Neurology 4 mrcp questions book - part 5 potx

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. [...]... true, except: 1- post splenectomy states 2- post hemorrhage states 3- post surgical states 4- post partum states 5- polycythemia rubra vera Q22: Myelodysplastic syndromes, all of the followings are true, except: 1- Seen increasingly in old people but no age is exempted 2- cytopenias are very common and dysplastic changes in the bone marrow are seen 3- Up to 40 % will progress to AML 4- 5q minus syndrome... 2- The paraprotein remains stable over many months of period of observation 3- No bone disease 4- No renal disease 5- Hypogammaglobulinemia Q20: Causes of secondary polycythemia, all of the followings are true, except: 1- Adaptation to high altitude 2- Pickwikian syndrome 3- Hemoglobin M disease 4- Primary hepatocelluar carcinoma 5- Polycythemia rubra vera Q21: Causes... NSAIDS 5- Treatment with glucocorticoids Q28: Bad prognostic sings in multiple myeloma at the time of diagnosis, all of the followings are true, except: 1- Severe hypoalbuminemia 2- Plasma cell leukemia 3- Low serum Beta 2 microglobulin level 4- Intractable renal failure 5- Hemoglobin less than 7 g/ dl Q29: Multiple myeloma, all of the followings are true, except: 1- High fluid intake is an important part. .. characteristic 2- It is a rare indolent B-cell lymphoproliferative disorder 3- The malignant B-cells characteristically carry CD 25 and CD103 4- The response to Cladribin is excellent with long term remission is the rule in many cases 5- Lymph node enlargement is very common Q31: Myelodysplastic syndrome (MDS), all of the followings are true, except: 1- The treatment is still unsatisfactory 2- Chromosomal... gall stones are seen up to 50 % of cases 3- Recurrent severe crisis is an indication for splenectomy 4- 75 % of cases are from fresh new mutations 5- Coomb’s test is negative Q 34: G6PD deficiency, all of the followings are true, except: 1- The prematurely released reticulocytes may have normal level of the enzyme 2- Bite cells and blister cells are seen in peripheral blood film 3- Hienz bodies are seen... bank 2- Commence IV saline infusion and measure urine input /output 3- Inform the hospital transfusion department immediately 4- Treat any DIC 5- Ensure urine out put of at least 10 ml / minute Q40: Indication for a thrombophilia screen, all of the followings are true, except: 1- Venous thrombosis in an old patient following hip surgery 2- Venous thrombosis at an unusual site like portal vein 3- Combined... seen mainly in woman 5- The commonest type is refractory anemia Q23: Antiphosopholipid syndrome, all of the followings are true, except: 1- The aPTT is prolonged and does not correct with addition of normal plasma 2- Addison’s disease can be a complication 3- Thrombocytopenia and immune hemolytic anemia 4- Chorea, migraine and transverse myelopathy 5- There is a bleeding diathesis Q 24: Von Willibrand... stain 4- May present as a neonatal jaundice 5- The African type of deficiency is very severe Q 35: Magaloblastic anemias, all of the followings are true, except: 1- The blood film cannot differentiate between vitamin B12 and folic acid deficiencies 2- Neurological manifestations are in favor of vitamin B12 than folic acid deficiencies 3- Serum folate is less useful than red cell folate level 4- The... severe hyperkalemia 5- The response to hematinic replacement is seen even within minutes Q36: Features in favor of hemolysis, all of the followings are true, except: 1- Raised serum LDH 2- Indirect hyperbilirubinemia 3- Reticulocytosis 4- Hemoglobinemia 5- Negative urinary hemosiderin Q37: Assessing iron status in iron deficiency anemia (IDA), all of the followings are true, except: 1- Ferritin is raised... illness 3- 2/3rd of cases will respond to steroid therapy 4- The bone marrow has a limited role in the diagnosis 5- In adults the disease is usually preceded by an upper respiratory tract infection Q27: Causes of renal impairment in multiple myeloma, all of the followings are true, except: 1- Hyperuricemic nephropathy 2- Hypercalcemia and dehydration 3- Amyloidosis and light chain deposition 4- Severe . 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) Q 14: AML M3 subtype, all of the followings are true, except: 1- The presence of t( 15, 17) confers. 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. 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-