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<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>

<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>

<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>

<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>

<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>

<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>

<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>

<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>

<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>

<|im_start|>user One of the following is a known cause of gynecomastia: (6/2019) A. Hepatitis A infection B. Acute renal failure C. Hyperparathyroidism D. Hyperpituitarism E. Furosemide diuretic <|im_end|> <|im_start|>assistant Answer: D Causes of gynecomastia: l-Physiological: growing infants, puberty 2-Cirrhosis of liver 3-Klinefelter's syndrome 4-Testicular cancer 5-Chronic renal failure 6-Hyperthyroidism 7-Drugs: spironolactone, CCB, ketoconazole, methyldopa, cimetidine, digoxin, drugs of abuse (alcohol, heroin, marijuana) <|im_end|>

<|im_start|>user A 44 years old female known to have gave's disease underwent thyroidectomy, come to her GP complaining change of her breath sound. she first noted numbness, particular in her toes and finger three month ago but attributed this to the cold weather. her BMI 27, while measuring her blood pressure you notice the patient flex her wrist. The most likely diagnosis: (6/2019) and toes, A. Obstructive sleep apnea B. Secondary hypoparathyroidism C. Primary hypoparathyroidism D. Gullian-barre syndrome E. Raynaud's syndrome <|im_end|> <|im_start|>assistant Answer: C This patient has symptoms of hypocalcemia (numbness of finger Trousseau's sign) which cause by primary hypoparathyroidism (most common complication of thyroidectomy) Secondary hypoparathyroidism caused by causes of hypercalcemia <|im_end|>

<|im_start|>user A 42-year-old female presented with visual disturbance. she reports have double vision which intermittent initially but has now become much more frequent. Ln addition, she become breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing, all of the following true except : (6/2019) A. B. C. D. E. This condition is due to Ig G antibodies binding to the TSH receptor Thi s condition associated with multinodular goiter Thi s condition associated with pernicious anemia and high T3, T4 This condition in long tern can lead to osteoporosis Thi s condition can be teated with radioactive iodine <|im_end|> <|im_start|>assistant Answer: B This patient has clinical features of Grave's disease = hyperthyroidism + diffuse goiter + exophthalmos + dermopathy <|im_end|>

Effects of angiotensin Il receptor antagonist include all Of the following except: (6/2019) A. Decrease renin activity B. Vasodilation C. Decrease aldosterone D. Decrease sodium absorption E. Decrease potassium excretion <|im_end|> <|im_start|>assistant Answer: A Action of ARABS: l-Block angiotensin receptor 2-Decrease aldosterone decrease vasoconstriction >> decrease blood pressure decrease absorption of Na and H20 and decrease excretion of K and H+ 3-Decrease renin secretion (compensatory ) angiotensin Il increase level of angiotensin I and <|im_end|>

<|im_start|>user A 38-year-old female patient, who has BMI 29 and type 2 DM, she has been taking metformin with good effect for the last four months. He has started to lose weight and maintained good glucose control. In the last two months, however, the patient has been persistently hyperglycemic despite increased metformin dosage and Hb Alc targets have not been achieved and now Hb A1c is A. B. C. D. E. 11%. The most appropriate management? (6/2019) Add thiazolidinedione Add insulin therapy Add sulfonylurea Increase metforrnin dose Add exenatide <|im_end|> <|im_start|>assistant Answer: C Oral hypoglycemics: A-Metformin: first drag of choice in all newly diagnosed for all type 2 -Not cause hypoglycemia -not cause weight gain -contraindicated in renal insufficiency -side effect : nausea & diarrhea (most common) lactic acidosis B-Sulfonylureas (glyburide, glipizide, glimepiride) -Increase weight -cause hypoglycemia Sulfa group -side effect : hepatotoxicity C-thiazolidinediones (Rosiglitazone, pioglitazone) -decrease insulin resistance -worsen CHF -linked to bladder cancer -side effect : hepatotoxicity D-incretin mimetics (exenatide, liraglutide) (GIP, GLP) -given injection-increase insulin release -slow gastric motility E-Dipeptidyl peptidase IV (DPP-IV) (Sitagliptin, saxagliptin) -Prevent metabolism of incretins GIP, GLP -Increase insulin release & slow stomach emptying -given orally <|im_end|>

<|im_start|>user A 41-year-old male has been recently diagnosed with type 2 DM and has been following a plan lifestyle measures to improve his diet and increase his level of exercise, as well as he is on metformin and sulfonylurea. On returning to clinic, his BMI is 23, fasting plasma glucose 9. () mmo VL, blood pressure 133/84 mm Hg and Hbalc is 11%. The most appropriate treatment: (6/2019) Increase metformin dose A. B. Increase sulfonylurea dose C. Add insulin D. Add exenatide Further diet and exercise E. <|im_end|> <|im_start|>assistant Answer: C This patient need triple therapy including insulin as his Hb Alc more than 10% We use exenatide when BMI is very high <|im_end|>

<|im_start|>user A 35-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing. The most specific test to make the expected diagnosis is: (6/2019) A. Serum free T3 level B. Serum free T4 level C. Serum TSH level D. Serum thyroid stimulating immunoglobulin antibodies E. Serum total T4 level <|im_end|> <|im_start|>assistant Answer: D This patient has clinical pictures of grave's disease (hyperthyroidism + exophthalmos + dermatopathy + goiter ) which caused by thyroid stimulating immunoglobulin antibodies T3, T4, TSH used to diagnosis hyperthyroidism in general <|im_end|>

<|im_start|>user A fifteen year old boy who is Diabetic presents with pain abdomen , vomiting and shortness of likely cause of breath. There is history of fever and sore throat two days back. The most his symptoms is ? (4/2019) A. DKA B. Gastritis. C. Hypoglycemia. D. Renal failure. E. Non ketotic hyperosmolar coma <|im_end|> <|im_start|>assistant Answer: A This patient has clinical pictures of DKA ( which come in type I DM ) Precipitated by infection <|im_end|>

<|im_start|>user A forty year old lady gives history of weight gain and hoarseness of voice. On examination her pulse is 54 per minute and skin is pale, coarse and dry. The most important Investigation to find diaglosis in this case is ? (4/2019) A. ACTH B. Cortisol level. C. Gonadotrophin levels D. IGF E. TFT <|im_end|> <|im_start|>assistant Answer: E This female has clinical pictures of hypothyroidism which need thyroid function test in diagnosis <|im_end|>

<|im_start|>user A fony-year-old man presents with cold intolerance and weight gain. Examination reveals goiter. The most likely finding on central nervous system examination is: (4/2019) A. Ataxia B. Delayed C. Hypertonia D. Hyper reflexia E. Loss of sensations of ankle jerk <|im_end|> <|im_start|>assistant Answer: B Clinical pictures of hypothyroidism: lethargy, constipation, cold intolerance, stifress & cramping of muscles, carpal tunnel syndrome, menorrhagia, slow motor activity, decrease appetite, weight increase, hair & skin dry, deep voice, defiess, slow motor reflexes, high cholesterol, periorbital puffiness, large tongue, pale cool skin<|im_end|>