I n t e r n a L medicine questions Bank

ICU care is:

1. 
   Strep. pnuemonia
   
2. 
   Legionella
   
3. 
   H. influenza
   
4. 
   Gram negative bacilli
   
5. 
   Mycoplasama pneumonia
   
19. 
    In chronic obstructive pulmonary disease, there is increased risk of respiratory
    

tract infection with all of the following pathogens, except:

1. 
   Strep/ pneumonia
   
2. 
   H. influenza
   
3. 
   Atypical mycobacteria
   
4. 
   Moraxxela cataralis
   
5. 
   Legionella pneumonia
   
19. 
    Actions of PTH include all of the following, except:
    
    1. 
       Increase bone resoption
       
    2. 
       Increase net acid excretion
       
    3. 
       Increased calcium absorption from GI tract
       
    4. 
       Increased calcium reabsorption in the kidney
       
    5. 
       Increased phosphate excretion
       
20. 
    ^{effect of serum osmolarity of a patient with the following labs: Na+} 125 mmol/l, glucose
    

108 mg/dL and BUN of 140 mg/dL is:
Serum osmolarity= 2 x[Na+] + Glucose/18 + Urea/2.8 = 2x15+108/18+140/2.8= 250+ 6 + 50 = 306

19. 
    Actions of PTH include all of the following, except:
    
    1. 
       Increase bone resoption
       
    2. 
       Increase net acid excretion
       
    3. 
       Increased calcium absorption from GI tract
       
    4. 
       Increased calcium reabsorption in the kidney
       
    5. 
       Increased phosphate excretion
       

Answer: C (this is a function of vitamin D). So, PTH acts indirectly to increase calcium absorption from GI tract by increasing the synthesis of vitamin D.

19. 
    ^{The effect of serum osmolarity of a patient with the following labs: Na+} 125 mmol/l, glucose 108 mg/dL and BUN of 140 mg/dL is:
    

Serum osmolarity= 2 x[Na+] + Glucose/18 + Urea/2.8 = 2x15+108/18+140/2.8= 250+ 6 + 50 = 306

85. 
    Syndrome of inappropriate ADH secretion is characterized by all of the following, except:
    

1. 
   Urine osmolarity more than 100
   
2. 
   Hypoosmolarity of the serum
   
3. 
   Urine Na+ more than 40
   
4. 
   Normovolemia and hyperuricemia
   

85. 
    All of the following factors increase distal tubular secretion of K+, except:
    
    1. 
       Increased serum K+.
       
    2. 
       Increased tubular flow rate
       
    3. 
       Increased serum H+ concentration
       
    4. 
       Increased tubular Cl- concentration
       
    5. 
       Increased aldosterone → Correct Answer: D?
       
86. 
    All of the following electrolyte and acid-base disturbances may be seen in a patient with diabetic ketoacidosis upon presentation, except:
    

1. 
   Hyponatremia
   
2. 
   Normal anion gap metabolic acidosis
   
3. 
   Hyperkalemia
   
4. 
   Hyperphosphatemia
   
5. 
   Increased urea
   

Answer: B (DKA causes high anion gap metabolic acidosis)

85. 
    All of the following are causes of high turnover bone disease in chronic renal failure, except:
    

1. 
   Aluminum toxicity
   
2. 
   Decreased vitamin D hydroxylation
   
3. 
   Metabolic acidosis
   
4. 
   Hyperpohsphatemia
   
5. 
   Increased parathyroid hormones
   

85. 
    All of the following are true about chronic myeloid leukemia (CML), except:
    
    1. 
       It is a disease of middle aged which could present with constitutional symptoms
       
    2. 
       The laboratory finding usually show leukocytosis, with left shift and high leucocyte alkaline phosphatase.
       
    3. 
       It is characterized by specific transloation between chromsomes 9, 22 (Philadelphia chromosome)
       
    4. 
       Possible treatment for CML include; imtinib ??? and allogenic BMT
       
    5. 
       CML could transfer to AML or ALL Answer: B (low Luecocyte alkaline phosphatase).
       

85. 
    All of the following are true about myeloproliferative disorders, except:
    
    1. 
       In polycythemia vera, the serum erythropoietin level is high.
       
    2. 
       In essential thrombocytosis, the bone marrow biospy usually show hypercellular marrow with increased megakaryocytes
       
    3. 
       Massive splenomegaly in CML and myelofibrosis
       

96. 
    The adrenal glands, one is correct:
    
    1. 
       The zona reticularis is the most important area in the cortex during embryogenesis
       
    2. 
       There is no relation between the adrenal cortex and the adrenal medullar regarding catecholamine synthesis  Wrong! Cortisol increases catecholamine sysnthesis.
       
    3. 
       Phechromocytoma is associated with high blood pressure and hyperkalemia
       
    4. 
       Atrophy of the glnads is a late sign of autoimmune adrenalitisi
       
    5. 
       Zona fasiculata is the place for adrenal androgen synthesis
       

96. 
    In Cushing syndrome, one is correct:
    
    1. 
       Significant hypokealima is associated with Cushign diseas
       
    2. 
       Easy bruisability is associated only with oral steroid therapy – induced cushign syndrome
       
    3. 
       Loss of diurnal variation of serum cortiosol is found in cushing syndrome
       
    4. 
       Proimal myopathy is a rare feature of Cushing syndrome
       
    5. 
       Glucose intolerance in Cushing syndrome is related to suppression of insulin release
       

96. 
    In Addison disease, one is correct:
    

1. 
   Hyperpigmention of the gums and skin is secondary to the increased release of prolactin hormone…
   
2. 
   Postural dizziness is a common feature in the history of a paitient with Addison disease
   
3. 
   Normokaleima is the rule unlcess there is recurrent vomiting
   
4. 
   The ACTH level is normal in the later stage of disease
   
5. 
   Hemorrhage into the adrenals is the most common cause Ans: B???
   

Extra info: Schmitdt syndrome: Primary adrenal insufficiency + Hypothryoidism (and often type 1 DM).

96. 
    A 17 year old pregnant lady was referred for evaluation of anemia. As a child, she was hospitalized with pneumonia and visited ER twice with abdominal pain. Two years ago, she was found anemia and iron was recommended, but intermittently taken. The examination was unremarkable except for a palpable spleen tip. The Hb was 10 with ferritin 105 and saturation 18%. The peripheral smear revealed slight hypochrmoasia and target cells, but no sickle forms. Hb electrophoresis results were HbA 26%, HbF 5%, and HbS 69%. Which of the following is the most likely diagnosis:
    

1. 
   ?
   
2. 
   ?
   
3. 
   ?
   
4. 
   ?
   
5. 
   ?
   

Answer: B?  B-Thalassemia minor + Sickle cell trait

96. 
    A 65-year-old man with progressive pancytopenia is referred for evaluation. On examination, there is splenomegaly. Bone marrow aspirate demonstrated no dysplasia but decreased cellularity. Which diagnosis is most likely:
    

1. 
   Aplastic anemia
   
2. 
   Megaloblastic anemia
   
3. 
   Myelodysplasia
   
4. 
   Hairy cell leukemia