Problems related to nephrotic syndrome and other diseases

Problems related to nephrotic syndrome and other diseases

Nephrotic syndrome is a clinical syndrome characterized by proteinuria, edema, hypoalbuminemia, and hypercholesterolemia.

1. Common abnormalities in patients with primary nephrotic syndrome:

• Thrombocytosis and increased fibrinogen.

2. Which of the following diseases is characterized by decreased white blood cell count and platelet count in patients with nephrotic syndrome?

• Lupus nephritis (A)

3. What is the reason for low serum sodium levels in nephrotic syndrome?

• Sodium leaks into the interstitial space.

4. Which type of casts in the urine is most characteristic of patients with primary nephrotic syndrome?

• Hyaline casts (B)

5. What is the characteristic of joint fluid in acute gout?

• White blood cell count below 2,000 cells/mm³, urate crystals are present in polymorphonuclear leukocytes (D)

6. Which test is done for systemic lupus erythematosus?

• Hargraves cell (B)

7. How should a patient diagnosed with chronic adrenal insufficiency due to glucocorticoid be treated?

• Hydrocortisone at a dose of 0.2-0.4mg/kg/day (A)

8. Which side effect of antithyroid drugs does NOT occur?

• Renal failure (A)

9. Which of the following drugs belongs to the Acarbose group for the treatment of type 2 diabetes?

• Glucobay (D)

10. Which of the following drugs belongs to the biguanide group for the treatment of type 2 diabetes?

• Glucophage (B)

11. Which drug should be chosen for treatment of obese patients with type 2 diabetes?

• Glucophage

12. Duration of medical treatment for Graves’ disease:

• Minimum 2 years

13. Duration of attack treatment for Graves’ disease:

• 6-8 weeks

14. Which tests are done for systemic lupus erythematosus?

• Complete blood count, antinuclear antibodies, Hargraves cell

15. The usual follow-up time for an active VKDT patient:

• Every 4 weeks

16. A 28-year-old female patient has secondary amenorrhea and galactorrhea for the past 6 months. Prolactin blood test showed an elevated level of 3250 mU/L; MRI revealed microadenoma. What is the appropriate treatment for the patient? (The patient is planning to get married soon)

• Dostinex

17. Which of the following factors are related to decreased ADH secretion?

• Drinking a lot of water (A)

18. Which of the following hormones increases during pregnancy?

• Human chorionic goandotropin (hCH) (C)

19. The typical joint fluid of osteoarthritis is:

• White blood cell count < 2,000/mm3 (B)

20. Incidence of hepatocellular carcinoma in Vietnamese men:

• 20-150/100,000 people

21. Which of the following cases is prioritized for liver resection?

• A single liver tumor < 5cm, Child-Pugh A cirrhosis, no esophageal varices, normal bilirubin, general condition <1 point (D)

22. Immune resistance is related to cancer, which age group of patients with hepatocellular carcinoma has the worst prognosis?

• < 20 years old (A)

23. AFP usually does not increase in which of the following cases?

• Intrahepatic cholangiocarcinoma (D)

24. In which of the following cases is the use of Western medicine for dissolving gallstones NOT indicated?

• Patients with large stones who have had biliary stent placement or supportive treatment after lithotripsy (D)

25. The first-line drug (baseline drug) for the treatment of bleeding ulcerative colitis is:

• 5-Aminosalicylic acide (5-ASA) (B)

26. In the treatment of intestinal tuberculosis, which of the following drugs is NOT combined with anti-tuberculosis regimen?

• Corticosteroids (A)

27. Which of the following ranges of histological activity scores according to Knodell is considered moderate active chronic hepatitis?

• 9 – 12 points (C)

28. Which of the following statements about mitral valve regurgitation is NOT true?

• In young people with rheumatic heart disease, isolated mitral regurgitation is uncommon (C)

29. The murmur of mitral valve regurgitation:

• Soft, running along the sternum

30. Of the following peripheral symptoms, which one has high reliability for the diagnosis of aortic valve regurgitation?

• Durozier’s sign (C)

31. Which of the following symptoms indicates the worst prognosis for patients with aortic stenosis?

• Heart failure (C)

32. Which of the following statements about aortic valve disease is TRUE?

• Rheumatic aortic stenosis is usually not isolated (B)

33. Which of the following murmurs suggests aortic stenosis?

• Systolic murmur in the 2nd left intercostal space, radiating to the neck (A)

34. A male patient was admitted to the hospital due to sudden onset of dyspnea, wheezing, and agitation. Examination revealed increased anxiety, diaphoresis, frequent dry cough, respiratory rate of 35 breaths/min, SpO2: 88%. Blood pressure 150/100mmHg. There was a systolic murmur in the 2nd right intercostal space near the sternum, radiating to the right supraclavicular fossa. S2 was loud, splitting in the 2nd right intercostal space near the sternum and in the 2nd, 3rd left intercostal spaces. Rales, rhonchi, and crackles were heard in both lung fields, reaching the lung apex. Bedside ultrasound showed left ventricular hypertrophy, left ventricular dilatation, mean aortic valve pressure gradient of 50mmHg, aortic valve area of 0.9 cm2.

What is the clinical diagnosis of the patient?

• Mitral valve regurgitation, aortic stenosis – Acute pulmonary edema (B)

35. A 49-year-old male patient was examined because he accidentally measured his blood pressure to be 140/60mmHg during a routine health checkup. He had no chest pain or dyspnea. Examination revealed regular heart rhythm, heart rate of 90 beats/min; S1 was faint, a 3/6 systolic murmur and a 2/6 diastolic thrill at the apex. A 3/6 diastolic murmur was heard in the 3rd left intercostal space at the left sternal border, the murmur was soft, gentle, and ran along the sternum. Capillary pulsation (+) was present, Musset’s sign (+) was present.

ECG: Sinus rhythm, left axis deviation, R height of 30mm in V5, V6.

What is the most likely clinical diagnosis of the patient?

• Mitral valve regurgitation, aortic valve regurgitation (B)

36. A male patient had been diagnosed with aortic stenosis for many years, but he did not receive regular treatment. He was admitted to the hospital for sudden onset of severe dyspnea. Examination revealed increased anxiety, diaphoresis, frequent dry cough, respiratory rate of 35 breaths/min, SpO2: 88%. Blood pressure 150/100mmHg. Many crackles, rhonchi, and rales were heard in both lung fields, reaching the lung apex. Ultrasound showed left ventricular hypertrophy, mean aortic valve pressure gradient of 50mmHg, aortic valve area of 0.9 cm2. The patient was treated with loop diuretics (TM).

What is the next step in the emergency treatment of the patient?

• Nitroglycerin (B)

37. Contraindications of ACE inhibitors:

• Renal artery stenosis, renal failure, PNCT

38. Treatment of ankylosing spondylitis:

• NSAIDs and TNF alpha

39. What is NOT true about PPIs?

• Decreased absorption when used concomitantly with sucralfate

40. Which factor is NOT used in Blatchford?

• hematemesis and age

41. Which method is NOT used to treat esophageal variceal rupture?

• esophageal stent (used for K esophagus)

42. Symptoms to differentiate irritable bowel syndrome from constipation:

• Abdominal pain

43. Reduce or stop propranolol for preventing esophageal variceal rupture when:

• liver and kidney

44. Barcelona staging for K liver does NOT include:

• AFB

45. Child-pugh score for prognosis of liver cirrhosis does NOT include:

• AST, ALT, age

46. Okuda staging for K liver does NOT include:

• PT, stage 2

47. Initial furo/aldos dose:

• 40/100

48. What is wrong about pyloric stenosis complications?

• The least common

49. Micronodular cirrhosis (portal tract) is often caused by alcohol:

• It can’t become macronodular

50. Lupus nephritis is divided into how many histopathological types?

• 6

51. SCC marker:

• Squamous cells

52. Late complications of acute myocardial infarction:

• Ventricular aneurysm

53. Vincristin affects the phase:

• M

54. Urine with 10 dipsticks having 1g/24l protein. HC (+++), BC (+++) suggests:

• Acute interstitial nephritis

55. After two days of influenza, cough with purulent sputum, rhonchi, rales, and crackles were present in the lungs, what is the choice of treatment?

• Antibiotics, expectorants, bronchodilators

56. Histopathology of post-streptococcal acute glomerulonephritis:

• Diffuse proliferative glomerulonephritis

57. Reed-Sternberg:

• Hodgkin’s lymphoma

58. Granuloma appearance in which disease?

• Hodgkin’s lymphoma

59. Acute bronchitis:

• Rhonchi

60. Tuberculous granuloma:

• Caseous necrosis, Langhan’s giant cells

61. The significance of MDF in alcoholic fatty liver disease:

• Prognosis of death

62. Coat-sleeve edema:

• Superior mediastinum

63. Treatment of withdrawal syndrome:

• Thiamine IM and benzodiazepine

64. Mechanism of bronchodilation:

• Traction, displacement, and destruction of airway wall structures

65. Epidemiology of ITP (Immune Thrombocytopenic Purpura):

• Usually in females

66. PQ diameter/mm diameter is associated with the diagnosis of:

• Degree

67. NK is most common in patients with esophageal variceal rupture:

• Spontaneous bacterial peritonitis