26- Which of the following features would be expected on lipid analysis in a 57 year old female with two year history of primary biliary cirrhosis?
1) A lipaemic appearance of the serum would be expected.
2) is treated with clofibrate therapy
3) is characteristically associated with tendon xanthomas
4) is characteristically associated with palmar xanthomas
5) No evidence of a dyslipidaemia would be expected with this short a duration of disease
Answers-4
In prolonged cholestasis features include: increased serum cholesterol, a moderate increase in triglyceride, the serum is not lipaemic, and reduced HDL levels. Clinical features include: palmar xanthomas; tuberous xanthomas (particularly on extensor surfaces); tendinous xanthomas are rare. Xanthomas usually only occur if
cholestasis has persisted for more than 3 months sometimes fat deposits may involve bone and peripheral nerves.
27- Which of the following is associated with Hyperuricaemia?
1) is usually due to an excess purine consumption
2) occurs in association with acute lymphoblastic leukaemia
3) in primary gout is inherited in an autosomal dominant manner
4) can be reduced with low dose aspirin therapy
5) can be treated with uricosuric drugs even in renal failure
Answers-2
Hyperuricaemia may be due to increased purine intake, urate production or reduced urate clearance, and is most commonly due to the latter. Therefore it can
occur in association with enhanced cell destruction particularly leukaemias. Primary gout has no obvious mode of inheritance, but familial juvenile gouty nephropathy
is an autosomal dominantly inherited disorder. Low dose aspirin may exacerbate gout but high dose aspirin is uricosuric. Many of the uricosuric drugs may be
detrimental in renal failure and may not be effective.
28- A 53-year-old man presented with hypertension of 150/110 mmHg. He is generally asymptomatic and has no previous medical history of note. He is a smoker of 5 cigarettes daily and drinks modest quantities of alcohol. He takes no prescribed medications. Examination reveals a BMI of 33.5 kg/2 but nil else. The following detail his investigations:
Serum sodium 146 mmol/l (NR 133-145)
Serum potassium 3.2 mmol/l (NR 3.5 - 5)
Urinary potassium excretion 42 mmol/l (NR less than 30)
What is the likely diagnosis?
1) Adrenocortical adenoma
2) Bartter's syndrome
3) Liddle's syndrome
4) Liquorice ingestion
5) Pheochromocytoma
Answers-1
This patient is most likely to have Conn's syndrome as reflected by the hypokalaemic hypertension. Liquorice ingestion or Liddle's syndrome are again possible causes of hypokalaemic hypertension but the question asks for the most likely cause. This is Conn's and is most often caused by an adrenocortical adenoma. Aldosterone promotes active sodium transport and excretion of potassium in the renal tubules (and also sweat glands, salivary glands and colon).
"Clinically, [Primary hyperaldosteronism] Conn's syndrome is characterized by hypertension (often diastolic hypertension), muscular weakness, paresthesias,
headache, polyuria, and polydipsia."
29- Phenytoin:
1) is a benzalkonium Derivative
2) is clinically effective serum level is in the range on 2-10 micrograms/ml.
3) A steady state blood level is achieved by 2-5 days
4) Can be used in management of alchohol withdrawl syndrome
5) Is the drug of choice in absence seizures.
Answers-4
Phenytoin is an imidazolidine derivative.It relates to barbiturates in chemical structure. Clinically effective seum level is in the range on 10-20 micrograms/ml. A
steady state blood level is achieved by 7-10 days.
30 -Which of the following techniques would be most useful in the differential diagnosis between ectopic Cushing's syndrome and pituitary dependent Cushing's disease.
1) Urine free cortisol
2) High dose Dexamethasone suppression test
3) ACTH concentrations
4) Inferior petrosal sinus sampling
5) CRF test
Answers-4
Inferior petrosal sinus sampling with an elevated central ACTH concentration compared with the peripheral value is the most valuable test in the differential
diagnosis of either Cushing's disease or ectopic Cushing's syndrome. The other tests are far less useful in comparison.
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1) A lipaemic appearance of the serum would be expected.
2) is treated with clofibrate therapy
3) is characteristically associated with tendon xanthomas
4) is characteristically associated with palmar xanthomas
5) No evidence of a dyslipidaemia would be expected with this short a duration of disease
Answers-4
In prolonged cholestasis features include: increased serum cholesterol, a moderate increase in triglyceride, the serum is not lipaemic, and reduced HDL levels. Clinical features include: palmar xanthomas; tuberous xanthomas (particularly on extensor surfaces); tendinous xanthomas are rare. Xanthomas usually only occur if
cholestasis has persisted for more than 3 months sometimes fat deposits may involve bone and peripheral nerves.
27- Which of the following is associated with Hyperuricaemia?
1) is usually due to an excess purine consumption
2) occurs in association with acute lymphoblastic leukaemia
3) in primary gout is inherited in an autosomal dominant manner
4) can be reduced with low dose aspirin therapy
5) can be treated with uricosuric drugs even in renal failure
Answers-2
Hyperuricaemia may be due to increased purine intake, urate production or reduced urate clearance, and is most commonly due to the latter. Therefore it can
occur in association with enhanced cell destruction particularly leukaemias. Primary gout has no obvious mode of inheritance, but familial juvenile gouty nephropathy
is an autosomal dominantly inherited disorder. Low dose aspirin may exacerbate gout but high dose aspirin is uricosuric. Many of the uricosuric drugs may be
detrimental in renal failure and may not be effective.
28- A 53-year-old man presented with hypertension of 150/110 mmHg. He is generally asymptomatic and has no previous medical history of note. He is a smoker of 5 cigarettes daily and drinks modest quantities of alcohol. He takes no prescribed medications. Examination reveals a BMI of 33.5 kg/2 but nil else. The following detail his investigations:
Serum sodium 146 mmol/l (NR 133-145)
Serum potassium 3.2 mmol/l (NR 3.5 - 5)
Urinary potassium excretion 42 mmol/l (NR less than 30)
What is the likely diagnosis?
1) Adrenocortical adenoma
2) Bartter's syndrome
3) Liddle's syndrome
4) Liquorice ingestion
5) Pheochromocytoma
Answers-1
This patient is most likely to have Conn's syndrome as reflected by the hypokalaemic hypertension. Liquorice ingestion or Liddle's syndrome are again possible causes of hypokalaemic hypertension but the question asks for the most likely cause. This is Conn's and is most often caused by an adrenocortical adenoma. Aldosterone promotes active sodium transport and excretion of potassium in the renal tubules (and also sweat glands, salivary glands and colon).
"Clinically, [Primary hyperaldosteronism] Conn's syndrome is characterized by hypertension (often diastolic hypertension), muscular weakness, paresthesias,
headache, polyuria, and polydipsia."
29- Phenytoin:
1) is a benzalkonium Derivative
2) is clinically effective serum level is in the range on 2-10 micrograms/ml.
3) A steady state blood level is achieved by 2-5 days
4) Can be used in management of alchohol withdrawl syndrome
5) Is the drug of choice in absence seizures.
Answers-4
Phenytoin is an imidazolidine derivative.It relates to barbiturates in chemical structure. Clinically effective seum level is in the range on 10-20 micrograms/ml. A
steady state blood level is achieved by 7-10 days.
30 -Which of the following techniques would be most useful in the differential diagnosis between ectopic Cushing's syndrome and pituitary dependent Cushing's disease.
1) Urine free cortisol
2) High dose Dexamethasone suppression test
3) ACTH concentrations
4) Inferior petrosal sinus sampling
5) CRF test
Answers-4
Inferior petrosal sinus sampling with an elevated central ACTH concentration compared with the peripheral value is the most valuable test in the differential
diagnosis of either Cushing's disease or ectopic Cushing's syndrome. The other tests are far less useful in comparison.
More Questions & Answers:-
Page1 Page2 Page3 Page4 Page5 Page6 Page7 Page8 Page9
Page10
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