Final (GEN) All Qestions.pdf

1. Which of the following statements regarding the use of Thionamide drugs, i.e., methimazole and propylthiouracil, for treatment of hyperthyroidism is true? Select one: a) Methimazole is the preferred drug in patients with Autoimmune Thyroiditis; b) Methimazole can cause agranulocytosis;...

1. Which of the following statements regarding the use of Thionamide drugs, i.e., methimazole and propylthiouracil, for treatment of hyperthyroidism is true? Select one: a) Methimazole is the preferred drug in patients with Autoimmune Thyroiditis; b) Methimazole can cause agranulocytosis; c) Methimazole can cause tachycardia; d) Methimazole is well tolerated in pregnancy; 2. Diagnostic criteria for prediabetes is: Select one: a. Fasting glycemia - 126 mg/dl, OGTT - >140 mg/dl, HbA1c >6.5%; b. Fasting glycemia - 120 mg/dl, OGTT - >140 mg/dl, HbA1c >6.5%; c. Fasting glycemia - 115-120 mg/dl, OGTT - >120 mg/dl, HbA1c >7.0%; d. Fasting glycemia - 100--125 mg/dl, OGTT - 140-199 mg/dl, HbA1c -5.7-6.4%; 3. A 30-year-old woman who received no prenatal care has marked vaginal bleeding after the onset of labor at 38 weeks of gestation. Cesarean section is performed, and a lacerated low-lying placenta is removed. She remains hypotensive for 6 hours and requires transfusion of 12 packed RBC units. Postpartum, she becomes unable to breastfeed the infant. She does not have a resumption of normal menstrual cycles. She becomes more sluggish and tired. Laboratory findings include hyponatremia, hyperkalemia, and hypoglycemia. Which of the following pathologic lesions is she most likely to have had the following delivery? Select one: a. Pituitary necrosis; b. Subacute thyroiditis; c. Metastatic choriocarcinoma; d. Insulitis; 4. Vasopressin secretion is regulated by: Select one: a. Osmoreceptors; b. Portal system; c. Ventromedial axons; d. Paraventricular axons; 5. Luteinizing hormone stimulates: Select one: a. Cortisol synthesis; b. Testosterone synthesis;  c. Hirsutism; d. Artificial labour; 6. A 55-years-old female has broken her femur during walking, and then she knocked down. Her last menstrual cycle was eight years ago. What do you suspect the most? Select one: a. Hyperprolactinemia; b. Osteoporosis; c. Metastatic cancer; d. Osteomyelitis; 7. A 41-year-old man is referred at the recommendation of his ophthalmologist, who reported findings consistent with proliferative diabetic retinopathy. The patient has noted blurred vision, polyuria, polydipsia, and weight loss of about 7 kg during the past three months. History and system review are otherwise unremarkable. The clinical exam is significant for the weight of 85 kg, BMI 28, decreased sensation in the feet by monofilament testing and absent Achilles reflexes. Laboratory data: · Fasting Glucose 354 mg/dL (Nl < 100) · HbA1c 11.8% ( Nl 4.3-5.8) · Electrolytes- normal · Creatinine 1.25 mg/dL (0.4-1.3 mg/dL) · Microalbuminuria 408mg/gram creatinine (< 300) · Kenton in urine –negative · C peptide – 3.4 ng/ml(NL- 0.3-1.9 ng/ml) Which of the following statements is true? Select one: a. The patient probably has type 1 diabetes; b. The patient probably has MODY; 41 yr old c. The patient probably has type 2 diabetes; polificative diabetic dephropathy d. The patient probably has LADA; 8. A 59-year-old man is found comatose. On physical examination, he has decreased skin turgor. Laboratory studies show blood glucose of 780 mg/dl. Urinalysis reveals no ketosis or proteinuria, though there is glucosuria, no ketonuria. Which of the following is the most likely diagnosis? Select one: a. Neuroendocrine tumour secreting insulin; b. Ketoacidosis; c. Cushing syndrome; d. Hyperosmolar Coma; 9. Luteinizing hormone stimulates: Select one: a. Lactation; LH- Ord b. Labour; c. Ovulation; d. sweatiness; 10. Which of the following statements concerning medullary thyroid carcinoma is true? Select one: a. The most common type of thyroid cancer;  b. Are derived from parafollicular cells of the thyroid; medullary Thyroid - carcinoma c. Pituitary tumours are found frequently in association with these tumours; d. Are derived from follicular cells of the thyroid; 11. The most characteristic of chronic cholecystitis is: Select one: a. Diarrhoea; b. Night pain; c. Acholia; d. Intolerance of fatty food; e. Belching with rotten egg taste; 12. Which of them is most informative for the evaluation of liver cirrhosis? Select one: a. Albumin;[Func:such as, immunomodulation, endothelial stabilization, Antioxidanteffect,binding multiple drugs,toxing b. Alpha-globulin; c. Beta-globulin; d. Gamma-globulin; 13. Contraction of the Gallbladder will cause: ↓) Select one: a. Gastrin; b. Secretin; induced by the action ofC c. Cholecystokinin; d. Pancreatic juice; 14. For liver failure is characteristic except: Select one: a. Hypoprothrombinemia; b. Hypoproduction of antihemolytic factors; c. Hyperbilirubinemia; d. Haemorrhage syndrome; e. ALT and AST are normal in the blood; 15. What is the volume of fluid that the gallbladder can accommodate? Select one: a. 10 ml to 30 ml; b. 30 ml to 50 ml; c. 50 ml to 70 ml; d. 70 ml to 100 ml; 16. Characteristic for biliary cirrhosis is except: Select one: a. Hyperbilirubinemia; b. Xanthelasma; c. Osteoporosis; d. Urobilinuria; e. Bilirubinuria; 17. Hydrochloric acid helps the absorption of: Select one: a. Vitamin B12; b. Calcium; c. Iron; d. Protein; e. All of them; 18. Liver function is except: Select one: a. Storage; b. Detoxication; c. Excretory; d. Exocrine; e. Metabolic 19. Plasma protein is made by which organ? Select one: a. Liver; b. Spleen; c. Stomach; d. Thyroid; 20. Which of the following may be the major mediator of satiety and food intake? Select one: a. Somatostatin; b. Acetylcholine; c. Gastrin; d. Cholecystokinin; 21. Fever, Dysuria, Pyuria and Hematuria suggests the diagnosis of: Select one: a. Urinary Tract Infection;  b. Acute Nephritic Syndrome; c. Nephrotic Syndrome; d. Systemic Lupus Erythematosus; e. Diabetic Nephropathy; 22. A 6-year-old boy is noted to have increased puffiness around his eyes for the past week. On physical examination, he has periorbital oedema. Vital signs include T 36.4°C, P 82/minute, RR 24/minute, and BP 110/70 mm Hg. A urinalysis reveals sp. gr. 1.010, pH 6.5, no glucose, 4+ protein, no blood, no casts, and no ketones. Microscopic urinalysis reveals oval fat bodies, but no WBC's or RBC's. Which of the following renal lesions is most likely to have been present in this boy: Select one: a. Mesangial immune complex deposition; b. Hyperplastic arteriolosclerosis; c. Podocyte foot process effacement; d. Glomerular crescent formation; 23. A normal glomerular filtration rate is that of 100mL/minute. What is the reason why creatinine is not the most accurate method of GFR? Select one: a. It is both filtered and secreted in the proximal tubule; b. It is secreted by renal tubules; c. It is reabsorbed by renal tubules; d. It is neither filtered nor reabsorbed in the proximal tubule; 24. A pregnant woman is breathing rapidly. Which changes do you expect in arterial blood gas test: Select one: Pregnant patients experience mild Respiratory alkalosis due to the stimulation a. of Respiratory center by progesterone. This is associated soft corresponding 4 in a Respiratory alkalosis; bicarbonate excretion by kidneys. as a resultpH remains High (7.40-7.45) b. Metabolic acidosis; c. Respiratory acidosis; d. Metabolic alkalosis; 25. 7 years old boy is admitted to the emergency department with recurrent vomiting. Which acid-base disorder do you expect: Select one: a. Respiratory alkalosis; b. Metabolic acidosis; c. Respiratory acidosis; d. Metabolic alkalosis; 26. Which of the following is an extrarenal manifestation of autosomal dominant polycystic kidney disease: Select one: ⑨ a. Colonic diverticula; ⑤ b. Intracranial aneurysm;  c. Mitral valve prolapse; - d. All of the above; 27. Which of the following is not a feature of the nephrotic syndrome? Select one: a. Peripheral oedema; b. Macrohematuria; c. Hypoalbuminemia; d. Hypercholesterolemia; e. Proteinuria >3.5 g/24 h; 28. Which one of the following is correct about urinary tract infections (UTIs) in pediatric patients: / Select one: a. They are more common in younger children; b. After 1 year of age girl are at higher risk than boys; c. Constipation increases the risk for UTI; d. Vesicoureteral reflux (VUR) increases the risk for UTI; e. All of the above; 29. All of the following are possible features of Autosomal Dominant Polycystic Kidney Disease (ADPKD), except: Select one: a. Liver cysts; b. Hypertension; c. Bilateral kidney enlargement; d. Thyroid disease; e. Intracranial Cerebral Aneurysm; 30. The most common causative agent of urinary tract infection is: Select one: a. E.Coli; b. Candida; c. Pseudomonas aeruginosa; d. Adenovirus; e. BK virus; 31. A 70-year-old patient with late period of acute intestinal obstruction due to sigmoid colon cancer presented to the hospital. Which of the following medical approach is the most rational one: Select one: a. Examination and surgery within 48-72 hours; b. Acute conservative therapy;  c. Emergency surgery with sigmoid colon resection and end-to-end anastomosis; d. Preparation to surgery during 2-3 hours with following Hartmann's operation; 32. Treatment of Clostridium difficile colitis include: Indications for Hartmann's procedure have expanded to include a Select one: range of pathologies resulting in obstruction or perforation of the left colon including malignancy, diverticulitis, ischemia, volvulus or trauma. a. Metronidazole or vancomycin per os intake; Ideally, Hartmann's procedure is followed by reversal of Hartmann's, restoring intestinal continuity. b. Ceftriaxone injections; c. Insulin therapy; d. Penicillin injections 33. In congenital diverticula: Select one: a. All layers of the bowel are present in the wall of the diverticulum; b. There is no muscularis layer present in the diverticulum; c. There is no mucous layer present in the diverticulum; d. All of them 34. Which of the following statements about Crohn's disease is false? Select one: a. Can affect any part of the GI tract; b. Nausea and vomiting are not usually seen; c. More commonly seen in smokers; d. Can cause fistulas, fissures and strictures in the bowel; 35. Clinical representation of chronic anal fissure is characterized by: Select one: a. Pain after defecation b. Poor bleeding during defecation; c. Both of them; d. None of them; 36. CROHN'S DISEASE: Select one: a. Can affect any part of the gastrointestinal tract from the lips to the anal margin; b. Can affect only rectum and colon; c. Can affect only duodenum; d. Can affect only ileum; 37. Cushing's syndrome results from the effects of: Select one: a. Chronically increased cortisol levels; b. Chronically decreased cortisol levels;  c. Aldosterone deficiency; d. None of them; 38. The most common cause of an ‘acute abdomen' in young adults is: Select one: a. Acute appendicitis; b. Acute cholecystitis; c. Inguinal hernia strangulation; d. Adhesions and bands; 39. Which investigation should be used for differential diagnosing of acute intestinal obstruction and perforated gastric ulcer? Select one: a. Laparoscopy; b. Stomach roentgenoscopy; c. Plan radioscopy; d. Gastroscopy; 40. Ulcerative colitis is a disease of: Select one: a. Duodenum; b. Ileum and colon; c. All part of the GI tract can be affected; d. rectum and colon; 41. Which laboratory abnormality indicates Subclinical thyrotoxicosis: Select one: a. Normal FT4 and FT3, decreased TSH; b. Normal FT4 and FT3, increased TSH; c. Normal TSH, decreased FT4 and FT3; d. Normal TSH, increased FT4 and FT3; 42. Circadian rhythm affects one of the following: Select one: a. Insulin; b. C peptide; c. Prolactin; d. Growth factor; 43. Which pituitary cells produce prolactin: Select one: a. Acidophilus;  b. Basophils; c. Dental cells; d. Infraorbital cells; 44. Which hormonally active cancer causes hypoglycemia? Select one: a. Vipoma; b. Insulinoma; c. Gastrinoma; d. Glucagonoma; 45. Dopamine Select one: a. Stimulates prolactin secretion; b. Inhibits prolactin secretion; c. inhibits adenosine secretion; d. Reduces acetylcholine secretion; 46. A 31-year-old woman has noted discomfort with fullness to her neck over the past year. On physical examination, she is afebrile and normotensive. There is the irregular enlargement of her thyroid gland, but no tenderness on palpation. A scintigraphic scan shows normal uptake except for increased uptake in a 1 cm area in the left lower lobe. HerC anti-thyroid peroxidase antibody is negative.7Which of the following complications is Autoimmune disease ruleoutanunderlyingeditis) she most likely to develop? ↳ To Select one: a. Thyrotoxicosis; b. Papillary carcinoma; c. Medullary carcinoma; d. Hypothyroidism; 47. A 34-year-old woman has had insomnia for the past four months, as well as episodes of diarrhoea with up to 4 loose stools per day. Her outstretched hands have a fine tremor. On palpation of her neck, the thyroid gland does not appear to be enlarged, and no masses are palpable. Laboratory studies show a & serum TSH of 8.8 microU /mL(NL 0.4-4 microU/mL) in association with a serum total thyroxine of 15.1 microgram/dL(NL 8-22 microU/mL). Which of the following is the most likely diagnosis? Select one: C < a. Graves disease; TSH,4T3274 ↓ Graves like b. Pituitary adenoma; ↳ Hyperthyroidism Pituitary adenoma c. Chronic Chronic thyroiditis; thyroiditis d. Prior thyroidectomy; 48. A 41-year-old man has been drinking large quantities of water--up to 20 litres per day--for the past week. On physical examination, he has diminished skin turgor and dry mucous membranes. His fasting serum glucose is 98 mg/dl ,serum osmolality is 343 mOsm/kg(N/L- 280 - 303 mOsm/kg). A deficiency of which of the following hormones is most likely present in this man? Select one:  Blood & Blood volume a. Vasopressin; regulate- blood pressure, Osmolality b. Oxytocin; c. Insulin; d. Growth hormone; 49. Somatostatin inhibits the action of: Select one: a. TSH; b. FSH; c. FSH; d. Prolactine; appear that after Bleeding. 50. Which of the following does not cause petechiae: red, pinpointspots Select one: a. Vitamin C deficinecy; b. Vitamin K deficiency; If you don't have enough platelets, bleeding can happen inside your body, under your skin or on your skin. Bleeding that happens under your skin can create purple c. Thrombocytopenia; bruises (purpura) that you can see on your skin. You may also have very small red or purple dots (petechiae) on your skin that may look like a rash. d. Lymphocytopenia 51. Which vitamin when deficient, will cause prolonged coagulation? Select one: a. Vitamin C; b. Vitamin B12; c. Vitamin A; d. Vitamin K; 52. The daily volume of bile secreted by the liver ranges from Select one: a. 50 to 100 ml; b. 250 to 300 ml; Posthepatic c. 300 to 400 ml; jaundice is most often due to biliary d. 500 to 600 ml; You might have higher levels of unconjugated (indirect) bilirubin if your body is breaking down red blood cells faster obstruction by a stone in the e. 900 to 1000 ml; than your liver can keep up with. This might indicate: Hemolytic disease. Sickle cell disease. common bile 53. Indirect hyperbilirubinemia is not characteristic for: duct or by Select one: & Gilbert syndrome is caused by a modified gene you inherit from your parents. This gene usually controls an enzyme that helps break down carcinoma of bilirubin in your liver. When you have an ineffective gene, your blood contains excess amounts of bilirubin because your body doesn't the pancreas. a. Gilbert syndrome; -> produce enough of the enzyme. the faulty gene means bilirubin is not passed into bile at the normal rate. Instead, it builds up in the bloodstream, giving the skin and whites b. Hemolytic anaemia; of the eyes a yellowish tinge. Other than inheriting the faulty gene, there are no known risk factors for developing Gilbert's syndrome. c. Mechanic (posthepatic) icterus; d. Crigler-Najar Syndrome; Crigler-Najjar syndrome is a rare autosomal recessive disorder of bilirubin conjugation characterized by severe unconjugated hyperbilirubinemia that can result in bilirubin-induced neurologic dysfunction (BIND)  54. Which marker indicates hepatic encephalopathy? Select one: Hepatic encephalopathy is a nervous system disorder brought on by severe a. Albumin; liver disease. When the liver doesn't work properly, toxins build up in the b. Bilirubin; blood. These toxins can travel to the brain and affect brain function. People with hepatic encephalopathy may seem confused. c. Ammonia; Ammonia is cleared lives, due lives by there'll be disease, d. Creatinin; build e. All of them; up. 55. The main reason for GI-bleeding is: Select one: a. Oesophagitis b. Erosive gastritis; c. Gastric ulcer; d. Duodenal ulcer; 56. Which of the following medications are associated with reactive gastropathy? Select one: a. Aspirin and NSAID-s; Reactive gastropathy develops when the stomach lining comes into contact with irritating substances over a long b. Oral Iron; period of time. Some types of pain relief medicines called All of them nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, and c. Oral potassium; bile are among the most common irritating substances. d. Alcohol Alcohol; e. All of them; 57. Which of the following complications of gallstone disease is most rapidly fatal? Select one: a. Biliary colic; Pancreatitis if left untreated it will lead to necrosis.Necrosis is the medical b. Cholecystitis; term for the death of tissue. The dead tissue is extremely vulnerable to infection from bacteria. Once an infection has occurred, it can quickly c. Gallstone ileus; spread into the blood (blood poisoning) and cause multiple organ failure. If left untreated, infected pancreatic necrosis is almost always fatal. d. Pancreatitis; ⑧ 58. Polycystic kidney disease is thought to be primarily due to a genetic abnormality of: Select one: a. Cilia function; b. Cell division; c. Tubular membrane structure; d. Epithelial permeability; e. Sodium transport; 59. A 45-year-old man presented with left ureteric colic. He later passed a stone and analysis showed it to be composed of calcium oxalate. He had experienced no previous symptomatic nephrolithiasis and had no other past medical history. What is the most appropriate way to prevent further stone formation: Select one: a. restriction of dietary oxalate; b. Restriction of dietary protein; c. Restriction of dietary calcium; d. Restriction of dietary sodium; e. Restriction of dietary potassium; 60. Patients with Chronic kidney disease typically develop: Select one: a. Hemolytic anaemia; b. Macrocytic anaemia; c. Aplastic anaemia; d. Hypochromic, microcytic anaemia; e. Normochromic, normocytic anaemia; 61. In stage V chronic kidney disease, glomerular filtration rate is below which of the following levels: Select one: Stage 5 CKD means that your kidneys are severely damaged a. 25 mL/min/1.73 m2; and have stopped doing their job to filter waste from your b. 60 mL/min/1.73 m2; blood. Waste products may build up in your blood and cause other health problems, such as: High blood pressure. Anemia c. 15 mL/min/1.73 m2; (not enough red blood cells in your body) d. 40 mL/min/1.73 m2; e. 90 mL/min/1.73 m2; 62. Which of the following should be monitored in a patient who has experienced AKI and is thought to be at high risk for chronic renal disease? Select one: a. Serum creatinine; b. Blood pressure; c. Urine protein content; d. All of the above; 63. Analysis of the arterial blood shows the following values: pH 7.15, HCO3 - 8 mmol/l and PCO2 19 mm Hg. Define acid-base disorder: Select one: a. Respiratory alkalosis; b. Metabolic acidosis; c. Respiratory acidosis; d. Metabolic alkalosis; 64. Which one of the following electrolytes usually must be restricted in patients with acute renal failure? Select one:  a. Sodium; b. Chloride; c. Potassium; d. Bicarbonate; e. Calcium; B-lactam Antibiotics;pencillin & cephalosporin > Drug-induced AIN 65. Acute interstitial nephritis from cephalosporin antibiotics is suspected. Which of the following findings corresponds to the diagnosis: Select one: a. Dysmorphic erythrocytes; b. White blood cell casts on urine microscopy; c. Urinary eosinophils on urine microscopy; d. Glucosuria e. All of the above 66. Analysis of the arterial blood shows the following values: pH 7.0, HCO3 - 13 mmol/l and PCO2 58 mm Hg. Define acid-base disorder: For Respiratory acidosis -> pCO2> due 40-45 ventilation to Select one: Metabolic acidosis Alterations - due to in Bicarbonate, a. Respiratory acidosis with partial renal compensation; PC02 3.5 g per day; d. Urine protein/creatinine ratio < 0.2; ⑧ 118. Transient proteinuria may be seen in: Select one: a. Nephrotic syndrome;  b. Vigorous exercise; c. Acute Poststreptococcal Glomerulonephritis; d. Chronic Glomerulonephritis; e. Fanconi syndrome; ⑥ 119. 2 distinct functioning kidneys on each side of the midline, connected at the lower poles are known as: Select one: a. Ectopic kidney; b. Horseshoe kidney; c. Kidney agenesis; d. Duplex Kidney; e. Pelvic Kidney; 120. Which of the following symptoms best characterizes nephrotic syndrome: Select one: a. Proteinuria, oedema, hypoalbuminemia; b. Proteinuria, hematuria, oliguria; c. Hypertension, oedema, oliguria; d. Polyuria, Polydipsia, Hypokalemia; e. Hematuria, Hypertension, renal failure; 121. A 4-year-old boy presents to his paediatrician with puffy eyes of duration 2 weeks. The parents deny any recent upper respiratory infections (URIs). Physical examination shows periorbital oedema, pedal oedema, ascites, and weight gain. Urine test reveals massive proteinuria. Which morphological type of nephrotic syndrome do you suspect: Select one: a. IgA Nephropathy; b. Minimal Change Disease; c. Membranous nephropathy; d. Diabetic Nephropathy; e. Focal Segmental Glomerulosclerosis; 122. An elderly male patient produced only 25 mL of urine in the past 24 hours. The urologist discovers that prostatic hypertrophy is the cause. Which one of the following best describes this patient's acute renal failure? Select one: a. Prerenal Oliguric; b. Postrenal Anuric; c. Renal Anuric; d. Renal Polyuric; e. Non-oliguric; ⑧ 123. The thyroid is supplied with arterial blood from: Select one: a. Superior thyroid artery; b. Inferior thyroid artery; c. Ima artery; d. All of them. ⑳ 124. Risk factor for soft tissue sarcoma are: Select one: a. Radiation exposure; b. Trauma; c. Chronic lymphedema; d. All of them; 125. The most reliable method of colon polyps diagnosing is: Select one: a. Radiographic contrast study; b. Irrigoscopy; c. Colonoscopy; d. Feces analysis on the presence of occult blood; 126. The most effective treatment of rectal fistulas is: Select one: a. Conservative; b. Sclerosing; c. Surgical; d. Fistula filling; 127. Which of the following statements about ulcerative colitis is true? Select one: a. Can affect any part of the GI tract; b. More commonly seen in smokers; c. Surgery to the colon and rectum resolves the disease; d. Can cause fistulas, fissures and strictures in the bowel; 128. Which lab value is to be assessed in the presence of an increased prolactin level for the differential diagnosis of pituitary adenoma? Select one: a. TSH; b. Cortisol; c. Growth hormone;  d. Insulin; 129. Hypersecretion of prolactin causes: Select one: a. Anovulation; b. Increases LH and FSH; c. Hair lose; d. Dehydration; 130. 22-year old a pregnant patient is diagnosed with hyperthyroidism. What is the treatment of choice? Select one: a. Radioactive iodine thyroid ablation; b. Propylthiouracil; c. Methimazole; d. Propranolol; 131. What is the most common cause of hypothyroidism? Select one: a. Hashimoto thyroiditis; b. Subacute thyroiditis; c. Acute thyroiditis; d. Multinodular goiter; 132. Which of the following are functions of the liver? Select one: a. Secretion of bile; b. Storage of vitamin C; c. Enzyme activation; d. Blood detoxification; e. All the above; 133. Diagnostic marker of the Hepatocellular carcinoma is: Select one: a. Carcinoembryonic antigen; b. Alpha-fetoprotein; c. Chorionic gonadotropin; d. Alkaline phosphatase; 134. What is the major mediator of pancreatic hydrogen ion-stimulated bicarbonate and water secretion? Select one: a. Cholecystokinin; b. Secretin;  c. Acetylcholine; d. Gastrin; 135. Characteristic for Zollinger-Ellison syndrome is except: Select one: a. Steatorrhea; b. Diarrhoea; c. Hypercalcemia; d. Ulcers in the stomach and the duodenum; e. Acid hypersecretion; 136. Which chemical enhances vascular spasms: Select one: a. Serotonin; b. Tyrosine; c. Testosterone; d. Estrogen; 137. 12-year-old boy has passed cola-coloured urine. He had a sore throat two weeks ago. On physical examination, she is afebrile with blood pressure 140/90 mm Hg. Laboratory studies show her serum creatinine is 1.8 mg/dL and urea nitrogen 24 mg/dL. Urinalysis shows 2+ blood, 2+ protein, no glucose, and no ketones. Microscopic urinalysis shows dysmorphic RBC's. A renal biopsy is performed and on microscopic examination shows glomerular hypercellularity. Electron microscopy shows subepithelial electron-dense 'humps'. Which of the following laboratory test findings is most likely to be present in this girl: Select one: a. Elevated antistreptolysin O titer; b. Antiglomerular basement membrane antibody; c. Elevated serum glucose; d. Antibody to double-stranded DNA; e. Elevated total cholesterol level; · 138. Which of the following is not required to estimate GFR using the MDRD equation: Select one: a. Age; b. Creatinine; c. Sex; d. Weight; 139. Which of the following will not cause respiratory alkalosis? Select one: a. Pregnancy; b. Anxiety;  c. Salicylate toxicity; d. Laryngospasm; 140. A 40-year-old man passes a small amount of dark urine. The urine dipstick test for blood is positive but no red blood cells are seen on microscopic examination of the urine sediment. Which of the following is the most likely diagnosis: Select one: a. Post-streptococcal glomerulonephritis; b. Nephrotic syndrome; c. Urolithiasis; d. Rhabdomyolysis; e. Acute Interstitial Nephritis; 141. Which of the following compounds is the most effective buffer system at physiological pH: Select one: a. Protein buffer; b. Phosphate buffer; c. Bicarbonate ion and carbon dioxide (HCO3−-CO2) system; d. Haemoglobin; · 142. The most common cause for a congenital solitary kidney is: Agenesis / Select one: => Renal a. Severe hydronephrosis; Congenitalsolitary kidney b. Renal agenesis/aplasia; Aplasia c. Multicystic dysplastic kidney; d. Renal vein thrombosis; ② 143. What is indicated in tumour perforation of ascending colon with metastases into the liver? Select one: a. Cecostomy; b. Right-sided hemicolectomy, terminal ileostomy; c. Perforation suturing, d. left-sided hemicolectomy, and colostomy; ⑥ 144. Large intestinal mechanical obstruction most often is caused by: Select one: a. Foreign bodies; b. Bile stones; c. Malignant tumours; d. Helminths; 145. The adult's thyroid weighs: Select one: a. 5 grams; b. 25 grams; c. 200 grams; d. 125 grams; 146. Proctitis is: Select one: a. Inflammation of the proximal ileum; b. Inflammation of the rectum; c. Inflammation of the colon; d. All of them; 147. A 44-year-old woman has noted enlargement of her anterior neck region over the past eight months. On physical examination, there is diffuse, symmetrical thyroid enlargement without tenderness. A chest radiograph is normal. Fine needle aspiration of the thyroid yields cells consistent with a neoplasm. Laboratory studies show that she is euthyroid, but her serum ionized Calcium is decreased, serum calcitonin is positive. Which of the following neoplasms is she most likely to have? Select one: a. Follicular carcinoma; b. Medullary carcinoma; c. Papillary thyroid carcinoma; d. Metastatic renal cell carcinoma; 148. A 25-year-old woman develops acne, hirsutism, disordered menstrual cycle. Which of the following tests would you perform? Select one: a. Gonadotropins; b. Prolactin; c. TSH; d. Free Testosterone ; e. All of them; 149. Circadian rhythm influences? Select one: a. Growth hormone; b. C peptide; c. Insulin; d. Glucagon; 150. A 40-year-old man experiences abdominal pain, nausea, and constipation for the past three days. On physical examination, he has no palpable abdominal masses, and bowel sounds are present. His lungs are clear to auscultation. He has a heart rate of 80/min with an irregular rhythm. An electrocardiogram demonstrates a shortened QT (corrected) interval. Which of the following laboratory test findings is most likely to be present in this man? Select one: a. Elevated thyroid peroxidase antibody; b. Decreased Serum calcium; Decreased serum Calcium. c. Blood glucose of 225 mg/dL; d. Decreased serum TSH; 151. Potential problems with the patient's current two-shot insulin regimen would be likely to include: Select one: a. More difficulty with overnight hypoglycemia than with a long-acting regimen; b. More difficulty with meal-timing than with a short-acting-containing regimen; c. More difficulty achieving tight glycemic control than with a four-shot regimen; d. All of the above; 152. Which are risk factors for colon cancer: Select one: a. Polyposis of the colon; b. Genetic predisposition; c. Chronic obstipation; (severe form of Constipation) d. Nonspecific ulcerative colitis; e. All of them; 153. Causes of haemorrhage: Select one: a. Hypoxia, anoxia; b. Abnormal coagulation of blood; c. Toxic injury; d. Nutritional deficiency; e. All of the above; ⑥ 154. Which of the following compartments is not part of the glomerular filtration barrier? Select one: a. Fenestrated Endothelium; b. Glomerular basement membrane; c. Podocyte foot processes; d. Intercalated alpha cells; 155. In which of the following circumstances is the urea-to-creatinine ratio most likely to increase: Select one: a. A malnourished patient with small muscle mass; b. High blood pressure treated with vasodilator drugs;  c. When the rate of flow of filtrate along the nephron is slowed; d. A bodybuilder taking protein supplements; 156. The most common systemic disease causing end-stage renal failure in Western countries is: Select one: a. Polycystic kidney disease; b. Amyloidosis; c. Diabetes Mellitus; d. Hypertensive Nephrosclerosis; e. Wegener Granulomatosis; 157. Each of the following organisms is an important cause of urinary tract infections EXCEPT: Select one: a. Proteus mirabilis; b. Klebsiella pneumonia; c. Escherichia coli; d. Pseudomonas aeroguinosa; e. Bacteroides fragilis; 158. Massive proteinuria typically results from damage to which structure: Select one: a. Loop of Henle; b. Mesangial cells; c. Preglomerular arterioles; d. Podocytes; e. Distal convoluted tubule; 159. Therapy of choice for diffuse toxic goiter in a patient over 45 years: Select one: a. Thyroxin; b. Radioiodine; c. Both of them; d. None of them; 160. Thyroid investigations include all of them except: Select one: a. Ultrasound scanning; b. Isotope scanning; c. Angiography; d. Fine-needle aspiration cytology; 161. The most common localization of the invagination is: Select one: a. Rectosigmoid area; b. Ileocecal segment; c. Ilio-iliac segment; d. Sigmoid colon; 162. The patient complains weakness, tiredness, sleepiness, hair loss. TSH- 11,6(normal ranges 0,4-4,0), FT4 - 5 mmol/l (normal ranges 8-20), antibodies negative. Diagnosis: Select one: a. Primary hypothyroidism; b. Secondary hypothyroidism; c. Transient thyrotoxicosis; d. Permanent thyrotoxicosis; 163. The patient has frequent urination, thirst, muscle weakness, blood pressure – 177/90 mm. Hg. Anamnesis: the patient has been treated for rheumatoid arthritis with methylprednisolone. Which tests would you order? Select one: a. Electrolytes; b. HbA1c; c. Blood coagulability test; d. All of them; 164. A 43-year-old woman has had increasing cold intolerance, weight gain of 4 kg, and sluggishness over the past two years. A physical examination reveals dry, coarse skin and alopecia of the scalp. Her thyroid is not palpably enlarged. Her serum TSH is 11.7 mU/L (NL_0.4 - 4.0 mU/L) with thyroxine of 2.1 micrograms/dL (NL- 0.8 - 1.8 ng/dL). A year ago, anti-thyroglobulin and anti-thyroperoxidase antibodies were detected at high titer. Which of the following thyroid diseases is she most likely to have? Select one: a. Medullary Carcinoma; b. Papillary carcinoma; c. Hashimoto thyroiditis; d. Multinodular goiter; 165. A 69-year-old man with a 5-year history of type 2 diabetes. He had symptoms indicating hyperglycemia for 2 years before diagnosis. He had fasting blood glucose records indicating values of 118–200 mg/dl. He also remembered past episodes of nocturia associated with large pasta meals and Italian pastries. At the time of initial diagnosis, he was advised to lose weight, but no further action was taken. He has vision loss in both eyes. Which other condition do you suspect most of all? Select one: a. Microalbuminuria; b. Coronary artery disease; c. Hypoglycemia;  d. Stroke; · 166. Which of the following is not a component of bile? Select one: a. Water; b. Lipase; c. Cholesterol; d. Bile pigments; e. Phosphatidylcholine; 167. Which steroid do you use for the treatment of idiopathic nephrotic syndrome? Select one: a. Dexamethasone; b. Hydrocortisone; c. Betamethasone; d. Prednisolone; 168. Patients with nephrotic syndrome are at particular risk for: Select one: a. Gastritis; b. Peritonitis; c. Hepatitis; d. Myositis; e. Pericarditis; 169. Which medications taken by a pregnant woman can influence kidney development: Select one: a. Nonsteroidal anti-inflammatory drugs; b. Angiotensin receptor blockers; c. Gentamicin; d. All of the above; 170. Non-pharmacological renoprotection in children with a solitary kidney include: Select one: a. Limited intake of vitamin D; b. Protein intake < 1 g/kg per day; c. High sodium intake; d. High potassium intake; e. Hydration > 2 L/24 h per 1.73 m2; 171. The approximate number of nephrons in each kidney is: Select one:  a. 1 -1,5 million; b. 4 million; c. 2 billion; d. 2,5 billion; e. 3 – 3.5 million; ⑧ 172. Most primary soft tissue sarcomas originate in: Select one: a. Neck; b. Breast; c. An extremity; d. Head; 173. What contributes to anal fissure development? Select one: a. Acute anal abscess; b. Hemorroids; c. Lasting constipation; d. None of them; ⑧ 174. During the Hartmann's operation: - Hartmann's Coal (colostomy) Select one: a. The rectum is excised, the anorectal stump is transected, and an end colostomy is formed. - b. Gastric resection is performed; c. Appendectomy is performed; d. The rectum is excised, the anorectal stump is transected, and an end ileostomy is formed. · 175. Somatotropin secretion is controlled by: Select one: a. Gonadoliberin; b. Thyroliberin; c. Dopamine; d. Somatostatin; ⑥ 176. Insulin-like Growth factor 1 is synthesized in: Select one: a. Pancreas; b. liver; c. Spleen; d. Bone marrow; 177. A 35-year-old woman has increasing fullness in her neck for the past five months since the delivery of her last infant. On physical examination, her thyroid gland is diffusely enlarged but not painful to palpation. Laboratory studies show an anti-thyroglobulin and anti-thyroid peroxidase antibodies are negative. Her TSH and thyroxine are normal. Which of the following is the most likely diagnosis? Select one: a. Hashimoto thyroiditis; b. Viral infection; c. Subacute lymphocytic thyroiditis; d. Cretinism; 178. Which antibody is characteristic for diffuse toxic goitre Select one: a. Elevated Thyroid peroxidase antibody; b. Elevated thyroglobulin antibody; c. Elevated antibody against thyroid receptors; d. Elevated Glutamic acid decarboxylase antibody; 179. A 50-year-old man has a lump on his neck found at physical examination. A fine needle aspirate of this lump shows a follicular neoplasm of the thyroid. He undergoes a total thyroidectomy. Within a day following surgery, he is noted to have tingling sensations and neuromuscular irritability and cramps in lower and upper extremities. Which of the following serum laboratory tests should be ordered immediately to determine further therapy for this man? Select one: a. TSH; b. Thyroglobulin antibody; c. Thyroxine; d. Calcium; 180. A 40-year-old man has enlargement of his neck for the past ten months. His sister and maternal aunt had thyroid cancer. On Ultrasound, his thyroid is nodular. A fine-needle aspiration biopsy is performed, and cytologic examination shows cells present consistent with an Anaplastic Cr. TSH is normal. What's the treatment? Select one: a. Total thyroidectomy; b. Hemithyroidectomy; c. Resection of the nodule; d. Follow up in dynamics; 181. Which of the following anaemia is not characteristic for chronic enteritis? Select one: a. Iron-deficiency; b. B12- deficiency; c. Hemolytic; d. None of them;  e. All of them; 182. Which of the following is the modality of choice for detecting renal stones? Select one: a. Ultrasound; b. Doppler ultrasound; c. Isotope renography; d. CT scanning; e. MRI; ⑳ 183. Which of the following symptoms is suggestive of chronic kidney disease: Select one: a. Urinary frequency; b. Nausea; c. Pain in the renal angle; d. Nocturia; e. Tremor; ⑳ 184. Which hormone secreted by the kidney stimulates bone marrow activity: Select one: a. Renin; b. Aldosterone; c. Erythropoietin; d. Calcitriol; e. Angiotensin II; 185. What is the most common extrauterine acute abdominal condition in pregnancy? Select one: a. Acute appendicitis; b. Acute cholecystitis; c. Femoral hernia strangulation; d. Duodenal ulcer perforation; 186. The thyroid gland secretes hormones: Select one: a. Thyroxine/T4; b. Triiodothyronine /T3; c. Calcitonin; d. All of them; 187. What is characteristic for proliferative diabetic retinopathy Select one:  a. Micro aneurysms; Neovascularization b. Exudates; c. Neovascularization; d. All the above mentioned; 188. The duration of ultra-short acting insulin is: Select one: a. Starts in 15 minutes and lasts for 3 hours; b. Starts in an hour and lasts for 5 hours; c. Starts at the moment of eating and last for 30 minutes; d. Starts in 30 minutes and lasts for 4 hours; 189. To avoid hepatic coma, you have to restrict: Select one: a. Proteins; b. Fat; c. Mineral salts; d. Carbohydrates; 190. Among the following, which finding indicates that hematuria is of glomerular origin is: Select one: a. The brownish colour of the urine; b. Proteinuria; c. Hypertension; d. Red blood cell casts; 191. The reason for wound abscess after appendectomy is: Select one: a. Wound infection during a surgery; b. laparoscopic approach c. Blind gut cancer; d. Foreign body (tissue); 192. Most frequently large intestinal diverticulas are localized in: Select one: a. Sigmoid colon; b. Ascending colon; c. Transverse colon; d. Descending colon; 193. Functions of the liver include; Select one:  a. Destroying old RBCs; b. Production of fibrinogen; c. De-amination; d. All of the above; 194. Risk factors for perforation of the appendix are: Select one: a. Immunosuppression; b. Diabetes mellitus; c. Faecolith obstruction; d. All of them; 195. A 30-year-old woman has noted enlargement of her neck over the past four months. On physical examination, she has a diffusely enlarged thyroid that is not painful to palpation. Her TSH level is 0.02 mU/L. Which of the following is the most likely diagnosis? Select one: a. Subacute granulomatous thyroiditis; b. Hypothyroidism; c. Nontoxic Multinodular goiter; d. Graves disease; 196. Which Dopaminergic drug has a priority in the treatment of hyperprolactinemia: Select one: a. Cabergoline; b. Bromocriptine; c. Terguride; d. Quinagolide; 197. The pituitary-dependent gland in: Select one: a. Pancreas; b. Hypophysis; c. Thyroid gland; d. Parathyroid gland; ⑥ 198. Which mineral is essential for coagulation? Select one: a. Sodium; b. Iodine; c. Calcium; d. Iron;  199. The highly specialized cells, the kidney glomerulus that wraps around capillaries, the Bowman's capsule and performs a filtering function, referred to as: Select one: a. Visceral layer; b. Chondrocytes; c. Podocytes; d. Pericytes; 200. Which of the following drugs is not a common cause of interstitial nephritis? Select one: a. Vancomycin; b. Acyclovir; c. Carbamazepine; d. Amlodipine; 201. Serum creatinine-based equations should be avoided: Select one: a. For adolescents; b. For healthy children; c. For Patients with CKD; d. For Patients with reduced muscle mass; ⑧ In humans, nephrogenesis is completed at: 202. Select one: a. 28–30 weeks gestation; b. Normal term; c. 3 months of age; d. 2 years of age; e. 34–36 weeks gestation; 203. The most common cause of intestinal obstruction is: Select one: a. Adhesions and bands; b. Worms; c. Gallstones; d. Trychobezoars and phytobezoars; ⑧ 204. The most common clinical manifestation of symptomatic primary hyperparathyroidism (PHPT) remains: Select one: a. The presence of kidney stones; b. The presence of gallstones;  c. The presence of thyroid nodules; d. All of them; 205. Thirty-seven years old female with complaints of a lump in her neck. She has no symptoms. She noticed the mass is hard and not mobile. What is the next step in her investigation? Select one: a. Thyroid scan; b. TSH and T4; c. Fine needle aspiration; d. Ultrasound; 206. A 31-year-old woman has noted a weight gain of 6 kg over the past year. She has normal menstrual periods. On physical examination, her blood pressure is 170/105 mm Hg. Her skin shows marked plethora. Abdominal striae are present. A serum electrolyte panel shows sodium 149 mmol/L(NL- 136 - 144 mmol/L), potassium 3.6 mmol/L(NL- 3.7 - 5.2 mmol/L), chloride 100 mmol/L(N.L- 101 - 111 mmol/L), CO2 25 mmol/L(NL- 20 - 29 mmol/L),fasting glucose 181 mg/dL, and creatinine 1.0 mg/dL(N.L- 0.7 - 1.4 mg/dL). Which of the following radiologic findings would you most expect to be present in this patient? Select one: a. Right adrenal mass with abdominal CT scan; b. Mass at aortic bifurcation with MR imaging; c. Multiple pulmonary nodules on chest radiograph; d. Cystic right ovarian lesion by abdominal Ultrasound; 207. Among Helicobacter pylori-infected patients, the risk of peptic ulcer is increased by which of the following? Select one: a. Alcohol use; b. NSAID use; c. Cigarette smoking; d. All of them; 208. Which of the following does not affect the serum creatinine concentration in chronic kidney disease: Select one: a. Tubular secretory function; b. Glomerular filtration rate; c. Skeletal muscle mass; d. Fluid overload; 209. A clinical study is performed with pediatric subjects who had a diagnosis of minimal change disease. These patients were observed to have prominent periorbital oedema at diagnosis. Laboratory test findings from serum and urine tests were analyzed. Which of the following urinalysis test findings is most likely to have been consistently present in these subjects: Select one: a. Nitrite positive;  b. Proteinuria >3.5 gm/24 hours; c. Hematuria with >10 RBC/hpf; d. Calcium oxalate crystals; e. Renal tubular epithelial cells and casts; 210. Drug use during kidney development: Select one: a. Is safe, unless noted differently in the package leaflet; b. May have a wide variety of consequences; c. Should always be prevented; d. Should not be subject of more research; 211. Which of the following measures is contraindicated in preparation for the surgery of a patient with mechanical intestinal obstruction? Select one: a. Aspiration of gastric contents; b. Infusion therapy; c. Spasmolytic therapy; d. Injection of drugs, increasing intestinal peristalsis; 212. Which is the first choice of treatment in subacute thyroiditis: Select one: a. Nonsteroidal anti-inflammatory drugs; b. Levothyroxine; c. Metoprolol; d. Steroids 213. A 32-year-old previously healthy man has lateral visual field deficits. His facial features have changed over the past year. His shoe size has increased. A head CT scan reveals enlargement of the sella turcica. Which of the following hormones is most likely being secreted in excessive amounts in this man? Select one: a. Antidiuretic hormone; b. Prolactin; c. ACTH; d. Growth hormone; 214. A patient with a congenital solitary functioning kidney: Select one: a. Can be safely discharged from follow-up when check-ups at the age of 2 years are normal; b. Should be checked until the age of 10 years, as no long-term sequelae have been noted after that; c. Has sufficient renal reserve capacity to go through life without any expected renal consequences, just as has been shown for large numbers of kidney donors;  d. Has a condition that warrants a relatively infrequent but long-term follow-up; 215. Which of the following is the most common cause of nephrotic syndrome in school-aged children: Select one: a. IgA nephropathy; b. Minimal change disease; c. Focal Segmental Glomerulosclerosis; d. Membranous Nephropathy; e. Membranoproliferative Glomerulonephritis; 216. What is the method for early acute intestinal obstruction diagnosis? Select one: a. Plan radioscopy of the abdominal cavity; b. Laparoscopy; c. Irrigoscopy; d. Ultrasonography of the abdominal cavity; 217. All of the following describe the natural course of chronic kidney disease, except: Select one: a. The onset of proteinuria is reflective of worsening of kidney disease; b. Hyperfiltration of non-injured nephrons cause eventual sclerosis; c. Proteinuria itself contributes to glomerular damage and progression of kidney disease; d. Progression of chronic kidney disease is mainly reversible; 218. What is the basic functional unit of the kidney: Select one: a. Renal pelvis; b. Major calyces; c. Nephron; d. Collecting duct; e. Glomerulus; 219. The adverse effects of the corticosteroids are all, except: Select one: a. Weight gain; b. Glucose intolerance; c. Growth impairment in children; d. Osteoporosis; e. Hair loss; 220. All of the following dietary measures may be recommended for kidney stone prevention except: Select one:  a. Low-sodium diet; b. Reduction in animal protein intake; c. Reduction in dietary calcium intake; d. Low-oxalate diet; e. 2-3 L of daily fluid intake; 221. The diagnosis of urinary tract infection is confirmed by: Select one: a. Urine culture; b. Renal Ultrasound; c. Complete blood count; d. Urine dipstick test; e. Positive nitrite test; 222. The patient is a 30-year-old woman who presents with a 10-day history of constant palpitations, weakness and irritability. She has had a number of symptoms for the past week, including heat intolerance, hand tremor, generalized weakness, inability to sleep and frequent bowel motions. Her past medical history includes eczema localized to her hands, which is longstanding. Family history includes ischaemic heart disease in her father, diagnosed after myocardial infarction at the age of 72, her mother suffers from vitiligo, and her sister has type 1 diabetes. How would this information help you in the diagnosis, what tests would you do and why? Select one: a. TSH, FT4, Anti TPO, Anti TG; b. Prolactin, LH; c. Prolactin FSH; d. Cortisol, norepinephrine; 223. Analysis of the arterial blood shows the following values: pH 7.50, HCO3 - 38 mmol/l and PCO2 50 mm Hg. Define acid-base disorder: Select one: a. Respiratory alkalosis; b. Metabolic acidosis; c. Respiratory acidosis; d. Metabolic alkalosis; 224. So-called benign proteinuria includes: Select one: a. Orthostatic proteinuria; b. Proteinuria after strenuous exercise; c. Proteinuria during feverish disease; d. All of the above; 225. In which of the following conditions is screening for and treatment of asymptomatic bacteriuria indicated: Select one:  a. Elderly men and women; b. Pregnant women; c. Patients with Diabetes Mellitus; d. Male infants; e. After treatment of pyelonephritis; 226. Which of the following factors is not associated with an increased risk of renal injury in congenital Single Functioning Kidney (SFK): Select one: a. Additional anomalies in the SFK ; b. Increasing age; c. Male sex; d. All of the above; 227. Which of the following is true regarding net acid production by the kidney? Select one: a. Plant foods are higher in organic anions and provide a net acid load; b. Animal foods are high in protein and organophosphates and provide a net acid diet; c. Sulfur-containing amino acids are metabolized to CO2; d. Metabolism of lysine and arginine yield base on metabolism; e. Daily volatile acid production is approximately 1 mmol H+; 228. High anion gap acidosis is observed in all except: Select one: a. Lactic acidosis; b. Uremic acidosis; c. Salicylate poisoning; d. Diarrhoea; 229. Tacking food influences: Select one: a. Growth hormone; b. C peptide; c. TSH; d. Prolactine; 230. A 35-year-old woman has had difficulty concentrating at work for the past month. She seems nervous and often spills her coffee. She has been eating more but has lost 5 kg in the past two months. On physical examination, her temperature is 37.2°C, pulse 99/minute, blood pressure 150/80 mm Hg. Which of the following laboratory findings is most likely to be present in this woman? Select one: a. Decreased catecholamines;  b. Decreased iodine uptake; c. Decreased plasma insulin; d. Decreased TSH; 231. The most common histologic types of soft tissue sarcoma in adults are? Select one: a. Malignant fibrous histiocytoma; b. Malignant peripheral nerve sheath tumours; c. Synovial sarcoma; d. None of them; 232. The reason of skin hyperpigmentation in patients with Addison disease is: Select one: a. The direct influence of sunlight; b. Excessive production of Proopiomelanocortin; c. Excessive production of aldosterone; d. Excessive production of cortisol; 233. All of the following is the function of the kidneys, except: Select one: a. Regulate blood pressure; b. Maintain blood pH; c. Excretion of toxic nitrogenous compounds; d. Stimulate erythropoiesis; e. Production of albumin; 234. A 30-year-old man has noted puffiness around his eyes and swelling of his feet for the past 2 weeks. On physical examination, his blood pressure is 120/80 mm Hg. Urine microscopic examination reveals oval fat bodies. Which of the following conditions is the most likely to have: Select one: a. Nephritic syndrome; b. Obstructive uropathy; c. Acute Interstitial Nephritis; d. Idiopathic Nephrotic Syndrome; 235. Causes of Metabolic Alkalosis are all except: Select one: a. Recurrent vomiting; b. Barter Syndrome; c. Use of Loop diuretics; d. Diarrhoea; 236. Which cases of hyperprolactinemia don't require pharmacologic treatment? Select one: a. Medication-induced hyperprolactinemia with hypogonadism; b. Macroprolactinemia; c. Microprolactinemia; d. Medication-induced asymptomatic hyperprolactinemia; 237. Excessive catabolism due to thyrotoxicosis can lead to: Select one: a. Decreased level of Potassium and decreased level of creatine phosphokinase; b. Decreased level of Potassium and increased level of creatine phosphokinase; c. Increased level of Potassium and increased level of creatine phosphokinase; d. Increased level of Potassium and decreased level of creatine phosphokinase; 238. Which is the first-line treatment option in patients with type 2 diabetes Select one: a. Secretagogues; b. Sensitizers; c. Incretins; d. Insulin; 239. The sequence of events in the hyperfiltration hypothesis is: Select one: a. Glomerular hyperfiltration, glomerular hypertension, systemic hypertension, GFR decline; b. Glomerular hyperfiltration, albuminuria, GFR increase, systemic hypertension; c. Systemic hypertension, glomerular hyperfiltration, albuminuria, GFR decline; d. Systemic hypertension, glomerular hypertension, GFR increase, albuminuria; 240. Phlegmon of the retroperitoneal space as a complication of acute appendicitis develops in: Select one: a. Anterior subhepatic vermiform appendix location; b. Local peritonitis in the right iliac area; c. Retroperitoneal location of the vermiform appendix; d. Medial location of the vermiform appendix;