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Internal Medicine 1-34

1-Check the false answer.


Plasma Glucose levels are regulated by
A) Central nervous system
B) Peripheral parasympathetic nervous
systems
C) Incretins
D) Cytokines
E) Peripheral sympatheticsystems.
2- One of the factors listed below do not
contrbute to hyperglycernia in Type 2
Diabetes Mellitus
A) Reduced insulin secretion
B) Insulin insensitivity
C) Decreased glucose utilization
D) Increased glucose production
E) Increased Incretins
3- Check the false statement
The destructionof the pancreatic beta
cells causes Type I A DM by combination
of some factors except one listed below,
A) Genetic background
B) Infectious agents
C) Acute or chronic pancreatitis
D) Immunologc factors
E) Environmental
4- One of the following statements is not
correct for gestational diabetes mellitus
A) Any degree of glucose intolerance
with onset or first recognition during
pregnancy is defined as gestational
diabetes,
B) Glucose tolerance is worse during the
first trimestr because of the stres of
anorexia and hyperemesis gravidarum
C) Best glucose tolerance must be
achived during gestational diabetes to
prevent stillbirths
D) To detect gestational diabetes , fasting
plasma glucose levels must be
determined in the first clinical
examination
E) At least 10-15 % of the gestational
diabetic women develop T 2 DM in 10
years or so
5- Chronic Complications of Diabetes
mellitus classified as vascular and

nonvascular complications. Which one


of the listed below pathologyis not a
vascular complication of diabetes
A) Retinal microaneurisms
B) Rubeosis iridis
C) Distal symetric Neuropathy
D) End stage renal disease
E) Accelarated Atherosclerosis
6- Check the false statement
A) Any mode of therapy does not
prevent the progression of
complications when hyperglycemia
was started at any point
B) Chronic hyperglycemia is the main
responsible factor for Diabetic
Microvascular Disease
C) The Duration of hyperglycemia is
strongly correlated with the extend
and progression of Diabetic
Microvascular Disease
D) Magnitude of hyperglycemia
correlated with the rate of
progression of Diabetic
Microvascular Disease
E) Chronic complications are cause of
motality and mobidity of diabetes
7- Diabetic nephropathy can be
characterized by following 4
appropriate statements. Check the
inappropriate statement
A) Clinical microalbuminuria
B) Microalbuminuria slowly
progresses to frank proteinuria
C) Clinical microalbuminuria when
started, progression to frank
proteinuria can not be prevented
by any measures
D) D Gradual decline in GFR ,
eventually leads to renal failure
E) Diabetic nephropathy is a leading
cause of End Stage Renal Disease
(ESRD) in western societies

8. Check the wrong statement Goals of


Diabetic treatment are
a)
b)
c)
d)
e)
f)

HbA1c < 7.5%


Fasting and pre-prandial capilary PG
( 70-120 mg/dL )
2-h post-prondial <140 mg/dL
Blood pressure < 130 /80 mmHg
TG < 150 mg/dL

9. Check the wrong answer Diabetic


ketoacidosis defined by
a)
b)
c)
d)
e)
f)

Serum osmolalitiy < 320m Osm/kg


Blood glucose > 250 mg dL
PH < 7.35
HCO3 < 25 mg Eq/L
S osm < 320m Osm/kg
S osm < 320m Osm/kg

10. Which one of the following is not a


precipitating factor for Hyperglycemic
hyperosmolar syndrome
a)
b)
c)
d)
e)

Acute pulmonary embolism


Excessive use of sulfonyureas
Surgery
Excessive use of glucocorticoids
Acute cerebrovascular

11. Check the false statement


a) Hypoglycemia defined as Low Plasma
glucose level
b) PG > 70 mg/dl after an overnight fast
is normal
c) PG 54-70 mg/ dl suggest
hypoglycemia
d) PG < 54mg/ dl indicate postabsorptive
hypoglycemia
e) When the person has neurogenic
sympoms suggesting
hypoglycemiaglucose containing
solutions must be given immediately
to prevent the detrimental effects of
hypoglycemia
12.So many conditions may be responsible
from vitamin D deficiency except
a) Older people
b) B-Obese people
c) Wearing traditional outfits to prevent
sun exposure
d) Winter Seasons
e) Living in tropical or subtropical
13.Check the statement: Normal aging
causes bone loss and fractures because of
a) Vitamin D activitiy decreases with less
exposure to sunlight
b) Fat mass decrease, causes swaying
c) Dietary calcium intake decreases
d) Calcium absorption decreases
e) Decreased weight bearing exercise

14. Which one of the following function is


not related to parathormon
a) Stimulate 1.25OH vitamin production
in the kidney
b) Stimulate Ca reabsorption from the
kidney
c) Inhibite phosphate reabsorption from
the kidney
d) Inactivate calcium transport in the
intestine
e) Stimulate osteoclastic bone resortion
15.Which of the following best explains the
conversion of testosterone to
dihydrotestosterone?
a)
b)
c)
d)
e)

Neural control
Chronotropic control
Metabolic control
Feedback control
Inhibitary control

16.Radioactive iodine uptake (RAIU) is


increased in all of the following except:
a)
b)
c)
d)
e)

Iodine deficiency
Graves disease
Postpartum transient thyrotoxicosis
Toxic multinodular goiter
TSH-secreting

17.Which of the following is not involved in


thyroid hormone biosynthesis ?
a) Active iodine transport
b) Iodination of thyrosyl residues in
thyroglobulin
c) Coupling of iodothyrosyl residues in
thyroyte
d) Proteolysis ofv thyroglobulin
e) Intrathyroidal deiodination

18.All the following are features of


lipoprotein lipase deficiency except:
a)
b)
c)
d)
e)

Xanthomas
Acute pancreatitis
Hepatos plenomegaly
Low levels of plasma chylomicrons
Autosomal recessive inheritance

19. Which effect of leptin is involved in the


regulation of body weight?

a) Leptin suppression of a melanocytestimulating hormone


b) Leptin suppression of neuropeptide Y
c) Leptin suppression of cocaine- and
amphetamine related transcript
d) Meal-induced rises in circulating leptin
levels
e) Rise of leptin levels during fasting and
dieting
20. Which of the following is used as definite
test for diagnosing hypercortisolism?
a)
b)
c)
d)
e)

ACTH stimulation test


Dexamethasone suppression test
Metyrapone test
CRH stimulation test
Insulin tolerance test

21. Which of the following is used to check


the mineralocorticoid reserve of a patient?
a)
b)
c)
d)
e)

Sympathetic stimulation
Cortisone suppression test
Tilt test
Atrial natriuretic peptide level
Upright posture

22. The end product of dopamin metabolis


is...
a)
b)
c)
d)
e)

3- methoxytiramin
Vanylil- mandelic acid (VMA)
Chromogranin A
Homovanyllic acid
Thyrosine

23. A 55 year-old patient with paroxysmsof


hypertensive attacks attend to the clinic .
After 5 minutes rest, his blood pressure is
measured as 180/110mm-Hg.Which of the
following should not be in the agenda as a
diagnostic tool for further evaluation of this
patient?
a)
b)
c)
d)
e)

Glucagon test
Clonidine test
Phentolamin test
Plasma metanephrine measurements
Urinary free catecholamine
measurements

24. Choose the correct statement for


primary hyperaldosteronism.
a) Increased whole body potassium
content
b) Hypokalemic metabolic alkalosis

c) Hypersentivity to ADH actions


d) Extracellular volme contraction
e) Massive edema
25. A 23 year old male patient admitted to
the out patient clinic with neck pain fever,
and palpitation .He had a history of upper
respiratory tract infection 10 days ago. On
examination body temperature was 39 C,
heart rate 110 beats/minand he had pain on
examination of the thyroid gland. His
sedimenentation rate was 100mm/hr. Which
one of the following would you prefer for the
patient?
a)
b)
c)
d)
e)

Asetilsalisilic acid + Propranolol


Propranolol + Propylthiouracil
Indometacin + Propranolol
Metimasole + Indometacin
Indometacin + Propylthiouracil

26.In which of the following do we find a


decreased Radioactive iodine uptake?
a)
b)
c)
d)
e)

Tokic adenoma
Toxic multinodular Goiter
Graves Disease
TSOma
Amiodarone

27. Which of the following is the correct


answer?
a) Adrenel insufficiency, thyroiditis , and
celiac disease can be seen in
autoimmune polylandular
endocrinopathy type III
b) Caisitonin levels are elevated
anaplastic thyroid carsinoma
c) Graves disease is an autoimmune
disease
d) Thyroid gland vascularity is decreased
in amiodarone induced type I
thyroiditis
e) Even if the patient is asyptomatic the
treatment of goite is always surgery
28- Which of the following is incorrect?
A) IGF-1 is secreted from the liver
B) Hypercalciurea is seen in
agromegalic patients
C) Cortisol isnt supressed after a 1
mg dexamethazone supression test
in Cushings Disease
D) Surgery is the main treatment in
prolactin secreting adenomas

E) Cold intolerance weight gain and


constipation is seen in TSH oma
patients
29- Which of the following is correct?
A) Inferior rectus and medial rectus
muscles are the effected mostly in
Graves Orbitopathy and the patient
can not look down and medially
B) RAI therapy is the first choice in
Graves disease
C) Hypokalemin and hyponatremia
are seen in Addisons disease
D) Hyperpigmentation is always seen
in adrenal failure
E) Surgery is the first line therapy in
Acromegaly
30- Which of the following is not a finding of
myxedema?
A)
B)
C)
D)
E)

Serum T3 and T4 low


Increased creatinin kinase level
Normacytic anemia
Hypernatremia
Hypoglycemia

31- In which of the following can we see


Cushing Syndrome?
A)
B)
C)
D)
E)

Papillary thyroid carsinoma


Medullary thyroid carsinoma
Anaplastic thyroid carsinoma
Follikuler thyroid carsinoma
Thyroid lymphoma

32- Which of the following is wrong?


A) Prolactinoma is the most
commonly seen pituitary adenoma
B) Microadenoma is usually seen in
acromegaly
C) Apoplexy is a life threatening
disorder
D) Ectopie ACTH producing
adenomas are ACTH dependant
causes of Cushings Syndrome
E) TSOmas are rarely seen
33- Which of the following is not seen in
adrenal insuffiency?
A) Hypotension

B)
C)
D)
E)

Hypocalcamia
Eosinophilia
Lymphocytosis
Anemia

34- Which of the following is correct?


A) Macroprolactinoma can be diagnosed
by using polyethylen glycol
precipitation
B) Macroprolactinemia must always be
treated
C) Macroprolactinomas are always
treated surgically
D) Prolactinoma may cause primary
osteoporosis
E) Oral contraceptives containing
estrogen may cause
hyperprolactinemia

Patology 35-44
35- Which of the following thyroid diseases
is most likely to show hurthle cell
transformation?
A)
B)
C)
D)
E)

Toxic nodular goiter


Hashimoto thyroiditis
Thyroid papillary carcinoma
Reidel thyroiditis
Subacute granulomatous thyroiditis

36- A 44 year old woman has noted


enlargement of her anterior neck region
over the past 6 months. On physical
examination, a nodul found in the left lobe
of the thyroid gland.She is taken to surgery
and a thyroidectomy is periomed. Thyroid
sections showed a malignant neoplasm
composed of polygonal cells in nests.
Immunostaining for calcitonin of the
sections is positive, and the neoplasm has an
amyloid stroma with Congo red
staining.Which of the following neoplasms is
the most likely to have?
A) Papillarycarcinoma
B) Follcular carcinoma
C) Modullary carcinoma
D) Anaplastic carcinoma
E) Metastatic carcinoma
37- Which of the following feature is
characterstic for thyroid follicular
carcinoma?

A)
B)
C)
D)
E)

Nuclear pleomorphism
Necrosis
Pseudoinclusion
Capsular invasion
Mitosis

38- Which of the following feature is not


characteristic for parathyroid adenoma?
A) All glands are affected
B) Atrophy or compression of
parathyroid parenchyma
C) Solitary mass
D) Encapsulation
E) Fatless module
39- Which of the following genetic
alterations is most likely to cause papillary
carcinoma of the thyroid?
A) PAX8-PPARG gene arrangement
B) BRAF point mutation
C) Ras point mutation
D) Myc mutation
E) C-KT mutation
40- Which of the following complication of
diabetes mellitus is not related to polyol
pathway?
A) Osmotic cell injury
B) Retinal microaneurysms
C) Myocardial infarction
D) Cataracts
E) Neuropathy
41- Which of the following is not correct for
pancreatic endocrine neoplasms?
A) They show evidence of endocrine
cell differentiation
B) They have a propensity to
elaborate pancreatic hormones
C) Lymph node metastasis is a
criterion of malignancy
D) Most tumors are composed of
delta cell type
E) The diagnosis of the cell type is
possible by immunohistochemical
staining

42- Which of the following is not a cause of


hyperprolactinemia?
A) Injury to the hypothalamus
B) Pregnancy

C) Renal failure
D) Dopamine receptor agonists
E) Pituitary adenoma
43- Which of the following features is the
most reliable indicator of malignancy
for an adrenocortical neoplasm?
A) Nuclear pleomorphism
B) Size of tumor
C) Increased mitosis
D) Invasion of the adjacent tissue
E) Necrosis
44- Which of the following diseases is not
cause of a chronic type adrenal
insufficiency?
A) Disseminated Mycobacterium
tuberculosis
B) Hemochromatosis
C) Systemic amyloidosis
D) Autoimmune adrenalitis
E) Waterhouse-Friderichien syndrome

Pediatrics 45-56
45- Mark the incorrect answer
A) Hypothalamus consist of a group of
nuclei present in the floor of fourth
ventriele
B) Endocrine system controls
numerous body processes such as
growth metabolism e.g.
C) In humans , neurosecretory cells are
found in the hypothalamus
D) Hypothalamic hormones can have
effect of stimulating or inhibiting
the release of anterior pituitary
hormones
E) Oxytocin and Vasopressin are
manifactured in the hypothalamus,
but released in the posterior
pituitary.

46- Mark the incorrect answer


A) Anterior pituitary gland makes up
20% of the pituitary gland
B) Hypopituitarm results from failure
of the anterior pituitary gland to
produce one or more of its
hormones
C) Acquired causes of
hypopituitarism are tumors,
neurosurgery and radiotherapy
D) Some of the clinical
manifestations of hypopituitarsm
at neonatal period are breech
presentation, hypoglycemia,
micropenis, undercended testes,
midline defects
E) Prolactinomas are rare in
childhood
47- Which one is incorrect for Diabetes
Insipidus?
A) Decreased amount or action of
vasopressin
B) Volume of urine = 1L / m2/ day in
children
C) Polyuria ,nocturia, polydipsia
D) Decreased urine osmolality(< 300 m
Osmol/kg)
E) Increased plasma osmolality,
hypernatremia
48- Which one is incorrect for risk factors of
obesity?
A) Birth weight
B) Early infant feeding
C) Race/ ethnicity
D) Parental obesity
E) Increased physical activity
49- Which one is the first sign of pubertal
development in boys?
A) Appearance of pubic hair
B) Acne
C) Testicular enlargement
D) Voice change
E) Penile enlargement
50-Which age is the border of precocious
puberty for girls and boys?
A) Girls 8 years of age,boys 9 years of
age
B) Girls 9 years of age,boys 10 years of
age
C) Girls 10 years of age,boys 11 years of
age

D) Girls 7 years of age,boys 8 years of


age
E) Girls 11 years of age,boys 12 years of
age
51-Mark the incorrect answer for sexual
differentiation
A) Genetic sex is determined at
fertilization
B) Gonadal sex is determined by
genetic sex
C) Presence of SRY gene is important
for gonadal differentiation into testes
D) Mullerian inhibiting factor
(MIF,AMH) is secreted by Leydig
cells, causes regression of Mullerian
ducts (ipsilateraly)
E) If testes, DHT, and androgen receptor
present: differentiation into male
external genitalia completed by 16
weeks.
52- Seven days old baby with increased
pigmentation, enlarged clitoris , gonads
nonpalpabl, uterus presence at USG and 17
OH Progesterone, is very high. What is your
probable diagnosis?
A) 46, XX, 21 OH deficiency
B) 46, XY, gonadal disgenesis
C) 46, XY, Inborn errors of testosterone
biosynthesis
D) 46, XY, AIS
E) 46, XY, 17 OH deficiency
53- Which one is correct for labarotary
findings of 21 OH deficiency
A) ACTH, 17 OH Progesterone, serum
Na, K are high
B) ACTH, 17 OH Pregesterone, serum K
are high, serum Na is low
C) ACTH, 17 OH Progesterone, serum
Na are high, serum K is low
D) ACTH is low, 17 OH Progesterone,
serum Na, K are high
E) ACTH and 17 OH Progesterone are
high, serum Na and K are low
54- Mark the incorrect answer for Diabetes
Mellitus
A) Early sign and symptoms of Diabetes
Mellitus are polydipsia, polyuria,
lethargy weakness and weight loss
B) Fasting glucose target for diabetes
management is 90-130 mg/dl

C) Hb A 1c reflects the average blood


glucose during the previous 4-6
months
D) Symptoms of diabetes + casual plasma
glucose concentration 200 mg/dl
E) Symptoms of diabetes + fasting
plasma glucose concentration 126
mg/dl
55- Mark the incorrect answer for bone
health
A) The skeleton is essential to protection
of the body organs and to movement
B) The skeleton is a reserve source of the
minerals such as calcium, phosphate
C) The diaphysis consist of trabecular
bone
D) Bone mass is composed of organic
matrix (osteoid) , minerals and
different cells
E) The accumulation and maintenance of
the substance of bone is the result of a
continuous process of formation,
predominantly mediated by osteoblast,
and resorption, facilitated by
osteoblast
56- Mark the incorrect answer for
osteoporosis
A) Osteoporosis is defined by WHO as a
systemic skeletal disorder
characterised by low bone mass and
micro- architectural deterioraton of
bone fragility and susceptibility to
fracture precursor of osteoporosis
B) There is now increasing evidence that
the roots of osteoporosis lie in
childhood
C) Osteogenesis imperfecta is a primary
osteoporosis desease
D) Hyperthyroidism is a risk factor for
osteoporosis

Pharmacology 57- 64
57- A glucocorticoid exhibiting equal antiinflammatory and salt- retaining activities
is:
A) Prednisolone
B) Cortisol

C) Flurocortisone
D) Dexamethasone
E) Deoxycorticosterone
58- A type 2 diabetic patient is under
metformin treatment for sometime. Which
of the following unwanted effects would
likely be occur:
A) Hypoglycemia
B) Persistent diarrhea
C) Heart failure
D) Weight gain
E) Fluid retention
59- All of the following are physiological
actions of insulin,except
A) Increased triglyceride synthesis in
adipocytes
B) Decreased hormone dependent lipase
activity in adipocytes
C) Decreased ketone synthesis in liver
D) Increased glycogenolysis in liver
E) Decreased gluconeogenesis in liver
60- Concerning antithyroid drugs , all of the
below statements are true except:
A) Propranolol inhibits conversion of T 4
to reserve T 3
B) Thiocyanide blocks active transport of
iodine
C) Thionamides block hormone synthesis
D) Iodides block hormone release
E) Propylthiouracil inhibits peripheral
deiodination of T 4
61- Which of the following is released from
hypothalamus:
A) Endorphin
B) Prolactin
C) Somatostatin
D) Luteinizing hormone
E) Growth hormone
62- In a patient underbiphosphanate
treatment all of the following unwanted
efects may occur, except:
A) Musculoskeletal pain
B) Nephrolithiasis
C) Peptic ulcer
D) Hypocalcemia
E) Esophagitis
63- Select the wrong pair for hormone
primary target organ matches:
A) Growth hormone-liver

B) Insulin- Skeletal muscle


C) FSH Leiding cells
D) Parathormone jejunum
E) Aldosterone renal tubule
64. Administration of which of the following
agents would significantly affevt the blood
levels of orally-administered glucocorticoids
( e.g.cortisol) ?
a)
b)
c)
d)
e)

Insulin
Furosemude
Phenobarbital
Aleminum hydroxide
Alendronate

Radiology
65.Select correct phrases :
I.
II.
III.
IV.
V.

Adenomas are the most common


tumors of the adrenal glands .
The size and fat content of the adrenal
tumors are the major criteria for
differential diagnosis.
Computed tomography is capable to
identify macroscopic fat of the adrenal
tumors.
Magnetic resonance imaging can
identify intracellular fat of the tumors.
Intracellular fat is commonly seen in
adrenal adenomas.
A) I,II
IV

B) I-III
D) I-V

C) IE) II-V

Nuclear Medicine
66. Which of the following
radiopharmaceuticals is used for dual-phase
parathyroid scintigraphy?
a) Tc99m - M1B1
b) In111 - Octreotide
c) 1 - 131
d) 1 - 123
e) Tc99m - (V) DMSA

General Surgery
67.which of the statements given below
regarding thyroid surgery is not correct?
a) Goiter is chronic enlargement of the
thyroid gland not due to neoplasm

b) Goiter is not a definition associated


with the functional status of thyroid
gland . The patient with a goiter can be
either toxic (hyperthyroid) or non toxic
( hypo or euthyroid )
c) The term thyroid nodule refers to any
abnormal growth of thyroid cells into a
lump within the thyroid
d) Most of the thyroid nodules are
malignant and should be removed
surgically
e) Fine needle aspiration cytology
(FNAC) is a useful tool for evaluating
thyroid nodules.