Neurology 4 mrcp questions book - part 2 ppsx

e- Indicated when the PaO2 is below 9 kPa with any level of PaCo2. Q7: Acute exacerbation of COPD may be presented as one of the followings, except: a- An increase in the amount sputum production. b- An increase in the purulence of the sputum. c- Simply some patients may present with fluid retention. d- An increase in the chest tightness and wheeze. e- Fever. Q8: Indications for corticosteroids in COPD, all of the followings are true, except: a- A previous response to steroids. b- During an acute exacerbation. c- Early in the course to lessen progression. d- Con-commitment asthma. e- If the patients was already on steroids. Q9: Regarding the prognosis of COPD, all of the followings are true, except: a- The best guide to progression of COPD is the rate of decline in FEV1 over time. b- The prognosis is inversely related to age. c- The prognosis is directly related to post-bronchodilator FEV1. d- Atopy patients have a bad prognosis. e- Pulmonary hypertension in COPD implies a poor prognosis. Q10: Treatment of acute exacerbation of COPD, all of the followings are true, except: a- Prophylactic subcutaneous heparin should be considered. b- If the blood PH is less than 7.26, and the PaCo2 is rising, consider ventilatory support, c- If ventilatory support is needed but not indicated because of poor quality of life or significant co-morbidity, then doxapram should be considered. d- Diuretics should be avoided. e- When giving O2, it is better to be given at a rate of 2 liters / minutes by nasal prongs. Q11: Air plane traveling for a patient with COPD, which one is the wrong statement? a- There is a risk of expansion of non-functional pulmonary bullae. b- There is a risk of producing excessive abdominal gases. c- There is high risk of dryness of the bronchial secretions. d- All patients with a resting PaO2 of less than 9 kPa on air require supplementary O2. e- Hypercapnia is an absolute contraindication to air plane traveling. Q12: In COPD, which one is the wrong statement? a- Central cyanosis may bee seen. b- Peripheral edema may indicate the development of cor pulmonale. c- Weight loss is uncommon. d- Only 15% of smokers are likely to develop a clinically significant COPD. e- Smoker's emphysema is usually seen in the upper zones of the lung. Q14: Bronchial asthma, during histopathological examination, all of the followings are true, except: a- Tthere is smooth muscles hypertrophy and hyperplasia. b- Desquamation of the epithelium and edema of the sub mucosa. c- Thickening of the basement membrane is rarely seen. d- Mucus plugs are common especially in severe episodes. e- The changes are initially reversible. Q15: Prophylaxis of exercise induced asthma, all of the followings may be used, except: a- Adequate warm up exercises. b- A pre-treatment with beta 2 agonists. c- Intravenous steroids. d- Nedochromil sodium. e- Monteleukast. Q16: Chest x ray findings in asthma, all of the followings are true, except: a- May be totally normal. b- Proximal bronchiectasis may indicate the presence of allergic bronchopulmonary aspergillosis. c- Fluffy transient and patchy changes may indicate an underlying Church-Strauss vasculitis. d- During an acute attack of asthma, hyper-lucency is a rare finding. e- Pneumothorax should always be looked for in severe cases unresponding to standard treatment Q17: In preventive measures against asthma episodes, the followings are considered to be of a HIGH efficiency when used to prevent asthma provocation, except: a- Avoid contact with dogs, cats and horses (for animal dander induced cases). b- Avoid all possible drugs that may induce asthma attack (for drug-induced asthma). c- Avoid exposure to chemicals or change occupation if necessary (industrial chemicals for occupational asthma). d- For feathers in pillows, substitute latex foam pillows (feathers in pillows-induced asthma). e- For food, try to identify and eliminate it from diet (for food induced asthma). Q18: Treatment of an acute asthmatic attack, all of the followings are true, except: a- The objective is to maintain a PaO2 above 8 to 8.5 kPa with O2 therapy. b- High flow high concentration O2 should be given even in the presence of hypercapnia. c- Systemic steroids should be given in all acute severe asthmatic attacks. d- Peak expiratory flow rate has no role in the initial management. e- Nebulized beta 2 agonists are preferred over the IV route. Q19: In the treatment of acute severe asthma, still signs of severity are present after giving an optimal medical therapy,what to do NEXT. All of the followings are, except: a- Ipratropium bromide 0.5 mg should be added to the nebulized beta 2 agonists. b- Magnesium infusion may be considered. c- Loading dose aminophyllin may be used even in those who are already on oral theophyllin. d- iv beta 2 agonists may be used. e- There is a place for mechanical ventilation. Q20: Indications for mechanical ventilation in acute severe asthma, all of the followings are true, except: a- Exhaustion, confusion and drowsiness. b- Coma. c- Sudden respiratory arrest. d- Peek expiratory flow rate below 50% of the patient previous best value. e- PaCo2 of more than 6 kPa and rising. Q21: In bronchiectasis , all of the followings are true, except: a- May be caused by pulmonary sequestration. b- May be caused by bronchomalacia. c- Hemoptysis is common and may be life threatening. d- Clubbing is uncommon. e- Dry bronchiectasis indicates upper lobe bronchiectasis and may be caused by TB. Q22: Cystic fibrosis, all of the followings are true, except: a- The commonest mutation is the delta 508 in CFTR gene on chromosome 17. b- Staphyllococcal infections tend to occur early in the course while pseudomonas infections tend to occur later. c- Spontaneous pneumothorax should be suspected in any sudden deterioration. d- Nasal polypi are common. e- Amyloidosis may be seen. Q23: In cystic fibrosis, which one is the wrong statement? a- Treatment with recombinant human DNAase has been shown to decrease the infective exacerbation in a sub group of patients. b- Treatment with recombinant human DNAase has been shown to improve the pulmonary function and the sense of wellbeing in a subgroup of patients. c- Recombinant human DNAase is delivered to the bronchial tree by a nebulizer. d- Treatment with recombinant human DNAase has been shown to be effective in cystic fibrosis as well as other causes of bronchiectasis. 5- Treatment with recombinant human DNAase has been shown to be expensive. Q24: Community acquired pneumonias, all of the followings are, except: a- The commonest cause is streptococcus pneumoniae. b- Staph aureus is a rare cause. c- Many organisms produce an overlapping clinical picture. d- It is easily to differentiate between typical and atypical pneumonias on clinical grounds alone. e- In any severe community acquired pneumonia; legionella infection has to be excluded. Q25: Objectives in the management of pneumonias in general, all of the followings are, except: a- Obtain a radiological confirmation of the diagnosis. b- Exclude other conditions which may mimic pneumonias. c- Obtain a microbiological diagnosis. d- Asses the severity of pneumonia. e- Looking for the development of complications is usually a minor thing. Q26: The following microbiological investigations should be done routinely in all cases of community acquired pneumonias, except one investigation: a- Sputum for gram stain and culture. b- Sputum for acid fast bacilli and culture. c- Pleural fluid aspirate. d- Blood cultures. e- Seorology with acute and convalescent titers to diagnose mycoplasma, chlamydia, legionella and viral pneumonias. Q27: Features suggestive of high mortality in pneumonias, all of the followings are true, except: a- Respiratory rate more than 30 cycles / minute. 2- Systolic blood pressure below 90mmHg and or Diastolic blood pressure below 60 mmHg. 3- Blood urea more than 17 mmol/L. 4- Hypoalbuminaemia. 5- Positive blood culture. Q28: Differential diagnosis of acute pneumonias, all of the followings are true, except: 1- Pulmonar infarction. 2- Pleural / pulmonary TB. 3- Certain types of pulmonary edema, usually atypical types. 4- Subphrenic abscess. 5- Paracolic abscess. Q29: Hospital acquired pneumonia, all of the followings are wrong, except: a- Does not include post operative pneumonia. b- Does not include a new pneumonia while the patient is on a ventilator. c- Includes certain types of aspiration pneumonias. d- Occurs in up to 20% of in-hospital admitted patients. e- Usually gram negative organisms predominate. Q30: Cryptic military TB, all of the followings are true, except: a- Usually occurs in old females. b- Chest signs are rare. c- Leukemoid reaction may be seen. d- Pancytopenia may be seen. e- Chest x ray is usually abnormal. Q31: False negative tuberculin test may be seen in all of the followings, except : a- Miliary TB. b- Immune suppressive therapy. c- Early in the course of TB meningitis. d- Elderly patients. e- AIDS patients. Q32: In the treatment of pulmonary TB, which one is the true statement? a- Thiacetazone is not used in AIDS patients in poor resources developing countries b- Optic neuritis is usually caused by pyrazinamide. c- Hemolytic anemia with rifampicin is common. d- Streptomycin mainly affects hearing rather than vestibular function. e- Pyridoxin should be given to all patients receiving isoniazide. Q33: Allergic broncho-pulmonary aspergillosis, all of the followings are true, except: a- Serum IgG precipitins is usually strongly positive. b- It is an immune complex disease, not an invasive one. c- Esosinphilia is very common. d- Is not caused by aspirgillus clavatus. e- Usually there is a preexistent lung disease. Q34: Lung cancer, all of the followings are true, except: a- Passive smoking is responsible for 5% of all lung cancers. b- Exposure to naturally occurring radon is responsible for 5 % of all lung cancers. c- May be caused by chromium and cadmium exposure. d- The incidence is slightly higher in rural than urban dwellers. e- The incidence of adenocarcinoma is rising. Q35: In lung Cancer, all of the following are true, except: a- Responsible for 25% of all cancer deaths. b- 80% of cancer deaths in women and 40% cancer deaths in men. c- The commonest cause of cancer death in men. d- The most rapidly increasing cause of cancer death in women. e- More than 3 folds increase in cancer deaths since 1950. Q36: Chest X ray findings in lung cancer, all of the followings are true, except: a- Totally normal films virtually exclude lung cancer. 2- Pleural effusion. 3- Lung, lobe or segmental collapse. 4- Broadening of the mediastinum. 5- Rib destruction. Q37: Contraindications to surgery in non-small cell lung cancer, all of the followings are true, except: a- Esophageal invasion. b- FEV1 less than 2.8 L. c- Malignant pleural effusion. d- Severe ischemic heart disease. e- Contralateral mediastinal lymph node involvement. Q39: Posterior mediastinal mass on chest x ray includes all of the followings, except: a- Paravertebral abscess. b- Neurogenic tumors. c- Foregut duplication. d- Diaphragmatic hernia through foramen of Morgagni. e- Diaphragmatic hernia through foramen of Bockdaleck. Q40: Presentation of sarcoidosis, all of the followings are true, except: a- May be asymptomatic and discovered incidentally by an x ray film in up to 30 % of cases. b- Ocular symptoms in 5-10 % of patients. c- Skin sarcoids in 5 % of cases. d- Symptoms of hypercalcemia in 30% of cases. e- Superficial lymph node enlargement in 5 % of cases. Q41: Indications of treatment of sarcoidosis with steroids, all of the followings are true, except : a- Hypercalcemia . b- Ocular sarcoidosis. c- CNS involvement. d- Stage I or II disease. e- Cardiac sarcoidosis. Q42: Cryptgenic fibrosing alveolitis, all of the followings are true, except: a- Twice as common among cigarette smokers than in nonsmokers. b- Bronchoalveolar lavage shows predominance of neutrophils. c- Clubbing is seen in 60% of cases. d- Query association with Epstien Barr virus infection. e- LDH is elevated in a minority of patients. Q43: In extrinsic allergic alveolitis and other lung diseases due to exposure to organic dusts, which one of the following associations is true? a- Byssinosis-penicillium cassie. b- Malt worker's lung –aspirgillus fumigatus. c- Maple bark stripper's lung-cryptostroma corticale. d- Cheese worker's lung –thromophilic actinomycetes. e- Bird fancier's lung –aspirgillus clavatus. Q44: In asbestosis, all of the followings are true, except: a- The commonest type of asbestos fibers produced world-wide is the white one (chrysotile). b- Exposure mainly occurs through mining and milling of the mineral. c- Greatly increases the risk of lung adenocarcinomas especially in smokers. 4- Greatly increases the risk of pleural mesotheliomas especially in smokers. 5- The overall risk of malignancy is higher in smokers than non-smokers. Q45: Pulmonary eosinophilia may be seen in all of the followings , except: a- Nitufurantoin. b- Mansonella steptocerca. c- Wuchereria Bancrofti. d- Phenylbutazon. e- Wegner's granulomatosis. Q46: In alveolar proteinosis, all of the followings are true, except: a- Spontaneous remission occurs up to 30 %. b- Fever and hemoptysis are common. c- The is a 5 % remission rate after whole lung lavage. d- Air bronchogram on chest x ray is a common finding. e- Diffuse bilateral shadowing mainly around the hili is the usual cheat x ray finding. Q47: Lymphangioleiomyomatosis, all of the followings are true, except: a- Usualy seen in females during their child bearing age. b- Chylous pleural effusions are common. 3- Recurrent pneumothoraces are seen. 4- Hormonal ablation therapy and progestins are highly effective in the treatment. 5- Hemoptysis is seen. Q48: Uncommon causes of pleural effusions, all of the followings are true, except: 1- Yellow nail syndrome. 2- Meig's syndrome. 3- Aacute rheumatic fever. 4- Subphrenic abscess. 5- Myxedema. Q49: Indication for tube drainage in Pneumothorax , all of the followings are true, except: a- Tension type. b- More than 2-5 liters of air aspirated. c- If you faced resistant during aspiration. d- Pneumothorx with underlying COPD. e- Any degree of dyspnea. Q50: Causes of elevation of a hemi diaphragm, all of the followings are true, except: a- Severe pleuritic pain. b- Subphrenic abscess. c- Pulmonary infarction. d- Eventration of the diaphragm. e- Intercostal nerve palsy. Q51: Common causes of solitary lung nodule include all of the followings, except: a- Single metastasis. b- Bronchial carcinoma. c- Wegner's granuloma. d- Tuberculoma. e- Lung abscess. End of Chapter II Written by Dr. Osama Amin All Rights Reserved. mrcpfrcp@gmail.com Chapter III / Gastro-Enterology Q1: In gut hormones, all of the followings are true, except: a- Gastrin is mainly secreted by the gastric antral G cells. b- Sectretin inhibits gastric acid secretion. c- Somatostatin stimulates insulin secretion. d- Motilin secretion is stimulated by dietary fat. e- Gastric inhibitory polypeptide is secreted from deuodenum and jujenum to inhibit gastric acid secretion and stimulate insulin secretion. Q2: Contrast radiology is commonly used in clinical gastroenterology, all of the followings are true, except: a- The main limitations of barium swallow are risk of aspiration and poor mucosal details. b- The main limitations of barium meal are the low sensitivity to detect early cancer and inability to assess H pylori status. c- The main limitations for barium follow through are being time consuming and greater risk of radiation exposure. d- The main limitations for barium enema are being difficult in elderly or those with incontinence and being some what uncomfortable. e- Barium enemas usually miss polyps less than 5 cm in size. Q3: In upper Gastrointestinal endoscope, all of the followings are contraindications, except: a- Severe shock. b- Recent myocardial infarction. c- Severe respiratory disease. d- Possible visceral perforation. e- Anemia. Q4: Complications of upper GIT endoscope, all of the followings are true, except: a- Aspiration pneumonia. b- Visceral perforation. c- GIT bleeding. d- Cardiopulmonary depression due to over sedation. e- Very minor risk of infective endocarditis. Q5: Dynamic tests are used in the diagnosis of many GIT diseases, all of the followings are true, except: a- Lactose hydrogen breath test is used for lactose intolerance and although being non invasive and accurate but it may provoke abdominal pain diarrhea in sufferers. b- 14C –triolein breath test is used for fat malabsorption, although being fast and non- invasive but is non quantitative. c- 75SeHCAT test is used in fat malabsorption and is accurate and specific but requires 2 visits and involves radiation. d- Pancreolauryl test is used as a test for pancreatic exocrine function and is accurate and avoids duodenal intubation but needs accurate collection of urine. e- 14C glycocholate breath test is a useful screening test for bacterial overgrowth. Q6: Radio-isotope tests are still used in clinical gastroenterology, all of the followings are true, except: a- 13C and 14C urea breath test is used in H pylori detection. b- 99mTc pertechnetate is used for the detection of Meckel's diverticulum. c- 99mTc HMPAO labeled leukocytes is used for the detection of visceral abscesses. d- 51Cr-albumin is used a test for epithelial permeability. e- 99Tc-sulphur is used a test for protein losing enteropathy. Q7: In Barrette's esophagus, all of the followings are true, except: a- Is a pre-malignant condition increases the risk of esophageal adenocarcinoma by 90-150 folds. b- Is always symptomatic with heartburn and regurgitation. c- It is due to long standing gastric acid reflux. d- The risk of malignancy is particularly very high when the metaplastic tissue is of intestinal with goblet cells origin. e- Long term acid suppression is not useful in reversing the histological abnormality. Q8: Complications of long standing gastro-esophageal reflux disease (GERD), all of the followings are true, except: a- Iron deficiency anemia. b- Benign stricture formation. c- Barrette's esophagus. d- Esophagitis. d- Esophageal squamous cell carcinoma. Q10: In Achalasia of the cardia, all of the followings are true, except: a- A similar picture may be seen in Chaga's disease. b- May result in esophageal squamous cell carcinoma even after treatment. c- Hear burn is prominent. d- Usually seen in middle age women, although no age is exempt. e- Treatment with botulinum toxin is effective, yet the effect is transient. Q11: Etiological factors in the development of esophageal carcinoma include all of the followings, except: a- Coeliac disease. b- Tylosis. c- Smoking and alcoholism. d- Chewing tobacco. e- Ulcerative colitis. Q12: Causes of acute gastritis includes all of the followings, except: a- Iron medications. b- Bile reflux following gastric surgery. c- CMV infection. d- Acute infection with H. pylori. e- Pernicious anemia. Q13: The following diseases are associated with H pylori infection, except: [...]... d- The overall 5 years survival is 1 0-1 5% e- All patients should be monitored for the future development or other features of MEN type I Q21: Predisposing factors to gastric cancer includes all of the followings, except: a- Previous partial gastrectomy b- Autoimmune gastritis c- Adenomatous gastric polyps d- Familial adenomatous polyposis e- Tylosis Q 22: In gastric cancer, all are true, except: a-... Commonly seen between 3 0-5 0 years of age c- 90% are due to gastrin secreting pancreatic tumors d- 5 0-7 0% are malignant e- 2 0-6 0 % of cases are part of MEN type II Q19: In Zollinger Ellison syndrome, all of the followings are true, except: a- Should be suspected whenever there is severe, multiple peptic ulceration b- Diarrhoea is common and may the presenting feature up to 30 % of cases c- Ulcer bleeding... infective diarrhea d- Tetracycline for 28 days will produce cure or long term remission and is the treatment of choice e- The disease is rare in Malaysia and Indonesia Q29: In Bacterial overgrowth syndrome, all of the followings are true, except: a- May be caused by pernicious anemia b- 14C-glycocholate breath test is a good screening test c- Serum B 12 and serum folates are low d- The treatment of choice... disease, except: a- Type II diabetes b- Splenic atrophy c- Hypothyroidism d- Primary biliary cirrhosis e- Inflammatory bowel disease Q28: In Tropical sprue, all of the followings are true, except: a- The disease occasionally occurs in epidemics and hence an infective etiology has been suggested b- Partial villous atrophy is much more common than total villous atrophy in small bowel biopsy c- The most important... true, except: a- Past history of peptic ulcer b- High dose or multiple NSAIDs c- Concomitant steroid therapy d- Age blow 50 years e- Treatment with azapropazone Q16: Side effects encountered during treatment with anti H pylori medications, all are true, except: a- Diarrhoa is uncommonly seen b- Metallic taste in the mouth is commonly seen with metronidazole c- Headache d- Skin rashes e- Abdominal cramps... restricted d- Minerals and vitamins may be given but in practice this is uncommon e- Poor compliance with dietary advices remains the commonest cause of treatment failure Q25: Complications of celiac disease, all of the followings are true, except: a- Ulcerative jejunitis b- Esophageal adenocarcinoma c- Small bowel T cell lymphoma d- Intensely itchy skin rash e- Small bowel carcinoma Q26: In diagnosis...a- Gastric ulcer b- Duodenal ulcer c- Gastric MALTOMA d- Gastric adenocarcinoma e- Gastro-esophageal reflux disease Q 14: Regarding methods to diagnose H pylori infection, all of the followings are true, except: a- H pylori serology although being rapid and useful for population studies but it can not differentiate between acute and past infections and lacks sensitivity and specificity b- Although... HLA –B8, DR17, DQ2 d- The earliest histological finding is an increase in the intra-epithelial lymphocyte e- The disease is seen world wide but is very rare in northern Europe Q 24 : In the treatment of celiac disease, all of the followings are true, except: a- Gluten free diet should be taken infinitely b- Dietary restriction of wheat, rye, barely and possibly oats should be encouraged c- Rice, maize and... true, except: a- Of all detected antibodies, IgA anti-endomysium antibodies have the highest sensitivity and specificity b- Small bowel biopsy is the gold standard c- Barium follow through will reveal non specific findings of dilated loops with coarse folds and contrast clumping d- Dimorphic blood picture may be seen e- Co-existent IgA deficiency will not affect the serological tests Q27: The followings... true, except: a- Cimetidin can cause confusion b- Omprazole can cause hypergastrenemia c- Sucralfate can enhance the effect of digoxin and warfarin d- Misopristol causes diarrhea up to 20 % of cases e- Colloidal bismuth blackens teeth, tongue and stool Q18: In Zollinger Ellison syndrome, all of the followings are true, except: a- Accounts for about 0.1 % of all cases of peptic ulceration b- Commonly seen . peptic ulceration. b- Commonly seen between 3 0-5 0 years of age. c- 90% are due to gastrin secreting pancreatic tumors. d- 5 0-7 0% are malignant. e- 2 0-6 0 % of cases are part of MEN type II. Q19:. a- Previous partial gastrectomy. b- Autoimmune gastritis. c- Adenomatous gastric polyps. d- Familial adenomatous polyposis. e- Tylosis. Q 22: In gastric cancer, all are true, except: a-. of the followings are true, except: 1- Yellow nail syndrome. 2- Meig's syndrome. 3- Aacute rheumatic fever. 4- Subphrenic abscess. 5- Myxedema. Q49: Indication for tube drainage in Pneumothorax