Chapter XVI / Genetics Q1: Klinefelter's syndrome, all of the followings are true, except; 1- Gynecomastia is seen only in 30% of cases.. 5- Hyperkalemia Q2: Tricyclic antidepressants ov
Trang 15- PCR for mycobacterium TB from skin biopsy specimen.
Q26: Complications of atopic eczema, all of the followings are true, except:
1- Secondary superinfection
2- Sleep disturbances
3- Loss of schooling
4- Very low incidence of food allergy
5- Irritant reactions are common
Q27: All of the followings can be used in the treatment of hirsutism in women, except:
1- Depilatory creams
2- Waxing
3- Electrolysis
4- Simple shaving
5- Minoxidil application
Q28: Full endocrinology assessment should be done in the following cases of hirsutism, except:
1- If hirsutism occurs in early childhood
2- If hirsutism is rapid and of a sudden onset
3- If hursutism is associated with signs of virilization
4- If hursutism is accompanied by prominent menstrual irregularity or cessation 5- If hursutism is present in other female family memebers
Q29: Causes of localized scarring alopecia, all of the followings are true, except:
1- Discoid lupus
2- Kerion
3- Pseudopelade
4- Idiopathic
5- Alopecia areata
Q30: Causes of diffuse scarring alopecia, all of the followings are true, except:
1- Radiotherapy
2- Discoid lupus
3- Folliculitis declavans
4- Lichen planopillaris
5- Androgenetic alopecia
Q31: Immune mediated skin blistering diseases, all of the followings are true, except:
1- In pemphigus vuglaris, the target antigen is desmoglein-3
2- In bullous pemphigoid, the mucosa of the mouth is involved in 100% of cases 3- In dermatitis herpetiformis, there is coarse granular IgA deposition in the papillary dermis
4- Epidermolysis bullosa acquisita responds poorly to corticosteroids
5- Pemphigoid gestationis usually attacks the periumbilical area and thighs
Q32: The following can cause skin blistering associated with oral mucosa
involvement, except one:
1- Erythema multiforme
Trang 22- Eczema herpeticum.
3- Steven Johnson syndrome
4- Prophyria cutanea tarda
5- Toxic epidermal necrolysis
Q34: Eryhtroderma can be caused by all of the followings, except:
1- Psoriasis
2- Drug reactions
3- Rare type of icthyosis
4- Pityriasis rubra pillaris
5- Porhyria cutanea tarda
Q35: Pregnancy-associated pruritis can be due to all of the followings, except:
1- Prurigo gestationis
2- Pemphigoid gestationis
3- Pruritic folliculitis
4- Polymorphic eruption of pregnancy
5- Vitiligo
Q33: All of the followings are photosensitive dermatosis, except:
1- Solar urticaria
2- Polyporphic light eruption
3- Pellagra
4- Erythema multiforme
5- Pretibial myxedema
End of dermatology
Trang 3Chapter XVI / Genetics
Q1: Klinefelter's syndrome, all of the followings are true, except;
1- Gynecomastia is seen only in 30% of cases
2- The affected person may have a 48 XXYY kryotyping
3- Short stature is more common than tall stature
4- Cardiac anomalies are very rare
5- Some degree of low intelligence may be seen
Q2: Turner's syndrome, all of the followings are true, except:
1- Aortic coarctation is not the only cause of hypertension
2- Branch pulmonary artery stenosis suggests Noonan's syndrome rather than Turner's
3- Lymphedema of the hands and feet may be seen early in life
4- Large doses of growth hormone therapy can induce an increase in height 5- Hormonal replacement therapy can be used to induce fertility in the majority of patients
Q3: The followings are autosomal recessive ….except:
1- Phenylketonuria
2- Famial Mediterranean fever (FMF)
3- Oculocutaneous albinism
4- Wilson's disease
5- Familal hypercholesteremia
Q4: Serum maternal alpha fetoprotein (AFT) may be raised in all of the followings except:
1- Twin pregnancy
2- Threatened abortion
3- Spina bifida
4- Hepatocelluar carcinoma
5- Postdate pregnancy
Q5: Amniocentesis, all of the followings are true, except:
1- The risk of abortion is lower than that of chorionic villous sampling (CVS) 2- Usually performed around the 14th -16th weeks of gestation
3- Cytological examination may be used to detect karyotyping
4- Usually done blindly
5- Useful in the prenatal diagnosis of congenital adrenal hyperplasias
Trang 4Chapter XVII / Toxicology
Q1: Digoxin toxicity is enhanced by all of the followings, except:
1- Cardiac amyloidosis
2- Hypomagnesemia
3- Hypothyroidism
4- Concomitant treatment with amiodarone
5- Hyperkalemia
Q2: Tricyclic antidepressants overdose, all of the followings are true, except;
1- Cardiac and CNS toxicities are responsible for most of the fatalities
2- Skin blisters may be seen but they are unusual
3- Seizures are documented
4- Rhabdomyolysis indicates severe poisoning
5- Sodium bicarbonate infusion is indicated when the ECG shows short QT interval
Q3: Lead poisoning, all of the followings are true, except:
1- Red cell ALA dehydratase activity is decreased
2- Glycosuria and aminoaciduria are seen
3- Blue lines on gums indicates acute poisoning
4- Urinary ALA and coproporphyrin are increased
5- Encephalopathy is mainly seen in children
Q4: Ethylene Glycol poisoning, all are true, except:
1- Both, anionic gap and osmolal gap are increased
2- Renal failure is usually reversible
3- Hypocalcemia is seen
4- Hemodialysis is the best option in treating severe cases
5- Activated charcoal is used if the poisoning occurs with in 2 hours
Q5: Ecstasy poisoning, all of the followings are true, except:
1- DIC may be seen
2- CPK may be increased
3- Hyponatremia is common
4- Hypotension may be due to myocardial infarction
5- Intracranial hemorrhage is not seen
Q6: Carbon monoxide poisoning, all are true, except:
1- The gold standard investigation is by measuring the blood carboxyhemoglobin level
2- Despite of severe intoxication the pulse oxymetery is usually normal
3- The earliest features are headache, nausea and vomiting
4- When seizures occur, try to avoid phenobarbitone
5- Hyperbaric O2 is used when the level of Carboxyhemoglobin is more than 5%
Q7: Phenytoin toxicity, all of the followings are true, except:
1- Seizures are rare
2- Fatality is fortunately uncommon and mainly due to cardiac toxicity
3- May be enhanced in renal and hepatic failures
4- Hemodialysis is of great benefit in the treatment
Trang 55- Gingival hypertrophy indicates a chronic exposure and hence superadded toxicity rather than an accidental poisoning
Q8: Lithium toxicity, all of the followings are true, except:
1- Enhanced by concomitant thiazide diuretic therapy
2- There may be raised TSH with low T4 blood levels
3- Seizures and hyper-reflexia are seen
4- Fine tremor supports the diagnosis of overdose
5- Hemodialysis is the treatmnent of choice in severe toxicity
Q9: Ethanol intoxication, which one is the wrong statement:
1- Ethanol intoxication produces nystagmus, dysarthria, and limb and gait ataxia 2- In non-chronic alcoholics, the clinical manifestations decline over hours despite a stable blood ethanol level
3- Plasma osmolality is useful in the assessment and should be normal in acute intoxication
4- Should be differentiated from sedative-hypnotic drugs intoxication
5- Might cause life threatening hypoglycemia
Q10: Sedative drug intoxication, which one is the wrong statement:
1- Can present as a confusional state or coma
2- The pupils are usually reactive and prominent papillary abnormalities should prompt a search for another pathology
3- Nystagmus, gaze paresis, decerebrate or decorticate posturing might be seen 4- The mortality rate is unfortunately very high and is due to the CNS depressant effect of these medications
5- Forced alkaline diuresis is ineffective for short acting barbiturates
Q11: Sedative drug withdrawal, which one is the wrong statement:
1- The frequency and severity of these withdrawal syndromes depend on the duration
of drug intake, total daily does and the half life of the medication
2- The overall clinical picture can exactly resemble ethanol withdrawal syndromes and is also self limiting
3- The diagnosis can be confirmed by Phenobarbital challenge test
4- Like ethanol withdrawal seizures, seizures here should not be treated with
anticonvulsants
5- A delirium tremens like syndrome may be seen 3-8 days after abstinence
Q12: Opioid overdoses, which one is the wrong statement:
1- Can present as an iatrogenic confusional state or coma in hospitalized patients 2- The cardinal features are pinpoint pupils and respiratory depression
3- Can simply be confirmed at the bed side by giving naloxone to the patient
4- The mortality rate is very high
5- Because most opioids are long acting, nalaxone should be given repeatedly
Q13: Antichlinergics intoxication, which one is the wrong statement:
1- Can be seen with antipsychotics overdoses
2- Produces a characteristic picture of agitated delirium and fever, dry skin, fixed dilated pupils, blurring of vision and hallucinations
3- Can be confirmed by toxicology screen of blood and urine
Trang 64- The symptoms are usually progressive with a high mortality rate
5- Can be treated with physostigmine
Q14: Sympathomimetic intoxication, which one is the wrong statement:
1- Can produce hyperactivity, hallucinations and schizophreniform paranoid
psychosis
2- Cardiac dysrrhytmias are the main cause of serious morbidity
3- Amphetamine and cocaine can produce thrombotic or hemorrhagic strokes 4- Beta blockers are very useful in cases complicated by severe hypertension
5- Haloperidol can be very useful to offset the central dopaminergic effects
Q15: LSD (lysergic acid diethylamide) intoxication, which one is the wrong statement:
1- Can produce nystagmus, ataxia, hypertonia and hyperreflexia
2- Visual and somatosensory illusions and hallucinations are the hallmark of this syndrome
3- Seizures are very common and should be treated aggressively
4- There are dilated pupils and hyperthermia
5- Treatment usually involves verbal calming and reassurance
Q16: PCP (phenelcyclidine) intoxication, which one is the wrong statement:
a- Considered to be a medical emergency with many fearful and aggressive
complications
b- The patient can be drowsy or extremely agitated with amnesia, hallucinations, and violent behavior
c- Phenothiazines should be given in the treatment of psychotic features
d- In general, signs and symptoms resolve with 24 hours
e- Might be complicated by severe hypertension, status epilepticus , malignant hyperthermia, coma and death
Q17: Drug -induced confusional state might be caused by all of the followings except one:
1- When used in larger than customary doses
2- Many medications can cause prominent confusion in elderly people even when given in small recommended doses
3- Especially seen when the metabolism of the medication is impaired by organ failure
4-those with pre-existent cognitive impairment are more susceptible to drug-induced confusional states
5- Poly-pharmacy protects against the development of drug-induced confusional states
Q18: Ethanol withdrawal fits (Rum Fits), which one is the wrong statement:
1- Usually seen within 2 weeks after the beginning of abstinence
2- More than 90% of patients will have between 1 to 6 seizures
3- Anticonvulsant treatment is usually not required
4- Focal seizures should be taken seriously and may suggest another diagnosis or a coexistent pathology
5- The patient should be closely observed for any subsequent or concomitant
complications of alcohol
Trang 7Q19: Ethanol withdrawal subtype delirium tremens, which one is the wrong statement:
1- It the most serious of all ethanol withdrawal syndromes
2- Characterized by confusion, agitation, fever and hallucination
3- Fortunately the mortality rate is low around 1%
4- Should be treated with diazepam 10-20 mg intravenously and repeated every 5 minutes as needed until the patient is calm
5- Concomitant treatment with beta blockers is also advisable
Q20: Ethanol withdrawal subtype tremulousness and hallucination, which one is the wrong statement:
1- Is considered to be a benign self-limiting condition
2- Usually seen within 2 days after cessation of drinking
3- There is agitation, anorexia, hypertension, insomnia and tachycardia
4- Prominent confusion dominates the clinical picture
5- Can be treated by chlodiazepoxide or diazepam
End of toxicology
Trang 8End of the "Questions Book"
Please see answers in the "Answers Book"