Neurology 4 mrcp questions book - part 3 ppsx

Q49: Chronic pancreatitis, all of the followings are true, except: a- The commonest cause is alcoholism.. Q2: The following statements are true, except: 1- Low blood urea is seen in many

c- Daily bowel motions more than twice a day

d- ESR more than 30 mm/hr

e- Serum albumin less than 30 g/ L

Q39: Systemic complications of inflammatory bowel disease that tend to occur during an active relapse include all of the followings, except:

a- Mouth ulceration

b- Episcleritis

c- Pyoderma gangrenosum

d- Deep venous thrombosis

e- Sacroiliitis

Q40: Management of inflammatory bowel disease, all of the followings are true, except:

a- Salphasalazine side effects are usually dose dependent and reversible

b- Specific nutritional therapy in Crohn's disease can be very effective but it is expensive and poorly tolerated by most patients

c- The most important indication for surgery is the impairment of the quality of life including schooling, occupation, social and family life

d- Colectomy should be done when the diameter of the transverse colon in an acute attack exceeds 6 cm as this indicates impending perforation

e- Total colectomy is rarely curative in ulcerative colitis

Q41: Irritable bowel syndrome, all of the followings are true, except:

a- Diarrhea predominant type should be differentiated from microscopic colitis, lactose intolerance and bile salt diarrhea

b- The commonest presentation is abdominal pain

c- 1% of cases only will meet criteria of a psychiatric disease

d- Reassurance of the patient has a very important aspect in the management

e- Amitriptylin may be used in selected patient

Q42: Indicators of malignancy in adenomatous polyps, all of the followings are true, except:

a- The presence of dysplastic changes on histology

b- The presence of multiple polyps

c- Large size polyps, of more than 2 cm

d- The presence of a villous architecture on histology

e- The presence of metaplastic polyps

Q43: Familial adenomatous polyposis (FAP), all of the followings are true, except:

a- It is has been shown to be due to a germ line mutation in the APC gene on

chromosome 5

b- 50% of cases have adenomatous polyps in the stomach and 90% in the duodenum c- Congenital hypertrophy of the retinal pigment epithelium when found in an at risk patient, it is a 100% predictive for the presence of FAP

d- It has many variants like Gardner syndrome, Turcot's Syndrome and an attenuated form called attenuated FAP

e- Desmoid tumors are malignant tumors, usually in the abdominal wall; occur up to 10% of cases

Q44: All of the following statements are true, except:

a- Although the hamartomatous polyps of Peutz-Jegher syndrome have no malignant potential, but still there is a risk of small bowel carcinoma and carcinomas of the pancreas, ovary, endometrium and breasts

b- Juvenile polyposis has no risk of colorectal cancer

c- In Cowden's disease there is a risk of thyroid cancer with polyps through out the GIT

d- In Cronkhite-Canada syndrome, there hair loss, skin pigmentation and nail

dystrophy with polyps through out the GIT

e- Of all GIT polyposis syndromes, esophageal polyps are found only in Cronkhite-Canada syndrome and Cowden's disease

Q45: Risk factors for the development of colorectal cancer, all of the followings are true, except:

a- Acromegaly

b- Pelvic irradiation

c- There is a weak association with alcohol and smoking

d- Diet rich in meat and fats

e- Diet rich in fibers and fruits

Q46: The commonest causes of acute pancreatitis are all of the followings,

except:

a- Alcoholism

b- Post ERCP

c- Idiopathic

d- Gall stones

e- Viral infections

Q47: Adverse prognostic factors in acute pancreatitis (Glasgow's Criteria), all of the followings are true, except:

a- PaO2 less than 8 kPa

b- Blood sugar more than 10 mmol/ L

c- Serum calcium (corrected) less than 2.00 mmol/L

d- Very high serum amylase

e- Serum albumin less than 30 g/L

Q48: The following statement about acute pancreatitis are true, except:

a- Serum amylase are only useful in the first 24-48 hours of the illness, otherwise after that urinary amylase: creatine ratio is used

b- Necrotizing pancreatitis is better assessed and suggested by CT scan

c- Any visible gases in the pancreatic tissue suggests the development of abscess formation

d- Persistently elevated serum amylase suggests the development of a pancreatic pseudocyst

e- C reactive protein has a very limited role in the follow up

Q49: Chronic pancreatitis, all of the followings are true, except:

a- The commonest cause is alcoholism

b- Up to 20% of patients are opiates dependent

c- 15% of cases only presents with steatorrhea but no abdominal pain

d- Pancreatic ascites is an indicator for terminal pancreatectomy

e- Most patients fortunately stop drinking alcohol after the diagnosis

Q50: In chronic pancreatitis, all of the followings are true, except:

a- The over all incidence of diabetes is 30% but this rises to 70% in calcific

pancreatitis

b- Steatorrhea occurs only after 90% of the exocrine function had been destroyed c- Unfortunately pain may continue despite total pancreatectomy

d- Chronic pancreatitis is a risk factor for pancreatic carcinoma

e- Pancreatic enzymes supplements are useful in malabsorption but have no effect on abdominal pain

Written By Dr Osama Amin

All Rights Reserved 2005

mrcpfrcp@gmail.com

END of Chapter III/ Gastro-Intestinal Diseases

Chapter IV / Hepatobiliary System

Q1: Regarding the normal liver, all of the followings are true, except:

1- 15% of the liver is composed of cells other than hepatocytes

2- Clearance of bacteria, viruses and erythrocytes is done by Kupffer cells

3- Ito cells have a role in the uptake and storage of vitamin A

4- Vitamin K and folic acids are stored in a huge amount

5- Hepatic synthesis of urea, endogenous proteins and amino acid release by the liver all are suppressed during fasting

Q2: The following statements are true, except:

1- Low blood urea is seen in many acute and chronic liver diseases

2- High blood urea in the context of severe liver damage may indicate

gastrointestinal hemorrhage or hepatorenal syndrome

3- Hyponatremia is very common in severe liver disease and usually

multifactorial

4- Raised gamma GT enzyme level may occur during treatment with

carbamazepin

5- Large increase in serum aminotransferases activity with a small rise in alkaline phosophatase activity is in favor of biliary obstruction

Q3: Drugs that induce hepatic microsomal enzyme activity, all of the followings are true, except:

1- Chronic ethanol ingestion

2- Glucocorticoids

3- Griseofulvin

4- Carbamazepin

5- Cimetidin

Q4: Imaging in liver diseases, all of the followings are true, except:

1- Ultrasound of the liver is a rapid, cheap and easy method and usually the first imaging to be done, yet its main limitation is that small focal lesions less than 2 cm will be missed

2- Color Doppler studies are very useful and used to investigate hepatic veins, portal vein and hepatic artery diseases

3- MRI is usually used for pancreaticobiliary diseases rather than parenchymal liver diseases

4- Outlining the biliary tree can be done by injecting a contrast medium into the biliary tree through the skin or by an endoscopic approach

5- Plain abdominal radiographs are very helpful in liver diseases

Q5: Regarding liver biopsy, all of the followings are true, except:

1- The patient should be cooperative

2- The PT prolongation if present should be less than 4 seconds above the upper normal control value

3- Severe COPD is a contraindication

4- Marked ascites will make the procedure easier

5- Local skin infection should not be present

Q6: Regarding the metabolism of bilirubins, all of the followings are true,

except:

1- Every day, about 300 mg of indirect bilirubin is produced

2- Jaundice will be seen clinically if the total bilirubin exceeds 50 micromole / L 3- About 100-200 mg of stercobilinogen is lost in stool

4- About 400 mg of urobilinogen is passed outside in urine

5- The indirect bilirubin will be conjugated in the endoplasmic reticulum of

hepatocytes to be water soluble

Q7: Causes of indirect hyperbilirubinemia ,all are true except:

1- Vitamin B12 deficiency

2- Wilson's disease

3- Gilbert's syndrome

4- Rotor syndrome

5- Major ABO incompatibility reaction

Q8: When examining a patient with a direct bilirubin of 30 micromole / L, all of the followings are useful signs in guessing the diagnosis, except:

1- A palpable gall bladder

2- An upper abdominal paramedian scar

3- Irregular hard liver

4- Upper midline abdominal mass

5- Scratching marks

Q9: Local measures to stop a variceal upper GIT bleeding, all of the followings are true, except:

1- Banding

2- Sclerotherapy

3- Esophageal transaction

4- Balloon tamponade

5- Terlipressin infusion

Q10: Measures to prevent variceal recurrent upper GIT bleeding, all of the followings are true, except:

1- Oral propranolol

2- Sclerotherapy / banding

3- Transjugular intra hepatic portosystemic shunt (TIPSS)

4- Esophageal transaction

5- Selective or non selective portosystemic shunt surgery

Q11: A patient with chronic liver disease presents with upper GIT bleeding, all

of the followings are true, except:

1- Upper GIT endoscope should be done in all cases as 20% of cases the bleeding is non variceal

2- Despite all advances in the management, the mortality rate is still high

3- Portosystemic shunt surgery in this patient may have a mortality of 50%

4- Vasopressin is contraindicated in ischemic heart disease

5- Esophageal transection is commonly used as a first line treatment

Q12: TIPSS (transjugular intrahepatic porto-systemic shunt), all of the

followings are true, except:

1- It is done by placing a stent between the hepatic vein and the portal vein in the liver under radiological control

2- The objective is to produce a porto systemic shunt to reduce the portal pressure and hence the variceal bleeding

3- Prior patency of the portal vein should checked beforehand by angiography

4- May precipitate or worsen hepatic encephalopathy

5- When rebleeding occurs, the shunt should be removed

Q13: Spontaneous bacterial peritonitis in the context of cirrhosis, all of the followings are true, except:

1- Unfortunately, in up to one third of cases the abdominal signs are mild or absent 2- Almost always a mono-microbial infection state

3- Recurrence is common but unfortunately there is no way to prevent it

4- The commonest organisms are enteric gram negatives, but no source of infection is usually present

5- The ascitic fluid is cloudy with more than 250 neutrophils / mm3

Q14: Precipitating factors for hepatic encephalopathy in a patient with cirrhosis, all of the followings are true, except:

1- Occult infection

2- Aggressive diuresis

3- Diarrhea or constipation

4- Treatment with oral neomycin

5- Excess dietary proteins

Q15: Differential diagnosis of hepatic encephalopathy, all of the followings are true, except:

1- Primary psychiatric disease

2- Hypoglycemia

3- Wernicke's encephalopathy

4- Subdural hematoma

5- Treatment by enemas

Q16: Acute fulminant hepatic failure, all of the followings are true, except:

1- The commonest causes are viral hepatitis and medications-induced

2- The hallmark is the presence of acute hepatic encephalopathy

3- The absence of jaundice is against the diagnosis

4- There are long listed complications and these usually complicate the picture further

5- The patient should be managed in an intensive care unit or a high dependency unit once the PT is prolonged

Q17: Hepato-renal syndrome, all of the followings are true, except:

1- Carries a very bad prognosis unless hepatic transplantation is carried out

2- One of the causes of fractional Na excretion of more than 2

3- Characterictically presents as rapidly evolving uremia with bland urinary sediment 4- Seen in advanced cirrhosis, and ascites is almost always present

5- Renal dose dopamine has a minor role in the management

Q18: Causes of micro-vesicular steatosis, all are true except

1- Fatty liver of pregnancy

2- Rye's syndrome

3- Treatment with didanosine

4- Wolman's disease and Alpers syndrome

5- Treatment with amiodarone

Q19: Causes of acute hepatitis, all of the followings are true, except:

1- Halothane

2- Wilson's disease

3- Autoimmune hepatitis

4- CMV

5- Hemochromatosis

Q20: Causes of chronic liver disease and cirrhosis, all of the followings are true, except:

1- Alpha 1 anti-trypsin deficiency

2- Chronic hepatitis C infection

3- Hemochromatosis

4- Autoimmune hepatitis

5- Epstein Barr virus infection

Q21: Liver cirrhosis, all of the followings are true, except:

1- Hyperpigmentation is seen in hemochromatosis and prolonged biliary obstruction 2- Spider telangiectasias are seen early in the course of cirrhosis

3- Parotid gland enlargement goes with alcoholic etiology

4- Ascites is seen early

5- Finger clubbing is a non specific sign

Q22: The hepatitides viruses, all of the followings are true, except:

1- Hepatitis A is an RNA enterovirus which does not lead to a carrier state

2- Hepatitis B is a DNA virus that is 42 nm in diameter and leads to chronic infection

in up to 10% of adults versus 90% of neonatal hepatitis B infection

3- Hepatitis C is an RNA flavivirus that is the commonest cause of chronic liver disease in USA and of those infected, up to 20 % of them will develop cirrhosis after

20 years

4- Hepatitis D is a defective RNA virus that can be prevented by preventing hepatitis

B infection in high risk groups by using hepatitis B vaccine and immunoglobulin 5- Hepatitis E is a RNA calicivirus that carries a mortality of 2% if the infection occurs in pregnancy

Q23: The followings predict a poor response to INF alpha treatment in chronic hepatitis B viral infection, except:

1- Being a male

2- Pre-core mutant strains of the virus

3- Being an Asian

4- Very high pretreatment serum hepatitis B viral DNA level by PCR

5- Absence of cirrhosis

Q24: Autoimmnue hepatitis, all of the followings are true, except:

1- Type I is ANA and anti-smooth muscle antibodies positive

2- Amenorrhea is the rule and Cushingoid faces may be seen

3- 25% of cases present as a hepatitis like picture

4- Corticosteroids are effective in the treatment of acute flare ups

5- Hepatocelluar carcinoma as a complication is common

Q25: Histological changes in alcoholic liver disease, all are true except

1- Mitochonsrial swelling

2- Siderosis

3- Lipogranulomas

4- Autoimmune interface hepatitis

5- Few endoplasmic reticula

Q26: Primary biliary cirrhosis, all of the followings are true, except:

1- Anti mitochondrial antibodies are seen up to 96% of cases

2-Early, there is proliferation of small bile ductules

3-Hypercholesteremia is common and greatly increases the risk of coronary artery disease

4- Polished nails with clubbing are seen

5- Ursodeyoxycholic acid has been shown to improve the liver function tests

Q27: Primary sclerosing cholangitis, all of the followings are true, except:

1- 80% of cases are seen in the context of ulcerative colitis

2- Spontaneous ascending cholangitis is uncommon but usually occurs after biliary instrumentation like post ERCP

3- Is risk factor for cholangiocarcinoma

4- There is an association with HIV infection and retroperitoneal fibrosis

5- Corticosteroids and immune-suppressants are useful in the treatment

Q28: Hepatocelluar carcinoma (HCC), all of the followings are true, except:

1- Occurs in the background of cirrhosis in up to 80% of cases

2- Chronic hepatitis B infection is the commonest cause world-wide

3- May be treated by liver transplantation

4- Any patient with cirrhosis should be screened for the development of HCC by serial serum alpha fetoprotein and liver ultrasound

5- The fibrolammellar variant has a very poor prognosis

Q29: Criteria for giving ursodeoxycholic acid as a medical treatment for gall stones solubilization, all of the followings are true, except:

1- The stone should be radiolucent

2- The stone size is up 15 mm

3- Functioning gall bladder

4- Moderate obesity

5- Prominent symptoms ascribed to the stone

Q30: Risk factors for pigment gall stones, all of the followings are true, except:

1- Liver cirrhosis

2- Biliary parasites

3- Chronic long term hemolysis

4- Ileal resection / disease

5- Pregnancy

END of Hepatology

Written by Dr Osama Amin mrcpfrcp@gmail.com All Rights Reserved

Chapter V / Nephrology

Q1: A normal kidney, all of the followings are true, except:

a- Erythropoieten is secreted by peritubular cells in response to hypoxia

b- Hydroxylates 1- hydroxycholecalciferol to its active form

c- Renin is secreted from the juxta glomerular apparatus

d- Locally produced prostaglandins have a very important role in maintaining renal perfusion

e- 90% of the erythropoietin comes from the kidneys and 10 % from the liver

Q2: Normal adult kidneys, all of the followings are true, except:

a- Its length is about 11-14 cm (about 3 vertebral bodies)

b- Both kidneys rise and descend several centimeters during respiration

c- Each kidney contains approximately 10 million nephrons

d- Both kidneys receive about 20-25% of the cardiac output

e- The right kidney is usually few centimeters lower than the left

Q3: Causes of polyuria, all of the followings are true, except:

a- Excessive fluid intake

b- Hyperglycemia

c- Early stage of chronic renal failure

d- Tubulointerstitial diseases

d- Heavy smoking

Q4: Renal ultrasound examination, all of the followings are true, except:

a- Its disadvantage is that it is highly operator dependent

b- Quick, rapid, cheap and non-invasive and often the only required method of renal imaging

c- It can show the renal size, position, dilatation of the collecting system and other abdominal pathologies like cystic liver

d- In chronic renal failure, the density of the renal cortex is unfortunately decreased and there is loss of cortico-medullary differentiation

e- By utilizing the Doppler techniques, much information can be gained like the resistivity index

Q5: IVU (intravenous urography) is commonly used in clinical nephrology, all of the followings are true, except:

1- Risky in diabetes mellitus

2- Risky in multiple myeloma

3- Risky in pre-existent renal disease

4- The risk of contrast nephropathy can be reduced by avoiding dehydration and by giving diuretics

5- The risk of contrast nephropathy can be reduced by using less hyperosmolar (yet expensive) contrast media

Q6: Disadvantages of IVU (intravenous nephrography), all of the followings are true, except:

a- It is a time consuming investigation

b- Needs and injection