Neurology 4 mrcp questions book - part 3 ppsx

c- Daily bowel motions more than twice a day
d- ESR more than 30 mm/hr.
e- Serum albumin less than 30 g/ L
Q39: Systemic complications of inflammatory bowel disease that tend to occur
during an active relapse include all of the followings, except:
a- Mouth ulceration.
b- Episcleritis.
c- Pyoderma gangrenosum.
d- Deep venous thrombosis.
e- Sacroiliitis.
Q40: Management of inflammatory bowel disease, all of the followings are true,
except:
a- Salphasalazine side effects are usually dose dependent and reversible.
b- Specific nutritional therapy in Crohn's disease can be very effective but it is
expensive and poorly tolerated by most patients.
c- The most important indication for surgery is the impairment of the quality of life
including schooling, occupation, social and family life.
d- Colectomy should be done when the diameter of the transverse colon in an acute
attack exceeds 6 cm as this indicates impending perforation.
e- Total colectomy is rarely curative in ulcerative colitis.
Q41: Irritable bowel syndrome, all of the followings are true, except:
a- Diarrhea predominant type should be differentiated from microscopic colitis,
lactose intolerance and bile salt diarrhea.
b- The commonest presentation is abdominal pain.
c- 1% of cases only will meet criteria of a psychiatric disease.
d- Reassurance of the patient has a very important aspect in the management.
e- Amitriptylin may be used in selected patient.
Q42: Indicators of malignancy in adenomatous polyps, all of the followings are
true, except:
a- The presence of dysplastic changes on histology.
b- The presence of multiple polyps.

c- Large size polyps, of more than 2 cm.
d- The presence of a villous architecture on histology.
e- The presence of metaplastic polyps.
Q43:
Familial adenomatous polyposis (FAP), all of the followings are true,
except:
a- It is has been shown to be due to a germ line mutation in the APC gene on
chromosome 5.
b- 50% of cases have adenomatous polyps in the stomach and 90% in the duodenum.
c- Congenital hypertrophy of the retinal pigment epithelium when found in an at risk
patient, it is a 100% predictive for the presence of FAP.
d- It has many variants like Gardner syndrome, Turcot's Syndrome and an attenuated
form called attenuated FAP.
e- Desmoid tumors are malignant tumors, usually in the abdominal wall; occur up to
10% of cases.
Q44: All of the following statements are true, except:
a- Although the hamartomatous polyps of Peutz-Jegher syndrome have no malignant
potential, but still there is a risk of small bowel carcinoma and carcinomas of the
pancreas, ovary, endometrium and breasts.
b- Juvenile polyposis has no risk of colorectal cancer.
c- In Cowden's disease there is a risk of thyroid cancer with polyps through out the
GIT.
d- In Cronkhite-Canada syndrome, there hair loss, skin pigmentation and nail
dystrophy with polyps through out the GIT.
e- Of all GIT polyposis syndromes, esophageal polyps are found only in Cronkhite-
Canada syndrome and Cowden's disease.
Q45: Risk factors for the development of colorectal cancer, all of the followings
are true, except:
a- Acromegaly.
b- Pelvic irradiation.

c- There is a weak association with alcohol and smoking.
d- Diet rich in meat and fats.
e- Diet rich in fibers and fruits.
Q46: The commonest causes of acute pancreatitis are all of the followings,
except:
a- Alcoholism.
b- Post ERCP.
c- Idiopathic.
d- Gall stones.
e- Viral infections.
Q47: Adverse prognostic factors in acute pancreatitis (Glasgow's Criteria), all of
the followings are true, except:
a- PaO2 less than 8 kPa.
b- Blood sugar more than 10 mmol/ L.
c- Serum calcium (corrected) less than 2.00 mmol/L.
d- Very high serum amylase.
e- Serum albumin less than 30 g/L.
Q48: The following statement about acute pancreatitis are true, except:
a- Serum amylase are only useful in the first 24-48 hours of the illness, otherwise after
that urinary amylase: creatine ratio is used.
b- Necrotizing pancreatitis is better assessed and suggested by CT scan.
c- Any visible gases in the pancreatic tissue suggests the development of abscess
formation.
d- Persistently elevated serum amylase suggests the development of a pancreatic
pseudocyst.
e- C reactive protein has a very limited role in the follow up.
Q49: Chronic pancreatitis, all of the followings are true, except:
a- The commonest cause is alcoholism.
b- Up to 20% of patients are opiates dependent.
c- 15% of cases only presents with steatorrhea but no abdominal pain.

d- Pancreatic ascites is an indicator for terminal pancreatectomy.
e- Most patients fortunately stop drinking alcohol after the diagnosis.
Q50: In chronic pancreatitis, all of the followings are true, except:
a- The over all incidence of diabetes is 30% but this rises to 70% in calcific
pancreatitis.
b- Steatorrhea occurs only after 90% of the exocrine function had been destroyed.
c- Unfortunately pain may continue despite total pancreatectomy.
d- Chronic pancreatitis is a risk factor for pancreatic carcinoma.
e- Pancreatic enzymes supplements are useful in malabsorption but have no effect on
abdominal pain.
Written By Dr. Osama Amin
All Rights Reserved. 2005

END of Chapter III/ Gastro-Intestinal Diseases
Chapter IV / Hepatobiliary System
Q1: Regarding the normal liver, all of the followings are true, except:
1- 15% of the liver is composed of cells other than hepatocytes.
2- Clearance of bacteria, viruses and erythrocytes is done by Kupffer cells.
3- Ito cells have a role in the uptake and storage of vitamin A.
4- Vitamin K and folic acids are stored in a huge amount.
5- Hepatic synthesis of urea, endogenous proteins and amino acid release by the liver
all are suppressed during fasting.
Q2: The following statements are true, except:
1- Low blood urea is seen in many acute and chronic liver diseases.
2- High blood urea in the context of severe liver damage may indicate
gastrointestinal hemorrhage or hepatorenal syndrome.
3- Hyponatremia is very common in severe liver disease and usually
multifactorial.
4- Raised gamma GT enzyme level may occur during treatment with
carbamazepin.

5- Large increase in serum aminotransferases activity with a small rise in alkaline
phosophatase activity is in favor of biliary obstruction.
Q3: Drugs that induce hepatic microsomal enzyme activity, all of the followings
are true, except:
1- Chronic ethanol ingestion.
2- Glucocorticoids.
3- Griseofulvin.
4- Carbamazepin.
5- Cimetidin.
Q4: Imaging in liver diseases, all of the followings are true, except:
1- Ultrasound of the liver is a rapid, cheap and easy method and usually the first
imaging to be done, yet its main limitation is that small focal lesions less than 2 cm
will be missed.
2- Color Doppler studies are very useful and used to investigate hepatic veins, portal
vein and hepatic artery diseases.
3- MRI is usually used for pancreaticobiliary diseases rather than parenchymal liver
diseases.
4- Outlining the biliary tree can be done by injecting a contrast medium into the
biliary tree through the skin or by an endoscopic approach.
5- Plain abdominal radiographs are very helpful in liver diseases.
Q5: Regarding liver biopsy, all of the followings are true, except:
1- The patient should be cooperative.
2- The PT prolongation if present should be less than 4 seconds above the upper
normal control value.
3- Severe COPD is a contraindication.
4- Marked ascites will make the procedure easier.
5- Local skin infection should not be present.
Q6: Regarding the metabolism of bilirubins, all of the followings are true,
except:
1- Every day, about 300 mg of indirect bilirubin is produced.

2- Jaundice will be seen clinically if the total bilirubin exceeds 50 micromole / L.
3- About 100-200 mg of stercobilinogen is lost in stool.
4- About 400 mg of urobilinogen is passed outside in urine.
5- The indirect bilirubin will be conjugated in the endoplasmic reticulum of
hepatocytes to be water soluble.
Q7: Causes of indirect hyperbilirubinemia ,all are true except:
1- Vitamin B12 deficiency.
2- Wilson's disease.
3- Gilbert's syndrome.
4- Rotor syndrome.
5- Major ABO incompatibility reaction.
Q8: When examining a patient with a direct bilirubin of 30 micromole / L, all of
the followings are useful signs in guessing the diagnosis, except:
1- A palpable gall bladder.
2- An upper abdominal paramedian scar.
3- Irregular hard liver.
4- Upper midline abdominal mass.
5- Scratching marks.
Q9: Local measures to stop a variceal upper GIT bleeding, all of the followings
are true, except:
1- Banding.
2- Sclerotherapy.
3- Esophageal transaction.
4- Balloon tamponade.
5- Terlipressin infusion.
Q10: Measures to prevent variceal recurrent upper GIT bleeding, all of the
followings are true, except:
1- Oral propranolol.
2- Sclerotherapy / banding.
3- Transjugular intra hepatic portosystemic shunt (TIPSS).

4- Esophageal transaction.
5- Selective or non selective portosystemic shunt surgery.
Q11: A patient with chronic liver disease presents with upper GIT bleeding, all
of the followings are true, except:
1- Upper GIT endoscope should be done in all cases as 20% of cases the bleeding is
non variceal.
2- Despite all advances in the management, the mortality rate is still high.
3- Portosystemic shunt surgery in this patient may have a mortality of 50%.
4- Vasopressin is contraindicated in ischemic heart disease.
5- Esophageal transection is commonly used as a first line treatment.
Q12: TIPSS (transjugular intrahepatic porto-systemic shunt), all of the
followings are true, except:
1- It is done by placing a stent between the hepatic vein and the portal vein in the liver
under radiological control.
2- The objective is to produce a porto systemic shunt to reduce the portal pressure and
hence the variceal bleeding.
3- Prior patency of the portal vein should checked beforehand by angiography.
4- May precipitate or worsen hepatic encephalopathy.
5- When rebleeding occurs, the shunt should be removed.
Q13: Spontaneous bacterial peritonitis in the context of cirrhosis, all of the
followings are true, except:
1- Unfortunately, in up to one third of cases the abdominal signs are mild or absent.
2- Almost always a mono-microbial infection state.
3- Recurrence is common but unfortunately there is no way to prevent it.
4- The commonest organisms are enteric gram negatives, but no source of infection is
usually present.
5- The ascitic fluid is cloudy with more than 250 neutrophils / mm3.
Q14: Precipitating factors for hepatic encephalopathy in a patient with cirrhosis,
all of the followings are true, except:
1- Occult infection.

2- Aggressive diuresis.
3- Diarrhea or constipation.
4- Treatment with oral neomycin.
5- Excess dietary proteins.
Q15: Differential diagnosis of hepatic encephalopathy, all of the followings are
true, except:
1- Primary psychiatric disease.
2- Hypoglycemia.
3- Wernicke's encephalopathy.
4- Subdural hematoma.
5- Treatment by enemas.
Q16: Acute fulminant hepatic failure, all of the followings are true, except:
1- The commonest causes are viral hepatitis and medications-induced.
2- The hallmark is the presence of acute hepatic encephalopathy.
3- The absence of jaundice is against the diagnosis.
4- There are long listed complications and these usually complicate the picture
further.
5- The patient should be managed in an intensive care unit or a high dependency
unit once the PT is prolonged.
Q17: Hepato-renal syndrome, all of the followings are true, except:
1- Carries a very bad prognosis unless hepatic transplantation is carried out.
2- One of the causes of fractional Na excretion of more than 2.
3- Characterictically presents as rapidly evolving uremia with bland urinary sediment.
4- Seen in advanced cirrhosis, and ascites is almost always present.
5- Renal dose dopamine has a minor role in the management.
Q18: Causes of micro-vesicular steatosis, all are true except
1- Fatty liver of pregnancy
2- Rye's syndrome
3- Treatment with didanosine
4- Wolman's disease and Alpers syndrome

5- Treatment with amiodarone
Q19: Causes of acute hepatitis, all of the followings are true, except:
1- Halothane.
2- Wilson's disease.
3- Autoimmune hepatitis.
4- CMV.
5- Hemochromatosis.
Q20: Causes of chronic liver disease and cirrhosis, all of the followings are true,
except:
1- Alpha 1 anti-trypsin deficiency.
2- Chronic hepatitis C infection.
3- Hemochromatosis.
4- Autoimmune hepatitis.
5- Epstein Barr virus infection.
Q21: Liver cirrhosis, all of the followings are true, except:
1- Hyperpigmentation is seen in hemochromatosis and prolonged biliary obstruction.
2- Spider telangiectasias are seen early in the course of cirrhosis.
3- Parotid gland enlargement goes with alcoholic etiology.
4- Ascites is seen early.
5- Finger clubbing is a non specific sign.
Q22: The hepatitides viruses, all of the followings are true, except:
1- Hepatitis A is an RNA enterovirus which does not lead to a carrier state.
2- Hepatitis B is a DNA virus that is 42 nm in diameter and leads to chronic infection
in up to 10% of adults versus 90% of neonatal hepatitis B infection.
3- Hepatitis C is an RNA flavivirus that is the commonest cause of chronic liver
disease in USA and of those infected, up to 20 % of them will develop cirrhosis after
20 years.
4- Hepatitis D is a defective RNA virus that can be prevented by preventing hepatitis
B infection in high risk groups by using hepatitis B vaccine and immunoglobulin.
5- Hepatitis E is a RNA calicivirus that carries a mortality of 2% if the infection

occurs in pregnancy.
Q23: The followings predict a poor response to INF alpha treatment in chronic
hepatitis B viral infection, except:
1- Being a male.
2- Pre-core mutant strains of the virus.
3- Being an Asian.
4- Very high pretreatment serum hepatitis B viral DNA level by PCR.
5- Absence of cirrhosis.
Q24: Autoimmnue hepatitis, all of the followings are true, except:
1- Type I is ANA and anti-smooth muscle antibodies positive.
2- Amenorrhea is the rule and Cushingoid faces may be seen.
3- 25% of cases present as a hepatitis like picture.
4- Corticosteroids are effective in the treatment of acute flare ups.
5- Hepatocelluar carcinoma as a complication is common.
Q25: Histological changes in alcoholic liver disease, all are true except
1- Mitochonsrial swelling.
2- Siderosis.
3- Lipogranulomas.
4- Autoimmune interface hepatitis.
5- Few endoplasmic reticula.
Q26: Primary biliary cirrhosis, all of the followings are true, except:
1- Anti mitochondrial antibodies are seen up to 96% of cases.
2-Early, there is proliferation of small bile ductules.
3-Hypercholesteremia is common and greatly increases the risk of coronary artery
disease.
4- Polished nails with clubbing are seen.
5- Ursodeyoxycholic acid has been shown to improve the liver function tests.
Q27: Primary sclerosing cholangitis, all of the followings are true, except:
1- 80% of cases are seen in the context of ulcerative colitis.
2- Spontaneous ascending cholangitis is uncommon but usually occurs after biliary

instrumentation like post ERCP.
3- Is risk factor for cholangiocarcinoma.
4- There is an association with HIV infection and retroperitoneal fibrosis.
5- Corticosteroids and immune-suppressants are useful in the treatment.
Q28: Hepatocelluar carcinoma (HCC), all of the followings are true, except:
1- Occurs in the background of cirrhosis in up to 80% of cases.
2- Chronic hepatitis B infection is the commonest cause world-wide.
3- May be treated by liver transplantation.
4- Any patient with cirrhosis should be screened for the development of HCC by
serial serum alpha fetoprotein and liver ultrasound.
5- The fibrolammellar variant has a very poor prognosis.
Q29: Criteria for giving ursodeoxycholic acid as a medical treatment for gall
stones solubilization, all of the followings are true, except:
1- The stone should be radiolucent.
2- The stone size is up 15 mm.
3- Functioning gall bladder.
4- Moderate obesity.
5- Prominent symptoms ascribed to the stone.
Q30: Risk factors for pigment gall stones, all of the followings are true, except:
1- Liver cirrhosis.
2- Biliary parasites.
3- Chronic long term hemolysis.
4- Ileal resection / disease.
5- Pregnancy.
END of Hepatology
Written by Dr. Osama Amin

All Rights Reserved
Chapter V / Nephrology
Q1: A normal kidney, all of the followings are true, except:

a- Erythropoieten is secreted by peritubular cells in response to hypoxia.
b- Hydroxylates 1- hydroxycholecalciferol to its active form.
c- Renin is secreted from the juxta glomerular apparatus.
d- Locally produced prostaglandins have a very important role in maintaining renal
perfusion.
e- 90% of the erythropoietin comes from the kidneys and 10 % from the liver.
Q2: Normal adult kidneys, all of the followings are true, except:
a- Its length is about 11-14 cm (about 3 vertebral bodies).
b- Both kidneys rise and descend several centimeters during respiration.
c- Each kidney contains approximately 10 million nephrons.
d- Both kidneys receive about 20-25% of the cardiac output.
e- The right kidney is usually few centimeters lower than the left.
Q3: Causes of polyuria, all of the followings are true, except:
a- Excessive fluid intake.
b- Hyperglycemia.
c- Early stage of chronic renal failure.
d- Tubulointerstitial diseases.
d- Heavy smoking.
Q4: Renal ultrasound examination, all of the followings are true, except:
a- Its disadvantage is that it is highly operator dependent.
b- Quick, rapid, cheap and non-invasive and often the only required method of renal
imaging.
c- It can show the renal size, position, dilatation of the collecting system and other
abdominal pathologies like cystic liver.
d- In chronic renal failure, the density of the renal cortex is unfortunately decreased
and there is loss of cortico-medullary differentiation.
e- By utilizing the Doppler techniques, much information can be gained like the
resistivity index.
Q5: IVU (intravenous urography) is commonly used in clinical nephrology, all of
the followings are true, except:

1- Risky in diabetes mellitus.
2- Risky in multiple myeloma.
3- Risky in pre-existent renal disease.
4- The risk of contrast nephropathy can be reduced by avoiding dehydration and by
giving diuretics.
5- The risk of contrast nephropathy can be reduced by using less hyperosmolar (yet
expensive) contrast media.
Q6: Disadvantages of IVU (intravenous nephrography), all of the followings are
true, except:
a- It is a time consuming investigation.
b- Needs and injection.
c- The dependence upon adequate renal function for good images to be obtained.
d- The risk of exposure to contrast media (allergic reactions, nephro-toxicities).
e- Unfortunately, there is a poor definition of the collecting systems on AP films.
Q7: Anterograde pyelography, which one of the following statements is true?
a- It is the injection of a contrast media into kidney through the bladder and ureters.
b- It is usually done blindly.
c- Much more difficult and hazardous in a non-obstructed kidney.
d- Usually used in cases of glomerulonephritis.
e- Poorly outlines the collecting system.
Q8: Micturition cystourethrogram , all of the following statements are wrong,
except:
a- Is not used in the diagnosis and assessment of severity of vesicicoureteric reflux.
b- It is usually used in conjunction with urodynamic studies.
c- It is part of the last stages of IVU (intravenous urography).
d- It is not indicated in those with recurrent urinary tract infections (UTIs).
e- It is not indicated in those with renal scars .
Q10: Renal angiography and venography, all of the followings are true, except:
a- The main indication of renal angiography is the diagnosis of renal artery stenosis
and renal hemorrhage.

b- Therapeutic intervention may be undertaken at the same time of doing renal
angiography like dilatation and stenting of renal artery stenosis and occluding an AV
fistula.
c- Unlike IVU (intevenous urography), there is a risk of cholesterol athero-
embolisation.
d- When compared to IVU, the risk of contrast nephropathy is much lower.
e- Renal venography is mainly used in the diagnosis of renal vein thrombosis and
renal cell carcinoma extension.
Q11: Renal biopsy, all of the followings are true indications, except:
a- Unexplained acute renal failure.
b- Chronic renal failure with normal sized kidneys.
c- Atypical childhood nephrotic syndromes.
d- Isolated hematuria with normal looking RBCs.
e- Nephrotic syndrome in adults.
Q12: Contraindications to renal biopsy, all of the followings are true, except:
a- Severe hemophilia.
b- Platelets count of 10000 /mm3.
c- Uncontrolled hypertension.
d- Renal size less than 90% predicted.
e- Biopsy from a single kidney is a relative contraindication.
Q13: Causes of DARK urine, all of the followings are true, except:
a- All cases of porphyria.
b- Inter-vertebral dics calcification with dark ears.
3-A Parkinsonian patient.
4- Pulmonary TB patient.
5- Massive crushing trauma patient.
Q14: Proteinuria, are of the following statements are true, except:
a- Standard sticks usually miss Bence John's protein.
b- In myoloma, it is due to protein overflow rather than renal amyloidosis.
c- The majority of the daily excreted protein is Tamm Horesful mucoprotein.

d- Defined as albumin / creatinine (A/C) ratio on a random urine sample of less than
4.5 in females and less than 3.5 in males.
e- Positive dipstick for protein may occur in fever per se.
Q15: Acute renal failure, all of the followings are wrong, except:
a- Pre-renal causes are uncommon.
b- 85% of intrinsic renal causes of acute renal failure are due to acute tubular necrosis.
c- Under-perfusion causes of acute renal failure are usually irreversible.
d- Stones as a cause of acute obstructive uropathy are very common causes.
e- 50% of intrinsic acute renal failure is due to acute glomerulonephritis.
Q16: Regarding the prognosis of acute renal failure, all of the followings are
true, except:
a- In uncomplicated renal failure e.g. due to bleeding or drugs, the mortality is low.
b- Serious infections complicating acute renal failure portends bad prognosis.
c- Multiple end organ failure portends a poor prognosis.
d- Complicated acute renal failure may have a mortality approaching 5- 10%.
e- The outcome and prognosis is determined by the severity of the underlying disease
and by complications rather than by renal failure per se.
Q17: Rapid respiratory rate in acute renal failure may be due to all of the
followings, except:
a- Acidosis per se.
b- intravenous fluid overload and pulmonary edema.
c- ARDS picture.
d- Chest infection.
e- Hyperkalemia.
Q18: Anemia in the setting of acute renal failure is very common and usually
multi-factorial, all of the followings are true causes, except:
a- Hemolysis.
b- Excessive bleeding.
c- Profound suppression of erythropoiesis.
d- Drug induced.

e- Hyperphophatemia.
Q19: General urine examination (GUE) is one of the commonest investigations
done every day, all of the followings are true, except:
a- Elevated urinary concentration of ascorbic acids gives a false negative result for
bilirubin dipsticks.
b- Elevated urinary concentration of ascorbic acids gives a false negative result for
glucose dipsticks.
c- Gross hematuria can give false positive results for protein.
d- Significant glycosuria gives a falsely low specific gravity.
e- MESNA gives false positive results for ketone sticks.
Q20: Urine Dipstick tests are commonly used in the medical ward side labs by
nurses, juniors and senior house officers, all of the followings are true, except:
a- False negative results for nitrite may be due to short bladder transit time.
b- False negative results for nitrite may be due to infecting organisms lacking nitrates
and nitrate reductase.
c- High urinary level of tetracycline gives false negative results for leukocyte esterase.
d- High urinary level ascorbic acid gives false negative results for nitrite.
e- Medications which discolor urine will give false negative for nitrite.
Q21: Urinary specific gravity is measured in some clinical conditions like
diabetes insipidus, do you know how it is measured? It is measured by all of the
following methods, except:
a- Freezing point depression.
b- Vapor pressure technique.
c- Using a refractormeter.
d- Using a hydrometer.
e- Calorimetric reagent strips.
Q22: In microalbuminuria, all of the followings are true, except:
a- Is defined as proteinuria between 30-300 mg / day.
b- Is defined as proteinuria between 20-200 microgram / minute.
c- It is always protein dipstick negative.

d- Important in the follow up of type II not type I diabetes mellitus.
e- Persistent proteinuria has been associated with the development of atherosclerorsis.
Q23: Daily excretion of urinary protein, all of the followings are true, except:
a- Up to 150 mg / day is normal.
b- 300-500 mg / day will be dipstick test positive.
c- More than 3.5 g / day is called nephrotic range proteinuria.
d- More than 2.5 g / day, a glomerular source is more likely than a tubular source.
e- Between 0.5-2 g / day usually indicates a glomerular source.
Q24: In diagnosing a pre-renal failure, all of the followings when present are
highly suggestive, except one:
a- History of excessive upper GIT bleeding.
b- A bland urinary sediment.
c- A progressive rise in blood urea and creatinin in a congestive heart failure patient.
d- Urine osmolality more than 500 mosm / Kg.
e- Fractional sodium excretion more than 4.
Q25: In chronic renal failure, all of the followings are true, except:
a- The commonest causes world wide are hypertension and diabetes mellitus.
b- The presence of rea frost is a useful early sign.
c- Itching is multi factorial rather than due to hyperphosphatemia alone.
d- Hypotension and dehydration may be seen.
e- In clinical practice, about 4-18 % of cases are of unknown or uncertain etiology.
Q25: Although chronic renal failure is an irreversible process, there are many
"reversible factors" that may accelerate the course, all of the following reversible
factors are true, except:
a- Nephrotoxic medications.
b- Renal artery stenosis.
c- Hypotension due to drug therapy.
d- Any infection per se.
e- Normal blood pressure.
Q26: Endocrinal abnormalities are common in chronic renal failure, all of the

following statements are true, except:
a- Hyperprolactinemia may be seen but unfortunately many cases don’t respond to
bromocryptine.
b- The half life of insulin is greatly shortened.
c- Amenorrhoea is common in females.
d- Loss of libido in both sexes is very common.
e- Hypothyroidism like picture may be seen.
Answer: b
The half life of insulin is prolonged and hence the total daily doses should be reduced
for fear of hypoglycemia.
Q27: In the management of chronic renal failure, all of the followings are true,
except:
a- Hypertriglyceridemia is common and hypercholesteremia is almost universal in
those who have significant proteinuria.
b- ACE inhibitors for hypertension have significantly been shown to retard the disease
progression especially in diabetics.
c- Profound protein restriction is unwise as this may produce malnutrition.
d- Replacing sodium and chloride with high fluid intake should be avoided in all
patients.
e- Hypocalcemia is very common and should be corrected by vitamin D metabolites.
Q28: Regarding the prognosis of chronic renal failure, all of the followings are
true, except:
a- The commonest cause of death in general is vascular events.
b- 5 year survival of " home hemodialysis " patients is about 80%.
c- 5 year survival following renal transplantation is about 80%.
d- 5 year survival for "hospital hemodialysis " patients is about 60%.
e- 5 year survival for " CAPD patients is about 16%.
Q29: In acute renal failure patient, you suggested that the patient needs renal
replacement therapy in the form of hemodialysis, all of the followings are usually
your target , except:

a- Maintain a pre-dialysis blood urea concentration of less than 15 mmol/L.
b- Adequate control of potassium.
c- Adequate control of phosphate.
d- Achieving normal extra cellular fluid volume status.
e- Each session of hemodialysis should be done every day.