5- 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. 2- 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 Chapter 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 14 th -16 th 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. Chapter 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. 5- 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. 4- 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 Q19: 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 End of the "Questions Book" Please see answers in the "Answers Book" . 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. multiforme. 2- Eczema herpeticum. 3- Steven Johnson syndrome. 4- Prophyria cutanea tarda. 5- Toxic epidermal necrolysis. Q 34: Eryhtroderma can be caused by all of the followings, except: 1- Psoriasis. 2-. 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-