Neurology 4 mrcp questions book - part 4 pdf

Q30: Renal artery stenosis, all of the followings are true, except:
a- The commonest cause is atheromatous narrowing.
b- Should suspected when the blood pressure is severe or of rapid onset or difficult to
control.
c- Fibromuscular dysplasia as a cause is commoner in the young age groups.
d- Fibromuscular dysplasia usually does not cause complete occlusion and usually
stabilizes once the patient stops growing.
e- Surgical treatment is superior to medical treatment or angioplasty.
Q31: In Alport's syndrome, all of the followings are true, except:
a- The second commonest inherited cause of renal disease.
b- Usually autosomal recessive.
c- Bilateral anterior lenticonus is the usual eye manifestation.
d- Sensory neural deafness, usually to high tones first.
e- The pathological hallmark is progressive degeneration of the glomerular basement
membrane
Q32: In adult polycystic kidney disease, all of the followings are true, except:
a- 85% of cases are due to mutations in PKD1 gene on chromosome 16.
b- Mitral and or aortic regurgitations are frequent but rarely severe.
c- 30% have an associated hepatic cysts but disturbances in hepatic function is very
rare.
d- 90% will develop subarachnoid hemorrhage.
e- Colonic diverticulae and abdominal wall hernias are well recognized associations.
Q33: In adult poly cystic kidney disease, all of the followings are true, except:
a- The mean age for those who are heterozygous for PKD1 mutation to start dialysis
is 57 years.
b- 50% of patients will never need chronic dialysis.
c- To screen a patient's relative, renal ultrasound as a screening method is less reliable
in the 10-18 years age group.
d- Urinary tract Infections should be treated aggressively.
e- All patients will develop hypertension.
Q34: In medullary sponge kidney, all of the followings are true, except:

a- It is sporadic, not genetic.
b- Has a characteristic picture on intravenous urography.
c- The cysts are confined to the proximal tubules.
d- The prognosis is generally good.
e- Nephrocalcinosis may be seen on the KUB film.
Q35: Fanconi's Syndrome (renal tubular acidosis type II, proximal), all of the
followings are true, except:
a- Glycosuria is present with normal blood sugar.
b- Aminoaciduria does not result in malnutrition.
c- May be caused by Wilson's disease.
d- Hypercalciuria is profound.
e- Very large amounts of bicarbonate are need in the treatment.
Q36: In Type I distal renal tubular acidosis, all of the followings are true, except:
a- May cause osteomalacia in adults and rickets in children.
b- Nephrocalcinosis is seen.
c- Hypokalemia is present with normal anion gap metabolic acidosis.
d- Incomplete forms are never seen.
e- Ability to form very acidic urine in the context of systemic acidosis is the hallmark
of the disease.
Q37: Causes of hypocomplementemia in inflammatory nephritides include all of
the followings, except:
a- Infective endocarditis.
b- Systemic lupus erythematosus.
c- Shunt nephritis.
d- Post-infectious glomerulonephritides.
e- Microscopic polyangiitis.
Q39: Causes of rapidly progressive glomerulonephritis (RPGN), all of the
followings are true, except:
a- Systemic lupus erythematosus.
b- Aggressive phase of certain inflammatory nephritides like IgA nephropathy.

c- Goodpasture's syndrome.
d- Post-infectious glomerulonephritis.
e- Membranous nephropathy.
Q40: In Goodpasture's syndrome, all of the followings are true, except:
a- It is an autoimmune disease against alpha 1 chain of type III collagen.
b- Linear IgG deposition in the glomerular basement membrane is seen on immuno-
flourescence staining of a renal biopsy specimen.
c- Plasma pharesis may be used in the treatment.
d- Lung hemorrhage is more common in smokers.
e- Usually produces rapidly progressive crescentic glomerulonephritis.
Q41: In Renal biopsy with immunoflourescence staining looking for immune
deposits, all of the followings are true findings of the suggested disease, except:
a- Minimal change disease – no immune deposits.
b- Focal segmental glomerulosclerosis-nonspecific trapping in focal scars.
c- Membranous nephropathy –granular subendothelial IgG deposits.
d- IgA nephropathy – mesangial IgA deposition.
e- Type II membranoproliferative glomerulonephritis – intramembranous dense
deposits.
Q42: IgA nephropathy, the followings indicate a bad prognosis, except:
a- Male gender.
b- Presence of hypertension.
c- Absence of hematuria.
d- Presence of renal impairment.
e- Persistent proteinuria.
Q43: Chronic interstitial nephritis may be caused by all of the followings, except:
a- Chronic exposure to ochratoxin.
b- Chronic exposure to aristolochic acid.
c- Wilson's disease.
d- Hanta virus infection.
e- Chronic ingestion of phenacetin.

Q44: In acute interstitial nephritis, all of the followings are true, except:
a- The commonest cause is drug induced.
b- Blood eosinophila is seen only in 30 % of cases.
c- Should be suspected in any non-oliguric acute renal failure.
d- The predominant infiltration of the tubulo-interstitial areas with eosinophils on
renal biopsy is more suggestive of a viral etiology.
e- The majority of drug induced acute interstitial nephritides will recover following
drug withdrawal.
Q45: Recurrent urinary tract infection (UTI) is common in adult females. The
followings are prophylactic measures adopted by females against recurrent UTI,
except:
a- A fluid intake of at least 2 liters per day.
b- Regular emptying of the urinary bladder.
c- Local application of an antiseptic like cetrimide cream to the periurethral area
before intercourse.
d- Urinary bladder emptying before and after intercourse.
d- Double micturition will worsen reflux nephropathy.
Q46: Indications for intervention in renal calculi:
a- If the patient is anuric.
b- The presence of an infection upstream.
c- A large stone that is unlikely to pass.
d- Total obstruction of the pelvi-ureteric junction.
e- The presence of a radiolucent stone.
Q47: Risk factors for renal stone formation all are true except
1- hypercalciuria
2- hyperoxaluria
3- hypercitraturia
4- hyperuricosuria
5 cystinuria
Q48: In renal cell carcinoma, all of the followings are true, except:

a- Hematuria is the commonest symptom.
b- 30% of cases present due to systemic metabolic effect of the tumor like fever,
hypertension and abnormal liver function tests.
c- Raised ESR is seen in 50% of cases while amyloidosis is seen in only 2% of cases.
d- During surgical removal, the adrenal gland and local lymph nodes should be
removed as well.
e- Radiotherapy is very effective in the treatment.
Q49: In Renal cell carcinoma, all of the followings are true, except:
1- More common in males.
2- Adenocarcinoma is the commonest type.
3- The tumor is vascular and spread to the lungs and bones.
4- The tumor may be multicentric and or bilateral in some patients like Von Hippel
Lindau.
5- The tumor may enlarge upon administration of progestins.
Q50: In Drug and toxin induced renal disease, the following associations are
true, except:
a- NSAIDS and minimal change nephropathy.
b- Cyclosporin and chronic interstitial nephritis.
c- Lithium and nephrogenic diabetes insipidus.
d- Cisplatin and renal loss of sodium.
e- Acyclovir and crystal formation inside tubules.
Q51: In Glomerulopathies, all of the followings are true, except:
a- Minimal change disease is associated with HLD DR7, atopy, and certain
medications.
b- Membranous nephropathy is associated with HLA DR3, certain medications, and
heavy metal poisoning.
c- Association with liver disease has been documented in IgA nephropathy.
d- Membrano-proliferative glomerulonephritis type I is associated with C3 nephritic
factor and partial lipodystrophy.
e- Focal segmental glomerulosclerosis is associated with obesity, HIV infection, and

heroin abuse.
End of Chapter V
Written By Dr. Osama Amin

All Rights Reserved
Chapter VI/ Electrolyte and Acid-Base Disturbances
Q1: Regarding body water, all of the followings are true, except:
a- In a healthy 65 Kg male, it is about 40 liters in amount.
b- 70 % of total body water is intracellular.
c- 70 % of extra cellular water is in the interstitium.
d- Water moves between different body compartments by an active process.
e- Whole body extra cellular water is about 12 liters.
Q2: All of the following statements are true, except:
a- The tonicity of plasma and interstitial fluids is determined by the concentration of
sodium and chloride.
b- The tonicity of intracellular fluid is determined by the concentration of potassium,
magnesium, phosphate and sulphate.
c- The amount of hydrogen ion in the extra cellular fluid is tiny (about 40nmol/liter).
d- Much of the extra cellular hydrogen ions can be buffered by anionic proteins like
albumin and hemoglobin.
e- The difference in the ionic composition of cells and interstitial fluid is important for
the normal cell function.
Q3: Factors increasing potassium excretion in urine, all of the followings are
true, except:
a- Avid sodium re-absorption.
b- High urinary flow rate.
c- Excess poorly absorbed anions, like ketones and phosphates.
d- A rise in intra tubular potassium e.g. alkalosis.
e- A fall in intracellular potassium e.g. acidosis.
Q4: In the proximal convoluted tubules of the nephron, all of the followings are

true, except:
a- 90% of the filtered sodium is reabsorbed.
b- 80-90% of the filtered potassium is reabsorbed.
c- 90% of the filtered bicarbonate is reabsorbed.
d- 99% of the filtered glucose is reabsorbed.
e- 99% of the filtered amino acids are reabsorbed.
Q5: Regulation of water excretion by the kidney, all of the followings are true,
except:
a- In the presence of ADH, the collecting duct becomes more permeable to water.
b- In the absence of ADH, the distal nephron is almost impermeable to water.
c- About 95% of the filtered water is reabsorbed with an equivalent amount of sodium
in the proximal tubule.
d- ADH binds to V2 receptors in the distal nephron to enhance the passive movement
of water.
e- In the thick ascending limb of loop of Henle, sodium and chloride are preferably
absorbed without water and hence called the diluting segment.
Q6: Drugs which cause sodium retention, all of the followings are true, except:
a- Corticosteroids.
b- Liquorice.
c- Carbenoxolone.
d- Estrogens.
e- Ethacrynic acid.
Q7: Causes of diuretic resistance, all of the followings are true, except:
a- Profound hypoproteinemia.
b- Volume contraction.
c- Reduced renal function.
d- Secondary aldosteronism.
e- When given in low doses.
Q8: Etiology of hyponatraemia associated with LOW extra cellular fluid volume,
all of the followings are true, except:

a- Salt losing renal disease.
b- Adrenal failure.
c- Liver cirrhosis.
d- Extensive burns.
e- Cardiac failure.
Q10: Causes of SIADH (syndrome of inappropriate secretion of ADH), all of the
followings are true, except:
1- Morphine.
2- Cigarette smoking.
3- Alcohol.
4- Amitryptilin.
5- Clofibrate.
Q11: The following lab findings are consistent with SIADH (syndrome of
inappropriate secretion of ADH), except:
a- Plasma osmolality of 260 mosm / Kg.
b- Serum sodium of 115 mmol / L.
c- Urine osmolality of 100 mosm / Kg.
d- Blood urea of 2.5 mmo l/ L.
e- Plasma potassium 3.5 mmol / L.
Q12: Drug induced hyperkalemnia, all of the followings are true, except:
a- Digoxin toxicity.
b- Cyclosporin.
c- Heparin.
d- Beta agonists.
e- ACE inhibitors.
Q13: The followings are true regarding the treatment of hyperkalemia, except:
a- Bicarbonate infusion reduces serum potassium by 1-1.5 meq / L.
b- Glucose and insulin infusion policy reduces serum potassium by 0.6-1.2 meq / L.
c- Calcium gluconate infusion does not reduce serum potassium.
d- Calcium resonium is not used in acute hyperkalemia treatment.

e- Beta agonists' infusion may be additive or alternative to glucose and insulin policy.
Q14: Complications of severe hypophosphatemia, all of the followings are true,
except:
a- Increased serum CPK enzyme.
b- Respiratory muscle weakness.
c- Intra-vascular hemolysis.
d- Hypocalciuria.
e- Cardiac dysrrhythmias.
Q15: Causes of hypophosphatemia, all of the followings are true, except:
a- Chronic alcoholism.
b- Alcohol withdrawal.
c- Peritoneal dialysis.
d- Hemodialysis.
e- Extra cellular fluid contraction.
Q16: Causes of hypomagnesaemia, all of the followings are true, except:
a- Gitelman's syndrome.
b- Post-obstructive diuresis.
c- Acute pancreatitis.
d- Protracted vomiting.
e- Treatment with spironolactone.
Q17: Causes of normal anion gap metabolic acidosis, all of the followings are
true, except:
a- Treatment of glaucoma.
b- After radical surgery of urinary bladder cancer.
c- Ingestion of arginin hydrochloride.
d- Renal tubular acidosis type IV.
e- Advanced diabetic ketoacidosis (DKA).
Q18: Causes of high anion gap metabolic acidosis with their corresponding
accumulating compounds, all of the followings statements are true, except:
a- Methanol poisoning- accumulation of formic acid.

b- Lactic acidosis- accumulation of lactic acid.
c- Ketoacidosis- accumulation of acetoacetic acid and beta hydroxybutyrate.
d- Ethylene glycol poisoning – accumulation of formic acid.
e- Chronic renal failure – accumulation of phosphoric acid and sulphuric acid.
Q19: Causes of lactic acidosis type A, all of the followings are true, except:
a- Septic shock.
b- Severe anemia.
c- Metformin.
d- Cyanide poisoning.
e- Respiratory failure.
Q20: Causes of respiratory alkalosis, all of the followings are true, except:
a- Assisted ventilation.
b- Salisylate poisoning.
c- Hysterical over breathing.
d- Lobar pneumonia.
e- Protracted vomiting.
END of Chapter VI
Written By Dr. Osama Amin

All Rights Reserved
Chapter VII / Endocrinology
Q1: When we are trying to investigate the endocrine system for a disease, the
followings are true, except:
a- The release of many hormones is pulsatile, so a random blood sample is usually
useless.
2- Many endocrine glands have what is called incidentalomas.
3- Many endocrine tumors are difficult to classify as being malignant or benign
during histopathological examination.
4- If you suspect a hormonal excess then choose a suppression test.
5- Endocrinal abnormalities are rarely characterized by loss of normal regulation of

hormonal secretion.
Q2: When dealing with a pituitary tumor, the followings are true, except:
a- Is a very rare a cause of hydrocephalus.
b- May be an incidental finding on brain MRI done for another reason.
c- Rarely, there is a downward extension, and hence may be seen as a nasal polyp.
d- May produce a hypothalamic syndrome by an upward extension.
e- Pituitary apoplexy is usually asymptomatic.
Q3: Surgical treatment is usually considered to be a first line treatment for the
following pituitary / hypothalamic tumors, except:
a- Non-functioning pituitary macro adenoma.
b- Craniopharyngioma.
c- Cushing's disease.
d- micro-prolactinoma.
e- Acromegally.
Q4: Causes of Hyperprolactinemia, all of the followings are true, except:
a- Stress.
b- Primary hypothyroidism.
c- Chronic renal failure.
d- Chronic chest wall stimulation.
e- Treatment with pergolide.
Q5: Treatment of prolactinomas, all of the followings are true, except:
a- Treatment with dopamine agonists, is almost always effective in normalizing
prolactine level and restoration of gonadal function.
b- After menopause, treatment of microprolactinomas is only indicated if there was a
trouble some galactorrhea, otherwise can be left untreated.
c- Trans-sphnenoidal surgery has a success rate approaching 80%.
d- Macroprolactninomas may enlarge rapidly during pregnancy and hence
bromocyptin should be continued despite pregnancy with close follow up during the
whole pregnancy.
e- External irradiation is a useful first line treatment in the majority of patients

Q6: Acromegaly, all of the followings are true, except:
a- Although glucose intolerance is seen in 25% of cases, yet overt diabetes mellitus is
seen only in 10% of cases.
b- There is a 2-3 folds increase in the relative risk of colonic cancer and coronary
artery disease.
c- Trans-sphenoidal surgery as a treatment option has a high success rate.
d- A dopamine agonist may be used in those with co-existent hyperprolactinemia
because it is generally less effective than octreotide.
e- External irradiation has a good rapid action against the tumor.
Q7: A random blood sample for growth hormone (GH) assessment in a
suspected deficiency state is useless because it is commonly undetectable , so
there are several " tricks " to collect a blood sample for GH assessment, all of the
following tricks are true, except:
a- Sampling before exercise.
b- Frequent sampling during sleep.
c- Sampling 1 hour after going asleep.
d- Sampling during an insulin induced hypoglycemia.
e- Sampling after stimulation with arginine.
Q8: ACTH stimulation test, all of the followings are true, except:
a- Used in the diagnosis of primary and secondary adrenal insufficiency.
b- The 250 microgram tetracosactrin injection should be given in the early morning.
c- Relies upon ACTH dependent adrenal atrophy in secondary adrenal failure.
d- Normally, after 30 minutes the blood cortisol should be above 550 nmol/ L.
e- Usually useless in adrenal failure secondary to acute ACTH deficiency.
Q10: Panhypopituitarism , all of the followings are true, except:
a- There is a striking pallor.
b- Growth hormone is usually the earliest hormone to be lost.
c- Coma is multi-factorial and may be due to water intoxication, hypoglycemia, or
hypothermia.
d- The skin is smooth with a baby like texture.

e- Serum TSH should be measured to assess the optimal T4 replacement dose.
Q11: Insulin tolerance test, all of the followings are true, except:
a- Used in the assessment of hypothalamic pituitary adrenal axis.
b- Contraindicated in ischemic heart disease and epilepsy.
c- The aim of the test is to produce signs of hypoglycemia with a glucose level below
2.2 mmol / L.
d- We should take serial blood samples of glucose, GH, and cortisol.
e- The usual dose used in the test is NPH insulin 0.15 u/kg given subcutaneously.
Q12: Water deprivation test for a suspected diabetes insipidus, all of the
followings are true, except:
a -It is used in the diagnosis of diabetes insipidus (DI) and to differentiate between
cranial and nephrogenic DI.
b- There should be no coffee, tea, or smoking on the test day.
c- The test should be stopped if the patient loses 3% of his body weight.
d- When trying to differentiate DI from compulsive water drinking, DDAVP is very
useful and should always be used.
e- If the initial urinary osmilality is 700 mosm / kg the test should be stopped and DI
is excluded.
Q13: Hyperthyroidism, all of the followings are true, except:
a- The commonest cause is Grave's disease.
b- If there is prominent anorexia, a malignant cause should be suspected.
c- vitilligo and lymphadenopathy goes more with Grave's disease than other
etiologies.
4- Apathy and osteoporosis are mainly seen in elderly patients.
5- Pruritis, palmar erythema, and spider nevi are more suggestive of an associated
chronic active hepatitis.
Q14: Non specific biochemical abnormalities in thurotoxicosis , all are true
except
a- Raised alkaline phosphatase.
b- Raised ALT and AST.

c- Hypercalcemia is usually seen in 50% of cases.
d- Glycosuria.
e- Raised gamma GT in the absence of enzyme-inducing drugs or alcoholism.
Q15: Treatment of thyrotoxicosis, all of the followings are true, except:
a- Following successful treatment with carbimazole, up 50% will relapse following
drug stoppage.
b- Subtotal thyroidectomy is contraindicated in those with previous thyroid surgery.
c- Radio-iodine is contraindicated in pregnancy.
d- Following subtotal thyroidectomy, up to 50% will develop permanent
hypocalcaemia.
e- Following treatment with radio-iodine, up to 80% will develop permanent
hypothyroidism after 15 years.
Q16: Subacute thyroiditis, all of the followings are true, except:
a- Usually virally induced.
b- There is anterior neck pain worsened by coughing.
c- The ESR is usually normal.
d- Usually responds well to treatment with non steroidal anti inflammatory drugs.
e- The hyperthyroidism per se is usually mild and no treatment is needed for it.
Q17: Factitious hyperthyrosidism , all of the followings are true, except:
a- It is an uncommon condition due to self administration of T4.
b- The radio-iodine uptake scan is suppressed.
c- Undetectable serum thyroglobulin.
d- High T3:T4 ratio.
e- The TSH is suppressed.
Q18: Post-partum thyroiditis, all of the followings are true, except:
a- Occurs in 5-10% of women in the first 6 months following delivery.
b- Thyroid biopsy shows lymphocytic thyroiditis.
c- It tends to recur after subsequent pregnancies.
d- There is an association between post partum depression and post partum
thyoriditis.

e- There is a negligible radio-iodine thyroid scan.
Q19: Hyperthyroid crisis, all of the followings are true, except:
a- The commonest precipitation factor is an infection in a previously undiagnosed or
improperly treated hyperthyroidism patient.
b- Although being a life threatening increase in the activity of the thyoird gland,
fortunately in clinical practice it is rare.
c- Re-hydration and broad spectrum antibiotics are important in the management.
d- If the patient can not swallow carbimazole, then it should be given intravenously.
e- After 10-14 days of treatments with various antithyroid measures, sodium iopodate
and propraanolol can be stopped
Q20: The causes of goitrous hypothyroidism, all of the followings are true,
except:
a- Hashimoto thyroiditis.
b- Dyshormonogenesis.
c- Drug induced hypothyroidism.
d- Iodine deficiency.
e- Post-ablative hypothyroidism.
Q21: Rare, but well recognized features of hypothyroidism, all of the followings
are true, except:
a- Frank psychosis.
b- Myotonia.
c- Ascites.
d- Ileus.
e- Iron deficiency anemia.
Q22: Biochemical findings that are useful in the assessment of hypothyroidism,
all of the followings are true, except:
a- Raised serum LDH and CPK enzymes.
b- Raised cholesterol and triglycerides.
c- Macrocytic anemia.
d- Low serum T3 level.

e- Raised TSH.
Q23: During treatment and follow ups of a patient with hypothyroidism, all of
the followings are true, except:
a- Oral T4 is the cornerstone of treatment.
b- The correct dose of thyroxin is that which restores the serum TSH to normal.
c- The patient usually feels better after 2-3 weeks.
d- Restoration of skin and hair texture is usually seen after 3 weeks.
e- Elderly patients should be started on a low dose thyroxin with gradual escalation.
Q24: Myxoedema coma, all of the followings are true, except:
a- Unfortunately the mortality rate is 50%, but fortunately the condition is rare.
b- Convulsions are not uncommon, and opening CSF pressure may be raised.
c- It is a medical emergency and treatment must be started before the biochemical
confirmation.
d- Unless there is an evidence of primary hypothyroidism like thyroid scar , it should
be considered to be secondary to pituitary or hypothalamic dysfunction.
e- Thyroxin should be given intravenously.
Q25: During follow up of a patient treated by oral thyroxin for hypothyroidism,
all of the followings are true, except:
a- It is important to ensure compliance and the drug should be taken infinitely.
b- Once the dose of thyroxin is stabilized based on serum TSH, the TSH and T4
should be measure every 1-2 years.
c- During a visit, the combination of raised serum T4 and high TSH indicates a strict
compliance.
d- Some patients may take thyroxin erratically when they know that the half life is
long.
e- Excessive sweating, tachycardia, and anxiety may indicate over treatment.
Q26: Medications that affect thyroid hormones, all of the followings are true,
except:
a- Amiodarone may cause hypo or hyperthyroidism.
b- Lithium may cause hypothyroidism.

c- Potassium iodide may cause hypothyrodism.
d- Phenytoin may decrease the needed dose of thyroxin.
e- Oral contraceptive pills may increase the total but not the free thyroxin.
Answer: e
Phneytoin is an enzyme inducer, so the dose of thyroxin may need to be increased in
hypothyroidism and concomitant use of phenytoin.
Q27: Causes of obesity, all of the followings are true, except:
a- Cushing's disease.
b- Kallaman's syndrome.
c- Prader Willi syndrome.
d- Hypothalamic tumors.
e- Gastric tumors.
Q28: Thyroid carcinomas, all of the followings are true, except:
a- Each type usually has a certain age group to affect.
b- Papillary carcinoma is the commonest type.
c- Some tumors are TSH dependent.
d- Follicular carcinoma can be diagnosed easily by FNA cytology.
e- Very rarely thyrotoxicosis is seen.
Q29: Thyroid malignancy, all of the followings are true, except:
a- Papillary carcinomas usually seen between 20-40 years of age.
b- Medullary thyroid carcinoma in a 20 year old man may indicate MEN type II.
c- Anaplastic carcinomas usually seen in elderly people.
d- Thyroid lymphomas may arise from a preexistent Hashimoto's thyroiditis.
e- Secondary tumors to the thyroid gland are very commonly seen.
Answer: e
Secondary tumors are rarely seen.
Q30: Medullary thyroid carcinoma, all of the followings are true, except:
a- The prognosis is generally poor when compared with differentiated thyroid
carcinomas.
b- When seen in a young person, it may be part of MEN type 1.

c- As a treatment option, total thyroidectomy is preferred.
d- High level of calcitonin, rarely if ever causes hypocalcemia.
e- The tumor secreting cells do not respond to radio-iodine treatment.
Q31: Primary Hyperparathyroidism, all of the followings are true, except:
a- The commonest cause is a single parathyroid adenoma.
b- The commonest cause of asymptomatic hypercalcemia in outpatients.
c- Together with malignancy, they both account for up to 90% of cases of
hypercalcemia.
d- Lithium induced hyperparathyroidism may present as a primary
hyperparathyroidism-like picture.
e-The parathyroids are usually palpable in the neck.
Q32: Causes of hypercalcemia with raised level of parathyroid hormone, all of
the followings are true, except:
a- Primary hyperparathyroidism.
b- Tertiary hyperparathyroidism.
c- Lithum-induced hyperparathyroidism.
d- Familial hypocalciuric hypercalcemia.
e- Metastatic bone malignancy.
Q33: Treatment of malignancy associated hypercalcemia, all of the followings
are true, except:
a- IV fluids have a very important role in the treatment.
b-In the presence of very high calcium levels, iv pamidronate is given initially
with excellent results.
c- Forced diuresis may be used.
d- Like primary hyperparathyroidism, glucocorticoids are very effective ar
reducing the serum calcium level.
e- In resistent cases, there is a place for hemodialysis.
Q34: Long term Hypocalcemia , all are true except
a- May be seen in peudopseudohypoparathyroidism.
b- May be a cause of cataract.

c- Basal ganglia calcification is seen.
d- Papilloedema has been documented.
e- Chronic mucocutaneous candidiasis is an association.
Q35: Causes of hypocalcemia and hyperphosphatemia, all of the followings are
true, except:
a- Chronic renal failure.
b- Hypoparathyroidism.
c- Pseudohypoparathyroidism.
d- Hypomagnesemia.
e- Pseudopseudohypoparathryoidism.
Q36: Hypocalcemia, all of the followings are true, except: