Neurology 4 mrcp questions book - part 3 ppsx

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. [...]... following methods, except: a- Freezing point depression b- Vapor pressure technique c- Using a refractormeter d- Using a hydrometer e- Calorimetric reagent strips Q22: In microalbuminuria, all of the followings are true, except: a- Is defined as proteinuria between 3 0 -3 00 mg / day b- Is defined as proteinuria between 2 0-2 00 microgram / minute c- It is always protein dipstick negative d- Important in the follow... followings are true, except: a- All cases of porphyria b- Inter-vertebral dics calcification with dark ears 3- A Parkinsonian patient 4- Pulmonary TB patient  5- Massive crushing trauma patient Q 14: Proteinuria, are of the following statements are true, except: a- Standard sticks usually miss Bence John's protein b- In myoloma, it is due to protein overflow rather than renal amyloidosis c- The majority of the... kidneys c- Atypical childhood nephrotic syndromes d- Isolated hematuria with normal looking RBCs e- Nephrotic syndrome in adults Q12: Contraindications to renal biopsy, all of the followings are true, except: a- Severe hemophilia b- Platelets count of 10000 /mm3 c- Uncontrolled hypertension d- Renal size less than 90% predicted e- Biopsy from a single kidney is a relative contraindication Q 13: Causes... mellitus e- Persistent proteinuria has been associated with the development of atherosclerorsis Q 23: Daily excretion of urinary protein, all of the followings are true, except: a- Up to 150 mg / day is normal b- 30 0-5 00 mg / day will be dipstick test positive c- More than 3. 5 g / day is called nephrotic range proteinuria d- More than 2.5 g / day, a glomerular source is more likely than a tubular source e-... mucoprotein d- Defined as albumin / creatinine (A/C) ratio on a random urine sample of less than 4. 5 in females and less than 3. 5 in males e- Positive dipstick for protein may occur in fever per se Q15: Acute renal failure, all of the followings are wrong, except: a- Pre-renal causes are uncommon b- 85% of intrinsic renal causes of acute renal failure are due to acute tubular necrosis c- Under-perfusion... per se b- intravenous fluid overload and pulmonary edema c- ARDS picture d- Chest infection e- Hyperkalemia Q18: Anemia in the setting of acute renal failure is very common and usually multi-factorial, all of the followings are true causes, except: a- Hemolysis b- Excessive bleeding c- Profound suppression of erythropoiesis d- Drug induced e- Hyperphophatemia Q19: General urine examination (GUE) is... source e- Between 0. 5-2 g / day usually indicates a glomerular source Q 24: In diagnosing a pre-renal failure, all of the followings when present are highly suggestive, except one: a- History of excessive upper GIT bleeding b- A bland urinary sediment c- A progressive rise in blood urea and creatinin in a congestive heart failure patient d- Urine osmolality more than 500 mosm / Kg e- Fractional sodium... sodium excretion more than 4 Q25: In chronic renal failure, all of the followings are true, except: a- The commonest causes world wide are hypertension and diabetes mellitus b- The presence of rea frost is a useful early sign c- Itching is multi factorial rather than due to hyperphosphatemia alone d- Hypotension and dehydration may be seen e- In clinical practice, about 4- 18 % of cases are of unknown... except: a- Nephrotoxic medications b- Renal artery stenosis c- Hypotension due to drug therapy d- Any infection per se e- Normal blood pressure Q26: Endocrinal abnormalities are common in chronic renal failure, all of the following statements are true, except: a- Hyperprolactinemia may be seen but unfortunately many cases don’t respond to bromocryptine b- The half life of insulin is greatly shortened c- Amenorrhoea... the bladder and ureters b- It is usually done blindly c- Much more difficult and hazardous in a non-obstructed kidney d- Usually used in cases of glomerulonephritis e- Poorly outlines the collecting system Q8: Micturition cystourethrogram , all of the following statements are wrong, except: a- Is not used in the diagnosis and assessment of severity of vesicicoureteric reflux b- It is usually used in . 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. Q 24: Autoimmnue. 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 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