Q30: Renal artery stenosis, all of the followings are true, except: a- The commonest cause is atheromatous narrowing. b- Should suspected when the blood pressure is severe or of rapid onset or difficult to control. c- Fibromuscular dysplasia as a cause is commoner in the young age groups. d- Fibromuscular dysplasia usually does not cause complete occlusion and usually stabilizes once the patient stops growing. e- Surgical treatment is superior to medical treatment or angioplasty. Q31: In Alport's syndrome, all of the followings are true, except: a- The second commonest inherited cause of renal disease. b- Usually autosomal recessive. c- Bilateral anterior lenticonus is the usual eye manifestation. d- Sensory neural deafness, usually to high tones first. e- The pathological hallmark is progressive degeneration of the glomerular basement membrane Q32: In adult polycystic kidney disease, all of the followings are true, except: a- 85% of cases are due to mutations in PKD1 gene on chromosome 16. b- Mitral and or aortic regurgitations are frequent but rarely severe. c- 30% have an associated hepatic cysts but disturbances in hepatic function is very rare. d- 90% will develop subarachnoid hemorrhage. e- Colonic diverticulae and abdominal wall hernias are well recognized associations. Q33: In adult poly cystic kidney disease, all of the followings are true, except: a- The mean age for those who are heterozygous for PKD1 mutation to start dialysis is 57 years. b- 50% of patients will never need chronic dialysis. c- To screen a patient's relative, renal ultrasound as a screening method is less reliable in the 10-18 years age group. d- Urinary tract Infections should be treated aggressively. e- All patients will develop hypertension. Q34: In medullary sponge kidney, all of the followings are true, except: a- It is sporadic, not genetic. b- Has a characteristic picture on intravenous urography. c- The cysts are confined to the proximal tubules. d- The prognosis is generally good. e- Nephrocalcinosis may be seen on the KUB film. Q35: Fanconi's Syndrome (renal tubular acidosis type II, proximal), all of the followings are true, except: a- Glycosuria is present with normal blood sugar. b- Aminoaciduria does not result in malnutrition. c- May be caused by Wilson's disease. d- Hypercalciuria is profound. e- Very large amounts of bicarbonate are need in the treatment. Q36: In Type I distal renal tubular acidosis, all of the followings are true, except: a- May cause osteomalacia in adults and rickets in children. b- Nephrocalcinosis is seen. c- Hypokalemia is present with normal anion gap metabolic acidosis. d- Incomplete forms are never seen. e- Ability to form very acidic urine in the context of systemic acidosis is the hallmark of the disease. Q37: Causes of hypocomplementemia in inflammatory nephritides include all of the followings, except: a- Infective endocarditis. b- Systemic lupus erythematosus. c- Shunt nephritis. d- Post-infectious glomerulonephritides. e- Microscopic polyangiitis. Q39: Causes of rapidly progressive glomerulonephritis (RPGN), all of the followings are true, except: a- Systemic lupus erythematosus. b- Aggressive phase of certain inflammatory nephritides like IgA nephropathy. c- Goodpasture's syndrome. d- Post-infectious glomerulonephritis. e- Membranous nephropathy. Q40: In Goodpasture's syndrome, all of the followings are true, except: a- It is an autoimmune disease against alpha 1 chain of type III collagen. b- Linear IgG deposition in the glomerular basement membrane is seen on immuno- flourescence staining of a renal biopsy specimen. c- Plasma pharesis may be used in the treatment. d- Lung hemorrhage is more common in smokers. e- Usually produces rapidly progressive crescentic glomerulonephritis. Q41: In Renal biopsy with immunoflourescence staining looking for immune deposits, all of the followings are true findings of the suggested disease, except: a- Minimal change disease – no immune deposits. b- Focal segmental glomerulosclerosis-nonspecific trapping in focal scars. c- Membranous nephropathy –granular subendothelial IgG deposits. d- IgA nephropathy – mesangial IgA deposition. e- Type II membranoproliferative glomerulonephritis – intramembranous dense deposits. Q42: IgA nephropathy, the followings indicate a bad prognosis, except: a- Male gender. b- Presence of hypertension. c- Absence of hematuria. d- Presence of renal impairment. e- Persistent proteinuria. Q43: Chronic interstitial nephritis may be caused by all of the followings, except: a- Chronic exposure to ochratoxin. b- Chronic exposure to aristolochic acid. c- Wilson's disease. d- Hanta virus infection. e- Chronic ingestion of phenacetin. Q44: In acute interstitial nephritis, all of the followings are true, except: a- The commonest cause is drug induced. b- Blood eosinophila is seen only in 30 % of cases. c- Should be suspected in any non-oliguric acute renal failure. d- The predominant infiltration of the tubulo-interstitial areas with eosinophils on renal biopsy is more suggestive of a viral etiology. e- The majority of drug induced acute interstitial nephritides will recover following drug withdrawal. Q45: Recurrent urinary tract infection (UTI) is common in adult females. The followings are prophylactic measures adopted by females against recurrent UTI, except: a- A fluid intake of at least 2 liters per day. b- Regular emptying of the urinary bladder. c- Local application of an antiseptic like cetrimide cream to the periurethral area before intercourse. d- Urinary bladder emptying before and after intercourse. d- Double micturition will worsen reflux nephropathy. Q46: Indications for intervention in renal calculi: a- If the patient is anuric. b- The presence of an infection upstream. c- A large stone that is unlikely to pass. d- Total obstruction of the pelvi-ureteric junction. e- The presence of a radiolucent stone. Q47: Risk factors for renal stone formation all are true except 1- hypercalciuria 2- hyperoxaluria 3- hypercitraturia 4- hyperuricosuria 5 cystinuria Q48: In renal cell carcinoma, all of the followings are true, except: a- Hematuria is the commonest symptom. b- 30% of cases present due to systemic metabolic effect of the tumor like fever, hypertension and abnormal liver function tests. c- Raised ESR is seen in 50% of cases while amyloidosis is seen in only 2% of cases. d- During surgical removal, the adrenal gland and local lymph nodes should be removed as well. e- Radiotherapy is very effective in the treatment. Q49: In Renal cell carcinoma, all of the followings are true, except: 1- More common in males. 2- Adenocarcinoma is the commonest type. 3- The tumor is vascular and spread to the lungs and bones. 4- The tumor may be multicentric and or bilateral in some patients like Von Hippel Lindau. 5- The tumor may enlarge upon administration of progestins. Q50: In Drug and toxin induced renal disease, the following associations are true, except: a- NSAIDS and minimal change nephropathy. b- Cyclosporin and chronic interstitial nephritis. c- Lithium and nephrogenic diabetes insipidus. d- Cisplatin and renal loss of sodium. e- Acyclovir and crystal formation inside tubules. Q51: In Glomerulopathies, all of the followings are true, except: a- Minimal change disease is associated with HLD DR7, atopy, and certain medications. b- Membranous nephropathy is associated with HLA DR3, certain medications, and heavy metal poisoning. c- Association with liver disease has been documented in IgA nephropathy. d- Membrano-proliferative glomerulonephritis type I is associated with C3 nephritic factor and partial lipodystrophy. e- Focal segmental glomerulosclerosis is associated with obesity, HIV infection, and heroin abuse. End of Chapter V Written By Dr. Osama Amin mrcpfrcp@gmail.com All Rights Reserved Chapter VI/ Electrolyte and Acid-Base Disturbances Q1: Regarding body water, all of the followings are true, except: a- In a healthy 65 Kg male, it is about 40 liters in amount. b- 70 % of total body water is intracellular. c- 70 % of extra cellular water is in the interstitium. d- Water moves between different body compartments by an active process. e- Whole body extra cellular water is about 12 liters. Q2: All of the following statements are true, except: a- The tonicity of plasma and interstitial fluids is determined by the concentration of sodium and chloride. b- The tonicity of intracellular fluid is determined by the concentration of potassium, magnesium, phosphate and sulphate. c- The amount of hydrogen ion in the extra cellular fluid is tiny (about 40nmol/liter). d- Much of the extra cellular hydrogen ions can be buffered by anionic proteins like albumin and hemoglobin. e- The difference in the ionic composition of cells and interstitial fluid is important for the normal cell function. Q3: Factors increasing potassium excretion in urine, all of the followings are true, except: a- Avid sodium re-absorption. b- High urinary flow rate. c- Excess poorly absorbed anions, like ketones and phosphates. d- A rise in intra tubular potassium e.g. alkalosis. e- A fall in intracellular potassium e.g. acidosis. Q4: In the proximal convoluted tubules of the nephron, all of the followings are true, except: a- 90% of the filtered sodium is reabsorbed. b- 80-90% of the filtered potassium is reabsorbed. c- 90% of the filtered bicarbonate is reabsorbed. d- 99% of the filtered glucose is reabsorbed. e- 99% of the filtered amino acids are reabsorbed. Q5: Regulation of water excretion by the kidney, all of the followings are true, except: a- In the presence of ADH, the collecting duct becomes more permeable to water. b- In the absence of ADH, the distal nephron is almost impermeable to water. c- About 95% of the filtered water is reabsorbed with an equivalent amount of sodium in the proximal tubule. d- ADH binds to V2 receptors in the distal nephron to enhance the passive movement of water. e- In the thick ascending limb of loop of Henle, sodium and chloride are preferably absorbed without water and hence called the diluting segment. Q6: Drugs which cause sodium retention, all of the followings are true, except: a- Corticosteroids. b- Liquorice. c- Carbenoxolone. d- Estrogens. e- Ethacrynic acid. Q7: Causes of diuretic resistance, all of the followings are true, except: a- Profound hypoproteinemia. b- Volume contraction. c- Reduced renal function. d- Secondary aldosteronism. e- When given in low doses. Q8: Etiology of hyponatraemia associated with LOW extra cellular fluid volume, all of the followings are true, except: a- Salt losing renal disease. b- Adrenal failure. c- Liver cirrhosis. d- Extensive burns. e- Cardiac failure. Q10: Causes of SIADH (syndrome of inappropriate secretion of ADH), all of the followings are true, except: 1- Morphine. 2- Cigarette smoking. 3- Alcohol. 4- Amitryptilin. 5- Clofibrate. Q11: The following lab findings are consistent with SIADH (syndrome of inappropriate secretion of ADH), except: a- Plasma osmolality of 260 mosm / Kg. b- Serum sodium of 115 mmol / L. c- Urine osmolality of 100 mosm / Kg. d- Blood urea of 2.5 mmo l/ L. e- Plasma potassium 3.5 mmol / L. Q12: Drug induced hyperkalemnia, all of the followings are true, except: a- Digoxin toxicity. b- Cyclosporin. c- Heparin. d- Beta agonists. e- ACE inhibitors. Q13: The followings are true regarding the treatment of hyperkalemia, except: a- Bicarbonate infusion reduces serum potassium by 1-1.5 meq / L. b- Glucose and insulin infusion policy reduces serum potassium by 0.6-1.2 meq / L. c- Calcium gluconate infusion does not reduce serum potassium. d- Calcium resonium is not used in acute hyperkalemia treatment. e- Beta agonists' infusion may be additive or alternative to glucose and insulin policy. Q14: Complications of severe hypophosphatemia, all of the followings are true, except: a- Increased serum CPK enzyme. b- Respiratory muscle weakness. c- Intra-vascular hemolysis. d- Hypocalciuria. e- Cardiac dysrrhythmias. Q15: Causes of hypophosphatemia, all of the followings are true, except: a- Chronic alcoholism. b- Alcohol withdrawal. c- Peritoneal dialysis. d- Hemodialysis. e- Extra cellular fluid contraction. Q16: Causes of hypomagnesaemia, all of the followings are true, except: a- Gitelman's syndrome. b- Post-obstructive diuresis. c- Acute pancreatitis. d- Protracted vomiting. e- Treatment with spironolactone. Q17: Causes of normal anion gap metabolic acidosis, all of the followings are true, except: a- Treatment of glaucoma. b- After radical surgery of urinary bladder cancer. c- Ingestion of arginin hydrochloride. d- Renal tubular acidosis type IV. e- Advanced diabetic ketoacidosis (DKA). Q18: Causes of high anion gap metabolic acidosis with their corresponding accumulating compounds, all of the followings statements are true, except: a- Methanol poisoning- accumulation of formic acid. b- Lactic acidosis- accumulation of lactic acid. c- Ketoacidosis- accumulation of acetoacetic acid and beta hydroxybutyrate. d- Ethylene glycol poisoning – accumulation of formic acid. e- Chronic renal failure – accumulation of phosphoric acid and sulphuric acid. Q19: Causes of lactic acidosis type A, all of the followings are true, except: a- Septic shock. b- Severe anemia. c- Metformin. d- Cyanide poisoning. e- Respiratory failure. Q20: Causes of respiratory alkalosis, all of the followings are true, except: a- Assisted ventilation. b- Salisylate poisoning. c- Hysterical over breathing. d- Lobar pneumonia. e- Protracted vomiting. END of Chapter VI Written By Dr. Osama Amin mrcpfrcp@gmail.com All Rights Reserved Chapter VII / Endocrinology Q1: When we are trying to investigate the endocrine system for a disease, the followings are true, except: a- The release of many hormones is pulsatile, so a random blood sample is usually useless. 2- Many endocrine glands have what is called incidentalomas. 3- Many endocrine tumors are difficult to classify as being malignant or benign during histopathological examination. 4- If you suspect a hormonal excess then choose a suppression test. 5- Endocrinal abnormalities are rarely characterized by loss of normal regulation of hormonal secretion. Q2: When dealing with a pituitary tumor, the followings are true, except: a- Is a very rare a cause of hydrocephalus. b- May be an incidental finding on brain MRI done for another reason. c- Rarely, there is a downward extension, and hence may be seen as a nasal polyp. d- May produce a hypothalamic syndrome by an upward extension. e- Pituitary apoplexy is usually asymptomatic. Q3: Surgical treatment is usually considered to be a first line treatment for the following pituitary / hypothalamic tumors, except: a- Non-functioning pituitary macro adenoma. b- Craniopharyngioma. c- Cushing's disease. d- micro-prolactinoma. e- Acromegally. Q4: Causes of Hyperprolactinemia, all of the followings are true, except: a- Stress. b- Primary hypothyroidism. c- Chronic renal failure. d- Chronic chest wall stimulation. e- Treatment with pergolide. Q5: Treatment of prolactinomas, all of the followings are true, except: a- Treatment with dopamine agonists, is almost always effective in normalizing prolactine level and restoration of gonadal function. b- After menopause, treatment of microprolactinomas is only indicated if there was a trouble some galactorrhea, otherwise can be left untreated. c- Trans-sphnenoidal surgery has a success rate approaching 80%. d- Macroprolactninomas may enlarge rapidly during pregnancy and hence bromocyptin should be continued despite pregnancy with close follow up during the whole pregnancy. e- External irradiation is a useful first line treatment in the majority of patients Q6: Acromegaly, all of the followings are true, except: a- Although glucose intolerance is seen in 25% of cases, yet overt diabetes mellitus is seen only in 10% of cases. b- There is a 2-3 folds increase in the relative risk of colonic cancer and coronary artery disease. c- Trans-sphenoidal surgery as a treatment option has a high success rate. d- A dopamine agonist may be used in those with co-existent hyperprolactinemia because it is generally less effective than octreotide. e- External irradiation has a good rapid action against the tumor. Q7: A random blood sample for growth hormone (GH) assessment in a suspected deficiency state is useless because it is commonly undetectable , so there are several " tricks " to collect a blood sample for GH assessment, all of the following tricks are true, except: a- Sampling before exercise. b- Frequent sampling during sleep. c- Sampling 1 hour after going asleep. d- Sampling during an insulin induced hypoglycemia. e- Sampling after stimulation with arginine. Q8: ACTH stimulation test, all of the followings are true, except: a- Used in the diagnosis of primary and secondary adrenal insufficiency. b- The 250 microgram tetracosactrin injection should be given in the early morning. c- Relies upon ACTH dependent adrenal atrophy in secondary adrenal failure. d- Normally, after 30 minutes the blood cortisol should be above 550 nmol/ L. e- Usually useless in adrenal failure secondary to acute ACTH deficiency. Q10: Panhypopituitarism , all of the followings are true, except: a- There is a striking pallor. b- Growth hormone is usually the earliest hormone to be lost. c- Coma is multi-factorial and may be due to water intoxication, hypoglycemia, or hypothermia. d- The skin is smooth with a baby like texture. e- Serum TSH should be measured to assess the optimal T4 replacement dose. Q11: Insulin tolerance test, all of the followings are true, except: a- Used in the assessment of hypothalamic pituitary adrenal axis. b- Contraindicated in ischemic heart disease and epilepsy. c- The aim of the test is to produce signs of hypoglycemia with a glucose level below 2.2 mmol / L. d- We should take serial blood samples of glucose, GH, and cortisol. e- The usual dose used in the test is NPH insulin 0.15 u/kg given subcutaneously. Q12: Water deprivation test for a suspected diabetes insipidus, all of the followings are true, except: a -It is used in the diagnosis of diabetes insipidus (DI) and to differentiate between cranial and nephrogenic DI. b- There should be no coffee, tea, or smoking on the test day. c- The test should be stopped if the patient loses 3% of his body weight. d- When trying to differentiate DI from compulsive water drinking, DDAVP is very useful and should always be used. e- If the initial urinary osmilality is 700 mosm / kg the test should be stopped and DI is excluded. [...]... T3:T4 ratio e- The TSH is suppressed Q18: Post-partum thyroiditis, all of the followings are true, except: a- Occurs in 5-1 0% of women in the first 6 months following delivery b- Thyroid biopsy shows lymphocytic thyroiditis c- It tends to recur after subsequent pregnancies d- There is an association between post partum depression and post partum thyoriditis e- There is a negligible radio-iodine thyroid... hypothyroidism, all of the followings are true, except: a- Frank psychosis b- Myotonia c- Ascites d- Ileus e- Iron deficiency anemia Q22: Biochemical findings that are useful in the assessment of hypothyroidism, all of the followings are true, except: a- Raised serum LDH and CPK enzymes b- Raised cholesterol and triglycerides c- Macrocytic anemia d- Low serum T3 level e- Raised TSH Q23: During treatment and follow... true, except: a- Cushing's disease b- Kallaman's syndrome c- Prader Willi syndrome d- Hypothalamic tumors e- Gastric tumors Q28: Thyroid carcinomas, all of the followings are true, except: a- Each type usually has a certain age group to affect b- Papillary carcinoma is the commonest type c- Some tumors are TSH dependent d- Follicular carcinoma can be diagnosed easily by FNA cytology e- Very rarely thyrotoxicosis... normal d- Usually responds well to treatment with non steroidal anti inflammatory drugs e- The hyperthyroidism per se is usually mild and no treatment is needed for it Q17: Factitious hyperthyrosidism , all of the followings are true, except: a- It is an uncommon condition due to self administration of T4 b- The radio-iodine uptake scan is suppressed c- Undetectable serum thyroglobulin d- High T3:T4 ratio... except: a- Oral T4 is the cornerstone of treatment b- The correct dose of thyroxin is that which restores the serum TSH to normal c- The patient usually feels better after 2-3 weeks d- Restoration of skin and hair texture is usually seen after 3 weeks e- Elderly patients should be started on a low dose thyroxin with gradual escalation Q 24: Myxoedema coma, all of the followings are true, except: a- Unfortunately... carbimazole, then it should be given intravenously e- After 1 0- 14 days of treatments with various antithyroid measures, sodium iopodate and propraanolol can be stopped Q20: The causes of goitrous hypothyroidism, all of the followings are true, except: a- Hashimoto thyroiditis b- Dyshormonogenesis c- Drug induced hypothyroidism d- Iodine deficiency e- Post-ablative hypothyroidism Q21: Rare, but well recognized... c- Forced diuresis may be used d- Like primary hyperparathyroidism, glucocorticoids are very effective ar reducing the serum calcium level e- In resistent cases, there is a place for hemodialysis Q 34: Long term Hypocalcemia , all are true except a- May be seen in peudopseudohypoparathyroidism b- May be a cause of cataract c- Basal ganglia calcification is seen d- Papilloedema has been documented e-... true, except: a- It is important to ensure compliance and the drug should be taken infinitely b- Once the dose of thyroxin is stabilized based on serum TSH, the TSH and T4 should be measure every 1-2 years c- During a visit, the combination of raised serum T4 and high TSH indicates a strict compliance d- Some patients may take thyroxin erratically when they know that the half life is long e- Excessive... surgery c- Radio-iodine is contraindicated in pregnancy d- Following subtotal thyroidectomy, up to 50% will develop permanent hypocalcaemia e- Following treatment with radio-iodine, up to 80% will develop permanent hypothyroidism after 15 years Q16: Subacute thyroiditis, all of the followings are true, except: a- Usually virally induced b- There is anterior neck pain worsened by coughing c- The ESR... all of the followings are true, except: a- Primary hyperparathyroidism b- Tertiary hyperparathyroidism c- Lithum-induced hyperparathyroidism d- Familial hypocalciuric hypercalcemia e- Metastatic bone malignancy Q33: Treatment of malignancy associated hypercalcemia, all of the followings are true, except: a- IV fluids have a very important role in the treatment b-In the presence of very high calcium levels, . self administration of T4. b- The radio-iodine uptake scan is suppressed. c- Undetectable serum thyroglobulin. d- High T3:T4 ratio. e- The TSH is suppressed. Q18: Post-partum thyroiditis, all. hypothalamic tumors, except: a- Non-functioning pituitary macro adenoma. b- Craniopharyngioma. c- Cushing's disease. d- micro-prolactinoma. e- Acromegally. Q4: Causes of Hyperprolactinemia,. are true except 1- hypercalciuria 2- hyperoxaluria 3- hypercitraturia 4- hyperuricosuria 5 cystinuria Q48: In renal cell carcinoma, all of the followings are true, except: a- Hematuria is the