Neurology 4 mrcp questions book - part 5 potx

Q43: Addison's disease, all of the followings are true, except: a- The commonest cause is autoimmune adrenalitis.. Q49: Carcinoid tumors and syndromes, all of the followings are true, ex

a- Carpo-pedal spasm is more common in children than adults.

b- In adults, stridor is uncommon

c- Seizures are usually resistant to antiepileptic therapy

d- The cornerstone in the treatment of pseudohypoparathyroidism is calcium

supplement

e- Regular follow up is needed with measurement of serum calcium

Q37: Cushing syndrome in general, all of the followings are true, except:

a- Obesity is the commonest sign

b- Hypertension is absent in 25% of cases

c- Prominent hyper-pigmentation is in favor of an ectopic ACTH secreting source d- Depression is the commonest psychiatric manifestation

e- Muscle biopsy will show type I fiber atrophy

Q38: In the diagnosis of Cushing syndrome, all of the followings are true, except:

a- Acclimatization to hospitalization for 48 hours is very important before hand b- 24 hours urinary free cortisol or overnight low dose dexamethasone suppression test are the preferred initial screening tests

c- Unfortunately dexamethason cross reacts with the cortisol immunoassay

d- Chronic alcoholism sometimes exactly resembles Cushing's syndrome clinically and biochemically

e- Suppressed ACTH levels indicate an adrenal tumor

Q39: Treatment of Cushing syndrome, all of the followings are true, except:

a- In pituitary dependent disease, trans-sphenoidal surgery is the preferred option b- If treated by bilateral adrenalectomy, the pituitary should be irradiated to prevent the development of Nelson's syndrome

c- Medical treatment is usually given in the way to prepare the patient for surgery d- Adrenal carcinoma should be removed surgically and the tumor bed is irradiated and then the patient is given the drug o'p'DDD

e- Without treatment, the 5 year survival rate is 90%

Q40: Causes of apparent hyperaldosteronism, all of the followings are true, except:

a- Treamtent with carbenoxolone

b- 11 deoxycorticosterone secreting tumors

c- Liddle's syndrome

d- Ectopic ACTH syndrome

e- Glucocorticoides suppressible hyperaldosterosnism

Q41: In primary aldosteronism, all of the followings are true, except:

a- Hypertension is almost always present and is the commonest presenting feature b- Serum potassium is normal up to 70% of cases at the time of diagnosis

c- Of all causes, only Conn's adenoma can be treated by surgery

d- Spironolactone is very effective in normalizing the blood pressure and biochemical abnormalities in the majority of cases

e- Leg edema is very common

Q42: Pheochromocytoma, all of the followings are true, except:

a- May be part of specific syndromes

b- Predominantly elevated noradrenalin suggests either a large adrenal tumor or an extra adrenal tumor

c- Weight loss indicates associated diabetes mellitus

d- Postural hypotension may be seen

e- The rise in blood pressure may occur during urination

Q43: Addison's disease, all of the followings are true, except:

a- The commonest cause is autoimmune adrenalitis

b- Vitilligo is seen in 20% of cases

c- Hyperglycemia indicates an associated type I diabetes

d- Postural hypotension is indicates glucocorticoids rather than mineralocorticoids deficiency

e- It is a common condition with an incidence of 8000 new case/ million of

population

Q44: Congenital adrenal hyperplasia, all of the followings are true, except:

a- The commonest cause is 21 alpha hydroxylase deficiency

b- All cases are autosomal recessive

c- Causes ambiguous genitalia in females and precocious pseudopuberty in males d- 11 beta and 17 alpha hydroxylases are associated with hypotension

e- The condition can be prevented by appropriate prenatal diagnosis and giving dexamethason to the pregnant mother

Q45: Drug induced gymecomastia may be due to all of the followings, except:

a- Digoxin

b- Cimetidin

c- Stilboestrol

d- Spironolactone

e- Ameloride

Q46: In polycystic ovarian syndrome, all of the followings are true, except:

a- Insulin resistance is though to be the central key in the pathogenesis

b- There is a mild elevation in serum prolactin

c- There is a mild elevation of serum androgens

d- There is an elevated blood estron level

e- FSH: LH ratio is more than 3.5:1

Q47: In the assessment of hirsutism in a female, all of the followings are

important clues to the underlying cause, except:

a- As idiopathic hirsutism is the commonest cause, so being an Asian or

Mediterranean are important clues to it

b- High levels of androgens that don’t suppress with steroids or estrogens are very important clues to ovarian or adrenal tumors

c- Being a highly trained athletic female may suggest an exogenic androgen intake d- Mooning of the face with obesity and striae may be a clue to Cushing's syndrome e- Family history of hirsutism is not that important

Q48: MEN type I and type II, all of the followings are true, except:

a- Due to mutation in MENIN gene on chromosome 11 in type I

b- Symptomatic hypercalcemia is the commonest presenting feature in type II

c- Family history of one relevant endocrine tumor may be present

d- Pheochromocytomas in type II are bilateral in 70% of cases

e- Carcinoid syndrome is uncommon in type I

Q49: Carcinoid tumors and syndromes, all of the followings are true, except:

a- The commonest site is the ileum for carcinoid tumors

b- May present as appendicitis

c- The long term prognosis is excellent in the majority

d- Carcinoid syndrome may present as right sided heart failure

e- Cramping abdominal pain and diarrhea with flushing and wheeze are the commonest presenting features of carcinoid tumors

Q50: In pancreatic endocrine tumors, all of the followings are true, except:

a- Somatostatinomas may presents with gall stones and diabetes

b- Glucagonomas may present with anemia and weight loss

c- Gastrinomas may present with steatorrhea

d- VIPOmas may present with watery diarrhea and profound hyperkalemia e- Insulinomas may present with dizzy spells

End of part of endocrinology

Chapter VIII / Diabetes Mellitus

Q1: Diabetes mellitus may be associated with many genetic syndromes, all of the following associations are true, except:

1- Myotonia dystrophica

2- Down's syndrome

3- Lipodystrophy

4- Friedriech's ataxia

5- Nesidiolastosis

Q2: Type I diabetes mellitus, all of the followings are true, except:

1- It is a T cell mediated immunological disease

2- There is a mononuclear cell infiltration of the pancreas causing insulinitis 3- There is an association with HLD B8/DR3 DR4

4- Concordance rate in monozygotic twins is almost 100%

5- The disease can be induced to enter a remission by immune suppressed

Q3: Type II diabetes mellitus, all of the followings are true, except:

1- About 70% of patients are above the age of 50 years at the time of diagnosis 2- About 10% of the whole population above the age of 65 years has type II diabetes mellitus

3- About 80% of females with a history of gestational diabetes will ultimately develop type II diabetes

4- Overeating, obesity and under-activity are risk factors for the future development

of type II diabetes

5- Concordance rate in monozygotic twins is around 50%

Q4: Type 2 diabetes mellitus has been shown to be associated with many single gene mutations, all of the following gene mutations are autosomal dominant , except:

1- Mutation in hepatocyte nuclear factor 4 alpha gene

2- Mutation in hepatocyte nuclear factor 1alpha gene

3- Mutation in glucokinase gene

4- Mutation in insulin promoter factor gene

5- Mutation in mitochondrial DNA

Q5: Action of insulin, all of the followings are true, except:

1- Decreases lipolysis

2- Enhances the action of lipoprotein lipase

3- Enhances potassium and amino acid entry into cells

4- Enhances glycogensis and glycolysis

5- Enhances fatty acid synthesis by the liver

Q6: Oral glucose tolerance test, all of the followings are true, except:

1- Is not used in the routine diagnosis of diabetes mellitus

2- There should be unrestricted carbohydrate diet 3 days before the test

3- The patient may be allowed to smoke during the test

4- The patient should fast overnight

5- If the 2 hours plasma glucose level was between 7.8-11.1 mmol /L, it is called impaired glucose tolerance test

Q7: Diagnosis of diabetes mellitus, all of the followings are true, except:

1- Glycated hemoglobin is not used for the diagnosis

2- The presence of glycosuria should warrant further investigations and should not be used as a diagnostic test per se

3- Ketonuria per se is not pathognomonic for diabetes and may found in normal people after prolonged fasting or exercise

4- The fasting blood glucose is always preferred over the random one in the diagnosis 5- The random blood glucose of more than 11.1 mmol/L on 4 or more occasions is diagnostic for diabetes mellitus

Q8: Dietary Management of diabetes, all of the followings are true, except:

1- 50% of type II diabetes will respond initially to diet alone

2- The total dietary fat better not to exceed 10% of total energy intake

3- Alcohol should be avoided

4- Salt restriction is advised

5- Encourage regular exercises

Q9: Effects of anti-diabetic agents, all of the followings are true, except:

1- Glyclizide has no effect on lipid profile

2- Insuline does not reduce post prandial glycemia

3- Acarbose has no hypoglycemic effect

4- Pioglitazone does not raise serum insulin

5- Metformin does not increase body weight

Q10: Side effects of anti-diabetic agents, all of the followings are true, except:

1- Metformin carries a risk of lactic acidosis

2- Chlopropamide may cause SIADH

3- Rosiglitazone may cause prominent fluid retention

4- Insulin may cause peripheral edema

5- Acarbose causes severe constipation

Q11: Severe hypoglycemia in diabetics may cause all of the followings, except:

1- Vitreous hemorrhage

2- Cardiac dysrrhythmia

3- Hyperthermia

4- Risks of accidents

5- Stroke

Q12: Causes of hypoglycemia in diabetics, all of the followings are true, except:

1- Absence of exercises

2- Unrecognized other endocrine diseases like Addison's disease

3- Missed, delayed or inadequate meal

4- Gastroparesis

5- Factitious and deliberately induced

Q13: Diabetic ketoacidosis, all of the followings are true, except:

1- Caused by severe and absolute insulin deficiency

2- Average fluid loss is 6 liters and potassium loss is 350 meq/ L.

3- Any sudden impairment in consciousness during treatment should alert you to the possibility of brain edema

4- Sudden gastric dilatation may occur

5- Leukocytosis indicates infection

Q14: Complications of diabetic ketoacidosis, all of the followings are true,

except:

1- DIC is common

2- Confusion, drowsiness and coma is seen up to 10%

3- Thromboembolism

4- Acute circulatory failure

5- ARDS

Q15: Non ketotic hyperosmolar coma, all of the followings are true, except:

1- Acidosis is not a prominent part of the picture

2- Hyperosmolarity is a must

3- Thromboembolic complications are common

4- 1% mortality rate

5- The condition usually affects elderlies with previously undiagnosed diabetes

Q16: Diabetic retinopathy, all of the followings are true, except:

1- Microaneurysms are the first ophthalmoscopic sign in background retinopathy 2- Hard exudates are characteristic

3- Prominent soft exudates indicate an advanced retinopathy state or an associated hypertension

4- IRMAs (intra-retinal micro vascular abnormalities) mainly indicate a

pre-proliferative stage

5- Venous loops and beadings are seen mainly in proliferative stage

Q17: Diabetic peripheral neuropathy, all of the followings are true, except:

1- Variable combination of axonopathy, demyelination and thickening of Shwann cell basal lamina

2- Overall, seen in 50 % of cases and usually not that symptomatic

3- May be associated with Charcot joints

4- Mainly motor and is irreversible

5- May cause trophic ulceration in the feet

Q18: Diabetic nephropathy, all of the followings are true, except:

1- Occurs in 30-35% of type I diabetes but 10-20% of type II diabetes

2- 50% of diabetic nephropathy patients are type II

3- Hypertension is very common and may accelerate the course

4- The nodular glomeruloscleorsis type is much more common than the diffuse type 5- ACE inhibitors are effective at reducing the rate of progression even in the absence

of hypertension

Q19: Diabetes and pregnancy, all of the followings are true, except:

1- Ideally, all patients should have pre-pregnancy counseling

2- Ideally, diabetes should be controlled before pregnancy rather than during the course of pregnancy

3- The objective of good diabetic control is to decrease the fetal congenital anomalies 4- Oral hypoglycemics are useful in the management

5- Insulin requirement varies through out the course of pregnancy

Q20: Surgery in diabetics, all of the followings are true about preoperative evaluation, except:

1- Pre-operative cardiovascular and renal assessments are very important

2- Preoperatively, check signs of neuropathy and especially autonomic one

3- Assess the over all glycemic control by HbA1c

4- Review the overall treatment and stop metformin and long acting sulphonylureases prior to the day of surgery

5- No need for hospitalization in all cases, as the assessment can be done on an

outpatient basis

END of Diabetes

-Chapter IX / Hematology

Q1: Differential diagnosis of iron deficiency anemia, all of the followings are true, except:

1- Aluminuim toxicity

2- Beta thalassemia syndromes

3- Alpha thalassemia syndromes

4- Lead poisoning

5- Aplastic anemia

Q2: Causes of macrocytosis without a megaloblastic bone marrow, all of the followings are true, except:

1- Myelodysplastic syndromes

2- Aplastic anemia

3- Multiple myeloma

4- Chronic myeloid leukemia

5- Fish tapeworm infestation

Q3: Causes of macrocytosis with normal bone marrow, all of the followings are true, except:

1- Liver disease

2- Neonatal

3- Pregnancy

4- Post –hemorrhage

5- Myelomatosis

Q4: Causes of dimorphic blood picture, all of the followings are true, except:

1- A patient with long standing iron efficiency anemia who had received blood

transfusion because of symptomatic coronary artery disease

2- Long standing iron deficiency anemia patient who had received iron therapy before

1 week

3- Celiac disease patient non-compliant with glutin free diet

4- Bone marrow study of a patient showing characteristic rings in the maturing

erythroid series

5- A young pregnant lady on long term treatment with phenytoin

Q5: Sickle cell anemia, all of the followings are true, except:

1- Despite the degree of anemia in the chronic stable state, it is usually rarely

symptomatic,

2- In contrast to beta thalassemia major, blood transfusion is rarely indicated except probably in crisis or in certain selected patients not in crisis

3- The target of blood transfusion is to raise the hemoglobine A to 85-90% of the total hemoglobins and the PCV should be between 30-36 %

4- Pulmonary infarction-chest syndrome is the commonest cause of death in adults 5- Stroke in general is seen in 70 % of adults

Q6: Beta thalassemias, all of the followings are true, except:

1- Hb A2 may be normal or even low in beta thalassemia minor

2- Regular transfusion is the mainstay in the treatment of beta thalassemia major

3- Beta thalassemia minor usually comes into light after a failure of oral iron therapy for a mild hypochromic anemia

4- Hear failure in beta thalassemia major is only due to iron overload causing

cardiomyopathy

5- Target cells are seen in peripheral blood film

Q7: Causes of prominent intravascular hemolysis, all of the followings are true, except:

1- Falciparum malaria

2- Clostridia septicemia

3- Immediate major ABO incompatibility reaction

4- Paroxysmal nocturnal hemoglobinuria

5- Hemolytic disease of the new born

Q8: Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP)

1- Neurological manifestations are more prominent in TTP

2- Renal impairment is more prominent in HUS

3- Skin rash is mainly seen in TTP

4- Prolonged PT and aPTT occurs in HUS rather than TTP

5- Vincristin may be used in the treatment

Q9: Causes of eosinophilia, all of the followings are true, except:

1- Psoriasis

2- Trichinosis

3- Treatment with steroids

4- Hodgkin’s disease

5- Chronic myeloid leukemia

Q10: Causes of monocytosis, all of the followings are true, except:

1- Bone marrow recovery from chemotherapy

2- Sarcoidosis

3- Myelodysplastic syndrome

4- Kala-azar

5- Hairy cell leukemia

Q11: Causes of neurtropenia, all of the followings are true, except:

1- Racial

2- Associated viral infections

3- Hypersplenism

4- Treatment with carbimazole

5- Leptospirosis

Q12: Poor prognostic factors in acute lymphonlastic leukemia, all of the

followings are true, except:

1- Male sex

2- Age less than 1 year and more than 10 years

3- CNS involvement at the time of diagnosis

4- Common ALL type

5- Very high leukocyte count at the time of diagnosis

Q13: Which one of the following cytogenetic abnormalities seen in acute

myeoloid leukemia is true:

1-M6 subtype–inv 16

2-M3 subtype–t(15,17)

3-M5 subtype- t( 8,21)

4-M1 subtype- t(1,15)

5-M2 subtype-t ( 2,14)

Q14: AML M3 subtype, all of the followings are true, except:

1- The presence of t(15,17) confers a good prognosis

2- The genetic defect lies in RARA gene

3- Treatment with ATRA enhances further differentiation of the promyeloblasts from its differentiation block site

4- Almost always of a hypogranular type

5- Evidence of DIC is present up to 80% at the time of diagnosis

Q15: Chronic myeloid leukemia, all of the followings are true, except:

1- The absence of Philadelphia chromosome portends a poor prognosis

2- Treatment with imatinib mesylate will produce an 80% cytogenetic remission 3- Basophilia is usually the first sign of the accelerated crisis

4- Associated vitamin B12 deficiency is very common

5- LAP (leukocyte alkaline phosphatase) score is low

Q16: Chronic lymphocytic leukemia, all of the followings are true, except:

1- Trisomy 12 is the commonest cytogenetic abnormality

2- Smudge cells are seen in peripheral blood film with absolute lymphocytosis of mature looking lymphocytes

3- Bullous skin rash may be seen

4- Monoclonal band is seen in some patients on serum protein electrophoresis 5- Hyperuricemia is common

Q17: Hodgkin's disease, all of the followings are true, except:

1- LDH is raised and is a useful guide to the bulk of the disease

2- Usually there is anemia, neutrophilia, thrombocytosis and in some esosinophilia at the time of diagnosis

3- Residual masses after treatment are common

4- Lymphocyte depleted type usually has poor prognosis

5- There is an association with CMV infection

Q18: Multiple myeloma, all of the followings are true, except:

1- The ESR is usually very high

2- 1% is non secretory

3- Human herpes virus type 8 infection is being increasingly recognized association 4- Bone scan is usually normal

5- Serum alkaline phosphatase is usually high a the time of diagnosis

Q19: Features in favor of monoclonal gammopathy of undetermined significance (MGUS) rather than multiple myeloma (MM) are all of the followings, except:

1- Low level of the paraprotein