Internal Medicine 1-34

1-Check the false answer. Plasma Glucose levels are regulated by

A) Central nervous systemB) Peripheral parasympathetic nervous

systemsC) IncretinsD) CytokinesE) Peripheral sympatheticsystems.

2- One of the factors listed below do not contrıbute to hyperglycernia in Type 2 Diabetes Mellitus

A) Reduced insulin secretionB) Insulin insensitivityC) Decreased glucose utilizationD) Increased glucose productionE) Increased Incretins

3- Check the false statement The destructionof the pancreatic beta cells causes Type I A DM by combination of some factors except one listed below,

A) Genetic backgroundB) Infectious agentsC) Acute or chronic pancreatitisD) Immunologıc factorsE) Environmental

4- One of the following statements is not correct for gestational diabetes mellitus

A) Any degree of glucose intolerance with onset or first recognition during pregnancy is defined as gestational diabetes,

B) Glucose tolerance is worse during the first trimestr because of the stres of anorexia and hyperemesis gravidarum

C) Best glucose tolerance must be achived during gestational diabetes to prevent stillbirths

D) To detect gestational diabetes , fasting plasma glucose levels must be determined in the first clinical examination

E) At least 10-15 % of the gestational diabetic women develop T 2 DM in 10 years or so

5- Chronic Complications of Diabetes mellitus classified as vascular and nonvascular complications. Which one of the listed below pathologyis not a vascular complication of diabetesA) Retinal microaneurismsB) Rubeosis iridisC) Distal symetric NeuropathyD) End stage renal diseaseE) Accelarated Atherosclerosis

6- Check the false statementA) Any mode of therapy does not

prevent the progression of complications when hyperglycemia was started at any point

B) Chronic hyperglycemia is the main responsible factor for Diabetic Microvascular Disease

C) The Duration of hyperglycemia is strongly correlated with the extend and progression of Diabetic Microvascular Disease

D) Magnitude of hyperglycemia correlated with the rate of progression of Diabetic Microvascular Disease

E) Chronic complications are cause of motality and mobidity of diabetes

7- Diabetic nephropathy can be characterized by following 4 appropriate statements. Check the inappropriate statement

A) Clinical microalbuminuriaB) Microalbuminuria slowly

progresses to frank proteinuriaC) Clinical microalbuminuria when

started, progression to frank proteinuria can not be prevented by any measures

D) D – Gradual decline in GFR , eventually leads to renal failure

E) Diabetic nephropathy is a leading cause of End Stage Renal Disease (ESRD) in western societies

8. Check the wrong statement Goals of Diabetic treatment are

a) HbA1c < 7.5%b) Fasting and pre-prandial capilary PGc) ( 70-120 mg/dL )d) 2-h post-prondial <140 mg/dLe) Blood pressure < 130 /80 mmHgf) TG < 150 mg/dL

9. Check the wrong answer Diabetic ketoacidosis defined by

a) Serum osmolalitiy < 320m Osm/kgb) Blood glucose > 250 mg dLc) PH < 7.35d) HCO3 < 25 mg Eq/Le) S osm < 320m Osm/kgf) S osm < 320m Osm/kg

10. Which one of the following is not a precipitating factor for Hyperglycemic hyperosmolar syndrome

a) Acute pulmonary embolism b) Excessive use of sulfonyureasc) Surgeryd) Excessive use of glucocorticoidse) Acute cerebrovascular

11. Check the false statement

a) Hypoglycemia defined as Low Plasma glucose level

b) PG > 70 mg/dl after an overnight fast is normal

c) PG 54-70 mg/ dl suggest hypoglycemia

d) PG < 54mg/ dl indicate postabsorptive hypoglycemia

e) When the person has neurogenic sympoms suggesting hypoglycemiaglucose containing solutions must be given immediately to prevent the detrimental effects of hypoglycemia

12.So many conditions may be responsible from vitamin D deficiency except

a) Older peopleb) B-Obese peoplec) Wearing traditional outfits to prevent

sun exposured) Winter Seasons e) Living in tropical or subtropical

13.Check the statement: Normal aging causes bone loss and fractures because of

a) Vitamin D activitiy decreases with less exposure to sunlight

b) Fat mass decrease, causes swayingc) Dietary calcium intake decreases d) Calcium absorption decreasese) Decreased weight –bearing exercise

14. Which one of the following function is not related to parathormon

a) Stimulate 1.25OH vitamin production in the kidney

b) Stimulate Ca reabsorption from the kidney

c) Inhibite phosphate reabsorption from the kidney

d) Inactivate calcium transport in the intestine

e) Stimulate osteoclastic bone resortion

15.Which of the following best explains the conversion of testosterone to dihydrotestosterone?

a) Neural controlb) Chronotropic controlc) Metabolic controld) Feedback controle) Inhibitary control

16.Radioactive iodine uptake (RAIU) is increased in all of the following except:

a) Iodine deficiencyb) Graves’ diseasec) Postpartum transient thyrotoxicosisd) Toxic multinodular goitere) TSH-secreting

17.Which of the following is not involved in thyroid hormone biosynthesis ?

a) Active iodine transportb) Iodination of thyrosyl residues in

thyroglobulinc) Coupling of iodothyrosyl residues in

thyroyted) Proteolysis ofv thyroglobuline) Intrathyroidal deiodination

18.All the following are features of lipoprotein lipase deficiency except:

a) Xanthomasb) Acute pancreatitisc) Hepatos plenomegalyd) Low levels of plasma chylomicronse) Autosomal recessive inheritance

19. Which effect of leptin is involved in the regulation of body weight?

a) Leptin suppression of a melanocyte-stimulating hormone

b) Leptin suppression of neuropeptide Yc) Leptin suppression of cocaine- and

amphetamine –related transcript d) Meal-induced rises in circulating leptin

levels e) Rise of leptin levels during fasting and

dieting

20. Which of the following is used as definite test for diagnosing hypercortisolism?

a) ACTH stimulation testb) Dexamethasone suppression testc) Metyrapone testd) CRH stimulation test e) Insulin tolerance test

21. Which of the following is used to check the mineralocorticoid reserve of a patient?

a) Sympathetic stimulation b) Cortisone suppression testc) Tilt test d) Atrial natriuretic peptide levele) Upright posture

22. The end product of dopamin metabolis is……...

a) 3- methoxytiramin b) Vanylil- mandelic acid (VMA)c) Chromogranin Ad) Homovanyllic acid e) Thyrosine

23. A 55 year-old patient with paroxysmsof hypertensive attacks attend to the clinic . After 5 minutes rest, his blood pressure is measured as 180/110mm-Hg.Which of the following should not be in the agenda as a diagnostic tool for further evaluation of this patient?

a) Glucagon test

b) Clonidine testc) Phentolamin testd) Plasma metanephrine measurementse) Urinary free catecholamine

measurements

24. Choose the correct statement for primary hyperaldosteronism.

a) Increased whole body potassium content

b) Hypokalemic metabolic alkalosisc) Hypersentivity to ADH actionsd) Extracellular volüme contractione) Massive edema

25. A 23 year old male patient admitted to the out patient clinic with neck pain fever, and palpitation .He had a history of upper respiratory tract infection 10 days ago. On examination body temperature was 39 ◦C, heart rate 110 beats/minand he had pain on examination of the thyroid gland. His sedimenentation rate was 100mm/hr. Which one of the following would you prefer for the patient?

a) Asetilsalisilic acid + Propranololb) Propranolol + Propylthiouracilc) Indometacin + Propranolold) Metimasole + Indometacine) Indometacin + Propylthiouracil

26.In which of the following do we find a decreased Radioactive iodine uptake?

a) Tokic adenomab) Toxic multinodular Goiterc) Graves’ Diseased) TSOmae) Amiodarone

27. Which of the following is the correct answer?

a) Adrenel insufficiency, thyroiditis , and celiac disease can be seen in autoimmune polylandular endocrinopathy type III

b) Caisitonin levels are elevated anaplastic thyroid carsinoma

c) Graves’ disease is an autoimmune disease

d) Thyroid gland vascularity is decreased in amiodarone induced type I thyroiditis

e) Even if the patient is asyptomatic the treatment of goite is always surgery

28- Which of the following is incorrect?

A) IGF-1 is secreted from the liverB) Hypercalciurea is seen in

agromegalic patientsC) Cortisol isn’t supressed after a 1

mg dexamethazone supression test in Cushing’s Disease

D) Surgery is the main treatment in prolactin secreting adenomas

E) Cold intolerance weight gain and constipation is seen in TSH oma patients

29- Which of the following is correct?

A) Inferior rectus and medial rectus muscles are the effected mostly in Graves Orbitopathy and the patient can not look down and medially

B) RAI therapy is the first choice in Grave’s disease

C) Hypokalemin and hyponatremia are seen in Addison’s disease

D) Hyperpigmentation is always seen in adrenal failure

E) Surgery is the first line therapy in Acromegaly

30- Which of the following is not a finding of myxedema?

A) Serum T3 and T4 lowB) Increased creatinin kinase levelC) Normacytic anemiaD) HypernatremiaE) Hypoglycemia

31- In which of the following can we see Cushing Syndrome?

A) Papillary thyroid carsinomaB) Medullary thyroid carsinomaC) Anaplastic thyroid carsinomaD) Follikuler thyroid carsinomaE) Thyroid lymphoma

32- Which of the following is wrong?

A) Prolactinoma is the most commonly seen pituitary adenoma

B) Microadenoma is usually seen in acromegaly

C) Apoplexy is a life threatening disorder

D) Ectopie ACTH producing adenomas are ACTH dependant causes of Cushing’s Syndrome

E) TSOmas are rarely seen

33- Which of the following is not seen in adrenal insuffiency?

A) HypotensionB) HypocalcamiaC) EosinophiliaD) LymphocytosisE) Anemia

34- Which of the following is correct?

A) Macroprolactinoma can be diagnosed by using polyethylen glycol precipitation

B) Macroprolactinemia must always be treated

C) Macroprolactinomas are always treated surgically

D) Prolactinoma may cause primary osteoporosis

E) Oral contraceptives containing estrogen may cause hyperprolactinemia

Patology 35-44

35- Which of the following thyroid diseases is most likely to show hurthle cell transformation?

A) Toxic nodular goiterB) Hashimoto thyroiditisC) Thyroid papillary carcinomaD) Reidel thyroiditisE) Subacute granulomatous thyroiditis

36- A 44 year old woman has noted enlargement of her anterior neck region over the past 6 months. On physical examination, a nodul found in the left lobe of the thyroid gland.She is taken to surgery and a thyroidectomy is periomed. Thyroid sections showed a malignant neoplasm

composed of polygonal cells in nests. Immunostaining for calcitonin of the sections is positive, and the neoplasm has an amyloid stroma with Congo red staining.Which of the following neoplasms is the most likely to have?

A) PapillarycarcinomaB) Follıcular carcinomaC) Modullary carcinomaD) Anaplastic carcinomaE) Metastatic carcinoma

37- Which of the following feature is characterstic for thyroid follicular carcinoma?A) Nuclear pleomorphismB) NecrosisC) PseudoinclusionD) Capsular invasionE) Mitosis

38- Which of the following feature is not characteristic for parathyroid adenoma?

A) All glands are affectedB) Atrophy or compression of

parathyroid parenchymaC) Solitary massD) EncapsulationE) Fatless module

39- Which of the following genetic alterations is most likely to cause papillary carcinoma of the thyroid?

A) PAX8-PPARG gene arrangementB) BRAF point mutationC) Ras point mutationD) Myc mutationE) C-KİT mutation

40- Which of the following complication of diabetes mellitus is not related to polyol pathway?

A) Osmotic cell injuryB) Retinal microaneurysmsC) Myocardial infarctionD) CataractsE) Neuropathy

41- Which of the following is not correct for pancreatic endocrine neoplasms?

A) They show evidence of endocrine cell differentiation

B) They have a propensity to elaborate pancreatic hormones

C) Lymph node metastasis is a criterion of malignancy

D) Most tumors are composed of delta cell type

E) The diagnosis of the cell type is possible by immunohistochemical staining

42- Which of the following is not a cause of hyperprolactinemia?

A) Injury to the hypothalamusB) PregnancyC) Renal failureD) Dopamine receptor agonistsE) Pituitary adenoma

43- Which of the following features is the most reliable indicator of malignancy for an adrenocortical neoplasm?

A) Nuclear pleomorphismB) Size of tumorC) Increased mitosisD) Invasion of the adjacent tissueE) Necrosis

44- Which of the following diseases is not cause of a chronic type adrenal insufficiency?

A) Disseminated Mycobacterium tuberculosis

B) HemochromatosisC) Systemic amyloidosisD) Autoimmune adrenalitisE) Waterhouse-Friderichien syndrome

Pediatrics 45-56

45- Mark the incorrect answer

A) Hypothalamus consist of a group of nuclei present in the floor of fourth ventriele

B) Endocrine system controls numerous body processes such as growth metabolism e.g.

C) In humans , neurosecretory cells are found in the hypothalamus

D) Hypothalamic hormones can have effect of stimulating or inhibiting the release of anterior pituitary hormones

E) Oxytocin and Vasopressin are manifactured in the hypothalamus, but released in the posterior pituitary.

46- Mark the incorrect answerA) Anterior pituitary gland makes up

20% of the pituitary glandB) Hypopituitarm results from failure

of the anterior pituitary gland to produce one or more of its hormones

C) Acquired causes of hypopituitarism are tumors, neurosurgery and radiotherapy

D) Some of the clinical manifestations of hypopituitarsm at neonatal period are breech presentation, hypoglycemia, micropenis, undercended testes, midline defects

E) Prolactinomas are rare in childhood

47- Which one is incorrect for Diabetes Insipidus?

A) Decreased amount or action of vasopressin

B) Volume of urine = 1L / m2/ day in children

C) Polyuria ,nocturia, polydipsiaD) Decreased urine osmolality(< 300 m

Osmol/kg)E) Increased plasma osmolality,

hypernatremia48- Which one is incorrect for risk factors of obesity?

A) Birth weightB) Early infant feedingC) Race/ ethnicityD) Parental obesityE) Increased physical activity

49- Which one is the first sign of pubertal development in boys?

A) Appearance of pubic hairB) AcneC) Testicular enlargementD) Voice changeE) Penile enlargement

50-Which age is the border of precocious puberty for girls and boys?

A) Girls 8 years of age,boys 9 years of age

B) Girls 9 years of age,boys 10 years of age

C) Girls 10 years of age,boys 11 years of age

D) Girls 7 years of age,boys 8 years of age

E) Girls 11 years of age,boys 12 years of age

51-Mark the incorrect answer for sexual differentiation

A) Genetic sex is determined at fertilization

B) Gonadal sex is determined by genetic sex

C) Presence of SRY gene is important for gonadal differentiation into testes

D) Mullerian inhibiting factor (MIF,AMH) is secreted by Leydig cells, causes regression of Mullerian ducts (ipsilateraly)

E) If testes, DHT, and androgen receptor present: differentiation into male external genitalia completed by 16 weeks.

52- Seven days old baby with increased pigmentation, enlarged clitoris , gonads nonpalpabl, uterus presence at USG and 17 OH Progesterone, is very high. What is your probable diagnosis?

A) 46, XX, 21 OH deficiencyB) 46, XY, gonadal disgenesisC) 46, XY, Inborn errors of testosterone

biosynthesisD) 46, XY, AISE) 46, XY, 17 OH deficiency

53- Which one is correct for labarotary findings of 21 OH deficiency

A) ACTH, 17 OH Progesterone, serum Na, K are high

B) ACTH, 17 OH Pregesterone, serum K are high, serum Na is low

C) ACTH, 17 OH Progesterone, serum Na are high, serum K is low

D) ACTH is low, 17 OH Progesterone, serum Na, K are high

E) ACTH and 17 OH Progesterone are high, serum Na and K are low

54- Mark the incorrect answer for Diabetes Mellitus

A) Early sign and symptoms of Diabetes Mellitus are polydipsia, polyuria, lethargy weakness and weight loss

B) Fasting glucose target for diabetes management is 90-130 mg/dl

C) Hb A 1c reflects the average blood glucose during the previous 4-6 months

D) Symptoms of diabetes + casual plasma glucose concentration ≥ 200 mg/dl

E) Symptoms of diabetes + fasting plasma glucose concentration ≥ 126 mg/dl

55- Mark the incorrect answer for bone health

A) The skeleton is essential to protection of the body organs and to movement

B) The skeleton is a reserve source of the minerals such as calcium, phosphate

C) The diaphysis consist of trabecular bone

D) Bone mass is composed of organic matrix (osteoid) , minerals and different cells

E) The accumulation and maintenance of the substance of bone is the result of a continuous process of formation, predominantly mediated by osteoblast, and resorption, facilitated by osteoblast

56- Mark the incorrect answer for osteoporosis

A) Osteoporosis is defined by WHO as a systemic skeletal disorder characterised by low bone mass and micro- architectural deterioraton of bone fragility and susceptibility to fracture precursor of osteoporosis

B) There is now increasing evidence that the roots of osteoporosis lie in childhood

C) Osteogenesis imperfecta is a primary osteoporosis desease

D) Hyperthyroidism is a risk factor for osteoporosis

Pharmacology 57- 64

57- A glucocorticoid exhibiting equal anti-inflammatory and salt- retaining activities is:

A) PrednisoloneB) CortisolC) FlurocortisoneD) DexamethasoneE) Deoxycorticosterone

58- A type 2 diabetic patient is under metformin treatment for sometime. Which of the following unwanted effects would likely be occur:

A) HypoglycemiaB) Persistent diarrheaC) Heart failure

D) Weight gainE) Fluid retention

59- All of the following are physiological actions of insulin,except

A) Increased triglyceride synthesis in adipocytes

B) Decreased hormone –dependent lipase activity in adipocytes

C) Decreased ketone synthesis in liverD) Increased glycogenolysis in liverE) Decreased gluconeogenesis in liver

60- Concerning antithyroid drugs , all of the below statements are true except:

A) Propranolol inhibits conversion of T 4 to reserve T 3

B) Thiocyanide blocks active transport of iodine

C) Thionamides block hormone synthesisD) Iodides block hormone releaseE) Propylthiouracil inhibits peripheral

deiodination of T 4

61- Which of the following is released from hypothalamus:

A) EndorphinB) ProlactinC) SomatostatinD) Luteinizing hormoneE) Growth hormone

62- In a patient underbiphosphanate treatment all of the following unwanted efects may occur, except:

A) Musculoskeletal painB) NephrolithiasisC) Peptic ulcerD) HypocalcemiaE) Esophagitis

63- Select the wrong pair for hormone – primary target organ matches:

A) Growth hormone-liverB) Insulin- Skeletal muscleC) FSH – Leiding cellsD) Parathormone – jejunumE) Aldosterone –renal tubule

64. Administration of which of the following agents would significantly affevt the blood levels of orally-administered glucocorticoids ( e.g.cortisol) ?

a) Insulin b) Furosemudec) Phenobarbital

d) Aleminum hydroxidee) Alendronate

Radiology

65.Select correct phrases :

I. Adenomas are the most common tumors of the adrenal glands .

II. The size and fat content of the adrenal tumors are the major criteria for differential diagnosis.

III. Computed tomography is capable to identify macroscopic fat of the adrenal tumors.

IV. Magnetic resonance imaging can identify intracellular fat of the tumors.

V. Intracellular fat is commonly seen in adrenal adenomas.

A) I,II B) I-III C) I-IV D) I-V E) II-V

Nuclear Medicine66. Which of the following radiopharmaceuticals is used for dual-phase parathyroid scintigraphy?

a) Tc99m - M1B1 b) In111 - Octreotidec) 1 - 131d) 1 - 123e) Tc99m - (V) – DMSA

General Surgery

67.which of the statements given below regarding thyroid surgery is not correct?

a) Goiter is chronic enlargement of the thyroid gland not due to neoplasm

b) Goiter is not a definition associated with the functional status of thyroid gland . The patient with a goiter can be either toxic (hyperthyroid) or non toxic ( hypo or euthyroid )

c) The term thyroid nodule refers to any abnormal growth of thyroid cells into a lump within the thyroid

d) Most of the thyroid nodules are malignant and should be removed surgically

e) Fine needle aspiration cytology (FNAC) is a useful tool for evaluating thyroid nodules.