Internal Medicine/ Clinical Chemistry

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  1. Chemistry.
     

  1. Electrolyte Physiology & the Kidney.
    ***) Renin is secreted by:

  1. Cells in the macula densa
  2. Cells in the proximal tubules
  3. Cells in the renal glomeruli
  4. Juxtaglomerular apparatus
  5. Renal medullary cells
     
    Answer: D* Juxtaglomerular apparatus
     

  1. Acid-Base Balance.
    ***) 35 years old male presented with dyspnea (history of arthritis), ABGs showed pH 7.2, CO2 23, HCO3 12, Na 140, Cl 103, K 4.1. The acid base imbalance is: Q2012

  1. Metabolic acidosis
  2. Metabolic acidosis and respiratory alkalosis
  3. Metabolic alkalosis and respiratory acidosis
  4. Metabolic acidosis and respiratory acidosis
  5. Normal ABG
     
    Answer: B* Metabolic acidosis and respiratory alkalosis
     
    ***) ABGs showed pH 7.2, PCO2 23, HCO3 16, PO2 85. The acid base imbalance is: Q2012

  1. Metabolic alkalosis and respiratory acidosis
  2. Metabolic acidosis and respiratory alkalosis
  3. Metabolic alkalosis and respiratory alkalosis
  4. Normal ABG
  5. Metabolic acidosis and respiratory acidosis
     
    Answer: B* Metabolic acidosis and respiratory alkalosis
     
    ***) In a patient with metabolic acidosis, Serum bicarbonate 10, Sodium 130, Calcium 110, Blood glucose 79, Urea 20, the anion gap in this patient is:

  1. 5
  2. 10
  3. 15
  4. 20
  5. 25
     
    Answer: B* 10
     
    ***) All of the following can cause metabolic acidosis with anion gap, except: Q2012

  1. Renal failure
  2. Diabetic ketoacidosis
  3. Lactic acidosis
  4. Aspirin overdose
  5. Renal tubular acidosis
     
    Answer: E* Renal tubular acidosis
     
    ***) All of the following are causes of metabolic acidosis, except:

  1. Diabetic ketoacidosis
  2. Alcohol poisoning
  3. Uremia
  4. Lactic acidosis
  5. Vomiting
     
    Answer: E* Vomiting
     
    ***) All of the following are causes of metabolic acidosis, except:

  1. Salicylate poisoning
  2. Metformin
  3. Insulin deficiency
  4. Diarrhea
  5. Loop diuretics
     
    Answer: E* Loop diuretics
     
    ***) All of the following are causes of metabolic acidosis, except:

  1. Acute renal failure
  2. Pyloric obstruction
  3. Shock states and cardiac arrest
  4. Small intestinal fistula
  5. Ulcerative colitis
     
    Answer: B* Pyloric obstruction
     
    ***) Metabolic acidosis may be seen in all of the following, except:

  1. Uretero-enterostomy
  2. Renal insufficiency
  3. Carbon monoxide poisoning
  4. Pyloric stenosis
  5. Biliary fistula
     
    Answer: D* Pyloric stenosis
     
    ***) Causes of metabolic acidosis include all except:

  1. Hemorrhagic shock
  2. Starvation
  3. Renal failure
  4. Vomiting
  5. Small bowel fistula
     
    Answer: D* Vomiting
     
    ***) Acidosis is found in all of the following, except

  1. Pyloric stenosis
  2. Diabetes mellitus
  3. Severe dehydration
  4. Renal insufficiency
  5. Renal Fanconi's syndrome
     
    Answer: A* Pyloric stenosis
     
    ***) Which of the following is a potential consequence of prolonged diarrhea:

  1. Acidosis
  2. Low hematocrit
  3. Hyperkalemia
  4. Hyponatremia
  5. Hypoglycemia
     
    Answer: A* Acidosis
     
    ***) One of the following causes metabolic alkalosis:

  1. Hyperglycemic diabetic coma
  2. Renal failure
  3. Shock states and cardiac arrest
  4. Pyloric obstruction
  5. Small intestinal fistula
     
    Answer: D* Pyloric obstruction
     
    ***) A 45 years old patient with severe nephritic syndrome is admitted with nausea, fever and vomiting. BP is 90/50 mmHg, HR 110/m, RR 20/m, pH 7.05, PaCO2 32mmHg, Na 132mmol/L, K 4.0mmol/L, Cl 103mmol/L, HCO3 17mmol/L, albumin 1.5g/dl, BUN 20mg/dl, Creatinine 1.4mg/dl. One of the following acid base disorders is present:

  1. Anion gap metabolic acidosis
  2. Non anion gap metabolic acidosis
  3. Non anion gap metabolic acidosis and respiratory alkalosis
  4. Anion and non anion gap metabolic acidosis
  5. None of the above
     
    Answer: C* Non anion gap metabolic acidosis and respiratory alkalosis
     
    ***) Hyperventilation leads to:

  1. Metabolic acidosis
  2. Metabolic alkalosis
  3. Respiratory acidosis
  4. Respiratory alkalosis
  5. Respiratory acidosis with metabolic alkalosis
     
    Answer: D* Respiratory alkalosis
     

  1. Hypernatremia.
    ***) Hypernatremia is known to occur in which of the following: Q2012

  1. Syndrome of Inappropriate ADH Secretion (SIADH)
  2. Diabetes insipidus
  3. Renal failure
  4. Hypothyroidism
  5. Addison's disease
     
    Answer: B* Diabetes insipidus
     
    ***) The Major extracellular cation is:

  1. Na – Sodium
  2. K – Potassium
  3. Mg – Magnesium
  4. HCO3 – Bicarbonate
  5. Cl – Chloride
     
    Answer: A* Na – Sodium
     
    ***) All of the following are common clinical features in cases of severe hyperntremia, except:

  1. Dry mucous membranes
  2. Hypothermia
  3. Delirium
  4. Tachycardia
  5. Hypotension
     
    Answer: B* Hypothermia
     

  1. Hyponatremia.
    ***) Hyponatremia can present with all the following except: Q2012

  1. Restlessness
  2. Headache
  3. Increased appetite
  4. Seizures
  5. Weakness
     
    Answer: C* Increased appetite
     
    ***) All of the following statements are correct about hyponatremia, except:

  1. Sodium serum level of 132mEq/L is considered hyponatremia
  2. It can be a manifestation of adrenogenital syndrome
  3. When correcting hyponatremia, body weight is important in calculating the deficit
  4. Hyponatremia does not cause convulsions
  5. It may associate with inappropriate antidiuretic hormone syndrome
     
    Answer: D* Hyponatremia does not cause convulsions
     
    ***) Concerning hyponatremic dehydration all of the following are true, except:

  1. Serum sodium is over 150mmol/L
  2. Leads to intracellular dehydration
  3. Neurological manifestations may be present
  4. The skin is doughy
  5. Best management is by rapid rehydration
     
    Answer: A* Serum sodium is over 150mmol/L
     

  1. Syndrome of Inappropriate ADH Secretion (SIADH).
    ***) 52 years old male with 20 years history of smoking is admitted to hospital because of cough and weakness. On admission, his serum electrolytes revealed Na 112, K 4.5, Cl 80 and HCO3 26. The BUN was 8, serum creatinine 8, and serum uric acid 3. These data are most consistent with one of the following: Q2012

  1. Addison's disease
  2. Congestive heart failure
  3. Cirrhosis with ascites
  4. SIADH
  5. Myxedema
     
    Answer: D* SIADH
     
    ***) SIADH can present with all the following except: Q2012

  1. Decreased serum osmolality
  2. Decreased serum sodium
  3. Increased urine sodium
  4. Hyperkalemia
  5. Increased urine osmolality
     
    Answer: D* Hyperkalemia
     
    ***) Which of the following statements concerning clinical and laboratory findings in patients with inappropriate secretion of antidiuretic hormone is correct:

  1. High serum sodium
  2. Low urine sodium
  3. Low blood pressure
  4. May lead to seizures
  5. Evidence of dehydration
     
    Answer: D* May lead to seizures
     

  1. Hyperkalemia.
    ***) 50 years old male patient of DM, HTN, IHD, on the following medications, Statin, insulin, beta blocker, and ACE inhibitors started recently. After 2 weeks he presented with weakness, and the labs showed K 7.1, FBS 300, and CPK 300. The most likely cause of hyperkalemia is: Q2012

  1. Hyperglycemia
  2. Rhabdomyolysis due to statins
  3. ACE inhibitors
  4. HTN
  5. IHD
     
    Answer: C* ACE inhibitors
     
    ***) All of the following are used in the treatment of hyperkalemia, except: Q2012

  1. Calcium resonium
  2. Sodium bicarbonate
  3. Amiloride
  4. Salbutamol
  5. Calcium gluconate IV
     
    Answer: C* Amiloride
     
    ***) All of the following can cause coma, except: Q2012

  1. Hyperglycemia
  2. Hypoglycemia
  3. Hypernatremia
  4. Hyponatremia
  5. Hyperkalemia
     
    Answer: E* Hyperkalemia
     
    ***) All of the following are ECG manifestations of hyperkalemia, except: Q2012

  1. Peak T wave
  2. Wide QRS
  3. Prolonged PR
  4. Absent T wave
  5. Ventricular Fibrillation
     
    Answer: D* Absent T wave
     
    ***) Hyperkalemia is known to occur in which of the following:

  1. Hydrochlorothiazide therapy
  2. Propranolol
  3. Captopril
  4. Digoxin
  5. Nifedipine
     
    Answer: C* Captopril
     
    ***) All of the following are causes of hyperkalemia, except:

  1. Spironolactone
  2. Amiloride
  3. Corticosteroids
  4. ACE inhibits
  5. Transfusion of stored blood
     
    Answer: C* Corticosteroids
     
    ***) All of the following are used in the treatment of hyperkalemia, except:

  1. I.V glucose plus soluble insulin
  2. I.V 10% calcium gluconate
  3. I.V sodium bicarbonate
  4. Dialysis
  5. Amiloride
     
    Answer: E* Amiloride
     
    ***) The management of hyperkalemia includes all of the following, except:

  1. IV calcium gluconate
  2. IV glucose and insulin
  3. IV ammonium chloride
  4. IV furosemide
  5. IV sodium bicarbonate
     
    Answer: C* IV ammonium chloride
     
    ***) The management of hyperkalemia includes all of the following, except:

  1. IV calcium gluconate
  2. IV glucose and insulin
  3. IV Ranger’s lactate
  4. IV furosemide
  5. IV sodium bicarbonate
     
    Answer: C* IV Ranger’s lactate
     

  1. Hypokalemia.
    ***) 55 years old male presented with generalized muscle weakness, he recently started Lasix. The most likely electrolyte disturbance is: Q2012

  1. Hyperkalemia
  2. Hypokalemia
  3. Hypernatremia
  4. Hyponatremia
  5. Hypocalcemia
     
    Answer: B* Hypokalemia
     
    ***) All the following are manifestations of hypokalemia, except:

  1. Intense drowsiness
  2. Muscular weakness
  3. Weak or absent deep tendon reflexes
  4. ECG changes
  5. Intestinal colic
     
    Answer: E* Intestinal colic
     
    ***) All the following are manifestations of hypokalemia, except:

  1. Drowsiness
  2. Muscular hyperreflexia
  3. Listlessness and slurring of speech
  4. Depressed S-T segment in ECG
  5. Sluggish or absent intestinal movements
     
    Answer: B* Muscular hyperreflexia
     
    ***) Hypokalemia is associated to all the following except:

  1. Renal tubular acidosis
  2. Periodic paralysis
  3. Bartter's syndrome
  4. Paralytic ileus
  5. Tumor lysis syndrome
     
    Answer: E* Tumor lysis syndrome
     
    ***) All of the following are causes of hypokalemia, except:

  1. Ulcerative colitis
  2. Villous adenoma of the rectum
  3. Acute renal failure
  4. Small intestinal fistula
  5. Ileostomy
     
    Answer: C* Acute renal failure
     
    ***) All of the following can cause hypokalemia, except:

  1. Vomiting
  2. Chronic laxative ingestion
  3. Cushing's syndrome
  4. Renal failure
  5. Diuretic therapy
     
    Answer: D* Renal failure
     
    ***) All of the following are the causes of hypokalemia, except:

  1. Vomiting and diarrhea
  2. Captopril intake
  3. Cushing's syndrome
  4. Primary hyperaldosteronism
  5. High dose insulin
     
    Answer: B* Captopril intake
     
    ***) Each of the following diuretics can cause hypokalemia, except:

  1. Furosemide
  2. Hydrochlorothiazide
  3. Spironolactone
  4. Ethacrynic acid
  5. Bumetanide
     
    Answer: C* Spironolactone
     

  1. Hypercalcemia.
    ***) All of the following are causes of hypercalcemia, except: Q2012

  1. Acute pancreatitis
  2. Sarcoidosis
  3. Multiple myeloma
  4. Cancer of lungs
  5. Hyperparathyroidism
     
    Answer: A* Acute pancreatitis
     
    ***) Tetany may occur in all of the following, except:

  1. Hyperventilation syndrome
  2. Metabolic alkalosis
  3. Hypocalcemia
  4. Hypomagnesaemia
  5. Hyperkalemia
     
    Answer: E* Hyperkalemia
     
    ***) All of the following are causes of hypercalcemia, except:

  1. Primary hyperparathyroidism
  2. Sarcoidosis
  3. Cancer of lungs
  4. Acute pancreatitis
  5. Hypervitaminosis D
     
    Answer: D* Acute pancreatitis
     
    ***) All of the following are causes of hypercalcemia, except:

  1. Medullary carcinoma of the thyroid
  2. Squamous cell carcinoma of the lung
  3. Milk alkali syndrome
  4. Addison's disease
  5. Thyrotoxicosis
     
    Answer: A* Medullary carcinoma of the thyroid
     
    ***) All of the following are causes of hypercalcemia, except:

  1. Primary hyperparathyroidism
  2. Renal failure
  3. Hypervitaminosis D
  4. Thiazides
  5. Osteomalacia
     
    Answer: E* Osteomalacia
     
    ***) All of the following are causes of hypercalcemia, except:

  1. Acute pancreatitis
  2. Hyperparathyroidism
  3. Hypervitaminosis D
  4. Sarcoidosis
  5. Milk alkali syndrome
     
    Answer: A* Acute pancreatitis
     
    ***) All of the following are causes of hypercalcemia, except:

  1. Myeloma
  2. Thyrotoxicosis
  3. Sarcoidosis
  4. Thiazides
  5. Hypogonadism
     
    Answer: E* Hypogonadism
     
    ***) All of the following are useful in the acute treatment of hypercalcemia, except:

  1. Hydration using intravenous saline solution
  2. Furosemide
  3. Hydrochlorothiazide
  4. Mithramycine
  5. Calcitonin
     
    Answer: C* Hydrochlorothiazide
     

  1. Hypocalcemia.
    ***) All of the following are side effects of furosemide, except: Q2012

  1. Hypokalemia
  2. Hyperuricemia
  3. Hyperglycemia
  4. Ototoxicity
  5. Hypercalcemia
     
    Answer: E* Hypercalcemia
     
    ***) Which of the following causes hypocalcemia:

  1. Osteoporosis
  2. Vitamin D intoxication
  3. Celiac disease
  4. Primary hyperparathyroidism
  5. Acromegaly
     
    Answer: C* Celiac disease
     
    ***) Hypocalcemia is a recognized feature of all of the following conditions, except:

  1. Magnesium deficiency
  2. Exogenous inorganic phosphate excess
  3. Di-George syndrome
  4. Pseudopseudo-hypoparathyroidism
  5. Renal failure
     
    Answer: D* Pseudopseudo-hypoparathyroidism
     
    ***) All of the following are common features of hypocalcemia, except:

  1. Numbness and circumoral tingling
  2. Slow tendon reflexes
  3. Carpopedal spasm
  4. Abdominal cramps
  5. Prolonged S-T interval in ECG
     
    Answer: B* Slow tendon reflexes
     

  1. Pophosphate.
    ***) The serum alkaline phosphatase level is characteristically normal in:

  1. Hemolytic jaundice
  2. Osteomalacia
  3. Osteitis deformans
  4. Hypophosphatasia
  5. Primary hyperparathyroidism
     
    Answer: A* Hemolytic jaundice
     

  1. Urate & the Kidney.
    ***) All of the following are causes of hyperuricemia, except:

  1. High dose aspirin
  2. Chronic renal disease
  3. Hypothyroidism
  4. Alcohol
  5. Leukemia
     
    Answer: C* Hypothyroidism
     
    ***) All of the following are causes of hyperuricemia, except:

  1. Chronic renal failure
  2. Amyloidosis
  3. Leukemia
  4. Carcinoma
  5. Severe psoriasis
     
    Answer: B* Amyloidosis
     

  1. Metabolic Bone Disease.
    ***) All of the following can cause osteoporosis, except:

  1. Inadequate sunlight exposure
  2. Acromegaly
  3. Corticosteroids
  4. Lack of exercise
  5. Smoking
     
    Answer: A* Inadequate sunlight exposure
     
    ***) Recommended treatment for osteoporosis includes all the following except:

  1. Estrogen
  2. Potassium
  3. Exercise
  4. Calcium
  5. Vit D
     
    Answer: B* Potassium

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