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1. A 45 year-old man presented with Cough & Haemoptysis for 3 days, with dark
urine & Sinusitis for 2 months . Urinalysis shows red cell casts and dysmorphic
red
cells.
A
biopsy
showed
Necrotising
Vasculitis.
Which of the following will confirm the suspected Diagnosis ?
ABCDE-
An elevated angiotensin converting enzyme (ACE)
Antiglomerular basement membrane antibodies (anti-GBM)
Antineutrophilic cytoplasmic antibodies (ANCA)
eosinophilia
X-bodies
ABCDE-
Diabetic Nephropathy
Paraprotienemia
Acute renal failure
Clear cell carcinoma
Iodine sensitivity
2.
3.
IVU is contraindicated in the following conditions except:
A 24 year old female complains of Rt. Flank pain, burning micturition fever
& chills for the last 24 hours. On examination: T: 38.9 C, HR: 109 RR: 20. BP:
90/50. with rt. costovertebral angle tenderness. Urinalysis will most likely be:
ABCD-
4.
Positive for nitrate & esterase
Positive for nitrate only
Positive for esterase only
Negative for both nitrate & esterase
A 26 year old male came to the ER complaining of severe Rt. Sided
flank
colicky pain, radiating to his scrotum with nausea vomiting & dark urine .
Diarrhea for 6 months & weight loss of 4.5 kg. Physical Examination was
unremarkable . KUB shows a 4 mm stone high in the Rt. ureter. Lab.
investigations : Calcium 9.8 mg/dl, serum creatinine
0.9 mg /dl . BUN 24
mg/dl .
Which of the following is the most likely cause of these symptoms:
ABCDE-
Calcium oxalate stones
Calcium phosphate stones
Uric acid stones
Cysteine stones
Struvite stones
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5.
A 30 year-old female previously well until last few weeks when she developed
generalised oedema , easy fatigability & loss of appetite, with stable vital signs
& low Serum albumin, HBsAg is positive with abnormal liver function
tests.Urinalysis : +4 protienurea & microscopic hematurea
The most probable diagnosis in this patient is:
ABCDE-
Membranoproliferative glomerulonephritis
Minimal change disease
Focal segmental glomerulosclerosis
Diffuse proliferative glomerulonephritis
Membranous glomerulonephritis
6. A 27 year- old male presents with periorbital swelling & dark urine for the
past 2 days. Was given dicloxacillin for skin infection 3 weeks ago. P/E was
unremarkable except for periorbital swelling &B.P 150/90 . His urine showed 10
RBC’s , RBC casts & mild protienurea. Low Serum C3 low. His BUN is 40
mg/dl & serum creatinine 2 mg/dl. Based on this . What is the most likely
diagnosis?
ABCDE-
7.
A 33 year-old presented with a 4 day history of lt. sided flank pain, nausea,
vomiting, fever & chills. His B.P: 100/60, T: 39C, his urine reveals many WBC’s
& positive nitrite & bacteria.His CBC 17000 WBCs.
You decide that the patient now needs:
ABCDE-
8.
Drug induced acute interstitial nephritis
Acute pyelonephritis
Post streptococcal glomerulonephritis
Membranoproliferative glomerulonephritis
IgA nephropathy
X-ray
CT
Ultrasound
Blood culture
IVP
A 34 year-old female smoker, previously well, complains of Headache &
Palpitation . P/Ex : B.P = 170/100, HR: 80/min & bilateral flank masses
Lab. Findings : Na+: 140, K+:4.4, BUN: 17mg/dl, Creatinine:1.1 mg/d
Urine analysis 12 RBC/HPF .
Which of the following is a feared complication in this patient?
ABCDE-
Liver cirrhosis
Intracranial aneurysms
Restrictive cardiomyopathy
Pancreatic cancer
Aortic dissection
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9.
A 64 year- old male with long standing hypertension , D.M. , IHD , gout ,
Hypercholesterolemia , & Peripheral Vascular disease, is scheduled for
hemodialysis due to end stage renal disease. His hemoglobin was 9 g/dl. despite
iron therapy, so Erythropoietin injections twice weekly were suggested.
Which of the following is likely to be seen with this new treatment?
ABCDE-
Worsening of his hypertension
Increase in insulin requirement
Increased infection susceptibility
Deterioration of kidney function
Flare up of gout
10. A 14 year-old boy presents with fever & nasal discharge of two days
with
malaise, fatigue, & myalgia. HR: 90/ min, RR 16/min, T: 38.8C. with
unremarkable physical examination. Urinalysis : protienurea +2
What is the most appropriate next step?
ABCDE-
Repeat urine analysis
24 hour collection for protein
Reassurance
Renal Ultrasound
Urea & creatinine
11. 57-year-old female is admitted to the ICU after being involved in a highway
motor vehicle accident. She had multiple fractures, skin loss & significant
external blood loss. She was found to be hypotensive at the scene and had
received 7 liters of fluids, including crystalloids, blood, and fresh frozen plasma.
After surgery, was transferred to the ICU and received continuous IV fluids &
vasopressors. Her lab results 24 hours later are :
Hb
WBC
Platelets
BUN
Serum Creatinine
9.5 g/dL
15,000/cmm
130,000/cmm
34 mg/dL
2.2 mg/dL
Which of the following is the most likely microscopic finding in urinalysis.
ABCDE-
Broad cast
Muddy brown cast
RBC casts
WBC casts
Fatty casts
F- Eosinophils
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12.
A 27 year-old white male previously well until the last 2 weeks when he came
with hemoptysis, breathing difficulty, ankle edema, and dark urine Lab
results are:
Hb
Serum Na
Serum K
BUN
Serum creatinine
10.5 g/dL
135 mEq/L
5.4 mEq/L
36 mg/dL
2.8 mg/dL
Urinalysis : numerous dysmorphic RBCs, moderate proteinuria& red cell
casts . Chest radiograph
showed
bilateral
alveolar
infiltrates.
What is your Diagnosis that requires emergency plasmapheresis?
ABCDE-
Goodpasture’s syndrome
Wegener’s granulomatosis
SLE-associated nephritis
Polyarteritis nodosa
Idiopathic rapidly progressive glomerulonephritis (RPGN)
13.
An 18 year-old girl who has been sexually active with the same partner for
the past 4 months., developed rash and arthralgia 3 days after starting Bactrim
for dysuria and urinary frequency. Family history is positive for Lupus . P/Ex =
T 38.5C HR: 90 b/min RR: 20/min, oliguria with disseminated maculopapular
rash and painful joints with limited range of motion without costovertebral
tenderness or flank pain. Serum creatinine is 2mg/dl. Urinalysis : RBCs, WBC
casts made mostly of eosinophils, and proteinuria .
What is the most likely diagnosis?
ABCDE-
Disseminated gonococcemia,
Post-infectious acute glomerulonephritis
Drug induced interstitial nephritis
Lupus nephritis
Pyelonephritis
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5
14.
A 15-year-old boy with a family history of renal disease, presents with
hematuria and lower abdominal pain , as his third episode in the past 2
years.His BP:145/90mmHg,HR:80/min,T:37.C RR: 14/min. Examination is
significant for mild sensorineural deafness bilaterally. Urinalysis : hematuria
and proteinuria. BUN is 50mg/dl & serum creatinine is 3.1mg/dl. Serum
complement levels are normal . Renal biopsy = foam cells and
immunofluorescence is negative for immunoglobulins and complement .
Electron microscopy reveals alternating areas of thinned and thickened
capillary loops with splitting of GBM .
What is the most likely diagnosis?
ABCDE-
Acute interstitial nephritis
Henoch-Schonlein purpura
Good pasture’s syndrome ephritis
Alport’s syndrome
Benign recurrent hematuria
15. A 65-year-old white woman presents with a two-month history of fatigue and
weight gain. Her past medical history is significant for rheumatoid arthritis and
hypertension. Her current medications include hydrochlorothiazide and
naproxen. She does not smoke or consume alcohol. Her blood pressure is 120/70
mmHg and heart rate is 80/min. Physical examination reveals generalized
edema. Liver is palpated 2 cm below the costal margin. Urinalysis shows
proteinuria 4+. Kidneys are slightly enlarged on ultrasonography. Renal biopsy
was performed.
What is the most probable finding in her renal biopsy specimen?
ABCDE-
16.
Crescent formation on light microscopy
Deposits revealed under polarized light
Immunofluorescence microscopy: Linear immunoglobulin deposits
immunofluorescence microscopy: Granular immunoglobulin deposits
Normal light microscopy findings
A 45-year-old male with advanced chronic renal failure presents with edema
of his feet. His vitals are as follows: HR: 78/min; RR: 15/min; Temperature
37C(99F); BP: 150/100mm Hg. Examination is unremarkable except for
bilateral ankle edema. Labs show: BUN of 62 mg/dl, serum creatinine 4.2
mg/dl, serum potassium 5.6 meq/l, serum sodium 146 meq/l, and total
plasma cholesterol of 260 mg/dl.
Which of the following is expected to improve his disease?
ABCDE-
Captopril
Simvastatin
Protein restriction
Salt restriction
Potassium restriction
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6
17.
A 47-year-old diabetic Caucasian female underwent combined pancreatic
and kidney transplantation secondary to end stage renal disease and diabetes.
She presented with a recent onset of tremor. On examination, she has gum
hypertrophy. She is on multiple medications including immunosuppressants.
Her vital signs are: BP 152/90 mmHg, PR 78/min, RR 16/min, and
temperature 36.1C (97F).
Lab results are:
Hb
WBC
Serum Na
Serum K
BUN
Serum Creatinine
13.0 g/dL
8,000/cmm
135 mEq/L
5.3 mEq/L
26 mg/dL
1.7 mg/dL
Which immunosuppressant is most likely responsible for her presentation?
ABCD-
18.
A 50 year-old male smoker & occasional alcoholic. Diabetic , with gout
&Ischemic Heart Disease on Atenolol & Glyburide . Has a family history of
D.M. & early M.I . He is stable but he came for a routine check up. Physical
examination is unremarkable. But You are concerned about end organ damage
due to diabetes mellitus.
What is the expected earliest renal abnormality in this patient?
ABCDE-
19.
Tacrolimus
Cyclosporine
Azathioprine
Mycophenolate
Nodular sclerosis
Glomerular basement membrane (GBM) thickening
Mesangial expansion
Immune deposits
Glomerular hyperfiltration
A 22-year-old male complains of Dark Urine for 2 days with FLU few days
earlier. P/Ex. is unremarkable except for B.P 145/90 & R.R.14/m Urinalysis :
Hematuria with RBC casts and mild proteinuria. BUN is 25mg/dL and serum
creatinine is 2.1 mg/dL. Complement level is normal.
Select the most likely diagnosis in this patient:
ABCDE-
Good pasture’s syndrome
IgA nephropathy
Thin basement membrane disease
Wegener’s granulomatosis
Henoch-Schonlein purpura
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20. A 12 year-old child complains of episodes of headache for the last two
months. Denies nausea, vomiting, chills or fevers. Says that each episode lasts 1
- 2 hours and has no fixed time of occurrence. On examination, the child is alert
and not distressed, but her diastolic pressure was very high with a soft to-andfro bruit heard at the right costovertebral angle.
What is the most likely cause of her hypertension?
ABCDE-
Coarctation
Renal artery atherosclerosis
Pheochromocytoma
Fibromuscular dysplasia
Conn’s syndrome
21. Stoke Adams attack is characterized by all , except:
A.
B.
C.
D.
Sudden fall to the ground.
Loss of consciouness.
Slow or absent pulse.
Rapid weak pulse.
22. The pain of myocardial ischaemia:
A.
B.
C.
D.
Is typically induced by exercise and relieved by rest.
Radiates to the neck and jaw but not teeth.
Rarely lasts longer than 10 seconds after rest.
Is easily distinguished from oesphageal pain.
23. The following pulse character is associated with:
A. Pulsus paradoxus with aortic regurgitation.
B. Collapsing pulse with severe anaemia.
C. Pulsus alternans with extrasystoles.
D. Slow rising pulse with mitral stenosis.
24. The following statement about jugular venous pressure is true:
A.
B.
C.
D.
The external jugular vein is a reliable guide to right atrial pressure.
The JVP is conventionally measured from the suprasternal notch.
The normal JVP does not rise on abdominal compression.
The normal JVP falls during inspiration.
25. In which of the following situations would digoxin be most useful?
A. Atrial fibrillation with fast ventricular response.
B. Congestive heart failure due to diastolic dysfunction.
C. Acute myocardial infarction.
D. Mitral stenosis with sinus rhythm.
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26. Angiotensin converting enzyme inhibitors are useful in all except:
A.
B.
C.
D.
Dilated cardiomyopathy.
Mitral stenosis.
Mitral regurgitation.
Aortic regurgitation.
27. High incidence of coronary artery disease is associated with all except:
A.
B.
C.
D.
Eleveted total cholesterol level.
Elevated low density lipoprotein levels.
Elevated high density lipoprotein levels.
Elevated triglyceride levels.
28. Cerebrovascular accident is least likely to occur as a result of:
A.
B.
C.
D.
Tricuspid valve endocarditis.
Anterior wall myocardial infarction.
Aortic dissection.
Mitral stenosis.
29. Common causes of aortic valve regurgitation include all except:
A. Aortic dissection.
B. Endocarditis.
C. Marphan’s syndrome.
D. Myocardial infarction.
30. The following indicates an absolute contraindication to thrombolytic
in acute ST segment elevation myocardial infarction:
A. A. 70 year old hypertensive male with acute chest pain and new diastolic
left lower sternum & ST elevation in lead II, III & aVF.
B. 40 year old lady with 7 missed periods and abdominal distension.
C. 34 year old diabetic male recently underwent LAZER retinal therapy.
D. A blood pressure of 180 over 100.
31. Complications of longstanding hypertension include all except:
A.
B.
C.
D.
Diastolic heart failure.
Coronary artery disease.
Cerebrovascular accident.
Peripheral vascular disease.
32. In treatment of myocardial infarction the following is true, except:
A. Aspirin per se reduces the mortality by 30%.
B. Thrombolysis reduces the overall mortality by 25 – 50 % .
C. Beta blockers greatly reduce the susceptibility to arrhythmias.
D. Intravenous nitroglycerine reduces the overall mortality.
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therapy
murmur in
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33. The following are contraindications to exercise ECG testing:
A. Uncontrolled hypertension.
B. Severe aortic stenosis.
C. Acute pericarditis.
D. Subjective feeling of weakness.
34. In acute pericarditis, the following is false:
A. The commonest type is the idiopathic.
B. The majority progress to tamponade.
C. Uraemic pericarditis may progress to tamponade.
D. The rub is usually transient.
35. in the treatment of heart failure we aim to achieve the following except:
A.
B.
C.
D.
Reduction of the afterload.
Augmentation of the cardiac contractility.
Controlling the heart rate.
Aggressive diuresis to remove all oedemas.
36. The heart rate is slowed by:
A. Nifedipine.
B. Atropine.
C. Propranolol.
D. Dobutamine.
37. Dopamine actions include the following, except:
A. increases cardiac output.
B. In high dose causes peripheral vasodilatation.
C. In small dose increases renal blood flow.
D. Increases ventricular exitability.
38 . Venous return to the heart is decreased by:
A. Exercise.
B. Paralysis of skeletal muscles.
C. Femoral arteriovenous fistula.
D. Rapid infusion of blood.
39. The serology of persons vaccinated for Hepatitis B will show .
A.
B.
C.
D.
E.
Anti hepatitis B core antibody.
Anti hepatitis B surface antibody .
Hepatitis B surface antigen .
Anti hepatitis B surface & core antibodies .
Anti hepatitis E antibody .
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40. Non bloody diarrhea is associated with which of the following .
ABCDE-
Shigella infection .
E coli serotype O 157:H7 infection .
Ulcerative Colitis .
Giardia Lamblia infection .
Colonic ischemia .
41. Which of the following is characteristic of Celiac disease .
ABCDE-
Prominent villi on D2 Bx .
High anti-gliadin antibody titers .
Ingestion of barley & oats improves diarrhea .
Increased risk of Lymphoma in 0.1 of patients .
Distal intestinal movement .
42. In a 45 year-old male patient with frequent bowel motion , mucus & few
streaks of blood of 2 months duration .
ABCDE-
Rx with Metronidazole even if stool is –tive for E.Histolitica trophozoit
Masalazine & Prednisone are the best combination .
Treat as Irritable Bowel Syndrome with Mebeverine.
Barium enema is better than colonoscopy for diagnosis .
Colonoscopy & wait for biopsy result .
43. AST/ALT ratio greater than 2 is characteristic of which .
ABCDE-
Chronic viral hepatitis .
Nonalcoholic steatohepatitis .
Alcoholic hepatitis .
Hemochromatosis.
Wilson’s disease .
44. Characteristic features of pseudobulbar palsy include all Except .
ABCDE-
45.
Wasting & fasciculation of the tongue .
Emotional lability .
Dysphagia .
Dysarthria .
Dysphonia .
Which one helps exclude Dx. of Seizure in sudden loss of consciousness.
ABCDE-
Short period of tonic clonic movement at time of falling .
An aura of a strange odour before falling .
Immediate return of normal mental function upon awakening.
Urinary incontinence .
Laceration of the tongue .
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46. Occlusion of distal posterior cerebral artery causes which of the following.
ABCDE-
47.
Cerebellar ataxia .
Contralateral hemiplegia .
Dysarthria .
Homonymous hemianopia .
Palatal palsy .
Which of the following is an unlikely Dx. in a 59 year-old female who
presented with multiple variable symptomatology & Fasciculations .
A- Motor neurone disease .
B- Cervical spondylosis .
C- Thyrotoxicosis .
D- Multiple sclerosis .
48. Which is true in Pseudotumor Cerebri (BenignIntracranial Hypertension).
A. Mildly increased CSF cell count is typical .
B.
C.
D.
E.
May be caused by prolonged steroid therapy .
Occasionally associated with focal neurological signs .
Frequently presents with ataxia .
Absence of suture separation distinguishes it from hydrocephalus
49. These patients presented with abnormal liver functions . match the history
with the appropriate diagnosis & disease marker .
Patient History
Diagnosis
Marker
1- 47 year-old man with known
chronic hepatitis B, came with
hepatomegaly & wt. loss
A. Wilson’s Disease
2- 58 year-old woman with recent
weight. loss & constipation
B. 1ry. biliary
cirrhosis
B- Anti smooth muscle
antibody
3- A 56 year-old woman with signs
of chronic liver disease & periorbital xanthelasma.
C- Hepatoma
C- Low serum copper
& caeruloplasmin
4- A 34 year-old man with diabetes
sun tan & jaundice
5- A 33 year-old woman with
chronic liver disease , jaundice
& cushingoid appearance
6- A 39 year-old man with gait
problems , tremors & KayserFleicher rings .
D- Ca colon with
metastasis.
D- Antimitochondrial
Antibody.
E- Haemochromatosis
F- Autoimmune
hepatitis
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A- High serum
ferritin
E- Alpha
faetoproteins
F- Markedly raised
carcino-embryonic
antigens
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ANSWERS :
50.
1-
4-
2-
5-
3-
6-
Neutropenia might be seen in all Except .
A. Viral infections .
B. Sulfonamide treatment .
C. Severe sepsis .
D. Polyarteritis nodosa .
51. All are true for vitamine B 12 Except .
A.
B.
C.
D.
Body stores are adequate for years .
Are lipid bound .
Its deficiency causes falls at night time .
Affects thymidine & DNA synthesis .
52. All are risk factores for systemic arterial thrombo-embolism Except .
A. Protein S & protein C deficiency .
B. Hyperlipidemia .
C. Diabetes mellitus .
D. Atrial fibrillation .
53. All are possible causes for fasting hypoglycemia Except .
ABCD-
Exogenous insulin with high C peptide .
Insulinoma with high C peptide .
Addison’s disease .
Pituitary insufficiency .
54. A 40 year-old female was previously well until last year, throughout which
recurrent episodes of Raynauds phenomenon were encountered, heartburn
due to a barium swallow & meal proved sliding hernia . Sought medical advice
for polarthralgias & skin pigmentation . Haplotyping was known as A1 B8
DR3 .
All might be true Except .
A.
B.
C.
D.
Positive antibodies to single stranded RNA is characteristic .
Anti DNA antibodies are positive .
Normal C3 , C4 & CH50 .
Overall 5-year survival is about 70% .
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55. In hyponatremia with urine (Na >20 mmol/L & Osmolality>500mosmolKg)
plasma osmolality < 250 mosmol/ kg . The most likely cause :
ABCD-
Severe Hypothyroidism .
Glucocorticoid insufficiency .
Syndrome of inappropriate antidiuretic hormone .
Villous adenoma of the rectum .
56. In a 70 year-old non smoker ICU male patient with these ABG’s on room air
PH: 7.25 PaO2 : 85 mm hg . PaCO2 : 25 mm hg . HCO3 : 15 mmol
The most likely cause of this acid-base disorder is
ABCD-
Diabetic ketoacidosis .
Flail chest .
Status asthmaticus .
Pulmonary embolism .
57. All are true for Cheyne-Stokes breathing Except .
ABCD-
Denotes prolonged Lung to Brain circulation time .
More suggestive of a cardiovascular than a pulmonary disease .
Might be seen in a supramedullary brain dysfunction .
Always denotes a pulmonary disease .
58. Kussmaul’s breathing might be seen in all Except .
ABCD-
In normal persons with physical exertion .
In diabetic ketoacidosis .
In uremia .
Always in metabolic alkalosis & alkalemia .
59. In Hypokalemia all are true Except .
A.
B.
C.
D.
Is invariably seen in acute metabolic acidosis & academia .
Occurs In mechanically over ventilated COPD severe exacerbations .
In patients with metabolic alkalemia , acetazolamide might help.
Continuous infusion of up to 5 meq/h to the total required dose is safe.
60. A 60 year-old male was admitted to the ICU for worsening COPD , after initial
improvement on conventional treatment , showed a sudden deterioration with
the following ABG’s on 2 l of O2 :
PH: 7.20 SaO2: 80% PaCO2: 55 mm HCO3: 21 meq Base excess: -8meq
All are true for his ABGs status Except .
A.
B.
C.
D.
Respiratory acidosis & acidemia .
Combined respiratory & metabolic acidosis & academia .
Multiple pulmonary emboli might be the cause of his deterioration .
Giving HCO3 is not recommended if Mech. Ventilation is planned .
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61. In ARDS all are true except .
A- Use of steroids is controversial .
B- Lung compliance & functional residual capacity are increased .
C- PEEP of 10 cm H2O might improve PaO2 .
D- There is a wide spread alveolar collapse .
62. All are true for Extrinsic Allergic Alveolitis Except .
ABCD-
It is characteristically an Ig E mediated allergic lung reaction.
Commonly cause a restrictive lung disorder .
Might be caused by thermophillic actinomycetes .
Best treated by steroids .
63. Calcification in a solitary lung nodule usually denotes a benign natureExcept.
ABCD-
Popcorn pattern .
Eccentric pattern.
Laminated or ring shaped pattern .
Central or diffuse .
64. All are true for 1ry malignant lung tumors in smokers Except .
ABCD-
Never cavitate .
Majority not calcified .
Majority affect central rather than distal airways .
Unlikely to double its size on CXR in less than a month .
65. In pleural effusion all are true except .
ABCD-
Lowest glucose content is in bacterial & rheumatoid causes .
Chylous effusions are common in lymphomas , T.B. or chest trauma.
Contains a high level of complements in SLE .
Positive smears for AFB are seen in less than 30% of T.B. effusions .
66. Pulmonary angiography is justified & diagnostic in all Except .
ABCD-
Pulmonary A-V malformations .
Lung sequestration .
Pulmonary embolism .
All cases of haemorrhagic pleural effusions .
67. All are true for extra thoracic manifestations of sarcoidosis Except .
ABCD-
Lupus pernio is the commonest granulomatous skin lesion .
Granulomatous uveitis & conjunctivitis are seen in 10% of the cases .
Parotid gland involvement is not uncommonly seen.
Erythema nodosum is the commonest granulomatous skin lesion .
68. All are true for pulmonary embolism Except .
ABCD-
Absence of moderate to severe hypoxemia doesn’’t rule it out .
Abnormal perfusion scan spares the need for a ventilation scan.
Abrupt rise of pulmonary artery pressure > 50 mm is usually fatal .
Thrombolytic Rx. Should only be reserved to hemodynamic instability .
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69. All are true for corticosteroid resistant asthma Except .
ABCD-
90% have a normal or high number of glucocorticoid receptors .
Cushingoid side effects are seen in all .
Morning Cortisol level could be suppressed in the majority .
High T-Lymphocytes counts in their airways .
70. A 30 year-old female with refractory hypertension , poluria , polydipsia,
weakness & cramps , not on diuretics found to have Hypokalemia .
All are true Except .
ABCD-
Conn’s syndrome is the most likely diagnosis .
Mostly has hypernatremia & metabolic alkalosis .
Has high aldosterone & low rennin .
Has high 24 hour-urine catecholamines .
71. All are true for Cushing’s syndrome Except .
A- There is a chronic glucocorticoid excess .
B- There is a chronic mineralocorticoid excess .
C- Commonest cause is excessive exogenous steroid intake .
D- Rarely caused by cushing’ s disease .
72. A 25 year-old infertile female with H/O headaches & recurrent deudenal
ulcers with recurrent bone fractures .
All the following might be true Except .
ABCD-
MRI of brain is highly indicated .
High resolution computorised tomography of abdomen is indicated too .
Most likely Dx. is MEN ( multiple endocrine neoplasia ) .
Mostly has low serum calcium & low parathyroid hormone .
73. All are true for acute lymphoblastic leukemia Except .
ABCD-
Very common childhood cancer .
Best cure rate is among children .
Worst prognosis is among old males with Philadelphia chromosome .
Originates from T cell lymphocytes only .
74. All are true for Anaphylactoid reaction Except .
ABCD-
Is an IgE mediated hypersensitivity reaction .
Mediated by direct release of mediators without an immunoglobulin role.
Usually caused by drugs as acetyl cysteine.
Best Rx. By Adrenaline .
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75. A 50 year-old male heavy smoker with long standing backache & dry cough
presented with a pathological fracture . His CXR showed bilateral interstitial
infiltrates not resolving on antibiotics . CBC: Neutropenia & anemia . High
creatinine & BUN with hypercalcemia . A lung biopsy showed Amyloidosis .
All the following steps are diagnostically relevant Except .
ABCD-
Serum Immunoglobulin electrophoresis .
Urine immunoglobuline electrphoresis .
Bone marrow biopsy .
Parathyroid hormone assay .
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