Professional Documents
Culture Documents
H مش
H مش
a) All-cause mortality
b) Hypoglycemia
c) Myocardial infarction
d) Retinopathy
e) Stroke
2. A 63-year-old man comes to the urgent care center with a 2-week history of an ulcer on his right foot.
He has no associated pain, fever, chills, or skin rash. The patient was diagnosed with hypertension 5
years ago but did not follow up with a physician, and he has had no surgeries or hospitalizations. He
takes ibuprofen for occasional back pain. The patient has a 30-pack year smoking history but quit 2 years
ago . He drinks 1 or 2 beers daily and does not eat red meat or processed foods. The patient considers
himself to be in good health and walks several miles a day. Temperature is 36. 7 C (98.1 F), blood
pressure is 156/98 mm Hg, and pulse is 88/min. BMI is 32 kg/m2. On examination, the feet are warm
and dry. A nontender ulcer with a thick surrounding callus is present on the sole of the foot just below
the head of the first metatarsal bone. Which of the following will most likely diagnose the underlying
cause of this patient's foot ulcer?
4. Which of the following is not considered a routine test used in the investigation of DKA?
a) Glucose tests every 1-2 hours until stable, then every 4-6 hours
b) Prothrombin time initially and then repeated 4-6 hours later
c) Serum electrolyte determinations every 1-2 hours until stable, then every 4-6 hours
d) Initial arterial blood gas measurements, followed by bicarbonate measurement as necessary
Hoth
5. A 52-year-old obese woman has long-standing type 2 diabetes mellitus inadequately controlled on
metformin and pioglitazone. Insulin glargine (15 units subcutaneously at bedtime) has recently been
started because of a hemoglobin A1C level of 8.4. Over the weekend, she develops nausea, vomiting,
and diarrhea after exposure to family members with a similar illness. Afraid of hypoglycemia, the patient
omits the insulin for 3 nights. Over the next 24 hours, she develops lethargy and is brought to the
emergency room. On examination, she is afebrile and unresponsive to verbal command. Blood pressure
is 84/52. Skin turgor is poor and mucous membranes dry. Neurological examination is nonfocal; she
does not have neck rigidity.
Which of the following is the most likely cause of this patient’s coma?
a) Diabetic ketoacidosis
b) Hyperosmolar hyperglycemic state
c) Syndrome of inappropriate ADH secretion
d) Drug-induced hyponatremia
e) Bacterial meningitis
• Graves disease
• Candidiasis
• Hypothyroidism not hyper
• Addison
• papillary
Hoth
1-The most common cause of primary hyperaldosteronism is:
a) Hypokalemia
b) Hyponatremia
c) Hypotension
d) High renin level
a) Hypervolemia
b) Hyperkalemia
c) Hypernatremia
d) Hyperglycemia
e) Hypertension
Hoth
7-Which is not a symptom of Cushing's syndrome?
a) moon face
b) low blood pressure (hypotension)
c) osteoporosis
d) obesity
e) memory loss
Hoth
1- A 67‐year‐old woman is admitted to the intensive care unit following a
four‐node parathyroidectomy with reimplantation for secondary
hyperparathyroidism due to renal failure. She has a calcium level of 7.2
mg/dL 12 hours postoperatively. She is asymptomatic, but an ECG is
obtained which shows prolonged QT interval. Which of the following is
the best treatment option for this patient?
a. Proceed urgently to the operating room for removal of the implanted
parathyroid
b. Give 2 gm intravenous calcium gluconate
c. Electively re‐explore the patient in the morning for a missed
parathyroid gland
d. Double her calcitriol dose from 0.25 mcg to 0.5 mcg twice daily
e. Continue observation with no intervention at this time
10-A 73-year-old woman has experienced malaise and a 10-kg weight loss
over the past 4 months. She also has developed a chronic cough during
this time. She has a 100 pack-year history of smoking cigarettes.
Physical examination shows wasting and 4/5 motor strength in all
extremities. Abdominal CT scan shows bilaterally enlarged adrenal
glands. A chest radiograph shows a 6-cm perihilar mass on the right and
prominent hilar lymphadenopathy. Laboratory studies show Na+, 118
mmol/L; K+, 6 mmol/L; Cl–, 95 mmol/L; CO2, 21 mmol/L; and glucose,
49 mg/dL. Her 8:00 am serum cortisol level is 9 ng/mL. What is the
most likely diagnosis?
a. Amyloidosis
b. Ectopic corticotropin syndrome
c. Meningococcemia
d. Metastatic carcinoma
e. Pituitary adenoma
11-A 28-year-old, otherwise healthy man has had headaches for the past 2
weeks. Physical examination yields no remarkable findings except for a
blood pressure of 174/116 mm Hg. An abdominal CT scan shows an
enlarged right adrenal gland. A right adrenalectomy is done; the figure
shows the gross appearance of the specimen. Which of the following
laboratory findings in his blood was most likely reported in this patient
before surgery?
a. Hyperglycemia
b. Hyperkalemia
c. Low corticotropin level
d. Low insulin levl
e. Low renin level
12- All of the followings are true regarding Nelson's syndrome except
a. The development of large destructive pituitary adenoma after
surgical removal of the adrenal glands
b. Loss of excitatory effect of of adrenal cortisol on a pre-existimg
ACTH microadenoma
c. Hypercortisolism does not develop
d. Hyperpigmentation is characteristic
e. Nelson's syndrome is a potentially life-threatening condition
16-Regarding pituitary gland hormones all of the followings are true except
a. Hashimoto thyroiditis can lead to hyperprolactinemia
b. Uterine contractions have a positive feedback mechanism on
oxytocin
c. Chlorpromazine and haloperidol can cause hyperprolactinemia
d. Optic chiasm compression by pituitary adenoma results in bilateral
temporal hemianopsia
e. Cushing reflex due to increased ICP as a result of macroadenoma
involve tachycardia, hypotension, and irregular respirations
21- Regarding nerve injuries of the thyroid gland all of the following are
true except
24- regarding potassium and pH regulation all of the following are true
except
a. Almost hyperkalemia leads to metabolic acidosis
b. Addison disease causes normal anion gap ( hyperchloremic )
metabolic acidosis
c. Renal tubular acidosis 1 & 2 are exceptions to the general rule in
which acidosis is accompanied by hypokalemia
d. Potassium concentration will rise by 0.6 meq/l for every 0.1 unit
reduction of the extracellular pH
e. Potassium concentration will rise by 0.3 for every 0.1 unit increased
of the extracellular pH
26- Regarding Hashimoto thyroiditis all of the following are true except
a. It is chronic lymphocytic thyroiditis
b. It is type 2 or 4 hypersensitivity reaction
c. Can occur n children
d. Atrophic thyroid follicles lined by Hurthle (oxyphil) cells
e. It is associated with increased risk of follicular thyroid carcinoma,
hurthle cell carcinoma and B cell lymphoma
27-All of the following increase the risk of malignancy of thyroid nodule
except
a. Solitary nodule
b. Male gender
c. Solid nodule
d. Mobile nodule
e. Nodule in a child
28- Regarding thyroid carcinoma, all of the followings are true except
a. FNAB can not differentiate between follicular adenoma and
carcinoma since it will not show the integrity of the capsule
b. Psammoma bodies are diagnostic characteristic of papillary thyroid
carcinoma
c. 10-year survival rates in papillary thyroid carcinoma is 95%
d. Follicular thyroid carcinoma can result from long standing MNG and
it is followed up by thyroglobulin
e. FMTC without an associated MEN syndrome occurs in children
31- Regarding adrenal gland, all of the followings are true except
a. Addison disease is chronic primary adrenal insufficiency most
caused by autoimmune adrenalitis in which antibodies to 17
hydroxylase enzyme is most commonly present
b. Short synacthen test is used to diagnose Addison disease
c. Hypoglycemia in Addison disease is due to glucocorticoid deficiency
and impaired gluconeogenesis
d. In secondary hypoadrenalism there is bilateral Atrophic cortex &
intact medulla
e. TB& fungal infections is characterized by granulomatous
inflammation
32- Regarding thyroid and parathyroid glands all of the followings are true
except one
a. In most cases superior parathyroid glands are variant n position in
contrast to inferior parathyroid glands which are constant in position
b. Middle thyroid vein is the first vessel to be ligated in thyroid surgery
c. Platysma muscle is supplied by cervical branch of facial nerve
d. All parathyroid glands are supplied by the inferior thyroid artery
e. In Sistrunk operation excision of cyst and also full tract up to the
foramen caecum is done along with removal of central part of the
hyoid bone as the tract passes through it.
33- Regarding Li Fraumeni syndrome all of the following are true except
a. inherited autosomal dominant disorder
b. is usually associated with abnormalities in the tumor suppressor
protein P53 gene (TP53) located on chromosome 17
c. most common malignancies are thyroid, pancreas, and kidney
cancers
d. they usually present at young age
e. first or second degree relative with any cancer before age 45 years
or a sarcoma is a diagnostic criterion