b. Pneumonia. c. Orchitis. d. Unfavorable pregnancy outcomes. 4. The most common complications of pertussis result from: a. Toxemia. b. Secondary bacterial infection. c. Increased intracavitary pressure. d. Repeated vomiting. 5. The main source of infection in case of meningococcal meningitis is: a. Carriers. b. Cases. c. Both. 6. From the epidemiological point, the most important clinical type of plague is: a. Bubonic plague. b. Pneumonic plague. c. Septicemic plague. 7. Meningococcal vaccine type is: a. Live attenuated. b. Killed. c. Polysaccharide. d. Toxoid.

8. The trend of carrier is increasing all over the world due to: a. Better diagnosis. b. Increase life expectancy. c. Better reporting. d. All of the above. 9. Which of the following cancers can be prevented by vaccination: a. Lung cancer. b. Hepatocellular cancer. c. Breast cancer. d. Cancer bladder. 10.Reason for increase of non-communicable diseases include all of the followings EXCEPT: a. Decrease in the life expectancy in Egypt. b. Increase incidence of traffic injuries. c. Tobacco addiction. d. Lack of physical activity and sedentary life. 11.Difficulties facing control of Diabetes Mellitus include: a. Defective health education programs. b. Absent screening strategy. c. Nutritional trends (70% of the Egyptians diet depends on carbohydrate). d. All of the above. 12.Cancer promoting agents in cigarette smoke is: a. Nicotine. b. Tar. c. Carbon monoxide. 13.Habituation to a drug differs from addiction in that the drug has not produce: a. Physical dependence. b. Psychological dependence. c. Both of the above. 14.Accident-proneness is usually due to: a. Impaired psychological makeup and behavior. b. Impaired physical condition. c. Both factors.

15.The most common reason for recurrence of gonorrheal infection is: a. Improper treatment. b. Short lived antibodies. c. Untreated infected sexual partner. 16.The commonest cause of death among middle aged women all over the world is: a. Improper treatment. b. Breast cancer. c. Cancer uterus. d. Cardiovascular diseases. 17.The most recent emerging disease is: a. SARS. b. AIDS. c. Pathogenic Escherichia coli. 18.Current adult smokers are people who smoke at least: a. 100 cigarettes in their lives. b. 50 cigarettes in their lives. c. 150 cigarettes in their lives. 19.Among blood borne infections in health care facilities, the following is the most infectious: a. Hepatitis A virus. b. Hepatitis C virus. c. HIV. 20.The most serious complication of diabetes mellitus: a. Peripheral poly neuropathy. b. Atherosclerosis. c. Diabetic foot.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam (Old System) for the 4th academic year Medical Students (Sept, 2013) Time: (2) Hours.

Total Marks: (78) Answer the following Question:

1. Discuss: a. Causes of maternal mortality and how to control. (10 marks) b. Causes and impact of protein energy malnutrition on children. (10 marks) 2. Mention: a. Direct causes of infant mortality. (5 marks) b. Characters of morons. (5 marks) c. Screening tests used for school children. (5 marks) d. Vaccination for adolescents. (5 marks) 3. Explain why: a. School children are more susceptible for infectious diseases. (6 marks) b. Women are not allowed printing and painting industries. (6 marks) c. Population pyramid of Egypt has a narrow apex and wide base. (6 marks) 4. Give short account on: a. Characters of potable water. (5 marks) b. Hazards of exposure to cotton dust. (5 marks)

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam (Old System) for the 4th academic year Medical Students (Sept, 2013) Time: (2) Hours.

Total Marks: (78) Answer the following Question:

1. Discuss the following: (30 marks) a. Types of carriers and their importance. b. Risk factors for type II diabetes mellitus and health education messages for a diabetic patient. c. Primary and secondary preventive measures of cancer. 2. Mention: (18 marks) a. Specific preventive measures for Typhoid fever. (5 marks) b. Modes of transmission of human immunodeficiency virus (HIV). (5 marks) c. Reservoirs of infection of: (4 marks) a. Yellow fever. b. Rabies. d. Complications of: (4 marks) a. Whooping cough. b. Mumps. 3. Enumerate: (10 marks) a. Two values of notification of infectious diseases. b. Two risk groups that should be screened for diabetes. c. Two risky groups for salmonella food poisoning. d. Two risky groups for pulmonary tuberculosis. e. Two of the Quarantinable diseases.

4. Explain why?: (20 marks) a. Egypt is considered a receptive area for yellow fever. b. Pneumonic plague is the most serious clinical type of plague. c. Vitamin A is given compulsory to infants with the immunization schedule. d. High fibrous diet is indicated for elderly.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2012) Time: (3) Hours.

Total Marks: (150) Answer the following Question:

1. Give short notes on: (35 marks) a. Characters of milk-borne epidemic. b. Vaccination during pregnancy. c. Accidents in rural communities. d. Secondary prevention of rheumatic fever and for how long. e. Health care services for pre-school children. (mention five) f. Problems associated with breast feeding. g. Dietary manifestations in hypertension. 2. Explain why: (25 marks) a. Elderly group are considered a special vulnerable group. b. DOTS was recommended by WHO for management of TB and mention its main criteria. c. Smoking is an important risk factor for coronary heart diseases. d. A married male who got gonorrhea through an extra marital relation suffered from relapse after successive treatment. e. A child suffered from measles although he received measles vaccine. 3. Mention modes of transmission of the following diseases: (20 marks) a. HIV infection. b. Yellow fever. c. Brucellosis. d. Tetanus.

4. Mention methods of prevention of the following diseases: (15 marks) a. Mental handicapping. b. Cholera. c. Occupational anthrax. 5. Enumerate: (30 marks) a. Screening tests among school children. b. Complications of pertussis. c. High risk groups for typhoid fever. d. Predisposing factors for type II diabetes mellitus. e. Causes of maternal mortality. f. Risk factors for iron deficiency anemia. 6. Give definitions of the following : (10 marks) a. High risk pregnancy. b. Neonatal mortality rate. c. Mental health. d. An epidemic. 7. Case study: (15 marks) a. An adult male came to you with results of investigations of premarital counseling showing that the future wife has a positive test result of hepatitis B surface antigen. They arranged for wedding next month. He was worried if she has any disease that may be transmitted to him and his future children. I. Whatâ&#x20AC;&#x2122;s the explanation of this test result? (2 marks) II. What were your recommendations to him concerning his worries? (8 marks) b. 27 years old married male has confirmed to have HIV infection. He is worried that he may infect his wife and his three young children. What will you do for the wife and children? (5 marks)

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (Sept, 2012) Time: (3) Hours.

Total Marks: (150) Answer the following Question:

1. Enumerate: (18 marks) a. Components of reproductive health program. b. Types of immunity. c. Factors affecting nutritional problems in old age. 2. Explain why: (32 marks) a. Cases of gonorrhea appear more frequently at STDs clinics than syphilis. b. Tetanus toxoid is the only recommended vaccine to pregnant woman. c. DPT vaccine is replaced by DT on school entry. 3. Give short account on: (40 marks) a. Reservoirs, methods of transmission, incubation period and period of infectivity of cholera. b. Benefits of breast feeding. c. Management of overpopulation problem. d. General functions and uses of vitamins. 4. Mention methods of prevention of the following diseases: (30 marks) a. HIV/AIDS. b. Meningococcal meningitis. c. Typhoid.

5. (30 marks) a. Give a health education message for a patient having non-insulin dependent diabetes mellitus. b. What are measures of prevention of occupational dust diseases? c. What are chemical standards of potable water?

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2011) Time: (3) Hours.

Total Marks: (150) Answer the following Question:

1. Discuss shortly: (40 marks) a. Chemical quality of safe potable water. b. Dietary management of obese non-insulin dependent (type II) diabetes. c. Different grades of bysinosis. d. Hazards of chemical air pollution. e. Infection control measures applied to personnel. 2. Give an account on each of the following: (40 marks) a. Secondary preventive measures of psychotic drug abuse. b. Steps of health care waste management. c. Preventive measures of communicable diseases among school children. d. Etiological factors of mental handicaps. 3. Enumerate: (20 marks) a. Two determinants of priority. b. Two preventive measures of puerperal sepsis. c. Two measures for lowering maternal mortality. d. Two etiological factors for delicate children. e. Two health hazards of prematurity. f. Two consequences of vitamin (A) deficiency. g. Two preventive natal care measures for mother. h. Two deferential diagnosis items for silicon TB from TB. i. Two characteristics of population pyramid in Egypt. j. Two neonatal causes of mortality.

4. Mention reservoir(s) of infections and mode(s) of transmission of the following diseases: (20 marks) a. Rift valley fever. b. Salmonella food poisoning. c. Dangue fever. d. Botulism. e. Influenza. f. Meningitis. g. Plague. h. Avian (Bird) flu. i. Yellow fever. 5. Give reason for the following: (10 marks) a. Surgical wound infection is the second most common nosocomial infection. b. Rheumatic fever has special social importance.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (August, 2011) Time: (3) Hours.

Total Marks: (150) Answer the following Question:

1. Discuss shortly: a. Health hazards of cooling power of the air. b. Iodine deficiency disorders (IDD) as an important nutritional health problem. c. Clinical and radiological stages of silicosis. d. Health hazards of physical pollution of air by radiation. e. Malnourishment is a common maternal health problem. 2. Give an account on each of the following: a. Control measures of plague when cases appear in a free area. b. Health hazards due to defects of potable water standard quality. c. Appraisal of health status (physical, mental, emotional and social) of school children. d. Types of physical handicaps. 3. Enumerate: a. Two questions that guide the collection of information in progress evaluation. b. Two postpartum risk signs if pregnancy. c. Two methods for tracing of nosocomial infection as an infection control measure. d. Two metabolic effects of fever leading to certain dietary considerations. e. Two preventive measures of dust diseases applied for workers. f. Two characteristics of iron deficiency anemia. g. Two basic phases of secondary treatment of water waste. h. Two treatment items of cases of Anthracosis.

i. Two hazards of overpopulation in Egypt on family. j. Two aims of investigations of nosocomial infection outbreak. 4. Mention reservoir(s) of infections and mode(s) of transmission of the following diseases: a. Meningitis. b. Tuberculosis. c. Acquired immunodeficiency syndrome (AIDS). d. Poliomyelitis. e. Rabies. 5. Mention the preventive measures of the following diseases: a. Influenza. b. Cholera. c. Tetanus. d. Measles. e. Rabies (post exposure with previous vaccination). 6. Give reasons for the following: a. Nosocomial infection has special public health importance. b. Segregation of school health children as a control measure of mumps is not required.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students (2nd group) 24/11/2012 Time: (90) Minutes.

Total Marks: (50) All Questions should be answered

1. Answer the following questions:

(20 Marks)

a. Differentiate between reservoir and source of infection. Discuss carriers as a source of infection. b. Mention primary preventive measures that could be applied for protection of susceptible host. c. What are the common organisms that cause food poisoning? How to differentiate between them from clinical manifestations. d. Discuss blood precautions for protection from food borne infections. e. Discuss why tuberculosis is considered a social disease.

2. Mention:

(10 marks)

a. Mode(s) of transmission of: 1. Brucellosis 2. Yellow fever. 3. Plague. 4. HIV/AIDS. b. Period of infectivity of: 1. Measles. 2. Whooping cough. 3. Mumps. 4. Hepatitis A viral infection.

3. Choose the correct answer:

(20 marks)

1. Vaccines must be stored in refrigerator at a constant temperature between: a. 5⁰C - 0⁰C. b. 20⁰C – 25⁰C. c. 2⁰C - 8⁰C.

2. When the cold-chain is disturbed: a. Vaccines may become toxic. b. Vaccines may lose their effectiveness. c. No change in vaccine potency occurs. 3. Which of the following variables is considered a continuous variable: a. Respiratory rate. b. Weight. c. Number of bed in a hospital. d. Number of visits of pregnant woman to MHC center. 4. Shaking is proper method to check the validity of: a. DPT vaccine. b. BCG vaccine. c. MMR vaccine. 5. BCG vaccine is given: Intramuscular. Intradermal. Subcutaneous. Intravenous. 6. All are true about MMR vaccine EXCEPT: a. Gives the same result as that of individual measles, mumps and rubella vaccines. b. Living attenuated vaccine. c. Kept at (2-8) â °C or colder. d. Recommended to pregnant female to prevent congenital rubella syndrome. 7. Salk vaccine is given to infants: a. Intramuscularly. b. Subcutaneously. c. Orally. 8. Non-probability sample include the following EXCEPT: a. Quota sample. b. Accessibility sample. c. Cluster sample. d. Purposive sample. 9. Simple random sample has the following characteristics EXCEPT: a. Each selected unit has an equal chance of being selected. b. The population should be heterogenous.

c. Each unit is selected independent of the other. d. A sample frame must be present to choose the needed unit from it. 10.A sample of 99 distances has a mean of 24 feet and a median of 24.5 feet. Unfortunately, it has just been discovered that an observation which was erroneously recorded as “30” actually had a value of “35”. If we make this correction to the data, then: a. The mean and the median remain the same. b. The median remains the same, but the mean is increased. c. The mean and the median are both increased. 11.Vaccines are stored in the local health unit for a period of: a. 1-2 days. b. 1-2 months. c. 1-2 years. 12.Which of the following vaccines is not destroyed by freezing: a. Salk. b. Measles. c. DPT. 13.The best measure of central tendency is: a. The mean. b. The range. c. The median. 14.In a stratified random sample, we select from: a. Heterogeneous population. b. Homogenous population. c. Both types. 15. Among the variables that could not be measured by ordinal scale is: a. Weight. b. Height. c. Sex. d. All variables. 16.Measles vaccine is not given in the 1st 6 months of life because: a. Presence of maternal antibodies against measles. b. Maternal antibodies interfere with vaccine virus. c. Both factors. 17.Infants with immunodeficiency should not vaccinated with: a. DPT vaccine. b. Hepatitis B vaccine.

c. BCG vaccine. 18.The typical characteristic of the rash of chickenpox is: a. Vesicle. b. Pleomorphic. c. Pustule. d. Itching. 19.The common route of entry of tetanus in newborn is: a. Injury. b. Umbilical cord. c. Ear. d. All of the above. 20.The skin rashes are infectious in case of: a. Measles. b. German measles. c. Chickenpox.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2010) Time: (3) Hours.

Total Marks: (150) Answer the following Question:

1. Discuss briefly each of the followings: (50 marks) a. Dietary modifications in cases of liver cirrhosis. b. Health hazards of tobacco smoking. c. Indices of pulmonary tuberculosis. d. Mental handicaps: definition, etiology and prevention. e. Prematurity: predisposing factors, hazards and management. 2. Give short notes on each of the following: (50 marks) a. Differences between asbestosis and silicosis. b. Health care waste: hazards and management. c. Home accidents forms, predisposing factors and prevention. d. Maternal mortality: definition, causes and measures for lowering it. e. Non pathological risk factors for coronary heart disease. 3. Mention period of infectivity for each of the following diseases: (10 marks) a. AIDS. b. Hepatitis A virus infection. c. Measles. d. Poliomyelitis. 4. Mention reservoir(s) of infections and mode(s) of transmission of the following diseases: (20 marks) a. Botulism. b. Rift valley fever. c. Tetanus. d. Typhoid.

5. Enumerate two for each of the followings: (20 marks) a. Arthropod borne hemorrhagic viral diseases. b. Aspects of evaluating health program performance. c. Characteristics of milk borne outbreak. d. Characteristics of population pyramid of Egypt. e. Complications of cerebrospinal meningitis. f. Effects of global warming. g. Fertility indices. h. Health hazards of obesity. i. Most common causes for mortality among adolescents. j. Objectives of antenatal care.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students May 2010 Time: (90) Minutes.

Total Marks: (50) All Questions should be answered

1. Discuss briefly each of the following: a. b. c. d. e.

(20 Marks)

Differentiate Primary prevention of communicable diseases. (8 marks) Avian influenza: public health importance and methods of transmission. (8marks) Causative agent and prevention of yellow fever. (8marks) Adverse effects of psychoactive drug abuse. (8 marks) Describe two methods of epidemiological study. (8 marks)

2. Choose the correct answer:

(20 marks)

1. Non probability sample includes the following except: a. Quota sample. b. Accessibility sample. c. Cluster sample. d. Purposive sample. 2. An occupational disease is: a. Outcome of prolonged exposure to harmful agent in work environment. b. Outcome of stress condition sin work environment. c. Outcome of exposure to any agent in work environment. d. All of the above. 3. Hepatitis â&#x20AC;&#x153;Bâ&#x20AC;? vaccine is compulsory in Egypt for: a. School children. b. At risk groups. c. Infants. d. Adolescents females. 4. Surveillance is indicated to: a. Ensure good treatment. b. Ensure good prognosis.

c. Detect any signs or symptoms. d. Determine the period of treatment. 5. The following diseases can be transmitted by multiple modes of transmission: a. Brucellosis. b. Meningitis. c. Poliomyelitis. d. Tuberculosis. 6. Absolute immunity is known for: a. Mumps. b. Measles. c. Poliomyelitis. d. German measles. 7. All are communicable diseases Except: a. Rheumatic fever. b. Chickenpox. c. Poliomyelitis. d. Avian flu. 8. Herd immunity acquired among population a given community is related to: a. Severity of the infectious disease. b. Availability of vaccine on large scale. c. Endemicity of naturally occurring infection. d. Virulence of the organisms. 9. Infection indices of TB: a. Percentage of tuberculin test reactors among vaccinated persons in a survey. b. Percentage of tuberculin test reactors among unvaccinated persons in a survey. c. Percentage of tuberculin test nonreactors among unvaccinated person in a survey study. d. None of the above. 10.The following vitamins act as antioxidants Except: a. Vitamin A. b. Vitamin C. c. Vitamin D. d. Vitamin B.

3. Mark true or false on each of the following statements: (10 marks) 1. Case findings means: to be put under observation to detect signs and symptoms. 2. The first step on investigating an epidemic is to demonstrate the existence of the epidemic. 3. WHO has set a cure rate of 100% through DOTS strategy for TB. 4. If the individual remains infected for few weeks, he is called transient carrier. 5. Immunization given during antenatal period is MMR. 6. Case control study is costly and time consuming. 7. Antibiotics should be given to every case of dysentery. 8. Pattern of spread of avian influenza among human in Egypt is epidemic. 9. On the control of water borne epidemic, cases stop completely. 10.Hormonal replacement therapy at menopause is an example of secondary prevention.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students June 2009 Time: (90) Minutes.

Total Marks: (60) All Questions should be answered

1. Give short account on:

(30 Marks)

a. Natural acquired passive immunity. b. Cases and magnitude of the problem of iron deficiency anemia in Egypt. c. Occupational accidents. d. Brucellosis as an occupational disease. e. Dietary management of a case of hypertension. f. Pulmonary tuberculosis is considered a social disease.

2. Explain why?

(5 marks)

1. Protein from meat is considered a complete protein. 2. There is no second typical attack of measles. 3. Vaccination of woman with MMR vaccine is recommended to be postpartum. 4. New born infants are usually susceptible to tuberculosis infection and are not susceptible to measles. 5. Water soluble vitamins must be consumed daily.

3. Enumerate:

(10 marks)

1. Two indications for vaccination by TAB vaccine in endemic areas. 2. Two indications of clear liquid diet. 3. Two indications for dietary supplementation of diabetic patients. 4. Two risk factors for surgical wound infection. 5. Two types of dust that cause pulmonary fibrosis.

4. Define: 1. Surveillance. 2. Carrier. 3. Nosocomial infection. 4. Reference man. 5. Screening test.

(5 marks)

5. Choose the correct answer from the following:

(5 marks)

1. The skin rashes are infectious in the case of: a. Measles. b. German measles. c. Chickenpox. 2. The commonest for of nosocomial infection is: a. Urinary tract infections. b. Surgical wound infection. c. Lower respiratory tract infection. 3. The following form of food poisoning is considered infection not intoxication: a. Salmonella food poisoning. b. Staphylococcal food poisoning. c. Botulism. 4. The disease with no carrier state is: a. Measles. b. Meningococcal meningitis. c. Diphtheria. 5. Salk vaccine is given: a. Intramuscularly. b. Subcutaneously. c. Orally. 6. The vaccine that is given through intradermal injection is: a. Salk. b. MMR. c. BCG. 7. The vaccine which is not destroyed be freezing is: a. Salk. b. Sabin. c. DPT. 8. The accepted duration of vaccines in the regional sores is: a. 1-3 weeks. b. 1-3 months. c. 2 years or till expiry date.

9. Which of the following conditions is not a contraindication for vaccination of infants: a. Immuno-compromised. b. Those children with hyperthermia above 40 C. c. Those with minor illness as cold. 10. Infants with immunodeficiency should not be vaccinated with: a. DPT. b. Hepatitis B vaccine. c. BCG.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2009) Time: (3) Hours.

Total Marks: (150) Answer the following Question:

1. Give short account on: (40 marks) a. Chemoprophylaxis for prevention of cholera. b. Prevention of communicable diseases among school children. c. Indications for combined Seroprophylaxis and vaccination in cases of hepatitis B virus infection. d. Chemical agents in cancer etiology. 2. Discuss shortly: (40 marks) a. Sex is a risk factor for coronary heart diseases. b. Prevention of neonatal tetanus. c. The most effective agents in tobacco smoke causing or promoting disease d. Prematurity: definition, causes and health hazards. e. Accidents in rural community. 3. Define: (10 marks) a. Drug addiction (give examples). b. Reproductive health. c. Case fatality rate. d. Yellow fever receptive areas. 4. Mention reservoir(s) of infections and mode(s) of transmission of the following diseases: (20 marks) a. Rift valley fever. b. Gas gangrene. c. Rabies. d. Plague.

5. Mention period of infectivity in case of the following diseases: (20 marks) a. Typhoid fever. b. Measles. c. Hepatitis â&#x20AC;&#x153;Câ&#x20AC;? virus infection. d. AIDS. 6. Enumerate: (20 marks) a. Two complications of German measles. b. Two criteria for diagnosis of bulimia nervosa. c. Two indications for post exposure immunization against rabies. d. Two objectives for pre-marital care. e. Two direct causes for maternal mortality. f. Two factors that help successful initiation of breast feeding. g. The most common causes of mortality among adolescents. h. Two characteristics of mentally healthy individual. i. Two measures for prevention of occupational dermatosis. j. Two drugs that cause addiction. 7. Give reason for: (10 marks) a. Dietary fiber is an important component in the diet of healthy individuals. b. A case of meningococcal meningitis can be released from isolation once clinically free. c. Wide base of population pyramid of Egypt. d. Coliform organisms are a satisfactory index of the bacterial quality of water.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2008) Time: (3) Hours.

Total Marks: (96) Answer the following Question:

1. Give short account on each of the following: (24 marks) a. Mortality statistics. b. Occupational accidents. c. Risk factors for cancer. 2. Discuss briefly each of the following: (24 marks) a. Health risks and management of obesity. b. Surveillance; objectives, cycles and characteristics. c. Health hazards of chemical pollution. 3. Give short notes on modes of transmission and prevention of: (24 marks) a. Plague. b. Meningococcal meningitis. c. Rabies. 4. Discuss the public health importance of: (24 marks) a. HIV/HCV co-infection. b. Health education. c. School children and their screening tests.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2007) Time: (3) Hours.

Total Marks: (96) Answer the following Question:

1. Give short account on each of the following: (24 marks) a. Differences of asbestosis from silicosis. b. Maternal mortality: causes and measures for lowering it. c. Risk factors for coronary heart diseases. 2. Discuss briefly each of the following: (24 marks) a. Chemical carcinogens. b. Pattern of spread of communicable diseases. c. Types of physical handicaps. 3. Give short notes on modes of transmission and prevention of: (24 marks) a. Hepatitis â&#x20AC;&#x153;Bâ&#x20AC;? viral infection. b. Nosocomial infection. c. Yellow fever. 4. Discuss the public health importance of: (24 marks) a. Cold chain in primary health care. b. DOTS strategy for management of TB. c. Geriatric health program.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2006) Time: (3) Hours.

Total Marks: (96) Answer the following Question:

1. Give short account on each of the following: (24 marks) a. Forms of acquired immunity. b. Modes of transmission and prevention of Anthrax. c. Types of evaluation of public health program. 2. Discuss briefly each of the following: (24 marks) a. Constrains in the Egyptian health care program. b. Forms of diarrheal diseases in children. c. Types of samples in biostatistics. 3. Write short notes on the preventive aspects of the following: (24 marks) a. Nosocomial infection. b. Childhood physical handicaps. c. Diabetes mellitus. 4. Discuss the public health importance of: (24 marks) a. HIV/TB co-infection. b. Occupational health program. c. Psychoactive drug abuse.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students May 2006 Time: (90) Minutes.

Total Marks: (60) All Questions should be answered

1. Give an account on each of the following:

(30 Marks)

1. Procedures to study and investigate epidemic. 2. Micronutrient (iodine deficiency) disorders. 3. Rationale and components of DOTS strategy of TB control.

2. Discuss briefly: 1. Occupational dermatosis. 2. Strategies of poliomyelitis eradication. 3. Components of reproductive health program.

(30 marks)

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (August, 2006) Time: (3) Hours.

Total Marks: (96) Answer the following Question:

1. Give short account on each of the following: (24 marks) a. Passive immunization. b. Differences between asbestosis and silicosis. c. Elements of health program planning process. 2. Discuss briefly each of the following: (24 marks) a. Factors ensuring success of EPI in Egypt. b. Statistical indices used to measure population dynamics. c. Radiations as a source of environmental pollution. 3. Write short notes on the preventive aspects of the following: (24 marks) a. Meningococcal meningitis. b. Botulism. c. Breast cancer. 4. Discuss the public health importance of: (24 marks) a. HIV/HCV co-infection. b. Infant prematurity. c. School health screening tests.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students May 2005 Time: (90) Minutes.

Total Marks: (60) All Questions should be answered

1. Write short notes on:

(15 Marks)

1. Types of natural active acquired immunity. 2. Prevention and control of bysinosis.

2. Write an account on:

(15 marks)

1. Causes and health hazards of obesity. 2. Surveillance, isolation and segregation.

3. Write an account on: 1. Prevention and control measures of botulism. 2. Laboratory significance of HbaAg.

(15 marks)

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (May, 2005) Time: (3) Hours Answer the following Question:

1. Give short account on each of the following: d. Importance, procedures and components of cold chain. e. Causes, health hazards and management of infant prematurity. f. Case-finding prevention and control pulmonary TB. g. Types of eating disorders and discuss health problems and management of one of them. 2. Write short notes on each of the following: d. Forms and management of diarrheal diseases in children. e. Substance (drug) abuse and addiction as a social, economic, health problem and measures of prevention and control. f. Enumerate arthropod-borne hemorrhagic fevers and discuss preventive and control measures of one of them. g. Enumerate diseases caused by exposure to organic dust and discuss prevention and control measures of one of them.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students May 2005 Time: (60) Minutes.

Total Marks: (60) All Questions should be answered

1. Write short notes on:

(30 Marks)

1. Factors influencing antibody formation following active Immunization. 2. Prevention of diarrheal diseases in infants and children.

2. Write an account on:

(30 marks)

1. Polio vaccination and control in Egypt. 2. Clinical and laboratory assessment of the nutritional status and disorders of the community.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2004) Time: (3) Hours. Total Marks: (96) Answer the following Question:

1. Give short account on each of the following: (36 marks) a. Causes, health hazards and management of infants prematurity. b. Difference between Water-borne epidemics and milk-borne outbreaks. c. Types of evaluation used in public health program application. 2. Discuss briefly each of the following: (36 marks) a. Reservoir, modes of transmission and prevention of Gas gangrene. b. Drug-addiction as a social and economic health problem and recommended measures for prevention and control. c. Health hazards and management of obesity. 3. Write short notes on each of the following: (36 marks) a. Enumerate diseases transmitted by mosquitoes and discuss preventive and control measures of one of them. b. Enumerate diseases caused by exposure to mineral dust (pneumoconiosis) and discuss preventive and control measures of one of them.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students May 2003 Time: (60) Minutes.

Total Marks: (60) All Questions should be answered

1. Give an account on each of the following:

(30 Marks)

1. Types and public health importance of carriers. 2. Routes of infection with HIV. 3. Passive immunization.

2. Write an account on: 1. Isolation, segregation and quarantine. 2. Incidence and prevalence rates. 3. Laboratory diagnosis of HbsAg.

(30 marks)

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (June, 2003) Time: (3) Hours. Total Marks: (96) Answer the following Question:

1. Give short accounts on preventive measures of the followings: a. Childhood physical handicaps. b. Occupational dermatosis. c. Nosocomial infection. 2. Discuss in brief each of the following: a. Modes of transmission and prevention of HBV infection. b. Factors influencing population growth. c. Prevention of drug addiction. 3. Discuss the preventive aspects of each of the following: a. Ischemic heart diseases. b. Diabetes mellitus. c. Bronchial asthma. 4. Discuss the public health importance of: a. Antenatal care. b. Pre-placement medical examination. c. School health screening tests.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Final Exam for the 4th academic year Medical Students (Sept, 2003) Time: (3) Hours. Total Marks: (96) Answer the following Question:

5. Write short accounts on each of the following: d. Patterns of spread of communicable diseases. e. Post-exposure immunization against rabies. f. Indoor environmental pollution. 6. Discuss in brief each of the following: d. Indices of tuberculosis. e. Naturally acquired immunity. f. Differences between asbestosis and silicosis. 7. Provide short notes on each of the following: d. Group B hemolytic streptococcal infections. e. Preventive and control measures of botulism f. Types of evaluation of public health programs. 8. Discuss the hazards of each of the followings: d. Over-population. e. Over-weight. f. Tobacco smoking.

Tanta Faculty of Medicine Dept. of Public Health & Community of Medicine Mid-Year exam for the 4th academic year Medical Students Sept 2003 Time: (120) Minutes All Questions should be answered

1. Write short notes on each of the following:

(30 Marks)

4. Bulimia nervosa. 5. Sanitary requirements of housing. 6. Types of evaluation of health program performance.

2. Discuss briefly each of the followings: 1. Health hazards and management of prematurity. 2. Clinical picture and prevention of lead poisoning. 3. Special features of Geriatric illness.

(30 marks)

General Epidemiology 1- Give reason(s) for: 

Carriers of infectious diseases is the most important potential reservoir of infection. (midyear2014)  Mild infectious disease cases might be hazardous compared to severe cases. (midyear2013) 2- Define: Health, Public health & its concept, Epidemiology + objectives (Jun2013), an epidemic (Sep2013, Jun2012, midyear2006) 3- Pattern of spread of communicable diseases. )midyear2014,Aug2013, midyear2013) 4- Factors favoring infection ‘‘definition , sequel & favoring infection’’. 5- Infectious cycle definition, ‘‘components & short notes about each one’’. 6- Relation between severity of disease & infectivity. 7- Public health significance of carriers ‘‘def , types , public significance‘‘. (Jun2013, Sep2013, Jun2009, midyear2003) 8- Zoonosis “Def , Ex. & control”. (Jul2014, Sep2014) 9- Characters of causative agent. 10- Modes of diseases transmission “direct & indirect”. (midyear2013) 11- How food get contaminated? 12- Characters of water-borne epidemic. (Jun2014, midyear2013, Jun2004) 13- Characters of milk-borne epidemic. (Jun2012, Jun2010, Jun2004) 14- Classification of immunity. (Sep2012) 15- Natural immunity & factors affecting it “species, race, family &individual”. (midyear2005) 16- Passive acquired immunity “natural & artificial”. (midyear2013, Jun2009, Jun2006) 17- Herd immunity. (Aug2014, Sep2013, midyear2013) 18 -Factor influencing antibodies formation after active immunization. (midyear2005) 19- Sero-prophylaxis. (Aug2006, midyear2003) 20- 1ry prevention of communicable diseases. 21- International preventive measures. 22- Chemoprophylaxis. 23- Public Health Importance of notification. )Aug2013,Sep2013) 24- Public Health Importance of isolation. 24- Public Health Importance of disinfection. 25- Measures for control of contact. (midyear2013) 26- Differences between surveillance, segregation & isolation. (midyear2005, midyear2003) 27- Quarantine. (Aug2013, Sep2013) 28- 3ry prevention. 29- Epidemiological importance of incubation period. 30- Health education “Def & 2 Ex.”. (Jul2014, Jun2008) Reservoirs of infection (midyear2013) 31- Clinical forms of infectious disease cases. (Sep2014) 32- Vectors transmitting infections to human, Vehicles of infection. “2 Ex.” (midyear2014) 33- Define: Endemic disease. (Jun2013), Outbreak (Aug2013) 34- Two of the Quarantinable diseases. (Sep2013) 35- Infection control measures applied to personnel. (Jun2011)

36- Differentiate between reservoir and source of infection. Discuss carriers as a source of infection. (midyear2011) 37- Mention primary preventive measures that could be applied for protection of susceptible host. (midyear2011) 38- Naturally acquired immunity. (Sep2003)

Diseases of droplet infection 1- Give reason(s) for:    

DOTS strategy is recommended by WHO for T.B management.(Sep 2014,Jun2012) A child suffers from Measles although he received measles vaccine. (Jun2012) T.B as a social disease. (midyear2012,Jul2014) New born infants are usually susceptible to tuberculosis infection and are not susceptible to measles. (midyear2009)  There is no second typical attack of measles. (midyear2009)  Segregation of school health children as a control measure of mumps is not required. (Aug2011) 2- Define: Health, Public health & its concept, Epidemiology + objectives (Jun2013), an epidemic (Sep2013, Jun2012, midyear2006) 2- Causes, reservoir & mode of transmission of pulmonary T.B. (Aug2012, May2005) 3- Reinfection of T.B. 4- Mention uses of tuberculin testing & significance of its negative reaction. (Jun2013) 5- Specific prevention &control of T.B. 6- DOTS. (Jun2007, midyear2006) 7- T.B indices. (Jun2010) 8- Causes, reservoir, infectivity & mode of transmission of Measles. (midyear2013, midyear2012, Jun2010, Jun2009) 9- IP of Measles, Influenza, Mumps & Meningitis. 10- Specific protection against Measles. (Aug2012, Sep2013) 11- Contact control of Measles. 12- School Measles, Mumps &Meningitis control. 13- Causes, reservoir, infectivity & mode of transmission of Mumps. (Sep2014, midyear2012) 14- Pathognomonic features & complications of Measles & Mumps. (Sep2013) 15- Contact control of Mumps. (midyear2014, midyear2013) 16- Causes, reservoir, comp. & mode of transmission of Meningitis. (Sep2013, midyear2012, Aug2012, Jun2010, Jun2008) 17- Specific prevention of Meningitis. (Sep2012, Aug2006) 18- Specific protection against Mumps. (Aug2013) 19- Causes, reservoir, infectivity & mode of transmission of Influenza.(midyear2012) 20- Specific prevention of Influenza . (Aug2012, June 2014) 21- Differences between bird flu viruses & human flu viruses. 22- Emergence of ‘New viruses’ through antigenic shift & drift. 23- Public health importance of avian flu. 24- Causes, reservoir, infectivity, prevention & mode of transmission of avian flu. (Jul2014, midyear2012)

25- Give short note on Significance of nasopharyngeal swapping for meningococcus. (midyear2013) 26- Give short notes on objectives and items of tuberculosis survey. (midyear2013) 27- Reservoir (s) of infectious and mode (s) of transmission of Swine flu. (midyear2013) 28- TB risk group. (Sep2013) 29- Indications for vaccination by TAB vaccine in endemic areas. (midyear2009) 30- complications of German measles. (Jun2009)

Viral Hepatitis 1- Causes & sequel of hepatitis. 2- Causes & reservoir of HBV. 3- Mode of transmission of HCV, HBV. (Jun2007, Jun2003) 4- Complication of HBV. 5- What is the laboratory sig. of HBsAg? (midyear2005, midyear2003) 6- Prevention of HBV. “Specific prevention of HBV” (Jun2013, Jun2007, Jun2003) 7- Mention: Period of infectivity of: Hepatitis A virus infection,, Hepatitis A virus infection. (midyear2013, midyear2012, Jun2010, Jun2009) 8- Indications for combined Seroprophylaxis and vaccination in cases of hepatitis B virus infection. (Jun2009)

Contact& Sexually transmitted diseases 1- Public health sig. of STDs. (midyear2014, midyear2013) 2- Causes, reservoir, mode of transmission of AIDS. (Aug 2013, Sep 2013, Jun2013, Aug2012, midyear2012, midyear2003) 3- Stage of illness “range of infection” of AIDS. 4- Diagnose of AIDS. 5- Prevention of AIDS. (Sep2012) 6- Control of contact of AIDS. 7- Give definition and (2) examples for Sexually Transmitted Diseases (STDs). (Sep 2014) 8- Explain why sexually transmitted diseases constitute a major public health problem of special priority. (midyear 2013) 9- Explain why Cases of gonorrhea appear more frequently at STDs clinics than syphilis. (Sep2012) 10- Public health sig. of: HIV/TB co-infection. (Jun2006) HIV/HCV co-infection. (Jun2008, Aug2006) 11- Causes, reservoir & mode of transmission of Rabies. (Jun2009, Sep2013, Sep2014, Jun2008) 12- Prevention of Rabies. (Aug2012, Jul2014) 13- Post-exposure management of dog biting. 14- Post-exposure immunization of Rabies. (Sep2003) 15- Causes, reservoir & mode of transmission of Tetanus. (Jun2010, Aug2012, Jun2012, Jul2014) 16- Specific prevention of Tetanus. (Aug2012, Sep2014) 17- Prevention of neonatal Tetanus. (Jun2009) 18- Causes, reservoir & mode of transmission of Gas gangrene. (Jun2004, Jun2009)

18- Causes, reservoir & mode of transmission of Gas gangrene. (Jun2004, Jun2009) 19- Prevention of Gas gangrene. 20- Drastic measures when a case of Gas gangrene appear in hospital. 21- Mention two vaccines used against rabies. (Jun2013) 22- Modes of transmission and prevention of Anthrax. (Jun2006)

Arthropod borne diseases 1- Give reason(s) for:  

Egypt is considered a receptive area for yellow fever. (Jun2009, Sep2013) Pneumonic plague is the most serious clinical type of plague. (Sep2013, Aug2013, Jun2013)

2- Causes, reservoirs, vectors, mode of transmission of plague. (Jun2011, midyear2012, Jun2008) 3- Diagnose of plague “clinical & lab”. 4- Prevention & control of plague. (Jun2008) 5- Hg fevers. (Sep 2014, midyear2013, Jun2011, Jun2010, Jun2009, May2005) 6- Prevention of yellow fever.(midyear2010) 7- International sanitary regulations against yellow fever. 8- Mention mode of transmission & reservoir of yellow fever. (July 2014, midyear2013, Sep2013, Jun2012, Jun2011, midyear2012, Jun2009, Jun2007)

Nosocomial infection 1- Give reason(s) for:  

Nosocomial infection have a significant Public Health burden. (July2014, Aug2011) Surgical wound infection is the second most common nosocomial infection. (Jun2011)

2- Nosocomial infection classification. 3- Causes, reservoir & mode of transmission of nosocomial infection. (Jun2007) 4- Clinical forms of nosocomial infection. 5- Infection preventive control measures of nosocomial infection. (Jun2007, Jun2003) 6- Enumerate Two common sites for nosocomial infection. (Sep2013) 7- Give def. & 3 Ex. Of Nosocomial infection. (Sep2014) 8- Methods for tracing of nosocomial infection as an infection control measure. (Aug2011) 9- Aims of investigations of nosocomial infection outbreak. (Aug2011)

Non-communicable diseases 1- Give reason(s) for: 

Physical activity is important in prevention of non-communicable diseases.(Aug2013)

2- Predisposing factors & social impacts of Rh Fever. (Jun2011) 3- Prevention & control of Rh Fever. (Jun2012) 4- Risk factors of Hypertension. “1ry & 2ndry” 5- Prevention & control of hypertension. 6- Risk factors of ischemic heart diseases. (Jun2009, Jun2007) 7- Prevention of ischemic heart diseases. (Jun2003) 8- Risk factors of IDDM. 9- Personal risk factors of NIDDM. (Sep2013) 10- Diagnosis of DM. 11- Prevention & control of DM.(Jun2003) 12- Give short note on 2ndry prevention of Rh fever & for how long . 13- Enumerate predisposing factors of type II DM. (Jun2012) 14- Give a health education message for a patient having non-insulin dependent diabetes mellitus. (Jun2012) 15- Enumerate - Risk factors of: a- Coronary heart disease. b- Hepatocellular carcinoma. (July2014) 16- Enumerate Three preventable risk factors for each of the following: a- Coronary heart disease. (Jun2010) b- Breast cancer. (Sep2014, Aug2006) 17- Self-care and patient education messages for diabetic patients. (Feb2014, Sep2013) 18- Discuss primary and secondary preventive measures of cancer. (Aug2013, Sep2013) 19- Discuss risk factors of cancer. (Sep2013, Jun2008) 20- Enumerate Two risk groups for hypertension. (Sep2013) 21- Discuss risk factors and nutrition education messages for patients with cardiovascular disease. (Aug2013)

Global challenges & threats 1- Give definition and (2) examples for emerging infectious disease. (Jul2014) 2- Explain why some of the communicable diseases may re-emerge. (Sep2014) 3- Enumerate environmental factors behind emerging and re-emerging of infectious diseases. (midyear2014) 4- Discuss causes of emergence and re-emergence of infectious diseases. (Jun2013) 5- Enumerate Three of the health risks related to international travel. (Jul2014)

Important Public health problems 1- Give reason(s) for: Drug addiction is considered an important public health problem.(Aug2013,Jun2006)  Drug addiction is considered a social problem. (Sep2013)  The risk of smoking is more serious among pregnant women. (Aug2013)  Smoking is an important risk factor for coronary heart diseases. (Jun2012) 2- Epidemiology of Accidents. 3- Impact of accidents. 4- Classification of accidents 5- Risk factors, forms & prevention of home accidents. (Jun2010) 6- Risk factors of road accidents. 7- Difference between Drug “dependence, habituation & addiction”. 8- Forms of drug dependence. 9- Problem of drug dependence in Egypt. 10- High risk group & pattern of use of: CNS stimulants, CNS depressants, Opioids, Volatile inhalants, Hallucinogens & Cannabis “Hashish”. 11- Adverse effects of drug dependence. 12- Risk factors of drug dependence. 13- Prevention of drug dependence. (Jun2003) 14- Give definition and (2) examples for Drug addiction. (Sep2014, Jun2009) 15- Define Current smoker. (Aug 2013), Ex-smoker. (Sep2013) 16- Give short notes on accidents in rural communities. 17- Accidents in rural communities. (Jun2012, Jun2009) 18- Health hazards of tobacco smoking. (Jun2010, Sep2003) 19- The most effective agents in tobacco smoke causing or promoting disease. (Jun2009) 

Reproductive Health 1- What is reproductive health? (Jun2009) 2- Enumerate Items of reproductive health program. (Sep2012, midyear2006) 3- Safe motherhood. (July2014, Sep2014)

Maternal Health 1- Enumerate maternal morbidity. 2- Puerperal sepsis. (Jun2011) 3- High risk pregnancy. (Jun2012) 4- Measures to lower MMR. (Jun2011) 5- Outcome of pregnancy. 6- Objectives of premarital care. (Feb2014) 7- Objectives of Antenatal care. 8- Natal care. 9- Mention problems associated with breast feeding. 10- Give short note on vaccination during pregnancy. 11- Define Neonatal mortality rate. (Jun2012) 12- Discuss: common nutritional problems among pregnant mothers and how to prevent. (June2013, Aug2013) 13- Enumerate: Two laboratory findings indicating high risk pregnancy. (Aug2013) Two personal factors indicating high risk pregnancy. (Sep2013) 14- Postpartum risk signs of pregnancy. (Aug2011)

Child Health 1- Infant mortality. 2- Prematurity. (Jun2011, Jun2010, Jun2009, May2005, Jun2004, midyear2003) 3- Predisposing factors of handicapping. 4- Physical handicapped. (Aug2011, Jun2007, Jun2006, Jun2003) 5- Mental handicapped. (July2014, Sep2014, Jun2011, Jun2010) 6- Moron. (Sep2013) 7- Mention methods of Prevention of mental handicapping. 8- Social handicapped. 9- Define premature infant. (June2013) 10- Mention Characteristics of idiots. (Aug2013) 11- Define Crippled child. (Aug2013, Sep2013) 12- Explain why Prematurity has a significant Public Health burden. (Sep2014) 13- Enumerate Five of the individual factors behind mental disorders. (July2014) 14- Mention 5 health care services for pre-school children. (Jun2012) 15- Etiological factors for delicate children. (Jun2011)

School & Adolescent Health 1- Importance of school health services. (Sep2014) 2- Health appraisal aspects of school health program. (Aug2011) 3- Screening tests in school. (July2014, Feb2014, Sep2013, Jun2012, Jun2003) 4- Role of school health program in prevention of communicable diseases. (Jun2011, Jun2009) 5- Role of school health program in prevention of nutritional diseases. 6- Role of school health program in care of handicapped. 7- School health education. 8- Healthful school day. 9- Mention Characters of healthy classrooms. (Aug2013) 10- The most common causes of mortality among adolescents. (Jun2009) 11- Explain why Communicable diseases are common among school children. (Sep2013, July2014)

Geriatric Health 1- Enumerate two of the factors influencing nutritional status of elderly. (Sep2012, Jul2014) 2- Explain why elderly group considered as special vulnerable group. 3- Enumerate two causes of social problems among elderly. (Jun2013) 4- Special features of Geriatric illness. (Sep2003) 5- Geriatric health program. (Jun2007) 6- Factors affecting nutritional problems in old age. (Sep2012)

Occupational health 1- Give reason(s) for: 

   

Occupational exposure to small-sized dust particles (1-5 microns) can cause pneumoconiosis (fibrotic lung disease). (Jul2014, Sep2014, midyear2014, midyear2013) Periodic medical examination is important for industrial workers. (Jun2013) Pre-placement medical examination is important in industrial workers.(Aug2013, Sep2013, Jun2003) Women are not allowed printing and painting industries. (Sep2013) The allergic theory is more accepted in development of byssinosis. (Jun2013)

2- Discuss the public health importance of Occupational health program. (Jun2006) 3- Diagnosis & prevention of Lead exposure. (midyear2003) 4- Prevention of occupational exposure. (Jul2014, Aug2013, Sep2013) 5- Classification of occupational dust. (midyear2009) 6- Compare between Silicosis & Asbestosis. (Jun2010, Jun2007, Aug2006, Sep2003) 7- Compare between Silicosis & Byssinosis. (Jun2011, midyear2005) 8- Diseases to which cotton workers expose. 9- Bagassosis. 10- Prevention of dust diseases. (Sep2012, Aug2011) 11- Clinical and radiological stages of silicosis. (Aug2011) 12- Difference between Mill fever & Monday fever. 13- Give def & 2 Ex. Of Pneumoconiosis. (Sep2014, Jun2013) 14- Give def , characters & 2 Ex. Of clinical forms of occupational dermatosis, Occupational infection (Sep2014, midyear2006, midyear2013, Jun2009, Jun2003) 15- Analyze the relation between work environment and the occurrence of occupational accident. (Feb2014) 16- Mention How to know that tuberculosis has complicated silicosis. (Jun2013, Jun2011) 17- Enumerate: * Two occupations in which workers are at risk of exposure to lead. (Jun2013) * Two occupations in which workers are at risk of exposure to silica. (Aug2013) * Occupational diseases related to mineral (inorganic) dust exposure. (midyear2014, May2005, Jun2006) * Occupational hazards related to exposure to wool dust. (midyear2013) 17- Give a brief account on Etiology and clinical forms of occupational dermatitis. (Sep2014)

Human nutrition & Diet therapy 1- Give reason(s) for:          

Complex carbohydrate is preferred for diabetic patients. (June2013) Infants after six months of life are at risk of iron deficiency anemia. (June2013) Adolescent females suffering from goiter are indicators for magnitude of problem of iodine deficiency in a community. (June2013 ,Sep2013) Premature infants are at risk of iron deficiency anemia. (Aug2013 ,Sep 2013) People living in oasis are suffering more from iodine deficiency disorders. (Aug2013) Physical activity has an important role in prevention and management of obesity. (Sep2013) High fibrous diet is indicated for elderly. (Sep2013) Protein from meat is considered a complete protein. (midyear2009) Dietary fiber is an important component in the diet of healthy individuals. (Jun2009) Water soluble vitamins must be consumed daily. (midyear2009)

2- Etiology & prevention of PEM. (Sep2013) 3- Magnitude of problem, risk group & prevention of Iron def. anemia. (Feb2014, Aug2011, midyear2009) 4- Public health importance of Iron def. anemia. 5- Public health importance of Iodine def. 6- Public health importance of Dental caries. 7- Magnitude of problem, consequence & prevention of Vit. A def. (Jul2014, Jun2011) 8- Causes, diagnosis, health hazards & prevention of obesity. (Jul2014, Sep2014, Jun2010, Jun2008, midyear2005, Jun2004) 9- Enumerate risk factors of Iron def. anemia. (Midyear2006, Jun2012) 10- Enumerate hospital diets. 11- Modified consistency diets. 12- Therapeutic diets. 13- Diet modification in Peptic ulcer. 14- Diet modification in DM. 15- Diet modification in cardiovascular patients. 16- Diet modification in Hypertension. 17- Etiology of Iron def. anemia. (Jul2014, Sep2014) 18- Enumerate: * Two indications for low salt diet. * Two indications of high protein diet. (Jun2013, Sep2013) * Two indications for clear liquid diet. (midyear2009) * Two indications for low protein diet. (Aug2013) * Two indications for full liquid diet. (Sep2013) * Two criteria for diagnosis of bulimia nervosa. (midyear2003, Jun2009) * Two indications for dietary supplementation of diabetic patients. (midyear2009) 19- General functions and uses of vitamins. (Sep2012) 20- Dietary management of obese non-insulin dependent (type II) diabetes. (Jun2011) 21- Dietary modifications in cases of liver cirrhosis. (Jun2010)

Environmental Heath 1- Give reason(s) for:    

Nitrites should be nil in potable water samples. (midyear2014, midyear2013) Low fluoride content of potable water is as hazardous as high fluoride content. (midyear2014,midyear 2013) Coliform bacteria are the organisms of choice to indicate fecal examination in the routine water examination. (Jun2013, Aug2013) Global warning may carry both benefits and hazards to human being. (Sep2013)

2- Requirement of town planning & sanitary housing. 3- Health hazards of impaired cooling powder in air. (Aug2011) 4- Indoor environmental pollution. (Sep2003) 5- Health hazards of exposure to changes in atmospheric pressure changes. 6- Chemical health hazards. (Jun2011, Jun2008) 7- Biological health hazards. 8- Standard of potable water. (Jun2011, Sep2014) 9- Steps of water purification. 10- Health hazards of defects of potable water. (Jun2013) 11- Principles of food sanitation. 12- Sanitary requirement of milk. 13- Health hazards of refuse. 14- Municipal waste water management. 15- Health care waste. (Jun2010) 16- Health hazards due to exposure to medical waste. (Aug2011) 17- Sanitary requirement of environment. (Sep2003) 18- Health hazards related to exposure to ionizing radiations. (Jul2014, Sep2013) 19- Enumerate Two of the health hazards related to noise. (Sep2014) 20- Enumerate Effects of Global warming. (midyear2014, midyear 2013, Jun2010) 21- Discuss hazards of exposure to high atmospheric humidity and temperature. (Aug2013) 22- Enumerate Two disinfectants for potable water. (Aug2013) 23- Enumerate Two characters of safe food. (Sep2013)

Demography & Vital Statistics 1- Give reason(s) for:     

High fertility motive. (Sep2013, midyear2013) Low fertility motive. (Aug2013) Higher birth rates of natural increase in developing countries. (July2014, Sep2014, midyear2013) Decline of death rate in Egypt. (June2013) The wide base and narrow apex of the pyramid representing age distribution of the population in developing countries. (July2014, June2013, Aug2013, Sep2013)

2- Difference between estimated population & population census. 3- Characters of population pyramids of Egypt. (Jun2010, Jun2011) 4- Hazards of overpopulation in Egypt. (Aug2011) 5- Policy of management of overpopulation in Egypt. (Sep2012) 6- Give a brief account on Population census. (Sep2014) 7- Enumerate Uses of population census data. (midyear2014, midyear 2013) 8- Compare between population pyramids of developed and developing countries; analyze causes of differences. (Feb2014) 9- Enumerate Two rates that measure fertility. (June 2013) 10- Define Maternal mortality. (June2013) 11- Give short account on methods of population estimation. (Aug2013, Sep2013) 12- Discuss causes of maternal mortality and how to control. (Sep2013, Feb2014) 13- Mention Direct causes of infant mortality. (Sep2013) 14- Morbidity statistics. (midyear2013) 15- Fertility statistics. (Jun2010) 16- Statistical indices used to measure population dynamics. (Aug2006) 17- Incidence and prevalence rates. (midyear2003) 18- Factors influencing population growth. (Jun2003)

Administration 1- Difference between management & administration. 2- Elements of health program planning process. (Aug2006) 3- Determinants of priority in planning. (Jun2011, Jun2013) 4- Factor affecting planning. 5- Organization. 6- Supervision. 7- Budgeting. 8- Two questions that guide the collection of information in progress Evaluation. (Aug2011) 9- Activities for implementation of health programs. (Sep2014) 10- Give brief account on Steps of health program planning. (Jul2014) 11- Types of evaluation of public health program. (Jun2006, Jun2004, Sep2003)

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 2/8/2014

I-Complete: (18 Marks) 1- A tirade of depressed consciousness, depressed respiration and pinpoint pupil in poisoned patient indicate toxicity with…………. 2- ……,…….,……,……. Are considered contraindications to emesis 3- Activated charcoal is used in poisoning treatment because it is …………….. 4- The first line of treatment in coma is………………. 5- Convulsions in poisoning is best treated by …….. except in ……which is treated by……. 6- False hermaphrodite is characterized by ..... 7- The best clinical application of foot prints in practice is……… 8- Stab wound is considered penetrating when ……….. 9- Imprint abrasion is considered one of …... wounds while ……. abrasion gives an idea about the direction of impact. 10- Homicidal cut throat is best characterized by ……….,……….. 11- Post-concussion automatism is characterized by……………. 12- Tight contact firing leads to an inlet with the following characters …..,…..,……,…….

II-Give reason (s) for: (16 Marks) 1- Greenish discoloration of right iliac fossa is an early sign of putrefaction. 2- The concept of brain death is a matter of international debate. 3- Froth is considered a highly suggestive sign of drowning. 4- If an apparently normal victim of concussion is discharged, there will be medico legal responsibility of negligence. 5- In young raped female child, the local signs of violence are severe. 6- Dentate hymen is of medico-legal importance. 7- Abortion in uncontrolled diabetic mother is considered lawful. 8- Subdural hematoma is found in child abuse.

III-What is the mechanism of the following: (12 Marks) 1- Toxicity of organophosphrous insecticides. 2- Central effects of alcohol. 3- Cannabis toxicity. 4- Immediate death from electric current. 5- Botulism.

IV-What is clinical picture of the following: (8 Marks) 1- Brain compression. 3- Zinc phosphide toxicity.

2- Heat stroke. 4- Severe salicylate toxicity.

V-Give the treatment in the following Toxicities: (9 Marks) 1- Paracetamol. 85

2- Digitalis.

3- Carbon monoxide.

VI-Case scenarios: (22 Marks) A- A female aged 21 years was admitted to emergency hospital suffering from severe abdominal bleeding, her relative alleged that she tried to commit suicide by stabbing the left side of her abdomen using a nail. During examination, there was a rounded deep wound in the left iliac area surrounded by abraded, bruised and greasy collars with protrusion of the intestine from the wound. (12 Marks) 1- How to identify the age of the female? (2) 2- How to prove that the allegation of the relative is untrue? (6) 3- How to differentiate between homicide and suicide wounds? (4) B- A 20 years old agitated man was brought to the emergency room (ER). During examination, he had an attack of convulsion. His friends stated that 5 minutes before arrival his eyes were rolled back and he had violent movements of all his extremities. There was no clear history of taking drugs. On examination his vital signs were, B.P. 220/130mmHG, pulse 120 beat/minute, R.R. 28 breath/minutes. There were hyperthermia and mydriasis. (10 Marks) 1- What is the provisional diagnosis? And why? (4) 2- What are the investigations required for this case? (3) 3- How to treat this case? (3)

VI-Choose the best answer: (15 Marks) 1-Which of the following is considered a patterned wound? a- Trame line bruises b- Tangential abrasion c- Finger nails abrasions d- Contused wound induced by hammer

5-Which of the following is BEST diagnostic for suicidal cut throats? a- The wound is high up in the neck b- The wound is slanting c- Presence of hesitation marks d- The victim is male.

2 -Which of the following is the best indicator as an early sign of death? a- Low body temperature b- Trucking of blood in retinal vessels c- Flat ECG with no respiration d- Dilatation of pupil

6-A comatosed man came to the toxicology unit suffering from Hypotension. Motor incoordination, hypothermia and hyporeflexia what is the most probable diagnosis? a- Morphine toxicity b- Benzodiazepines c- Barbiturate toxicity d- Salicylate toxicity

3-Which of the following could help in differentiation between identical twins? a- DNA genotyping b- Finger prints c- Typing of serum protein system d- X-ray on skull 4-Heat fracture occurs mainly in: a- Skull bones b- Lower limb bones c- Ribs d- Vertebrae.

7- Which of the following is true for lucid interval?

a- It is a period of regaining, consciousness. b- It occurs for few' minutes only c- During which the patient is unconscious d- It occurs in situations other than head injury.

8- In which of the following cases the bullet is ricocheting? a- The bullet hits a bone inside the body b- The bullet hits a surface before it enters the body c- The bullet changes its direction due to hitting a surface outside the body or bone inside d- The bullet moves in a straight line

12- What is the first emergency treatment in corrosive toxicity? a- Decontamination b- Correct ABC c- Pain killer d- H2 blocker.

9- Which of the following is best diagnostic for point blank? a- It is caused by a rifled weapon b- Occurs only if the inlet is in a fatty area c- It indicates 0-15 cm distance of firing d- It has an inverted edge.

13- In organophosphrous toxicity, Which of the following should be given before atropinization? a- Oximes b- Diazepam c- Activated charcoal d- Oxygen.

10 -Which of the following arrhythmias is usually seen in acute digitalis toxicity? a- Atrial tachycardia b- Bradycardia c- Atrial flutter d-Atrial fibrillation 11-A man was hit by an axe on his head .Which of the following fractures can be found in this case? a- Fissure fracture b- Cut fracture c- Localized depressed fracture d- Any of the above

14- Why alkalanization of urine is used in treatment of barbiturate toxicity? a- To increase its clearance b- To decrease its absorption c- To prevent its metabolism d- To convert barbiturate to less toxic 15 -Which of the following is best diagnostic for old tear in the hymen? a- Painless edge b- No bleeding on touch c- Reach the vaginal wall d- Opaque

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 27/9/2014

I-Complete: (18 Marks) 1- A tirade of flushed face, fever and dilated pupil in poisoned patient indicate toxicity with …………. 2- ……,…….,……,……. Are considered contraindications to gastric lavage. 3- Catharsis is used in poisoning treatment because it …………….. 4- The first line of treatment in convulsion is ………………. 5- Hyperthermia in poisoning is treated by …….,……,……. 6- True hermaphrodite is characterized by………………. 7- The best clinical application of DNA prints in practice is ……… 8- A wound is considered patterned when ………….….. 9- In wounds, ………… is considered one of the most rapid causes of death, while ………….is the most common cause of death. 10- Suicidal firearm is best characterized by ……….,……….. 11- Concussion is characterized by ………………….. 12- Faint ill defined hypostasis occurs in ……….,………..

II-Give reason (s) for: (16 Marks) 1- Rigor mortis helps in estimation of time passed since death. 2- Dysrrhythmia, hypertension and pulmonary edema in scorpion stinge. 3- Cadaveric spasm is considered a highly suggestive sign of drowning. 4- Apnea test in brain death is not recommended. 5- Young raped female child, the local signs of violence are severe. 6- Imperforate hymen is of medico-legal importance. 7- Abortion in fetus with hydrocephalus is considered unlawful. 8- Multiple contusions are usually found in child abuse.

III-What is the mechanism of the following: (12 Marks) 1- Toxicity of cannabis. 2- Drugs used in detoxification of opioid dependence. 3- Contercoup in traumatic head injury. 4- Death from bum. 5- Acetaminophen poisoning.

IV-What is clinical picture of the following: (8 Marks) 1- Brain compression. 3- Zinc phosphide toxicity.

2- Heat cramp. 4- Phenol toxicity.

V-Give the treatment in the following Toxicities: (9 Marks) 1- Organophosphorus toxicity. 88

2- Methyl alcohol.

3- Kerosene.

VI-Case scenarios: (22 Marks) A- A female child aged 6 years was admitted to Emergency hospital suffering from chest infection. During examination the pediatrician found multiple scars in her back and buttocks. He also found discoid bruises on her face and thigh. There was a suspicious stain on her underwear. (12 Marks) 1- How to identify the age of the female? (2) 2- Give your possible evidence based diagnosis? (4) 3- How to deal with the case from the medicolegal point of view? (6) B- 15 years male presented in a suicide attempt with agitation, dystonia, constricted pupil hypotension, disturbed consciousness, sinus tachycardia and parkinsonism. (10 Marks) 1- What is the provisional diagnosis? (2) 2- What are the investigations required for this case? (2) 3- How to treat this case? (6)

VI-Choose the best answer: (15 Marks) 1- Which of the following is considered a penetrating wound? a- Suicidal cut throat b- Homicidal cut throat c- Stab wound in the arm d- Stab wound in the lung

5- Which of the following is BEST diagnostic for homicidal cut throats? a- The wound is low down in the neck b- The wound is slanting c- Presence of hesitation marks d- The victim is male

2- Which of the following is best indicator as an early sign of the putrifaction? a- Arborization of the chest region b- Greenish discoloration of right iliac fossa c- Secondary flaccidity d- Skin blackening

6- A comatosed man presented to toxicology unit suffering from hypotension, hypothermia, hyporeflexia and skin bullae. What is the most probable diagnosis? a- Morphine toxicity b- Benzodiazepines c- Barbiturate toxicity d- Salicylate toxicity

3- Which of the following could help in differentiation between identical twins? a- DNA genotyping b- Finger prints c- Typing of serum protein system d- Blood grouping 4- Skull comminuted fracture is caused by: a- Blunt instrument b- Sharp instrument c- Blunt instrument with wide surface d- Heavy blunt instrument

7- Which of the following is true for signs of lateralization? a- Exaggerated reflexes b- Dilated pupil c- Hemiplegia on the opposite side d- Constricted pupil 8- In which of the following cases the bullet is ricocheting? a- The bullet hits a bone inside the body b- The bullet hits a surface before it enters the body c- The bullet changes its direction due to hitting a surface outside the body or bone inside d- The bullet moves in a straight line

9- Which of the following is best diagnostic for cadaveric spasm? a- It occurs in suicidal deaths b- It is one of the postmortem changes c- It indicates severe nervous tension at the time of death d- It helps in estimating the postmortem interval 10- Which of the following sign is usually seen in acute atropine toxicity? a- Hypertension b -Sinus rhythm c- Constricted pupil d- Low grade fever 11- A man was hit by a stick on his head Which of the following fractures can be found in this case? a- Fissure fracture b-Cut fracture c- Localized depressed fracture d-Any of the above

12- What is the first treatment in Rhabdomyolysis? a- Decontamination b- Alkalanization of urine c- Change urine pH d- Peritoneal dialysis 13- In acute morphine toxicity, Which of the following should be given? a- Atropine b- Diazepam c- Naloxone d- Oxygen 14- In which of the following toxicities pinpoint pupil occur? a- Tricyclic antidepressants b- Atropine c- Digitalis d- Non of the above 15- Which of the following is best diagnostic for recent tear in the hymen? a- Painless edge b- Do not bleed on touch c- Reach the vaginal wall d- Translucent

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 1 hour Date: 15/12/2013

1) Choose THE BEST answer: (10 Marks) 1- When does a permanent central incisor erupt patterned wound? a- 6 years b- 7 years c- 8 years d- 9 years

6- Which of the following is a complication of repeated doses of activated charcoal? a- Neurogenic shock b- Electrolyte disturbance c- Intestinal obstruction d- Vomiting

2- A female alleged that her age is 19 years, which of the following x-rays confirm her allegation? a- Upper end of radius and ulna b- Knee joint c- Upper end of femur d- Lower end of tibia.

7- Which one of the following signs is best diagnostic for compression? a- Unequal pupils b- Deep rapid respiration c- Rapid weak pulse d- General flaccidity

3- Which of the following is the best a- Traumatic fracture b- Fissure fracture c- Indirect fracture d- Diastatic fracture

8-A 24 years old man complained of diarrhea, description for ring fracture? colic, salivation and urination. What is your provisional diagnosis? a- Organophosphrous poisoning b- Food poisoning c- Paraquate poisoning d- Zink phosphide poisoning

4- Dropping of the lower jaw in a very cold dead body is due to: a- Rigor mortis b- Primary flaccidity c- Joint dislocation d- Secondary flaccidity 5- Which of the following is considered a sure sign drowning? a- Goose skin b- Hypostasis in the neck and shoulder c- Froth d- Peeling of the skin

9- Which of the following is the best for emesis? a- Mechanical method b- Salt and water c- Apomorphine d- Syrup of ipecac 10- Which of the following is considered specific antidote for ethyl alcohol toxicity? a- Naloxone b- Methanol c- Vitamin Bl d- No specific antidote

2) Give reason: (10 Marks) 1- X-rays on clavicle and femur help in the diagnosis of age of 18 in male. 2- Transient loss of consciousness occurs in concussion. 3- In compression, the pulse is slow and full. 4- Chest x-ray is indicated in acute organophosphrous poisoning. 5- Anemic patients are more affected by CO poisoning. 6- Activated charcoal is not effective in hydrocarbons. 7- Oxime is given in the treatment of organophosphrous poisoning. 8- Hypostasis helps in estimation of time passed since death. 9- Cadaveric spasm is seen in browning. 10- Naloxone is used in the treatment of acute ethyl alcohol poisoning.

3) Complete: (10 Marks) 1- In females, union of iliac crest occurs at …………….. 2- Drowning is defined as …………….. 3- Treatment of toxic coma is done by…………….. and giving …………….. 4- Lucid interval is a period of …………….. Between …………….. Of unconsciousness one is due to…………….. And the other is due to…………….. 5- Possible injuries in a man hit by sharp heavy instrument on the head are ……,…….,……,…….

6- Adipocere formation is due to………… It indicates that time passed since death ranges between ………… 7- In summer, a dead body, greenish discoloration of the skin in right iliac fossa indicates that time passed since death ranges between ……………..

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 20/6/2013 I-Complete: (18 Marks) 1- Ossific center appears at upper end of radius at …………. While, ossific center in lower end of femur appears at …………. 2- Lacerated scalp wounds are of regular edges due to…………. 3- In any wound, hesitation marks indicate that manner of injury is …………….. 4- Glistening mucosa indicates that rupture intestine is …………….. 5- Fabricated wound is usually aimed to …………….. 6- Caliber of non rifled weapon is estimated as if ………………. 7- Dentate hymen is mistaken for ………… while imperforate hymen raise suspicious of ………………. 8- ………………. are considered as sources of lead inhalation. 9- Apnea test is done by ………………. then ………………. 10- From the medicolegal point of view abortion is ………………. 11- The most dangerous degree in bum is Due to affection of ………………. That may lead to death due to ………………. 12- Mechanical occlusion of the air passage from inside is diagnosed as ………………. II-Give reason for: (20 Marks) 1- Reduced IQ and learning disabilities in lead poisoned children. 2- Hematemesis and melena in acute inorganic mercury toxicity. 3- Nail examination is valuable in identification. 4- Fatal child abuse differs from common murder. 5- Rigor mortis starts early in deaths following convulsion. 6- CT scan is important in diagnosis of cocaine intoxicated patients. 7- Antabuse is used in treatment of alcohol dependence. 8- Cyanide poisoning leads to red asphyxia. 9- Physician-patient relationship must be taken in consideration. 10- Emesis is contraindicated in treatment of antipsychotics III- What is clinical picture of the following poisons and its antidote: (8 Marks) 1- Acute Carbon monoxide poisoning. 2- Kerosene poisoning. 3- Elapidea bite. 4- Acute Digitalis poisoning. IV-What is the mechanism of the following: (18 Marks)| 1- Rigor mortis. 2- Concussion. 3- Death from scalds. 4- Dry drowning. 5- Botulism. 6- Acute warfarin and super-warfarin toxicity.

V- Give the forensic solution in the following condition: (4 Marks) 1-Suspected virginity. 2- A man alleged that he was hit by a heavy stick on his head. VI- Indications and contraindications in each of the following conditions: (10 marks) 1- Gastric lavage. 2- Emesis. 3- Hemodialysis. 4- Activated charcoal. 5- Morphine in traumatized patients. 93

VII- Case scenarios: (12 Marks) 1- A left handed 23 years old man was found dead in his closed room with a wound in his left temple, the autopsy report stated that the manner of death was by committing suicide. (8 Marks) a- What is the most probable causative instrument? b- Describe the expected external characters of the wound c- How to verify the age of the victim? 2- A 47-year-old man with a history of depression presented to the emergency department complaining of thirst and tinnitus. The patient admits the intake of several pills in a suicide attempt. On examination he was noted to be diaphoretic, tachycardic (120 beats/min), tachypneic (28 breaths/min) with hyperpnea, and to have a temperature of 38.2째C. (4 Marks) a- What is the most probable diagnosis? b- How to treat the case? VIII- Choose the best answer: (10 Marks) 1- Which of the following is included in the treatment of acute acetaminophen poisoning? a- N-acetyl cysteine b- Hemodialysis c- Vitamin K d- All of the above

6- Which of the following Is considered mcdicolegally a sure sign of pregnancy? a- Positive pregnancy test b- Enlarged abdomen c- Amenorrhea d- Fetal heart sounds

2- Which category of drugs is associated with neuroleptic malignant syndrome? a- Antidepressants b- Anticholinergics c- Antipsyehotics d- Mood stabilizers

7- Which of the following is a common cause of brain death? a- Meningitis b- Encephalopathy c- Cerebral thrombosis d- Coma

3- In asphyxia cheyene stoke respiration occurs in: a- The stage of apnea b- The stage of dyspnea c- The stage of convulsion d- The final stage

8- Which of the following is the best treatment of heat stroke? a- Salt and water b- Anti-shock measures c- I.V saline d- Ice bags

4- Which of the following occurs due to constricting the neck? a- Smothering b- Throttling c- Asphyxia d- Chocking

9- A child came to ER hospital with history of drinking a liquid, he was crying what is the best treatment of this case? a- Morphine b- Gastric lavage c- Emesis d- Cold milk

5- Which of the following is the first step in examination of a case of rape? a- History taking b- General examination c- Local examination d- Consent

10- Which of the following as contraindicated in theophylline toxicity? a- Gastric lavage b- Saline cathartic c- Whole bowel irrigation d- Emesis

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 2/9/2013 I-Complete: (18 Marks) 1- Union of the upper end of radius occurs at ………….While, union of the lower end occurs at …………. 2- Edges of contused wounds should be surrounded by contusion due to …………. 3- In any crime, multiplicity of fatal wounds indicate that manner of injury …………….. 4- Opaque mucosa indicates that rupture intestine is …………….. 5- Self inflicted wounds are either …………….. or …………….. 6- Caliber of non rifled weapon is estimated as if ………………. 7- Dentate hymen is mistaken for ………… while imperforate hymen raise suspicious of ………………. 8- ……,…….,……,……. are considered as poison prevention strategies. 9- In medicolegal practice, the most common cause of traumatic brain death is ……………. 10- From the medicolegal point of view pregnancy test is ………… a sure sign of pregnancy. 11- The most characteristic feature of electric inlet is ………… 12- Asphyxia is defined as …………………………… II-Give reason for: (20 Marks) 1- Reduced IQ and learning disabilities in lead poisoned children. 2- Hematemesis and melena in acute inorganic mercury toxicity. 3- Clothes examination is valuable in identification. 4- The most common lesions in child abuse are the skin and skeleton. 5- Rigor mortis is not an accurate method to estimate time passed since death. 6- CT scan is important in diagnosis of cocaine intoxicated patients. 7- Neonates may suffer withdrawal symptoms. 8- Carbon monoxide poisoning leads to red asphyxia. 9- Communication and consent is considered one of the important items in medical ethics. 10- Emesis is contraindicated in treatment of antipsychotics. III- What is clinical picture of the following poisons and its antidote: (8 Marks) 1- Acute cyanide poisoning. 2- Organophosphate poisoning 3- Scorpion bite. 4- Acute opiate poisoning. IV-What is the mechanism of the following: (18 Marks)| 1- Adipocere. 2- Compression. 3- Death from dry bum. 4- Hydrocussion. 5- Botulism. 6- Paracetamol toxicity.

V- Give the forensic solution in the following condition: (4 Marks) 1- Suspeeted criminal abortion. 2- A man alleged that he was hit by a knife not by a stick on his head. VI- Indications and contraindications in each of the following conditions: (10 marks) 1- Whole bowel irrigation. 2- Emesis. 3- Hemodialysis. 4- Forced diuresis. 95

VII- Case scenarios: (12 Marks) 1- A 21 years old woman was found completely suspended from her neck in a dosed room the autopsy report stated that the manner of death was by committing suicide. (8 Marks) a- Discuss the mechanism of death? b- Describe the expected external postmortem signs? c- How to verify the age of the victim? 2- A twelve years-old boy was brought to the emergency department with vomiting and abdominal colic relieved by abdominal pressure with sweat metallic taste. He gave history of bloody diarrhea. On examination his BP was 90/60 9 pulse was 90/ minute wife cold skin. (4 Marks) a- What is the most probable diagnosis? b- How to treat the case? VIII- Choose the best answer: (10 Marks) 1- Which of the following is included in the treatment of acute cocaine poisoning? a- Diazepam. b- Sodium nitroprusside c- Antiarrytihmic measures d- All of the above 2- In. acute toxicity, which of the following is considered hepatotoxic: a- Salicylate b- Insecticides c- Alcohol d- Paracetamol 3- A dead body was recovered from water Which of the following can be considered as a sure sign of drowning? a- Silvery spots b- Goose skin c- Hypostasis in the neck and shoulders d- Cadaveric spasm 4- Which of the following occurs due to constricting the neck? a- Smothering b- Throttling c- Asphyxia d- Chocking 5- Which of the following is the first step in examination of a case of rape? a- History taking b- General examination c- Local examination d- Consent

6- Which of the following Investigations can be relied on in medicolegal diagnosis of pregnancy? a- Pregnancy test b- Hormonal assay c- Uterine ultrasonography d- Any of the above. 7- Which of the following Is a common cause of maceration? a- Adipocere b- Putrifaction c- Intrauterine fetal death d- Criminal Aboition 8- Which of the following Is the best treatment of heat cramp? a- Salt and water b- Anti-shock measures c- I.V saline d- Ice bags 9- A child came to E'R hospital with history of taking sugar like substance. He was crying with muscle spasm What is the most probable diagnosis of this case? a- Carbolic acid crystals b- Oxalic acid c- Salicylic acid powder d- Insecticide powder 10- What is the best treatment of the above case? a- Morphine b- Calcium by every root c- Emesis d- Diazepam

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 1 hour Date: 19/1/2013

1) Choose THE BEST answer: (10 Marks) 1- Which of the following tooth erupt at 7 years? a- Central incisor b- Lateral incisor c- First molar d- Canine 2- A dead body was recovered from water Which of the following can be considered as a sure sign of drowning? a- Salivary spots b- Goose skin c- Hypostasis in the neck and shoulders d- Cadaveric spasm 3-In acute toxicity, which of the following is considered hepatotoxic: a- Salicylate b- Insecticides c- Alcohol d- Paracetamole 4- Which one of the following postmortem signs is considered an early sign of death? a- Dilated pupil b- Bilateral retinal segmentation c- Hypostasis d- Cooling of the body 5- Which one of the following is considered most diagnostic feature of braises? a- The causative instrument is heavy blunt instrument b- The force of infliction exceeds skin elasticity c- The overlying skin is intact while the subcutaneous vessels are ruptured d- a&b

6- A man came to the emergency hospital with agitation, sweating, rhinorrhea, goose skin and muscle aches, what is the most probable diagnosis? a- Alcohol withdrawal b- Morphine poisoning c- Cannabis overdose d- Morphine withdrawal 7- Which of the following is a common complication of peritoneal dialysis? a- Neurogenic shock b- Intestinal perforation c- Bleeding d- Peritonitis 8- Which of the following is considered a sure sign of recent delivery? a- Slit shape external Os of the cervix b- Enlarged breast c- Lax abdomen d- Lochia 9- Which of the following is best diagnostic for compression? a- Transient loss of consciousness b- Deep rapid respiration c- High blood pressure d- Unequal constricted pupils 10- Wounds Are classified medicolegally according to: a- The causative instrument b- Mechanism of wound infliction c- Lines of treatment d- Whether or not the wound leads to permanent infirmity

2) Give reason: (10 Marks) 1- X-rays on clavicle and femur help in the diagnosis of age of 18 in male. 2- Drastic purgatives are considered as abortificiant drugs. 3- In compression, the pulse is slow and full. 4- Contused wound edges are always surrounded by contusion. 5- Under normal circumstances, dead-bodies usually become cold and flaccid after 36 hours. 6- The user of cannabis believes that he may stop cannabis without withdrawal. 7- Chest x-ray is indicated in acute organophosphrous poisoning. 8- Activated charcoal is not effective in hydrocarbons. 9- In overdose, acetaminophen causes hepatocellular necrosis. 10- Dribbling of saliva is a sure sign of ante-mortem hanging.

3) Complete: (10 Marks) 1- In female, union of hip bones occurs at …………. while union of the lower end of femur occurs at …………. 2- Silvery spots in asphyxial deaths occur due to …………. 3- A wound is defined as …………. 4- Lucid interval is a period of…………. Between …………. Of unconsciousness one is due to …………. And the other is due to …………. 5- Therapeutic abortion is only indicated to …………. 6- Cadaveric spasm occurs in deaths associated with …………. 7- In drug dependence, relapse is defined as …………. 8- In case of treatment of acute organophosphrous poisoning the best sign of atropinization is …………. 9- In case of salicylate poisoning, hyperthermia is due to …………. 10- Rope mark in strangulation is usually transverse except ………….

4) Put "T" in front of true statement and "F" in front of false one and correct the false: (10 Marks) 1- A permanent infirmity means only loss of any organ. 2- Polar fracture is parallel to the line of force. 3- Gastric lavage is allowed in Phenol poisoning. 4- Hypostasis is seen in the back of the body in deaths due to drowning. 5- Drug habituation is characterized by absent withdrawal symptoms. 6- Organophosphrous insecticides are commonly used in homicide. 7- The most rapid cause of death in criminal abortion is acute poisoning. 8- Fusion of manubrium with the body of sternum at 30 years. 9- In all types of asphyxia, hypostasis is dark blue. 10- Small dose of salicylate leads to hyperglycemia.

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 1 hour Date: 30/3/2013

1) Choose THE BEST answer: (10 Marks) 1- When does 2 permanent Lateral incisor erupt? a- 6 years b- 7 years c- 8 years d- 9 years

6- In asphyxia tardue spots occur in: a- The stage of apnea b- In the stage of dyspnea c- In the stage of convulsion d- In the final stage

2- A female alleged that her age is 19 years, Which of the followings x-ray confirm her allegation? a- Upper end of radius and ulna b- Knee joint c- Upper end of ulna d- Lower end of hum eras

7- Which of the following is a common cause of brain death? a- Epilepsy b- Hypothermia c- Loss of consciousness d- Cerebral laceration

3- Trameline braise is considered: a- One of the patterned wounds b- A simple wound c- A blunt wound that may reflect the direction of impact d- A blunt force wound caused by rounded blunt instrument

8- Constipation and ileus commonly occur in opiate use due to: a- Decreased gastrointestinal motility b- Increased HCl secretion c- Decreased anal sphincter tone d- Increased biliary secretions

4- Dropping of the lower jaw in a very cold dead body is due to: a- Rigor mortis b- Primary flaccidity c- Joint dislocation d- Secondary flaccidity 5- Which the following wound (s) has an inlet and Exit? a- Stab penetrating wound c- Electric wound c- Contused wound d- Stab puncture

9- In toxic bite, Parathesia of involved: extremity characterize: a- Elapidea bite b- Vipredea bite c- Scorpion bite d- Bees bite 10- Which of the following is effective in the treatment of zinc phosphide toxicity? a- Enhanced elimination b- Specific antidote c- Care for respiration d- Emergency and supportive measures

2) Give reason: (10 Marks) 1- Tongue is swollen and protruded in hanging. 2- Fabricated wounds. 3- Transient loss of consciousness occurs in concussion. 4- Little force is required to induce cut wound. 5- Chipped fracture - is not considered a permanent infirmity. 6- Coagulation necrosis occurs at electric burn. 7- Anemic patients are more affected by Co poisoning. 8- N-acetyl cysteine is considered the physiologic antidote ox choice for acetaminophen toxicity. 9- Slow heart rate in opiate toxicity. 10- Carpo-pedal spasm in oxalic acid poisoning.

3) Complete: (10 Marks) 1- In female, union of head of humorous occurs at …………. 2- Hanging is defined as …………. 3- A contusion is defined as …………. 4- Lucid interval is a period of …………. Between …………. Of unconsciousness one is due to …………. And the other is due to …………. 5- Possible injuries in a man hit by sharp heavy instrument on the head are ……,…….,……,…….

6- Brain death is defined as …………. 7- Cadaveric spasm is defined as …………. 8- In a dead body greenish discoloration of the skin in right iliac fossa indicates that time passed since death ranges between …………. 9- Elapidea poison, is mainly …………. 10- Most patients of paraquate poisoning die from ………….

4) Put "T" in front of true statement anf "F" in front of false one and correct the false: (10 Marks) 1- Fling fracture is considered as an indirect fracture. 2- A man with a localized depressed fracture alleged that, lie was hit by a heavy blunt instrument with a large surface on his head. 3- Maceration is septic autolysis. 4- Hypostasis is seen in the legs of the body in deaths due to drowning. 5- Vipredea poison is only heamatotoxic. 6- Zinc phosphide toxicity is treated by its specific antidote. 7- A 7 years old child has 24 teeth. 8- Fusion of manubrium sterni with the body of sternum occurs at 30 years. 9- Polyneuropathy may occur m alcohol toxicity. 10- Corticosteroid is used in the treatment of kerosene poisoning. 100

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 19/7/2012 I- Complete: (18 Marks) 1- In comatosed patient the following drugs/substances are given ……,…….,……,……. 2- Increases susceptibility to hemolytic effect of some drugs like sulphonamides in some persons are due to ................... 3- ................... is an example of poisons with hepatotoxicity. 4- The first line of treatment in corrosive ingestion is...................to guard against................ 5- Convulsions due to oxalic acid are treated by................... 6- Potential ECG changes in tricyclic antidepressant poisoning are ……,…….,……,……. 7- Morphine produced pinpoint pupil is due to................... 8- Ethanol toxicity is due to ……,…….,……,……. 9- Shock due to methanol toxicity may be.......or.......or....... 10-................... is the predominant type of hemoglobin in cyanide toxicity. 11- Organophophate toxicity occurs due to inhibition of ................... leading to accumulation of ................... 12- Although identical twins have similar DNA profile they have different ................... 13- Wounds are classified legally into ……,…….,……, and medico-legally according to ........ 14- Weakness of media in arteries of circle of willis leads to 15- Skull fractures in boxers is called ................... 16- Silvery spots are due to ................... while tardue spots are due to ................... II- Write true or false and correct the false: (13 Marks) 1- Urine is dark and turns green on exposure to air in oxalic acid poisoning. 2- Clinical presentation of cocaine toxicity includes hyperthermia, severe hypertension, constricted pupil and hypererfiexia. 3- Coma caused by atropine is characterized by fever, slow full regular pulse, dry hot skin, and dilated fixed pupil. 4- The target organ/substance of cyanide toxicity is hemoglobin. 5- Hyperbaric oxygen is the antidote in CO poisoning. 6- Alkalanization of both urine and blood by sodium bicarbonate is useful in treatment of salicylate toxicity. 7- In acetaminophen overdose hepatotoxicity is induced by acetaminophen itself. 8- The specific antidote in iron toxicity is disulfiram. 9- Non cardiogenic pulmonary edema is present in herion toxicity. 10-Lead colic is relieved by intravenous atropine. 11- Acromial end of male clavicle unites with the shaft at 16 years. 12- Contused wound is not considered as patterned wound. 13- The victim of sodomy is examined in lithotomy position.

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III- Give reason (s) for: (16 Marks) 1- Perforation of stomach is more common in alkaline corrosives. 2- Abdominal x-ray in the sitting position is indicated in kerosene ingestion. 3- It is recommended to give 100%oxygen in fire victims with cyanide toxicity. 4- Fractured skull base is more common than fracture vault. 5- Bruises may be dangerous. 6- After concussion the victim may not be able to give a proper history. 7- X-ray is helpful in diagnosis of child abuse. 8- Facial pallor in plumbism. IV- Mention the mechanism of the following: (10 Marks) 1- Digitalis toxicity. 2- Hemolytic effect of salicylate toxicity. 3- Concussion 4- Hypostasis. 5- Death from strangulation. V- Case scenarios: (14 Marks) 1- A farmer presented to the emergency department with disturbed consdousness, pinpoint pupil, pulmonary edema, sweating and salivation. (6 Marks) a- What is your provisional diagnosis? b- What is the mechanism of toxicity in this case? c- What is the specific antidote? 2- A female aged 25 years alleged being raped on examination within 24h, abrasions were observed. (8 Marks) a- How to verify her age? b- What are the expected possible types and sites of abrasions in this case? c- How to prove the date of the crime? d- Which evidence can be collected from the female in this case to prove her allegation? VI- Choose the best answer: (30 Marks)

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Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 8/2012 I- Complete: (16 Marks) 1- Posterior fontanel is closed at ...................while anterior fontanel is dosed at about ……….. months after birth. 2- A wound is ........................ produced by........................ 3- Periorbital haematoma occurs due to …….. or ……. or ……… 4- Fabricated wounds are characterized by being ................ 5- Chipped fracture caused by ................... passing ................... 6- More than one firearm wound inlet is found in ……,…….,…… 7- Sharp demarcation line occurs in ................... 8- Medicolegal importance of adipocere include ……,…….,……,……. 9- Ethanol coma is characterized by ……,…….,……,……. 10- Flumazenil is considered an antidote in cases of ........................ 11- ........................ is the principle active ingredient in cannabis. 12- Atropihe shouldn't be given in organophosphrous toxicity except if the patient is ………... 13- Contraindications to forced dieresis are ……,…….,……,……. II- Write true or false and correct the false: (13 Marks) 1- Hydrocarbons are successfully adsorbed to activated charcoal. 2- Naloxone is not indicated in opiate toxicity. 3- Cumulation is an abnormal response to the drug or substance. 4- Carbon monoxide is the fastest poison ever known. 5- Radiology is not needed in severe cocaine toxicity. 6- Barbiturates compete with receptors in the brain therefore toxicity occurs. 7- Mummification is a postmortem picture replacing putrefaction when the body is buried in damp area. 8- Hemoconcentration is the most rapid cause of death in dry burn. 9- More than one inlet is found in tandem bullet. 10- Otorrhea and bleeding from nose are present in fracture middle fossa of the skull. 11- Crush syndrome is found in toxicity of lead. 12- Incised wound is a clean division of tissue under the pressure of Sharp-edged instrument.

103

III- Give reason (s) for: (16 Marks) 1- Cannabis user develops false believe that cannabis is not a dependent substance. 2- Two substances with equal toxicity may differ in their hazards. 3- Contusion may appear at a site far from the site of the original trauma. 4- Brain contusion away from the site of impact to the head. 5- Constipation and ileus commonly occur in opiate toxicity. 6- Sodium bicarbonate is the first drug of choice in treatment of tricyclic antidepressant toxicity. 7- Queen Cleopatra during the tragedy of her death was unable to ask for help despite she was conscious. 8-Whole bowel irrigation is contraindicated in ileus or intestinal obstruction. IV- Mention the mechanism of the following: (10 Marks) 1- Lucid interval. 2- Hyperglycemia in theophylline toxicity. 3- Rigor mortis. 4- Chipped fracture. 5- Iron toxicity. V- Case scenarios: (14 Marks) 1- The police was notified that a dead body of a female about 20 years old was extracted from one elmahmodia branch of river Nile. The medicological expert was called to examine the case. After complete autopsy he reported that the case was manually strangulated. He also reported a recent rupture of the hymen. (8 Marks) a- How would you verify the age of the female. b- Discuss the PM signs by which the case was diagnosed. c- Discuss the different types of hymen. 2- A 21-year-old woman was brought to the emergency department (ED) complaining of stomach ache. She felt extremely nauseated and vomited once. She denied taking any medication except for a few analgesic pills. On physical examination, the woman was diaphoretic, pale, and she appeared uncomfortable. Her vital signs were blood pressure, 95/70mmHg, pulse 100 beats/min, respiratory rate 20 breaths/min, oral temperature 37CO. Examination of the head, eyes, ears, nose and throat was unremarkable. Her neck was supple, her lungs were clear, and the cardiac examination was within normal limits. Examination of the abdomen revealed only moderate epigasteric tenderness. (6 Marks) a- What is your provisional diagnosis? b- What is the mechanism of toxicity in this case? c- What is the specific antidote? d- How to treat the case? VI- Choose the best answer: (30 Marks)

104

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 1 hour Date: 24/11/2011 1) Give the postmortem interval in each of the following postmortem changes: a- Hypostasis appears as mottled patches. b- Marbling phenomenon. 2) Complete: a- Defense wounds indicate ……,……. and ……… b- The acromial end of a female undies with the shaft at the age of about ……… c- Drowning is defined as ......... d- In dry drowning death may be due to ……… or ……… 3) A man alleged that his. scalp wound was induced by sharp edged instrument. How to prove that his allegation is true? 4) Write True or false and correct the false: a- Subdural hemorrhage should be associated with, skull fracture. b- A man alleged that his skull fissure fracture that extends into one of his skull sutures results from one blow to his head. 5) Differentiate between adipocer and mummification regarding the mechanism of each. 6) How many teeth does the child have at the age of 2 years? Identity them. 7) Give reason: a- Little force is required to induce cut wound. b- All contused wounds are associated with surrounding bruises. 8) Choose from column A what suits from column B: Column A Column B 1- Trauma with blunt instrument with large a- Fissure fracture striking surface area and high momentum 2- Trauma with blunt instrument with localized striking surface area and low momentum

b- Comminuted fracture

3- Trauma with blunt instrument with localized striking surface area and high momentum

c- Cut comminuted fracture

4- Trauma with sharp instrument with High momentum

d- Localized depressed comminuted fracture e- Localized depressed fracture

NB. MCQs with this exam are not included… 105

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 1 hour Date: 27/3/2012

I- Forensic Medicine: 1- Give reason: a- Tangential abrasion gives an idea about direction of impact not imprint abrasion. b- Morphine is contraindicated in head injured patients. 2- Write true or false and correct the false: a- Inner wad is present inside the wound at a distance of firing up to 6 meters. b- Electric bum mainly results from Vibrations of electricity. 3- Give the forensic solution in the following eases: a- Showing up bruises in an area with hypostasis. b- Skeletal lesions could accuse the parents of abusing their child. 4- Complete: a- Kunckle punches are diagnostic of ……… Cases, they are in the form of ……… commonly found on ……… or ……… b- Rigor mortis is defined as ……… c- Smothering is a type of ………caused by ……… d- In order to diagnose age of 16 in males do x-ray on ……… the you will find the following radiologic signs ………….,……………

II- Clinical Toxicology: 1- Give reason: a- The patient can withstand toxic dose without ill effects. b- Alkaline dieresis is indicated in salicylate, meprobamate, lithium. c- Alcohol should not be given with benzodiazepines. d- X-ray should be done in alkalis and inorganic acid ingestion. 2- Write true or false and correct the false: a- Hypertension, tachycardia and mydriasis are muscarenic effects of organophosphrous insecticides. b- Alcohol induced polyneuropathy is due to metabolic changes induced by alcohol. 3- Give the conditions where the following antidotes are given and mention its doe and regimen of intake: a- Naloxone. b- Oximes. 4- Complete: a- In lead poisoning, arthralgia is due to …………… b-With Abrupt withdrawal of alcohol the patient should be given …………… NB. MCQs with this exam are not included… 106

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 17/7/2011

I- Forensic Medicine: 1- Case Scenario: A virgin female aged about 18 years alleged that a man raped her by force that results in abrasions and contusions around her month and in the inner sides of her thighs. The medico legal doctor examined her with in 4h after the crime. The police couldn't arrest the assailant. a- How to prove that, the female allegation was true? (12 Marks) b- How to verify the age of the victim? (5 Marks) c- Mention the role of the physician in this case? (5 items only) (5 Marks) 1- How to prove that: a- The wound is an entry mark of direct contact electricity. b- The child skin lesions are due to physical abuse. c- The patient is in concussion.

(6 Marks) (5 Marks) (7 Marks)

3- Mention medicolegal importance of: a- Hypostasis. (5 Marks) b- Powder mark in firearm injuries. (5 Marks) II- Clinical Toxicology: 1- Case Scenario: A young child ingested colorless prismatic crystals in mistake of sugar then he complains of severe burning pain in month and had severe vomiting and diarrhea, rapid weak pulse and low blood pressure then he had muscle twitches with carpopedal spasm. a- What is your provisional diagnosis of the case (4 Marks) b- Mention in detail the full clinical picture of the case and the mechanism of action of the poison. (6 Marks) c- How to treat the case? (4 Marks) 2- Mention the role of atropine and oximes in the treatment of acute organophosphrus poisoning, with reference to their doses and mode of administration. (7 Marks) 3- What is the mechanism(s) and antidote(s) in case of the following toxicities: (8 Marks) a- Acetaminophen. b- Digitalis 4- Describe Clinical presentation and treatment of: a- Acute iron toxicity. b- Elapidae snake bite.

(8 Marks) (7 Marks)

5- How to treat a case of acute adult food-borne botulism.

(6 Marks)

107

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 8/2011

I- Forensic Medicine: 1- Case Scenario: It was alleged that a man aged 30 years had committed suicide by contact firing to the skull. a- Mention the characters of the wound? b- How to verify the age of the victim? c- What are the factors affecting the shape of firearm wound? 2- Mention the mechanism of the following: a- Silver spots in death due to asphyxia. b- Hypostasis. c- Concussion. d- Death in scalds. 3- How to differentiate between the following (3 differences only): a- Hypostasis and contusion. b- Antemortem and postmortem wounds. c- Hanging and strangulation. d- Thermal and traumatic skull fracture. 4- How to prove that: a- The case is masculine hermaphrodite. b- The wound is fabricated wound. c- Skull fracture is polar fracture. II- Clinical Toxicology: 1- Case Scenario: A child ingested a dark fluid stored in a bottle labeled Pepsi, then he developed pain in the mouth, vomiting and diarrhea. Then grayish patches appeared on mouth and urine became dark his pulse 100/min. and his blood pressure was 80/50. a- What is your provisional diagnosis of the case. b- How to treat the case. c- What is the remote action of the poison and associated clinical presentation. 2- Mention the clinical presentation of the following moderate acute toxicities: a- Carbon monoxide. b- Salicylate. 3- What are the specific antidote(s) in acute toxicity of each of the following: a- Opiates. b- Benzodiazepines. c- Iron. 4- How to prove that Coma is due to ethanol toxicity. 108

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 14/6/2010

I- Forensic Medicine: 1- Case Scenario: Medicolegal examination of a case of infanticide revealed that: the foetus was full term with putrefactive bullae under the skin and foul coarse bloody froth at the mouth and nostrils. The umbilical stump was still present and relatively thick with ulcerations around it. Two females suspected to be the mother were examined. The first 18 years female showed signs of recent delivery (about 10-14 days), while the other female (38 years) was nulliparous. a- How to verify the age of the both suspected females? Mention the medicolegal importance of the age of 18 years? (8 Marks) b- Explain how to identify the most probably accused female from the given data? How to confirm your suspicion (mention only the name of a confirmatory test. (10 Marks) c- What are the characters of full term foetus? (6 Marks) 2- Discuss the following: a- Differences between hypostasis and bruises. (6 Marks) b- Differences between thermal and traumatic fracture. (6 Marks) c- Sequelae and complications of head injuries. (8 Marks) d- Mechanism of death in hanging. (6 Marks) II- Clinical Toxicology: 1- Case Scenario: A 30 years old farmer was brought to the Emergency Toxicology Unit Tanta University suffering from excessive secretions (lacrimation, salivation, sweating and diarrhea). Chest tightness, abdominal colic, muscle fasciculations and weakness. The patient was cyanosed with signs of pulmonary edema and miosis. a- What is your provisional diagnosis? (2 Marks) b- Enumerate other six poisons that cause cyanosis? Mention the mechanism(s) of action of two of them? (4 Marks) c- Enumerate other four poisons that cause Miosis? (2 Marks) d- How to treat this case? (10 Marks) 2- Comment on the following: a- A method used for GIT decontamination. (indications, contra indications and two adverse effects). (6 Marks) b- Treatment of Atropine toxicity. (6 Marks) 3- Mention One physiologic antidote (with its dose) of each of the following: (12 Marks) a- Acetaminophen b- Morphine c- Oxalic acid d- Methanol e- Digitalis f- Carbon Monoxide 4- Discuss the clinical presentation of Carbolic acid (phenol) poisoning? 109

(8 Marks)

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 13/7/2009

I- Forensic Medicine: 1- Case Scenario: (15 Marks) The police was notified that, a newly born infant was found crying near a mosque. A woman (38 years old) who is suspected to be the mother was arrested and sent for examination. The medicolegal expert reported that: -The infant is full term. -The woman is recently delivered. a- How would you verify the age of the woman? b- Discuss the signs by which the case was diagnosed? c- Name the test used to confirm the infant maternity? 2- Define: (10 Marks) a- Brain compression and mention its lateralizing signs? b- Diatoms and mention its medicolegal importance? 3- Give an account on: (25 Marks) a- Mechanisms of death in case of electrocution. b- Estimation of distance of firing from powder marks. c- Causes of black eye. d- Common bruises that is highly suggestive of child abuse. II- Clinical Toxicology: 1- Case Scenario: (15 Marks) A boy 16 years old has ingested colored pills related to his mother therapy, after few hours he developed nausea, vomiting, abdominal colic, explosive diarrhea, and then hemorrhagic gastroenteritis. On examination pulse was 70/min, B.P. 115/75, temp. 37CO. a- What is the provisional diagnosis of this case ? b- Mention three (3) toxicological causes of diarrhea ? c- Mention investigations and treatment of this case? 2- Give an account on: (20 Marks) a- Causes and treatment of toxic coma. b- Clinical picture of acute digitalis toxicity. c- Action ÂŠf snake poison and treatment of its toxicity. 3- Mention treatment of each of the following: (15 Marks) a- Acetaminophen toxicity. b- Caustic potash ingestion. c- Opiate dependence.

110

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 1 hour Date: 15/2/2009

I- Forensic Medicine: A- Give an account on: 1- Fabricated wound. 2- Clinical picture of heat collapse. B- Mention four medico-legal importance of nail examination Clinical Toxicology.

II- Clinical Toxicology: A- Give short account on the following: 1- Hematologic effects of salicylate poisoning and treatment of these effects. 2- Characters of ethanol coma. B- Mention four clinical presentations of stage of excitation in atropine toxicity.

NB. MCQs with this exam are not includedâ&#x20AC;Ś 111

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 22/7/2008

I- Clinical Toxicology: 1- Case Scenario: A young girl ingested a large number of tablets prescribed for her pregnant mother as a tonic after few hours she suffered from repeated vomiting and diarrhea with hematemesis and bloody stool. Some hours later she became very ill. On examination blood pressure was 80/50, pulse rate was 100/min, respiratory rate was 28 /min. Laboratory investigations revealed severe metabolic acidosis. A- What is your provisional diagnosis? (2 Marks) B- What are the investigations necessary to confirm the diagnosis and manage the case ? (2 Marks) C- How to treat this case? (6 Marks) 2- Give an account on: A- Clinical picture of acute phenol poisoning. (5 Marks) B- Indications of Multiple dose activated charcoal. (3 Marks) C- Toxicological causes of respiratory failure. (4 Marks) 3- Mention the mechanism of toxicity (actions) and physiologic antidotes of each of the following poisons: (10 Marks) A- Methanol. B- Organophosphate (Parathion). C- Digitalis. D- Botulinum toxin. II-Forensic Medicine: 1- Case Scenario: A comatosed (Six years old) child was brought to the emergency department by his father (Forty years old) and step mother (21 years old).After taking full history, examining the case and ordering investigations, the emergency room doctor notified the case as child abuse. A- How to verify the ages of the father, child and step mother? (3 Marks) B- Mention 4 possible lesions suggestive of child abuse. (4 Marks) C- What is the classical radiological picture that confirms the diagnosis of long term child abuse? (2 Marks) 2- Mention four differences between: A- Ante mortem and postmortem wounds. (4 Marks) B- Homicidal and suicidal fire arm wounds. (4 Marks) C- Cadaveric spasm and rigor mortis. (4 Marks) 3- Explain: A- Mechanisms and Medico legal importances of intracranial Countercoup lesions. (2.5 Marks) B- Mechanisms of immediate death after burn (within 6 hours ). (4 Marks) 4- How to examine and determine sex in an alleged inter sex state? (4.5 Marks) 112

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 23/8/2008

I- Mention the medicolegal importance of: A- Lucid interval. B- Cadaveric spasm. C- Age of 21 years old .How to estimate this age in a male & female subjects?

II- Give an account on: A- Causes of immediate death in fire victims. B- Skull injuries produced by an axe. C- Four differences between cut and contused wound. D- Characters of fire arm injuries.

III- Describe: A- The mechanism of toxicity of carbon monoxide inhalation. B- Treatment of organophosphorus poisoning. C- Three poisons manifested by convulsions. Mention the clinical picture of one of them. D- Four contraindications for gastric lavage in a poisoned patient. Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 1 hour Date: 4/5/2008

I- Mention 4 medicolegal importance for each of the following: A- Fingernail abrasions. (2 Marks) B- Fingerprints. (2 Marks) C- Adipocere formation. (2 Marks)

II- Enumerate: A- Two contraindications for the use of activated charcoal. (2 Marks) B- Four toxic causes of convulsions. (2 Marks)

III-Choose the most correct answer: NB. MCQs with this exam are not includedâ&#x20AC;Ś 113

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 21/7/2007

I- Forensic Medicine: 1- Case Scenario: (11 Marks) The police was notified that a 19-year-old female was found dead. The medicolegal expert was called to examine the case. After complete autopsy, he reported that the case was manually strangulated. Also he repotted a recent tear of the hymen. A- How would you verify the age of the female? B- Discuss the signs by which the case was diagnosed? C- Discuss different types of hymen? 2- Give an account on: (25 Marks) A- Characteristics of suicidal firearm injuries. B- Clinical picture of compression. C- Heat stroke (heat hyperpyrexia. D- Skin lesions in child abuse. E- Factors affecting hypostasis. II- Clinical Toxicology: 1- Case Scenario: (10 Marks) A nurse slipped on wet floor while she was carrying a vessel containing a strong odorous disinfectant, the contents were spilt allover her clothes. After 10 minutes, "she became delirious, then passed into coma with cyanosis. On examination, there were oilguria, miosis, blood pressure: 80/50, pulse: 100 beat/min. A- What is the most likely diagnosis? B- Enumerate five poisons causing cyanosis? C- How could this patient be treated? 2- Give an account on: (18 Marks) A- Clinical picture of acute digitalis toxicity? B- Clinical picture of paraquate toxicity? C- Uses and mechanism of four common physiological antidotes? D- Treatment of acute salicylate toxicity? E- Treatment of carbon monoxide toxicity?

114

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 29/8/2007

I- Forensic Medicine: 1- Case Scenario: (10 Marks) A woman about 21 years old put an end to her marital life by setting fire to her apartment after pouring kerosene. She met her death immediately, while her husband (23 years) got multiple burns. He was transferred to the hospital where he died on the fifth day. A- How to verify the ages of both the woman and the husband? B- What are the possible mechanisms of their death? C- Describe the postmortem picture of the woman? 2- Give an account on: (10 Marks) A- Types of fissure fracture of the skull, B- Findings of external examination of a live born infant one week age. 3- Mention Characteristics of the following: (12 Marks) A- Homicidal cut throat. B- Ligature mark in both hanging and strangulation C- Sporting gun inlet at a distance of 2 meters. II- Clinical Toxicology: 1- Case Scenario: (10 Marks) An 8-year-old boy drank a colorless odorous fluid that was put by mistake in a familiar soda bottle. He suddenly coughed and vomited twice. On arrival to emergency department, he was cyanotic with respiratory distress. On examination, blood pressure: 110/60mmHg, pulse: 120beat/min, temperature: 33.5 CO, pupils were dilated with signs of pulmonary edema and grade II coma. A- What is the most likely diagnosis? B- Enumerate five poisons causing coma? 2- Give an account on: (10 Marks) A- Clinical picture of atropine toxicity? B- Indications, contraindications &complications of forced alkaline diuresis? 3- Discuss: (12 Marks) A- Mechanism of iron toxicity? B- Curative treatment of botulism? C- Treatment of acetaminophen toxicity?

115

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 1 hour Date: 2/5/2007

I- Mention 4 differences between each of the following: A- Inlet and exit of firearm injuries. (4 Marks) B- Antemortem and postmortem wounds. (2 Marks) C- Male and female pelvis. (2 Marks)

II- Mention: A- Four precautions before performance of therapeutic abortion. (2 Marks) B- Medicolegal importance of cadaveric spasm. (3 Marks)

III-Give an account on: A- Clinical picture of oxalic acid toxicity. (4 Marks) B- Treatment of rhabdomyolysis. (3 Marks)

IV-Choose the most correct answer: NB. MCQs with this exam are not includedâ&#x20AC;Ś

116

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 5/7/2006

I- Forensic Medicine: 1- Case Scenario: (10 Marks) A female aged 16 years was hit by an axe (fass) on her head and found unconscious with an axe nearby. Her brother (21 years) claimed that he tried to kill her for the sake of honour. A- How to verify the ages of both the victim and assailant? B- What are the possible fractures that can be detected in the skull of the victim? C- What are the signs of virginity that can be looked for in the victim to prove the allegation of the assailant? D- If the victim survived, mention the possible sequelae of the resulting head trauma. 2- Mention the differences between: (12 Marks) A- Homicidal and accidental strangulation by umbilical cord in newly born baby. B- Inlet and exit of a bullet. C- Torn and dentate (fimbriated) hymen. 3- Give an account on: (10 Marks) A- Examination and diagnosis of the victim (habitual sodomist) in a case of sodomy? B- Medico legal importance of hypostasis II- Clinical Toxicology: 1- Case Scenario: (10 Marks) A 37 year old man was brought to the hospital suffering from chest tightness, lacrimation, hyper salivation, sweating, diarrhea, abdominal colic, muscle fasciculation and weakness. O/E the patient was cyanosed with signs of pulmonary edema and miosis. A- What is your provisional diagnosis? B- What is the differential diagnosis of other poisons causing miosis?

117

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 21/8/2006

I- Forensic Medicine: 1- Case Scenario: One of the most miserable transportation accidents in our history was sinking of the ferry boat AlSalam 98 in the red sea with death of over 1000 passengers. Two non putrefied bodies were retrieved from water after one month and suspected to be of a male (30 years) and a female (21 years). A-What is the post mortem condition that can be observed in the retrieved bodies? Mention its medicolegal importance. B- How to identify the ages of these bodies? C- How to prove that death was due to drowning? 2- Mention the differences between: A- Hypostasis and Bruises. B- Respired and Unrespired lungs in a case of infanticide. C- Recent and Old torn hymen. 3- Give an account on: A- Indications and precautions before performance of therapeutic abortion? B- Characters of fabricated wounds? II- Clinical Toxicology: 1- Case Scenario: A chemist was brought to the poison control center by the ambulance. His assistant stated that, while in the laboratory, he fell down suddenly in coma after having a loud cry. On examination there was red skin with froth at mouth and a characteristic smell, fixed dilated glistening pupils and convulsions .BLP. 100\65, subnormal temp., gasping respiration, and imperceptible pulse. A- What is your provisional diagnosis? B- What is the differential diagnosis of other poison(s) causing red (not flushed) skin? C- How to treat this case? 2- Give an account on: A- Treatment of caustic potash ingestion in a child. B- House hold antidotes . C- Technique of gastric lavage. D- Clinical picture of food-born botulism. 3- Mention the mechanism of toxicity (actions) and physiologic antidote of each of the following poisons: A- Organophosphates (Parathion(. B- Snake venom. C- Iron. D- Arsine gas. 118

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 5/7/2005 1- Comment on: A- Compression (definition, mechanism and clinical picture. B- Complications of contused wounds. C- Possible mechanisms of death by electrocution. D- Types of emboli. 2- In a big fire of a house a group was affected, a guard (50 years), family formed of a further 40 years a mother 30 years boy 10 years and a girl 7 years. All died and their bodies were charred and disfigured. A- How can you identify the victims? B- What are the possible mechanism of death? 3- Comment: on clinical picture, diagnosis and treatment of: A- Acute cannabis toxicity. B- Benzodizepines acute toxicity. 4- Give short notes on: A- Treatment of acute iron toxicity. B- Curative treatment of acute botulism. C- Cross dependence. 6- A young female working in a lab. had mistaken sugar, for a toxic white powder and put it into a cup of tea and drank it she started to vomit and got abdomen pain and after; 10 min she started to have twitches then generalized convulsions, headache and dyspnea. A- Give your provisional diagnosis. B- Comment on treatment of the case.

119

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 13/9/2005 1- Comment on: A- Factors affecting hypostasis. B- Traumatic asphyxia. C- Why atropine and oximes are used in treatment of organophosphorus compounds toxicity? D- Clinical picture of digitalis acute toxicity. 2- A dead body (about 30 years old) was seen floating in a water pool. A- How to identify its age and sex. B- What are the possible causes of death? 3- Give short notes on: A- Heat stroke. (Hyperpyrexia) B- Diagnosis of child abuse. C- Clinical picture of cyanide poisoning. D- Treatment of carbon monoxide toxicity. 4- A young girl had ingested few colored pills related to her mother's therapy, after few hours she got shocked, cyanosed, hyperventilated with a state of metabolic acidosis. A- Give your provisional diagnosis. B- What are your-main lines of treatment?

120

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 10/7/2004 1- Discuss Circumstances, action, clinical picture, toxic levels, laboratory investigations and treatment of: A- Iron toxicity. B- Digitalis toxicity. 2- Comment on: A- Clinical signs of a Cobra snake bite. B- Cannabis, marijuana, bango, source and mode of action. C- 4 steps of treatment in a case of paracetamol toxicity D- 4 poisons responsible for visual hallucinations and their actions (just enumerate) E- 4 poisons can be diagnosed by odor and identify the nature of the smell. F- Skull base fractures. G- Signs of rape in an accused male. H- Difference between meconium and stool in case of a newly born baby and their medicolegal importance. 3- A farmer showed a picture restlessness headache irritability drowsiness, miosis, laboured, respiration, and wheezes in chest. When he was brought to hospital there were signs of shock and pulmonary edema. His clothes also were wet and carrying a certain odor. A- Give your differential diagnosis. (4 only) B- How can you manage this case? C- The important investigations of this case. 4- The police notified that a man was found dead in the street. On examination, the body showed some abrasions and contusions. He was seen alive 2 hours ago for the last time. A- Comment on the possible circumstances and mode of his death B- How can you identify him (write in short)? C- Verify the postmortem interval. D- What is the importance of DNA in identifying this case? 5- Mention: A- 4 factors affecting the shape of a fire arm injury. B- 4 differences between an old and a recent tear of hymen. C- 4 cardiovascular changes in a live birth baby two weeks age. D- 4 characters of a corrosive burn. E- Signs of rope mark the case of suicidal hanging. 121

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 11/9/2004 1- A family composed of a father aged 35 years, mother aged 23 years and her young daughter aged 7 years. One afternoon while the mother was making tea for her young brother aged 16 years, a fire broke out. Her daughter and brother were found dead, while she was transferred to hospital and she died after 12 hours. A- How would you verify the age of the child and brother and give causes of their death? B- How would you verify that the bum on the brother was a post-mortem one? 2- Comment on: A- Sure signs of drowning. B- How can you diagnose concussion and compression? 3- Differentiate between: A- A stab wound and a firearm injury. B- Medicolegal aspect and sure signs of pregnancy. 4- A young man working in a printing shop was admitted to hospital suffering from abdominal colic, constipation, pulse was 80/min and regular BI.P. 130/90, temp. 37 Co, complete blood picture and complete urine analysis were done. A- What is your provisional diagnosis (enumerate 4 only) and give other symptoms and signs to confirm your diagnosis? B- What are the expected results of the investigations and the possible antidotes? 5- Comment on clinical picture and treatment of: A- Acute salicylate toxicity B- Paraquate toxicity.

122

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 1 hour Date: 15/5/2004

I- Comment on: A- Ocular signs of death. B- Hemoglobin changes in contusions. C- Two cases of ring fractures.

II- Define: A- Rape. B- Bestiality. C- Necrophilia.

III- Mention Three causes of death in child abuse. IV- An actively seizing 35-years old man was brought to emergency department and his wife stated that he was irritable with frequent attacks of headache, vomiting and abdominal pain. The man was pale with dark blue line at the base of the gum. Rectal examination revealed hard feces. Blood film revealed Rbcs changes. He was working in gasoline industry. A- Give your provisional diagnosis. B- Give also the mechanism of these toxin induced seizures. C- Give specific physiological antidotes for this case.

III- Choose the correct answer. NB. MCQs with this exam are not includedâ&#x20AC;Ś

123

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 8/7/2003 1- An athletic strong man was found dead since about 9 hours. There were semi lunar abrasions around the mouth and nose. A 15 year-old thin mentally retarded female suspect said that she used only a soft pillow to commit the crime. A- Identify the age of the suspect. B- Do you think that the suspect is a liar? Why? C- Give the possible external postmortem pictures of the case. D- Mention the postmortem changes in this case. 2- Give short account on: A- Stab penetrating wounds. B- Hazards of radiation. C- Characteristics of suicidal fire arm injuries. 3- Give the difference between: A- Acute cocaine poisoning and datura poisoning. B- Acute morphine poisoning and cerebral hemorrhage. C- Recently tom hymen and fambriated hymen. 4- During winter a wife and her photographer husband were found unconscious. Their room was warm due to the use of heater. The husband who has history of using a drug for angina arrived dead with red - brown hypostasis. The C/P of the wife was coma grade HI, pulse 97/M & irregular, BP 85/55 and red cherry skin. A- Give three possible diagnoses for the husband and why? B- Mention in detail a test that may confirm the diagnosis. C- Outlines the treatment for the wife. D- Mention six factors that affect the action of a poison. 5- Mention in brief: A- The main lines of diagnosis of a case of parathion poisoning. B- Uses and mechanism of four common physiological antidotes. C- Four poisons causing cyanosis and the C/P of one of them. 6- ? ‫ماهي األخطاء التي يمكن أن تحدث من الطبيب أثناء عمله‬

124

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Total time allowed: 3 hours Date: 9/9/2003 1- A 15-year-old drowsy thin virgin, arrived to the hospital with a cut wound in her neck. She alleged to be raped. Three suspects claimed that there was a free consent. Different signs of resistance and violence were found in the suspects. A- Identify the age of the virgin. B- Do you think that three is a free consent? Why? C- How can you verify that the wound in her neck is self-inflicted? D- Mention the possible local findings in this raped virgin. 2- Give short account on: A- Fissure fracture and its types. B- Complications and emergency treatment of electrocution. C- Characteristics of sporting gun inlet at a distance of 2.5 meters. D- Definition and characteristics of drug dependence . E- Grading of coma due to poisoning. 3- Give the difference between: A- Hypostasis and contusion. B- Acute morphine poisoning and of parathion poisoning. C- Accidental and homicidal umbilical cord strangulation. 4- A child drink a fluid with characteristic odor. On arrival to the hospital, he was drowsy and feverish. Crepitation were heard over the chest. A- Give your diagnose and the differential diagnosis. B- Mention the treatment for this case. 5- Mention in brief: A- Treatment of a case of snakebite. B- Uses and mechanism of four common local antidotes. C- Four poisons causing convulsion and the C/P of one of them. 6- ? ‫ماهي واجبات األطباء نحو زمالئهم‬

125

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 2 hours Date: 14/5/2003

Mention in brief: 1- Medico legal importance of the age of 18 years. 2- Estimation of age of 21 year in females. 3- Four Causes of brain death. 4- Four Eye criteria of death within half an hour. 5- Four differences between Cut and contused wounds. 6- Four differences between Dry and corrosive burns. 7- Four main lines of treatment in a case of coma due to poisoning. 8- Two contraindications of emesis. 9- Two poisons causing flushed face. 10- Three main important symptoms of acute arsenic poisoning. 11- Three signs in the oral cavity in a case of chronic mercury poisoning. 12- Four local antidotes.

126

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department End Year exam for 4th grade Egyptian and Malaysian students Total time allowed: 3 hours Date: 5/8/2002 1- In a transportation accident, fire was set up in the Upper Egypt train. Thousands of victims were died. The medicolegal experts and the police were cooperated to investigate the accident. A- Discuss the phases of investigation that should be done in such a circumstance. B- What are the different causes of death in burn that might be sustained by the victims? 2- Answer: A- What are the medicolegal importance of the age of sixteen and how to estimate it. B- Mention the different factors governing fracture of the skull bone. C- Give an account on the medicoiegal aspects of smothering. D- Discuss signs of live birth In the circulatory system. E- ‫اذكر االحتياطات الالزمة لعمل شهادة طبية ؟‬ F- Give an account on death under anesthesia and due to it. 3- Give an account on: A- Physiological antidotes. B- Action and clinical picture of carbon dioxide poisoning. C- Common lead (pb) compounds and clinical picture of chronic lead poisoning. D- Treatment of strychnine poisoning. E- Uses of barbituric acid derivatives and their actions. 4- Discuss in short: A- Treatment of Organophosphorus poisoning. B- Types and clinical features of food poisoning. C- Action of phenol.

127

Tanta University Faculty of Medicine Forensic Medicine & Clinical Toxicology Department 20% exam for 4th grade Total time allowed: 2 hours Date: 18/3/2002

I- Discuss in short: A- Skull injuries produced by an axe. B- Causes of death in hanging. C- Sequences of milk teeth eruption. D- Medico legal importance of abrasion.

II- Give an account on: A- Etiology of breathing difficulties in patients with poisoning or drug over dose. B- Action of carbolic acid (phenol). C- Treatment of cyanides poisoning. D- Action of morphine. E- Chelators.

128

Forensic Medicine Identification 1- Give reason:  X-rays on clavicle and femur help in the diagnosis of age of 18 in male. (2013)  Nail examination is valuable in identification. (2013)  Clothes examination is valuable in identification. (2013) 2- How many teeth does the child have at the age of 2 years? Identity them. (2011) 3- Medico legal importance of nail examination. (2009) 4- How to examine and determine sex in an alleged inter sex state. (2008), (2006) 5- Medicolegal Importance of age of 21 years old. How to estimate this age in a male & female subjects. (2008) 6- Medicolegal Importance of the age of 18 years. (2003) 7- Medicolegal Importance Fingerprints. (2008) 8- Mention differences between male and female pelvis. (2007) 9- Medicolegal Importance of age of 16 and how to estimate it. (2002) 10- Sequences of milk teeth eruption. (2002)

Wounds 2. 1- Give reason:  Fabricated wound. (2013), (2011), (2009), (2006)  Little force is required to induce cut wound. (2013), (2011)  Bruises may be dangerous. (2012)  Contusion may appear at a site far from the site of the original trauma. (2013), (2012)  All contused wounds are associated with surrounding bruises. (2011)  Tangential abrasion gives an idea about direction of impact not imprint abrasion. (2012) 2- Differences between Hypostasis and Bruises. (2010), (2006) 3- Differences between Hypostasis and Contusion. (2011), (2003) 3. 4- Differences between ante mortem and post mortem wounds. (2008), (2007) 4. 5- Differences between cut and contused wound. (2008), (2003) 6- Complications of contused wounds. (2005) 6. 7- Medicolegal Importance of abrasions. (2002) 7. 8- Give an account on stab penetrating wounds. (2003) 8. 9- Differences between Hypostasis and contusion. (2003) 10- Hemoglobin changes in contusion. (2003)

130

Head Injuries 1- Give reason:  If an apparently normal victim of concussion is discharged, there will be medico legal responsibility of negligence. (2014)  Transient loss of consciousness occurs in concussion. (2013)  In compression, the pulse is slow and full. (2013)  Chipped fracture - is not considered a permanent infirmity. (2013)  Fractured skull base is more common than fracture vault. (2012)  After concussion the victim may not be able to give a proper history. (2012)  Brain contusion away from the site of impact to the head. (2012) 2- Brain compression. (2005), (2007), (2014) 3- What is the mechanism of Contercoup in traumatic head injury? (2014) 4- Brain concussion. (2011), (2012), (2013) 5- Give forensic solution of a man alleged that he was hit by a heavy stick on his head. (2013) 6- Give forensic solution of a man alleged that he was hit by a knife not by a stick on his head. (2011), (2013) 7- How to prove that Skull fracture is polar fracture? (2011) 8- How to differentiate between Thermal and traumatic skull fracture? (2010), (2011) 9- Squeal and complication of head injuries. (2010) 10- Define Brain compression & Mention its lateralizing signs. (2009) 11- Explain Mechanisms and Medico legal importance of intracranial contrecoup lesions. (2008) 12- Give an account on Skull injuries produced by an axe. (2002), (2008) 13- Lucid interval (2008), (2012) 14- Give an account on Types of fissure fracture of the skull. (2007), (2003). 15- Factors governing fracture of the skull bone (2002). 16- Comment on 2 Cases of ring fractures (2004) 17- Comment on Skull base fractures (2004) 18- Comment on How Can you Diagnose Concussion and compassion (2004) 19- Mention the mechanism of Chipped fracture. (2012)

Firearm Injuries 1- Mention medicolegal importance of Powder mark in firearm injuries. (2011) 2- Estimation of distance of firing from powder marks. (2009) 3- Differences between Homicidal and Suicidal firearm wounds. (2008) 4- Causes of immediate death in fire victims. (2008) 5- Characters of fire arm injuries. (2008), (2003) 6- Differences between Inlet and Exit of fire arm. (2006), (2007) 7- Characteristics of suicidal firearm injuries. (2007) 8- Characteristics of sporting gun inlet at a distance of 2 meters. (2003), (2007) 9- How to estimate the distance of firing in shotgun injuries. (2001) 10- Mention 4 factor affecting shape of fire arm injuries. (2004)

131

Physical Injuries 1- Give reason:  Coagulation necrosis occurs at electric burn. (2013) 2- How to prove that the wound is an entry mark of direct contact electricity. (2011) 3- Mechanism of death in case of electrocution. (2005), (2009) 4- Clinical picture of heat collapse. (2009) 5- Clinical picture of heat cramp. (2009), (2014) 6- Mechanisms of immediate death after burn (within 6 hours). (2008) 7- Heat stroke (Heat Hyperpyrexia). (2005), (2007), (2014) 8- Give an account on:- Hazards of radiation. (2003) 9- Characters of a corrosive burn. (2004) 10- Differences between Dry and corrosive burns. (2003) 11- Give an account on complications and emergency treatment of electrocution. (2003)

Death & Postmortem Changes 1- Give reason:  Rigor mortis helps in estimation of time passed since death. (2014)  Rigor mortis starts early in deaths following convulsion. (2013)  Rigor mortis is not an accurate method to estimate time passed since death. (2013)  Hypostasis helps in estimation of time passed since death. (2013)  Showing up bruises in an area with hypostasis. (2012)  Cadaveric spasm is considered a highly suggestive sign of drowning. (2013), (2014) 2- Rigor Mortis. (2013), (2012) 3- Hypostasis. (2005), (2006), (2007), (2011), (2012) 4- Differences between hypostasis and contusion. (2011) 5- Differences between hypostasis and bruises. (2003), (2006), (2010) 6- Differences Between cadaveric spasm and rigor mortis. (2008) 7- Medico legal importance of cadaveric spasm. (2007), (2008)

Brain Death 1- Give reason:  The concept of brain death is a matter of international debate. (2014)  Apnea test in brain death is not recommended. (2014) 2- Causes of Brain death (2003)

132

Sexual Offences 1- Give reason:  Dentate hymen is of medico-legal importance. (2014)  Imperforate hymen is of medico-legal importance. (2014)  In young raped female child, the local signs of violence are severe. (2014) 2- Discuss different types of hymen. (2007) 3- Differences of Recent and old torn hymen. (2003), (2004), (2006) 4- Differences between torn and dentate (Fimbriated) Hymen. (2006) 5- Give an account on: Examination and diagnosis of the victim (Habitual Sodomist) in case of sodomy. (2006) 6- Comment signs of rape in an accused male. (2004) 7- Define rape. (2004)

Pregnancy, Delivery & Abortion 1- Give reason:  Abortion in fetus with hydrocephalus is considered unlawful. (2014)  Abortion in uncontrolled diabetic mother is considered lawful. (2014) 2- Give the forensic solution Suspected criminal abortion. (2013) 3- Precautions before performance of therapeutic abortion. (2007) 4- Indications and precautions before performance of therapeutic abortion. (2006) 4- Medico legal aspect and sure signs of pregnancy. (2004)

Child Abuse 1- Give reason:  Subdural hematoma is found in child abuse. (2014)  Multiple contusions are usually found in child abuse. (2014)  Fatal child abuse differs from common murder. (2013)  The most common lesions in child abuse are the skin and skeleton. (2013)  X-ray is helpful in diagnosis of child abuse. (2012) 2- How to prove that the child skin lesions are due to physical abuse. (2011) 3- Give an account on common bruises that is highly suggestive of child abuse. (2009) 4- Skin lesions in child abuse. (2007) 5- Diagnosis of child abuse. (2005) 6- Causes of death in child abuse. (2004)

Infanticide 1- Findings of external examination of alive born infant one week ago. (2007) 2- Differences between respired and unrespired lungs in a case of infanticide. (2006) 3- Differences between homicidal and accidental strangulation by umbilical cord in newly born baby. (2003), (2006) 4- Mention 4 Cardiovascular changes in alive birth baby two weeks ago (2004).

133

Asphyxia 1- Give reason:  Dribbling of saliva is a sure sign of ante-mortem hanging. (2013)  Tongue is swollen and protruded in hanging. (2013)  Froth is considered a highly suggestive sign of drowning. (2014)  Cadaveric spasm is considered a highly suggestive sign of drowning. (2014) 2- Differences between hanging and strangulation. (2011) 3- Mechanism of dry drowning. (2013) 4- Mechanism of silver spots in death due to asphyxia. (2011) 5- Mechanism of death in hanging (2002), (2010) 6- Define: Diatoms and Mention its Medico legal importance. (2009) 7- Characteristics of Homicidal cut throat. (2007) 8- Characteristics of ligature mark in both hanging and strangulation. (2007) 9- Mention the different types of Hanging and discuss the possible causes of death in them. (2001) 10- Medico Legal aspects of smoothing. (2002) 11- Mention signs of rope mark the case of suicidal hanging. (2004) 12- Comment on: Sure signs of drowning. (2004) 13- Comment on: Traumatic asphyxia. (2005) 14- Mention the mechanism of Death from strangulation (2012)

Miscellaneous 1- Causes of Black eye. (2009) 2- Primary impact injuries to pedestrians. (2001) 3- Differences between meconium and stool in case of newly born baby and Medico legal importance. (2004)

134

Clinical Toxicology General Toxicology 1- Give reason:  Activated charcoal is not effective in hydrocarbons. (2013)  Two substances with equal toxicity may differ in their hazards. (2012)  Whole bowel irrigation is contraindicated in ileus or intestinal obstruction. (2012)  The patient can withstand toxic dose without ill effects. (2012)  Alkaline dieresis is indicated in salicylate, meprobamate, and lithium. (2012) 2- Indications and contraindications of:  Gastric lavage. (2003), (2013), (2008)  Emesis. (2013)  Hemodialysis. (2013)  Activated Charcoal. (2013), (2008)  Whole bowel irrigation. (2013)  Forced diuresis. (2013), (2007) 3- Four local antidote (2003) 4- A Method used for GIT Decontamination (indication, contraindication, adverse effect). (2010) 5- Give an account on causes and treatment of toxic coma. (2009) 6- Indication of Multiple dose activated charcoal. (2008) 7- Four contraindication for gastric lavage in a poisoned patient. (2008) 8- Indication, contraindication and complication of forced Alkaline diuresis. (2005), (2007) 9- Treatment of rhabdomyolysis. (2008), (2007) 10- House hold antidote. (2006) 11- Technique of gastric lavage. (2006) 12- Chelators. (2002) 13- Cross dependence. (2005) 14- Physiological antidotes. (2002), (2003) 15- Etiology of breathing difficulties in patient with poisoning or overdose. (2002) 16- Four common physiological antidotes (uses and mechanism). (2007) 17- Causes and treatment of toxic coma. (2009) 18- Toxicological causes of respiratory failure. (2008) 19- Describe three poisons manifested by convulsions. Mention the clinical picture of one of them. (2008) 20- Four main lines of TTT of come due to poisoning. (2003) 21- Two poisons causing flushed face. (2003) 22- Four poisons causing cyanosis and clinical picture of one of them. (2003)

135

Corrosives 1- Give reason:  Carpo-pedal spasm in oxalic acid poisoning. (2013)  X-ray should be done in alkalis and inorganic acid ingestion. (2012)  Perforation of stomach is more common in alkaline corrosives. (2012) 2- Clinical picture of Phenol toxicity. (2008), (2010), (2014) 3- Action of phenol. (2002) 4- Treatment of caustic potash ingestion. (2004), (2006), (2009) 5- Physiologic antidote of Oxalic acid. (2010) 6- Clinical picture of oxalic acid toxicity. (2007)

Pesticides 1- Give reason:  Chest x-ray is indicated in acute organophosphrous poisoning. (2013)  Oxime is given in the treatment of organophosphrous poisoning. (2013)  Hypertension, tachycardia and mydriasis are muscarinic effect organophosphrous insecticides. (2012) 2- Mechanism of organophosphrous insecticides. (2006), (2008), (2014) 3- Treatment of organophosphates poisoning (2002), (2008), (2014) 4- Clinical picture of organophosphrous poisoning. (2013) 5- Mention the role of atropine and oximes in the treatment of acute organophosphrus poisoning, with reference to their doses and mode of administration. (2005), (2011) 6- Clinical picture of paraquat toxicity. (2004), (2007) 7- Clinical picture of zinc phosphide toxicity. (2014)

Substance dependence, Sedatives & Hypnotics 1- Give reason:  Emesis is contraindicated in treatment of antipsychotics. (2013)  Sodium bicarbonate is the first drug of choice in treatment of tricyclic antidepressant toxicity. (2012)  Alcohol should not be given with benzodiazepines. (2011)  Antabuse is used in treatment of alcohol dependence. (2013)  Cannabis user develops false believe that cannabis is not a dependent substance. (2012) 2- Specific antidote of benzodiazepines. (2012) 3- Clinical picture, diagnosis and treatment of benzodizepines acute toxicity. (2005) 4- Mechanism of drugs used in detoxification of opioid dependence. (2014) 5- Opiate dependence. (2009) 6- Definition and characteristics of drug dependence. (2003) 7- Uses of barbiturate (Barbituric acid) derivatives and their action. (2002) 8- Treatment of Morphine addiction. (2004)

136

Volatiles & Noxious Gases 1- Give reason:  Carbon monoxide poisoning leads to red asphyxia. (2013)  Cyanide poisoning leads to red asphyxia. (2013)  It is recommended to give 100% oxygen in fire victims with cyanide toxicity. (2012)  Abdominal x-ray in the sitting position is indicated in kerosene ingestion. (2012) 2- Characters of Ethanol toxicity. (2010) 3- How to prove that Coma is due to ethanol toxicity. (2011) 4- Physiologic antidote of methanol. (2010) 5- Characters of ethanol coma. (2009) 6- Methanol toxicity. (2008) 7- Treatment of carbon monoxide poisoning. (2005), (2007), (2008), (2014) 8- Clinical picture and antidote of acute carbon monoxide poisoning. (2011), (2013) 9- Physiologic of carbon monoxide. (2010) 10- Mechanism of toxicity of carbon monoxide inhalation. (2008) 11- Action and clinical picture of carbon dioxide poisoning. (2002) 12- Treatment of cyanide poisoning. (2002) 13- Clinical picture of cyanide poisoning. (2005), (2013) 14- Treatment of kerosene toxicity. (2014) 10- Clinical picture and antidote of kerosene poisoning. (2013)

Analgesics & Antipyretics 1- Give reason:  In overdose, acetaminophen causes hepatocellular necrosis. (2013)  N-acetyl cysteine is the physiologic antidote of choice for acetaminophen toxicity. (2013). 2- Clinical picture of severe salicylate toxicity. (2011), (2014) 3- Hemolytic effect of salicylate poisoning and treatment of this effect. (2009), (2012) 4- Mechanism of acetaminophen (paracetamol) poisoning. (2013), (2014) 5- Antidote of acetaminophen. (2010), (2011) 6- Mention treatment of acetaminophen toxicity. (2007), (2009) 7- Treatment of acute salicylate toxicity. (2007), (2008) 8- Treatment of acute Acetaminophen toxicity. (2007) 9- Treatment of paracetamol toxicity. (2004), (2014) 10- Clinical picture and treatment of acute salicylate toxicity. (2004)

137

Animal Poisons 1- Give reason:  Dysrrhythmia, hypertension and pulmonary edema in scorpion stinge. (2014) 1- Clinical picture of elapidae snake bite. (2011) 2- Action of snake poisons and treatment of this case. (2009) 3- Mechanism of toxicity and physiologic antidote snake venom. (2006) 4- Treatment of snake bites. (2003), (2006) 5- Comment on clinical signs of a cobra snake bite. (2004) 6- Clinical picture of scorpion bite. (2013) 4- Queen Cleopatra during the tragedy of her death was unable to ask for help despite she was conscious. (2012)

Food Poisons 1- Give reason:  Dysrrhythmia, hypertension and pulmonary edema in scorpion stinge. (2014) 2- Mechanism of botulism toxicity. (2013), (2014) 3- How to treat a case of acute adult food-borne botulism. (2011) 4- Curative treatment of botulism. (2007) 5- Clinical picture of food borne botulism. (2006), (2002) 6- Types and clinical picture or clinical feature of food poisoning. (2002)

Plant Poisons 1- Give reason:  Slow heart rate in opiate toxicity. (2013)  Constipation and ileus commonly occur in opiate toxicity. (2012)  Morphine is contraindicated in head injured patients. (2012)  The user of cannabis believes that he may stop cannabis without withdrawal. (2013)  Cannabis user develops false believe that cannabis is not a dependent substance. (2012)  CT scan is important in diagnosis of cocaine intoxicated patients. (2013) 2- Clinical picture of acute opiate poisoning. (2013) 3- Specific antidote of opiates. (2011) 4- Physiologic antidote of morphine. (2010) 5- Differentiate between acute morphine poisoning and cerebral hemorrhage. (2003) 6- Differentiate between acute morphine poisoning and of parathion poisoning. (2003) 7- Differentiate between acute cocaine poisoning and datura poisoning. (2003) 7- Mechanism of cannabis toxicity. (2014) 8- Acute cannabis toxicity. (2005) 9- Cannabis, Marijuana, Bango (source and mode of action). (2004) 10- Treatment of atropine toxicity. (2010) 11- Mention four clinical presentation of stage of excitation in atropine toxicity. (2004), (2009)

138

12- Action of morphine. (2002) 13- Treatment of digitalis toxicity. (2014) 14- Clinical picture of digitalis acute toxicity & antidote (2005), (2007), (2008), (2009), (2011), (2013) 15- Physiologic antidote of digitalis. (2010) 16- Mechanism of digitalis toxicity. (2012) 17- Clinical picture of atropine toxicity (2006), (2007) 18- Action of morphine (2002) 19- Circumstances, action, clinical picture, Toxic level laboratory investigation and treatment of digitalis toxicity. (2004)

Metallic Irritants 1- Give reason: ď&#x201A;ˇ Reduced IQ and learning disabilities in lead poisoned children. (2013) ď&#x201A;ˇ Hematemesis and melena in acute inorganic mercury toxicity. (2013) 1- Four Physiological antidotes for metallic poisons. (2008) 2- Mechanism of Iron toxicity. (2006), (2007), (2012) 3- Clinical picture of acute iron toxicity. (2011) 4- Specific antidote of iron. (2011) 5- Treatment of iron toxicity. (2005) 6- Common lead compounds and C/P of chronic lead poisoning. (2002) 7- Three main important symptoms of acute arsenic poisoning. (2003) 8- Three signs in the oral cavity in case of a chronic mercury poisoning. (2003) 9- Circumstances, action, clinical picture, toxic level, laboratory investigation and treatment of iron toxicity. (2004) 10- Acute iron toxicity. (2005)

Miscellaneous Poisoning 1- Mention the mechanism of hyperglycemia in theophylline toxicity. (2012)

139

Final Examination in Ophthalmology August 18th, 2014 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1-Compelete by filling the spaces (Suggested time: 15 minutes)

(10 Marks)

1- Methods of measurement of the intra-ocular pressure (IOP) includes ………. and …………. 2- The causative organism of typical hypopion ulcer is ……………………………………………………… 3- Perception of light is a test of ……………. While projection of light is a test of ………………… 4- Cherry red spot is seen in case of ………………………….. 5- In acute congestive glaucoma the pupil is …………………………. and …………………………………. 6- Ptosis is defined as ………………………………….. 7- Image obtained by Direct ophthalmoscope …………………………… and …………………………….. 8- Norma Corneal is ……………………………….. and ………………………………… 9- In Iridodialysis type of Diplopia is …………………………………………………. 10- Vitamin A deficiency is a common cause of ……………………………….. 2-Mark with True (T) or False (F) (Suggested time: 15 minutes)

(10 Marks)

1- Symblepharon means adhesion between palpebral conjunctiva and the eye ball. 2- The causative organism of dendritic ulcer is pneumococci. 3- Double staining of the cornea is characteristic perforated corneal ulcer. 4- Central retinal vein occlusion causes acute painful loss of vision. 5- Blind spot of the eye corresponding to the optic nerve head. 6- UBM is used for examination of the retina. 7- Diabetic retinopathy is best detected by fluorescein angiography. 8- Tremulous iris can be seen in aphakia. 9- Blood staining of the cornea is due to corneal FB. 10- Slit lamp is binocular instrument used for examination of the anterior segment of the eye. 3-Write short notes on the following (Suggested time: 40 minutes) 1- Complications of ulcerative blepharitis. 2- Types of optic atrophy. 3- Types of scleral staphyloma. 4- Lens induced glaucoma. 5- Anisometropia. 6- Classification of trachoma 141

(30 Marks)

4-Enumerate

(30 Marks) (Suggested time: 40 minutes)

1- Causes of Ciliary injection. 2- Field changes in primary open angle glaucoma. 3- Types of Astigmatism. 4- Signs of Aphakia. 5- Effect of blunt trauma on posterior segment of the eye. 6- Causes of shallow anterior chamber. 5-Explain why --- or Give reason for (Suggested time: 10 minutes)

(10 Marks)

1- Occurrence of glaucoma in hypermature cataract. 2- Perforated corneal ulcer can cause severe visual loss. 3- Corticosteroids are contraindicated in dendritic corneal ulcer. 4- Atropine is used in treatment of aoute Iridocyclitis. 5- Enucleation is not preferred in cases of panophthalmitis. 6-Problem Solving

(15 Marks) (Suggested time: 30 minutes)

Problem 1 A 3 years old child presented with right esotropia and on examination there was evident leucocoria (white pupil).Family history revealed that his older brother did enucleation of his right eye at age of 4 years due to same picture. a. What is the possible diagnosis of such case? b. What is the differential diagnosis of such case (only enumerate) (5 Marks) Problem 2 Male patient aged 55 years came complaining of rapid diminution of vision in the right eye since few days with redness, pain, photophobia, lacrimation, blepharospasm and halos around the light. Examination of this patient revealed: right eye VA: 6/60, lid edema, ciliary injection, grayish infiltration of the center of the cornea with loss of corneal luster. The anterior chamber shows yellowish material settled down at the bottom with upper straight level and the pupil is constricted with muddy iris. There is history of right chronic dacryocystitis and diabetes mellitus since few months. a- What is your diagnosis? b- What are the Complications of the condition? c- Outline the main line of treatment of this case? (10 Marks) 7-MCQs

(20 Marks) (Suggested time: 30 minutes)

1- Lagophthalmos can be caused by all of the following except: a) Facial nerve palsy b) 6th nerve palsy c) Cicatricial ectropion d) Postoperative repair for ptosis 142

2- Glaucoma due to intumescent cataract is: a) Pigmentary glaucoma b) Phacolytic glaucoma c) Pharcomorphic glaucoma d) Malignant glaucoma 3- All of the following surgeries can be used to treat keratoconus except: a) Keratoplasty b) Cross linking c) Posterior chamber IOL d) Intracorneal ring 4- All these are true about ulcerative blepharitis except: a) Can cause madarosis. b) Can be complicated by ulcerative keratitis c) Can be caused by herpes simplex virus d) Can be treated by antibiotics 5- Tremulous iris can be seen in: a) Aphakia, b) Sublaxation of the lens c) Hypermature cataract d) All of above 6- Diplopia due to right 4th cranial nerve palsy disappears on covering: a) Right eye b) Left eye c) Either one d) Neither one 7- Third cranial nerve innervates all the following except: a) Superior oblique muscle b) Levator palpebre muscle c) Inferior oblique muscle d) Medial rectus muscle 8- In an acute angle closure glaucoma, the choice of surgery is decided after: a) Gonioscopic examination b) Fundus examination c) Tonometry d) Visual field examination 9- Afferent pupillary defect occurs in all the following except: a) Papillitis b) Early papilledema c) Primary Optic atrophy d) Retrobulbar neuritis 10- Consecutive optic atrophy can occur with the following pathologies except: a) Degenerative myopia b) Retinitis pigmentosa c) Central retinal artery occlusion d) Central retinal vein thrombosis 11- The corneal touch reflex involves the following cranial nerves: a) 2nd and 4th b) 2nd and 3rd c) 5th and 3rd d) 5th and 7th 143

12- Patient had a pterygium, excised since one month, and starts to see double vision, this may be due to: a) Medial rectus weakness b) Lateral rectus paralysis c) Symblepharon formation d) Recurrence 13- All the following can be caused by chlamydial infection except: a) Ophthalmia neonatorum b) Trachoma. c) Inclusion Conjunctivitis d) Central corneal ulcer 14- Treatment of active anterior uveitis with secondary glaucoma includes: a) Cortisone plus mydriatic. b) Cortisone plus mydriatic plus betablocker c) Cortisone plus miotics d) Antibiotics plus betablocker 15- In acute retrobulbar neuritis which of the following is true: a) Optic nerve head is normal b) There is marcus Gunn pupil c) Positive scotoma for red and green d) All of the above 16- The best line of treatment of acute congestive glaucoma after control of intraocular pressure is: a) Laser peripheral iridectomy b) Clear lens extraction c) Argon laser trabeculoaplasty d) Trabeculectomy 17- Corneal ulcer associated with very severe pain is: a) Fungal ulcer b) Viral ulcer c) Acanthameobic ulcer d) Neurotrophic ulcer 18- In glasses for compound regular astigmatism we use: a) Sphero-cylindrical lenses b) Cylindrical lenses c) Convex lenses d) Concave lenses 19- All these are signs of central retinal vein occlusion except: a) Retinal hemorrhages b) Dilated tortuous veins c) Macular edema d) Cherry red spot 20- Second sight occurs with: a) Cortical cataract b) Nuclear cataract c) Sub-capsular cataract d) Anterior polar cataract

144

Final Examination in Ophthalmology September 20th, 2014 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1-Compelete by filling the spaces (Suggested time: 15 minutes)

(10 Marks)

1- Methods of measurement of the intra-ocular pressure (IOP) includes ………. and …………. 2- The most common causative organism of dendretic ulcer is ………………………………………… 3- Cherry red spot is seen in case of………………………………….… and …...………………………………. 4- The only muscle that elevate the eye ball in adduction is ..…………………………………………… 5- In acute congestive glaucoma the anterior chamber is ..………………………………………………. 6- Squint is defined as ………………………………….. 7- Image obtained by Direct ophthalmoscope …………………………… and …………………………….. 8- Normal cornea is clear due to …………..……………… and ………………………………. 9- Nerve supply of superior oblique muscle is ………………………………. 10- Vitamin A deficiency is a common cause of …………..……………… and …………..……………….. 2-Mark with True (T) or False (F) (Suggested time: 15 minutes)

(10 Marks)

1- Ptosis means adhesion between palpebral conjunctiva and the eye ball. 2- The causative organism of typical hypopyon ulcer is pneumococci. 3- Double staining of the cornea is characteristic of dendretic ulcer. 4- Central retinal vein occlusion causes acute painless loss of vision. 5- Blind spot of the eye is the macula. 6- UBM is used for examination of the optic nerve. 7- Diabetic retinopathy is best detected by fluorescein angiography. 8- Tremulous iris can be seen in aphakia. 9- Blood staining of the cornea is due to corneal degeneration. 10- Slit lamp is a binocular instrument used for examination of the anterior segment of the eye only. 3-Write short notes on the following (30 Marks) (Suggested time: 40 minutes) 1- Complications of myopia. 2- Types of staphyloma. 3- Lens induced open angle glaucoma. 4- Complications of chemical burn on the eye. 5- Types of astigmatism. 6- Classifications of trachoma. 145

4-Enumerate

(30 Marks) (Suggested time: 40 minutes)

1- Causes of Ciliary injection. 2- Field changes in primary open angle glaucoma. 3- Types of hypermetropia. 4- Signs of Aphakia. 5- Effect of blunt trauma on the eye. 6- Causes of deep anterior chamber. 5-Explain why --- or Give reason for (Suggested time: 10 minutes) 1- Perforation is uncommon in atypical hypopion ulcer. 2- Occurrence of glaucoma in intumescent cataract. 3- Perforated corneal ulcer can cause irreversible visual loss. 4- Corticosteroids are indicated in the shield ulcer. 5- Enucleation is not preferred in cases of panophthalmitis. 6-Problem Solving (Suggested time: 30 minutes)

(10 Marks)

(20 Marks)

(15 Marks) (Suggested time: 30 minutes)

1- Lagophthalmos can be caused by all of the following except: a) Facial nerve palsy b) 6th nerve palsy c) Cicatricial ectropion d) Postoperative repair for ptosis 146

2- Glaucoma due to hypermature cataract is: a) Pigmentary glaucoma b) Phacolytic glaucoma c) Pharcomorphic glaucoma d) Malignant glaucoma 3- All of the following surgeries can be used to treat keratoconus except: a) Keratoplasty b) Cross linking c) Posterior chamber IOL d) Intracorneal ring 4- All these are true about ulcerative blepharitis except: a) Can cause madarosis. b) Can be complicated by ulcerative keratitis c) Can be caused by herpes simplex virus d) Can be treated by antibiotics 5- Diplopia due to iridodialysis disappears on covering: a) Healthy eye b) Affected eye c) Either one d) Neither one 6- Third cranial nerve innervates all the following except: a) Superior oblique muscle b) Levator palpebre muscle c) Inferior oblique muscle d) Medial rectus muscle 7- Acute angle closure glaucoma can be treated by all the following except: a) Medical treatment b) Peripheral Laser iridotomy c) Trabeculectomy d) Trabeculotomy 8- Causes of consecutive optic atrophy are: a) Papillitis b) Papilledema c) A and B d) None of the above 9- Anterior polar cataract does not markedly affect vision because: a) Its shadow lies on the macula b) Away from the nodal point c) It lies on the posterior capsule d) It blocks the pupillary area 10- Patient had a pterygium, excised and starts to see double vision in the early post operative period, this may be due to: a) Muscle injury during surgery b) Lateral rectus recession c) Symblepharon formation d) Recurrence. 11- The following can be caused by chlamydial infection except: a) Ophthalmia neonatorum b) Trachoma. c) Inclusion Conjunctivitis d) Central corneal ulcer

147

12- In acute retrobulbar neuritis which of the following is not true: a) Optic nerve head is normal b) There is marcus Gunn pupil c) Positive scotoma for blue d) Painful ocular motility 13- The best line of treatment of acute pressure and the angle of AC is open congestive glaucoma after control of intraocular less than 180째: a) Laser peripheral iridectomy b) Clear lens extraction c) Argon laser trabeculoaplasty d) Trabeculectomy 14- Corneal ulcer associated with very severe pain is: a) Fungal ulcer b) Viral ulcer c) Acanthameobic ulcer d) Neurotrophic ulcer 15- In glasses for simple regular astigmatism we use: a) Sphero-cylindrical lenses b) Cylindrical lenses c) Convex lenses d) Concave lenses

148

Final Examination in Ophthalmology July 14th, 2013 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1-Compelete by filling the spaces (Suggested time: 15 minutes)

(10 Marks)

 That muscle that closes the eyelid is ……………….. and its nerve supply is ……………….  The causative organism of mucoppurulent conjunctivitis is ……………………….  The axial length of the eye is …………… and is measured by.  Pulsating proptosis with audible bruit is seen in ………………………………  In orbital blow out fracture, the type of diplopia is ……………………………………..  One of the sure signs of trachoma is …………………………………………..  Double staining pattern of the cornea is characteristic for ………………………….  Prolonged treatment with systemic steroids causes ………………… type of cataract.  Cattle tract appearance of fundus examination is seen in ……………………………..  Chalcosis bulbi means ………………………………………….. 2-Mark with True (T) or False (F) (10 Marks) (Suggested time: 15 minutes) 1. Central retinal vein occlusion causes acute painless loss of vision. 2. Diffuse corneal nebula is a common cause of irregular astigmatism. 3. Descematocele is uncommon in typical hypopoin ulcers. 4. Blind spot of the eye is the fovea centralis. 5. Granulomatous iridocyclitis causes a mutton fat KPs on the back of the cornea. 6. Vitamin C deficiency is a common cause of night blindness. 7. Evisceration is the treatment of choice in endophthalmitis. 8. Zenular (Lamellar) cataract is the most important type of congenital cataract. 9. Hordeolum externum is an acute suppurative inflammation of Zeis gland. 10.Optimum type for operative correction of congenital ptosis is school age. 3-Write short notes on the following (30 Marks) (Suggested time: 40 minutes) 123456-

Signs of buphthalmos. Complications of ulcerative blepharitis. Types of optic nerve atrophy. Etiology of complicated cataract. Complications of chemical burn on the eye. Types (signs) of spring catrarrh.

149

4-Enumerate

(30 Marks) (Suggested time: 40 minutes)

1. 2. 3. 4. 5. 6.

Effect of vitamin A deficiency on the eye. Signs of paralytic strabtismus. Main lines of treatment of infective corneal ulcers. Effect of blunt ocular trauma on the iris. Causes of Leucocoria. Types of astigmatism.

5-Explain why --- or Give reason for (Suggested time: 10 minutes) 1. 2. 3. 4. 5.

(10 Marks)

Enucleation is not preferred in cases of panophthalmitis. Incision and curettage of chalazion is done by vertical incision. Occurrence of glaucoma in some cases of hypermature cataract. Occurance of corneal ulcers in cases of purulent conjunctivitis. Vision loss caused by diabetes mellitus.

6-Problem Solving

(15 Marks) (Suggested time: 30 minutes)

Problem 1: A child three months old, presented to you by unilateral lacrimation dating since birth. a. What are the possible causes of this condition? b. What are the main steps needed to investigate a case of watery eye? Problem 2: Female 45 years old, coming complicating of headache with painful diminution of vision of the right eye. On examination, VA was 1/60 in right eye, eye was congested, mild lid oedema, diffuse ciliary injection, and the cornea was clear by multiple KPs on the epithelial side. The anterior chamber was turbid and of normal depth with small pupil. a. Whatâ&#x20AC;&#x2122;s your diagnosis? b. Whatâ&#x20AC;&#x2122;s the surest sign that helped you to confirm the diagnosis? c. Enumerate other conditions to be differentiated from this one. d. Outline the main lines of treatment of such condition. 7-MCQs

(20 Marks) (Suggested time: 30 minutes)

1. Lagophthalmos occurs as a result of paralysis of: a. 3rd cranial nerve. b. 5th cranial nerve. c. 6th cranial nerve. d. 7th cranial nerve.

150

2. The corneal touch reflex involves the following cranial nerves: a. II and III. b. II and IV. c. V and III. d. V and VII. 3. Follicular conjunctival reaction is seen in these conditions except: a. Adenoviral conjunctivitis. b. Inclusion conjunctivitis. c. Spring catarrh. d. Trachoma. 4. The only staphyloma with normal IOP is: a. Ciliary staphyloma. b. Intercalary staphyloma. c. Equatorial staphyloma. d. Posterior staphyloma. 5. The cause of decreased visual acuity in acute congestive glaucoma is: a. Glaucomatous optic atrophy. b. Increased intraocular pressure. c. Corneal edema. d. Glaucomfleckens. 6. The crystalline lens is embryologically derived from: a. Surface ectoderm. b. Mesoderm. c. Neural ectoderm. d. Endoderm. 7. Stop of progression of diabetic retinopathy can be done through: a. Good metabolic control. b. Argon laser photo coagulation. c. Both A & B. d. Neither one of these options. 8. Progressive myopia might be associated with the following except: a. Tigroid fundus. b. Pseudo-papillitis. c. Myopic crescent. d. Posterior staphyloma. 9. The most urgent ocular condition of the following is: a. Rupture globe. b. Acute congestive glaucoma. c. Chemical eye injuries. d. Retinal detachment. 10. Ocular motality is limited in the following conditions except: a. Orbital cellulitis. b. Panophthalmitis. c. Optic neuritis. d. Paralytic squint. 151

11. A 65 years old patient bad recurrence of chalazion after removal from the same site two times. The best management is: a. Systemic antibiotic and steroids. b. Excision and histolopathological evaluation. c. Excision and curette evacuation. d. Excision and cautery of the edges. 12. Macular sparing is seen in lesions occurring in: a. Optic tract. b. Lateral geniculate body. c. Occipital lobe. d. Optic chiasma. 13. Spherocylinderical lenses are indicated for correction of: a. Myopia. b. Hypermetropia. c. Simple myopic astigmatism. d. Compound myopic astigmatism. 14. Aneiskonia refers to: a. Difference in refractive power. b. Difference in corneal diameter. c. Difference in retinal image power. d. Difference in image size. 15. A patient is C/O monocular diplopia after blunt ocular trauma, the following could cause this except: a. Sublaxated lens. b. Iridodialysis. c. Traumatic hyphema. d. Incipient immature cataract.

152

Final Examination in Ophthalmology June, 2012 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Illustrate with labeled diagram the angle of anterior chamber and mention the pathway of aqueous humor outflow. 2- Discuss the clinical picture, investigation and treatment of acute iridocyclitis and differential diagnosis of red eye. 3- Enumerate: A- Criteria of essential infantile esotropia. B- Types of ectropion. C- Local causes of complicated cataract. D- Indication of peripheral iridectomy. 4- Give a short account on each of the following: A- Dendritic ulcer. B- Ptergium (definition, types, cinical picture, treatment) C- Anisomtropia. 5- Problem Solving: A young 16 years old boy received a strong fist in his right eye during playing basketball game. The boy complained of blurring of vision with mild lid edema, photophobia and few spots of subconjunctival hemorrhage. On the second day the patient noticed flashes of light in his right eye, multiple floaters and loss of lower temporal field of vision with marked visual impairment. On examination; VA was CF finger in the right eye and 6/6 in the left eye by glasses. His recent glasses prescription was -12diopters (high myopia) in both eyes. Anterior segment examination was unremarkable. Intraocular pressure was 10 mmHg in right eye and 16 mmHg in left eye. A-What are the causes of immediate diminution of vision following severe blunt ocular trauma without ruptured globe? *Describe: B- The final diagnosis of such case. C- Management of this condition (investigations and treatment). D- What is your recommendation for the other eye? 153

Final Examination in Ophthalmology August, 2012 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Illustrate with diagrams anatomy of lacrimal system. (15 Marks) 2- Discuss the clinical picture, investigation and treatment of acute iridocyclitis and differential diagnosis of primary open angle glaucoma. (20 Marks) 3- Enumerate: A- Types of optic atrophy. (10 Marks) B- Complications of trachoma. (10 Marks) C- Types of intraocular lens. (10 Marks) D- Types of diplopia &causes. (10 Marks) 4- Give a short account on each of the following: A- Types of retinal detachment. (Pathogenesis & Etiology) B- Alkali trauma to the eye. C- Types of blepharitis. 5- Problem Solving: Male patient aged 55 years old come complaining of rapid diminution of vision of right eye since few days with rednees, pain, phtophopia, lacrimation, blepharospasm & haloes around light. Examination of the patient reveled: right VA 6\50. lid edema, ciliary injection-grayish infiltration of the center of the cornea with loss of the corneal luster .the anterior chamber shows yellowish material settled down at the bottom with upper straight level and the pupil is constricted with muddy iris, there is history of chronic dacrocystitis & diabetes mellitus since few months. A- What is the differential diagnosis? B- What is the final diagnosis? C- What are the complications of these conditions? D- What is the management of this case?

154

Final Examination in Ophthalmology

Tanta University

June, 2011 Total 125 marks

Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Describe and illustrate with a labeled diagram the anatomy of the eye lid. (15 Marks) 2- Discuss the clinical picture, complications and treatment of trachoma. (20 Marks) 3- Enumerate: A- Stages of diabetic retinopathy. (10 Marks) B- Ocular and orbital manifestations of Graves disease. (10 Marks) 4- Give a short account on each of the following: A- Emergency treatment of chemical eye burn. (10 Marks) B- Keratoconus. (10 Marks) C- Lens induced glaucoma. (10 Marks) D- Complications of chronic anterior uveitis. (10 Marks) E- Differential diagnosis of leukocoria in infants. (10 Marks) 5- Problem Solving: Female patient aged 46 years old complaining of right deterioration of vision since yesterday with pain, photophobia, lacrimation and headache. Examination of this case revealed: Right eye: VA 1/60, Ciliary injection. Corneal edema, shallow anterior chamber, with dilated oval pupil. Fundus: could not be examined due to hazy media. Left eye: VA 6/9 with glasses (+4 diopters) with shallow anterior chamber. A- What is the differential diagnosis? B- Comment on: final diagnosis and how to manage this case in details (right and left eye).

155

Final Examination in Ophthalmology

Tanta University

August, 2011 Total 125 marks

Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Describe and illustrate with labeled diagram a cut section in the human cornea. 2- Discuss in details management of acute attack of angle closure glaucoma. 3- Enumerate causes of gradual painless diminution of vision. 4- Give a short account on each of the following: A- Clinical picture of corneal hypopion ulcer. B- Stages of diabetic retinopathy. C- Methods of correcting unilateral aphakia. D- UIcerative blepharitis. E- Types of optic atrophy. 5- Problem Solving: 62 years female complaining of rapid appearance of black certain in front of left eye with marked diminution of vision. History of bilateral high myopia, patient had car accident 2 weeks earlier. Comment on: 1- Differential diagnosis. 2- Investigation. 3- Treatment of most possible causes.

156

Final Examination in Ophthalmology June, 2010 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Illustrate with diagrams anatomy of lacrimal system. (15 Marks) 2- Discuss the clinical picture, investigation and treatment of primary open angle glaucoma. (20 Marks) 3- Enumerate: A- Types of optic atrophy. (10 Marks) B- Complications of trachoma. (10 Marks) C- Types of intraocular lens. (10 Marks) D- Types of diplopia & causes. (10 Marks) 4- Give a short account on each of the following: A- Types of retinal detachment. (Pathogenesis & Etiology) B- Alkali trauma to the eye. C- Types of blepharitis. 5- Problem Solving: Male patient aged 55 years old come complaining of rapid diminution of vision of right eye since few days with rednees, pain, phtophopia, lacrimation, blepharospasm & haloes around light. Examination of the patient reveled: right VA 6\50. lid edema, ciliary injection-grayish infiltration of the center of the cornea with loss of the corneal luster .the anterior chamber shows yellowish material settled down at the bottom with upper straight level and the pupil is constricted with muddy iris, there is history of chronic dacrocystitis & diabetes mellitus since few months. A- What is the differential diagnosis? B- What is the final diagnosis? C- What are the complications of these conditions? D- What is the management of this case?

157

Final Examination in Ophthalmology August, 2010 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Describe the anatomy of the orbit. (15 Marks) 2- Discuss briefly orbital infection (causes, clinical pictures, complications, treatment). (25 Marks) 3- Give a short account on each of the following: A- Differences between conjunctival & ciliary injections. (10 Marks) B- Treatment of the acute stage of narrow angle glaucoma. (10 Marks) C- Causes & types of diplopia. (10 Marks) D- Causes of loss of corneal clarity. (10 Marks) E- Retinopathy of prematurity. (10 Marks) F- Ocular complications of vitamine A deficiency. (10 Marks) 4- Problem Solving: A mother came to complain of the eyes of her newly born baby showed: redness, discharge & buffness of the lids. She gave a past history of genital problems and discharge during the last trimester. *Discuss: A- The diagnosis. (5 Marks) B- The differential diagnosis. (10 Marks) C- Investigations. (5 Marks) D- The treatment. (5 Marks)

158

Final Examination in Ophthalmology June, 2009 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Describe and illustrate with a labeled diagram the anatomy of the human crystalline lens. (10 Marks) 2- Discuss the clinical pictures, complications and treatment of senile cortical cataract. (15 Marks) 3- Give a short account on each of the following: A- Causes of secondary glaucoma. (10 Marks) B- Complications of trachoma. (10 Marks) C- Treatment of herpes simplex keratitis. (10 Marks) D- Cause of epiphora. (10 Marks) E- Treatment of chemical eye bum. (10 Marks) F- Complications of myopia. (10 Marks) 4- Enumerate eye manifestations: A- Hyperthytoidism. (10 Marks) B- Blunt trauma of eye. (10 Marks) 5- Problem Solving: A mother came to complain of continuous crying of her baby (aged 8 months) since one month and an abnormal pupillary reflex. On examination the right eye was Mild injected with yellowish pupillary reflex but the left eye was normal. His brother had the same condition since 2 years. *Comment on: A- The diagnosis. (5 Marks) B- The differential diagnosis. (5 Marks) C- Investigations. (5 Marks) D- The treatment. (5 Marks)

159

Final Examination in Ophthalmology August, 2009 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Describe and illustrate with a labeled diagram the anatomy of the angle of the anterior chamber. (10 Marks) 2- Discuss the clinical pictures and the treatment of acute congestive glaucoma. (15 Marks) 3- Give a short account on each of the following: A- Causes of complicated cataract. (10 Marks) B- Complications of trachoma. (10 Marks) C- Treatment of hypopyon ulcer. (10 Marks) D- Stages of retinoblastoma. (10 Marks) E- Correction of myopia. (10 Marks) F- Complications of chronic iridocyclitis. (10 Marks) 4- Enumerate eye manifestations: A- Diabetes. (10 Marks) B- Blunt trauma of the eye. (10 Marks) 5- Problem Solving: A patient aged 55 y.s old came to complain of gradual painless diminution of the vision of his right eye. He was diabetic ( of 10 years duration). The family history was negative & no treatment received before. On examination; the vision of his right .was H.M. & the left eye was 6/12. The color of pupil of the right eye was grayish white while the left eye was grayish with positive iris shadow No other abnormal signs. *Comment on: A- The diagnosis. (3 Marks) B- The differential diagnosis. (10 Marks) C- Investigations. (3 Marks) D- The treatment. (4 Marks)

160

Midyear Examination in Ophthalmology May, 2009 Time Allowed 1 Hour

Tanta University Faculty of Medicine Ophthalmology Department

Mark right (√) or wrong (×) in front of the following statements: 1- The tarsal insertion of the levator palpebrae superioris muscles causes the upper eye lid furrow. 2- Lagophthalmos means dropping of the upper eyelid over the cornea. 3- Herpes simplex keratitis gives solid immunity. 4- Tuberculous iridocyclitis characterized by matton fat K.P.S. 5- The absolute indication of I.C.C.E. is the intumescent stage of senile cataract 6- Hydroxyamphetamine 1% (paredrine) eye drop: cause dilatation of the pupil in Homer's syndrome of central lesions. 7- Diabetes Mellitus causes a second sight in the patients over 10 years 8- Pituitary tumors causes homonymous Held defects. 9- Hyperthyroidisim causes sudden forward proptosis 10- Chemical bum of the eye with sulphuric add is more worse than with sodium hydroxide. Select only one answer: 11- Ptosis may be found in all of the following except: a- Diabetes. b- Bell's palsy (facial nerve palsy), c- Myasthenia gravis. d- Homer’s syndrome. 12- Dryness of the eye occurs in all of the following except: a- Trachomatous conjunctivitis. b- Pemphegius. c- Steven Johnson syndrome. d- Iridocyelitis. 13- The oculomotor nerve supplies all these muscles except: a- The levator palpebrae superioris b- The superior oblique muscle c- The superior rectus muscle d- The medial rectus muscle 14- The accommodation means: a- Increase the dioptric power of the lens. b- Convergence. c- Pupillary constriction. d- AII of the above. c- None of the above. 15- The visual pathway has a relation to these structures except: a- Optic foramen. b- Optic chiasma. c- Pituitaiy gland. d- Parietal lobe of the brain. 16- Intracranial hypertension may be presented by the following except: a- Projectile vomiting. b- Severe headache. c- Diplopia. d- Sudden loss of vision. 17- One of the following causes secondly narrow angle glaucoma: a- Hyphaema. b- iridocyclitis. c- Local cortisone eye drops. d- Sderitis. 161

18- Collagen diseases may be complicated by the following except: a- Sderitis. b- Keratitis. c- Iridocyditis. d- Ulcerative blepharitis. 19- All are the differential diagnosis of papillitis except: a- Papilloedema. b- Highastigmatism. c- Drusn of the optic disc. d- Retrobulbar neuritis. 20- All are causes of night blindness except: a- Vitamin B defidency. b- Retinitis pigmentosa. c- Senile cortical cataract d- High myopia. 21- Enophhalmos may be caused by: a- Blunt orbital trauma b-Pituitary tumors. c- Hypothyroidism. d- All of the above. e- None of the above. 22- All are causes of excessive lacrimation in the newborn baby except: a- Acute dacryocystitis b- Acute dacryoadenitis. c- Ophthalmia neonatorum. d- Imperforate Hansen's valve. 23- All are causes of leukocorea except: a- Retrolental fibroplasias. b- Retinoblastoma. c- Retinal detachment. d- Retinitis pigmentosa. 24- All are lines in the treatment of acute stage of narrow angle glaucoma except: a- Morphine sulphate I.M. or I.V. b- Dehydrating measures (Mannitol IV.). c- Atropine, eye drops even/ 2 hours. d- Diamox tablet. 25- Gradual painless diminusion of vision in 35 years old adult patient occurs in all of the following except: a- Degenerative myopia. b- Keratoconus. c- Cornell dystrophy. d- Retinal detachment. 26- The most diagnostic sign in the primary retinal detachment is: a- An elevated grayish retina. b- A retinal tear. c- Vitrous hemorrhage. d- Visual field defects. 27- Binocular diplopia occurs in: a- Unilateral external ophthalmoplegia. b- Unilateral internal ophthalmoplegia. c- Optic glioma. d- AII of the above. 28- Myopia may cause all of the following except: a- Apparent divergent squint. b- Manifest divergent squint. c- Latent divergent squint. d- Alternating divergent squint. 29- Ocular complications of the diabetes: a- Complicated cataract. b- Optic neuritis. c- Hyphaema. d- All of the above. 30- Local cortisone treatment may be used in: a- Keratomalacia. b- Sderomalacia. c- Moorn's corneal ulcer. d- Herps simplex keratitis.

162

Final Examination in Ophthalmology June, 2008 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Describe and illustrate with a labeled diagram the anatomy of the iris. (10 Marks) 2- Enumerate the systemic diseases associated with iridocyclitis. (10 Marks) 3- Give a short account on each of the following: A- Complications of senile cortical cataract. (10 Marks) B- Differential diagnosis of orbital cellulites. (10 Marks) C- Diagnosis and treatment of the primary open angle glaucoma. (10 Marks) D- Clinical pictures and treatment of herpes simplex keratitis. (10 Marks) 4- Problem Solving: Male diabetic patient aged 50 years old. Came to complain of a rapid diminution of vision of his left eye, with photopsia and micropsia, the duration of diabetes was 15y. There was no positive family history. -On examination it was found that the visual acuity after correction of the RT eye was 6/12 & the left eye was C.F. 3/60. By fundus microscopy the macular area was found edematous with spots of deep hemorrhage. *Discuss: A- The final diagnosis. (2 Marks) B- The differential diagnosis. (10 Marks) C- Investigations. (4 Marks) D- The treatment. (4 Marks)

163

Final Examination in Ophthalmology June, 2007 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Describe and illustrate with a labeled diagram the Anatomy of the upper Eye lid. (10 Marks) 2- Discuss definition, causes, complications, and management of Lagophthalmos. (10 Marks) 3- Discuss clinical picture and differential diagnosis of Retinoblastoma. (10 Marks) 4- Discuss the clinical picture, complications and management of hypermature senile cataract. (10 Marks) 5- Give a short account on each of the following: A- Causes of acute proptosis. (4 Marks) B- Complications of membranous conjunctivitis. (4 Marks) C- Causes of night blindness. (4 Marks) D- Complications of blunt trauma to the eye. (4 Marks) E- Definition and types of staphyloma. (4 Marks) 4- Problem Solving: A 45-year old female came to the emergency department complaining of sudden sever pain in her right eye with sever redness and marked drop of vision. She had Severe temporal headache with nausea and vomiting. With Photophobia, Lacrimation and blepharospasm. The condition started suddenly since 8 hours. Past history: She has history of a transient attack of headache and ocular pain with blurring of vision and colored haloes since 2 months while she was in a cinema. Family history was positive On examination: The right eye: - Visual Acuity: Counting fingers at 2 -meters Ciliary injection - Hazy cornea (corneal edema) - Very shallow anterior chamber - Dilated vertically oval non-reactive pupil - IOP very high digitally T+++ - The fundus could not be seen The left eye: shallow AC, normal IOP, hypermetropia +1.0 D

(Discuss the differential diagnosis, final diagnosis and treatment) 164

Final Examination in Ophthalmology

Tanta University

September, 2007

Faculty of Medicine

Total 125 marks

Ophthalmology Department

Time Allowed 3 Hours

1- Describe and illustrate with a diagram the Anatomy of the Cornea. (10 Marks) 2- Discuss the etiology, clinical picture and management of phlyctenular Keratoconjunctivitis. (10 Marks) 3- Describe and illustrate with diagrams visual field changes in primary open angle glaucoma. (10 Marks) 4- Discuss etiology, clinical picture, complications, and management of Ulcerative Blepharitis. (10 Marks) 5- Discuss the clinical picture and differential diagnosis of a case of Retinitis pigmentosa. (10 Marks) 6- Give a short account on each of the following: A- Enophthalmos. (5 Marks) B- Ocular manifestations of Vitamin. A deficiencies. (5 Marks) C- WHO classification of Trachoma. (5 Marks) D- Retained iron intra ocular foreign body. (5 Marks) E- Atypical hypopyon ulcer. (5 Marks) 7- Problem Solving: Female patient aged 40 years came to complain of a mass in the inner angle of the Right eye with persistent tearing over her cheek. The conditio n started since 2 months with acute onset of a painful tender swelling below the nasal angle of the Right eye. She received treatment in the form of systemic & local antibiotics for one week. The condition improved & subsided but leaving a mass in the angle with persistent tearing. - Family history: negative - On examination: - The right eye shows a Swelling 1.5 X 1.2 cm below the medial palpebral ligament with positive regurge test

(Discuss the differential diagnosis, final diagnosis and treatment)

165

Midyear Examination in Ophthalmology May, 2007 Time Allowed 1 Hour

Tanta University Faculty of Medicine Ophthalmology Department

Select only one answer: 1- Doctor sees nothing & patient sees nothing in: a) Papillitis b) Papilloedema c) Retrobulbar neuritis (toxic amblyopia) d) All of the above 2- Which of the following treatment is used for optic neuritis a) Prednisolon I.V. b) Observation c) Pilocarpine 2% d) Atropine 1% 3- Papilloedema lead to: a) Rapid deterioration of vision b) Primary optic atrophy c) Pain on eye movements d) Optic disc edema more than 3D 4- Afferent pupillary defect occurs in all except a) Papillitis b) Hysteria c) Optic atrophy d) Retrobulbar neuritis 5- Rapid painful loss of vision occurs in all except: a) Acute angle closure glaucoma b) Blunt trauma c) Alkali burn d) CRAO 6- AII the following are signs of lens sublaxation except: a) Phakodenesis b) Iridodnesis c) Irregular anterior chamber d) Intact all zonule 7- All of the following are symptoms of Retinal Detachment except: a) Musca Volitants b) Flashes of light c) Deterioration of vision d) Sever ocular pain 8- The eyes susceptible to angle closure glaucoma are: a) Hypermetropic eye b) Myopic eye c) Astigmatic eye d) Pseudophakic eye 9- In acute angle closure glaucoma' the choice of surgery is decided after: a) Gonioscopic examination b) Fundus examination c) Tonometry d) Visual field examination 10- AH of the following are the characteristics of giaucomatus cup except: a) Large deep cup b) Overhanging margins c) Retinal vessels appear broken off at the margin d) Lamina criprosa is not visible 11- Encphtha Imos may be caused by: a) Blunt orbital trauma b) Schirrrus carcinoma of the breast metastasis c) cachexia d) all of the above

166

12- Beta B lockers lower IOP mainly by: a) Decreased aquous production. b) Increased aquous drainage. c) Lower episcleral venous peressure. d) All of above 13- Pre auricular lymphadenopathy occurs with the following conjunctivitis: a) Vernal keratoconjunctivitis b) Phlyctenular keratoconjunctivitis c) Viral conjunctivitis d) Angular conjunctivitis 14- Tremulous Iris can be seen in: a) Aphakia b) Hyper mature cataract c) Posterior dislocation of the lens d) All of above 15- Posterior polar cataract markedly affects vision because: a) Its shadow lies on the macula b) Close to the nodal point c) It matures early d) It blocks the pupillary area 16- Nudear cataract changes the refraction of the eye into: a) Myopia b) Hypermetropia c) Astigmatism d) No change 17- Most common cause of diminution of vision after ECCE is: a) Cystoid macular edema b) Posterior capsule opacification c) Corneal decompansation d) Retinal detachment 18- The best treatment for Posterior Capsule Opacification: a) Surgical excision b) Laser opening c) Surgical polishing d) Leave alone 19- The type of laser used to treat Posterior Capsule Opacification: a) Yag laser b) Argon laser c) Diode laser d) Excimer laser 20- AII of the following types entropion are known except: a) Spastic entropion b) Senile entropion c) Paralytic entropion d) Cicatricial entropion 21- AII of the following are causes of lagophthalmos except: a) Facial nerve palsy b) Proptosis c) Cicatricial ectropion d) Third nerve paralysis 22- Ectropion of the upper lid most commonly: a) Spastic ectropion b) Senile ectropion c) Paralytic ectropion d) Cicatricial ectropion 23- Munson's sign occurs in: a)Corneal fistula b) Corneal dystrophy c) Keratoconus d) Corneal facet 24- In corneal edema, all is true except: a) There is increase in corneal diameter b) There is increase in corneal thickness c) Cloudy cornea d) Predispose to Corneal vascularization 25- Double staining pattern of the cornea is characteristic for: a) Fungal corneal ulcer b) Herpetic corneal ulcer c) Exposure keratopathy d) Acanthaembic corneal ulcer

167

26- Topical Corticosteroids are contraindicated except in: a) Bacterial corneal ulcer b) Herpetic corneal ulcer c) Fasicular phlyctenular ulcer d) Stromal fungal keratitis 27- Tarrsorraphy is essential in: a) Bacterial corneal ulcer b) Viral corneal ulcer c) Exposure keratopathy d) Traumatic corneal ulcer 28- Blood staining of the cornea is due to: a) Hyphema b) Hyphema with rise of IOP c) Corneal edema d) Corneal FB 29- All are infective corneal ulcers except: a) Typical hypopion ulcer b) Atypical hypopion ulcer c) Fasicular ulcer d) Oendritic corneal ulcer 30- All the following muscles are supplied by Oculomotor nerve except: a) Superior oblique muscle b) Inferior oblique muscle c) Inferior rectus muscle d) Levator palpebre muscle

168

Final Examination in Ophthalmology July 19th, 2006 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

ď&#x201A;ˇ Give an account on: 1- Anatomy of the cornea proper and draw a labelled diagram. 2- Clinical picture of hypopyon ulcer. 3- Aetiological types and complications of ectropion. 4- Management of buphthalmos . 5- Management of acute iridocyclitis. 6- Fundus picture of diabetic retinopathy. 7- Differential diagnosis between concomitant and paralytic squint. 8- Causes of papilledema

Final Examination in Ophthalmology September 3rd, 2006 Total 125 marks Time Allowed 3 Hours

ď&#x201A;ˇ Give an account on: 1- Anatomy of the iris. 2- Differential diagnosis of acute iridocyclitis. 3- Causes of the ptosis. 4- Clinical picture of keratoconus. 5- Treatment of buphthalmos. 6- Complications of degenerative myopia. 7- Fundus pictures of retinal arteriosclerosis. 8- Complications of blunt trauma of the eye.

169

Tanta University Faculty of Medicine Ophthalmology Department

Final Examination in Ophthalmology

Tanta University

June 29th, 2005

Faculty of Medicine

Total 125 marks

Ophthalmology Department

Time Allowed 3 Hours

ď&#x201A;ˇ Give an account on: 1- Anatomy of the lacrimal passages and draw a labeled diagram. 2- Investigations of epiphora. 3- Corneal signs of phlyctenular Kerato-conjunctivitis. 4- Treatment of dendritic corneal ulcer. 5- Differential diagnosis of acute congestive glaucoma. 6- Clinical features of right 6th nerve palsy. 7- Causes of acute proptosis. 8- Fundus picture and treatment of central retinal artery occlusion.

Final Examination in Ophthalmology September 5th, 2005 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

ď&#x201A;ˇ Give an account on: 1- Anatomy of the angle of the anterior chamber with a diagram. 2- Treatment of acute congestive glaucoma. 3- Management of stye. 4- Management of perforating corneal ulcer. 5- Ophthalmic signs of (Grave's) or Thyroid ophthalmopathy. 6- Clinical picture of third cranial nerve palsy. 7- Treatment of spring catarrh. 8- Fundus picture of primary optic atrophy.

170

Final Examination in Ophthalmology

Tanta University

June 15th, 2004

Faculty of Medicine

Total 125 marks

Ophthalmology Department

Time Allowed 3 Hours

1- Draw a labelled diagram of the lacrimal apparatus. 2- Discuss the differential diagnosis of infantile dacryocystitis and its treatment. 3- Write short account on: A- Causes of enophthalmos. B- Aetiodogical types of ptosis. C- Causes of anisocoria. D- Differential diagnosis between ocular manifestations of herpes zoster and herpes simplex. E- Fundus changes and complications of degenerative myopia. F-Uses of corticosteroids in eye diseases

Final Examination in Ophthalmology August 23rd, 2004 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

ď&#x201A;ˇ Give an account on: 1- Anatomy of the crystalline Jens and draw a labelled diagram. 2- Lens induced glaucoma. 3- Causes and complications of lagophthalmos. 4- Management of ophthalmia neonatorum. 5- Corneal fistula. 6- Endocrinal exophthalmos. 7- Causes of retinal detachment. 8- Clinical types of optic atrophy.

171

Final Examination in Ophthalmology

Tanta University

June 15th, 2003

Faculty of Medicine

Total 125 marks

Ophthalmology Department

Time Allowed 3 Hours

1- A-Describe the anatomy of the Iris and draw, a labelled dagram. 2- Discuss the clinical picture, differential diagnosis and treatment of acute anterior uveitis (iridocyclitis). 3- Write short account on: 1- Causes of complicated cataract. 2- Management of traumatic hyphema. 3- Causes and investigations of epiphora. 4- Diplopia. 5- Papillitis. Final Examination in Ophthalmology September 6th, 2003 Total 125 marks

Tanta University Faculty of Medicine Ophthalmology Department

Time Allowed 3 Hours

1- Describe the anatomy of longitudinal section in the upper eye lid and draw a labeled diagram. 2- Discuss the management of a case of congenital cataract. 3- Write short account on: 1 - Causes of epiphora. 2- Clinical picture of buphthalmoa 3- Presbyopia. 4- Fundus picture of diabetic retinopathy. 5- Differential diagnosis of papilledema.

172

Midyear Examination in Ophthalmology

Tanta University

February 24th, 2003 Total 125 marks

Faculty of Medicine Ophthalmology Department

Time Allowed 2 Hours

1- Describe the anatomy of crystalline lens and draw a labelled diagram. 1- Discuss the differential diagnosis of gradual painless diminution of vision in old age. 2- Write short account on: 1- Fundus picture of central retinal vein occlusion. 2- Traumatic proptosis. 3- Ophthalmological complications of vitamin A deficiency. 4- Management of endophthalmitis. 5- Anisometropia. Final Examination in Ophthalmology

Tanta University

June 27th, 2002

Faculty of Medicine

Total 125 marks

Ophthalmology Department

Time Allowed 3 Hours

1- Draw a labelled diagram of the lacrimal apparatus. 2- Discuss management of congenital (developmental) cataract. 3- Write short account on: 1- Management of purulent conjunctivitis. 2- Management of dendritic ulcer. 3- Treatment of acute congestive glaucoma. 4- Differential diagnosis of papilledema. 5- Management of acute iridocyclitis.

173

Eye Lid 1- Describe and illustrate with a labeled diagram the anatomy of the eye lid. (2011) 2- Draw labeled diagram & describe anatomy of longitudinal section in upper eyelid (2003), (2007), (2011) 3- Complications of ulcerative blepharitis. (2013), (2014) 4- Types of blepharitis. (2010), (2012) 5- Give an account on ulcerative blepharitis. (2007), (2011) 6- Discuss definition, causes, complications, and management of Lagophthalmos. (2004), (2007) 7- Causes of ptosis. (2006) 8- Types of ptosis. (2004), (2006) 9- Management of stye. (2005) 10- Types of ectropion. (2005), (2006), (2012)

Conjunctiva 1- Describe anatomy of conjunctiva. (2005) 2- Classification of trachoma. (2014) 3- Types of spring catarrh. (2013) 4- WHO Classification of trachoma. (2007) 5- Complications of trachoma. (2009), (2012) 6- Discuss the etiology, clinical picture and management of phlyctenular Keratoconjunctivitis. (2007) 7- Corneal signs of phylectenular kerato conjunctivitis. (2006) 8- Complication of membranous conjunctivitis. (2007) 9- Management of purulent conjunctivitis. (2002) 10- Management of ophthalmia neonatorum. (2004) 11- Treatment of spring catarrh. (2005) 12- Ptergium definition, types and clinical picture. (2012)

Lacrimal System 1- Anatomy of lacrimal passages & draw labeled diagram. (2006), (2012) 2- Draw a labeled diagram of lacrimal apparatus. (2002), (2004) 3- Differential diagnose of infantile dacryocystits and its treatment. (2004) 4- Causes of epiphora. (2003), (2009) 5- Investigation of epiphora. (2003), (2006) 6- Causes & investigations of epiphora. (2003)

175

Cornea 1- Describe & illustrate with diagram anatomy of cornea. (2007), (2005) 2- Clinical picture and treatment of H.S keratitis. (2008) 3- Treatment of H.S keratitis. (2009) 4- Treatment of dentritic corneal ulcer. (2012) 5- Differential diagnose between ocular manifestation of H.Z & H.S. (2004) 6- Atypical hypopyon ulcer. (2007) 7- Clinical picture of hypopyon ulcer. (2005) 8- Treatment of hupopyon ulcer. (2009) 9- Corneal fistula. (2005) 10- Management of perforated corneal ulcer. (2005) 11- Give an account on keratoconus. (2011) 12- Clinical picture of keratoconus. (2006)

Sclera 1- Definition and types of staphyloma. (2007) 2- Types of scleral staphyloma. (2014)

Crystalline Lens 1- Lens induced glaucoma. (2004), (2011), (2014) 2- Lens induced open angle glaucoma. (2014) 3- Types of intraocular lens. (2010), (2012) 4- Describe and illustrate with a labeled diagram the anatomy of the human crystalline lens. (2003), (2009) 5- Complications of senile cortical cataract. (2008) 6- Discuss the clinical pictures, complications and treatment of senile cortical cataract. (2009) 7- Clinical pictures, complications and management of hypermature senile cataract. (2007) 9- Causes of complicated cataract. (2003), (2009) 10- Management of ccongenital cataract. (2003) 11- Complicated cataract. (2003), (2009), (2010), (2013) 12- Local causes of complicated cataract. (2012)

176

Glaucoma 1- Enumerate field changes in primary open angle glaucoma. (2014) 2- Describe & illustrate with diagrams visual field changes in primary open angle glaucoma. (2007) 3- Describe anatomy of angle of anterior chamber & draw labeled diagram. (2005), (2009) 4- Diagnosis & treatment of 1ry OAG. (2008) 5- Causes of 2ry glaucoma. (2009) 6- Management of buphthalmos. (2006) 7- Signs of buphthalmos. (2013) 8- Treatment of buphthalmous. (2006) 9- Clinical picture of buphthalmous. (2003) 10- Differential diagnose of acute congestive glaucoma. (2006) 11- Treatment of acute congestive glaucoma. (2005) 12- Clinical picture and treatment of acute congestive glaucoma. (2009) 13- Diagnosis of buphthalmous. (2010) 14- Illustrate with labeled diagram the angle of anterior chamber and mention the pathway of aqueous humor outflow. (2012) 15- Indication of peripheral iridectomy. (2012) 16- Discuss the clinical picture, investigation and treatment of acute iridocyclitis and differential diagnosis of primary open angle glaucoma. (2012)

Uveal tract 1- Enumerate effect of blunt ocular trauma on the iris. (2013) 2- Describe & illustrate with labeled diagrams anatomy of iris. (2003), (2006), (2008) 3- Differential diagnose of acute iridocyclitis. (2006) 4- Management of acute iridocyclitis. (2005) 5- Discuss clinical picture, differential diagnosis and treatment of anterior uveitis. (2003) 6- Enumerate systemic disease associated with iridocyclitis. (2008) 7- Management of endophthalmitis. (2003) 8- Complications of chronic iridocyciitis. (2009) 9- Discuss the clinical picture, investigation and treatment of acute iridocyclitis and differential diagnosis of red eye. (2012)

Pupil and visual pathway 1- Describe & illustrate with a labeled diagram the path way of the papillary light reflex. (2010) 2- Discuss in details the significance of abnormal papillary reactions. (2010) 3- Mention 4 different causes of miosis & mydriasis. (2010)

177

Retina 1- Clinical picture, differential diagnosis of Retinitis pigmentosa. (2007) 2- Fundus picture of retinal arteriosclerosis. (2006) 3- Fundus picture and TFT of CRAO. (2006) 4- Fundus picture of CRVO. (2003) 5- Fundus picture of Diabetic retinopathy. (2003), (2005) 6- Causes of retinal detachment. (2004) 7- Causes of night blindness. (2007) 8- Types of retinal detachment (Pathogenesis & Etiology). (2012)

Optic nerve 1- Types of optic atrophy. (2004), (2010), (2011), (2012), (2013), (2014). 2- Fundus picture of primary optic atrophy. (2005) 3- Papillitis. (2003) 4- Differential diagnose of papilledema. (2003), (2002) 5- Causes of papilledema. (2006) 6- Clinical picture of optic atrophy. (2004)

Squint 1- Clinical picture of Right 6th Cranial never palsy. (2005) 2- Clinical picture of 3rd Cranial nerve palsy. (2005) 3- Diplopia. (2003) 4- Differential diagnose between concomitant & paralytic squint. (2005) 5- Criteria of essential infantile esotropia. (2012)

Orbit 1- Ophthalmic sign of grave or thyroid ophthalmopathy. (2005) 2- Enumerate eye manifestation of hyper Hyperthyroidism. (2009) 3- Differential diagnose of orbital cellulites. (2008) 4- Enophthalmous. (2007) 5- Causes of enophthalmous. (2004) 6- Causes of acute proptosis. (2006), (2007) 7- Traumatic proptosis. (2003) 8- Endocrinol exophthalmos. (2004)

178

Errors of refraction 1- Complication of myopia. (2009) 2- Complication of degenerative myopia. (2006) 3- Fundus picture and complication of degenerative myopia. (2004), (2006) 4- Correction of myopia. (2009) 5- Types of astigmatism. (2013), (2014) 6- Types of diplopia and causes (2012) 7- Anisometropia. (2003), (2012)

Ocular Trauma 1- Complications of chemical burn on the eye. (2014) 2- Effect of blunt trauma on posterior segment of the eye. (2014) 3- Enumerate blunt trauma of eye. (2009) 4- Complication of blunt trauma of eye. (2006), (2007) 5- Treatment of chemical eye bum. (2009), (2010), (2011) 6- Retained iron intraocular. (2007) 7- Management or traumatic hyphema. (2003) 8- Alkali trauma to the eye. (2012)

Ocular Tumors 1- Stages of retinoblastoma. (2009) 2- Clinical picture and differential diagnosis of retinoblastoma. (2007)

Eye and systemic diseases 1- Ocular manifestation of vitamin A deficiency. (2007) 2- Ophthalmological complications of vitamin A deficiency. (2003) 3- Enumerate eye manifestation of Diabetes Miletus. (2009)

179

Tanta University Faculty of Medicine ENT Department July 21, 2014

Number of questions : 10 Time allowed : 3 hours Total : 100 marks

Give a short account on: 1- Clinical picture of adenoid hypertrophy (10 Marks). 2- Management of a case of severe epistaxis (10 Marks). 3- Enumerate causes of otalgia via Trigeminal and Vagus nerves (10 Marks). 4- Clinical picture and management of rhinoscleroma (10 Marks). 5- Indications of tonsillectomy (10 Marks). 6- D.D. of nasal polyps (10 Marks). 7- Indications, contraindications & complications of ear wash (10 Marks). 8- Causes of stridor in a 2-year old boy (10 Marks). 9- Match the suitable item from group (A) to group (B) then give the proper diagnosis and lines of treatment for each. (10 Marks). Group (A): 1- Persistent mucopurulent ear discharge. 2- Progressive stridor in a 5-year old boy with painful swallowing. 3- A pseudomembrane covering the tonsils in a 4-year old boy. 4- Enlarged deep cervical lymph nodes in a40-year old Chinese lady. 5- Right sided nasal obstruction in a 17- year old girl. Group (B): a- Complete opacity of right maxillary sinus on CT with a smooth mass hanging behind the soft palate. b- Severe toxaemia and dysphagia. c- Plain x-ray lateral view neck shows a Thumb sign. d- Severe headache, vomiting & positive Kernig's sign. e- Unilateral secretory otitis media with paralysis of soft palate. f- Severe recurrent epistaxis. g- Diminished air entry on the right side of the chest.

181

10- Read the passage and answer the following questions: A 7- year old boy has recently developed right mucopurulent otorrhoea following acute rhinitis. The child didn't receive the proper treatment. Few days later his right auricle was pushed downward and forward. There is a fluctuant tender swelling behind the ear. 1- What is the likely diagnosis of this patient? (2 Marks) 2- What are the possible findings you may see on otoscopy? (1 Mark) 3- Mention an important sign you may find? (1 Mark) 4- What is the type deafness in this case? (1 Mark) 5- Mention the recommended investigations needed (2 Marks) 6- What is the D.D of this case? (1 Mark) 7- Mention the main lines of treatment of this patient (2 Marks)

182

Tanta University Faculty of Medicine ENT Department September 10, 2014

Number of questions : 10 Time allowed : 3 hours Total : 100 marks

Give a short account on: 1- Rupture tympanic membrane: causes, clinical picture, complications & treatment (10 Marks). 2- Clinical picture of facial nerve paralysis (10 Marks). 3- Orbital complications of sinusitis (10 Marks). 4- Granulomas of the larynx (10 Marks). 5- Enumerate : indications of cortical mastoidectomy (10 Marks). 6- Enumerate : local causes of epistaxis (10 Marks). 7- Enumerate : causes of vocal cord paralysis (10 Marks). 8- Enumerate : oesophageal causes of dysphagia (10 Marks). 9- Match the suitable item from group (A) to group (B) then give the proper diagnosis and lines of treatment for each. (10 Marks). Group (A): 1- Unilateral nasal obstruction with offensive odour in a 2-year old boy. 2- A 2-year old baby with painful dysphagia, otalgia & torticollis. 3- Bilateral nasal granulomas in a 20- year old lady. 4- A 14-year old boy with recurrent severe epistaxis. 5- Bilateral normal tympanic membranes with bilateral conductive deafness. Group (B): a- A swelling of posterior pharyngeal wall limited to one side with pus on aspiration. b- A piece of sponge impacted in the right nasal cavity. c- Type (As) Tympanogram. d- Bilateral subglottic granulomas with mild stridor. e- CT paranasal sinuses shows right nasopharyngeal mass. f- Palatal paralysis with cervical lymphadenopathy. g- lnterarytenoid pale granulations with referred otalgia.

183

10- Read the passage and answer the next questions: A 20 year-old man who has recently developed acute rhinitis is complaining now of bilateral otalgia with a sense of blocked ears after landing of his aeroplane. 1- What is the most probable diagnosis? (2 Marks) 2- Give 3 findings you may see on otoscopy? (3 Marks) 3- What are the investigations needed for confirmation of diagnosis? (2 Marks) 4- What is the type of deafness in this patient? (1 Mark) 5- Give lines of treatment of this patient? (2 Marks)

184

Tanta University Faculty of Medicine ENT Department July 25, 2013

Number of questions : 10 Time allowed : 3 hours Total : 100 marks

Give a short account on: 1- Causes of stridor (10 Marks). 2- Clinical picture, audiological investigations and treatment of otosclerosis (10 Marks). 3- Parapharyngeal abscess (10 Marks). 4- Antrochoanal polyp (10 Marks). 5- Differential diagnosis of acute mastoiditis (10 Marks). 6- Causes of epistaxis (10 Marks). 7- Clinical picture and treatment of foreign body inhalation (10 Marks). 8- Investigations and management of cerebrospinal fluid (CSF) rhinorrhea (10 Marks). 9- Clinical picture, treatment and differentia diagnosis of rupture tympanic membrane (10 Marks).

10- Read the case description and answer the questions : The mother of 5-years old boy was concerned about diminution of hearing in the last 2 months . On examination the boy had a large adenoid with retracted both tympanic membranes . The doctor told her that the boy will need 2 surgical procedures in the same sifting. 1- What is the likely diagnosis of this boy? (2 Marks) 2- Which type of deafness is expected in this case? (1 Mark) 3- What is the expected result of tympanometry of this boy? (1 Mark) 4- Give the name of the 2 surgical procedures? (2 Marks) 5- Mention 2 complications for each of the 2 surgical procedures? (4 Marks).

185

Tanta University Faculty of Medicine ENT Department September 24, 2013

Number of questions : 10 Time allowed : 3 hours Total : 100 marks

Give a short account on: 1- Acute retropharyngeal abscess 2- Congenital choanal atresia 3- Diagnosis and treatment of Meniereâ&#x20AC;&#x2122;s disease 4- Haemorrhage due to tonsillectomy operation 5- Pulmonary complications of tracheostomy operation 6- Differential diagnosis of granulomas of the larynx 7- Otitic barotrauma 8- Nasal septal perforation 9- Causes of conductive hearing loss

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10- Read the case description and answer the questions : A 65-years old Asian man presented left ear conductive deafness with left ear and facial pain . On examination the soft palate was paralyzed on the left side. 1- What is the likely diagnosis of this patient? (3 Marks) 2- Do you have to examine the neck? (2 Marks) 3- What is the explanation of the ear condition? (2 Marks) 4- How to investigate and treat this patient? (5 Marks)

186

Tanta University Faculty of Medicine ENT Department July 1, 2012

Number of questions : 10 Time allowed : 3 hours Total : 100 marks

1- a. CORRELATE the pathological changes of acute non-specific laryngitis In children with its clinical manifestation (5 Marks). b. NAME causative micro-organism for the following 5 diseases: Malignant Otitis Externa, Epiglottitis, Syphilitic laryngitis, AIDS and Glandular fever (5 Marks). 2- a. RECOGNIZE the cause for each of the following six post-Tracheotomy Complications: Apnea, Pulmonary edema, Pneumothorax, Surgical Emphysema, Slipped Tube and Laryngeal Stenosis (6 Marks). b. LIST four Oropharyngeal causes of OSAS (4 Marks). 3- a. NAME the ENT Operation that puts each of the following four Cranial Nerves at risk: the second cranial nerve, the Extracranial part of the Seventh cranial nerve, the Eight cranial nerve and the Superior laryngeal Nerve (4 Marks). b. DESCRIBE the four characters of ametastatic Lymph Node (2 Marks). C. STATE the rationale and outlines of treatment of a 47-year-oid Woman with hypopharyngeal tumor (4 Marks). 4- a. REQUEST a Metastatic Work-up for a 63-year-old male with Nasopharyngeal Carcinoma (4 Marks). b. ENUMRATE three Complications of Parapharyngeal Abscess (3 Marks). C. OUTLINE treatment of Acute Retropharyngeal Abscess (3 Marks). 5- EXPLAIN your Strategy of Management of: a. A5-year-old boy with bilateral Otitis Media with Effusion (2.5 Marks). b. Clinical diagnosis sinusitis patients with major and minor factors (2.5 Marks). c. Primary Atrophic Rhinitis (2.5 Marks). d. Rhinoscleroma (2.5 Marks). 6- DIFFERENTIATE between Antrochoanal polyp and Nasopharyngeal Angiofibroma regarding age, site of origin, microscopic and gross appearance, behavior, main presenting symptoms and treatment (10 Marks).

187

7- a. MENTION the Key points in Managing a patient with: I. Transverse Fracture of temporal Bone (2.5 Marks). II. Otitic Barotrauma (2.5 Marks). b. WRITE short essay not more than one page on: I. Management of Meniere s disease (2.5 Marks). II. Physiology of (Functions mediated by) the Facial Nerve (2.5 Marks). 8- ENUMERATE: a. Causes of Conductive Hearing loss with an intact drum (2.5 Marks). b. lntracranial Complications of Chronic Suppurative OM (2.5 Marks). c. Causes of unilateral mucopurulant nasal discharge (2.5 Marks). d. Characters of Traumatic Drum perforation (2.5 Marks). 9- Case File: A 9-year-old girl presented to ENT clinic with apostauricular fluctuant tender swelling being the right auricle, She also had fever, right otalgic and right mucopurulent ear discharge. a. What is your likely diagnosis? (2 Marks). b. What is your differential diagnosis? (2 Marks). c. What are the suspected Tympanic Membrane changes? (2 Marks). d. What are the possible results of Tuning fork tests? (2 Marks). e. How would you treat this child? (2 Marks). 10- OSCE: This an axial CT of the nose and paranasal sinuses. a. What is your likely diagnosis? (2 Marks) b. How does the patient present of different ages? (2 Marks) c. Which investigations can be done before requesting CT? (3 Marks) d. How would you treat this patient? (3 Marks)

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Tanta University Faculty of Medicine ENT Department August 1, 2012

Number of questions : 9 Time allowed : 3 hours Total : 100 marks

1- a. CORRELATE the pathological changes of acute Non-specific Rhinitis with its clinical manifestations (5 Marks). b. NAME causative Micro-organism for the following diseases: Moniliasis, Vincent angina, Tuberculous laryngitis, AIDS and ASOM (5 Marks). 2- a. JDENITSFY the causes for each of the following post-tonsillectomy complications: Respiratory obstruction and hemorrhage (6 Marks). b. DESCRIBE the characters of Vocal fold nodules and polyp (4 Marks). 3- a. RECOGNIZE the most common etiology for the following gland swellings: unilateral parotid swelling, bilateral parotid gland swellings, unilateral submandibular gland swelling, euthyroid goiter and hyperthyroid goiter (5 Marks). b. STATE the rationale and outlines of treatment of a5-year-old boy presenting with mild stridor due to Acute Non-specific laryngitis (4 Marks). 4- a. INVESTIGATE a case of a57-years-old man with querry cancer larynx with left fixed vocal cord (5 Marks). b. OUTLINE diagnosis and management of Chronic Retropharyngeal abscess (5 Marks). 5- a. EXPLAIN your strategy of Management of a 30-year-old female with right stapedial otosclerosis (2.5 Marks). b. ENUMERATE: I. Causes of Oro-maxillary fistula (2.5 Marks). II. Indications of endoscopic sinus surgery (2.5 Marks). III. Orbital complications of sinusitis (2.5 Marks). 6- DIFFERENTIATE between Antrochoanal polyp and Inverted papilloma regarding age, site of origin, microscopic and gross appearance, behavior, main presenting symptoms and treatment (10 Marks). 7- a. MENTION the Keypoints in managing a patient with: I. Bell s palsy (2.5 Marks). II. Acute Suppurative otitis media (2.5 Marks). b. WRITE short essay not more than one page on: I. Diagnosis of Meniere s disease (2.5 Marks). II. Pathogenesis of Cholesteatoma (2.5 Marks). 189

8- ENUMERATE: a. Causes of Cochlear hearing loss b. Extracranial and cranial complications of CSOM c. Keypoints in management of severe posterior epistaxis d. Signs of retracted tympanic membrane

(2.5 Marks). (2.5 Marks). (2.5 Marks). (2.5 Marks).

9- Case File: I. A 65-year-old diabetic female presented to ENT clinic with severe otalgia and sanguinous purulent otorrhea. Local examination revealed granulation tissue in the floor of external auditory canal at the junction of cartilaginous and bony parts .she had no improvement for more than a month. a. What is your likely diagnosis? (2 Marks). b. What is your differential diagnosis? (2 Marks). c. What is your likely cause? (2 Marks). d. What are the necessary investigations? (2 Marks). e. How would you treat this patient? (2 Marks). II. 5-year-old female presented to ENT clinic with recurrent watery rhinorrhea only from right side of the nose. The attacks started 5 months ago with no history of head trauma or nasal surgery. Although the attacks of rhinorrhea occurred suddenly without effort, it increases with leaning forwards or straining. a. What is your likely diagnosis? (2 Marks). b. How to investigate this patient? (6 Marks).

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Tanta University Faculty of Medicine ENT Department July 1, 2011

Number of questions : 14 Time allowed : 3 hours Total : 100 marks

1- DIFFERENTIATE between: a. Tubotympanic and Atticoantral types of Chronic Suppurative OM (5 Marks). b. Ethmoidal Polypi and Antrochoanal Polyp (5 Marks). 2- CORRELATE the Pathological Changes of Acute Suppurative OM with Its Clinical Manifestations (10 Marks). 3- a. INVESTIGATE a 23-year-old male with query CSF Rhinorrhea - Is it CSF? - Where is the leak? - Why is the leak? (5 Marks). b. NAME the causative Micro-organism for Epiglottitis, Malignant Otitis Externa, Syphilitic Laryngitis, AIDS and Infectious mononucleosis (5 Marks). 4- a. FORMULATE a treatment plan for a 59-year-old hypertensive female patient with severe posterior Epistaxis (4 Marks). b. REQUEST audiological Tests for a 39-year-old female with query bilateral Oteosclerosis (2 Marks). c. STATE the Rationale for the following: I. Treatment of a 35-years-old man with right chronic Sinusitis by FESS (2 Marks). II. Treatment of a 4-year old boy with bilateral Otitis Media with Effusion by Myringotomy and Grommet Tube insertion (2 Marks). 5- LIST: a. Intracranial Complications of Cholesteatoma (5 Marks). b. Causes of Post-tonsillectomy Respiratory Obstruction (3 Marks). c. Characters of a metastatic lymph node (2 Marks). 6- Case File No.1: After a traffic accident, a 29-year-old male complained of bleeding from left ear, inability to close the left eye and deviation of the angle of the mouth to the right side. There was also a left hearing loss. A clear fluid appeared in the left external ear that increased in amount on straining and stooping. Two days later, the patient was drowsy and developed fever and neck stiffness. I. Write a provisional diagnosis (2 Marks) II. Support diagnosis by your evidence (2 Marks).

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III. Then, Explain: a. Inability to close the left eye (1 Mark). b. Deviation of mouth angle to right (1 Mark). c. The hearing loss: type and mechanism (2 Marks). d. The clear fluid which increased with straining and stooping (1 Mark). e. The development of fever and neck stiffness (1 Mark). 7- Case File No.2: A 17 year old male complained of recurrent attacks of severe Epistaxis that did not stop spontaneously. He also suffered from nasal obstruction more on the right side together with decreased hearing in the right ear. Three months later he developed proptosis of right eye and swelling of right cheek. CT scan showed a dumbbell-shaped mass. His physician requested angiography. I. Write a provisional diagnosis (2 Marks) II. Support diagnosis by your evidence (2 Marks). III. Then, Explain: a. Severe Epistaxis that did not stop spontaneously (1 Mark). b. Decreased hearing in right ear (1 Mark). c. Proptosis of right eye (1 Mark). d. Swelling of right cheek (1 Mark). e. The mass has a dumbbell shape (1 Mark). f. The physician requested angiography (1 Mark). 8- a. Patient Portofolio No.1: A 3-year-old boy with acute absolute dysphagia was investigated (3 Marks). I. Identify this investigation. II. What does it show? III. What is the probable diagnosis? b. Patient Portofolio No.2: A 3-year-old boy with long-standing left sided nasal obstruction was investigated (3 Marks). I. Identify investigation: II. What does it show? III. What is the probable diagnosis?

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9- ARRANGE the steps of pathogenesis of allergic rhinitis in their specific order (2 Marks). A. Release of Mediators. B. Sneezing, rhinorrhea and nasal obstruction. C. Exposure to allergen. D. Stimulation of sensitized Mast cells. 10- MATCH each of the following histopathological cells in group A with its corresponding disease in group B (2 Marks). Group (A): Group (B): Mast cells Rhinoscleroma. Reed-Sternberg giant cells Allergic Rhinitis. Mickulicz cells Tuberculosis. Langhans giant cells Hodgkin's lymphoma. 11- a- FLASH CARD No.1: Name the structures labeled in this drawing of the laryngeal inlet (5 Marks):

b- FLASH CARD No.2: Name Nerves and Gland labeled in this drawing of Facial Nerve Anatomy (5 Marks):

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12- WHICH OPERATION suits best for treatment of the following clinical scenarios? (4 Marks). (A= Myringotomy, B= Myringoplasty, C= Ossiculoplasty, & D = Stapedectomy). 1- A 23-year-old man presented with right severe conductive hearing loss due to traumatic ossicular dislocation. 2- A 35-year-old man presented with left dry central tympanic membrane perforation. 3- A 47-year-old woman presented with progressive bilateral conductive hearing loss. 4- A 5-year-old boy presented with fever and throbbing ear pain associated with bulging drum. 13- WHICH SINUS suits best for the following clinical scenarios? (4 Marks). (A= Maxillary sinus, B= Ethmoidal sinuses, C= Sphenoidal sinus & D= Frontal sinus). 1- A 23-year-old man underwent an intranasal operation to remove a growth hormone-secreting adenoma. 2- A 40-year-old woman presented with left orbital bony mass with proptosis downwards and laterally. 3- A 35-year-old man underwent dental extraction followed by offensive nasal discharge and swelling of the cheek. 4- A 47-year-old woman presented with orbital hematoma after an intranasal operation for removal of sinonasal polypi. 14- MATCH each of the following post-tracheotomy complications in group A with its corresponding cause in group B (2 Marks). Group (A): Group (B): Stridor Sudden wash of Carbon Dioxide Surgical Emphysema Slipped or obstructed tube Pneumothorax Injury of pleura Apnea Tight closure of the wound

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Tanta University Faculty of Medicine ENT Department July 1, 2010

Number of questions : 6 Time allowed : 3 hours Total : 100 marks

1- Make a short essay on: (Illustrated diagrams are accepted) (20 Marks). a- arteries supplying the nasal septum & common sites for epistaxis (5 Marks). b- Physiology of the facial nerve (5 Marks). c- Components & physiology of Waldeyere's ring (5 Marks). d- Pathology of rhinolaryngosderoma (5 Marks). 2- List symptoms of the following clinical conditions: (I5 Marks). a- Meniere's disease (4 Marks). b- Acute suppurative otitis media in stage of suppuration (5 Marks). c- Tuberculosis of the larynx (3 Marks). d- Nasopharyngeal carcinoma (3 Marks). 3- List signs of the following clinical conditions: a- Chronic tonsillitis (5 Marks). b- Otosclerosis (3 Marks). c- Orbital complications of ethmoiditis (5 Marks). d- Bulging tympanic membrane (2 Marks).

(I5 Marks).

4- Using tables, differentiate between: a- Juvenile & adult papillomas of the larynx (4 Marks).

(15 Marks).

b- Traumatic, Central & Marginal perforations of the tympanic membrane (4 Marks). c- Ethmoidal & Antrochoanal polyps (4 Marks). d- Grades of sleep apnea (3 Marks). 5- What are the: (15 Marks). a- Indications for endoscopic surgery of nose & sinuses (4 Marks). b- Possible results of Rinne's test (3 Marks). c- Clinical presentations of laryngeal obstruction (5 Marks). d- Possible sources of hemorrhage during tracheostomy (3 Marks).

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6- Problem solving:

(four cases, each for 5 Marks).

A) A 6 years old boy, presented with his parents to the outpatient clinic in Tanta university hospitals. He suffered increasing fever, headache, malaise & stridor. He was in the sitting position with difficulty on lying on his back. He had a protruding tongue with drooling of saliva. A GP tried to examine his throat using a tongue depressor. The boy had severe laryngeal spasm, cyanosis & coma. The specialist inserted a catheter in the mid neck of the boy. The boy was rapidly transmitted to the operating room, where an emergency surgery was performed. 1- What was wrong with examining the boy? 2- What would be the proper investigation & its result? 3- What were the diagnosis & the causative organism? 4- What was the procedure performed by the specialist & at which Anatomical site? 5- What was the surgery performed in the operating room? B) You have been called upon to (ICU) to examine a 40 years old patient with a Long history of a unilateral otorrhea. He just recovered from a coma caused by the ear disease. He no longer remembers the names of his family & reports smelling non-existing odors in the room. When asked to show his teeth, the angle of the mouth' deviated to the left side of the face So.... 1- Otorrhea was from the .... ear. (Right or Left). 2- No longer remembers the names of his family means………… 3- Reporting a non-existing odors in the room is …… due to ……. 4- Deviation of the angle of the mouth is due to which type of facial palsy (Right UMN. Left UMN, Right LMN, Left LMN) 5) The diagnosis was ……….. C) A 35 years old female patient, presented with a gradually progressive dysphagia. It was more to fluids & increased with cold drinks. She also reported frequent regurgitation of undigested food, recurrent aspiration, persistent cough & mild weight loss. 1- The provisional diagnosis was …………………………. 2- The underlying pathology is due to …………………………. 3- A diagnostic investigation is ………. & will show …………. 4- Differentiation from …………… is necessary. 5- The treatment would be …………………. 196

D) A 9 years old child suffered severe hematemesis, seven days after tonsillectomy. She presented shocked to the emergency room in Tanta University hospitals. Her Hemoglobin was below 8 grams/ 100ml. 1- What was the type of post tonsillectomy hemorrhage? 2- The 1st aid treatment would be ……………………. 3- The main line of treatment is …………………………. 4- A surgical treatment afforded by an ENT surgeon would be ………………. 5- A surgical treatment afforded by a vascular surgeon would be ……………….

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Tanta University Faculty of Medicine ENT Department January 2, 2010

Midyear Exam Time allowed : 30 minutes Total : 30 marks

Answer the questions:

1- Ear wash is indicated in all of the following conditions except: A- dry central perforation B- wax C- otomycosis D- caloric test 2- Nasal examination in patients with rhinoscleroma likely shows: A- Anterior septal perforation B- Posterior septal perforation C- A non-ulcerative granuloma on the turbinate D- A vascular thin-walled tumor 3- A unilateral adductor paralysis of a vocal fold may be helped by: A- Arytenoidectomy B- Intracord Teflon injection C- Cordotomy by laser D- Tracheostomy 4- High tracheostomy is generally avoided for fear of injury to A- The thyroid cartilage B- The cricoid cartilage C-The pleura D- The innominate vein 5- A 45-year old female reports sudden attacks of vertigo, on moving the head. The attacks last for seconds and are fatigable. The following procedure likely helps her A-Eply maneuver B-Caldwell-Luc maneuver C- Radical mastoidectomy D- Labyrintheetorny 6  9 complete the missing words: A 3J-year old lady C/O severe progressive {sore throat and left otalgia. She then developed trismus, torticollis and her voice changed to a hot potato speech. Her left tonsil was displaced downwards and medially: 6- The most likely diagnosis is……………………………… 7- An important differential diagnosis is……………………………. 8- Two possible complications are………………………………. 9- The trismus is due to……………………………………… 198

10- Acute otitis media in infants A- Is more common than in adults because the ET is narrow and more vertical B- General manifestations are severer than in adults C- Bulging of the tympanic membrane is generally earlier D- Myringotomy is contraindicated 11- The following paranasal sinus does not open in the middle meatus: A-Sphenoid sinus B- Maxillary sinus C- Frontal sinus D- Anterior ethmoid air cells 12- The usual cause of reactionary post-tonsillectomy bleeding is: A- Slipped ligature and dislodged blood clot B- Wound infection and arterial sloughing C- Tonsillar remnant and mucous tags D- failure to put the patient in a post-tonsillectomy position 13- The followings are true of laryngeal cancer except: A- Smoking is strongly related to aetiology B- Subglottic cancer is commoner than glottic cancer C- In early cancer, the larynx may be preserved D- Incidence is more common in males 14  17 Match each of the following radiologic modality to the appropriate case: A- Angiography B- Plain chest X-ray C- Ba swallow D- A coronal CT scan 14- A patient with sinonasal polyposis prepared for FESS 15- A patient suspected to have a post-corrosive esophageal stricture 16- A patient with left vocal fold paralysis 17- A patient with pulsatile tinnitus and a reddish hue behind the drum 18  21 Complete the missing words: A 32-year-old lady c/o increasing bilateral hearing loss worsened in her last pregnancy? The tympanic membranes were intact The patient hears the tuning fork on the mastoid better than in front of the external auditory canal. 18- The tuning fork result of this patient is known as…………. 19- The likely diagnosis is………….. 20- Tympanometry likely shows……………………. 21- Treatment of this patient……………………….. 22- Otalgia after adenoidectomy is referred via: A- The trigeminal nerve B- The facial nerve C- glossopharyngeal nerve D- The vagus nerve 199

23- In epistaxis, a bleeding point in the littleâ&#x20AC;&#x2122;s area is best controlled by: A- Anterior nasal pack B- Posterior nasal pack C- Coagulants D-Cautery 24- Acute laryngitis is more dangerous in infants than adults because: A- Infants usually have laryngeal webs B- Adults have a higher larynx in the neck C- Infants have a looser submucosal space d-lnfants have a more horizontal epiglottis 25- A 32-year old worker with recurrent meningitis reported left sided effortless clear watery nasal discharge. Next step is: A- Give antihistamines B- Ask for B2 transferrin and MRI nose, sinus and skull base C- Ask for CT temporal bone and arrange for radical mastoidectomy D- Refer to other specialty as there is no relation between C/O and meningitis 26- Myringotomy may be indicated in the following situations except: A- Otitic barotrauma B- Acute suppurative otitis media with complications C- Chronic suppurative otitis media with complications D- Chronic secrotory otitis media 27 ď&#x192; 30 Match each pathology, to the most likely case: A- Fluid behind an intact drum B- A central perforation C- A temporal lobe abscess D- Aspergillus niger hyphae infecting skin 27- A 41 -year old woman C/O severe ear itching and hearing loss 28- A 31 -year old man with a right cholesteatoma developed nominal aphasia, homonymous hemianopia and left hemiplagia 29- A 43 -year old man C/O painless profuse mucopurulent otorrhea 30- A 5 year old girl, mouth breather, presented with a3 -week hearing loss

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Tanta University Faculty of Medicine ENT Department July 26, 2009

Number of questions : 10 Time allowed : 3 hours Total : 100 marks

1- DIFFERENTIATE between: a. Dentogenic and Rhinogenic Sinusitis (5 Marks). b. Normal Cerebrospinal Fluid and that of Otitic Meningitis (5 Marks). 2- CORRELATE: a. The Pathological Picture of Nasopharyngeal Angiofibroma with its Clinical Manifestations (5 Marks). b. The Pathological Picture of OSAS with its Clinical Manifestations (5 Marks). 3- a. INVESTIGATE a 39-year-old female with query bilateral Otosclerosis (5 Marks). b. REQUEST Topognostic Tests for a 23-year-old male with acute left Facial Palsy (5 Marks). 4- a. NAME Oral Manifestation of AIDS (5 Marks). b. LIST Intracranial Complications of Cholesteatoma (5 Marks). 5- FORMULATE a treatment plan for a 5-year-old boy presenting with mild stridor due to Acute Non-specific Laryngitis (10 Marks). 6- STATE the Rationale for treatment of a 57-years-old man diagnosed as Cancer Larynx with left fixed vocal cord (10 Marks). 7- Case File No.1: In the ENT emergency room, a 35 year old female presented with an attack of spontaneous profuse bleeding from her right ear. The patient also complained of pulsatile tinnitus in the right ear of 2 years duration and a change in her voice of 2 months duration. History is negative for trauma. ENT examination revealed right red aural polyp, deviation of uvula to left side and right vocal fold paralysis. No lymph node enlargement was found in the neck. Analyze this case and Write a provisional diagnosis supported by your evidence (4 Marks). Then, Explain: a. Spontaneous profuse bleeding from the ear (1 Mark). b. Red aural polyp (1 Mark). c. Deviation of uvula to left side (1 Mark). d. Paralysis of right vocal fold (1 Marks). e. No lymph node detected in the neck (1 Mark). f. Site of origin of the disease (1 Mark).

201

8- Case File No.2: In the ENT emergency room, 3 62-years-old villagerian presented with posterior epistaxis. He reported previous similar attacks. History was negative for trauma. Decide: a. Why is posterior epistaxis more common in the elderly? (1 Mark). b. Which artery is probably affected? (1 Mark). c. What are your initial steps in examining the patient? (2 Mark1). d. What is the initial medical treatment you are going to prescribe? (2 M irks). e. Which investigations are you going to request? (2 Marks). f. Which signs tell you that your patient improves or not? (1 Mark). g. If the condition worsens, which interference will be performed? (1 Mark). 9- a. Illustration represents a biopsy taken from an oral ulcer: (5 Marks) I. Identify the disease. II. Describe characters of this ulcer. III. Name four, common oral ulcers.

b. A 3-year-old boy with acute absolute dysphagia: (5 Marks) I. Identify this investigations? II. What does it show? III. What is the probable diagnose?

10- a. A 31-year-old man with right sided headache was investigated. (5 Marks) I. Identify this investigations? II. What does it show? III. What is the probable diagnose?

b. NAME the five arteries marked in this drawing of the nasal septum (5 Marks).

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Tanta University Faculty of Medicine ENT Department September 7, 2009

Number of questions : 10 Time allowed : 3 hours Total : 100 marks

1- DIFFERENTIATE between: a. Adult and Juvenile Papilloma (5 Marks). b. Nasopharyngeal Angiofibroma and Nasopharyngeal Carcinoma (5 Marks). 2- CORRELATE: a. The Pathological Picture of Otosclerosis with its Clinical Manifestations (5 Marks). b. The Pathological Picture of Allergic Rhinitis with its Clinical Manifestations (5 Marks). 3- a. INVESTIGATE a 59-year-old male with query Glottis Carcinoma (5 Marks). b. REQUEST diagnostic tests for a 23-year-old female with Cerebrospinal Rhinorrhea (5 Marks). 4- a. NAME the causative Micro-organism for Epiglottitis, Malignant Otitis Externa, Syphilitic Laryngitis, AIDS and Glandular Fever (5 Marks). b. LIST Orbital Complications of Sinusitis (5 Marks). 5- FORMULATE a treatment plan for a 54-year-old man presenting with OSAS (10 Maries). 6- STATE the Rationale for treatment of a 57-years-old man diagnosed with Meniere's Disease (10 Marks). 7- Case file No.1: In the ENT emergency room, a 3 year old boy presented to the ENT specialist because of an inability to close the right eye and deviation of the angle of the mouth to the left side. His mother reported that he had fever and severe pain in the right ear for the last 3 days prior to his present condition. The ENT specialist examined his right ear and arranged for an urgent Myringotomy. Analyze this case and Write a provisional diagnosis supported by your evidence (4 Marks). Then, Explain: a. Pain has preceded deviation of mouth by 3 days. (1 Mark). b. Inability to close right eye (1 Mark). c. Deviation of mouth to left side (1 Mark). d. Condition of right tympanic membrane (1 Mark). e. Condition of the facial nerve canal (1 Mark). f. Role of Myringotomy in this case (1 Mark).

203

8- Case File No.2: A 62-year-old man presented with right proptosis, right epiphora and right sided offensive blood stained nasal discharge of 3 months duration. When examined, The ENT specialist detected looseness of the teeth of the right side of the upper jaw and swelling of right half of palate. Analyze this case and Write a provisional diagnosis supported by your evidence (3 Marks). Then, Explain: a. Right Proptosis (1 Mark). b. Right Epiphora (1 Mark). c. Blood-stained offensive discharge (1 Mark). d. Value of Nasal Endoscopy in this case (2 Marks). e. value of CT in this case (2 Marks). 9- a. A 5-year-old boy presenting with left offensive ear discharge, fever and neck rigidity was tested (5 Marks). I. Recognize the suspected disease. II. Request a diagnostic investigation.

b. A 36-year-lody boy with dysphagia and left cystic neck swelling was investigated (5 Mark). I. Identify this investigation. II. What does it show? III. What is the probable diagnosis?

10- a. A 3-year-old boy with long-standing left sided nasal obstruction was investigated (5 Marks). I. Identify investigation. II. What does it show? III. What is the probable diagnosis? b. NAME the five arteries marked in this drawing of the crier supply of the tonsil (5 Marks).

204

Tanta University Faculty of Medicine ENT Department May 5, 2009

Midyear Exam Time allowed : 75 minutes Total : 30 marks

Choose the best answer for each of the 60 questions:

1- The skin of the upper 2/3s of the lateral aspect of the auricle is innervated by: a- Lesser occipital nerve. b- Greater auricular nerve. c- Auriculotemporal nerve. d- Arnold's nerve. 2- The handle of malleus is embedded in which layer of the tympanic membrane: a- Middle fibrous layer. b- Outer skin layer. c- Inner mucosal layer. d- Pars flaccida. 3- The mesotympanum lies opposite to the: a- Scutum. b- Incus. c- Tympanic membrane. d- Oval window. 4- A middle ear with type-A tympanogram contains a- Blood. b- Air. c- CSF. d- Secretions. 5- Used as a landmark for the mastoid antrum is the: a- Scutum. b- lateral sinus. c- Mastoid tip. d- Supramastoid crest. Questions from 6 ď&#x192; 17 are related to the following problem: A 30 years old male patient presented with bilateral otorrhoea & hearing loss since childhood. On examination, the right middle ear had a cholesteatoma (Unsafe ear) with nonfunctioning (dead) inner ear. The left middle ear had a wet central perforation (tubotympanic disease) with moderate conductive hearing loss. Surgery in the right ear was performed to treat him. Immediately after surgery, he suffered facial palsy. 6- Rinne's test in the right ear was: a- positive. b- negative. c- reduced positive. d- false negative. 7- Rinne's test in the left ear was: a- positive. b- negative. c- reduced positive. d- false negative. 205

8- Weber's test was lateralized to the: a- Right ear. b- left ear. c- Vertex. d- Occiput. 9- A pure tone audiogram would show: a- right air-bone (AB)- gap. b- left sensory hearing loss. c- left air-bone (AB)- gap. d- right mixed hearing loss. 10- The complication that caused right nonfunctioning ear was: a- cerebellar abscess. b- mastoiditis. c- petrositis. d- labyrinthitis. 11- The fistula test in the right ear was: a- negative. b- false negative. c- positive d- false positive. 12- A Computerized tomography (CT) in this patient was" a- important. b- not necessary. c- non diagnostic. d- detrimental. 13- The proper surgery performed to this patient was: a- right tympanoplasty. b- left tympanoplasty. c- right radical mastoidectomy. d- left radical mastoidectomy. 14- The facial paralysis that followed surgery was: a- Upper motor neuron type (UMNL). b- Lower motor neuron type (LMNL). c- Both of the above (MIXED). d- none of the above. 15- The cause of facial palsy, was: a- Iatrogenic. b- transverse fracture base, d- otitis media. d- unknown. 16- On voluntary showing the teeth, the angle of the mouth would: a- be not affected. b- deviate the right. c- deviate to the left. d- none of the before. 17- A good prognostic test for the facial paralysis in this patient was: a- Schirmer's tear test. b- MRI. c- Pure tone audiogram. d- Electroneuronography (ENoG). 18- Acoustic reflex protects the inner ear against: a- infection. b- positional changes. c- cupulolithiasis. d- loud sounds.

206

19- This drug is used in the medical treatment of Meniere's disease: a- Betahistine. b- Mucolytics. c- anti fungal drugs. d- Rifampicin. 20- In benign paroxysmal positional vertigo (BPPV), the vertiginous attack lasts for: a- minutes. b- hours. c- days. d- seconds. 21- Temporo mandibular joint (TMJ) pain is referred to the ear via the following nerve: a- Chorda tympani. b- Arnold's branch. c- Jacobson's branch. d-trigeminal nerve. 22- Total inferior turbinectomy is: a- the best treatment for atrophic rhinitis, b- a possible cause for secondary atrophic rhinitis. c- always performed before FESS. d- none of the above. 23- A surgery that can be used to save a patient with severe, active, & extensive rhinolaryngosderoma is: a- FESS. c- turbinectomy.

b- tracheostomy. d- maxillectomy.

24- Rhinitis medicamentosa results from local use of: a- decongestants for 3 days. b- corticosteroids for 3 days. c- decongestants for prolonged time d- corticosteroids for prolonged time. 25- FESS is not the main treatment in the following diseases: a- complicated acute frontal sinusitis. b- chronic rhino sinusitis. c- bilateral maxillary sinusitis. d- nasopharyngeal carcinoma 26- The post operative diagram of this patient suggests the surgery performed to him to be: a- inferior meatal antrostomy. b- FESS. c- inferior turbintomy. d- right maxillectomy. 27- The sinus infection commonly causing cranial complication is usually the: a- maxillary. b- sphenoid. c- ethmoid. d- frontal. 207

28- A saddle nose results from the following diseases except: a- late congenital syphilis. b- after septal surgery. c- septal abscess. d- rhinoscleroma. 29- Persistent severe epistaxis from Brown- Kelly's area requires ligation of the: a- external carotid artery in the neck. b- ethmoidal arteries through an external ethmoidectomy. c- sphenopalatine artery endoscopicaily. d- internal carotid artery in the cavernous sinus. In Questions from 30  33. Match the symptom from column (I) to the causing disease from column (II): Column (I): Column (II): 30- Anosmia. A- dental maxillary sinusitis. 31- Parosmia. B- bilateral nasal polyposis. 32- Cacosmia. C- acute frontal sinusitris. 33- Vaccum headache. D- femoral lobe abscess. In Questions from 34  36. Match the sign from column (I) to the causing disease from column (II): Column (I): Column (II): 34- Apple-jelly nodule. A- CSF rhinorrhoea. 35- Supra tip crease. B- allergic rhinitis in children. 36- Halotest (sign). C- nasal syphilis. D- Lupus vulgaris in the nose. In Questions from 37  39. Match the radiological finding from column (I) to the appropriate disease from column (II): Column (I): Column (II): 37- Ground glass appearance. A- cavernous sinus thrombosis. 38- Empty delta sign. B- fibrous dysplasia. 39- Rat tail appearance. C- lateral sinus thrombosis. D- cancer lower 1/3 esophagus. In Questions from 40  42. Match the main line of therapy from column (I) to the appropriate disease from column (II) Column (I): Column (II): 40- Radiotherapy. A- juvenile NP angiofibroma. 41- Surgery. B- Meniere's disease. 42- Medical. C- nasopharyngeal carcinoma. D- mild laryngomalacia. 208

43- Post tonsillectomy Otalgia is referred via the following cranial nerve: a- 9th c- 7th

b- 5th d- 12th

44- Iron therapy in Plummer- Vinson syndrome is provided through: a- oral. b- injection. c- suppositories. d- nasogastric tube. 45- A membrane on the tonsil with a blood picture showing marked increase in lymphocytes & monocytes is due to infection with: a- corynebacterium diphtheria. b- Epstein- Bar virus. c- streptococci. d- borrelia vincenti. 46- Acute retropharyngeal abscess is a disease of: a- infants & young children. b- adults. c- elderly. d- women. 47- Surgical drainage of Ludwigâ&#x20AC;&#x2122;s angina is: a- rarely required. b- done through an internal incision. c- done through an external submandibular incision. d- done along the posterior border of sternomastoid muscle. 48- This diagram of indirect hypopharyngoscopy shows: a- pyriform sinus carcinoma, b- postcriccid carcinoma, c- supraglottic carcinoma, d- subglottic carcinoma. 49- Examination of the throat using tongue spatula is inadvisable in this disease: a- acute follicular tonsillitis. b- parapharyngeal abscess. c- acute epiglottitis. d- acute nonspecific laryngitis in adults. 50- Posterior cricoarytenoid muscle is: a- an extrinsic muscle of the larynx. b- a vocal cord adductor. c- a vocal cord abductor. d- supplied by the external laryngealnerve 51- Cricothyrotomy is performed as an emergency procedure in the following site: a- cricothyroid membrane. b- Killian's dehiscence. c- throhyoid membrane. d- cricotracheal ligament. 209

52- A foreign body, completely occluding the left main bronchus causes: a- emphysema + mediastinal shift to the left. b- emphysema + mediastinal shift to the right. c- atelectasis + mediastinal shift to the left. d- atelectasis + mediastinal shift to the right. In questions from 53 ď&#x192; 60, mark (A) if the verse is right, & mark (B) if the verse is wrong: 53- The 1st lymph node groups involved in nasopharyngeal carcinoma are the jugulodigastric. 54- In a patient with otosclerosis, stapedectomy is the only solution for his hearing loss. 55- The most serious complication after tonsillectomy is respiratory suffocation. 56- Multiple papillomas of the larynx never recur after excision. 57- The second most common congenital anomaly of the larynx is vocal cord paralysis. 58- Tuberculosis of the larynx is always primary, with the chest free of disease. 59- A high tracheostomy tube can convert a temporary stridor to permanent one. 60- Barrett's esophagus that complicates persistent reflux esophagitis is precancerous.

210

Tanta University Faculty of Medicine ENT Department July 8, 2008

Number of questions : 8 Time allowed : 3 hours Total : 100 marks

1- DIFFERENTIATE between: a. Tubotympanic and Atticoantral types of Chronic Suppurative OM (4 Marks). b. Supraglottic, Glottic and Subglottic Carcinoma (4 Marks). 2- CORRELATE: the Pathological Changes of Acute Suppurative OM with Its Clinical Manifestations (8 Marks). 3- a. INVESTIGATE a 23-year-bld male with CSF Rhinorrhea (4 Marks). b. NAME Oropharyngeal causes of OS AS (4 Marks). 4- a. FORMULATE a treatment plan for a 65-year-old hypertensive female patient with severe posterior Epistaxis (4 Marks). b. REQUEST a metastatic workup for a 58-year-old male with Nasopharyngeal Carcinoma (4 Marks). 5- a. STATE the Rationale for modern Treatment of a 27-years-old woman with left chronic Ethmoiditis and Maxillary Sinusitis (4 Marks). b. LIST Complications of Parapharyngeal Abscess (4 Marks). 6- Case file No.1: After a car accident, an 18-year-old male complained of bleeding from right ear, inability to dose the right eye and deviation of the angle of the mouth to the left side. There was also a right hearing loss. A clear fluid appeared in the right external ear that increased in amount on straining and stooping. Two days later, the patient was drowsy and developed fever and neck stiffness. Analyze this case and Write a provisional diagnosis supported by your evidence (2 Marks). Then, Explain: a. Inability to dose the right eye (1 Mark). b. Deviation of mouth angle to left (1 Mark). c. The hearing loss: type and mechanism (2 Marks). d. The dear fluid which increased with straining and stooping (1 Mark). e. The development of fever and neck stiffness (1 Mark).

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7- Case file No.2: In the ENT emergency room, a 3-year-o!d boy presented with fever (33.4* C) and mild stridor. His mother denied a history of foreign body inhalation. After complete ENT examination, you diagnosed the case as acute non-specific laryngitis. Now, Decide: a. Why does acute non-specific laryngitis present with stridor in children? (2 Marks). b. What is the initial medical treatment you are going to prescribe? (2 Marks). c. Which signs tell you that your patient improve or not? (1 Mark). d. If the condition worsens, which .interference will be performed? (1 Mark). e. Then, if you notice recurrence of stridor during postoperative care. What measures do you undertake to relieve the airway? (2 Marks). 8- CHOOSE the best answer: (8 Marks). 1- The attico-antral type of chronic suppurative OM is considered unsafe because: A. Ear discharge is fetid. B. Drum perforation is attic or marginal. C. It is frequently associated with granulations. D. Conductive hearing loss is maximal. E. It can spread beyond mucoperiosteal lining of middle ear cleft. 2- Type Ad Tympanogram means: A. Tympanic membrane perforation. B. Ossicular dislocation. C. Ossicular fixation. D. Middle ear effusion. E. Cdchlear disease. 3- Dentogenlc sinusitis is characterized by all of the following except: A. It is caused by anaerobic organisms. B. It affects mainly the maxillary sinus. C. Organisms enter the sinus through its ostium. D. It follows dental extraction or periapical infections. E. Discharge is foul-smelling. 4- All of the following are causes of CHL with Intact drum except: A. Otosclerosis. B. Ossicular Dislocation. C. Atelectatic Middle Ear. D. Chronic Suppurative Otitis Media. E. Chronic Otitis Media with Effusion.

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5- In Cancer Piriform sinus, pain is referred to ear along: A. Trigeminal nerve. B. Facial nerve. C. Glossopharyngeal nerve. D. Vagus nerve. E. Accessory nerve. 6- Regarding Multiple Laryngeal Papillomatosis, all of the following are true except: A. It is caused by Human Papilloma virus. B. It presents with stridor. C. Laser excision is the best treatment. D. It is recurrent after excision. E. It is premalignant. 7- The most common indication for Parotidectomy is: A. Congenital Malformation. B. Traumatic cut of Parotid Duct. C. Stone formation. D. PIeomorphic Adenoma. E. Adenoid cystic carcinoma. 8- A 28-year-old man with post-traumatic saddle nose is best treated by: A. Septoplasty. B. Augmentation Rhinoplasty. C. Reduction Rhinoplasty. D. Nasal Tip Reconstruction.

213

Tanta University Faculty of Medicine ENT Department March 5, 2008 1- Give an account on:

a. Indications of tracheostomy. b. Complications of tonsillectomy. c. Types of cholesteatoma.

2- Enumerate:

a. Indications of myringotomy. b. Local causes of epistaxis. c. Complications of chronic otitis media. d. Causes of oromaxillary fistula.

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Midyear Exam Time allowed : 2 hours Total : 30 marks

Tanta University Faculty of Medicine ENT Department August, 2007

Number of questions : 4 Time allowed : 3 hours Total : 100 marks

1- Give short account on: (16 Marks) )A) Acute mastoiditis (Signs, Symptoms, Differential diagnosis). (B) Chronic specific laryngitis (Aetiology, Localization, Signs, Main investigations and Main treatment). 2- Enumerate: (16 Marks) )A) Causes of unilateral nasal obstruction. (B) Indications of tonsillectomy. 3- Problem solving questions: (16 Marks) Case (1): Male elderly patient with uncontrolled diabetes mellitus presented with: • Severe stapping earache. • Granulation tissue in the floor of the external auditory meatus at the junction of the cartilagenous and bony part. • Otorrhoea: with serosangenous and purulent discharge which is scanty. 1- What is your diagnosis? 2- What are the helpful investigations for this case? 3- What are the complications of this condition? 4- Mention the main lines of the treatment of this condition? Case (2): Male patient was ambulated to hospital after car accident, on recovery he noticed clear watery discharge which is eiffortless, positional on leaning forwards, mixed with blood. 1- What is your diagnosis and the possible complications of this condition? 2- Mention 2 important investigations for diagnosis. 3- How to manage this patient? Case (3): After tracheostomy operation for a patient with upper respiratory obstruction, the Patient showed, noisy respiration, froth & cyanosis. 1- What is your explanation? 2- How to manage this condition?

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Case (4): A mother coming with her infant and she has noticed that the infant suffers from difficulty in suckling, torticollis & sometimes irritative cough. On examination: â&#x20AC;˘ Generally: fever and irritability. â&#x20AC;˘ Locally: cystic swelling of the posterior pharyngeal wail limited to one side of the midline. 1- What is the most probable diagnosis? 2- What is the differential diagnosis of this condition? 3- What are the possible complications of this condition? 4- How to treat the condition? 4- Define the correct ANSWERS: 1- A patient with epistaxis showring a bleeding point in little's area is best managed by: A- Cautery B- Anterior nasal pack C- Posterior nasal pack D- Coagulants 2- Primary atrophic rhinitis is characterized by all of the following except: A- Recurrent epistaxis B- Anosmia C- Bad odor smelled by the neighbors D- Affects male only 3- Functional endoscopic sinus surgery is the operation of choice in all of the following except: A- Chronic sinusitis B- Mucocele of the paranasal suiuses C- Nasal polyposis D- Twisted nose 4- Unilateral watery nasal discharge is most likely to suggest a diagnosis of: A- Acute viral rhinitis B- CSF riduorrhea C- Allergic rhinitis D- Rhinosderoma

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5- The usual cause of reactionary post-tonsillectomy bleeding is : A- Slipped ligature B- Wound infection C- Tonsillar reminant D- Early extubation 6- In multiple laryngeal papillomata, all of the following are true except: A- Occurs in children B- Affects only the glottis area C- Recurrence is common D- Best treated by laser surgery 7- T.B of the larynx mostly affects: A- Posterior part of the larynx B- Supraglottis C- Anterior part of the larynx D- Subglottis 8- Safe type of chronic suppurative otitis media is characterized by: A- Scanty offensive ear discharge B- Profuse mucopurulent ear discharge, C- Marginal perforation 4 All of the above D- All of the above

217

Tanta University Faculty of Medicine ENT Department August, 2006

Number of questions : 4 Time allowed : 3 hours Total : 100 marks

1- Give short account on: (20 Marks) A- Otogenic facial paralysis (etiology, clinical picture and lines of treatment). B- Foreign body inhalation (clinical picture, diagnosis and treatment). 2- Enumerate: (16 Marks) A- Causes of dysphagia. B- General causes of epistaxis. 3- Problem solving questions: (12 Marks) Case (1): Male patient presented with: • Earache in and around the ear. • Vesicles on the auricle and external auditory canal. • L.M.N. facial nerve paralysis a- What is your diagnosis? b- How to treat this case? c- Mention the other possible dissociated features. Case (2): Male patient with long history of ethmoiditis, presented by acute exacerbation followed by bilateral proptosis, ophtaimoplegia &visual loss. a-What is your diagnosis? b-Why the ocular signs are bilateral? c- How the infection can extend to present these occiilar manifestations? d- Mention the main lines of treatment. Case (3): During tracheostomy operation for a patient, with upper airway obstruction, arrest of respiration was noticed. a- Why respiratory arrest occurred? b- How to manage this condition? c- Mention the other possible pulmonary complications.

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Case (4): Adult male patient presented with Fever, headache, malaise, Pain in the throat, Painful dysphagia and Trismus. Throat examination revealed: â&#x20AC;˘ Unilateral swelling of the soft palate above & lateral to the tonsil â&#x20AC;˘ Downward & medial displacement of the tonsil Neck examination: there is enlarged tender cervical lymph nodes a- What is the most probable diagnosis? b- How to manage this condition? c- What is your advice to this patient? 4- Define the correct ANSWERS: (16 Marks) 1- In haematoma of the auricle the following is true except: (A) it is due to extravasation of blood in the subcutaneous tissue. (B) Treatment of haematoma of recent onset is initially by aspiration with wide bore naddle and tight bandage. (C) It should be treated urgently. (D) It can cause loss of cartilage support of the auricle. 2- In acute suppurative otitis media define the false statement: (A) Autophony occurs in early stage of eustachian tube obstruction. (B) Blood stream is the most commom route of spread. (C) It may be complicated by extracranial cranial or intracranial complications. (D) Myringotomy may be indicated in some situations. 3- Recurrent &severe sore throat with severe anemia & generalized lymphadenopathy requires: (A) Tonsillar biopsy. (B) Throat swab for culture & sensitivity. (C) Complete blood picture. (D) Blood culture& sensitivity. 4- Tonsillectomy is contraindicated in the following except: (A) Bleeding tendency. (B) During attack of acute tonsillitis. (C) Acute rhinosinusitis. (D) Chronic tonsillitis.

219

5- In septal abscess define the false statement: (A) Systemic sysmptorns are unusual. (B) It is pus & purulent collection between the mucoperichondrium & septal cartilage. (C) Saddling of nasal septum may follow. (D) Initial treatment consists of incisional drainage & systemic antibiotics. 6- In acute infective sinusitis: Define the false statement: (A) Tenderness can be elicited by pressure on the affected sinuse. (B) Pain is limited to the area overlying the affected sinuse. (C) Plain X-ray in acute bacterial sinusitis may show opacity or fluid level in the maxillary sinuse. (D) Surgery is rarely indicated for treatment of acute sinusitis. 7- In leukoplakia define the false statement: (A) Etiology is unknown, may be chronic irritation. (B) Histopathological examination is advised to exclude malignant changes. (C) It is circumscribed white nodules on the mucuos membrane. (D) Regular follow up & observation is essential as it is precancerous 8- Protective functions of the larynx: Define the true statement : (A) Closure of the larynx during swallowing of food. (B) Closure of the larynx if any foreign body reaches the pharynx. (C) If foreign body enters the larynx, it is expelled by the cough reflex. (D) All of the above.

220

Tanta University Faculty of Medicine ENT Department June 21, 2005

Number of questions : 2 Time allowed : 2 hours

1- Give short account on: A- Post- tonsillectomy bleeding. B - Diagnosis of Bell's palsy. C- Management of nasal polypi. D- Manifestations of lateral sinus thrombosis. 2- Enumerate: A- Manifestations of adenoid hypertrophy. B- Indications of myringotomy operation. C- Causes of acute laryngeal obstruction. D- Complications of frontal sinusitis. Tanta University Faculty of Medicine ENT Department August 29, 2005

1- Give short account on: A- Otitic labyrinthitis. B- Foreign body inhalation. C- Quinzy (peri-tonsillar abscess). D-atrophic rhinitis. 2- Enumerate: A- Causes of epistaxis. B- Complications of tracheostomy. C- Complications of otitis media . D- Indications & contraindications of tonsillectomy.

221

Number of questions : 2 Time allowed : 2 hours

Tanta University Faculty of Medicine ENT Department June 22, 2004

Number of questions : 2 Time allowed : 2 hours

1- Give short account on: A- Complications of adenoidectomy operation. B- Otogenic brain abscess. C- Management of foreign body bronchus. D- Management of nasal polyps. 2- Enumerate: A- Causes of otalgia. B- Indications of tracheostomy. C- Manifestations of nasopharyngeal malignancy. D- Manifestations of acute mastoiditis. Tanta University Faculty of Medicine ENT Department August 30, 2004

1- Give short account on: A- Bleeding after tonsillectomy operation. B- Diagnosis of chronic suppurative otitis media . C- Causes of unilateral vocal cord paralysis. D- Management of chronic maxillary sinusitis. 2- Enumerate: A- Causes of unilateral nasal discharge. B- Indications of myringotomy operation. C- Causes of sensorineural hearing loss. D- Causes of dysphagia.

222

Number of questions : 2 Time allowed : 2 hours

Tanta University Faculty of Medicine ENT Department June 21, 2003

Number of questions : 2 Time allowed : 2 hours

1- Give short account on: A- Acute mastoiditis. B- Diagnosis of nasopharyngeal carcinoma. C- Post - operative complications of tonsillectomy . D- Treatment of a case of epistaxis. 2- Enumerate: A- Causes of hoarseness of voice. B- Causes of unilateral nasal obstruction. C- Causes and diagnosis of conductive deafness. D- Indications of tracheostomy operation. Tanta University Faculty of Medicine ENT Department September 4, 2003

1- Give short account on: A- Post - adenoidectomy bleeding. B- Diagnosis of rhinolaryngeosderoma. 2- Enumerate: A- Causes of dysphagia B- Treatment of meniere's disease. C- Complications of ethmoidal sinusitis. D- Causes of acute laryngeal obstruction. E- Indications of radical antrum operations. F- intracranial complications of cholesteatoma.

223

Number of questions : 2 Time allowed : 2 hours

Tanta University Faculty of Medicine ENT Department June, 2002

Number of questions : 2 Time allowed : 2 hours

1- Give short account on: A- Antro - choanal polyp. B- Retropharyngeal abscess. C- Clinical picture and treatment of menier's disease. D- Diagnosis of safe typechronir suppurative otitis media. 2- Enumerate: A- Causes of chronic laryngeal obtruction. B- Causes of lower motor neuron facial nerve paralysis. C- Clinical picture of nasal septal deviation. D- Complications of adenoidectomy operation.

224

Ear symptomatology 1- Enumerate causes of otalgia. (Jun2004, Jul2014) 2- Enumerate causes of sensorineural hearing loss. (Sep2004, Aug2012, Aug2004) 3- Enumerate causes of conductive deafness with intact drum. (Sep2001, Jul2012) 4- Enumerate causes and diagnosis of conductive deafness. (Jun2003, Sep2013) 5- The hearing loss: type and mechanism. (Jul2011) 6- Possible results of Rinne's test. (Jul2010)

External ear 1- Name the causative M.O for malignant otits externa. (Sep2009 , Jul2011) 2- Diagnosis and management of traumatic drum perforation (no operative details). (Sep2014) 3- Name causative micro-organism for Malignant Otitis Externa. (Jul2012) 4- Characters of Traumatic Drum perforation. (Aug2012) 6- Indications, contraindications & complications of ear wash. (Jul2014) 7- Otitic barotrauma. (Sep2013, Jul2012) 8- Using table differentiate between Traumatic, Central & Marginal perforations of the tympanic membrane. (Jul2010) 9- Rupture tympanic membrane: causes, clinical picture, DD, complications & treatment. (Sep2014 , Jul2013)

Middle ear 1- Correlate pathological changes of acute S.O.M with its clinical manifestations. (Jun2008) 2- Diagnosis of secretory otitis media. (Sep2011) 3- Enumerate indications of myringotomy. (Sep2004, Jun2005, Mar2005) 4- Causes of chronic suppurative otitis media. (Sep2004) 5- Types of cholesteatoma. (Mar2008) 6- Diagnosis of safe Type of chronic suppurative otitis media. (Sep2002) 7- Differentiate between tubotympanic & atticoantral types of chronic suppurative OM (Jun2008) 8- Routes of spread of infection from Middle ear and cranial complications of otitis media. (Sep2000) 9- Enumerate complications of chronic otitis media. (Mar2008) 10- Enumerate complication of otitis media. (Sep2005) 11- List intracranial complications of cholesteatoma. (Sep2003, Jun2008, Jun2009, Jul2011) 12- Acute mastoiditis (signs - symptoms â&#x20AC;&#x201C; DD). (Sep2007) 13- Enumerate manifestations of acute mastoiditis. (Jun2004) 14- Acute mastoiditis (short account). (Jun2003) 15- Enumerate indication of cortical mastoidectomy operation. (Mar2002 , Sep2014)

226

16- Differentiate between normal CSF & that of Otitic meningitis. (Jun2009) 17- Enumerate signs & symptoms of lateral sinus thrombosis. (Jun2005) 18- Manifestation of lateral sinus thrombosis. (Jun2005) 19- Otogenic brain abscess. (Jun2004) 20- Enumerate signs & symptoms of otogenic temporal lobe brain abscess. (Mar2004) 21- EXPLAIN your Strategy of Management of A5-year-old boy with bilateral Otitis Media with Effusion. (Jul2012) 22- ENUMERATE Intracranial Complications of Chronic Suppurative OM. (Jul2012) 23- Name causative Micro-organism for ASOM. 24- Extracranial and cranial complications of CSOM. (Aug2012) 25- Pathogenesis of Cholesteatoma. (Aug2012) 26- Mention the Key points in managing a patient with Acute Suppurative otitis media. (Aug2012) 27- NAME the causative Micro-organism for Malignant Otitis Externa. (Sep2009, Jul2011, Jul2012) 28- List symptoms Acute suppurative otitis media in stage of suppuration. (Jul2010) 29- CORRELATE the Pathological Changes of Acute Suppurative OM with Its Clinical Manifestations. (Jul2011) 30- STATE the Rationale for Treatment of a 4-year old boy with bilateral Otitis Media with Effusion by Myringotomy and Grommet Tube insertion. (Jul2011) 31- Differential diagnosis of acute mastoiditis. (Jul2013) 32- Enumerate Indications of myringotomy operation. (Jun2005, Jun2004, Mar2008)

Inner ear 1- Otitic labrinythitis. (Sep2005) 2- Meniereâ&#x20AC;&#x2122;s disease. (Sep2002, Sep2003, Sep2009, Sep2013, Jul2012, Aug2012) 3- Causes of LMN lesion. (Sep2002) 4- Bellâ&#x20AC;&#x2122;s palsy. (Jun2005, Aug2012) 5- Otogonic facial paralysis (Sep2006, Jul2014) 6- Request of Topognostic test for 23 year old male with acute left facial palsy. (Jun2008) 7- Otosclerosis. (Jun2008, Sep2009, Mar2002, Jul2014, Jul2010) 8- Physiology of facial nerve. (Jul2012, Jul2010) 9- Management of transverse fracture of temporal bone. (Jul2012) 10- REQUEST audiological Tests for a 39-year-old female with query bilateral Oteosclerosis. (Jul2011, Jul2009)

227

Nose 1- Causes of unilateral nasal discharge. (Sep2004, Mar2002) 2- Causes of unilateral nasal obstruction. (Sep2007, Jun2003) 3- Causes of Epistaxis. (Mar2008, Sep2006, Sep2005, Sep 2001, Jul2013, Sep2014) 4- Treatment plan for 65 year old hypertensive female with severe post. Epistaxis. (Jun2008) 5- Treatment of epistaxis. (Jun2003, Jul2014) 6- Cause of oromaxillary fistula. (Mar2008, Aug2012) 7- Clinical pic. Of nasal septal deviation. (Sep2002) 8- Pathological pic. Of allergic rhinitis. (Jun2009) 9- Atrophic rhinitis. (Sep2005, Jul2012) 10- Treatment of Rhinoscleroma. (Mar2008, Mar2002, Jul2012, July2014) 11- Diagnosis of rhinolaryngoscleroma. (Sep2003) 12- Complications of frontal sinusitis. (Jun2005) 13- Management of chronic maxillary sinusitis. (Sep2004) 14- List orbital complication of sinusitis. (Jun2009, Jul2010 , Aug2012, Sep2014) 15- STATE the Rationale for modern Treatment of a 27-years-old woman with left chronic Ethmoiditis and Maxillary Sinusitis. (Jun2008) 16- DIFFERENTIATE between Dentogenic & Rhinogenic Sinusitis. (Jun2009) 17- Enumerate comp. of ethmoidal sinusitis. (Sep2003) 18- Enumerate Indications of radical antrum operations. (Sep2003) 19- Antro-choanal polyp. (Jun2002, Jul2013) 20- Management of nasal polyps. (Jun2004, Jun2005) 21- Comp. of submucous resection operation of nasal septum. (Sep2002) 22- Invetegate a 23-year-bld male with CSF Rhinorrhea. (Jul2008) 23- REQUEST diagnostic tests for a 23-year-old female with Cerebrospinal Rhinorrhe. (Sep2009) 24- Compare between Ethmoidal & Antrochoanal polyps. (Jul2010, Jul2011) 25- STATE the Rationale for Treatment of a 35-years-old man with right chronic Sinusitis by FESS. (Jul2011) 26- INVESTIGATE a 23-year-old male with query CSF Rhinorrhea. (Jul2011) - Is it CSF? - Where is the leak? - Why is the leak? 27- Indications of endoscopic sinus surgery. (Aug2012) 28- CORRELATE the pathological changes of acute Non-specific Rhinitis with its clinical manifestations. (Aug2012) 29- Enumerate Causes of unilateral mucopurulant nasal discharge. (Aug2012) 30- DIFFERENTIATE between Antrochoanal polyp and Nasopharyngeal Angiofibroma regarding age, site of origin, microscopic and gross appearance, behavior, main presenting symptoms and treatment . (Jul2012) 31- Clinical diagnosis sinusitis patients with major and minor factors. (Jul2012) 32- Congenital choanal atresia. (Sep2013) 33- Nasal septal perforation. (Sep2013) 34- Management of CSF rhinorrhea. (Jul2013) 35- Differential diagnose of nasal polyps. (Jul2014)

228

Larynx 1- Causes of hoarsness of voice. (Jun2003) 2- Causes of stridor. (Sep2001, Jul2013) 3- Laryngeal obstruction. (Sep2002, Sep2003, Jun2005, Mar2002) 4- FORMULATE a treatment plan for a 5-year-old boy presenting with mild stridor due to Acute Non-specific Laryngitis. (Jul2009) 5- Chronic laryngitis. (Sep2007) 6- Name causative M.O of epiglottitis, syphilitic laryngitis & Tuberculous laryngitis. (Jul2012, Sep2009) 7- Causes of vocal cord paralysis. (Sep2004 ,Sep2014) 8- Compare between Adult & Juvenile papilloma. (Sep2009, Jul2010) 9- Compare between Supraglottic, Glottic and Subglottic Carcinoma. (Jun2008) 10- STATE the Rationale for treatment of a 57-years-old man diagnosed as Cancer Larynx with left fixed vocal cord. (Jun2009) 11- Investigations of query glottis carcinoma. (Sep2007) 12- Symptoms of TB larynx. (Jul2010) 13- CORRELATE the pathological changes of acute Non-specific Rhinitis with its clinical manifestations. (Aug2012) 14- DESCRIBE the characters of Vocal fold nodules and polyp. (Aug2012) 15- Granulomas of the larynx. (Sep2014, Sep2013)

Trachea 1- Foreign body inhalation. (Sep2000, Sep2005, Sep2006, Aug2006 Aug2005, Jul2013) 2- Management of foreign body bronchus. (Jun2004) 3- Tracheostomy comp. (Mar2002, Aug2005, Sep2005) 4- Indications of tracheostomy. (Jun2003, Jun2004, Mar2008) 5- Causes of Hg during tracheostomy. 6- RECOGNIZE the cause for each of the following six post-Tracheotomy Complications: Apnea, Pulmonary edema, Pneumothorax, Surgical Emphysema, Slipped Tube and Laryngeal Stenosis. (Aug2012)

229

Pharynx 1- Enumerate oral manifestations of AIDS. (Jul2009) 2- Causative M.O of: Syphilitic, AIDS, Moniliasis, Vincent angina, and Glandular Fever. (Aug2012, Sep2009) 3- Adenoid Hypertrophy. (Jun2005, Sep2000, Jul2014) 4- Quinsy â&#x20AC;&#x153;peri-tonsillar abscessâ&#x20AC;?. (Sep2005) 5- Retropharyngeal. (Mar2002, Sep2002, Sep2013, Jul2012, Aug2012) 6- Comp. of pharyngeal abscess. (Jun2008) 7- Nasopharyngeal angiofibroma. (Jul2009) 8- Nasopharyngeal carcinoma. (Sep2001, Jun2003) 9- Compare between Nasopharyngeal angiofibroma & carcinoma. (Sep2009) 10- Manifestation of nasopharyngeal malignancy. (Jun2004) 11- REQUEST a metastatic workup for a 58-year-old male with Nasopharyngeal Carcinoma. (Jul2008) 12- Indications & contraindications of tonsillectomy. (Sep2007, Jun2003, Jul2014) 13- Complications of tonsillectomy. (Sep2000, Sep2005, Mar2008, Aug2012) 14- Post tonsillectomy bleeding. (Sep2004, Jun2005, Sep2013) 15- Comp. of adenoidectomy. (Jun2004, Sep2002) 16- Post adenoidectomy bleeding. (Sep2001, Sep2003) 17- Oropharyngeal causes of OSAS. (Jun2008, Jul2012) 18- Patho & clinical pict. Of OSAS. (Jul2009) 19- FORMULATE a treatment plan for a 54-year-old man presenting with OSAS. (Sep2009) 20- Parapharyngeal abscess. (Jul2013, Jul2012) 21- STATE the rationale and outlines of treatment of a 47-year-oid Woman with hypopharyngeal tumor. (Jul2012) 22- Causes of Post-tonsillectomy Respiratory Obstruction. (Jul2011) 23- Tonsillitis. (Jul2010) 24- Components & physiology of Waldeyere's ring. (Jul2010)

Esophagus Causes of dysphagia. (Sep2003, Sep2006, Aug2006, Jun2004, Jun2003, Sep2014)

Neck glands RECOGNIZE the most common etiology for the following gland swellings: unilateral parotid swelling, bilateral parotid gland swellings, unilateral submandibular gland swelling, euthyroid goiter and hyperthyroid goiter. (Aug2012)

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