I n t e r n a L medicine questions Bank

Drug therapy can only be started after tissue biospy

Dramatic response to steroids

19. 
    All of the following are true about vasculitis, except:
    
    1. 
       PAN is associated with hypertension
       
    2. 
       Wegner granulomatosis is associated with +ve C-ANCA
       
    3. 
       Hypersensitivity vasculitis mainly presents with large vessel involvement of the aortic arch vessls in females younger than 40 years of age.
       
    4. 
       Giant cell arteritis affects mainly people above the age of 50
       
    5. 
       Churg-strus disease occurs in people with history of atopy
       
       
       
20. 
    Which of the following associations is true?
    
    1. 
       Hepatitis a with PAN
       
    2. 
       RF and Riter’s syndroe
       
    3. 
       Giant cell arteritis and blindness
       
    4. 
       RA and addison’s disease
       
    5. 
       TB and reactive arthritis
       

19. 
    Which of the following is true about septic arthritis?
    
    1. 
       Hematogenous spread is the most common route of infection
       
    2. 
       Joint involvement is typically episodic recurrent polyarticular
       
    3. 
       Almost always occur in normal joints
       
    4. 
       Presence of urate crystals exclude its diagnosis
       
    5. 
       Gram negative bacteria is the leading cause
       
       
       
20. 
    Which statement about rheumatoid arthritis is not correct?
    
    1. 
       The commonest cause of anemia seen in pts with the diseas is due to hemolysis?
       
    2. 
       Synovitis characerisically involves Metarasophalangeal joints
       
    3. 
       RF is of an IGM type
       
    4. 
       Joint effusions occur in the first several months
       
    5. 
       Felty’s disease is more common in seropositive patients Answer: A (Anemia of chronic disease)
       
       
       
21. 
    Which antibody is rather specific for diffuse scleroderma?
    
    1. 
       Anticentromere AB
       
    2. 
       Anti-myeloperoidase AB (p-ANCA)
       
    3. 
       Anti-Jol AB
       
    4. 
       Antimitochondrial AB
       
    5. 
       Anti-Scl70
       

common in the diffuse form (30-40%) and in African-American patients (who are more susceptible to the systemic form).[19]

In 1980 the American College of Rheumatology agreed upon diagnostic criteria for scleroderma.[20]

Answer: E [Diagnosis is by clinical suspicion, presence of autoantibodies (specifically anti- centromere and anti-scl70/anti-topoisomerase antibodies) and occasionally by biopsy. Of the antibodies, 90% have a detectable anti-nuclear antibody. Anti-centromere antibody is more common in the limited form (80-90%) than in the diffuse form (10%), and anti-scl70 is more

19. 
    All of the following statement about gout are true, except:
    
    1. 
       In adult men the solubility of monosodium urate is 7 mg/dL
       
    2. 
       Women of child-bearing age have lower serum uric acid
       
    3. 
       Initial treatment of acuteattack should include NSAIDs, colchicine, and allopurinol
       
    4. 
       Diuretics should elevate serum uric acid
       
    5. 
       Attacks can be precipitated by acute MI.
       

Answer: C (allopurinol and colchicine never in acute treatment)

19. 
    One of the following is correct about aldosterone?
    
    1. 
       Increased Na and K reabsorption in the renal collecting duct
       
    2. 
       Causes increase synthesis of Na/K pumps in the principal cells of the renal collecting duct
       
    3. 
       Is released from the adrenal cortex in response to decreased plasma K
       
    4. 
       Promotes H secretion from the principle cells of the normal collecting duct
       
    5. 
       ?
       

19. 
    Acute interstitial nephritis might present with any of the following, except:
    
    1. 
       Fever
       
    2. 
       Rash
       
    3. 
       Renal impairment
       
    4. 
       Hypertension
       
    5. 
       Low grade proteinuria
       

19. 
    All of the following may cause renal papillary necrosis, except:
    

a. DM b. Analgesic abuse c. Sickle cell anemia d. pyelonephirits
e. hypertension
Answer E: Any condition that involves ischemia can lead to renal papillary necrosis. The four most significant causes are sickle cell disease or trait, analgesic use, diabetes mellitus, and severe pyelonephritis.[2]
A mnemonic for the causes of renal papillary necrosis is POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, chronic liver disease, analgesia/alcohol abuse, renal transplant rejection, diabetes mellitus, and systemic vasculitis. Often, a patient with renal papillary necrosis will have numerous conditions acting synergistically to bring about the disease. [3][4]

19. 
    A 40-year-old female presented to clinic because his blood pressure was 160/100. All the following are appropriate first line investigations, except:
    

1. 
   K+ level
   
2. 
   Urine analysis
   
3. 
   Renal US
   
4. 
   MRI suprarenals
   
5. 
   Creatinien level
   

19. 
    A 20-year-old male presented to you with generalized weakness. Labs showed:
    
    1. 
       DIarrhea
       
    2. 
       Spironolactone
       
    3. 
       Recovery from DKA
       
    4. 
       Thiazide diurectic
       
    5. 
       Amiloride
       

Ans: D (Thiazide diuretic cause metabolic alkalosis)

19. 
    All of the following are true about pre-renal acute renal failure, except:
    
    1. 
       FeNa<1%
       
    2. 
       BUN/CR ratio is elevated
       
    3. 
       Mostly irreversilbe
       
    4. 
       Most common cause of ARF
       
    5. 
       Urine output imporoves with IV fluid coverage
       

19. 
    All of the following is true about diabetic nephropathy in IDDM< except:
    
    1. 
       Microalbumnuria is seen within 5 years from onset
       
    2. 
       Usually preceded by retionopathy
       
    3. 
       Thickening of basement membrane is a ??? factor determining progressing of disease
       
    4. 
       It requires kidney transplant
       
    5. 
       More common in diabetic who have siblings with diabetic nephropathy
       

19. 
    All the following are true about effect of drugs in causing ARF, except:
    
    1. 
       Furosemise causes toxicity by forming crystals?
       
    2. 
       NSAIDs cause vasoconstriction
       
    3. 
       Aminogrlyicoside cause toxicity to proimal tubules
       
    4. 
       D-penicillamine causes membranous nephropahty
       
    5. 
       Ampicillin cuases acute tubulointerstitial nephritis
       

19. 
    One of the following is least likely feature of hemochromatosis:
    
    1. 
       Fulminant liver failure
       
    2. 
       Psuedogout
       
    3. 
       Diabetes
       
    4. 
       Bronze skin
       
    5. 
       Hepatocellular carcinoma
       
       
       
20. 
    All the following are subclinical presentations of celiac disease, except:
    
    1. 
       Mood changes
       
    2. 
       Iron def
       
    3. 
       B12 dfe
       
    4. 
       Unexplained elevation of liver enzymes
       
    5. 
       Recurrent abdominal pain
       

Ans: C (Mild to moderate anemia is present in 50% of cases. Folate deficiency is common, often causing macrocytosis. B12 deficiency is rare. Iron deficiency due to malabsorption of iron and increased loss of desquamated cells is common).

19. 
    All of the following are associated with rapid progression of chronic hepatitis C to cirrhosis, except:
    

1. 
   Acquiring the infection at older age
   
2. 
   Female sex
   
3. 
   Alcohol use
   
4. 
   HIV co-infeciton
   
5. 
   HBV co-infection
   

19. 
    The most common complication after ERCP: answer: b
    
    1. 
       Acute pancreatitis
       

19. 
    All of the following are initial management strategies in aptients with upper GI bleeding, except:
    

1. 
   Somatostatitn
   
2. 
   Bleeding scan
   
3. 
   Esophagogastroduodensoscoyp
   
4. 
   Acid suppressing medicaiton
   
5. 
   Gastric lavage
   
   
   

19. 
    Wilson’s disease should be considered in all of the following medical scenarios, except:
    

1. 
   Abnormal liver enzymes and non-immune hemolytic anemia
   
2. 
   Exaggerated high bilirubin level and depressed alkaline phosphtaea
   
3. 
   Decreases serum ceruloplasmis
   
4. 
   Elderly patient with neuropsychiatric problem
   
5. 
   Fuliminat liver failure with low uric acid
   

19. 
    All of the following medications are being used for non-alcohol steatohepatitis (NASH), except:
    

1. 
   Betaite
   
2. 
   Ursodeoxycholic acid
   
3.