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Al Azhar University-Gaza

Faculty of Dr. H .Abdulshafi Of Dentistry

Name :

Date : 25 June, 2011


Time : 2 Hours

Student No : ....

Final Exam
Internal Medicine
Second Semester 10-11
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Part (I) Examination (MCQs)


Select the best answer (Only ONE Answer)
1) High plasma insulin levels has the following effects
a)
b)
c)
d)
e)

It stimulates breakdown of adipose tissue


It stimulates the storage of glycogen in the liver
It enhances protein catabolism
It increases the absorption of glucose from the intestine
Causes glycogenolysis

2) Diabetes mellitus may be caused by


a)
b)
c)
d)
e)
3)

Endocrine disease such as Cushings syndrome or Acromegaly


Bacterial infection
Muscular dystrophy
Eating too much sugar
Dyslipidemia

Oral glucose tolerance test (OGTT)


a)
b)
c)
d)
e)

A 75 gm glucose load is usually used


Can be very dangerous and must be avoided in the elderly
If fasting blood glucose is 100 mg/dl, OGGT is needed to establish the diagnosis of diabetes
OGGT can differentiate between Type 1 and Type 2 diabetes
Is the method of choice in the diagnosis of diabetes

4) Gestational diabetes
a)
b)
c)
d)
e)

Occurs when a pregnant eats too much sugar


Occurs when a diabetic becomes pregnant
Occurs when a pregnant woman becomes diabetic
Occurs when the fetus becomes diabetic
Occurs when insulin is deficient

5) Clinical picture of hyperthyroidism include all of the followings Except


a)
b)
c)
d)
e)

Nervousness
Tremors
Excessive sweating
Weight loss and increased appetite
Cold intolerance

6) When there is severe lack of insulin, blood glucose increases and


a)
b)
c)
d)
e)

7)

Polyuria and dehydration develops


Edema develops
Tachycardia develops
Exophthalmus develops
Obesity develops

The classical endocrine action


a)
b)
c)
d)
e)

Hormone may be secreted by a neighboring cell.


Hormone may be secreted by the same cell.
Hormone carried via blood from a secreting gland.
Hormone may be manufactured in situ.
Hormones may be secreted by exocrine glands

8) Hormone membrane receptors respond to the following hormone


a)
b)
c)
d)
e)

Steroid.
Catecholamine.
Thyroid hormones.
Insulin.
Adrenalin

9) Homeostasis means
a) Arrest of bleeding.
b) Keeping external environment stable.
c) Maintaining stable internal environment of the body.

d) Maximizing reaction towards internal environment.


e) Keeping internal environment unstable
10) Hormones are
a)
b)
c)
d)
e)

Chemical messengers which are secreted by glands via ducts.


Secreted by the exocrine glands.
Non-specialized chemical messenger.
Chemical messenger produced by specialized cells of the endocrine system.
Are related to vitamins in structure

11) Hyperprolactinemia in females causes


a)
b)
c)
d)
e)

Galactorrhea amenorrhea syndrome.


Obesity.
Hypertension.
Hyperglycemia.
Cushings syndrome

12) Excess growth hormone secretion leads to


a)
b)
c)
d)
e)

Gigantism if it occurs after puberty.


Acromegaly if it occurs before puberty.
Gigantism if it occurs before puberty.
Diabetes insipidus if it occurs after puberty.
Short stature

13) The hormone vasopressin (AVP)


a)
b)
c)
d)
e)

Is synthesized in the posterior pituitary.


Its secretion is defective in diabetes insipidus.
Is important for lactation.
Is released by a trophic hormone from hypothalamus.
Is synthesized in the anterior pituitary

14) The anterior lobe of the pituitary secrets


a)
b)
c)
d)
e)

Thyroid stimulating hormone (TSH).


Anti diuretic hormone (ADH).
Corticotrophin releasing hormone (CRH).
Thyroid releasing hormone (TRH).
Oxytocin

15) The level of total thyroxin (T4)


a)
b)
c)
d)
e)

Will be increased during pregnancy.


Is usually normal in thyrotoxicosis.
Is usually elevated in hypothyroidism.
May be increased due to TBG deficiency.
Usually increased in hyperparathyroidism

16) Congenital adrenal hyperplasia


a)
b)
c)
d)
e)

Is due to ACTH deficiency.


Is due to pituitary adenoma.
Usually caused by 21-hydroxylase deficiency.
Estrogen is produced in excess.
Cortisol excreted in excess

17) The objectives of linking internal medicine to dentistry, all of the following is true Except
a) Dentists dont treat only healthy people
b) Dental treatments can affect the patient health

c) Give a full details of internal medicine topics to the dentist


d) Dentists can discover some signs of special diseases
e) Emergency treatments of medical emergiencies encountred in dental practice
18)
a)
b)
c)
d)
e)

Roles and responsiblilitis for dental professionalism , all of the followig is true Except
Early detection of systemic diseases and recognition of oral manifestations of common diseases
Often first to identify a systemic health problem based on what they see in the patients mouth
Oral evaluation and diagnosis
Make approprite referral to physician when needed
Manage and treat all medical diseases encountred in dental practice

19) All of the following can lead to resistant hypertension Except


a)
b)
c)
d)
e)

Improper blood pressure measurement


Improper drug combination
Low Sodium intake
Non compliance
Obesity

20) Type 1 diabetes mellitus, all of the followings are true Except
a)
b)
c)
d)
e)

Autoimmune disease
5 10 % of diabetes mellitus
Result from peripheral tissues resistance to insulin
Mainly disease of children and young adults
Treated with insulin

21) All of the followings are necessary precautions when treating T1DM patient Except
a) Brief morning appointments (Decrease stress)
b) Patient should not take normal insulin dosage and eat normal breakfast. Confirm this with patient.
c) Consult physician if procedure will affect the patients ability to eat. Physician may alter the
insulin therapy/diet for patient.
d) Minimize risk of infection: consider antibiotic coverage after surgery and treatment
in presence of suppuration.
e) Have a source of sugar available.

22) Which of the following is normal Body Mass Index ( BMI kg / meter square )
a)
b)
c)
d)
e)

20-25
25-30
30-35
35 -40
> 40

23) Warning symptoms and signs of heart attack include all of the followings Except
a)
b)
c)
d)
e)

High temperature ( Hyperthermia )


Shortness of breath- may occur with or without chest discomfort
Impending sense of doom
Fainting
Nausea and vomiting

24) Definition of chronicity of viral liver disease ( To diffirentiate between acute


and chronic viral disease )
a) Persistent viral Infection for 1-2 months
b) Persistent viral Infection for 3-4 months

c) Persistent viral Infection for 5-6 months


d) Persistent viral Infection for more than 6 month
e) Persistent viral Infection for less than 6 months
25)

Which Hepatitis Virus leads to very high chronicity rate?


a)
b)
c)
d)
e)

HAV ( Hepatitis A Virus )


HBV ( Hepatitis B Virus )
HCV ( Hepatitis C Virus )
HDV ( Hepatitis D Virus )
HEV ( Hepatitis E Virus )

26) High risk population for HAV ( Hepatitis A Virus )


a)
b)
c)
d)
e)
27)

Hemophiliacs
Dialysis patients
Individuals living in poor hygiene and sanitation areas
IV drug abusers
Health care personnel

The element most essential for the biosynthesis of thyroid hormones is:
a)
b)
c)
d)
e)

Sodium.
Phosphorus.
Calcium.
Iodine.
Magnesium

28) The symptoms of Addison's diseases result from dysfunction of the:


a)
b)
c)
d)
e)

Adrenal cortex.
Adrenal medulla.
Pancreas.
Hypothalamus.
Posterior pituitary.

29) The beta cells of pancreatic islets secret:


a)
b)
c)
d)
e)

Insulin.
Glucagon.
Epinephrine.
Amylase.
Amylin

30) Glucocorticoids and mineralocorticoids are secreted by the:


a) Pancreas.
b) Adenohypophysis.
c) Adrenal glands.
d) Gonads.
e) Parathyroid glands
31) A female patient with Cushing's syndrome is expected to have the following:
a)
b)
c)
d)
e)

"Buffalo hump" and hypertension.


Dehydration and menorrhagia.
Migraine headaches.
Loss of weight.
Hyperpigmentation

32) The most common cause of Cushing's syndrome is:


a) Insufficient ACTH production.
b) Hyperplasia of the adrenal cortex.
c) Pituitary hypofunction.

d) Deficient adrenocortical hormones.


e) Increased levels of catecholamines
33) Which of the following diseases is characterized by arrhythmias, tremors, diarrhea and weight loss:
a)
b)
c)
d)
e)

Cushing's syndrome.
Hypothyroidism.
Addison's disease.
Hyperthyroidism.
Sheehan's syndrome

34) Individuals whose diabetes is poorly controlled are vulnerable to several chronic complications, the
one least likely to develop as a consequence of diabetes is
a)
b)
c)
d)
e)

Neuropathy
Atherosclerosis
Retinopathy
Lymphadenopathy
Nephropathy

35) Myxedema is associated with following:


a)
b)
c)
d)
e)

Hypopituitarism.
Hypoparathyroidism.
Hyperthyroidism.
Hypothyroidism.
Addison's disease.

36) Which of the following diseases is characterized by arrhythmias, tremors, diarrhea and weight loss:
a)
b)
c)
d)
e)

Cushing's syndrome.
Hypothyroidism.
Addison's disease.
Hyperthyroidism.
Sheehan's syndrome

37) In Graves' disease


a)
b)
c)
d)
e)

TSH is usually elevated.


T4 elevated and T3 is low.
Both FT4 and FT3 are elevated.
ACTH is elevated.
FSH level is usually elevated

38) Oral antidiabetic sulphonylureas can be effective for all the following Except
a)
b)
c)
d)
e)

Mild diabetes
Type 1 diabetes
Type 2 diabetes
Non-ketotic diabetes
In combination with metformin

39) The most common cause of diabetic ketoacidosis is


a)
b)
c)
d)
e)

Increased insulin dose


Presence of infection
Inadequate food intake
Emotional stress
Increased physical exercise

40) If a doctor suspect diabetes, he will unusually test


a) Urine for the presence of insulin
b) Urine for the presence of acetone

c) Blood for the presence of insulin


d) Blood for the presence of increased glucose level
e) Blood for the presence of increased c-peptide
41) Why glucosuria is consequence of hyperglycemia
a)
b)
c)
d)
e)

Because the kidneys are damaged


Because the kidneys have congenital tubular defect
Because the amount of blood filtered by the kidneys is incorrect
Because the amount of filtered blood by the kidneys is decreased
Because the kidneys are unable to reabsorb all the filtered glucose in the filtered blood

42) Following are predisposing disorders to aortic dissection, Except


a) Pregnancy
b) Kyphoscoliosis
c) Coarctation of aorta
d) Myocardial infarction

e) Hypertension
43) A decrease in extracellular volume is expected to cause increased secretion of all Except
a)
b)
c)
d)
e)

vasopressin
renin
thyroxin
ACTH
Insulin

44) Thyroid hormone is stored in the lumen of follicles in the form of


a)
b)
c)
d)
e)

free T3
free T4
attached to thyroglobulin in the gland
attached to thyroid binding globulin (TBG)
attached to albumin

45) The following are characteristic of adrenal insufficiency Except


a)
b)
c)
d)
e)

Hypotension
Small heart
Hyperkalaemia
Increased fatiguability of striated muscle
Hypoglycaemia

46) In a patient with thyrotoxicosis all false Except


a)

b)
c)
d)
e)

Atrial is common fibrillation


Diabetes insipidus is a common complication
A hoarse voice is not uncommon
Increased tendency to sleep
Hypertensive heart disease is a common association

47) Which of the following diseases is characterized by arrhythmias, tremors, diarrhea and weight loss:
a)
b)
c)
d)
e)

Cushing's syndrome.
Hypothyroidism.
Addison's disease.
Hyperthyroidism.
Diabetes mellitus

48) Insulin secretion is at its maximum in a normal individual


a) After a meal
b) Several hours after a meal
c) During sleep
d) Just fasting
e) During exercise
49) Acute cholecystitis is characterized by the triad of sudden onset of right upper quadrant tenderness,
fever, and:
a) Dermatitis
b) Leukocytosis
c) Lymphadenopathy
d) Generalized pruritis
e) Tenderness of right renal angle
50) A 16 year old female attends your dental practice for an appointment. She is fit and healthy but has a
phobia of dental injections. During administration of an inferior nerve block she becomes unwell and
faints. What do you think is the most likely cause?
a) Addisonian crisis
b) Cerebrovascular accident
c) Hypoglycemic shock
d) Myocardial infarction
e) Vasovagal attack
51) A 45 year old male with a history of T1DM loses consciousness during the course of dental treatment.
What do you think is the most likely cause?
a) Addosonian crisis
b) Anaphylaxis
c) Hyperglycemia
d) Hypoglycemia

e) Ketoacidosis
52) A 45 old female develops anaphylaxis following administration of amoxicillin. Which one of the
following drugs would be the most appropriate first line therapy?
a)
b)
c)
d)
e)

Adrenaline
Chlorphenaramine
Diazepam
Hydrocortisone
Salbutamol

53) Which one of the following is the least likely indication for antibiotic prophlaxis to prevent infective
endocarditis
a)
b)
c)
d)
e)

Congenital heart disease


Diabetes mellitus
Previous history of endocarditis
Rheumatic fever
Valvular heart disease

54) Which one of the following is least likely to be associated with immunosuppression
a)
b)
c)
d)
e)

Acromegaly
Agammaglobulinemia
Anemia
Diabetes mellitus
Leukemia

55) Bone pain, renal calcinosis, and giant cell jaw lesions are most likely to be seen in which one of the
following disorders?
a)
b)
c)
d)
e)

Acromegaly
Fibrous dysplasia
Hyperparathyroidism
Hyperthyroidism
Pagets disease

56) A 45 year old female presents with a 6 months history of recurrent meal time swelling in her right
submandibular region. Clinical examination does not reveal any dental abnormality. What is the most
likely cause of her symptoms?
a)
b)
c)
d)
e)
f)

Lymphadenitis
Sialolithiasis
Sialadenitis
Sialometaplasia
Goiter
Xerostomia

57) Which one of the following conditions is the least likely to be associated with an inceased risk of oral
cancer
a)
b)
c)
d)
e)

Erythroplakia
Leukoplakia
Leukoedema
Plummer Vinson syndrome
Actinic cheilosis

58) Behcets Disease , all of the followings are correct Except


a)
b)
c)
d)
e)

Vasculitis with triad of oral and genital ulcers and uveitis or iritis
Aphthous like ulcers, covered in pale pseudomembrane
Painless ulcers on lips, gingiva, buccal mucosa, tongue and palate
Genital ulcers similar in appearance
Heal in days to weeks with scarring

59) Indications for hospitalization in acute viral hepatitis include all of the followings Except
a)
b)
c)
d)
e)

Persistent anorexia or vomiting


Disturbed consciousness
Rising bilirubin (with rapidly declining liver enzymes)
Aminotransferase level > 200 unit/l for ONE week
Prolonged Prothrombin Time

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60) The goals of treating hypertension ,all of the following is true Except
a)
b)
c)
d)
e)

To decrease cerebrovascular accidents


To decrease progression of kidney disease
To decrease acute coronary events
To decrease urinary tract infections
To decrease the progression of diabetic complications

Part (II) Examination


(Short Answer Questions)
Question (1)
What are the criteria used for Diagnosis of Diabetes Mellitus?

Question (2)
What are the criteria used for Diagnosis of Acute Rheumatic Fever?

Question (3)
Mention one systemic disease related to the following oral manifestation:
1

Hyperpigmentation Hyperbilirubinaemia .

Oral ulcers Lupus erythematosus

Oral bleeding Chronic liver diseases

Gum hypertrophy Leukemia

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Xerostomia Sjgren syndrome Lupus erythematosus .

Periodontitisdiabetes.

Question (4)
Discuss the classification of anemia and give an example for each.

Question (5)
Discuss the main functions of the liver and mention some liver abnormalities related to dental practice.

Question(6)
Explain the importance of rheumatology in dental practice.

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Part III Examination


(Extended Matching Questions EMQs)
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
Question (I)

A)
B)
C)
D)
E)
F)
G)
H)

diabetes insipidus
tuberculosis
renal carcinoma
carcinoma of the stomach
coeliac disease
diabetes mellitus
pancreatic carcinoma
thyrotoxicosis

(1) A 26-year-old woman complains of weight loss associated with diarrhoea and palpitations. Her pulse is
irregular.
(2) A 30-year-old man complains of fever, weight loss, night sweats and persistent cough.
(3) A 55-year-old woman presents with abdominal pain, weight loss and fatty stools. She also complains of
extremely uncomfortable itchy blisters on her knees and elbows.
(4) A 10-year-old boy presents with a history of weight loss and excessive thirst.

Question (II)
A)
B)
C)
D)
E)
F)
G)
H)

hypoparathroidism
hyperparathyroidism
hyperprolactinaemia
Cushings disease
hyperthyroidism
diabetes mellitus
acromegaly
phaeochromocytoma

(1) A 21-year-old woman presents with amenorrhoea, vaginal dryness and galactorrhoea. On examination she
has a bitemporal hemianopia.
(2) A 26-year-old woman complains of weight gain, menstrual irregularity and hirsuitism. Examination reveals
proximal muscle weakness and BP of 150/100 mmHg.
(3) A 28-year-old woman presents with chest tightness and anxiety attacks. She is hypertensive and her ECG
shows left ventricular hypertrophy.
(4) A 40-year-old woman is worried about her changing appearance and deepening voice. On examination she
has coarse oily skin, enlarged tongue and proximal muscle weakness. She also mentions paraesthesia in
both hands of recent onset.

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Question (III)
A)
B)
C)
D)
E)
F)
G)
H)

thiamine
vitamin D
folic acid
vitamin C
vitamin A
pyridoxine
vitamin K
vitamin B12

(1) A 55 year old with alcohol problems presents with nystagmus, ophthalmoplegia and ataxia.
(2) A 35-year-old patient recently diagnosed with coeliac disease complains of prolonged bleeding after a
small cut. The prothrombin time is increased.
(3) A 30-year-old woman with poor diet complains of bleeding gums.
(4) A 12-year-old boy presents with night-blindness.
Question (IV)

A)
B)
C)
D)
E)
F)
G)
H)
I)

Cushings syndrome
coarctation of the aorta
pregnancy
polycystic kidneys
malignant hypertension
hyperparathyroidism
renal artery stenosis
portal hypertension
phaeochromocytoma

(1) An anxious 26-year-old woman presents with episodes of chest pain and palpitations precipitated by
stress and smoking. Her 24-hour urine shows elevated catecholamines.
(2) A 45-year-old woman presents with weight gain, muscle weakness and hirsutism. On examination she is
hypertensive and has pedal edema.
(3) A 40-year-old man is brought to A&E with severe headache. On examination he has papilledema and
fundal haemorrhages. His BP is 220/145 mmHg.
(4) Hypertension in a 75 year old who is a heavy smoker with widespread peripheral.

Good Luck
Dr. Suhail Kishawi

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