Lung, hepatobiliary, renal MCQ
1. Which of the following usually presents as nephrotic syndrome
a)
b)
c)
d)
Membranoproliferative glomerulonephritis
Focal segmental glomerulosclerosis
Post infectious glomerulonephritis
Membranous glomerulopathy
2. In renal failure
a) Chronic renal failure is when the GFR is <25%of normal and kidneys although able to
regulate volume are unable to regulate solute composition any longer
b) A GFR of <15% of normal, indicates end stage renal disease
c) Renal insufficiency is when the GFR is 20-25% of normal amd azotemia appears
d) A GFR of around 70% of normal is associated with increasing creatinine levels and indicates
diminished renal reserve
3. Focal segmental glomerulosclerosis is characterised by
a)
b)
c)
d)
In situ immune complex formation
Loss of foot processes
Lipid in tubules
Nephritis syndrome
4. Testicular torsion
a)
b)
c)
d)
Is caused by arterial obstruction
Is more common in older adult men
Requires surgery within 6hours to remain viable
Typicaly has an insidious onset
5. Phimosis is associated with
a)
b)
c)
d)
Carcinoma
Syphilis
Condyloma acuminatum
Hypospadias
6. Post streptococci glomerulonephritis in children
a)
b)
c)
d)
Commonly presents with smoky urine 1 month after the resolution of the sore throat
Anuria is commonly present
Cs serum concentration rises
95% recover with simple conservative treatment aimed at maintaining sodium and water
balance
7. Renal artery stenosis
a)
b)
c)
d)
Is usually secondary to an occlusion of the artery by an atheromatous plaque
Fibromuscular dysplasia is the cause seen mostly in the female population
Uually is seen in people in their 6th decade of life
Bruits over the affected kidney are a common finding
8. Which bug can be associated with the production of magnesium ammonium phosphate stones?
a)
b)
c)
d)
Klebsiella
Streptococci
Enterococci
Staphylococci
9. Regarding acute respiratory distress
a) Neutrophils are thought to play an important role in its pathogenesis
b) It is thought that the sole cause is due to the compromised integrity of the microvascular
endothelium
c) The lungs become stiff late in the disease process
d) Resolution requires reabsorption of the transudate
10. Regarding obstructive pulmonary disorders
a) COPD is the result of smoking , however 20% of patients that develop the disease are non
smokers
b) In centrilobular emphysema the lower lobes are mostly affected
c) Paraseptal emphysema is associated with α1 antitrypsin deficiency
d) Irregular emphysema is usually asymptomatic and clinically insignificant
11. α1 antitrypsin
a)
b)
c)
d)
Is abnormal in 1% population of patients with emphysema
Is associated with the proteinase inhibitor locus found on chromosome 14
Is normally present in macrophages and secreted by neutrophils during inflammation
All the above are true
12. Which of the following is correct regarding obstructive pulmonary disease
a)
b)
c)
d)
Most heavy smokers develop the disease
Pulmonary function tests show a reduced forced expiratory volume at 1 sec
The source of airway obstruction in these diseases is narrowing of the small airways
Most acute exacerbations are due to pneumothorax formation
13. In chronic bronchitis
a) There is associated atypical metaplasia and dysplasia of the respiratory endothelium
b) As chronic bronchitis persists there is a marked increase in goblet cells predominately in the
large airways
c) Although there is marked gland hyperplasia the major changes seen are the increased
goblet cell numbers
d) The role of infection is a secondary feature in the pathogenesis of chronic bronchitis rather
than an initiating factor
14. Bronchiectasis
a)
b)
c)
d)
Has a rare complication of amyloidosis
is associated with reversible dilatation of bronchi and bronchioles
is most predominately seen in the upper lobes of the lung
is most severe in the more proximal bronchi/bronchioles
15. In atelectasis?
a)
b)
c)
d)
Usually occurs with partial obstruction of the distal airways
Mediastinum shifts toward the atelectic side
Is typically associated with bronchial neoplasms
Is never associated with congenital conditions
16. In haemodynamic pulmonary oedema
a)
b)
c)
d)
The most common attributing mechanism is decreased hydrostatic pressures
Is first seen in the hilar area of the lungs
In the acute phase , brown induration of the macrophages is present
Hydrostatic pressures are not usually elevated in association with microvascular injury based
oedema
17. Regarding pulmonary embolism and infarction
a)
b)
c)
d)
It accounts for 1% of all inpatient deaths
Only 25% of pulmonary emboli cause infarcts
75% of pulmonary infarcts affect the upper lobes
Infarcts are usually multiple
18. In pulmonary hypertension, which is incorrect
a)
b)
c)
d)
It is usually idiopathic
Maybe associated with interstitial lung disease
Is said to occur when pulmonary pressures reach 25% of systolic blood pressure
Death is usually secondary to cor pulmonale
19. The most common form of asthma is
a)
b)
c)
d)
Occupational
Atopic
Exertional
Intrinsic
20. Regarding lung abscesses
a)
b)
c)
d)
Those due to aspiration usually occur on the left side
Those due to aspiration are usually multiple
Those due to pneumonia are usually basal
Those due to pneumonia are usually singular
21. The most prevalent chronic occupational disease is associated with exposure to
a)
b)
c)
d)
Silica
Hydrocarbons
Coal dust
Asbestosis
22. Asbestosis
a)
b)
c)
d)
Serpentine form is most strongly associated with mesothelioma formation
Asbestosis begins as fibrosis around the repiratory bronchiloles and alveolar ducts
The least common morphological manifestation is pleural plaques
Clinical symptoms commonly occur in less than 10years from first exposure
23. Sarcoidosis
a)
b)
c)
d)
Is more common in women
Cxr changes are found in 50% of cases
Clinical splenomegaly is seen in upto 50% of cases
Caseating granulomas are the hallmark histological feature
24. Carcinoid tumours
a)
b)
c)
d)
Represent 10% of all lung tumours
Are seen commonly in > 60years of life
More common in women
20-40% are found in non smoking patients
25. Regarding community acquired pneumonias
a) H. Influenzae is the most common organism
b) The unencapsulate b form of H influenza is on the decrease since the introduction of
vaccination
c) Klebsiella pneumonia is the most frequent G+ve cause of bacterial pneumonia
d) H influenza is the most common organism in pneumonia in COPD exacerbations
26. In hepatorenal syndrome
a)
b)
c)
d)
it occurs in25% of patients with cirrhosis and ascites
is heralded by a decrease in blood urea nitrogen and an increase in creatinine
is usually associated with a stressor e.g. infection
prognosis is good especially in the rapid onset form
27. A post hepatic cause of portal hypertension is usually
a)
b)
c)
d)
cirrhosis
obstructive thrombosis
sarcoidosis
severe right heart failure
28. Unconjugated bilirubin
a)
b)
c)
d)
can be excreted in the urine once blood levels become high
is closely bound to serum albumin
is non toxic
is water soluble
29. Which lab finding is not seen in acute pancreatitis
a)
b)
c)
d)
Increased serum amylase
Increased serum lipase
Glycosuria
Hypercalcemia
30. All of the following are clinical findings/complications of hepatic failure EXCEPT
a)
b)
c)
d)
Fetor hepaticus is due to hyperammoniaemia
Palmer erythemia is associated with hyperestrogenaemia
Coagulopathy is due to impaired hepatic synthesis of clotting factors II, VII, IX,X
Hepatorenal syndrome is not associated with any morphological renal cause
31. The most common aetiology of hepatic cirrhosis is
a)
b)
c)
d)
Alcoholic liver disease
Viral hepatitis
Drug induced
Inherited storage disease
32. Which is true of hepatitis E INFECTION?
a)
b)
c)
d)
It is often associated with coinfection of hepatitis B
Has a mortality rate in pregnant woman of 40%
Is associated with chronic liver disease
Average post exposure incubation period is 6weeks
33. Fulminent hepatic failure is most commonly due to
a)
b)
c)
d)
Alcohol
Viral hepatitis
Drug/chemical toxicity
Liver ischaemia secondary to shock
34. The condition most frequently associated with hepatic vein thrombosis is
a)
b)
c)
d)
Polycythemia rubra vera
Pregnancy
Intrabdominal carcinoma
Oral contraceptive use