Final MCQ Intrenal medicine / 4 course (60 questions) 1 вариант

Impaired insulin secretion

Increased Insulin resistance 

Excessive hepatic glucose production

Diabetic ketoacidosis

Type 1 diabetes is caused by an absolute deficiency of insulin

Type 1 diabetes is associated with the autoimmune destruction of beta cells

Patients with type 1 diabetes present with diabetic ketoacidosis

All of the above

Fasting blood glucose from 120-180 mg/dL

Fasting blood glucose from 126-140 mg/dL

Fasting blood glucose from 110-125 mg/dL

All of the above

Increased blood glucose concentration

Increased glycogen breakdown

Decreased peripheral glucose utilization

Decreased gluconeogenesis

Decreased protein breakdown

Increased synthesis of amino acids

Decreased ureagenesis

Increased protein synthesis 

Increased triglyceride breakdown

Increased level of free fatty acids

Increased ketogenesis

Increased lipogenesis

Severe hyperglycemia shifts fluid from the intracellular to the extracellular space

Polyuria increases volume of extracellular space and decreased renal blood flow

The severe loss of intracellular fluid from the brain causes the coma

Increased serum osmolality

Decreased arterial blood pH, increased blood glucose, decreased bicarbonate ion concentration 

Decreased arterial blood pH, increased blood glucose, decreased anion gap

Increased arterial blood pH, increased blood glucose, decreased bicarbonate ion concentration

All of the above

Glucokinase

Fatty acid synthase

Lipoprotein lipase

Hormone-sensitive lipase

Myxoedema

Cretinism

Acromegaly

Goitre

Accumulation of urea in blood

Edema

Mental retardation

Lethargy

T3

T4

TSH

Both T3 and T4

Hypothyroidism

Hyperthyroidism

Goitre

None of the above

Thyroid cancer

Solitary thyroid nodules

Goitre

Thyroiditis

Dry skin and hair

Depression

Joint and muscle pain

All of the above

Thyroalbumin

Thyroglobulin

Thyroid binding globulin

All of the above

Albumin

Thyroglobulin

Thyroid binding globulin

None of the above

Carbimazole

Methimazole

Thiourea

All of the above

increased cGMP production in follicular cells

increased cAMP production in follicular cells

increased Ca+2 ions in the follicular cells

increased diacylglycerol production in follicular cells

Uptake of iodide into the follicular cells

Synthesis of thyroglobulin proteins

Incorporation of iodide ions into tyrosine molecules of thyroglobulin

All of the above

Excess release of TSH from the anterior pituitary

Hyperactivation of TSH receptor in thyroid glands

Presence of TSH receptor antibodies causing receptor activation

Decreased TSH levels

Triiodothyronine

Thyroxine

Diiodotyrosine

Iodide

Increased total and free T4

Suppressed plasma TSH

Exophthalmos

Decreased thyroid radioactive iodine uptake

there is no role

first line management in small pneumathoraces only

it should be tried in all pneumathoraces as long as there is no respiratory compromise

it can be repeated twice before thoracostomy tube is considered

none of the above

Ipratropium is of definite proven benefit in asthma when used with B agonists

Ketamine is the intubation agent of choise but in ongoing therapy in acute asthma no benefit has yet been proven in the few studies done

Oral steroids are as effective as parenteral steroids

Aminophylline may have a role in acute treatment in children but not in adults

No studies have been done to see whether adrenaine is better than parenteral salbutamol

Use of high dose penicillin in penicillin resistant Strep pneumoniae is rarely successful in treating the pneumonia

Mycoplasma pneumoniae is more commonly seen in elderly patients.

Leigonella spp pneumonia is usually moderately severe and can cause pancreatitis, and myocarditis.

H. influenzae is more commonly seen in young, otherwise well patients.

Klebsiella pneumoniae is an aerobic gram positive bacillus.

The bleeding is most likely secondary to pulmonary vessels.

The preferred position for this patient is with the affected lung up

Placement of an ETT will prevent possible contamination of the good lung with blood.

Placement of a Robertshaw ETT will protect the good lung and allow passing of a fiberoptic bronchoscope.

Bronchial artery embolization has an 80% chance of stopping the bleeding.

Intravenous hydrocortisone will have faster onset of anti-inflammatory action than oral prednisolone

Nebulized ipatropium bromide in combination with salbutamol has been shown to have a better clinical outcome than salbutamol used alone. 

It has been shown that IV aminophylline use in severe asthmatics with optimal beta agonist and corticosteroid therapy will confer benefit.

Magnesium has been shown in severe asthma to reduce admission rates and improve FEV1.

Long acting beta agonist have been shown to be beneficial in acute exacerbations of asthma.

Reduced compliance of lungs due to increased collagen and fibroblast activity is an early stage of ARDS.

Severe hypoxaemia despite normal or low PaC02 occurs early.

ARDS usually develops 12-72 hrs post triggering event.

Mechanical ventilation can sometimes worsen oxygen delivary to tissues secondary to reduced cardiac output.

Inhalational nitric oxide has been used in the treatment but is at present experimental due to unknown long term effects and clinical relevance of improvement.

Immune

Endocrine

Nervous

Autonomic

Dust

Food

Nickel jewelry

All of the above

Plasma

Epinephrine

Histamine

Red blood cells

Drop in blood pressure

Breathing is difficult

Runny nose

All of the above

Continue the milk formula prescribed at 8 weeks at least until the age of 12 months

Delay the introduction of egg, fish and standard milk or formula until the age of 2 years

Delay the introduction of egg, fish and standard milk or formula until the age of 1 year

Delay the introduction of peanuts, tree nuts and chocolate until de age of 4 years

Start the gradual introduction of other foods, including wheat, egg, fish, vegetables, pea nuts, and tree nuts after the age of 4 months

Early dietary intervention in high risk infants can reduce the risk for development of food allergy and eczema

Early dietary intervention in high risk infants can reduce the risk for development of allergic asthma

Early dietary intervention in high risk infants can reduce the risk for development of allergic rhinitis

Early dietary intervention in high risk infants increases the risk for development of allergic asthma

Early dietary intervention in high risk infants modifies the natural course of the allergic march

Refer to a paediatric allergologist for allergy evaluation and possible specific immunotherapy

All of the above are acceptable and may be complementary measures 

Recommendations to decrease exposure to pollens

Antihistamine or nedocromil eye drops from March 1 st to July 31st

Daily oral antihistamine and/or intranasal costicosteroid from March 1 st to July 31st

fluent, motor, receptive

non-fluent, sensory, receptive

fluent, sensory, expressive

fluent, sensory, receptive

naming skills are far worse

location of damage is in the parietal region instead of frontal

there are no signs of problems in reading and writing

repetition skills are far better than spontaneous speech

Ability to suppress seizure activity for more than 24 hours after one injection

Lack of respiratory depressant action

Rapid onset of action after intravenous administration

Lack of hypotensive effects

Lack of dependence on hepatic function for its metabolism and clearance

Mint, tomatoes, mustard

All of the above

Caffeine, alcoholic drinks, pepper

Oranges, grapefruit, vinegar

Colon cancer

Esophageal cancer

Mouth cancer

Stomach cancer

Respiratory symptoms are common

Barium swallow is the best test

Columnar lined epithelium is rare

Thickening infant feed and avoiding overfeeding are important

Metoclopramide is useful treatment

Co-phenotrope

Co-trimoxazole

Co-proxamol

Co-codamol

Co-amilofruse

Bromocriptine

Co-beneldopa

Benzhexol

Selegeline

Amantadine

Use of NSAIDs doubles the risk for an upper GI bleed

Urea will increase relative to creatinine in acute bleed

Presence of fresh blood on aspiration of NG tube increases mortality as opposed to a clear aspirate.

Active bleeding seen at endoscopy has a 10% risk of rebleeding after treatment.

Most deaths occur from decompensation of other organ systems rather than exsanguination. 

Usually occurs following a course of antibiotic treatment.

Approx 25% will resolve with supportive treatment only.

Vancomycin is the treatment of choice

The ELISA C. difficile toxin test is 60-90% sensitive

It may rarely result in toxic megacolon and perforation. 

Medications

 Pollen

 Latex

 Exercise

 Stinging Insect

Symptoms to get better on their own in months to years

Risk for anaphylaxis

Use of topical steroids for treatment

Controlling symptoms by following a limited diet

Treatment with allergy shots

Steroid injections

Allergy shots (immunotherapy)

Antihistamines

Topical creams

Anti-inflammatory medications like ibuprofen

Food allergies

No identifiable trigger

Medications

Lotions

Pets

I only

II only

III only

I and II

I and III

I only

II only

III only

I and II

II and III

I and III 

I only

II only

III only

I and II

II and III

I and III

I only

II only

III only

I and II

II and III

I and III

I only

II only

III only

I and II

II and III

I and III

I only

II only

III only

I and II

II and III

I and III

I only

II only

III only

I and II

II and III

I and III

I only

II only

III only

I and II

II and III

I and III

Respiratory failure

Pulmonary hypertension

Allergy-related asthma

Exercise-induced asthma

tartrazine

aspirin

cromolyn sodium

propranolol

sulfiting agents