Vaka Tustime

PEDIATRICS
CONTENTS
NEWBORN................................................. ..........................
........................ ............................. 7
GENETIC................................................. ..........................
........................ .................................. 83
DISORDERS OF CARBON HYDRATE
METABOLISM ............................................... ........................
93
NORMAL GROWTH AND
DEVELOPMENT .............................................. ........................
.......................... . 149
NUTRITION AND
MALNUTRITION ............................................... ......................
............................ 151
VITAMINS ................................................. ........................
.......................... ........................... 157
MINERALS AND
ELEMENTS ............................................... ..........................
........................ .... 177
RESPIRATORY
SYSTEM................................................ ............................
...................... .................. 185
IMMUNE
FAILURES ................................................ .........................
......................... ........... 225
ROMATOLOGICAL
DISEASES ................................................ .........................
......................... ... 235
INFECTIOUS
DISEASES ................................................ .........................
......................... ..... 245
VACCINES ................................................. ........................
.......................... ................................... 291
PEDIATRIC
CARDIOLOGY ................................................ .......................
........................... .......... 303
EMBRYOLOGICAL
ABNORMALITIES ................................................... .................
................................. ... 369
SMALL AND BIG INTESTINAL
DISEASES ............................................. ............................
............. 381
Liver, gallbladder and pancreatic
diseases ........................................... ................ 401
HYPOTALAMUS AND HYPOPHYSIS
DISEASES ................................................... ......................
.............. 415
ERYTHROCYTE
DISEASES ........................................................ .................
................................. .......... 463
LEUKEMIA AND
LYMPHOMAS ............................................... .........................
......................... ......... 519
PAYMENT, PROTEINURY AND NEPHROTIC
SYNDROME ............................................ .............................
... 561
LIQUID-ELECTROLITE AND ACID-BASE BALANCE ..........................................
............................................ 595
CONGENITAL CENTRAL NERVOUS SYSTEM ANOMALIES, HYDROSEFALY, HEAD ENVIRONMENTAL
ANOMALIES .. 601
NEWBORN
NEWBORN
PERINATAL PERIOD
PROBLEMS
one. From the mother to the fetus in the etiology of which of the following
neonatal diseases
do antibodies play a role? (September 2011)
A) Neonatal hypoglycemia
B) Neonatal hypocalcemia
C) Transient neonatal thyrotoxicosis
D) Macrosomy
E) Microcephaly
This question is very simple. The answer, of course, is
and transient neoantal thyrotoxicosis associated with the duration of antibodies.
Neonatal graves' disease: due to stimulant antibodies passed on to the baby due to
the mother's disease
It happens.
• It is more serious if the antibody level is high. It usually occurs in active
disease.
• If the mother is given antithyroid treatment, its appearance is delayed (starts
after 3-4 days).
• If the thyroid receptor blocking antibody is also present, the symptoms may take
several weeks.
• The findings improve with the decrease of antibodies passing through the mother
in 6- 12 weeks. Rarely persists.
Findings in Neonatal Gravity
IUBG - PM
Exophthalmos - wide open eyes
Goitre (most often)
Microcephaly - Craniostosis - ventricular expansion
Irritability, restlessness
Triangle Face
Tachycardia, tachypnea,
thrombocytopenia
hyperthermia
HSM and jaundice
hyperactivity
Severe hypertension - heart failure
Unrest
Death if not treated

Findings to help diagnosis in prenatal period: It is thought with tachycardia and
goiter in fetus.
Goiter is the most common finding with neonatal hyperthyroidism.
(Answer C)
ALL TYPES OF TISTIME QUESTIONS
one
PEDIATRICS
2nd. To prevent bleeding due to vitamin K deficiency in newborn infants

Which of the following statements is true about what needs to be done? (December
2010)
A) There is no need for special prevention since vitamin K deficiency is not seen
in breast-fed infants.
B) The mother is given a high dose of vitamin K before birth.

C) Multivitamin is started on the 15th day.
D) The baby is given 1 mg intramuscular vitamin K after birth.
E) Folic acid is started after the baby is born.
It was one of the easiest questions of the exam.
Vitamin A and C levels in breast milk are good, while vitamin K and D levels are
low. These are also two vitamins given to babies. Vitamin K is given to everyone
after birth with 1 mg IM K1.
It should be done for the prevention of classic hemorrhagic disease.
(Answer D)
3. Which of the following does not cause hypocalcemia in the newborn? (December
2010)
A) Maternal diabetes
B) Maternal anticonvulsant use
C) Prematurity
D) Hypomagnesemia
E) Maternal hypoparathyroidism
Maternal hypoparathyroidism is clearly noticed when you look at the hypercalcemia
in the baby, which can be done very easily if you reverse it.
The use of maternal anticonvulsants caused vitamin K deficiency by induction of
enzyme
as well as vitamin D deficiency.
2nd
NEWBORN
Hypocalcemia in the newborn is divided into early and late according to the time of
observation.
Early hypocalcemia of the newborn (first 4 days)
• DAB (PTH is low in uncontrolled diabetes, calcitonin and P are high, Mg is lost)
• It may be due to prematurity and low intake such as SGA.
• Perinatal stress (asphyxia)
• Alkalose (bicarbonate Ca bonds)
• Furosemide treatment (increases Ca excretion in urine and causes
nephrocalcinosis)
If citrate is used during blood storage, Ca and Mg are bound by citrate.
Lipid infusion and phototherapy (white light) also causes hypocalcemia.
Hypocalcemia in these conditions occurs after the 5th day of life.
Late hypocalcemia of the newborn
• Excess phosphorus load (due to undiluted cow's milk, feeding is now very rare)
• Mg deficiency
• Vitamin D deficiency
• Pseudohypoparathyroidism
• Hypoparathyroidism
• Hypercalcemia in the mother
Hyperparathyroidism in the mother
hypercalcemia
The most common cause of the newborn is excessive calcium or vitamin D. Serum Ca
level> 11 mg /
dl.
Hypotonia, lethargy, decreased absorption, hypotonia, constipation, polyuria (the
effect of ADH on renal tubules)
dehydration).
Reasons
• Iatrogenic excess Ca administration
• Excessive vitamin D administration
• Maternal hypoparathyroidism
• Subcutaneous fat necrosis
• Williams syndrome
• Vitamin A intoxication
(Answer E)
4. A normal vaginal baby weighing 4000 grams, right after birth
because he could not move his arm. Physical examination of the baby's right arm
extension and internal rotation, there is low tonus on that side and no Moro
reflex; but there is no pain in the baby during passive movements
It is observed.
Which of the following should be considered first in this baby? (December 2010)
A) Absence or weakness of the isolated muscle on the affected side
B) Early signs of early onset muscular dystrophies
C) Humerus fracture on the affected side
D) Brachial plexus injury on the affected side
E) Since the baby is born 4000 grams, the diabetic mother may have a baby and
thrombosis on the affected side.
may have formed
PEDIATRICS
Macrosomia of the baby is significant for birth trauma. In case of humeral fracture
but it should have been pain. Brachial plexus is the most commonly used plexus at
birth. in this
most often C 5 - 6 is injured and the typical table is the Moro's failure and the
waiter's hand.
Erb – Duchenne Paralysis: The most common is the brachial plexus paralysis. C5 - 6
roots are affected. The arm is in adduction and internal rotation and the forearm
is in pronation (waiter's hand).
There are no Moro, biceps and radial reflexes on the paralytic side. Hand movements
and hand-held are preserved.
(Answer D)
5. Which is one of the important factors that increase perinatal mortality
It is not? (September 2008)
A) Prematurity
B) Intrauterine growth restriction
C) Perinatal asphyxia
D) Placenta previa
E) Intrauterine infections
Nelson table question, causes of perinatal and neonatal mortality in fetus, preterm
and term
given separately. Ablation placenta is counted among fetal causes. As placenta
previa cause
It is not specified. While placental insufficiency is the most common cause of
death in fetus, preterms are
they die from complications related.
Asphyxia and birth trauma are seen as causes of death in term infants.
Congenital anomalies and infections are the cause of death in 3 cases.
Fetal deaths are more common in perinatal mortality than neonatal deaths.
Major causes of perinatal and neonatal mortality
Fetal
PREMATURE
TERM
Placental insufficiency
immaturity
Congenital anomalies
Intrauterine infections RDS
Asphyxia / birth trauma
Severe congenital anomaly
Intracranial hemorrhage
infections
Umbilical cord trauma
Congenital anomaly
Meconium aspiration
Hydrops fetalis
infections
PPHT
Abruptio placenta
NEC, BPD
(Answer D)
NEWBORN
6. In twin-to-twin transfusion syndrome developed in intrauterine period, donor

fetus
Which of the following develops? (April 2008)
A) Polyhydramnios
B) Hydrops fetalis
C) Intrauterine growth retardation
D) Polycythemia
E) Cardiac hypertrophy
The donor side is the artery side. The recipient is the vein side. The transmitter
remains small while the receiver is large. Anemia and
on the recipient side, which is polycythemic, considering that we may have
Let's underline the sight of hidrops.
Plesental vascular anastomoses are more common in monochorionic twins.
Arteriovenous anastomosis
Feto-fetal transfusion syndrome develops. 5 g / dl in hemoglobin, 20% of body
weight
difference. Anastomosis ablation is performed.
Arterial side-Transmitter
Vein side-Receiver
oligohidroamnios
polyhydramniosis
Small premature
LGA premature
Malnutrition
hydrops
Paleness, anemia
Pletorrhea, polycythemia
hypovolaemia
hypervolemia
Mikrokardi to
Cardiac hypertrophy, Myocardial dysfunction, Right ventricular outflow tract

obstruction, Tricuspid regurgitation, thick arteriole.
hypoglycemia
Large glomeruli
Thin-walled arterioles
Small or normal glomeruli
(Answer C)
7. Which of the following does not cause oligohydramniosis? (April 2006)
A) Fetal anomaly
B) Achondroplasia
C) Renal agenesis
D) Pulmonary hpplasia
E) Intestinal pseudoobstruction
Try to solve the question, which is the cause of polyhydramniosis.
Amniotic fluid volume increases to <10 ml / day by the 34th week, then begins to
decrease. amniotic
the liquid is termed <500 cc oligohydramniosis in the third trimester,> 2000 cc
polyhydramniosis.
Membrane rupture should be excluded before the diagnosis of oligohydramniosis.
Oligohydroamnios congenital anomalies, IUGR (placental insufficiency), severe renal
anomalies and fetal
It may accompany drug intake that disrupts urination. The most serious complication
is pulmonary hypoplasia. So
Pulmonary hypoplasia can result in both outcome. Special attention to drugs.
Diuretics with
or by replacing it with other drugs.
PEDIATRICS
Polyhydroamnios preterm labor, abruptio placenta, fetal neuromuscular dysfunction

and fetal swallowing
It is associated with GIS obstruction, which prevents the absorption of amniotic
fluid.
Achondroplasia is the cause of polyhydramniosis.
oligohydramniosis
polyhydramnios
Anencephaly-hydrocephalus
preeclampsia
GIS: Esophageal atresia, duodenal atresia, TEF, cleft palate and lip,
IUGR
AC: Cystic adenomatoid malformation, diaphragmatic hernia, chylothorax
Fetal anomalies
Achondroplasia, Spina bifida, Werding Hoffman, trisomy 18, 21, Klippel-Feil
Twin-twin transfusion (donor)
Diabetic mother baby, Backwith-Wiedemann syndrome
Amniotic fluid leakage
Fetal anemia, fetal heart failure, twin-twin transfusion (recipient), hydrops

fetalis,
TORCH,
Renal agenesis / urethral atresia
Polyuric renal disease
Prune-Belly syndrome
teratoma
Pulmonary hypoplasia
Amniotic nodosum
indomethacin
ACE inhibitors
Intestinal pseudo obstruction
(Answer B)
8. Which of the following conditions does Alpha Feto Protein (a-FP) not increase?
(April 2001)
A) Trisomy 18
B) Anencephaly
C) Spina bifida
D) Neural tube defect
E) Epidermolysis bullosa
It's the same kind of question. AFP is low. The opposite of such questions
the situation has to be in case.
In trisomies, water is very low and protein is low. In other words,
polyhydramniosis and low AFP are seen.
Increased contact of the amniotic fluid with body surfaces or renal loss is
prominent at the height of AFP,
Placental insufficiency and trisomies are prominent in low AFP.
Maternal serum alpha-fetoprotein level was determined in screening open neural tube
defects at 15-18 weeks.
used.
To remember that AFP, beta HCG and estriol were used in the triple test, trisomies
had decreased AFP.
it helps us understand more precisely.
(Answer A)
NEWBORN
High AFP
•
Multiple pregnancy
Open neural tube defects
Gastroschisis-omphalocele, intestinal atresia
Congenital nephrosis,
Epidermolysis bullosa
Low AFP
•
Trisomy 18-21
SGA
the Preklamps
9. What kind of disease does the mother have when she has a heart block?
(April 97)
A) Diabetes
B) SLE
C) Mitral disease
D) Tuberculosis
E) Pyelonephritis
A mother with SLE has heart block, neutropenia, anemia and thrombocytopenia due to
anti Ro and anti La antibodies. Heart block is permanent, while others are
temporary.
Let's remember that diabetes may be SGA and LGA, preeclampsia causes neutropenia
and thrombocytopenia.
Effects of Maternal Non-Infectious Diseases on Fetus and Baby
Cholestasis (HEV induced)
Preterm birth
Cyanotic heart disease
Intrauterine growth retardation (IUGR)
Diabetes mellitus
Hypoglycemia, LGA, Severe Diabetes: SGA
Endemic goiter
hypothyroidism
Graves disease / myasthenia gravis
Neonatal transient thyrotoxicosis / transient myasthenia
Herpes gestationalis
Bullous Rash
hyperparathyroidism
Neonatal hypocalcemia
ITP / isoimmunthrombocytopenia or neutropenia
Thrombocytopenia / neutropenia
Malignant melanoma
Fetal tumor
Myotonic dystrophy
Neonatal myotonic dystrophy, congenital contractures, respiratory

shortage, symptoms with genetic antisipation earlier and more severe
It happens.
Phenylketonuria
CHD, Microcephaly, Mental retardation
Preeclampsia, eclampsia
IUBG, Neutropenia, thrombocytopenia, fetal death
Renal Transplant
IUGR
Blood Disputes
Fetal anemia, hypoalbuminemia, hydrops, jaundice in the newborn.
SLA
Konjac. Heart block, rash, anemia, thrombocytopenia, neutropenia
(Answer B)
PEDIATRICS
10. Which is the cause of oligohydroamniosis? (April 94)

A) Esophageal atresia
B) Hydrocephalus
C) Neural tube defect
D) Renal agenesis
E) Gastroschisis
Renal agenesis is the cause of oligohydramniosis. See 7. Description of the
problem.
(Answer D)
11th. Which drug causes jaundice in premature children? (April 94)
A) Vitamin K analogs
B) Cephalotin
C) Tetracycline
D) Aminoglycoside
E) Phenobarbital
Jaundice: Vitamin K, novobiocin causes jaundice in preterms. Sulfonamides de
albumine
increases the risk of kernicterus.
Cephalotin Coombs positive hemolytic anemia
Tetracycline: Enamel hypoplasia
Aminoglycosides: Deafness and nephrotoxicity.
(Answer A)
12. The most common cause of neonatal deaths in the first 24 hours in the newborn
Which is? (September 89)
A) Prematurity-immaturity
B) Birth trauma
C) Newborn asphyxia
D) Congenital malformations
E) Hypoxia
The highest risk of neonatal mortality occurs in infants born below 1000 g and
before 28 weeks of gestation.
The lowest risk is between 3000-4000 gr and 38-42 weeks. Neonatal and infant
mortality
The main determinant is low birth weight (occurs due to preterm birth or IUBGG).
Low birth weight is defined as below 2500 g. Prematurity is the most common cause
in developed countries,
The most common cause in developing countries is intrauterine growth retardation.
(Answer A)
NEWBORN
EXAMINATION AND RESUSCITATION

one. Which of the following skin findings in the newborn spontaneously over time
It is not lost? (September 2011)
A) Port-wine hemangioma
B) Mongolian stains
C) Harlequin stains
D) Toxic erythema
E) Cutis marmorata
This question was similarly asked in previous TUS questions. The requested
information is the physiological of the newborn
and whether or not skin lesions are known. From this point of view, Portwine
hemangioma in the A strain is certainly pathological and Sturge-Weber is a
phakomatous group disease.
is typical for the disease.
Non-pathological skin findings of the beat:
• Capillary hemangioma: Most commonly located in the eyelid. Crying and fever
become apparent. in the nape
settlers are called stork spots (Salmon spots).
• Vernix caseosa: Desquame is composed of epithelial cells, hairs and sebaceous
secretion.
• Lanugo feathers: It is prominent in premature babies. The face is prominent on
the back and shoulders.
• Acrocyanosis: Neonates may have peripheral cyanosis in the hands, soles of the
feet and around the mouth. Top 48
disappears within hours.
• Mongolian blotch: bluish-gray purple with irregular edges, especially on the
buttocks and sacrum
lesions. It disappears in the first years of life.
• Cutis marmaratus: Due to lack of neuromuscular maturation due to ambient
temperature change
is a physiological introduction. It can be observed in the first few weeks. It can
also be seen in seriously ill infants.
• Harlequin discoloration (clown color): A crossing in the middle of the Vertex-
symphysis pubis line.
The half of the body is pink due to hyperemia and the other half is pale. It is
harmless and temporary.
Harlequin baby OR is a type of severe ichthyosis.
• Milia: White yellow, pearl-like papules 1-2 mm in diameter. Clogging sebaceous
glands
result. No treatment is required.
• Miliaria: Rash. Occurs as a result of clogging of sweat glands due to excessive
heat. Frequent bathing is recommended.
• Toxic erythema: yellowish white in the middle, erythematous around, starting in
1-3 days, 7-10. days disappear.
It occurs on the face, trunk and extremities. Not on the soles of the hands and
feet. Lesion with Wright stain
eosinophils are detected.
• Pustular melanosis: Neutrophil in the cheek, nape, back, extremities, hands and
feet
vesiculopustular rashes. There is at birth. Leaving mild hyperpigmentation every 2-
3 days
disappearing benign lesions. Both lesions are dangerous HSV and staphylococcal
vesicular
diseases should be separated.
• Acne neonatarum: It occurs due to transplacental passing hormones.
PEDIATRICS
Pathological Skin Findings of Newborn:

• Edema: Localized edema: May be in Milroy and Turner syndrome. Generalized edema:
Prematurity and
hypoproteinemia (erythroblastosis fetalis, nonimmune hydrops, congenital nephrosis
or Hurler syndrome)
result can be seen. Mild edema is normally also seen.
• Cavernous hemangioma: Surface cystic hemangiomas. Kasabach Merrit syndrome
(destruction of platelets due to cavernous hemangioma and disseminated
intravascular coagulation)
and Mafucci syndrome (multiple enchondromas and hemangioma).
• Port wine stain: It is accompanied by Sturge Weber syndrome that fits the
trigeminal nerve distribution and does not pass over time.
• Scleremia: Hardening of subcutaneous adipose tissue due to sepsis and severe
circulatory failure.
• Sacral dimple and hair: Spina bifida may be present.
• Bronze baby: It is seen as a result of phototherapy in direct hyperbilirubinemia.
• Petechiae, ecchymosis, purpura jaundice are other pathological skin findings.
Compression of separation from cyanosis
It is important that there is no color change as a result of the application.
• Amniotic tape: Amputation, syndactyly, abdominal and chest wall defects may occur
in the extremities as a result of rupture of the antibiotic membrane and impaired
circulation in the tissues.
• Joint hypermobility and increased skin fragility: Ehlers Danlos, Marfan syndrome,
congenital contractural arachnodactilia, other collagen defects.
(Answer A)
2nd. Which of the following does not cause microcephaly? (April 2010)
A) Fetal alcohol syndrome
B) Down syndrome
C) Congenital Rubella infection
D) Hyperthyroidism
E) Meningitis
Again, the question is similar to the old TUS question. All TUS questions are
listed in the neurology department for the causes of microcephaly. Here is the most
crippled stylish meningitis may be the cause of hydrocephalus macrocephaly
may also cause. The causes of hydrocephalus include meningitis. In this case,
macrocephaly
We may think that the cause. Hyperthyroidism may also cause craniosynostosis. In
this case the head
its surroundings may be normal or small. But NELSON in the table of causes of
microcephaly
meningitis and encephalitis, but not hyperthyroidism.
Megalencephaly: Extremely large head circumference. Hydrocephalus, cerebral
gigantism (Sotos syndrome), storage diseases, metabolic diseases (Glutaric
aciduria, Canavan disease, Alexander
neurocutaneous syndromes, familial. As seen, hydrocephalus is one of the reasons
where the head circumference is large. Based on this, meningitis, which makes
cominic hydrocephalus
head circumference can be thought to leave large. However in the table clearly the
causes of microcephaly
Although it may not be canceled because it is a questionable question.
Causes of hydrocephalus (including subheading hydrocephalus)
•
holoprosencephaly
Massive hydrocephalus
porencephaly
10
NEWBORN
Causes of microcephaly
primary
Secondary causes
Family (OR, OD)
Radiation
Down syndrome
TORCH infection
Edward syndrome
Fetal alcohol / hydantoin

Cri-du-chat syndrome
Meningitis / Encephalitis
Cornelli de Lange syndrome
malnutrition
Rubistein-Taybi syndrome
Metabolic (Hyperphenylalaninemia)
Smith-Lemli-Opitz syndrome
hyperthermia
Hypoxic ischemic encephalopathy
Causes of hydrocephalus
Komunika
noncommunicating
Achondroplasia
Aquaduct. Stenosis (X-linked, infectious)
Bacilli Impression
Chiari / DandyWalker malformation
Beningn subarachnoid space expansion
Klippel-Feil syndrome
Meningeal malignancy
Mass lesion: abscess, hematoma, tumor, neurocutaneous

syndromes, Galena vein malformation
Meningitis / Posthaemorrhagic
Choroid plexus papilloma
(Answer D)
3. Which of the following can lead to a small front fontanel? (September 2009)
A) Craniosinostosis
B) Mucopolysaccharidoses
C) Achondroplasia
D) Osteogenesis imperfecta
E) Hypophosphatasia
Craniosynostosis is an early closure of sutures and fontanelles.
Cases seen in small front fontanel:
one-
craniosynostosis,
2nd-
Microcephaly
3-
Congenital hyperthyroidism
4-
Wormian bone anomaly
Any ongoing shape or size anomaly requires CT removal.
11th
PEDIATRICS
Wide front fontanel

Achondroplasia and Osteogenesis imperfecta
prematurity
Cleidocanial dysostosis
Intrauterine growth retardation
Piknodizostoz
hypothyroidism
Russel-Silver syndrome
Hydrocephalus
13-18-21 trisomies
Congenital rubella syndrome
Apert syndrome
Rickets due to vitamin D deficiency
Hallermann-Streiff syndrome
hypophosphatasia
(Answer A)
4. Which of the following skin findings may be associated with other defects
considered pathological in the examination of the newborn? (April 2009)
A) Erythema toxicum
B) Pustular melanosis
C) Lanugo
D) Traces of amniotic tape

E) Mongolian stains
Amniotic tape fragments of the amniotic membrane in the early period
entangling it, causing amputation, fibrotic band formation, abdominal and chest
wall defects.
It happens.
Amniotic membrane rupture sequence is defined as dysruption in morphology.
Toxic erythema is lesions involving eosinophilia. It is a lesion that develops
after a few days and lasts for 1 week.
Pustular melanosis is a neutrophil-containing lesion at birth. HSV with
Staphylococcal infections
Miscible.
Lanugo are thin hairs that are abundant in preterm.
Mongol stain is the most common lumbosacral localization and gray-blue
discoloration. A few years.
If the edema is massive, it is pathological.
Cutis marmaratus persists because it is seen in peripheral circulatory disorders
and some syndromes
becomes pathological.
Scleremia is seen in infants with severe sepsis due to esterification of
subcutaneous adipose tissue.
is the finding showing the course.
(Answer D)
12
NEWBORN
Non-pathological findings:
•
Toxic Erythema
Temporary pustular melanosis
Acne neonatorum
Ebstein pearl, Ranula
Mongolian Stains
Milia, Miliaria
Capillary hemangiomas
•
Harlequin discoloration
lanugo
Verniks kazeoza
Acrocyanosis
Pathological findings:
•
I sclerotized
Petechiae and ecchymoses
“Cafe au lait” stains, “Junctional type”
Jaundice, bronze baby
Cavernous Hemangiomas
Harlequin baby: OR, severe ichthyosis
Port Wine stain
Amniotic tape
Sacral dimples
Joint mobility changes
5. Kraniotabes is not an expected finding in which of the following situations?

(April 2007)
A) Prematurity
B) Marfan syndrome
C) Rickets
D) Osteogenesis imperfecta
E) Hydrocephalus
When craniotabes are pressed into the parieto-occipital region, the head collapses
like a ping-pong ball. Physiological in the first 3 months. Premature lasts longer.
Persistent craniotabes:
•
Osteogenesis imperfecta
Rickets, cretinism
Cleidocranial disostosis
Skull and crossbones
Down syndrome
Marfan syndrome is an OD disease characterized by long stature, arachnodacty, lens

subluxation and aortic dissection due to mutation of fibril.
(Answer B)
13
PEDIATRICS
6. Which is not the cause of microcephaly? (April 2005)

A) CMV
B) Radiation
C) Aquaductal stenosis
D) Trisomy 21
E) Fetal alcohol syndrome
Aquaduct stenosis causes macrocephaly by causing hydrocephalus. See the neurology
section for detailed explanation.
(Answer C)
7. Which of the following is not one of the APGAR scoring criteria?April 2007)
A) Heart rate
B) Respiratory pattern
C) Muscle tone
D) Color
E) Patella reflex
Evaluation of APGAR
Parameter
0
one
2nd
Heart rate
No
<100
> 100
Respiratory
No
Irregular-slow
Regular, crying
Muscle tone
hypotonia
Flexion of the extremities
Active moving
NG catheter reflex
reply
No
Grimace
Cough Sneeze
Color
Blue-Pale
Limbs blue, body

pink
Fully pink
Apperarance consists of Pulse, Grimace, Activity, Respiration.

APGAR is evaluated at the first and fifth minutes. First minute Apgar score
required resuscitation
not used in evaluation. Heart rate, color and respiration in assessing the need for
resuscitation
used. The fifth minute is used to evaluate the success of resuscitation.
It does not predict the possibility of cerebral palsy (CP). In most CPs, APGAR is
normal. However, CP APGAR
develops more than normal ones in low.
It is used to predict neonatal death in combination with umbilical artery pH. 5.
Minute APGAR 0-3 is a better predictor of mortality than pH 7.0.
Apgar score 8-10: normal baby.
Apgar score 4-7: risky infant, tactile stimulation and oxygen may be given through
a mask.
Apgar score: <4 severe asphyxia.
(Answer E)
14
NEWBORN
8. Which of the following best describes Erb-Duchenne paralysis in infants?

(September 2004)
A) Arm weakness due to humeral fracture
B) Low due to wrist damage
C) Reduction in arm strength due to injury to selvical 5-6 nerves
D) Arm weakness due to clavicle fracture
E) Pseudoparalysis due to syphilitic arthritis
Erb-Duchenne Paralysis: The most common brachial plexus paralysis. Cervical 5th and
6th nerves are damaged.
The arm is in adduction and internal rotation and the forearm is in pronation
(waiter's hand). On the paralytic side Moro and
There is no biceps reflex. Hand movements and hand-held are preserved. The phrenic
nerve (C3-5) may be involved.
Klumpke paralysis: C7-8, T1 roots are involved. Intrinsic muscles of the hand are
involved. Claw is the hand. Catch
There is no reflex. Moro is taken. Horner syndrome (ptosis and
myosis).
Phrenic nerve paralysis has difficulty in breathing. Breathing sounds are reduced
on that side. Same on X-ray
on the right side, and on USG, there is a decrease in breathing participation.
The facial nerve is the most frequently damaged cranial nerve.
(Answer C)
9. In the following cases, immediately after birth with mask and air sac
positive pressure ventilation is indicated? (April 2004)
A) Heart rate is 90 / min
B) APGAR score of 8
C) Systolic blood pressure 60 mm-Hg
D) Hypotonia
E) Respiration rate of 20 / min
In cases where the heart rate is below 100, the mask and the air sac are
irrespective of other findings.
and positive pressure ventilation.
Objectives of Neontal Resuscitation
To prevent morbidity and mortality caused by hypoxic ischemic tissue damage,
adequate respiration and heart
to beat.
Three parameters are used to determine the course of the resuscitation.
one. Respiratory effort; Respiratory rate and depth increase with tactile
stimulation. Heart rate if inhaled
Evaluated.
2nd. Heart rate; is the most important determinant of resuscitation. The presence
of respiration does not guarantee adequate heartbeat. If the heart rate is below
100, positive pressure ventilation (PBV) is initiated.
3. Color; color may be discolored despite adequate ventilation and heart rate. If
there is central cyanosis
oxygen should be given until it is determined. Oxygen is not required in peripheral
cyanosis.
15
PEDIATRICS
PBV; inadequate respiration, increased cyanosis and / or CTA <100 / min despite
oxygen administration
Used in the case.
Chest compression; KTA <60 / min or KTA despite 15-30 sec PBV application with 100%
oxygen
It is done if there is no increase despite being between 60-80. Chest compression
always
100% oxygenated PBV should be accompanied.
Endotracheal Intubation
one. If ventilation with mask and air sac is unsuccessful
2nd. If you need long-term PBV
3. If tracheal aspiration is needed
4. If there is suspicion of diaphragmatic hernia
makes
(Answer A)
10. Which of the following is not used in the prophylaxis of neonatal
conjunctivitis?
(April 2002)
A) 1% silver nitrate
B) 1% erythromycin
C) 1% tetracycline
D) 2% povidone-iodine
E) 1% sulfomide
Silver nitrate is the most effective prophylaxis against gonorrhea. Povidone can be
used in iodine. Tetracycline and
Erythromycin is one of the drugs involved in prophylaxis.
When gonorrhea conjunctivitis develops, third generation cephalosporins are used in
systemic treatment.
Erythromycin and tetracycline can be used for prophylaxis against chlamydia.
However, if conjunctivitis develops, erythromycin should be administered
systemically to treat the infection. The purpose of this is to prevent pneumonia.
Tetracyclines under the age of 8 are not used for treatment because they disrupt
the development of teeth and bones.
(Answer E)
16
NEWBORN
Conjunctivitis developing in the first day is usually shimic conjunctivitis due to

AgNO3 use.
The conjunctivitis that started after day 2 was the most common causative agent N.
gonorrhea. Most commonly used treatments
silver nitrate drops or erythromycin pomades.
Pseudomonas conjunctivitis 5-18. days.
11th. Which of the following is a pathological finding in the newborn? (September

2001)
A) Epstein pearls
B) Sclerema
C) Milia
D) Mongolian stain
E) Cutis marmaratus
See description of question 3
(Answer B)
12. Heart rate 93, slow and irregular breathing rate, slightly flexed extremities,
nasal catheter insertion into the nose and body pink, purple limb
What is the APGAR score in the newborn? (April 2000)
A) 3
B) 4
C) 5
D) 6
E) 7
Each parameter is broken by 1 point. In APGAR, the maximum score can be 10 and
minimum 0.
See the description of question 2.
I would like to remind you of information that has not been asked before. False
positive and false negative
APGAR is a high-potential information.
False positive APGAR: Low in the absence of hypoxia or acidosis.
False negative APGAR: Normal detection despite acidosis and hypoxia.
Reasons for false positivity: Immature, narcotic-sedatives to mother,
administration of magnesium sulfate, acute
cerebral or spinal trauma, congenital myopathy, neuropathy, CNS anomaly,
diaphragmatic hernia,
coanal atresia, sepsis, hemorrhage-hypovolemia and asphyxia during recovery
Reasons for false negativity: High fetal catechol amine level, maternal acidosis
and some term infants
(Answer C)
13. Resuscitation immediately after birth, spontaneous breathing occurs with
tactile stimulation and heart rate is 78 / min. Which of the following should be
done first? (September 1999)
A) Intratracheal adrenaline
B) IV NaHCO3
C) Positive pressure ventilation with mask and air sac
D) Breast pressure
E) Free O2
17
PEDIATRICS
Resuscitation is needed in 5-10% of all babies. The aim is to prevent hypoxic

ischemic damage.
Resuscitation needs assessment: Respiration, heart rate and color are used. APGAR
is not used.
A, B, C of resuscitation: A: Airway, position, aspiration, intubation. Breathing:
Tactile warning, PBV
(mask pouch or tulle), C: Circulation: Breast compression and medication to
maintain circulation.
D: Medicines
Resuscitation steps
Procedures to be performed in the first 30 seconds after birth:
one. The radiant heater is placed underneath.
2nd. Respiratory tract is opened (head is slightly extended, aspiration first
mouth, then nose).
3. Drying (prevents heat loss, tactile warning).
4. The baby's condition is assessed: Respiratory-heartbeat and color.
Breathing is good, KTA> 100 and cyanosis is given O2, pink is not necessary
intervention.
Positive pressure ventilation (PBV): Apnea, CTA <100, persistent cyanosis. PBV
respiration
and KTA should not be terminated without recovery. If the heart rate is 60 - 100 /
min, PBV is continued.
Chest compression: It is performed if KTA is <60 / min despite thirty sec PBV.
Cardiac massage lower 1/3 of the sternum
section. Compression / ventilation should be 3/1. The speed should be 120 / min.
The drug is used if there is KTA <60 or asystole despite thirty-second effective
PBV and compression.
To initiate breathing, tactile stimulation is used to flick the soles of the feet,
stroking the back. Lack
tactile cautions: back hit, anal sphincter dilatation, thoracic compression,
hot / cold application, pushing legs towards belly, cold oxygen.
Drugs used in neonatal resuscitation:
one.
Adrenaline: 1: 10000 at a concentration of 0.1-0.3 ml / kg iv or is given from the

endotracheal tube.
2nd.
Volume expanders: Serum physiological, lactated ringer and blood.
3.
Sodium bicarbonate: Used in proven acidosis or prolonged resuscitation. One-on-one

diluted 8.4% NaHCO3. Without adequate ventilation and oxygenation
should not be used. It may cause IVC and paradoxical cerebral acidosis.
4.
Naloxane: Opioid antagonist. IM, IV or intratracheal.
Dopamine / dobutamine are other drugs that can be used in dextrose.

Unused: Atropine and calcium
(Answer C)
14. Which one does not have a large fontanelle? (September 1999)
A) Osteogenesis imperfecta
B) Congenital hyperthyroidism
C) Hydrocephalus
D) Rickets
E) Achondroplasia
Hyperthyroidism is the cause of small anterior fontanelle. See the description of
question 3.
(Answer B)
18
NEWBORN
15. Vacuum delivered newborn sutures and discoloration

If swelling was detected which of the following should be considered? (September
96)
A) Caput succadenum
B) Cephalic hematoma
C) Subdural bleeding
D) Subarachnoid hemorrhage
E) Linear fracture
Hood succadeneum: Edema with scalp crossing the sutures and midline. Edema within
2-3 days
It disappears. Molding and ecchymotic color changes may be accompanied by sutures.
Cephal hamatoma: Subperiostal hemorrhage. It is limited to one bone and does not
cross the other side of the suture. There is no color change. It gives
fluctuations. It often occurs a few hours after birth,
becomes increasingly apparent. It may be with a linear fracture. Cephalic hematoma
size 2 to 12 weeks
resorbs.
Subgaleal hemorrhages: Hemorrhage under the galea aponorotica. Cross the sutures.
In this region
it can be massive because of the wide potential gap. It may spread to the neck.
Linear fractures, sutures
diatase and emissary veins. Expands after birth and fluctuating
cause mass. Hypotension and consumption should be monitored for coagulopathy.
Skull fractures: Forceps or maternal symphysis pubis, sacral promontorium or
ischial spins
pressure. Linear fracture is most common. It is asymptomatic and does not require
treatment. Collapse
if fractures are excessive, they should be corrected.
Fractures in the occipital bone or separations in the basal and squamous part
always cause bleeding because it will tear.
Intracranial hemorrhages: Birth trauma, asphyxia and coagulation disorders in term
infants
It depends. Subarachnoid is subdural and subtentorial. Subarachnoid and subdural
hemorrhage USG
is not seen with. CT or MRI is used. Xanthochromic CSF is detected in subarachnoid
hemorrhage. subdural
Bleeding is an indicator of abuse except for the newborn.
The ICC in the preterm is periventricular-intraventricular and subepandimal
germinal matrix.
They arise. USG is used for diagnosis.
(Answer A)
16. Which of the following is the causative agent of conjunctivitis in a 12-day-old
baby? (September 96)
A) Chlamydia trochomatis
B) N. gonorrhea
C) Chemical conjunctivitis
D) P. auriginosa
E) H. influenza
Ophthalmia neonatorum: It is the most common eye disease in the newborn. Redness,
chemosis (cone edema), eyelid edema, discharge is seen. Occurrence times about the
factor
gives an idea.
Silver nitrate (chemical conjunctivitis): 6 to 12 hours after birth. There is clear
discharge.
It is related to irritation and passes in 24-48 hours.
N. gonorrhoea Incubation is 2-5 days, redness and purulent discharge occurs within
24 hours. Treatment is delayed
however, it progresses to corneal perforation.
C. trachomatis: Incubation is 5- 15 days. Tarsal involvement occurs. There is
sticky discharge. Corneal
involvement is rare. The organism is the most common cause of conjunctivitis.
Pneumonia and eosinophilia
suggest chlamydial infection.
Pseudomonas: Makes a rare but serious picture. Pannus formation can cause
endophthalmitis, sepsis and death.
N. gonorrhoea and pseudomonas can cause corneal perforation, blindness and death.
Prophylaxis uses silver nitrate (useless in active infection) Erythromycin and
povidone iodine.
(Answer A)
19
PEDIATRICS
17. What is your diagnosis if there is no other clinical pathology in the child who
is using forceps at birth, left arm internal rotation, left hand pronation
extension? (September 95)
A) Clavicle fracture
B) Shoulder dislocation
C) Klumpke
D) Erb Duchenne
E) Sepsis
(Answer D)
18. Conjunctival hyperemia in the first 6 hours after birth in a newborn child
If a clear discharge is detected in the eye, which of the following should be
considered?
(September 95)
A) Clamidial conjunctivitis
B) Gonococcal conjunctivitis
C) Chemical conjunctivitis
D) Physiological conjunctivitis
E) HSV Type II conjunctivitis

See explanation of question 13
(Answer C)
19. The presence of systemic disease in a newborn infant
indicates the presence of? (September 94)
A) Sclerema
B) Ebstein pearls
C) Milia
D) Mongolian stain
E) Transient malignant pustular lesion

Scleremia occurs in severely ill children and children with sepsis.
(Answer A)
20. Which is not one of the APGAR score parameters? (September 94)
A) Reflex activity
B) Blood pressure
C) Heart rate
D) Skin color
E) Muscle tone
(Answer B)
21. Which of the following does not cause hearing loss in the newborn? (April 94)
A) Perinatal asphyxia
B) Caesarean section
C) Hearing loss in the family
D) Birth below 1500 grams
E) Use of forceps
Indirect hyperbilirubinemia is a risk for deafness. Diseases that cause direct
hyperbilirubinemia
is not a risk. Remembering of ototoxic drugs, aminoglycosides, vancomycin and
furosemide
They are needed. The question can be updated again by replacing it with another
antibiotic. Jaundice is the most common of meningitis due to streptococci.
20
NEWBORN
Newborns at high risk for deafness

Family history
Asphyxia
Congenital infections
Prolonged mechanical ventilation
Craniofacial anomalies
Werdenburg syndrome,
Birth below <1500gr
Alport syndrome,
Hyperbiluribinemia, Ototoxic drugs Bacterial meningitis
Jervell - Lange - Nielson syndrome

Pendred and Usher syndrome
(Answer B)
22. Heart rate less than 90, respiratory superficial, slight flexion of
extremities, nose
blue, blue
What is the APGAR score if it is pink? (September 92)
A) 1
B) 3
C) 5
D) 7
E) 9

(Answer C)
23. Which of the following is pathological in a term newborn? (September 92)
A) Moro
B) Babinski
C) Capture
D) Hypotonosity
E) Stepping
The term newborn color is pink, in the semiflexion position.

Tonus: Defines resistance to passive movements. Preterm hypotonicity while term
infant hypotonicity
not as a normal finding. Primitive reflexes are normally taken in the newborn.
Their disappearance is craniocaudal.
Suction and swallow coordination is 32-34 GH. Those born before this week are fed
with catheters.
Asymmetric Tonic Nape Reflex: In a supine position, the child suddenly turns his
head to one side.
extension of the extremities and flexion on the opposite side. Criminal position.
It develops fully in 3-4 weeks after birth.
Standing capture is the latest disappearing reflectance.
Parachute reflex: 7-8 months after birth begins to be taken. Latest and never
disappeared
It is a reflex.
Reflex Start (week) End times (months)
Moro
28-32
3-6
Suction
32-34
4-7
Search
32-34
Capture by hand
28
2nd
Standing capture
28
10
Tonic neck
35
(Answer D)
21
PEDIATRICS
24. Which of the following is true for Erb-Duchenne paralysis? (April 92)
A) C8-T1
B) C6,7-T1
C) C7-8
D) C5-6 + Moro reflex loss
E) Loss of muscle strength in the lower extremity

Erb- Duchenne paralysis is defined as the waiter's hand. Brachial plexus is the
most common injury. Moro and
The biceps reflex disappears. Capture is preserved. See question 8
(Answer D)
25. A fluctuating swelling in the left parietal was detected in a 2-month-old baby.
What is the diagnosis? (September 91)
A) Caput quatratum
B) Epidural hematoma
C) Subdural hematoma
D) Cephalic hematoma
E) Caput sucsadeneum
Cephalous hematoma is associated with fracture. Subperiostal hemorrhage that does
not cross sutures and resorbs in 2-12 weeks
It happens. See explanation of question 12
(Answer D)
26. If a swelling was detected in the newborn that does not exceed the localized
sutures
what? (April 90)
A) Cephalic hematoma
B) Caput succadenum
C) Subgaleal bleeding
D) Subcutaneous bleeding
E) Epidural bleeding
(Answer A)
27. What is the cause of bloody vaginal discharge in a three-day-old baby?
(September 89)
A) Hemolytic anemia
B) Vitamin K deficiency
C) Vaginal adenosis
D) Bleeding tendency
E) Maternal hormone
Female infants may have vaginal discharge or bleeding due to the hormones passed
from the mother. pathologic
It is not. Estrogen is withdrawal bleeding.
(Answer E)
28. When does the Moro reflex disappear when awake? (September 88)
A) 1 month
B) 3 months
C) 6 months
D) 12 months
E) Does not disappear

(Answer B)
22
NEWBORN
PREMATURITY, POSTMATURITY,
SGA BABIES
one. In the neonatal period jaundice, which is directly bilirubin
does not depend on the increase? (May 2011)
A) Crigler-Najjar syndrome
D) Tyrosinemia
C) Sepsis
E) Cystic fibrosis
E) Ball atresia
Direct hyperbilurubinemia in the newborn period presents with cholestasis. There
may be intrahepatic and extrahepatic causes. Biliary atresia, metabolic causes,
neonatal hepatitis, Allagille syndrome, Caroli's disease, Byler's disease, alpha-1-
antitrypsin deficiency, sepsis, cystic fibrosis, urinary system
infections, drugs, hypothyroidism, Dubin-Johnson syndrome, Rotor syndrome, etc. why
could it be. Wilson does not affect the liver in the newborn period, does not do
cholestasis. Crigler-Najjar is a non-cholestatic, non-hemaolytic bilurubin
metabolism disorder with high indirect bilurubin. Type-1 and
type-II have. Type-1 does not have the enzyme glucronil transferase, resulting in
kernicterus. Again in Type-II
Indirect bilurubin is high. The use of phenobarbital in type II cases reduces
jaundice.
(Answer A)
2nd. A healthy baby weighing 3600 grams had a Apgar score of 8 in the 5th minute
and 9 in the 10th minute.
Features. Jaundice is detected in the 12th hour of life. Mother of the baby with
blood type A Rh (+)
blood group is 0 Rh (+). Total serum bilirubin level was 9 mg / dL.
It is found to be present.
What is the most appropriate approach for this baby? (May 2011)
A) Checking the bilirubin level after 4 hours by telling the mother to breastfeed
frequently
B) Starting the phenobarbital treatment and checking the bilirubin level after 4
hours
C) Initiation of preparations for blood exchange
D) Beginning of phototherapy and checking the bilirubin level after 4 hours
E) Initiation of fluid therapy considering that the baby is not fed enough
It's a very simple question for those with clinical experience;
Reach.
Hyperbilirubinemia in the first 24 hours, maternal blood group O Rh (+), infant
blood group A Rh (+), mother
and there is ABO incompatibility between the baby. It should always be considered
pathological. Hourly increments 0.75
mg, 5 mg / dl daily increased, 0.5 mg / dl per hour in case of increase in the
blood of this child
however, FT should be switched on and the bilirubin level checked first.
It is used for the induction of phenobarbital enzyme in Crigler Najjar type 2 and
Gilbert syndrome.
(Answer D)

23
PEDIATRICS
3. Indirect hyperbilirubinemia that is not within physiological limits is detected

in a term newborn due to jaundice. Which of the following is not included in the
examinations to determine the etiology? (April 2010)
A) Determination of mother-baby blood group
B) Determination of glucose-6-phosphate dehydrogenase level
C) Direct Coombs test
D) Apt test
E) Osmotic fragility test
Mother infant blood types should be performed to determine ABO and RH mismatch.
Again for the same reason
Direct Coombs test should be performed to detect antibodies on infant erythrocytes.
osmotic
fragility test is performed for hereditary spherocytosis. It is also the cause of
disorder and erythrocyte morphology
is an autosomal dominant disease. Determination of glucose 6-phosphate
dehydrogenase level (X-linked)
It is especially important in boys and as a result of hemolysis may cause jaundice.
Apt test
is made in the diagnosis of swallowed blood syndrome in the newborn and the blood
to the mother or the baby? belonging to
is used to indicate that.
Ingested blood syndrome: Blood in the stool due to swallowed blood or nipple
cracking at birth.
Apt test is used to differentiate from GIS bleeding. Fetal hemoglobin is resistant
to alkali
It is based. When mixed with NaOH -coffee color is the mother of the source, the
pink color persists
indicates that the baby.
Characteristics of pathological jaundice:
one. The first day of jaundice
2nd. 5 mg / dl increase per day
3. 12 in term and 14 mg / dl in preterm
4. Jaundice lasting more than 14 days
5. Direct bilirubin increase above 2 mg / dl.
6. History of hemolytic disease, pallor, hepatosplenomegaly, dehydration, excessive
weight loss,
vomiting, kernicterus findings, acolic stool, darkening of urine color and
pathological jaundice
It suggests.
In this case, the etiology should be examined.
Indications and indications to be requested in case of jaundice in infants
prepared table question.
24
NEWBORN
Protective factors for jaundice

• Total bilurib in low risk zone before discharge
• Discharge after the first 72 hours
• GH> 41
• Bottle feeding
•
Black breed
Major risk factors

•
Total bilurib in high zone before discharge
Jaundice in the first 24 hours
GH 35-36
History of FT taking in sibling
Nutrition with breast milk and loss of weighing
Asian breed
Minor risk factors

•
Presence of total bilurib in high-middle zone before discharge
Observation of jaundice during discharge
GH 37-38
History of jaundice in siblings
Macrosomic baby, DAÇ
Mother age> 25
Male gender
the indication
Examination
Jaundice for the first 24 hours
TSB / TcB
Extremely high bilirubin for age
TSB / TcB
FT taking baby or jumping percentile
Blood groups, Coombs test, complete blood count,
hyperbilirubinemia, history or physical examination
smear, direct bilirubin measurement, recurrent TSB
unexplained jaundice
measurement
Bilirubin level at the limit of blood exchange / FT
G6PDH, reticulocyte count, albumin level,
lack of response
entidal CO if measurable
Direct hyperbilirubinemia
> 3 weeks jaundice / jaundice in sick infants
Urine analysis, urine culture and sepsis

ratings
TB and DB were measured and cholesterol levels were higher in IB.
Evaluate. Screening for thyroid and galactosemia, searching for signs of
hypothyroidism
(Answer D)
4. Which of the following oligohydramnios in newborn babies

is one of the complications? (April 2010)
A) Anencephaly
B) Tracheoesophageal fistula
C) Pulmonary hypoplasia
D) Diabetes mellitus
E) Spinabifida
25
PEDIATRICS
Similar questions in previous years, which is the cause of oligohydramniosis / or

polyhydramniosis
in abundance. Pulmonary hypoplasia is the pathology that may be the cause and the
result of both. The most serious complication is pulmonary hypoplasia.
oligohydramniosis
polyhydramnios
Placental insufficiency,
Anencephaly-hydrocephalus
GIS: Esophageal atresia, duodenal atresia, TEF, cleft palate
preeclampsia
and lip,
AC: Cystic adenomatoid malformation, diaphragmatic hernia,
IUGR
Fetal anomalies
Amniotic fluid leakage
chylothorax
Achondroplasia, Spina bifida, Werding Hoffman, trisomy 18,
21, Klippel-Feil
Diabetic mother with her baby, Backwith-Wiedemann s
Fetal anemia, fetal heart failure, twin-twin transfusion (recipient)
, hydrops fetalis, TORCH,
Renal agenesis
Polyuric renal disease
Urethral atresia
teratoma
Prune-belly syndrome
Pulmonary hypoplasia
Amniotic nodosum
indomethacin
ACE inhibitors
Intestinal pseudo obstruction
(Answer C)
5. According to the developmental charts of a baby born thirty-seven weeks old
in the evaluation; body weight is less than 3%, the head circumference is
determined to be between 25-50%. Which of the following is most likely to occur in
this baby? (April 2007)
A) Hypothermia, hypoglycemia and polycythemia
B) Respiratory distress syndrome
C) Increased incidence of group B streptococcal infection
D) Hypernatremia, hypokalemia
E) Although the weight is low, no problems are expected since the head
circumference is within normal limits.
The question asks the problems of SGA babies.

Problems and pathogenesis of SGA infants:
Fetal death: Acidosis, hypoxia, infection, congenital anomalies.
Perinatal asphyxia: Chronic fetal hypoxia-acidosis, meconium aspiration,
uteroplasental perfusion
reduction.
Hypoglycemia: Low depot, reduced glyconeogenesis, increased need (hypoxia,
hypothermia and
relatively large brain tissue)
Dysmorphic features: Syndromes, genetic-chromosomal abnormalities, oligohydramnios-
related anomalies,
TORCH infection. Symmetrical SGAs are more common.
26
NEWBORN
Polycythemia / hyperviscosity: Erythropoietin increase

Reduced O2 consumption / hypothermia: Hypoxia, hypoglycemia, fasting effect and low
adipose tissue
Lung bleeding and persistent fetal circulation.
Hypopotasemia and hypercalcemia are not the problem of SGAs. If magnesium is given
to the mother
hypermagnesemia.
More common in premature: RDS, Apnea, IVK and neonatal death.
More common in SGA: Fetal death, meconium aspiration, air leak, persistent fetal
circulation, malformations, polycythemia, TORCH infections, hypoglycemia,
polycythemia, congenital malformations,
persistent fetal circulation.
Although intrauterine growth retardation (IUGR) and SGA are used interchangeably,
they are not synonymous. IUGR
refers to the inability to achieve optimal intrauterine growth. Intrauterine growth
Since insulin is the most effective factor, insulin deficiency, IGF-1 deficiency
and pancreatic hypoplasia in IUBG
It makes.
SGA: Weight is below 10th percentile compared to gestational week.
The most common cause of IUGR and SGA is uteroplacental insufficiency.
(Answer A)
6. Which of the following is not expected in infants of preeclamptic mothers?
(April 2007)
A) Intrauterine growth retardation
B) Polycythemia
C) Hypoglycemia
D) Thrombocytopenia
E) Macrosomy
The risk of placental insufficiency, preterm delivery, SGA, asphyxia, Mg toxicity,
neutropenia, thrombocytopenia is high in preeclamptic mother infants.
Polycythemia, hypothermia and hypoglycemia are also at increased risk
(Answer E)
7. Which of the following is not a problem for SGA 'babies? (September 2004)
A) Perinatal Asphyxia
B) Hypoglycemia
C) Hypothermia
D) Polycythemia
E) Hypopotasemia
Hypoglycemia and hypothermia are the major metabolic problems in SGA infants.
Hypercalcemia and hypopotasemia
It is not visible. Hypopotasemia is not seen in preterm infants. Renal tubular
functions in these
renal tubular acidosis, glycosuria and hyperpotasemia. Giving Mg to the mother
In the case of Mg may be height.
(Answer E)
8. Which of the following is not one of the expected problems in infants with
intrauterine growth retardation? (September 2002)
A) Polysystem
B) Hypoglycemia
C) Hypercalcemia
D) Intrauterine infection
E) Hypothermia
27
PEDIATRICS
See 5. Description of the problem.

(Answer C)
Increased risks in adulthood in premature and low birth weight infants:
•
obesity
Type 2 DM
Ischemic heart diseases and hypertension.
9. Which of the following is proportional to height, weight and head circumference

intrauterine
is not one of the factors that cause growth retardation? (April 2002)
A) Congenital infection
B) Chromosomal abnormalities
C) Teratojects
D) Fetal alcohol syndrome
E) Fetal malnutrition
Symmetrical SGA: Occurs in the early stages of pregnancy (<16 GH). The number of
cells is small. Postnatal
period can not catch his peers. The weight, height and circumference of the head
remain proportional.
Causes: Intrauterine infections (heaviest in CMV and rubella), chromosomal
abnormalities, radiation,
genetics, teratogens, severe maternal hypertension and congenital anomalies.
Asymmetric SGA: The relative protection of height and head circumference, lower
weight.
Fetal malnutrition develops due to an event occurring in the late pregnancy. their
peers
They catch. Causes: Placental insufficiency, maternal malnutrition, preeclampsia
and chronic hypertension.
Chronic heart AC, renovascular diseases, hemoglobinopathies and non-alcohol / drug
use of the mother
is also the cause of asymmetric SGA.
(Answer E)
10. Which of the following is not used to determine the neonatal age? (April 2001)
A) Nail elongation
B) Ear structure and cartilage
C) Nipple
D) Lanugo
E) Underfoot line
Ballard scoring using physical and neurological criteria for calculating
gestational age
GH ± 2 weeks. It can be done in the first 1 week. New Ballard
has developed for low birth weight babies.
Physical Maturity:
Skin structure, (pharyngitis, transparency, appearance of vessels ..)
Lanugo (abundant in preterms, less in term)
Soles of the soles (starts at the anterior, developing towards the heel)
Breast
Ear structure / eye
Genital organs
Neuromuscular mature: Posture, square window test (hand-wrist angle), arm movement
(return to the first position), popliteal angle, heel-ear maneuver, is calculated
using the sign of scarf.
Although nails are developed in term and not developed in preterms, they are not
one of the criteria used.
(Answer A)
28
NEWBORN
11th. Forty-first week of pregnancy; 2600 g born 48 cm and head circumference

Which of the following does a newborn 34 cm fit?
(April 2001)
A) Mature SGA doll
B) Premature SGA doll
C) Post mature SGA doll
D) Low birth weight baby
E) Mature normal weight baby
Low birth is independent of the weight of 2500 grams regardless of the week.
Very low birth weight: Birth weight less than 1500 grams
Extremely low birth weight: The birth weight is less than 1000 grams.
Term 37- 42 is used for babies born at gestational week.
Postterm identifies babies born at> 42 weeks.
SGA is below 10 p weight and LGA is above 90 percentile compared to gestational
week.
Definitions.
Term baby SGA limit is 2500, LGA limit is 4000 gr.
Mean length at birth is 50 cm and head circumference is 35 cm.
(Answer E)
12. 1600 g of normal spontaneous delivery at the time of delivery
is the pathological finding that is most likely to occur in the first 12 hours in a
baby weighing? (April 1999)
A) Anemia
B) Hypoglycemia
C) Cutis marmaratus
D) Hypotension
E) Hypercalcemia
Cutis marmaratus is a physiological condition caused by insufficient vasomotor
control.
(Answer B)
13. Which of the following is not a sign of neonatal hypothyroidism? (September 94)
A) Intrauterine growth retardation
B) Large fontanelle and open fontanelle
C) Prolonged jaundice
D) Umbilical hernia
E) Large language
In hypothyroidism, babies are born as postmature and LGA. Prolonged jaundice,
umbilical hernia and large fontanelles are other findings.
(Answer A)
29
PEDIATRICS
14. Which of the following is the most common with postmaturity? (April 1990)
A) Anencephaly
B) Renal agenesis
C) Urinary tract infection in mother
D) Polycystic kidney disease
E) Polyhydramniosis
POSTMATURITY: Postmaturity is defined as the duration of pregnancy exceeding 294
days or 42 weeks according to the last menstrual period.
Skin color pale, slight cyanosis of hands and feet, shortage of vernix casee, long
nails, abundant hair,
Similar to parchment paper or desquamized skin, increased irritability is seen.
If there is placental insufficiency, meconium staining and subcutaneous fat tissue
decrease.
Problems: Fetal distress, meconium aspiration, polycythemia, hypoglycemia.
Postmaturality: Anencephaly (the most common cause), trisomy 18, Seckel syndrome.
(Answer A)
15. Which of the following is wrong with premature babies? (April 1990)
A) Subcutaneous fat is less
B) Respiratory is rapid and the chest collapses
C) Breast tissue not developed
D) Foot soles formed
E) Labium major covers the minor
Physical properties of preterm babies
There is a physiological hypotonia in preterm infants.
The ratio of the head to the trunk is greater than that of a normal newborn
(preterm megascephaly)
The fontanel is wide, the chest wall is soft and the abdomen is taut.
The skin is thin, gelatinous in appearance and covered with vernix caseous.
Subcutaneous adipose tissue is low. The body surface is wide relative to the scale.
Consequently, heat loss in preterms
And more.
Edema is usually an accompanying symptom of preterm labor.
Genital organs are less developed. In the boy, the testes did not descend to the
scrotum and in the girl the labium majorler did not cover the minor.
The structure of the ear cartilage is soft and the number of folds is low.
Although 0.75-1 cm in nipple term, it is not palpated or 0.5 cm in preterms
is less than.
The soles of the soles are not developed.
(Answer E)
30
NEWBORN
16. Which of the following is not a cause of prematurity? (September September 89,
87)
A) Diabetic mother
B) Smoking
C) Polyhydramniosis
D) Multiple pregnancy
E) Uterine anomalies
Smoking causes SGA. Preterm is not the cause of birth.
Preterm is not a cause of birth, SGA is not a cause of birth.
Remembering that questions are likely to be asked frequently as postterm birth is
not the cause
It'll be helpful. Reasons for preterm birth SGA or postterm birth causes when not
asked
can be made easier by calling.
PRETERM CAUSES OF BIRTH
one.
Fetal: Fetal distress, multiple pregnancy, erythroblastosis, non-immune hydrops
2nd.
Plesental: Plesenta previa, abruptio plesenta, placental dysfunction
3.
Uterine: Bicornate uterus, cervical insufficiency (premature dilatation)
4.
Maternal: Preeclampsia, infection (Listeria, GBS, urinary tract infection,

chorioamnionitis,
bacterial vaginosis) chronic disease (cyanotic heart disease, renal disease), drug
use (cocaine).
5.
Other: Polyhydramniosis, early membrane rupture, trauma, iatrogenic
Postmaturality: Anencephaly (the most common cause), trisomy 18, Seckel syndrome.
Causes of SGA birth
•
Fetal
Chromosomal abnormalities (trisomies), congenital syndromes
Infection (cytomegalic inclusion disease, rubella, syphilis)
Multiple pregnancy
Radiation
Pancreatic hypoplasia, insulin deficiency, IGF 1 deficiency
Placental causes
Decrease of placenta size, surface area
Villous placentitis, infarction, placenta separation
Tumors (koryoangioma, hydatiform mole)
Maternal
Toxemia
Hypertension, renal disease
Hypoxia (cyanotic heart, lung disease, living at height)

•
Chronic disease, sickle cell anemia
Drugs: Cocaine, antimetabolites, alcohol, cigarettes, narcotics

(Answer B)
31
PEDIATRICS
RESPIRATORY SYSTEM
DISEASES
one. Newborn in babies delivered by cesarean section without labor
Which of the following is more common during the period? (September 2011)
A) Pneumonia
B) Hypoxic encephalopathy
C) Hypoglycemia
D) Temporary tachypnea of the newborn
E) Heart failure
One of the most important problems related to caesarean section is formerly known
as lung or type II RDS.
takip Temporary tachypnea of the newborn (TTN) an. Even the most important risk
factor for TTN is caesarean section
It is born. Caesarean section with pneumonia, hypoglycemia, heart failure and
hypoxic ischemic encephalopathy
There is no direct relationship between birth.
TEMPORARY FOLLOW-UP OF NEWBORN
It occurs due to the fact that fetal lung fluid cannot be cleared from the lungs at
birth. from AC
cleaning the liquid; catecholamine, vasopressin, prolactin, glycocorticoid increase
and birth canal
with compression of the thorax. The remaining part is cleaned by lymphatic
drainage.
Term is common in infants born with borderline preterm, LGA and cesarean section.
Risk factors for elective caesarean section
importantly, especially at <38 GH), male sex, diabetic mother child, macrosomy,
excessive fluid to mother
and sedation application, delay in cord clamping (ideal time 30-45 sec),
polycythemia,
breech presentation, asphyxia and β2 exposure.
Tachypnea begins immediately after birth. Withdrawals and moaning. Cyanosis is rare
and minimal O2
with. The anterior-posterior diameter of the chest increases due to the increase in
lift-off (barrel chest). Resting lung
sounds are normal. Hypoxia, acidosis hypercapnia is rare. Usually heals rapidly
within 3 days.
Rarely, it is severe (mostly in those born with elective caesarean section).
Resistant hypoxia is seen and malignant
It is called TTN. It might take a week.
Increased aeration on the X-ray, flattening of the diaphragm, increased pulmonary
vascularity, fluid in the fissures,
rarely pleural fluid. Decreased aeration from RDS, reticulogranular appearance and
air
bronchograms such as x-ray findings and clinical course.
(Answer D)
32
NEWBORN
2nd. Early neonatal period in a baby born 900 grams in the 27th week of pregnancy
respiratory distress syndrome developed and the baby 28 days mechanical ventilation
and
received oxygen therapy. The baby still needs free oxygen in the incubator at 36
weeks postconceptional.
What is the most likely diagnosis for this baby? (September 2009)
A) Bronchopulmonary dysplasia
B) Pneumonia
C) Pulmonary hypertension
D) Temporary tachypnea of the newborn
E) Respiratory failure of premature
Bronchopulmonary dysplasia (BPD): BPD is defined as the presence of oxygen
dependence in postconceptional 36th week or 28th day in patients born under 32
weeks of gestation.
Classical BPD oxygen and mechanical ventilation (MV) in infants with RDS
is a chronic lung disease. Extrapulmonary causes (central apnea, diaphragm
paralysis)
Infants receiving O2 and MV treatment do not develop unless lung parenchymal
disease develops. New BPD:
This is a form seen in very low birth weight infants who do not need MV and O2
before.
The development of BPD is multifactorial. Atelectasis, ventilator-induced excessive
aeration, free O2 radicals and
inflammation causes lung damage.
Protective factors: Vitamin A supplementation, early CPAP administration (most
effective), caffeine. Does not protect antenatal steroids and surfactants.
Treatment: Keep calories high, fluid restriction, diuretics, β2 agonists and
anticholinergics, methyl
xanthines are used. Dexamethasone cerebral palsy, neurological and somatic
developmental defects
therefore, it is not used routinely. Inhaled beclomethasone reduces the need for
systemic steroids and MV separation
Easier.
Pulmonary vascular resistance is increased and there is abnormal vascular
reactivity. Mild hypoxia even pulmonary artery
causes an abnormal increase in pressure.
BPD cardiac complications: Pulmonary hypertension, cor pulmonale, systemic
hypertension, left
ventricular hypertrophy, aortopulmonary collaterals.
The leading cause of death is due to cor pulmonale and RSV infections. For RSV
prophylaxis palivizumab is administered once a month during November - March.
Risk factors for BPD
MV and O2 treatment due to RDS
Interstitial emphysema
Prematurity and immaturity
Male gender
PDA, increase in pulmonary artery pressure
Giving excess fluid on the first day
Chorioamnionitis, genital Mycoplasma infection in mother
Family history of atopy / asthma
(Answer A)
33
PEDIATRICS
3. Treatment to reduce the risk of developing bronchopulmonary dysplasia in a baby

born at 26 weeks of age with the diagnosis of respiratory distress syndrome
Which is? (April 2009)
A) Surfactant treatment
B) Antibiotic treatment
C) Indomethacin treatment
D) Vitamin A treatment
E) Positive inotropic treatment
See 2. Description of the problem
(Answer A)
4. Which of the following is not a risk factor for sudden infant death syndrome
(SIDS)?
(April 2009)
A) Baby's use pacifier
B) Smoking of the mother
C) Laying the baby upside down
D) Baby sleeping in the same bed as the mother
E) Prematurity
While the use of a pacifier is not recommended beforehand, it can be used after 1
month after getting used to the breast.
It is indicated.
Sudden Infant Death Syndrome (SDS)
SIDS syndrome; It is defined as sudden and unexpected infant death which cannot be
determined in postmortem examinations including autopsy, which is unremarkable in
her anamnesis. postnatal
The most common cause of mortality is 1 month -1 years. Most often occurs in 2-4
months. Genetic factors in etiology
(cardiac Na / K channel, IL 10 gene polymorphism, complement components, serotonin
gene polymorphisms) and environmental factors are important.
The most important risk factor is the mother's smoking. Decreased frequency of
sudden infant death in supine position
It is about sleeping.
In sudden unexpected infant deaths, SIDS and deliberate strangulation cannot be
separated by autopsy. Congenital anomalies,
infections can be divided into traumatic child abuse.
Clearly life-threatening events and a history of SIDS in siblings are also
increased risk factors.
Vaccination is not a risk factor for SIDS.
SIDS cannot be prevented by any screening method and monitoring.
The risk of SIDS can be reduced by taking measures to reduce risk factors.
After getting used to the nipple, use the pacifier, baby sleeping on the back,
separate beds in the same room
sleep, the absence of soft covers in the baby's bed, avoiding overheating, the
mother
like no smoking.
34
NEWBORN
Environmental risk factors for SIDS

Maternal and antenatal: AFP height, IUGR, alcohol, smoking drug use, young
uneducated and single
mother, malnutrition
Child: 2-4 months, male sex, prematurity, low birth weight, growth retardation,
prone or
side sleeping, no pacifier use, thermal stress, extreme cold, history of previous
febrile illness
(Answer A)
5. Treatment of a premature baby with respiratory distress syndrome
which of the following does not apply? (September 2008)
A) Sodium bicarbonate treatment
B) Surfactant treatment
C) Positive pressure mechanical ventilation
D) Inotropic drug (dopamine) treatment
E) Betamethasone treatment
RESPIRATORY DISTRESS SYNDROME (RDS) (hyaline membrane disease)
It occurs as a result of a lack of surfactant. Diffuse atelectasis occurs. It is
the disease of premature babies.
Lung appears dark purplish red, liver consistency. Alveoli due to plasma leakage
acidophilic (hyaline membrane) membranes. The most important risk for RDS is
prematurity. insulin
delay the production of surfactants by antagonizing the effect of glucocorticoids.
Clinical Findings: RDS symptoms usually begin within minutes after birth.
Tachypnea, moaning,
withdrawals are seen in cyanosis and increasingly missed and partially O2. Late-
onset tachypnea other
situations. Increased dyspnea and cyanosis are typical in untreated RDS. Symptoms
and signs reach peak levels in 3 days, followed by gradual improvement. Spontaneous
diuresis
and the reduction of O2 requirement is predictive of recovery. Death is usually 2-
7. days alveolar air
leakage occurs due to pulmonary or intraventricular.
Prevention: If the lecithin / sphingomyelin ratio: 2/1 or more, the risk of RDS is
low. Diabetic mother
Phosphotidyl glycerol level is more reliable because it increases later in infants.
Prenatal corticosteroid (betamethasone) was given to the mother at 24-34 weeks of
gestation, 48 hours before birth.
It is given. Reduces RDS and related complications. Perinatal dexamethasone should
not be used. Periventricular leukomalacia develops, IVK, RDS and mortality are
higher than betamethasone.
The aim of treatment is to provide oxygenation. Mechanical ventilation is applied.
Liquid restriction is made.
Since GBS cannot be separated from pneumonia, ampicillin and gentamicin are
initiated. Recurrent Surfactant
The application can be done (2-4) times. If necessary, inotropic support or HCO3
may be used.
ECMO and inhaled NO are used for unresponsive treatment.
Surfactant use: Intratracheal. Immediately after birth (prophylactic) or in the
first hours
The use of surfactant (early recovery) reduces air leakage and death from RDS. But
BPD does not change.
Complications from the sufra; Transient hypoxia, bradycardia, tube obstruction,
pulmonary bleeding.
Betamethasone (not dexamethasone) is administered prophylactically to the mother.
(Answer E)
35
PEDIATRICS
6. In the first hour of a baby born 2800 grams by cesarean section in the 37th week
of pregnancy
tachypnea and intercostal retractions are developing. Pulmonary x-ray shows slight
prominence in the pulmonary vessels and fluid appearance in the fissures. Baby only
Oxygen treatment at the end of the 2nd day is healing.
A) Hyaline membrane disease
B) Respiratory distress syndrome
C) Temporary tachypnea of the newborn
D) Meconium aspiration syndrome
E) Congenital pneumonia
Transient tachypnea of neonate (TTN): RDS type II, also called wet lung. Fetal lung
fluid cannot be cleared from the lungs at birth.
Term is common in infants born with borderline preterm, LGA and cesarean section.
Risk factors are elective caesarean section (most importantly, especially in <38
GH), male sex, diabetic mother child,
macrosomy, excessive fluid and sedation to the mother, delayed cord clamping
(ideal)
time 45 sec), polycythemia, breech presentation, asphyxia and β2 exposure.
Tachypnea begins immediately after birth. Withdrawals and moaning. Cyanosis is rare
and minimal
Corrects with O2. The anterior-posterior diameter of the chest increases due to the
increase in lift-off (barrel chest). to relax
lung sounds are normal. Hypoxia, acidosis hypercapnia is rare. Usually within 3
days quickly
recover.
Rarely, it is severe (mostly in those born with elective caesarean section).
Resistant hypoxia is seen and malignant
It is called TTN.
Increased aeration on the X-ray, flattening of the diaphragm, increased pulmonary
vascularity, fluid in the fissures
and rarely pleural fluid. Decreased aeration in RDS, reticulogranular appearance
and air
bronchograms.
(Answer C)
7. Which of the following causes respiratory distress syndrome in newborn infants
is not one of the cases? (September 2001)
A) Diabetes mellitus in mother
B) Prematurity
D) Hypothermia
E) Induction history
The most important risk factor for RDS is preterm delivery. Increased risk of
caesarean section while normal birth
(with or without induction) reduces risk. Intrauterine stress increases cortisol
release
increases the synthesis of surfactants. Insulin antagonizes the effect of steroids.
36
NEWBORN
Increased Risk
Reduced Risk
prematurity
Chronic Intrauterine Stress
Male gender
Girl Gender
cesarean
Normal delivery
Family history
Prolonged membrane rupture time
asphyxia
Hypertension in the mother
Cold stress
Cocaine / smoking
Diabetes in the mother
İUBGG / SGA
Multiple pregnancy
Steroid, thyroid hormones, theophylline, tocolytics
chorioamnionitis
(Answer E)
8. Born spontaneously vaginally at 38 weeks from a primiparous preeclamptic mother
Cyanosis is seen immediately in the baby, after ventilation with mask and oxygen
although the general condition of the baby is slightly better
It is observed that there is insufficiency, moaning and tachypnea. The most likely
diagnosis in this baby
A) Amniotic fluid aspiration
B) Wet lung
C) Hyaline membrane disease
D) Periventricular bleeding
E) Hypoglycemia
Preeclamptic mother, term infant and RDS, normal birth and clinical course cyanosis
temporary tachypnea (wet lung), periventricular hemorrhage due to term
It is departing.
In hypoglycemia and periventricular hemorrhage, there is no inadequate lung
ventilation.
In this case, the most appropriate answer is aspiration of amniotic fluid. The
first birth of the mother is difficult birth
support and nasal aspiration of the mouth after birth is not specified
is another finding.
Amniotic fluid aspiration (fetal aspiration syndrome, aspiration pneumonia)
When prolonged and difficult delivery of placental O2 support decreases, the baby
develops strong respiratory movements. This
aspirate the amniotic fluid containing vernix, epithelium, blood, meconium and the
contents of the birth canal
would. Filling alveoli and small airways may cause respiratory distress and, if
infected, pneumonia
causes.
Coarse granular appearance and irregular aeration are typical in fetal aspiration
syndrome.
In order to prevent aspirations, firstly mouth and then nose aspiration should be
performed.
Postnatal aspiration may also be due to tracheoesophageal fistula, esophageal
atresia, gastroesophageal reflux, duodenal obstruction, inappropriate feeding and
depressing drugs.
(Answer A)
37
PEDIATRICS
9. A 30-week-old premature baby has developed apnea on day 3.

Which of the following is not used in the diagnosis and treatment of the patient?
(September 2000)
A) Apnea monitor
B) Theophylline
C) Hypoglycemia, infection intracranial hemorrhage tests
D) CBC, arterial blood gas, glucose, electrolyte tests
E) Start of antibiotics
APNEA: Breathing stops for 20 seconds or any time accompanied by bradycardia.
a stop.
Apnea serious illness seen after the first day or 14 days in preterm and at any
time in term
The findings.
Idiopathic premature apnea: Depends on the immaturity of the respiratory centers.
Between two-7 days
It happens. It is inversely proportional to the gestation week.
Mixed apnea (50-75%)
Obstructive apnea
Central apnea
Periodic respiration seen in preterm 5-10 sec. apnea period, rapid ventilation
lasting 10-15 seconds
(50-60 / min) period follows. It is not pathological.
Convulsive apnea: It can be seen in apneic convulsions in the newborn. During this
time, the heart rate increase and
The presence of mild seizure symptoms (such as blinking eyes, slipping eyes) is
important in differentiation.
Risky babies are monitored in the treatment of apnea. Antibiotic in idiopathic
prematurity apnea after exclusion of underlying metabolic disorders, anemia,
infection, bleeding
there is no need to start.
Apnea Treatment: Tactile stimulation is sufficient in mild apneas. In severe apnea;
airway opening, aspiration,
ventilation with oxygen and positive pressure; and, if necessary, intubation.
In recurrent apneas: Methylxanthines (theophylline, caffeine, aminophylline)
respiratory stimulation and diaphragm
to increase contractions. Therapeutic indexes are narrow. More caffeine central
apnea
effectively and reduces the risk of BPD. Doxapram stimulates breathing through
peripheral chemoreceptors but
Side effects are high. If there is an underlying cause such as anemia, it is
corrected.
(Answer E)
38
NEWBORN
10. A baby born on time and weighing 3300 gr.

first tachycardia and cyanosis in the patient with normal physical examination and
X-ray findings and arterial blood phases value PO2: 33, PCO2 44, pH: 7.2
which is considered? (September 1999)
A) Persistent pulmonary hypertension
B) Interstitial pulmonary fibrosis
C) Temporary tachypnea of the newborn
D) RDS
E) Viral pneumonia
PERSISTAN PULMONARY HYPERTENSION (PPHT, PERSISTAN FETAL CIRCULATION)
Term and postterm infants' disease.
Risk factors; asphyxia, meconium asipration syndrome, early onset sepsis-pneumonia,
respiratory
distress syndrome, pulmonary hypoplasia (oligohydramniosis, diaphragmatic hernia,
pleural effusion).
Hypoglycemia, polycythemia, abnormal venous return
Maternal use of NSAIDs and serotonin reuptake inhibitors.
Plasma arginine and NO levels are low. The reason for PPHT is postoperative low
pulmonary pressure,
foramen ovale and ductus arteriosus.
Pressure drop PO2 increase, PCO2 decrease, pH increase, release of vasoactive
substances.
Development of hypertrophy in the smooth muscle layer of pulmonary arterioles,
polycythemia and intrauterine hypoxia
abnormal pulmonary venous return develops PPHT due to obstruction of pulmonary
flow.
Hypoxia and cyanosis are incompatible with pulmonary findings. Hypoxia is labile.
PCO2 normal or
slightly increased. Hypoxia is always found.
Systolic murmur due to tricuspid regurgitation, Hard and single S2 is heard.
Preductal (right radial) and postductal
(umbilical artery, lower extremity) PaO2 difference> 20 mmHg, saturation O2
difference> 5 right-left
shunt. Diagnosis is confirmed by ECO. The degree of tricuspid insufficiency
increases pulmonary artery pressure.
estimation.
General precautions: Baby from all intervention and external stimuli (blood
collection, aspiration, sound-light, etc.)
It must be protected.
Metabolic disorders, hypothermia and polycythemia are corrected.
For pulmonary vasodilation, O2 is increased with MV and alkalosis with NaHCO3 is
tried.
Hypocarbia and alkalosis can cause neurosensory hearing loss and cerebral palsy.
It should be monitored.
Inotropic agents (dopamine) are used to increase systemic pressure.
Thalazoline is a nonselective α blocker.
Inhaled NO is used as a pulmonary vasodilator, its side effect is
methemoglobinemia. Sildenafil is an inhibitor of phosphodiesterase 5. Increases the
effect of NO by reducing degradation of CGMP. Prostoglandin I2
and MgSO4 are also used as vasodilators. ECMO is applied to patients who do not
respond to treatment. Heparin
There is a risk of bleeding and using <2 kg, <34 weeks of gestation.
(Answer A)
39
PEDIATRICS
11th. If the newborn baby is cyanotic while sucking and cyanosis regresses while
crying,
Considered? (September 98)
A) Koanal atresia
B) Tetralogy of Fallot
C) VSD
D) Persistent pulmonary hypertension
E) Tricuspid atresia
Koanal atresia: It is the most common congenital anomaly of the nose. The recovery
of cyanosis when crying is typical. Most
bilateral and bone structure. Congenital anomalies accompanying half of them
has. It is accompanied by CHARGE association. Diagnosis is made when the
nasogastric catheter is not advanced.
The best method for evaluating the anatomic structure is high resolution CT.
Common life-threatening anomalies at birth
Koanal atresia
Postpartum respiratory distress, apnea, catheter's nose

can not pass through the hole, CHARGE association
accompanies
Pierre Robin syndrome
Micrognathia, cleft palate, airway due to glossoptosis

Obstruction
Tracheesophageal fistula / esophageal atresia
Polyhydramniosis, excessive salivation, aspiration pneumonia, failure to advance

the catheter into the stomach, accompanies VATER association
Diaphragmatic hernia
Scaphoid abdomen, respiratory distress, bowel sounds in the thorax
Intestinal obstruction: duodenal atresia,

volvulus, intestinal atresia
Polyhydramniosis, biliary vomiting, abdominal distention,

Trisomy 21 related to cystic fibrosis and cocaine use
Gastroschisis / omphalocele
Polyhydramniosis, intestinal obstruction findings
Neural tube defect: anencephaly,

meningocoele
AFP height, polyhydramniosis, low fetal movement
Renal agenesis, Potter syndrome
Oligohydramniosis, pulmonary hypoplasia, pneumothorax
Ductus-dependent congenital heart diseases
Cyanosis, hypotension, murmur
(Answer A)
12. Born after forty-two weeks of pregnancy and amniotic fluid is meconium
first-line intervention if a baby is seen
A) Upper respiratory tract aspiration
B) Endotracheal intubation
C) Ventilation with air sac and mask
D) Cardiac compression
E) Drug administration
40
NEWBORN
MECONIUM ASPIRATION SYNDROME (MAS): Although 5-15% of deliveries have amnion fluid
meconium, meconium aspiration syndrome develops in 5%.
Term and postterm infants' disease. Thirty-four GH is rare before.
Risk factors: Postterm pregnancy (most importantly), preeclampsia-eclampsia,
maternal hypertension, cardiovascular disease, intrauterine growth retardation.
Meconium amniotic fluid is usually associated with fetal hypoxia. Most aspirations
during delivery
It happens.
Meconium amniotic fluid: mouth-nose and pharynx are aspirated as soon as the head
comes out. If the baby is active
(good breathing, KTA> 100, tonus good) routine maintenance. If the baby is
depressed, intubated
tracheal aspiration is performed. If meconium is detected under the vocal cords,
repeated aspirations should be performed. When MAS develops, its treatment is
supportive. Surfactant is given.
Clinical Findings: Postmature symptoms, meconium staining (detected on the first
cord) are detected. Light
The symptoms vary from respiratory distress to respiratory failure.
On examination, tachypnea, withdrawals, AP diameter increase, cyanosis,
auscultation ral, rocus and wheezing may be heard.
Atelectasis and ventilation perfusion disorder as a result of complete obstruction
of the airways with meconium,
partial confinement and air trapping - air leaks are seen.
MAS also causes chemical pneumonia and surfactant inactivation. All these factors
are hypoxia, acidosis,
hypercapnia causes pulmonary hypertension. This is the ductus arteriosus and
foramen
oval from right to left shunt and increases hypoxia.
X-ray patchy coarse granular infiltration, hyperinflammation, flattening of the
diaphragm and
Anterior posterior diameter increase is detected.
Surfactants used in term infants: MAS, pneumonia, surfactant protein B, C
deficiency, congenital diaphragmatic hernia.
(Answer A)
13. In a baby whose cyanosis disappears after crying and lungs found normal by
listening
Which of the following procedures should be performed for diagnosis? (April 96)
A) ECG is taken
B) Naloxane is given
C) Nasogastric catheter insertion into the nose
D) Chest X-ray is taken
E) Abdominal USG
Opening cyanosis when crying is typical for coanal atresia. Naloxane is an opioid
antagonist and
It is used to correct depression caused by opiods given.
(Answer C)
41
PEDIATRICS
14. Periodical apneas lasting 20-25 seconds in a child born at 1700 grams.
The pulse moans from 140 to 110 during apnea. What do you think of this kid?
(September 95)
A) Immature respiratory center
B) Periodic respiration
C) Hypoglycemia
D) Sepsis
E) Hypocalcemia
(Answer A)
15. What is the purpose of neonatal resuscitation? (April 94)
A) Inhalation
B) To provide central nervous system oxygenation
C) Increasing heart rate
D) Opening cyanosis
E) Correcting tone
The aim is to maintain oxygenation of the nervous system by providing adequate
oxygenation and ventilation.
(Answer B)
16. With a history of polyhydramniosis in the mother
What is the diagnosis of the baby in which the secretion is detected? (September
88)
A) Congenital pyloric stenosis
B) Aganglionic megacolon
C) Esophageal atresia
D) Meckel's diverticulum
E) Invagination
Although it is not very relevant, it is among the life-threatening anomalies.
(Answer C)
42
NEWBORN
GASTROINTESTINAL SYSTEM
PROBLEMS
one. Which of the following is necrotizing enterocolitis in premature newborns?
is the definitive diagnostic finding for? (September 2009)
A) Abdominal distension
B) Pneumatosis intestinalis on direct abdominal X-ray
C) Determination of acidosis in blood gases
D) Vomiting
E) Detection of thrombocytopenia in whole blood count
NECROTIZING ENTEROCOLITIS (NEC): NEC is the most common GIS emergency. Mucosal or
transmural involvement
It makes. It most commonly involves the terminal ileum and proximal colon. Most
often in the first 2 weeks of life.
Start time is inversely proportional to gestational age. Up to 3 months in very low
birth weights
visible.
Etiology: Intestinal ischemia, enteral nutrition and pathogenic microorganisms.
Prematurity is the major risk factor. Related microorganisms; E. coli, Klebsiella,
C. perfiringens, S.
epidermidis, rotavirus.
In preterm infants, it starts after feeding with formula. Enteral nutrition
before the onset and in breast-fed.
The first clinical signs of GIS are abdominal distension and gastric retention, and
the first systemic finding is lethargy.
and heat irregularity. Perforation of fecal occult blood positivity (recognized by
guaiac acid test),
peritonitis and shock. Thrombocytopenia is the first laboratory finding. As the
disease progresses, signs of neutropenia, acidosis and DIC develop.
Pneumomatosis intestinalis on the X-ray is diagnostic. Portal system
Having air (USG shows better) indicates advanced disease. Pneumoperitoneum can be
detected.
In the treatment, feeding is stopped and nasogastric drainage is performed.
Infection therapy and parenteral nutrition
Applied.
Absolute surgical indications: Perforation, positive paracentesis (feces or
microrganism).
Relative surgical indications: non-response to treatment, single fixed bowel loops,
erythema of the intestinal wall,
palpable mass.
Stress and short bowel syndrome are late complications.
Differential diagnosis: Systemic-intestinal specific infections, GIS obstruction,
volvulus and isolated intestinal
perforation
(Answer B)
43
PEDIATRICS
2nd. Which is associated with the pathogenesis of necrotizing enterocolitis in the

newborn
is not one of the risk factors? (April 2009)
A) Intestinal ischemia
B) Oral nutrition
C) Postmaturity
D) Pathogenic microorganisms
E) Low birth weight
The greatest risk factor for NEC is prematurity. Breastfeeding, parenteral
nutrition and postmaturity are not risky.
(Answer C)
3. Which is one of the findings observed in necrotizing enterocolitis
A) Abdominal distention
B) Bloody stool
C) Sepsis
D) Intestinal perforation
E) Alkalose
NEC is the cause of acidosis. See 1. Description of the problem
(Answer E)
4. Which of the following is the most common cause of cystic fibrosis in newborn
babies?
Is the evidence? (April 2006)
A) Bronchopulmonary dysplasia
B) Necrotizing enterocolitis
C) Meconium ileus
D) Pneumatosis intestinalis
E) Rectal prolapse
The most common presentation of cystic fibrosis in children is recurrent airway
findings in newborns.
The most common cause is meconium ileus.
MECONIUM ileus is the most common finding of cystic fibrosis in neonatal period. It
causes obstruction in the terminal ileum due to the lack of pancreatic enzymes and
meconium being viscous.
Abdominal distention and vomiting are seen. Sister history of cystic fibrosis,
abdominal obstruction
findings and meconium filling the intestines.
On the X-ray, a foamy granular image (lower right) is detected. Infants in terms of
cystic fibrosis
It should be evaluated. Sweat test should be done. It is more specific to cystic
fibrosis than meconium peritonitis and meconium plug.
Pneumotasis intestinalis is the presence of air in the intestinal wall. It is the
radiological finding that makes the diagnosis of NEC.
44
NEWBORN
MECONIUM PLUG: Obstruction of meconium in the lower colon or anorectal region.

Micro left colon (DAÇ), cystic fibrosis, aganglionic colon, magnesium
administration to the mother and opioid
with the habit. Glycerin is treated using isotonic gastrografin. After treatment
aganglionic megacolon.
(Answer C)
5. Which of the following should be considered in a patient with meconium ileus?
(September
2004, September 97)
A) Hypothyroidism
C) Cystic fibrosis
D) Alpha 1 antitrypsin deficiency
E) Wilson's disease
(Answer C)
6. Which examination of a newborn with blood after 12 hours of meconium
It should be done? (April 99)
A) Gastric lavage
B) Direct abdominal radiography
C) OMD (esophageal, gastric duodenal radiograph)
D) Column graph with barium
E) Apt test
Is your apt test your mother? The baby? to understand that it belongs. It is based
on the fact that fetal hemoglobin is resistant to alkali. When mixed with NaOH
yellow -coffee color is the mother of the source,
The continuation of the pink color indicates that the baby.
Ingested blood syndrome: Blood in the stool due to swallowed blood or nipple
cracking at birth. Apt test is used to differentiate from GIS bleeding.
Kleihauer-Betke (KB) test is used to determine the amount of fetal erythrocytes in
maternal blood.
This test is based on the fact that erythrocytes are resistant to acid.
Fetomaternal hemorrhage is detected and anti D globulin dose can be calculated for
prophylaxis in Rh immunization.
(Answer E)
45
PEDIATRICS
7. Two thousand grams of premature birth, high pressure oxygen to the child with
respiratory distress
treatment is given. Food is started on the 4th day, tolerates the food, on the 9th
day in the baby
abdominal distension develops, cyanosis begins, and bloody stinky stools.
Intestinal obstruction, abdominal wall and vena porta
If air shadows are seen, which is the possible diagnosis? (April 98)
A) NEK
B) Meconium ileus
C) Hypothyroidism
D) Aganglionic megacolon
E) Peritonitis
(Answer A)
8. Blood is detected in a stool in a newborn child. It is of mother or child origin
Which of the following is the test to determine whether the test? (April 95)
A) Apt test
B) Acid Raw test
C) Figlu test
D) Guiac test
E) Benedict test
The Benedict test is intended to detect reducing sugars.
Guaic acid test is used to detect occult blood in feces.
Figlu test is used to show folic acid deficiency. Formimunoglutamic acid increase
in urine is detected after histamine administration.
Acid Raw test is used in paroxysmal nocturnal hemoglobinuria.
(Answer A)
9. Restlessness, nausea, vomiting, bloody 10 days after birth in newborn
diarrhea, abdominal distention occurs. Pneumatosis intestinalis was detected on
direct X-ray. What do you think of this patient? (April 95)
A) Ulcerative colitis
B) Hirschsprung's disease
C) Anal atresia
D) Necrotizing enterocolitis
E) Invagination
NEC is most common in preterm infants who are fed with formula during the first 2
weeks of life. See question 1
description.
(Answer D)
46
NEWBORN
10. What is considered if there is gas in the vena port on the direct graph? (94 N)
A) Necrotizing enterocolitis
B) Liver abscess
C) Portal hypertension
D) Pancreatitis
E) Meconium peritonite
The presence of air in the Vena port is an indication of NEC's progress. Better
than direct radiography with USG
It is determined. See description of question 1.
(Answer D)
11th. What is the radiological finding in a baby with meconium ileus? (September
89)
A) Enlargement of the heart contours
B) Innovation in costumes
C) Air shadow under aperture
D) Psoas shadow becoming clear
E) Foam appearance in the lower right quadrant
(Answer E)
47
PEDIATRICS
CENTRAL NERVOUS SYSTEM

PROBLEMS
one. In premature infants, periventricular-intraventricular hemorrhage is most
commonly
in which regions? (September 2008)
A) Subependimal germinal matrix
B) Capsula interna
C) Hippocampus
D) Insula
E) Substansia nigra
INTRACRANIAL HEMORRHAGE (ICC): It may occur in term and preterm infants.
Term trauma in infants is due to asphyxia and coagulation disorder. Subarachnoid,
subdural
and subtentorial.
The ICC in the preterm is periventricular-intraventricular and subepandimal
germinal matrix.
Caused.
Traumatic epidural, subdural and subarachnoid hemorrhages are larger than the
pelvis of the mother
cases, prolonged births, breech presentation and use of instruments may occur.
Periventricular-intraventricular hemorrhage (PV-IVC): It occurs in premature. It
occurs in the gelatinous subepandimal germinal matrix. Embryonal neuron and fetal
glial migrate to the cortex of this area
is the source of cells.
It undergoes involution towards Terme and vascular maturation increases. Therefore,
periventricular hemorrhage is not seen in term infants.
Predisposing factors for IVC: Prematurity (most important), RDS, hypoxia-ischemic
and hypotensive
damage, reperfusion, increased or decreased cerebral blood flow, decreased vascular
integrity, increased
venous pressure, pneumothorax, hypervolemia, hypertension.
Most often occurs in 2-3 days. Late bleeding may occur in two to four weeks. It is
rare after the first month.
USG is recommended for screening for 3-5 days under thirty-four weeks.
Clinical findings are variable. Asymptomatic or sudden drop in hemotocrit, apnea,
bradycardia,
acidosis and seizures.
2-3 of life. sudden drop or transfusion of hematocrit in a premature patient whose
general condition
Although not elevated, in case of jaundice should suggest IVC.
Unlike subdural and subarachnoid hemorrhage, USG can be used for the diagnosis and
staging of IVC.
The treatment is followed in terms of supportive treatment and possible
hydrocephalus. Shunt develops hydrocephalus
or external drainage. Diuretic and acetozolamide are useless in treatment.
IVC poor prognostic indicators: Hydrocephalus requiring shunt, advanced stage
bleeding, excessive PVL, diffuse parenchymal bleeding.
Hydrocephalus, mental, motor retardation, hearing impairment and cerebral palsy
after IVC (spastic in preterm
diplegia).
48
NEWBORN
Periventricular cerebral infarction: It occurs due to venous congestion after

severe IVK.
Periventricular leukomalacia (PVL): Periventricular white matter is focal necrosis
or diffuse damage.
Although it is associated with IVK, it is mostly due to ischemic damage, not
bleeding.
Accelerating PVL formation: Fetal growth retardation, hypothyroxinemia, hypo /
hypercarbia, fetal
vasculitis, maternal / placental infection.
Possible protective factors from PVL: Antenatal corticosteroids, prostoglandin
inhibitors,
magnesium
Its frequency decreases with antenatal steroid (betamethasone) administration.
Dexamethasone periventricular leukomalacia
increases the risk. The administration of low-dose indomethacin is controversial.
2nd. Perinatal hypoxia and acidemia are directly related to the development of
is not responsible? (April 2003)
A) Neutropenia
B) Persistent fetal circulation
C) Respiratory distress syndrome
D) Cerebral edema
E) Disseminated intravascular coagulation
Hypoxia is the reduction of arterial oxygen and insufficient blood flow to
ischemia.
Perinatal asphyxia: Defines hypoxia, hypercapnia and metabolic acidosis as a result
of deterioration of gas exchange.
Increased anaerobic metabolism in fetal hypoxia increases lactic acid and
excitatory amino acids (especially glutamate), free radicals and NO. Intracellular
edema occurs with increased intracellular Na and Ca.
Blood flow is drawn from the lung, liver and intestine to the brain, heart and
adrenals.
Prognosis is associated with the treatment of concomitant complications,
gestational age and hypoxic ischemic encephalopathy.
It varies according to the degree of (HIE).
Poor prognosis: 1. Stage II-III HİE
2nd. Low APGAR at 20 minutes, lack of spontaneous respiration and abnormal
neurological findings at 2 weeks
presence of symptoms
3. Abnormal EEG and MRI findings.
Combination of EEG and MR in term infants is the most effective method for
predicting prognosis.
(Answer A)
Effects of asphyxia
•
CNS: HIE, infarction, HRC, convulsion, cerebral edema, hypotonia, hypertonia
Cardiovascular: Myocardial ischemia, contractility disorder, tricuspid

regurgitation, hypotension.
Pulmonary: Persistent fetal circulation, pulmonary hemorrhage, RDS
Renal: Oliguria, acute tubular or cortical necrosis, ARF.
Adrenal: Adrenal bleeding
Gastrointestinal: Paralytic ileus, NEC, perforation, necrosis, increased liver

enzymes,
ammonia and bilirubin height, decrease in the production of clotting factors.
Metabolic: Improper ADH secretion, hyponatremia, hypoglycemia, hypocalcemia,

myoglobinuria
Skin: Subcutaneous fat necrosis
•
Hematologic: DIC, thrombocytopenia and increased erythrocytes with nuclei.
49
PEDIATRICS
3. What is not seen in perinatal hypoxia? (September 97)

A) DIC
B) Convulsion
C) Hyperglycemia
D) Heart failure
E) Hemolysis
See. 2 Questions.
(Answer C)
Symptoms of hypoxia in the fetus:
•
IUGR
bradycardia
Reduction in variability in NST
Late (uteroplacental insufficiency) or variable deselation (cord compression)

pattern
PH <7.2 in salp blood analysis
Symptoms of hypoxic ischemic encephalopathy according to stages in term infant

Parameter
Stage 1
Stage 2
Stage 3
Consciousness
Hiperalert
letargic
Stupp's / coma
Tonus
Normal
the hypotonia
Tonus too ↓
posture
Normal
flexion
decerebrate
Reflex
Hyperactive
Hyperactive
No
Moro
Strong
Weak
No
pupil
Mydriatic
Myotik
IR weak, anisocoria
Time
<24 hours
1- 14 days
Weeks
4. Birth in a primiparous woman, vaginal delivery at term

After absorption, paralysis, hypotonia and pallor are detected. After a short time
The baby is losing. What is the possible diagnosis? (September 92)
A) Medulla spinalis injury
B) Pneumonia
C) Kernicterus
D) Myelodysplasia
E) Amyotonia congenita
Spine and Spinal Cord Injury: It is usually difficult and occurs at birth. Most
common arrival
C7-T1, C4 vertebrae are affected on head arrivals.
Spinal cord rupture, bleeding and edema are rarely seen. Clinical findings are
related to the level of the lesion and
varies by weight. In the region under the lesion there is a loss of neurological
function of type 1 neuron.
Heavy ones are lost immediately after birth. First day apnea with poor prognosis, 3
is the lack of motor recovery in the month.
The differential diagnosis includes Amyotonia congenita, myelodysplasia with occult
spina bifida.
(Answer A)
50
NEWBORN
5. A newborn born by forceps 8 hours before birth and 12 hours before forceps had
convulsions lasting for 2 minutes.
Learned. What is the diagnosis? (September 93)
A) Kernicterus
B) Meningitis
C) Intracranial tumor
D) Hypercalcemia
E) Asphyxia
Difficult delivery with forceps, low APGAR and convulsion asphyxia on the first
day.
Blood group mismatches are the most common cause of kernicterus. No such problem
has been mentioned.
During the intrauterine period, the placenta clears indirect bilirubin. Therefore,
the appearance of later
can. Symptoms start in 2-5 days in term babies and in 7th day in preterm babies.
Initial findings
decreased absorption, lethargy and loss of Moro reflex.
Meningitis may cause seizures, but more often accompanied by late sepsis.
Convulsion is not hypercalcemia but hypocalcemia and seizure with good prognosis.
Intracranial tumors are very rare in the newborn. The most common brain tumor under
one year of age is choroid plexus papilloma or carcinoma originating from the
choroid plexus. Hydrocephalus as a cause of CSF secretion
It makes.
(Answer E)
6. What is the most common cause of convulsions in the newborn? (April 92)
A) Hypocalcemia
B) Birth trauma
C) Hypoglycemia
D) Hyponatremia
E) Hypomagnesemia
The most common cause is hypoxic ischemic encephalopathy. First day. As it may
cause hypoxia,
The answer is birth trauma.
Neonatal convulsions: branching of axons and dentrites in newborn period and
myelinization
In general, tonic-clonic seizures are not seen in the newborn period. Most
common seizures are amorphous (subtle) salivation, pedaling, apnea seizures.
Newborn
seizures can also be confused with non-seizure tables.
Tips for separating the seizure:
- There are autonomic changes such as tachycardia and increased blood pressure.
- Sensory stimuli and non-seizures are triggered, but seizures are not affected.
- Tables without seizures do not change when the baby stops when the seizure stops.
Patients with seizures and EEG discharge clinically; Focal clonic, focal tonic and
some myoclonic seizures
It is seen. The seizure is epileptic and responds to antiepileptics.
Clinical signs of seizure No EEG discharge: Generalized tonic seizures. Often
infants with hyposic ischemic encephalopathy.
Patients with non-clinical EEG discharge; It can be seen in comatose babies without
anticonvulsant.
Etiology and diagnosis: Hypoxic ischemic encephalopathy is the most common cause in
neonates. In addition, seizures due to metabolic, infectious, traumatic,
structural, hemorrhagic, embolic and maternal causes may occur. Newborn
blood glucose, calcium, magnesium, electrolytes and BUN
It should be viewed.
LP and cranial imaging should be performed in seizures not related to metabolic
causes.
Traumatic PL: Bloody CSF to be clear after centrifugation
Subarachnoid / intraventricular hemorrhage: CSF xanthochromic color.
(Answer B)
51
PEDIATRICS
METABOLIC DISORDERS AND

DIABETIC MOTHER DOLLS
one. Which of the following findings is not seen in children with diabetic mothers?
(May 2011)
A) Hypoglycemia
B) Hypocalcemia
C) Tachyne
D) Tremor
E) Hypermagnesemia
Diabetic mothers are frequently asked and still popular.
Its main metabolic problems are hypoglycemia, hypocalcemia and hypomagnesemia.
Hypomagnesemia and hypermagnesis were used during the questioning. Most of the
clinical manifestations
LGA-born polycythemic infants. All organs except the brain are large.
one. Hypoglycemia should be checked for blood sugar in the first hour.
2nd. Hypocalcemia and hypomagnesemia
3. Polycythemia and jaundice III sheet page 509 Diabetic mothers:
Congenital anomalies are caused by periconceptional glucose elevation. It is
prevented by checking. Early
Acidosis due to the relative deficiency of insulin in the postoperative period
leads to congenital anomalies. 3 times more than non-diabetic.
Findings due to fetal hyperglycemia:
one. Congenital anomalies
2nd. Decreased growth (0-20 GH, early pregnancy)
3. Hyperinsulinemia (> 20 GH)
Findings due to fetal hyperinsulinism:
one. Hypoglycemia (0-7 days)
2nd. Lack of surfactant
3. Immature liver metabolism
Fetal hyperglycemia and hyperinsulinism-related findings
one. Fetal macrosomia (> 20 GH): labor asphyxia, transient tachypnea,
cardiomyopathy
2nd. Fetal hypoxia (> 30 GH): Polycythemia, iron anomalies Polycythemia-related
renal vein thrombosis and
The risk of stroke increases. Cardiomegaly occurs asymmetric septal hypertrophy and
idiopathic subaortic
stenosis Digoxin and other positive inotropics cause worsening.
RDS and tachypnea are more common.
(Answer E)
52
NEWBORN
2nd. Which of the following diseases may be associated with neonatal hypocalcemia?
(September 2009)
A) Down syndrome
B) Turner syndrome
C) DiGeorge syndrome
D) VATER syndrome
E) Apert syndrome
Dion syndrome is associated with neonatal hypocalcemia. Third and fourth pharyngeal
arch
It is defect. It can be recognized by hypocalcemic convulsions in the neonatal
period. Parathyroid hypoplasia, conotural cardiac anomalies and thymus hypoplasia
can be seen. Causes T cell deficiency.
Increased tendency to infection increased with fungi, viruses and P. jirovecii
(formerly P. carini).
Laboratory findings:
•
Low PTH / Low AMP in urine
Low calcium and phosphorus
1, 25 OH lower vitamin D (PTH 1 alpha hydrocylase actives)
The alkaline phosphate level may be variable.

(Answer C)
3. Which of the typical findings of Beckwith-Wiedemann syndrome

is not one? (September 2006)
A) Makroglossi
D) Severe anemia
B) Omphalocele
E) Microcephaly
C) Hepatoblastoma
Beckwith-Wiedemann syndrome (BWS), also known as omphalocele, macroglossia,
gigantism syndrome. Hyperinsulinemia and hypoglycemia are the main causes of the
problem in metabolic disorders.
Typical findings of the syndrome: Macroglossia, omphalocele, macrosomy and ear
lobe.
The disease is related to 11 chromosomes and macrosomia is caused by excessive
release of insulin-like growth factors. Liver, kidney and pancreas also grow.
It carries the risk of hemihypertrophy and increased malignancy.
Increased malignancies:
•
Wilms tumor (children with BWS should be followed by abdominal USG)
Hepatoblastoma (alpha fetoprotein tracking)
Adrenocortical tumors
Gonodal tumors
Increased insulin-induced polycythemia. No anemia.
Points to pay attention to: Polyhydroamniosis is not a history of oligo.
It becomes an omphalocele, not gastrointestinal.
The increased risk of tumors is Wilms, not neuroblastoma.

(Answer D)
53
PEDIATRICS
4. Which of the following is congenital, which can be seen in babies of diabetic

mothers?
is not one of the anomalies? (September 2006)
A) Gastric duplication
B) Duodenal atresia
C) Cardiac malformations
D) Neural tube defect
E) Small left colon syndrome
Diabetic mothers are always asked about their babies. The last updated edition with
why there are many questions at the bottom
We're looking at.
Tricuspid atresia, which is one of the cardiac valve anomalies, was replaced with
pulmonary and asked. In Mitralle
It was changed.
Double outlet right ventricle, left ventricular hypoplasia. Aortic coarctation. No
pulmonary artery hypoplasia. Or the most common anomalies asks which are not common
pathologies
cardiac and lumbosacral agenesis.
On the contrary, there is asymmetric septal hypertrophy.
While there was no problem with the right column, the left column remained small.
Diabetic mother with her baby
Common congenital anomalies:
Cardiac malformations: VSD, ASD, transposition of the great artery, truncus
arteriosus, double outlet
right ventricle, aortic coarctation and tricuspid atresia
Lumbosacral agenesis
Other accompanying anomalies:
Neural tube defect, Holoprosencephaly (Diabetes-related migration defect)
Renal agenesis, dysplasia, hydronephrosis, double ureter
(Answer A)
5. Which of the following is the most common cause of hypocalcemia in newborn
babies?
not from the findings? (September 2006)
A) Convulsion
B) Vomiting
C) Lethargy
D) Carpopedal spasm
E) Tremor
54
NEWBORN
Hypocalcemic neonates do not have carpopedal spasms. In neonates, irritability,

jitterines and tremor are seen in addition to convulsion. It may also cause sepsis-
like findings in newborns.
can.
Hypocalcemia total Ca levels below 7 mg / dl when symptomatic and 6 mg / dl when no
symptoms
or the amount of ionized Ca is less than 2.5-3 mg / dl.
Symptoms; hypoclasemia impairs muscle contraction and nerve conduction by lowering
the threshold potential. FAQ's
most important symptoms; convulsions, loss of consciousness and apnea. Hidden in
non-severe hypocalcemia
Chvostek and Trousseau (+) during the tetani period.
Hypocalcemia heart block, ventricular fibrillation, hypotension, heart failure, QT
prolongation in ECG
it may cause apnea and hypoxia, especially in newborns. Laryngospasm may occur.
If hypocalcemia becomes chronic (rickets, hypoparathyroidism), demineralization of
the bone occurs, resulting in bone
pains and fractures may occur. Cataract occurs if hypoclasia lasts more than 1
year.
Other findings; the skin dries, becomes rough and peeled. Sparse hair, nail
fracture and teeth
disorders are seen.
(Answer D)
6. Which of the following is seen in preterm infants who have undergone TPN for a
long time
complications are not? (September 2004)
A) Cholestatic jaundice
B) Hyperlipidemia
C) Alkalose
D) Nephrocalcinosis
E) Hyperammonemia
Complications after preterm TPN administration;
one. Osmotic diuresis
2nd. azotemia
3. hyperammonemia
4. hypoglycemia
5. nephrocalcinosis
6. Cholestatic jaundice
7. hyperlipidemia
(Answer C)
7. Which of the following has not increased in diabetic mothers?
(September 2004)
A) Transposition of the great arteries
B) Lumbosacral agenesis syndrome
C) Holoprosencephaly
D) Duodenal atresia
E) Isolated pulmonary atresia
55
PEDIATRICS

DIABETIC MOTHER BABY (DAB): Diabetes mothers type 1, type 2 and gestational
diabetes
has negative effects on
Increased risks in diabetic mothers: polyhydramniosis, preterm labor,
pyelonephritis, chronic hypertension, increased risk of fetal loss (especially> 32
GH, diabetic ketoacidosis and congenital anomalies
What happens in those).
The main factor that initiates pathological events in the baby of diabetic mother
is glucose elevation. hyperinsulinism
the result of this develops.
Congenital anomalies are caused by periconceptional glucose elevation. Control is
prevented.
Acidosis due to the relative deficiency of insulin in the early period leads to
congenital anomalies.
3 times more than non-diabetic.
Findings due to fetal hyperglycemia:
•
Congenital anomalies
Decreased growth (0-20 GH, early pregnancy)

•
Hyperinsulinemia (> 20 GH)
Findings due to fetal hyperinsulinism:
Hypoglycemia (0-7 days)
Lack of surfactant
Immature liver metabolism
Fetal hyperglycemia and hyperinsulinism-related findings
Fetal macrosomia (> 20 GH): labor asphyxia, transient tachypnea, cardiomyopathy
Fetal hypoxia (> 30 GH): Polycythemia, iron anomalies
The risk of stroke and renal vein thrombosis increases due to polycythemia.
Clinical manifestations are polycythemic infants, most of whom are born with LGA.
All organs except the brain are large
It happens. Canopy hairy (hypertrichosis pinna) can be seen
Hypoglycemia should be checked for blood sugar in the first hour.
Hypocalcemia and hypomagnesemia
Polycythemia and jaundice
Cardiomegaly occurs asymmetric septal hypertrophy and is confused with idiopathic
subaortic stenosis.
RDS and tachypnea are more common.
(Answer E)
56
NEWBORN
8. Which of the following should be considered first in the presence of resistant

hypocalcemia in the treatment of calcium in a newborn baby? (September 2003)
A) Hypophosphatemia
B) Hypomagnesemia
C) Hypopotasemia
D) Hyponatremia
E) Hypouricemia
The classic finding of hypomagnesemia is hypocalcemic convulsion unresponsive to
calcium treatment, such as tetany.
the findings. Treatment is intramuscular administration of magnesium. (Calcium
causes necrosis
must be given intravenously)
Generally, low magnesium is associated with hypocalcemia.
Causes of hypomagnesemia:
Maternal insufficiency - malnutrition
Diabetic mother with her baby
Blood exchange (due to binding of citrate, complete recovery takes 10 days) and
total parenteral
insufficiency
Multiple pregnancies, preterm labor and intrauterine growth retardation
Absorption disorders
Renal losses (amphotericin B, diuretics)
Hypoparathyroidism, hyperphosphatemia
Hypermagnesemia: It occurs because the mother is given too much at birth. Decrease
in absorption, decrease in reflexes, respiratory and nervous system depression may
cause meconium spigot syndrome.
Magnesium is abundant in antacids and laxatives. Their use in older children
hypermagnesemia. Treatment includes calcium administration and diuretics.
(Answer B)
9. Which of the following does not cause hypocalcemia in the neonatal period?
(April 2000)
A) Maternal hypoparathyroidism
B) Maternal diabetes
D) High phosphate cow milk intake
E) Hypomagnesemia
Causes of hypocalcemia in the newborn include:
one. prematurity
2nd. Asphyxia, stress
3. Diabetic mother with her child
4. High phosphate load
5. Primary hypoparathyroidism
6. Maternal hyperparathyroidism
7. Pseudohypoparathyroidism
8. hypomagnesemia
9. Renal diseases
10. Bicarbonate, citrated blood transfusion, furosemide, white light phototherapy,
intravenous
11th. Lipid administration
(Answer A)
57
PEDIATRICS
10. In the first 12 hours in a newborn with 38 weeks of 1600 gr, head circumference
of 33 cm and 48 cm
which is the most common? (April 99)
A) Anemia
B) Sclerodema
C) Respiratory distress syndrome
D) Hyperbilirubinemia
E) Hypoglycemia
The infant described above is a term SGA infant.
The most common reason for this is placental insufficiency and this situation
causes the baby to have hypoxia and
cause stress. Hypoxia causes erythropoietin increase and polycythemia.
Sclerodem, on the other hand, causes the subcutaneous fat tissue in infants with
severe sepsis and impaired peripheral circulation.
It becomes a hard wood like esterification and heralds the bad progress.
Respiratory distress syndrome is caused by a lack of surfactant in preterm infants.
At SGA
Increased stress due to cortisol stimulates the production of surfactant and
protects against RDS.
Hyperbilirubinemia may occur due to an increase in erythrocyte mass, but it does
not occur in the first 12 hours. (Within 24 hours
hyperbilirubinemia is most commonly caused by hemolytic anemia)
Hypoglycemia is a common finding due to the small number of stores.
SGA infants problems and pathogenesis
Fetal death: Acidosis, hypoxia, infection, congenital anomalies.
Perinatal asphyxia: Chronic fetal hypoxia-acidosis, meconium aspiration,
uteroplasental perfusion
reduction.
Hypoglycemia: Low depot, reduced glyconeogenesis, increased need (hypoxia,
hypothermia and
relatively large brain tissue)
Dysmorphic features: Syndromes, genetic-chromosomal abnormalities, oligohydramnios-
related anomalies,
TORCH infection
Polycythemia / hyperviscosity: Erythropoietin increase
Reduced O2 consumption / hypothermia: Hypoxia, hypoglycemia, fasting effect and low
adipose tissue
Lung bleeding and persistent fetal circulation.
(Answer E)
11th. Which of the following is not a cause of hypoglycemia in the newborn? (April
98)
A) Diabetic mother
B) Severe erythroblastosis fetalis
C) Low birth weight
D) Salicylate poisoning
E) Phenylketonuria
Diabetic mother causes hypoglycemia due to hyperinsulinism.
Pancreas of amino acids (mainly leucine) released from erythrocytes that break down
erythroblastosis fetalis
stimulates and causes hypoglycemia by causing pancreatic hypeplasia and
hyperinsulinism.
Hypoglycemia occurs due to insufficient stores at low birth weight.
Salicylate poisoning may cause hypoglycemia, although it is not likely to occur in
the newborn (since it cannot take it itself).
Phenyl ketonuria also does not show hypoglycemia.
(Answer E)
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NEWBORN
12. Which diabetic mother does not have a child? (April 97)
A) Myocardial hypertrophy
B) Congenital anomaly
C) Subdural hematoma
E) Renal vein thrombosis
E) RDS
Subdural hematoma may be increased due to increased birth traumas.
(Answer C)
13. A child born weighing 5600 grams has hypoglycemia. Acidosis and ketonuria
is the diagnosis in a non-patient? (April 96)
A) Hyperinsulinism
B) Glucagonoma
C) MSUD
D) Organic acidemia
E) Phenyl ketonuria
Macrosomia and hypoglycemia are associated with hyperinsulinism.
Hypoglycemia, acidosis and ketonuria occur in organic acidemias.
Phenyl ketonuria is screened because there are no signs at birth. Early pyloric
stenosis
resembling vomiting.
Hyperglycemia occurs because glucagonoma is the opposite hormone of insulin.
Hypoglycemia is not seen.
MSUD: Branched chain alpha-ketoacid occurs due to lack of dehydrogenase complex.
Main organic acidemias
MSUD: Valine, leucine, isoleucine
MMA: Valine and isoleucine
Propionic acidemia: Valine and isoleucine
Isovaleric acidemia: Leucine
The question LGA (large for gestational age) is a child.
LGA dolls
Identifies babies whose birth weight is above 90 p by week.
Mortality risk increases when birth weight exceeds 4000 g.
Diabetic and obese mothers are common in infants.
Risk of birth traumas, congenital anomaly (especially heart) and mental retardation
is increased.
Causes of LGA: Maternal diabetes (SGA occurs when vascular complications are not
developed)
Beckwith-Wideman syndrome
Genetic predisposition
Receiving twin in twin to twin transfusion
Hydrops fetalis
Transposition of large vessels
postmaturity
(Answer A)
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PEDIATRICS
14. In a macrosomic baby, plethoric face, hypertrichosis pinna and hypoglycemia are
detected.
Which of the following should be considered? (April 94)
A) Adrenal insufficiency
B) Desquamation of the skin
C) Congenital cytomegalovirus infection
D) Toxoplasma
E) Diabetic mother baby
(Answer E)
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NEWBORN
INFECTIONS
one. Which of the following congenital infections is not expected to develop
microcephaly?
(September 2011)
A) Cytomegalovirus
B) Herpes simplex virus
C) Rubella
D) Toxoplasmosis
E) Mumps
This question is one of the simplest questions asked in the relationship between
microcephaly and TORCH group infections.
It looks. Because the only picture that is thought to be associated with mumps
infection is primary endocardial
It is fibroelastozis.
Start related anomalies Wide anterior fontanel
•
Achondroplasia
Osteogenesis imperfecta
Cleidocanial dysostosis
Piknodizostoz
Russel-Silver syndrome
13-18-21 trisomies
Apert syndrome
•
Hallermann-Streiff send.
prematurity
Intrauterine growth retardation
I Hiptori
Hydrocephalus
Congenital rubella syndrome
Vita. D-deficiency rickets
hypophosphatasia
Primary microcephaly
•
Family (OR, OD)
Down send.
Edward send.
Cri-du-chat send.
Cornelli de Lange send.
Rubistein-Taybi send.
61
PEDIATRICS
Smith-Lemli-Opitz send.
Cases seen in small front fontanel:
•
1-craniosynostosis,
2-Microcephaly
3- Congenital hyperthyroidism
4-Wormian bone anomaly
Craniotabes: The first 3 months is physiological.

•
Osteogenesis imperfecta,
rickets,
cretinism,
cleidocranial disostosis
lacunar skull
Down syndrome
Secondary microcephaly
•
Radiation
TORCH infection
•
malnutrition
Metabolic (hyperphenylalaninemia)
hyperthermia
Transplacental infections in infants:

•
Growth retardation: CMV, Plasmodium, rubella, toxoplasmosis, Treponema pallidum,

Trypanosoma cruzi,
VZV
Congenital anatomical defects
Neonatal organ involvement
Late sequelae
Congenital anatomical defects and causing organisms:

Factors such as HIV, HBV, measles do not cause anatomical defects.
•
Congenital anatomical defect:
Cataract and heart defect: Rubella
Hydrocephalus: HSV, lymphocytic choriomeningitis virus, rubella, toxoplasmosis
Calcification: CMV (periventricular), HIV, toxoplasmosis (scattered), T. cruzi
Limb hypoplasia: VZV

-
Microcephaly: CMV, HSV, rubella, toxoplasmosis
Microphthalmitis: CMV, rubella, toxoplasmosis
Late sequelae:
Convulsions: CMV, enterovirus, rubella, toxoplasmosis
Deafness: CMV, rubella, toxoplasmosis
Tooth / skeleton: Rubella, T. pallidum
Endocrinopathy: Rubella, toxoplasmosis
Eye pathologies: HSV, rubella, toxoplasmosis, T. cruzi, T. pallidum. VZV
Hepatitis: Hepatitis B
Mental retardation: CMV, HIV, HSV, rubella, toxoplasmosis, T. cruzi, VZV
Nephrotic syndrome: Plasmodium, T. pallidum

(Answer E)
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NEWBORN
2nd. Related to congenital cytomegalovirus infections in newborns

which of the following statements is incorrect? (September 2011)
A) can cause progressive hearing loss
B) 90% of cases come with acute symptomatic findings at birth
C) May cause premature
D) May cause purpuric rash
E) Chorioretinitis may cause
Congenital CMV infection is the most common TORCH infection. 95% of cases are
asymptomatic. Chororrhein-tinitis, microcephaly, intracranial calcifications in the
eye in symptomatic cases,
hepato / splenomegaly, icter, cholestasis, petechiae, anemia, hearing loss.
Congenital CMV
prema-species.
(Answer B)
3. Which of the following is the most common complication of mumps?
(April 2010)
A) Thyroiditis
D) Pancreatitis
B) Nephritis
E) Optic neuritis
C) Meningitis
The same question asked in April 2004. The most common complications of mumps are
septic meningitis (meningoencephalitis) and orchitis and epididymitis in
postpubertal men. Of course, your answer was parotite
It would be.
Complications:
one. Nervous system complications: Meningitis is the most common complication that
may or may not be encephalitis.
Most often occurs after 5 days of swelling of the diaper. It can be before, during
and after. Others:
Transverse myelitis, factional paralysis, neurosensory deafness, aquaduct stenosis
2nd.
3.
pancreatitis
Orchitis, epididymitis. Atrophy can be seen but infertility is rare. It happens
more often in adults. oophoritis
rare.
4.
thyroiditis
5.
Myocarditis: Makes it rare. It causes endocardial fibroelastosis in fetus.
6.
Arthritis. It holds more large joints and does not cause permanent damage.
MUMPS: A RNA virus (Paramyxovirus) from the paramyxoviridae group. There is only
one serotype.
It is transmitted by droplet. Most infectious is 2 days before swelling and 5 days
after swelling. incubation
The period is 12-25 days, usually 6-18 days.
Objectives: Salivary glands, nervous system, pancreas, testis are frequently
involved. Less ovarian, thyroid, synovial
tissue, heart, kidney and liver.
Clinical findings: Parotid gland is bilateral, less unilateral swollen and painful.
Stenon at the mouth of the canal (second
molar level) hyperemia. As the swelling progresses, the jaw angle disappears and
the ear is pushed up. Ear
the parotid axis is intact.
Diagnosis is based on clinical findings.
Differential diagnosis: Parotitis should be made by other factors. HIV. Influenza,
parainfluenza, CMV, EBV and
enteroviruses. Sjögren's syndrome, suppurative parotitis (echinus S. aureus and
canal)
The treatment of mumps is symptomatic; There is no specific treatment.
(Answer C)
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PEDIATRICS
4. What is the most common complication of chickenpox? (April 2010)

A) Cerebellar ataxia
C) Pneumonia
B) Myocarditis
D) Nephrotic syndrome
E) Pancreatitis
The most common complication of chickenpox is secondary bacterial infections.
Chickenpox in healthy children
The second most common cause of hospitalization is neurologic complications.
Neurological
The most common complication is cerebellitis. Immunological response and vasculitis
were responsible for the pathogenesis. Neurological findings include
eningoencephalitis, cerebellar ataxia, sudden onset seizure, various
levels of consciousness or neck stiffness.
Chicken pox
The causative agent: Varicella-Zoster Virus. Herpes virus belongs to the family.
May cause primary, latent or recurrent infection. Chickenpox infection provides
lifelong immunity,
The virus remains hidden for life in the nerve ganglion cells and reactivates to
shingles. incubation
period is 10-21 days.
Clinical symptoms
one.
Chickenpox: It is a vesicular rash. The lesions begin as an itchy macule, papules,

vesicle occurs. Fluid in the vesicle becomes turbid, bellies and crusts heals in 1
week
The recovery in. All lesions are contagious until crusting.
It is typical that there are lesions at different stages at the same time and the
lesions are more dense in the trunk.
The lesions do not leave traces unless there is secondary bacterial infection. A
slight hypopigmentation or
hyperpigmentation.
2nd.
Infection seen in vaccines: 1/5 children spend.
3. Progressive varicella: It occurs in pregnant women, newborns and adolescents and

immune deficiencies.
It is rare in healthy children. There is widespread internal organ involvement and
coagulopathy. Death most often 3 days
in and due to pneumonia. It is also seen in asthmatic children taking inhaled
steroids.
4.
Neonatal varicella: Risk of varicella in the mother 5 days before and 2 days after
birth.
VZIG is given and acyclovir is started to the rash.
5.
Congenital varicella: zigzag scars in the skin are characteristic skin findings.
dermatomal
fits to distribution.
6.
Herpes zoster (Shingles) It is rare in healthy children under 10 years of age.

intrauterine or <1 year old
can be seen. Children do not have symptoms such as numbness, burning before, after
Postherpetic neuralgia is rarely seen. Dermatomal involvement.
(Answer A)
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NEWBORN
5. Which of the following is most common in congenital rubella syndrome (September

2008)
A) Patent ductus arteriosus
B) Transposition of large vessels
C) Ventricular septal defect
D) Atrioventricular block
E) Atrial septal defect
Transposition of the great arteries is common in diabetic mothers. Concomitant
pulmonary stenosis or right
If there are anomalies such as aortic arch, it is also associated with Di George
and CATCH syndrome.
CATCH (22 q deletion): Cardiac anomaly, abnormal face, thymic hypoplasia-aplasia,
cleft (cleft palate),
hypoplasia.
VSD is the most common congenital heart disease in children, while ASD is the most
common congenital heart disease in adults.
heart disease.
Atrioventricular block in infants with lupus due to SS-A (anti Ro), SS –B (anti La)
antibodies
It is seen.
Patent ductus arteriosus is the most common cardiac pathology seen in congenital
rubella.
We have prepared two tables with you, which is why we have a very frequently asked
topic.
(Answer A)
Clinical manifestations of congenital rubella infection
Rubivirus-related rubella is a mild self-limiting picture in childhood
causes a heavier table.
What is important is that congenital rubella syndrome (CRS) is a severe disease
involving almost all organs and systems.
makes the table.
Clinical manifestations of congenital rubella:
The most common finding alone is neural type deafness.
The most common cardiac finding is PDA, followed by right pulmonary stenosis.
In general, the most common findings were eye findings (71%)> deafness> low birth
weight> psychomotor retardation> congenital heart (48%).
The least sign of neonatal purpura (death is more and is due to pneumonia).
The most common ocular finding is salt and pepper retinopathy. Its effect on vision
is minimal. The most serious eye finding
uni or bilateral cataract.
Neurological findings may be progressive. Mental motor retardation and
behavioral problems, autism, deafness. Rarely progressive rubella panencephalitis
can also be.
65
PEDIATRICS
Late findings:
•
Progressive panencephalitis
Diabetes mellitus
Thyroid dysfunction
Glaucoma and vision problems
The information above is summarized from the Nelson 2007 table.
Pathological findings of congenital rubella

Nervous system: Chronic meningitis, parenchymal necrosis and calcification
Eye: Microphthalmitis, cataract, iridocyclitis, ciliary body necrosis, glaucoma,
retinopathy
Ear: cochlear hemorrhage
Cardiovascular: PDA, pulmonary stenosis, VSD, myocarditis
Lung: endothelial necrosis and interstitial pneumonia
Liver: Giant cell transformation, lobular disorder, fibrosis, bile stasis
Kidney and adrenal gland: Interstitial nephritis, cytomegaly in adrenal cortex
Bone: cartilage thinning, osteoid malformation and mineralization disorder
Skin: Erythropoiesis
Thymus: absence of germinal center and histiocytic reaction
6. Which is one of the clinical signs of intrauterine infections
A) Low birth weight
B) Hepatosplenomegaly
C) Jaundice
D) Ambiguous genitalia
E) Intracranial calcifications
Transplacental infections lead to a wide variety of relatively overlapping
findings. The answer to the question
very clear but let's explain a little other options.
Low birth weight: CMV, Rubella, toxo, Treponema pallidum (syphilis), plasmodium and
Trypanasoma cruzi, Varicella zoster virus
Hepatitis: CMV, enterovirus, HSV
Hepatosplenomegaly: CMV, Rubella, toxo, T. pallidum, Plasmodium, T. cruzi, HIV,
enteroviruses
Hyperbilirubinemia is direct.
Intracranial calcification: CMV, Tokso, HIV, T. cruzi is due to.
Ambigius genitalia is not seen due to intrauterine infections.
For simpler and relatively specific findings for those who call it too complex, see
subparagraph.
Clinical manifestations of these infections are indicated in a table and neonatal
organ involvement,
late sequelae and congenital anatomic defects.
The question, which makes the finding, can be in the form of which is late
sequelae.
Late sequelae in transplacental infection:
Convulsion, deafness, eye pathologies, mental retardation
endocrinopathy
Skeletal and tooth anomalies
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NEWBORN
Hepatitis: HBV-related. The above causes of hepatitis are organ involvement in the
neonatal period.
Hepatitis of HBV is late sequelae. Attention..
Nephrotic syndrome
Cataract and heart defect: only rubella
Limb hypoplasia: VZV
Carditis: Rubella, T. cruzi, Coxackie
Osteitis, tooth and skeletal anomalies: Rubella and T. pallidum.
Rhinitis: T. pallidum (bloody runny nose), enteroviruses
Endocrinopathy: Rubella and toxoplasmosis
Nephrotic syndrome: Plasmodium and T. pallidum
(Answer D)
7. Which of the following is the microorganism causing intrauterine infection with
symptoms such as microphthalmia, myocarditis, sensorineural hearing loss,
meningoencephalitis and patent ductus arteriosus? (April 2007)
A) Toxoplasma gondii
B) Chlamydia trachomatis
C) Varicella zoster virus
D) Cytomegalovius
E) Rubella virus
See 5. Part of the pathological findings of the question.
(Answer E)
8. Which is one of the most common causes of meningitis in newborn infants (0-1
months)
is not one of the bacteria?September 2006)
A) Group B streptococci
B) Group D streptococci
C) Staphylococcus aureus
D) Gram (-) enteric bacilli
E) Listeria monocytogenes
The question was a bit unfair.
Because we can clearly find the answer in Krugman.
Infection factors according to age
Neonatal period:
S. agalactia
E. coli (strain K1) and other gram negative enteric bacilli
L. monocytogenes
enterococci
67
PEDIATRICS
Infants and young children:

S. pneumonia
N. meningitidis
H. influenza (not vaccinated)
> Children over 5 years
S. pneumonia
N. meningitidis
Answer D (according to Krugman)
Nelson on page 798 The most common bacterial meningitis agents are GBS, E. coli and
L. monocytogenes.
Others S. pneumonia and other streptococci, non-typable H. influenza, coagulase
positive
and negative staphylococci (coagulase positive S. aureus), Enterobacter,
Pseudomonas, T. pallidum and M. tuberculosis. Not directly called enterococci but
other streptococci
(no problem if the author knows that the Enterococci are excluded from Group D).
In the neurology section where meningitis is described (p. 2513), for detailed
information, refer to the same page.
and common pathogens in groups B and D streptococci (enterococci), gram-negetive
enteric bacilli
(E. coli, Klebsiella) and listeria and the most common ones are group B
streptococci and E. coli.
It is written. None of the staphylococci. Enterococci.
After all this, meningitis can be a benefit to you.
Complication and prognosis in bacterial infections:
Complications of bacterial infection:
Endocarditis, septic emboli, septic arthritis, osteomyelitis and bone destruction.
Recurrent bacteremia
is a rare complication.
Candidemia: Causes vasculitis, endocarditis, endophthalmitis and abscess.
Mortality is highest in gram negative and fungal sepsis.
Risk factors for death and disability: seizures lasting longer than 72 hours, coma,
leukopenia, inotropic need
no.
Early complications of meningitis: Ventriculitis, abscess, cerebritis.
Late complications of meningitis: Hearing loss (the most common complication, half
occurs), behavior
Disorder, motor disorder, cerebral palsy, seizures and hydrocephalus. CT is the
imaging modality used in early and late complications in meningitis.
Prevention of nosocomial infections: The most important factor is the hand with
alcohol or antibacterial soaps.
And washing.
(Answer C)
9. Which of the following is not a characteristic finding of fetal alcohol
syndrome?
(September 2005)
A) Organomegaly
B) Facial anomalies
C) Cardiac anomalies
D) Mental retardation
E) Growth retardation
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NEWBORN
Characteristics of fetal alcohol syndrome (FAS):

Height, weight and growth retardation around head
Facial anomalies (short palpebral fissure, epicanthus, maxillary hypoplasia and
micrognathia, flat filtration and
thin upper lip)
Cardiac defect (septal defects)
Minor extremity and joint abnormalities (limitation of movement and abnormal hand
lines)
Developmental retardation and mental retardation
FAS risk increase: It depends on maternal advanced age, low socioeconomic status
and the amount of drinking.
Pulmonary involvement, genitourinary involvement and gastrointestinal system
involvement are primarily absent. One of the criteria in postnatal period according
to the dye showing that growth is chronically impaired
weighing is low.
(Answer A)
10. Which of the following is not considered in the differential diagnosis of
neonatal sepsis? (April 2005)
A) Congenital adrenal hyperplasia
B) Hyperglycemia
C) Organic acidemia
D) Urea cycle defects
E) Necrotizing enterocolitis
Hyperglycemia is not a differential diagnosis of sepsis. However, hypoglycemia may
produce sepsis-like findings and
differential diagnosis.
Metabolic disorders with sepsis differential diagnosis:
hypoglycemia
Adrenal problems: Bleeding, adrenal insufficiency and congenital adrenal
hyperplasia
Metabolic diseases: Urea cycle defects, organic acidemias, lactic acidosis and
galactosemia
The new question can be replaced by another disease such as homocystinuria,
phenylketonuria and histidinemia.
Differential diagnosis causes of GIS: NEC, spontaneous bowel perforation or
structural anomalies.
Many diseases are confused with newborn sepsis. Hypoplastic left most involved in
cardiac diseases
It is the heart.
Severe diseases with differential diagnosis of neonatal sepsis
Cardiovascular congenital: Hypoplastic left heart, other structural abnormalities,
pulmonary hypertension
Cardiovascular Acquired: Myocarditis, hypovolemic, cardiogenic shock, pulmonary
hypertension (other
secondary diseases).
Hematologic: Purpura fulminans (caused by homozygous protein C deficiency), immune-
mediated thrombocytopenia / neutropenia, hereditary coagulation disorders, severe
anemia, congenital leukemia
Respiratory system: RDS, aspiration pneumonia (amniotic fluid, meconium and gastric
content), pulmonary
hypoplasia (diaphragmatic hernia), tracheoesophageal fistula and transient
tachypnea
Neurological: hypoxic ischemic encephalopathy, intracranial hemorrhage, botulism,
seizure
(Answer B)
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PEDIATRICS
11th. Which of the following is a microorganism that does not cause congenital
infection?
(September 2004)
A) T. gondii
B) Rubella
C) Rubeola
D) CMV
E) T. pallidum
The TORCH group, in its classical form, includes T. gondii, Other's (syphilis),
rubella, CMV and HSV.
The vaccine that can be prevented is rubella.
In addition, many other factors can cause intrauterine infection.
Other viral infections such as HIV, HBV, Parvo, varicella zoster have been
introduced.
Tuberculosis from bacteria,
Plasmodiums and T. cruzi agents may also pass intrauterine from parasites.
Rubella rubella (ella cık means reduction jewelry), rubeola is measles.
Infants may be infected intrauterine, intrapartum and postpartum.
Syphilis, toxoplasmosis, rubella, CMV, parvo virus B19, varicella are most commonly
transmitted intrauterine transplacental.
HIV, HBV, HSV are mostly transmitted during the passage through the birth canal.
TB is most commonly transmitted by postnatal contact. Intrauterine transition is
the primary focus of the liver is serious
disease becomes the cause.
(Answer C)
12. The mother's use of moderate or large amounts of alcohol during pregnancy
Which does not lead to? (September 2003)
A) Growth retardation
B) Heart defects
C) Joint abnormalities
D) Genital system anomalies
E) Mental retardation
(Answer D)
13. Which of the following is not one of the typical eye findings of rubella?
(April 2003)
A) Cataract
B) Glaucoma
C) Retinopathy
D) Strabismus
E) Microphthalmia
See 6. Question.
(Answer D)
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NEWBORN
14. Which of the following is the most common cause of sepsis in the newborn?
(April 2001)
A) H. influenza
B) S. pneumonia
C) L. monocytogenesis
D) Group B streptococcus
E) S. pyogenes
The most common causative agents in neonatal sepsis are Group B streptococci, S.
agalactia and E. coli.
Empirical antibiotic therapy: Ampicillin + cefotaxime or gentamicin. Since late
sepsis is associated with meningitis, 3. Belt should be used.
Neonatal infections according to onset time
Early onset infections: Maternal origin. It spreads during or before birth.
The source is the maternal genital system. They go out in the first 7 days, mostly
in the first 3 days. GBS in first 24 hours
interest. Maternal obstetric complications and prematurity are common. Multisystem
involvement occurs. Early infections are common with pneumonia
Intrapartum antibiotic prophylaxis only prevents early GBS infections.
Late-onset infections: May be of the maternal genital system or environment. Seven
- 30
interests in the day. Infections can be focal or multisystem. Late infections
associated with meningitis
is common.
Late late onset infections occur after 30 days. Prematurity or chronic problem
because of long-term hospitalization.
Factors in neonatal systemic infections:
Early onset maternal origin: GBS, E. coli, Listeria are the most common agents.
Late-onset maternal origin: GBS, L. monositogenes most common, only salmonella from
gram negatives,
T. pallidum, M. tuberculosis are others.
Late onset community-acquired: S. pneumonia and E. coli are the most common agents.
Late onset hospital-acquired: Coagulase-negative staphylococci are the most common.
(Answer D)
15. Causes of increased risk of developing acute bacterial infection from newborn
which one is not? (September 2000)
A) Chorioamnionite in mother
B) Prematurity
C) Boy
D) Macrosomy
E) 5th minute apgar is below 6
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PEDIATRICS
Maternal chorioamnionitis is a risk for early neonatal sepsis.

Prematurity and low birth weight are the greatest risk for sepsis.
It is 2 times higher in boys than in girls. However, the difference is not
significant in low birth weight infants.
Low APGAR is consistent with hypoxia. Increased need for intervention, caused by
catheter, intubation
risk.
It should not be forgotten that the most important factor increasing the tendency
to infections in the newborn is prematurity and low
birth weight.
Possible reasons for this are;
Preterm labor caused by maternal infection
Intra-amniotic infection is inversely proportional with gestational age
Immature immune system
Invasive procedures have to be performed more often
Intrapartum antibiotic prophylaxis only prevents early GBS infections.
Risk factors for neonatal infections
Male gender
Low birth weight
Preterm birth
Complicated labor and multiple pregnancy
Chorioamnionitis and urinary tract infection, prolonged membrane rupture time
Immune deficiency
Galactosemia (E. coli)
Malformations (obstructive uropathy)
(Answer D)
16. It is seen healthy after birth but when suckling, vomiting, tachypnea at 3
days,
In the patient with lethargy and convulsions, which should be considered first
is not one of the situations you need? (September 1999)
A) Organic acidemia
B) Sepsis
C) Urea cycle enzyme defects
D) Homocystinuria
E) Meningitis
The first diagnosis should be considered in this patient is sepsis. Because it's
more frequent than others.
Homocysteinuria is a congenital methionine disorder (deficiency of cystathionine
synthase). Patients at birth
It is normal. Diagnosis is usually made after the age of 3 with lens subluxation
(ectopia lentis).
There are also skeletal disorders similar to Marfan. See 12. Description of the
problem
(Answer D)
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NEWBORN
17. What is the finding that is not in neonatal meningitis? (September 98)
A) Nape stiffness
B) Lethargy
C) Apnea
D) Cyanosis
E) Vomiting
Meningeal irritation symptoms may also be seen during meningitis except for
nonspecific findings (such as fever, headache, mayalgia, weakness, fever,
tachycardia and hypotension).
Signs of meningeal irritation: Nuchal stiffness, Kernig and Brudzinski and back
pain. fontanel
These findings may not be taken when open.
(Answer A)
18. What is empirical treatment for neonatal sepsis? (September 97)
A) Ceftazidime + aminoglycoside
B) Ampicillin + cefotaxime
C) Ampicillin + gentamicin
D) 3rd generation cephalosporin
E) Penicillin + vancomycin
Classical empirical therapy for ampicillin enterococci and listerias must be added
(third)
Because they are naturally resistant to generations). Ampicillin + gentamicin if
the other option is early sepsis
can be used as. However, if late sespsis is accompanied by aminoglycoside due to
accompanying meningitis
(not good for CSF). Third generation cephalosporin (cefotaxime is most appropriate)
should be used.
Ceftazidime can be used if pseudomonas is considered.
(Answer B)
19. Which virus is not the cause of congenital infection? (April 97)
A) CMV
B) Rubella
C) HBV
D) Herpes virus
E) Route virus
Rota virus is the causative agent of diarrhea in children in winter. Acute
gastroenteritis is the most common causative agent in children.
(Answer E)
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PEDIATRICS
20. Which of the following is the least common finding in neonatal meningitis?
(September 95)
A) Lethargy
B) Nape stiffness
C) Absorption
D) Convulsion
E) General condition disorder
(Answer B)
21. Feeding difficulty after three days in a normal born child
What would you think first if it evolved? (April 93)
A) Sepsis
C) Imperforate anus
D) Hyaline membrane disease
E) Congenital heart disease
Almost all of the newborn with feeding difficulty or reduced absorption in the form
we are more familiar with
disease as the first finding.
Respiratory distress syndrome is not expected in a healthy newborn. Hyaline
membrane disease
(RDS) is a disease of preterms and respiratory distress begins immediately after
birth. Tracheoesophageal fistulas often coexist with atresia and the most common
type is a proximal atresic distal fistula.
type. Polyhydramniosis occurs in antenatal history. Foamy secretion from mouth
after birth
revenue. Only H-type fustula may develop in late stages and may cause respiratory
complaints after feeding.
increase is seen.
In the imperforated anus, meconium output is delayed.
(Answer A)
22. Which of the following does not occur in neonatal meningitis? (September 89)
A) Restlessness
B) Cyanosis
C) Apnea
D) Nausea and vomiting
E) Neck stiffness
Meningitis is often accompanied by late sepsis. Meningeal irritation may not be
present when the fontanel is open.
(Answer E)
74
NEWBORN
23. Hydrocephalus, diffuse intracranial calcification and chorioretinitis

Which of the following should be considered first in the newborn? (April 88)
A) Congenital syphilis
B) Congenital rubella infection
E) Hepatitis B
D) T. gondii
E) CMV
These three findings are classic findings of congenital toxoplasma infection.
Similar findings in CMV
calcifications are typically periventricular.
(Answer D)
24. Which congenital disease is the most common cause of patent ductus arteriosus?
(September 87)
A) Herpes simplex virus
B) Rubella (rubella)
C) Measles
D) Down syndrome
E) Toxoplasmosis
See 3. Question
Initial findings according to systems in neonatal infections
General: Fever, heat irregularity (more important), decreased absorption, poor
appearance, edema
GIS: Abdominal distention, vomiting, circle, hepatomegaly
Respiratory system: Apnea, dyspnea, tachypnea, withdrawals, cyanosis, flank
breathing
Renal: Oliguria
Cardiovascular system: pallor, variegated, cold skin, tachycardia, bradycardia,
hypotension
Central nervous system: Irritability, lethargy, tremor, seizures, hypotonia,
decreased reflexes, irregular breathing, fontanel tension and treble crying
Hematologic: Jaundice (pronounced direct hyperbilirubinemia), pallor, petechiae,
purpura, bleeding
(Answer B)

75
PEDIATRICS
SCREENING
one. Which of the following routine newborn screening programs in Turkey
is covered? (September 2007)
A) Alpha-1 antitrypsin deficiency
B) Congenital hypothyroidism
C) Neuroblastoma
D) Tuberculosis
E) AIDS
In our country, routine neonatal screening is performed for congenital
hypothyroidism and phenylketonuria, while biotidinase deficiency is included in the
screening program. Scans baby on Guthrie card while being discharged
Taken. It is made with tandem mass from 1 drop of blood with extended neonatal
screening and fatty acid
Many diseases, including oxidation defects, aminoacidopathies, are screened.
In screening for hypothyroidism, only TSH cases are tried to detect high cases. TSH
pituitary or hypothalamus-induced hypothyroidism cannot be caught.
(Answer B)
2nd. The disease which is included in the routine screening of newborn in our
country is as follows:
A) Tyrosinemia
B) Alkaptanuria
C) Phenylketonuria
D) Tay Sachs
E) Congenital adrenal hyperplasia
Phenyl ketonuria is the first screening metabolic disease. Congenital
hypothyroidism and biotidinase deficiency
routine screening in our country.
(Answer C)
76
GENETIC
GENETIC
one. Her intelligence was normal and she had long stature, aortic dilatation and
lens dislocation.
Which of the following diseases should be considered in a child? (September 2011)
A) Marfan syndrome
B) Neurofibromatosis
C) Phenylketonuria
D) Glutaricaciduria
E) Hurler syndrome
Normal intelligence, long stature, lens dislocation and aortic dilatation are
typical features of MARFAN syndrome. Homocystinuria is important in differential
diagnosis.
Homocystinuria and Differential Diagnosis in Marfan Syndrome
symptoms
Homocysistinuria
Marfan Syndrome
Eye
Lens dislocation downwards
Lens dislocation upwards
CNS
Mental retardation, epilepsy, symptoms related to cerebral thromboembolism,

psychiatric disorders
Mental retardation is rare
cardiovascular
system
Arterial and venous thrombi, flushing
Dissecting aneurysm, mitral valve

prolapse, aortic dilatation
the Sülfitür
There is
No
Marfan syndrome; OD passes, no mental retardation and epilepsy, aortic dissection

rather than thromboembolism
anomalies. The lens ectopia is upward.
(Answer A)
2nd. A 9-year-old girl brought with the complaint of short stature is observed to
be -2.5 deviations in height. Physical examination of this child with
disproportionate short stature dome palate, low nape hairline,
mane neck and nipple separation is detected.
What is the most likely diagnosis for this child?
A) Hypothyroidism
B) Silver-Russell syndrome
C) Turner syndrome
D) Klinefeltersendrom
E) Hypochondroplasia
77
PEDIATRICS
Low nape hairline, mane neck and nipple separation, short stature, Turner syndrome
Turner syndrome findings;
• Short
• Congenital lymphedema, skin fold in the neck (in utero cystic hygroma)
• Horseshoe kidney
• Patella dislocation, K. Valgus, Madelung deformity (defromal distal radius), hip
dislocation, scoliosis
• Large split nipple, shield chest
• Cardiac: Coarctation, Bikuspid aortic valve (most common), conduction defects,
Hypop-rubber left heart
• Gonadal dysgenesis (infertility, amenorrhea), gonodoblastoma (if present)
• Learning problems [70%]
• Hypothyroidism, Type 2 diabetes mellitus
• Eye: Strabismus, cataract, color blindness
• Recurrent AOM, Sensorineural hearing loss
• Inflammatory bowel disease, celiac
(Answer C)
3. Chromosome analysis in the newborn
There is no need? (May 2011)
A) Achondroplasia
B) Down syndrome
C) Multiple anomalies
D) Mental retardation
E) Gender anomaly
Chromosome analysis is used for diagnosis of Down syndrome, chromosome in multiple
congenital anomalies
There are indications for analysis.
The most common cause of severe mental retardation is chromosomal anomalies and
should be diagnosed.
It is made for the determination of the chromosomal sex in sex anomalies and can be
remembered from CAD and androgen insensitivity.
Achondroplasia is a single gene disease and chromosomal analysis is not used for
diagnosis.
(Answer C)
4. Which is one of the clinical features observed in DiGeorge syndrome
It is not? (December 2010)
A) Ear anomalies
B) Neonatal hypocalcemia
C) Aortic arch anomaly
D) Situs inversus
E) Thymic hypoplasia
78
GENETIC
DiGeorge syndrome is a microdeletion (21q11.2) syndrome of chromosome 21. Thymic

aplasia / hypoplasia (T cell deficiency) dysmorphic facial structure, metal
retardation, visual problems, cardiovascular
anomalies (Truncus anomaly, etc.) renal anomalies, extremity anomalies, rectal
anomalies,
trachea and esophageal anomalies (EA / TEF), genital problems and cleft palate lip
anomaly
Characterized. Situs inversus is seen in Kartegener's syndrome.
(Answer D)
5. Which of the following is not microdeletion syndrome? (December 2010)
A) Silver – Russell syndrome
B) Prader – Willi syndrome
C) Angelman syndrome
D) DiGeorge syndrome
E) Williams syndrome
Microdeletions usually affect more than one gene and as contiguous gene syndrome
They called.
Microdeletions:
Di George's syndrome (velocardiofacial syndrome, 22q11): Thymus and paratioid
absence, konoturunkal
goes with heart defect, cleft palate, developmental defect in the outer ear. T cell
defect due to absence of thymus
It happens. 3–4 is the developmental defect of pharyngeal sacs.
Neonatal hypocalcemic convulsions are seen in the early period. Feature of
hepatosplenomegaly syndrome
It is not.
Williams syndrome (7q11): Supravalvular aortic stenosis, hypercalcemia, star-shaped
iris, periorbital
fullness, characterized by elfin face. It has an overly cheerful, talkative
personality structure.
Rubinstein Taybi (16p13): Mental retardation with beak nose, wide thumb and toes
has.
Sotos syndrome (5p35): Cerebral gigantism, there is excessive growth. The head
circumference is also macrocephalic. Bone
age is older. In adulthood, height becomes normal.
Alagille syndrome (20p12): Syndromic type is also called bile duct scarcity. Bile
duct hypoplasia,
cholestasis, pulmonary artery stenosis, butterfly vertebra and posterior
embryotoxon.
WAGR syndrome (11p13): Wilm's tumor, Aniridia, Genital anomaly, mental retardation
Miller Dieker syndrome (17q13): Lysencephaly, pakigiri, microcephaly, severe mental
retardation, seizure, hypogenitalia.
Xp21.2: Duchenne muscular dystrophy, retinitis pigmentosa, adrenal hypoplasia,
glycerol kinase deficiency,
mental retardation.
Genomic imprinting and Uniparental disomies
Prader – Willi, Angelman syndrome, Silver – Russell syndrome, Beckwith – Wiedemann
syndrome, neonatal diabetes and “growth retardation – hyperactivity – early puberty
gir fall into this group.
Prader Willi and Angelman syndrome are also found in Nelson
microdeletions.
(Answer A)
79
PEDIATRICS
6. Which of the following diseases is characterized by an increase in nucleotide

repeats?
(April 2010)
A) Fragile X syndrome
B) Spinal muscular atrophy
C) Progressive muscular dystrophy
D) Hemophilia
E) Osteogenesis imperfecta
Diseases due to increased nucleotide repeat are also known as "triple repeat
diseases."
Fragile X
Huntington's disease
Myotonic dystrophies
Spinoserebellar ataxia
Friedreich ataxia
(Answer A)
7. Which of the following results from a single gene mutation? (September 2009)
A) Anencephaly
B) Hypospadias
C) Trisomies
D) Cleft palate
E) Chondrodystrophies
Genetic diseases are divided into single gene defects, chromosomal disorders and
multifactorial diseases.
Mendelian inheritance: Autosomal dominant, recessive and consists of X-linked
inheritance.
Nonmendelian inheritance: Mitochondrial inheritance includes diseases with triple
recurrence and imprinting defects (Prader-Willi and Angelman syndrome).
Mitochondrial diseases: The source of mitochondria is only the mother. Most energy
in diseases
In need, the brain, muscle, heart and liver are affected. MERRF (myoclonic
epilepsy, ragged red fiber),
MELAS (myopathy, encephalopathy, lactic acidosis, stroke-like attacks), Pearson
syndrome, deafness,
chronic progressive external ophthalmoplegia.
Diseases with triple recurrence: Fragile X, Huntington's disease, myotonic
dystrophies, spinocerebellar ataxia and Friedreich ataxia
Multifactorial inheritance: Pyloric stenosis, neural tube defect, cleft palate-lip,
developmental hip
dysplasia, diabetes, coronary heart disease and schizophrenia.
(Answer D)
8. Which of the following is one of the findings observed in Klinefelter syndrome?
(April 2009)
A) Female phenotype
C) 46, XX chromosome structure
E) Gynecomastia
B) 45, X0 chromosome structure
D) Short stature
80
GENETIC
Klinefelter syndrome: 47, XXY is the most common. Hypogonadism and infertility are
the most common
Why it is. Paternal meiosis is the most common cause of non-separation. Long
stature
(increased stroke distance), gynecomastia occurs. Intelligence is normal, language
is backward. The testis is small. There are atrophy and hyalinization in the
seminiferous tubules. It is difficult to recognize before puberty. in mosaic
findings are lighter.
The risk of breast cancer, osteoporosis, autoimmune disease and diabetes is
increased.
(Answer E)
9. Which of the following is one of the microdeletion syndromes? (April 2008)
A) Williams syndrome
B) Wolf-Hirschhorn syndrome
C) Cri-du-chat syndrome
D) Turner syndrome
E) Patau syndrome
In addition to number anomalies such as trisomy and monosomy in chromosomes, it is
seen in structural anomalies such as deletion, duplication, translocation,
isochromosome, inversion. Deletions 5- 5 Mb
routine chromosome examination (performed on the metaphase).
Cri-du-cat syndrome (Cat meow, 5p-): deletion in the short arm of the fifth
chromosome
has. Early crying similar to cat meow is typical. Further development of larynx
periods are improved. Microcephaly, mental retardation, hypertelorism, hypotonia,
epicanthus,
face and growth development retardation is encountered.
Microdeletions: They cannot be seen on routine microscopic examination, they are
detected by FISH or DNA analysis performed on prophase. Microdeletions usually
affect more than one gene and are called contagious gene syndrome. FISH
(fluorescent in situ hybridization) or DNA in promethaphase
studies.
Microdeletion syndromes:
•
Di George's syndrome (velocardiofacial syndrome, 22q11): Thymus and parathyroid

absence, conoturuncal heart defect, cleft palate, external ear developmental
defects.
Williams syndrome (7q11): Supra valvular aortic stenosis, hypercalcemia, star-

shaped iris, periorbital fullness.
Rubinstein Taybi (16p13): Beak nose, wide thumb and toes, mental retardation.
Sotos syndrome (5p35): Cerebral gigantism, there is excessive growth.
Alagille syndrome (20p12): bile duct scarcity, cholestasis, pulmonary artery

stenosis, butterfly vertebrae and posterior embryo toxon.
Prader-Willi syndrome (15q11-q13): Severe hypotonia, short stature, obesity, small

hand-foot, hypogonadism, mental retardation.
Angelman syndrome (15q11-q13, happy puppet = Happy puppet): Ataxic movement,

unstoppable laughter attack, prognathism, severe mental retardation.
•
•
WAGR syndrome (11p13): Wilm'stumör-Aniridi-Genital anomaly, Mental Retardation

Miller Dieker syndrome (17q13): Lisencephaly, pakigiri, microcephaly, severe mental
retardation, seizure,
hypogenitalismus to.
Xp21. 2: Duchenne muscular dystrophy, retinitis pigmentosa, adrenal hypoplasia,

glycerol kinase
deficiency, mental retardation.
(Answer A)
81
PEDIATRICS
10. Which of the following is not one of the symptoms of Di George syndrome?
(April 2007)

C) Congenital heart diseases

E) Hypertelorism
B) Bifid uvula
D) Hepatosplenomegaly
Di-George 22. microdeletion syndrome (velocardiofacial syndrome)
CATCH 22 (Cardiac anomaly, Abnormal face, Thymic hypoplasia, Cleft palate,
Hypocalcemia) syndrome
also known as 22 is characterized by q11-.
3-4 is the developmental defect of the pharyngeal arches. Thymus, parathyroid and
aortic arch, 3rd and 4th pharyngeal arch
It develops.
Vascular anomalies (transposition of the aorta, truncus arteriosus pulmonary venous
return anomaly)
has.
Head anomalies: Micrognathia, low ear, hypertelorism, antimongoloid eyes, cleft
palate
induced conductive hearing loss, mental retardation.
Absence of thymus: (T cell deficiency), thymus is not seen on chest X-ray.
Lymphocyte count (T cells)
It is low. Recurrent fungal infections (especially candida), protozoa, bacteria and
viruses.
Absence of parathyroidism: There is hypocalcemia that is resistant to treatment
with hyperphosphatemia.
Esophageal atresia and anal atresia may accompany.
There is no hepatosplenomegaly.
1/3 CHARGE (colobam, heart defect, coanal atresia, growth retardation, genitalia)
hypoplasia, ear anomaly including deafness)
(Answer D)
11th. Oblique palpebral space, hypotonia, short stature, simian line, tongue out
IQ: 50 in a seven-year-old child with physical examination findings.
Respectively. What is the most likely diagnosis for this child? (April - 2006)
A) Trisomy 18
C) Cat-cry syndrome
E) Turner syndrome
B) Trisomy 13
D) Down syndrome
Down Syndrome (Trisomy 21): As in other trisomies, the frequency increases with
maternal age. Most often
is the most common genetic cause of middle MRI. Meiosis in most mothers
occurs with non-separation. Ninety-five percent free trisomy was the Robertsonian
translocation (4%).
14q; 21q).
Children with translocation carriers have an increased risk of recurrence. t (21;
21) carriers have a 100% risk of recurrence.
82
GENETIC
Epicantus, nasal root obstruction, hypertelorism, iris Brushfield stains, heart

anomalies (most common atrioventricular septal defect), Simian line, clinodacty,
wide between the first and second toes
clarity, hypotonia is detected.
The tongue remains outside but Down syndrome does not have macroglossia. Duodenal
atresia, annular
GIS abnormalities such as pancreas, tracheoesophageal fistula and Hirschsprung's
disease are seen.
Men are infertile women are fertile.
Fontanel closure, tooth retardation, atlantoaxial instability and joint laxity are
the other findings.
Increasing conditions in Down syndrome: Leukemia, myelodysplasia, transient
lymphoproliferative disease, immune deficiency, DM, hypothyroidism, celiac disease,
Alzehimer, epilepsy
obesity, obstructive sleep apnea, refractive errors and strabismus.
(Answer D)
12. Which of the following is one of the signs of Turner syndrome? (September -
2005)
A) Reduction in gonadotropins
B) Pulmonary stenosis
C) Short stature
D) Chromosome structure of 46, XX
E) Cubitus varus
Turner Syndrome: More than half of the chromosomal anomaly is 45, XO. Age of
parents
it does not matter. Most of the lost chromosomes are of paternal origin. Most
miscarriages end. birth
height and weight loss, marked ears, lymph edema on the back of the hand and foot
are detected.
Gonadal dysgenesis: Ovary degenerates and becomes fibrotic in puberty. Primary
amenorrhea and
secondary genus characters do not develop. Hypergonadotropic is the cause of
hypogonadism. FSH and LH increased,
Low estrogen.
Growth retardation, short stature (the most common cause of application), pigmented
nevi, mane neck, short neck,
cubitus valgus, patella and hip dislocation, shield chest, discrete nipples, nape
hairline
, renal anomalies (horseshoe kidney), heart anomalies (most common bicuspid aorta,
others aorta
coarctation and stenosis, mitral valve prolapse), hypothyroidism, type 2 DM,
although intelligence is normal
hearing impairment and learning difficulties, gonodoblastoma (if Y chromosome is
present), color blindness.
When the diagnosis is made, FISH is searched for Y chromosome and if positive,
gonadectomy is performed.
Noonan syndrome: Turner in terms of short stature, low hairline, mane neck
syndrome Differences: Presence of both sexes, autosomal dominant, cardiac anomalies
pulmonary valvular stenosis (most common), ASD, tetralogy of Fallot. Concomitant
bleeding disorder and
cryptoorchis.
(Answer C)
83
PEDIATRICS
13. Molecular genetic triple nucleotide in which of the following diseases:

Repetition of the sequence increased? (September - 2005)
A) Duchenne muscular atrophy
B) Fragile X syndrome
C) Osteogenesis imperfecta type 2
D) Achondroplasia
E) Vitamin D resistant rickets
Diseases with triple increase: Fragile X, Huntington's disease, myotonic
dystrophies,
spinoserebellar ataxia, Friedreich ataxia. Premature and genetic antisypation in
these diseases
It is important that the number of repetitions with no
return to mutation. Genetic antisypsation decreases the age of the disease and the
symptoms
causes heavy weight).
(Answer B)
14. Which is the most common cardiovascular disease in Turner syndrome
Seen? (April - 2003)
A) VSD
B) ASD
C) Trunkus arteriosus
D) Bicuspid aortic valve
E) Mitral stenosis
(Answer D)
15. Which of the following has typical chromosome deletion? (April 2000)
A) Patau syndrome
B) Edward syndrome
C) Down syndrome
D) Cri du chat syndrome
E) Fragil X syndrome
Down syndrome is trisomy 21, Patau trisoma 13, Edward trisoma 18 number anomaly.
Cri du chat 5
p-deletion. Fragile X is a disease with triple increase.
(Answer D)
16. Mental retardation, large testicles, long face appearance and scoop ears
which of the following is more common? (September 99)
A) Turner syndrome
B) Phenylketonuria
C) Fragil X syndrome
D) Down syndrome
E) Lesh Nyann syndrome

Fragile X: The most common familial cause of mental retardation. Distinctive chin
and scoop ears, long face view
It is characterized by. Autistic spectrum - attention deficit, typical of
macorchidia prominent in puberty
Features.
(Answer C)
84
GENETIC
17. Which anomaly is most likely to occur in newborns? (April 99)

A) Isolated hydrocephalus
B) Anencephaly
C) Gastroschisis
D) Ompholocele
E) Spina bifida
Omphalocele associated chromosomal abnormalities are common. Spina bifida,
anencephaly is multi-factorial.
Gastroschisis may develop due to amniotic tape.
(Answer D)
18. What is the low level of AFP during the mother's pregnancy? (April 98)
A) Twin pregnancy
B) Spina bifida
C) Trisomy 21
D) Intestinal atresia
E) Fetal hepatitis
AFP and estriol decreased and beta HCG increased in triple test used in Down
syndrome screening. Emergence
to summarize the situations in which AFP increases and decreases because of its
high potential.
It'll be helpful.
High AFP
Low AFP
Multiple pregnancy
Trisomy 18-21
Open neural tube defects
SGA
-Gastroschisis, omphalocele
preeclampsia
Intestinal atresia
Congenital nephrosis
Epidermolysis bullosa
(Answer C)
19. Barr body is not seen in one of the following (September 95)
A) Klinefelter syndrome
B) Super female
C) Turner syndrome
D) Down syndrome
E) Trisomy 18
Turner's syndrome occurs because one of the X chromosomes is inactive
It is not visible.
(Answer C)
85
PEDIATRICS
86
METABOLISM
CARBONHYDRATE METABOLISM
DISORDERS
one. Hepatomegaly due to renal tubular dysfunction and galactose intolerance
What is the most likely diagnosis for a 5-year-old girl? (December 2010)
A) Galactosemia
B) Glycogen storage disease type 1
C) Lack of GLUT – 2
D) Fructose intolerance
E) Glucose-galactose malabsorption
This is the most difficult question of the exam. It is a question that those who
eliminate very good choices are more fortunate.
Galactosemia can be eliminated by age.
For fructose intolerance, the introduction of fructose into the diet should lead to
the onset of symptoms.
Although hepatomegaly and renal tubular dysfunction are appropriate for type 1
glycogen storage, galactose is not expected to be tolerated.
GLUT 2 defect (Fanconi - Bickel syndrome): Hepatic glycogenosis and renal Fanconi
syndrome
It happens. Glucose transporter 2 (GLUT – 2) defect.
Growth retardation, rickets, hepatorenomegaly, proximal renal dysfunction, glucose
- galactose use
goes with the disorder.
GLUT 2: KC, kidney, pancreas and intestine.
Intolerance is detected in the oral glucose and galactose tolerance test.
(Answer C)
2nd. Which of the following enzymes should be considered in a 3-year-old child with
no complaints other than bilateral cataracts and without hepatocellular
dysfunction? (December 2010)
A) Galactose – 1 – phosphate uridyltransferase
B) Galactokinase
C) Galactose 4 – epimerase
D) Galactose pyrophosphorylase
E) Fructose – 1 – phosphate aldolase
87
PEDIATRICS
There is no mental retardation, liver involvement and renal involvement in

galactokinase deficiency. Isolated cataracts and rarely pseudotumor cerebri are
seen in healthy children. Diet is given.
There are three diseases in galactose metabolism disorders. Apart from glycokinase,
the other two and
main features.
Galactose – 1 – phosphate uridyl transferase deficiency (Classic galactosemia):
Findings appear in the first week. Galactose –1 phosphate accumulates after
ingestion causes toxic effects on kidney, liver and brain.
Findings to consider:
Jaundice, hepatomegaly, vomiting, hypoglycemia, convulsion, lethargy,
aminoaciduria, nuclear cataract, liver cirrhosis, acid, splenomegaly, mental
retardation.
Escherichia coli has increased risks for neonatal sepsis.
They die within a few days of liver, kidney failure and sepsis (if not diagnosed).
Diagnosis: Detection of reduced substance in urine by lactose-containing diet, oral
or IV galactose loading test
used.
If blood transfusion is not performed, erythrocyte galactose 1 phosphate uridyl
transferase enzyme assay can be performed.
Intraerythroist galactose 1 phosphate level can be used.
Galactose is removed from the diet for life. Casein hydrolyzate or soy based
formulations are used. dietary
liver, kidney, cataract, growth improves.
Findings despite diet:
• Ovarian insufficiency (primary - secondary amenorrhea, hypergonadotropic
hypogonadism)
• Decrease in bone mineral density
• Developmental delay
• Learning disorders, speech disorders
Epimerase deficiency is considered if galactose 1 phosphate is high and transferase
activity is normal. epimerase
level is recognized by measuring. Dependent on galactose and restricted from
galactose
(Answer B)
3. What is the missing enzyme in classical galactosemia? (September 2004)
A) Galactokinase
B) Aldolase
C) Phosphofructokinase
D) Fructose -1-6 diphosphatase
E) Galactose -1-Phosphate uridyl transferase

galactosemia
There are 3 types.
Type 1: Galactose -1-Phosphate uridyl transferase
Type 2: Galactokinase
Type 3: UDP galactose epimerase
Classic Galactosemia (galactosemia 1ip 1):
•
Prolonged neonatal jaundice
Liver failure
Cataract
E. coli sepsis
Fanconi syndrome
Hypoglycemic convulsions
Mental retardation, behavioral problems, attention deficit, learning difficulties
Hypergonadotropic hypogonadism (in women)
88
METABOLISM
Diagnosis: Non-glucose reducing substance (+) in urine is determined by Beutler

test.
Treatment: Breast milk is cut, lactose-free diet is given
Galactokinase deficiency may come with isolated cataracts. MRI, liver and kidney
damage
They do not.
Epimerase deficiency:
•
Type 1 (more frequent): Asymptomatic
Type 2 (diffuse epimerase deficiency) (rare): Similar to classic galactosemia.

(Answer E)
4. Which of the following enzymes is missing in Von Gierke's disease?
(September 2003)
A) Muscle phosphorylase

C) Glycogen synthetase
B) Amilo-1,6-glycosidase
D) Glucose-6-phosphatase
E) Liver phosphorylase
Muscle Phosphorylase Deficiency Anderson (Type V)
Amilo 1,6 glycosidase branch breaking enzyme (type 3, Cori-Forbes)
Glycogen synthase deficiency is type 0 glycogen storage. Morning convulsions are
seen.
Liver phosphorylase deficiency type VI (Hers disease): Has growth retardation and
hepatomegaly. Selim
It is trending.
Glucose 6 phosphatase is lacking in von Gierke's disease. Both glycogenolysis and
glyconeogenesis are impaired.
(Answer D)
Von Gierke's disease (Glucose-6-phosphatase deficiency, Type 1 glycogen storage
disease);
Both glycogenolysis and glyconeogenesis are impaired. Glycogen accumulates in the
liver as degradation is reduced
(Hepatomegaly). Gluconeogenesis is impaired because glucose-6-phosphate does not
convert to glucose (lactic acidosis).
Increased lactic acid reduces uric acid excretion through competition
(hyperuricemia → gout). Increased lipolysis to compensate for hypoglycemia leads to
hyperlipidemia. Lipid accumulation in cheeks
(stone baby face).
Glucagon is normally not expected hyperglycemia. Glucose after glucose loading
the lactate level decreases.
The clinical manifestations are severe hypoglycemia, lactic acidosis and
hepatomegaly at about 3-4 months of age.
Cirrhosis development is not expected. Hepatic adenoma may develop around 20-30
years of age.
There is no splenomegaly. There is nephromegaly.
Renal involvement: FSGS, amyloidosis, Fanconi syndrome, hypercalcuria
Bleeding time is prolonged due to a defect in platelet aggregation.
Type Ib: In addition, there are neutropenia, recurrent infections and inflammatory
bowel disease. glucose
There is a disturbance in the transport of 6 phosphate through the microsomal
membrane.
Gluconeogenesis is tried to suppress treatment. Feed frequently. Uncooked starch
slowly absorbed from the intestine
(corn, rice). Statins for allopurinol hyperlipidemia for hyperuricemia,
ACE inhibitors are used for microalbuminuria. Ringer lactate should not be used for
fluid treatment.
89
PEDIATRICS
Glycogen storage diseases spot information:

Common in early childhood: Von gierke (I), Pompe (II), Cori-Forbes (III), type IX
The most common adult: Mc Ardle (V), Muscle phosphorylase deficiency.
Muscle involvement in the foreground: Pompe (II), Mc Ardle (V), Tarui (VII)
Both liver and muscle are involved: Cori Forbes (III), type IX
Cirrhosis: Cori-Forbes (III), Andersen (IV)
Hemolysis: Tarui (VII)
Neutropenia and inflammatory bowel disease: Type Ib
Decreasing liver glycogen store: Type 0 (lack of glycogen synthase)
Cardio-respiratory insufficiency at an early age: Pompe (II)
Decreasing signs with age: Cori-Forbes (III)
5. Which of the following metabolic diseases is asymptomatic? (September 2002)
A) Lactose intolerance
B) Galactosemia
C) Glycogen storage disease
D) Glucose-galactose malabsorption
E) Fructokinase deficiency
Fructokinase deficiency is asymptomatic as does galactokinase (galactosemia-only
cataract form) deficiency. Catalyzes the phosphorylation of fructose to fructose-1-
phosphate. Routine urine of fructose
analysis is detected if the reductant substance screening. No clinical findings. No
treatment required.
However, hereditary fructose intolerance with fructose 1-phosphate aldolase
deficiency may lead to progressive liver disease despite jaundice, hepatomegaly,
vomiting, lethargy and fructose-free diet.
(Answer E)
6. Which of the following enzyme deficiencies is cataracts? (April 2001)
A) Fructokinase
B) UDP-I epimerase
C) Sphingomyelinase
D) Galactokinase
E) Glucose 6-phosphatase
(Answer D)
7. Which enzyme is missing in Von Gierke's disease? (September 98)
A) Hexokinase
B) Glucose-6-phosphatase
C) Glucokinase
D) Phosphofructokinase
E) Branching enzyme
(Answer B)
90
METABOLISM
8. Prolonged jaundice, hypoglycemia, convulsions, hepatomegaly and urine

What is your diagnosis in a child with positive reductant? (September 96)
A) Homocystinuria
B) Wilson's disease
C) Neonatal hepatitis
D) Cystinosis
E) Galactosemia
(Answer E)
9. What can be considered in a child with growth retardation, hepatomegaly,
hypoglycemia, lactic acidosis, hyperuricemia and hyperlipidemia? (April 96)
A) Glycogen storage disease
B) Hurler syndrome
C) Hunter syndrome
D) Phenyl ketonuria
E) Hyperinsulinism
See 2. Question
(Answer A)
10. Which of the following causes of neonatal metabolic hypoglycemia
hyperinsulinism
not connected? (September 95)
A) Severe erythroblastosis fetalis
B) Galactosemia
C) Beta cell nesidioblastosis
D) Insulinoma
E) Diabetic mother child
Hyperinsulinism is the most common cause of severe persistent hypoglycemia in early
infancy. Most common
The cause of hyperinsulinism is beta-cell hyperplasia. There are four major gene
defects. The heaviest sulfonylurea
receptor defect (SUR 1) and usually requires pacreatectomy in the neonatal period.
The causes of hypoglycemia due to hyperinsulinism in the newborn are as follows;
•
Diabetic mother with children
Erythroblastosis fetalis
Nesidioblastosis
Beta cell hyperplasia
Beta cell adenoma
•
Beckwith-Wiedemann syndrome
Leucine sensitivity
Falsiparum malaria
Criteria for hyperinsulinism (when plasma glucose <50 mg / dl)

•
Hyperinsulinemia (> 2 mu / ml)
Reduction of fatty acids (<1.5 mmol / L)
Hypoketonemia (<2.0 mmol / L)
Improper response to glucagone (1 mg lV glucagon, glucose> 40mg / dl)

(Answer B)
91
PEDIATRICS
11th. What is glycogen storage disease caused by amilo 1-6 glycosidase enzyme
deficiency?
(April 94)
A) Pompe disease
B) Anderson's disease
C) Cori disease
D) Mc Ardle's disease
E) Hers disease
Cori-Forbes (Type III) disease has amilo-1, 6-glycosidase deficiency.
A TIP
In Andersen, Brancher (branching enzyme) can be remembered as ABCD.
Debrancher (branch breaker enzyme) in Cori
(Answer C)
Cori-Forbes disease: liver and amylo-1, 6-glucosidase deficiency in Cori disease
borderline dextrin accumulation in muscle tissue.
The disease is usually associated with fasting hypoglycemia, hepatomegaly and
growth retardation in infancy.
we come across.
In some cases, heart (CMP, ventricular hypertrophy) and muscle involvement
(weakness, CPK height) may also be seen. Laboratory findings are like type I but
lighter than that. Splenomegaly is seen, nephronomegaly is not seen, cirrhosis may
progress. No lactic acidosis or hyperuricemia. Separations table below
as summarized.
Von Gierke
Cori Forbes
Broken
Sturdy
hypoglycemia
Heavy
Light
Lactic acidosis
Hyperuricemia
nephromegaly
splenomegaly
CMP and myopathy
Risk of cirrhosis
gluconeogenesis
Andersen's disease (type IV): Deficiency of branching enzyme. Amylopectin

accumulates.
The most common type of progressive liver injury requiring transplantation (<5
years), cirrhosis and splenomegaly
is the type that goes with. Muscle atrophy and cardiomyopathy are a rare
neuromuscular type.
12. Which enzyme is missing in Von Gierke? (April 92)
A) Debrancher enzyme
B) Sphingomyelinase
C) Muscle phosphorylase
D) Glucose 6 phosphatase
E) Glucose 1,6 diphosphatase

See 4. Question
(Answer D)
92
METABOLISM
13. Which enzyme is missing in essential fructosuria? (April 91)

A) 1,6-diphosphatase
B) Aldolase B
C) Phosphohexosisomerase
D) Phosphofructokinase
E) Fructokinase
Essential or benign fructosuria, a rare-occurring OR-transducing disorder with
fructokinase deficiency
is a benign disease. Enzyme deficiency is the liver, intestine and kidneys.
Fructose-containing foods
Fructose levels increase in blood and urine. In this asymptomatic disease,
treatment is unnecessary. It is detected incidentally by the positivity of the
reducing agent in the urine. Disease to be mixed
It is a hereditary fructose intolerance which is a serious condition due to name
connotation.
(Answer E)
Hereditary fructose intolerance: Aldolase B deficiency. It's heavy.
Similar to galactosemia (except E coli sepsis, cataract, prolonged jaundice)
It may give later clinical findings.
Diagnosis: IMR (+), enzyme determination
Treatment: sucrose-free, fructose-free and sorbitol-free diet
14. Face view of a four year old boy with hypoglycemia, hepatomegaly and stone baby
What do you think if it comes with the clinic? (April 91)
A) Von Gierke
B) Gaucher
C) Tay Sachs
D) Pompe
E) San-flippo
The lipid profile in type I glycogen storage is similar to type IV hyperlipidemia.
Pompe disease (type 2 glycogen depot): Lysosomal acid alpha glycosidase (acid
maltase) is deficient.
Infantile type is the most severe form. There is a severe hypotonia, hyporeflexia,
macroglossi. cardiomegaly
It develops. Hypertrophic CMP is detected. PR shortening and QRS heights in all
leads on ECG
It is available. Heart failure results in death within the first 6 months.
San flippo is the most common mucopolysaccharidosis.
Gaucher: It is the most common lipidosis. The first sign is splenomegaly. Massive
splenomegaly occurs. Bone
Gaucher cells filled with glucocerebrozitis in marrow and spleen aspiration smears
It is seen.
Tay Sachs: Maintains the FAQ as a primary. Hexsoaminidase A is missing. Usually the
first between 6-12 months
The findings are reduced eye contact and hyperreaction to noise (hyperacuzi).
Cherry on Macula
red stain is seen.
The findings were consistent with type I glycogen storage.
(Answer A)
93
PEDIATRICS
15. In an 8-month-old child with prolonged jaundice, hepatomegaly, cataract and

aminoaciduria
Which of the following diseases can be considered? (April 91)
A) Phenylketonuria
B) Cystinosis
C) Galactosemia
D) Wilson's disease
E) Glycogen storage disease
See question 1
(Answer C)
16. What do you think if a healthy child has a cataract? (September 90)
A) Lowe syndrome
B) Aryl sulfatase A deficiency
C) Galactokinase deficiency
D) Furuktokinase deficiency
E) Hypoparathyroidism
See 1. Question
(Answer C)
17. What do you think of the patient who developed nausea and vomiting when eating
ripe fruit? (September 90)
A) Galactosemia
B) Sucrose isomaltose deficiency
C) Trehalase deficiency
D) Hereditary fructose intolerance
E) Lactose intolerance
Hereditary fructose intolerance passes autosomal recessively. Due to deficiency of
aldolase B enzyme
is a disease seen.
Symptoms may result from ingestion of fructose as a result of fruit (fructose) or
sugar ingestion (sucrose = glucose + fructose).
emerges. Children do not have tooth decay because they stay away from sugar and
fruits.
Its most important findings are similar to galactosemia. See 5 for differences.
Question
•
Fructose-1-phosphate deposition in tissues
hypoglycemia
Developmental delay
•
Vomiting, nausea
Jaundice
hepatomegaly
Renal tubular acidosis
Generalized aminoaciduria
If dietary restriction and treatment are not applied, liver failure results in
death.
(Answer D)
94
METABOLISM
18. Which is not considered in an early child whose teeth are intact at 12 years
old? (April 90)
A) Fructose intolerance
B) Lactose intolerance
C) Galactose intolerance
D) Diabetes insipidus
E) Distal tubular acidosis

See question 17
(Answer A)
19. Which of the following is stored in Gaucher's disease? (September 89)
A) Cholesterol
B) Sphingomyelin
C) Cerebrozite
D) Gangliosite
E) Glycogen
Gaucher's disease accumulates due to inadequacy of beta-glucosidase
(Glucoserebrozidase) enzyme activity and cannot be destroyed. Accumulation of
reticuloendoterial system and some of the disease
forms are also seen in the brain.
(Answer C)
GAUCHER'S DISEASE type I (adult, chronic visceral type): It is the most common
lipidosis. First sign
splenomegaly is. Bone marrow insufficiency symptoms and hypersplenism (anemia,
leukopenia and thrombocytopenia) can occur at any time between birth and 80 years
of age. Due to thrombocytopenia
bleeding, chronic fatigue due to anemia, hepatomegaly and liver dysfunction, bone
pain, splenomegaly are typical findings. Characteristic Gaucher cells filled with
glucocerebrozitis are seen in S1 and spleen aspiration smears. X-ray, especially
distal femur
Erlenmeyer deformity and lytic lesions are seen in the bones. Hematologic
parameters, bone lesions, hepatomegaly and splenomegaly regress with intravenous
enzyme replacement (imiglucerase).
Infantile (acute neuropathic) type II: involved CNS. Early milk begins in
childhood. HSM, strabismus, trismus and
dorsiflexion of the head are typical findings. Convulsions are common. These
children with spastic and feeding-breathing problems die around 3-4 years of age.
Juvenile (subacute neuropathic) type III: Age of onset varies. HSM starts first in
childhood. one.
or 2 nd decade.
20. Prolonged jaundice, cataract, hepatosplenomegaly and aminoaciduria in the

newborn
Which of the following is considered in the presence of? (April 88)
A) Cystinuria
B) Galactosemia
C) Phenyl ketonuria
D) Tyrosinemia
E) Gaucher
See 1. Question
(Answer B)
95
PEDIATRICS
21. Which of the following should not be used by patients with galactosemia?
(September 87)
A) Glucose
B) Lactose
C) Maltose
D) Sucrose
E) Fructose
It is a metabolic disease that needs to be stopped. See 2. Question
(Answer B)
22. Glycogen accumulates in the body as a result of enzyme defect in Cori disease.
Missing in this disease
Which enzyme is the following? (September 87)
A) Glycogen synthetase
B) Phosphorylase
C) Branching enzyme
D) Amilo 1-6-glycosidase
E) Phosphofructokinase
Glycogen storage diseases are a group that causes impairment in the structure or
concentration of glycogen.
metabolic disease. So far, 11 variants have been identified with their variants.
Among these, most
the important ones are;
Type 0: Glycogen synthetase enzyme is missing. The mainly involved organ is the
liver. Fasting hypoglycemia
and hypoglycemic convulsions are the most important clinical findings.
Type 1 (Von-Gierke disease): Glucose-6-phosphatase enzyme is missing. Glycogen
liver, kidney and
stored in the small intestine. Hepatomegaly, hypoglycemic convulsions, acidosis,
growth retardation
and xanthomas.
Type II (Pompe disease generalized glycogenase): Lysosomal alpha-1,4 glycosidase
enzyme is missing.
There are 3 types of infantile (IIa), juvenile, (IIb) and adult (IIc) types. There
is widespread involvement of the infantile type.
Hypotonia, cardiomegaly, mild hepatomegaly, macroglossia are the main clinical
findings. Juvenile type muscle
and liver involvement is important. Clinic is similar to infantile type. It goes
slower. There is no cardiomegaly.
The adult type has muscle involvement. There is no organomegaly. It manifests
itself in chronic myopathy. Slow
There is progress.
Type III (Cori-Forbes' disease): Amilo-1,6-glycosidase (debrancher enzyme = branch
breaking enzyme)
There is a lack. Extensive organ involvement (liver, muscle, heart, spleen, etc.)
Similar to clinical type 1. More
hafifseyirl is. Hepatomegaly, hypoglycemia, myopathy, growth retardation. Stone
doll has a face.
Bleeding disorders and xanthomas are also seen. In Type III, splenomegaly is also
different from Type 1.
has. ECG disorders and moderate cardiomegaly are common.
Type 1V (Anderson's disease, amylopectinase): Amyl-1.4-1.6-transglycosidase
(brancher enzyme:
enzyme)). Widespread involvement. Hepatosplenomegaly, cirrhosis, growth
retardation dominates the clinical picture.
Type V (Mc Ardle's disease): Muscle phosphorylase is missing. Skeletal muscles are
involved. Quick fatigue at first,
There are muscle cramps that come from exercises during the adult period.
Type Vl (Hers disease): Liver phosphorylase is missing. Hepatomegaly, rarely
hypoglycemia.
It is similar to the mild form of type 1.
(Answer D)
96
METABOLISM
LIPID METABOLISM
DISORDERS
one. Vomiting, diarrhea, hepatosplenomegaly, fever and growth retardation in the
first days after birth
In the 2-month-old baby, calcification of the adrenal glands was detected on
abdominal X-ray.
Which of the following is the most likely diagnosis for this patient? (September
2011)
A) Cholesteryl ester storage disease
C) Wolman's disease
E) Zellweger syndrome
D) Neonatal adrenoleukodystrophy
E) Mitochondrial hepatopathy
Malabsorption, hepatosplenomegaly and “adrenal gland calcification” = Wolman's
disease
Wolman's disease:
Cholesterol esters and triglycerides are stored in histiocytic foam cells of
visceral organs.
Developmental delay, severe vomiting, steatorrhea, abdominal distention and HSM are
seen in the first week of life.
Calcification of adrenals is typical.
Death occurs within 6 months due to cachexia, peripheral edema and heart failure.
No specific treatment.
(Answer B)
2nd. Which of the following treatment for familial hypercholesterolemia
is one of the methods? (April 2010)
A) Bone marrow transplantation
B) Intravenous immunoglobulin treatment
C) Apheresis application
D) Hyperbaric oxygen therapy
E) Fresh frozen plasma
That's a tough question.
Hyperlipoproteinemia:
Familial hypercholesterolemia: Intracellular entry of LDL in patients with LDL
receptor mutation
decreases and increases serum level. Tendon xanthams and early coronary artery
disease are seen. Heterozygous form is one of the most common single gene diseases.
The frequency is 1/500. Total cholesterol is between 350550 mg / dL. Homozygous is
500-1200 mg / dL.Triglyceride level is normal, HDL
cholesterol is low, LDL cholesterol is increased excessively.
It is especially effective with plasmapheresis in homozygous form. Of course, diet,
exercise and
especially medical treatment with statins is also effective.
97
PEDIATRICS
Familial defective Apo B 100: LDL increases. Dominant passes. Coronary heart
disease increases. Treatment is like hypercholesterolemia.
Cytocyticolemia: Plant sterol absorption is increased from the intestines. OR
passes. Ezetimibe or bile in the treatment
acid-binding resins. HMG Co A reductase inhibitors are useless.
Polygenic hypercholesterolemia: It is the most common of all types in adults and
adolescents.
Familial combined hyperlipidemia: It is the most common pirmer lipid disorder. OD
passes. triglycerides
and LDL increases, HDL decreases. There are no xanthomas. It is associated with
metabolic syndrome.
Familial dysbeta lipoproteinemia (type III): Apo E defect. LDL and Tg increase. HDL
is normal.
Tuberoeruptif xanthomas and peripheral vascular disease are increased. Palmer
xanthomas are typical. Wide beta
band is seen.
Familial hyperchylomicronemia (type I): Increased triglyceride is very prominent.
Hepatosplenomegaly, pancreatitis and eruptive xanthomas are seen.
(Answer C)
3. The absence of hexosaminidase A in leukocytes makes a diagnosis of: (September
2004)
A) Niemann-Pick disease
B) Infectious Gaucher disease
C) Tay-Sachs disease
D) Krabbe disease
E) Fabry disease
Tay-Sachs disease is characterized by a lack of hexosaminidase A. GM2 is
ganglycidosis. Disease
typical gray matter involvement and severe mental retardation, blindness and
deafness. primary
keeps the CNS, no peripheral storage. There is no HSM. Between 6-12 months
usually the first findings. Initial findings include reduced eye contact and noise
overreaction (hyperacuzi).
Towards the end of a year, excessive hypotonia develops.
Eye examination may show cherry stain on the macula. The head is macrocephalic but
There is no hydrocephalus. Convulsions appear in the 2nd year. Death is usually
between 2-4 years
It happens.
Late onset or juvenile Tay-Sachs disease; ataxia, choreatethosis and dysarthria
major
the findings. Spasticity and blindness may develop before death. Cherry in juicy
form
red may not be macular.
The definitive diagnosis is made by demonstrating the lack of hexoaminidase A in
leukocytes.
It is a lysosomal storage disease. For others 3. Question or other metabolic
diseases 1. question
See.
Sandhoff's Disease;
Hexoaminidase A and B enzymes are deficient. Clinical findings with Tay-Sachs
disease
is the same, but watches faster.
98
METABOLISM
Disease
Enzyme
Accumulated substance
Gaucher
Beta glucosidase
Glucosyl ceramide
Nieman Pick
Acid sphingomyelinase
sphingomyelin
Metachromatic LD
Aryl sulfatase A
Cerebrozide sulfide
Fabry (linked to X)
Alpha galactosidase A
Seramidtriheksozid
GM1-gangliosidosis
Beta galactosidosis
GM1-ganglioside
Tay-Sachs (GM2 gangliosidosis)
Beta hexaminaminidosis A
GM2-ganglioside
Sandhoff (GM2-gangliosidosis)
Bet-hexosaminidase A / B
GM2-ganglioside
Krabbe
Galaktoserebrozidaz
Galactosyl ceramide
Faber disease
ceramidase
Ceramide
Wolman's disease
Lysosomal acid lipase
Cholesterol ester
(Answer C)
4. Which of the following findings of mitochondrial fatty acid oxidation defects
does not take place between? (April 2003)
A) Hypoglycemia following hunger and life-threatening acute coma
B) Chronic cardiomyopathy and skeletal muscle weakness
C) Sudden infant death
D) Dysmophric findings
E) Clinical picture mimicking Reye's syndrome
(Answer D)
5. Which of the following is not one of the biochemical properties of mitochondrial
fatty acid oxidation defects? (April 2002)
A) Severe acidemia
B) Hypoglycemia
C) Secondary carnitine deficiency
D) Dicarboxylic aciduria
E) Hypoketonemia
(Answer A)
Common explanation for question 4 and 5
The most common form of fatty acid oxidation defects is hypoglycemia followed by
prolonged fasting.
Main clinical features:
•
Coma and hypoglycemia attack
Chronic, progressive muscle weakness and cardiomyopathy
Lack of ketosis expected to accompany hypoglycemia
They do not present unless they are hungry for a long time
Diagnosis of Reye's syndrome and sudden infant death syndrome (SIDS)
99
PEDIATRICS
Main laboratory findings:

•
There is no ketosis despite hypoglycemia and hypoglycemia.
Ammonia high, no significant metabolic acidosis
Elevation of transaminases
Prothrombin time is prolonged.
Total carnitine low (high in CPTI deficiency)
The presence of dicarboxylic acids in urine

A large part of the energy with the destruction of fatty acids as much as water and
CO2 in the mitochondria in muscle and heart
In the liver, ketones are formed as a result of fatty acid oxidation.
Since there will be no ketone production, there is no heavy acidosis.
A. Defects related to carnitine metabolism
•
Carnitine transport defect
Carnitine Cycle Defects
Carnitine palmitoyltransferase 1 (CPT1) deficiency
Carnitine translocase deficiency
Carnitine palmitoyltransferase 2 (CPT2) deficiency
B. Oxidation enzyme defects

•
Very long and long chain acyl-CoA dehydrogenase (VLCAD / LCAD) deficiency
Moderate chain acyl-CoA dehydrogenase (MCAD) deficiency (most common)
Short chain acyl CoA dehydrogenase (SCAD) deficiency
Long chain hydroxyacyl CoA dehydrogenase (LCHAD) deficiency
Moderate chain hydroxyacyl CoA dehydrogenase (MCHAD) deficiency
Short chain hydroxyacyl CoA dehydrogenase (SCHAD) deficiency
C. Electron transfer path

D. Having problems in any of the ketone synthesis pathways causes fatty acid
oxidation defects.
No cardiomyopathy and myopathy: MCAD and CPT-1
No secondary carnitine deficiency: CPT-1
Most common: MCAD
The second most common: LCHAD
In mothers of fetuses with fatty acid oxidation defects (especially LCHAD
deficiency)
Acute fatty liver damage may be observed during pregnancy.
6. Which of the following is not one of the lipid storage diseases? (September
2002)
A) GM1 Gangliosidosis
E) Gaucher's disease
B) X-linked adrenoleukodystrophy
D) Niemann-Pick disease
one hundred
METABOLISM
X-linked adrenoleukodystrophy is a peroxisomal disease. See question 1 of other

metabolic diseases
Fabry Disease; Alpha-galactosidase enzyme is deficient. Skin rash, kidney and heart
failure is observed. X-linked recessive inheritance. Symptoms are observed only in
men.
Metachromatic Leukodystrophy; Aryl sulfatase A enzyme is missing. Mental
retardation in adults
psychological defects and demyelination. Nerves are painted yellow-brown with
cresyl violet
(Metachromatically a). OR indicates inheritance.
Krabbe Disease; There is a deficiency in beta-glucosidase enzyme. Mental
retardation and myelin
It is characterized by almost none. It shows autosomal recessive inheritance. White
matter of brain
globoid bodies and increased galactocerebrozides.
Gaucher's Disease; Beta-glucosidase enzyme is missing. Hepatosplenomegaly presents
with erosion of long bones and mental retardation in newborns. Autosomal recessive
inheritance
Shows.
Niemann Pick Disease; There is a deficiency in sphygmyelinase enzyme.
Hepatosplenomegaly and mental retardation are observed. It results in death at an
early age.
(Answer B)
Lysosomal lipidosis
Mucolipidosis (I cell = mucolipidosis II)
Sphingolipidosis: Fabry, Farber, Gaucher, GM1, GM2 gangliosidosis,
galactosialidosis, Niemann Pick
A, B, metachromatic leukodystrophy and Krabbe
Lipid storage diseases: Niemenn Pick C, Wolman's disease and seroid lipofuccinosis
7. Which of the following lipid storage diseases has no neurological signs?
(September 2001)
A) GM1 gangliosidosis
B) Fucosidosis
D) Sandhoff's disease
E) Gaucher's disease type I
Gaucher disease is caused by a deficiency of Beta-Glucosidase. (Glucocerebrosidase)
Gaucher's disease is Type 1 non-neuronopathic type:
It is the most common form of lysosomal storage diseases, non-neuronopathic and
neuronopathic
types. It is the most common lipidosis. Ashkenazi Jews are many.
The first sign is splenomegaly.
Bone marrow insufficiency symptoms and hypersplenism (anemia, leukopenia and
thrombocytopenia) with birth 80
may occur at any period between age.
Hemorrhage due to thrombocytopenia, chronic fatigue due to anemia, hepatomegaly and
hepatic dysfunction, bone pain and splenomegaly are typical findings.
Characteristic Gaucher cells filled with glucocerebrozite in bone and splenic
aspiration smears
It is seen.
101
PEDIATRICS
Erlenmeyer deformity and lytic lesions in the bones, especially in the distal
femur, are seen on the X-ray.
Painful bone attacks and elevated acid phosphatase may occur.
Hematologic parameters, bone lesions, hepatomegaly and splenomegaly regress with
intravenous enzyme replacement (imiglucerase).
(Answer E)
Infantile (acute neuropathic) type II: This form involves CNS. Early infancy begins
in childhood. HSM, strabismus,
dorsiflexion of the trismus and head are typical findings. Convulsions are common.
Spastic and nutrition-respiration
These children with problems die around 3-4 years.
Juvenile (subacute neuropathic) type III: Age of onset varies. HSM starts first in
childhood. one.
or in the second decade: ataxia, peripheral neuropathy, myoclonus, ophthalmoplegia
and
dementia.
8. What lipid storage disease only involves the central nervous system?
(April 2000)
A) GM, gangliosidosis
B) Tay-Sachs
C) Niemann-Pick
D) Sandhoff
E) Gaucher
(Answer B)
The most common lipidosis: Gaucher
X-linked recessive: Fabry
Enzyme replacement: Fabry, Gaucher type I
Bone marrow transplantation: Gaucher type I
No mental retardation: Fabry, Gaucher type I, Nieman-Pick type B, Wolman
No hepatosplenomegaly: Fabry, Krabbe, Metachromatic Leukodystrophy, Tay Sachs
Angiokeratoma: Fabry, Fucosidosis, GM1 gangliosidosis, Sialidosis II
Rough face and Disostosis multiplex ones: Mucolipidosis II and III,
Galactosialidosis, GM1
Ganliosidosis, Fucosidosis, Mannocidosis, Sialidosis II
9. Which one does not have cherry red spots on macula? (September 99)
A) Glycogen storage disease
B) Tay-Sachs disease
C) Nieman-Pick disease
D) GM Gangliosidosis
E) Mucolipidosis
102

METABOLISM
In the macula, cherry-red spots or “Japanese Flag” appear in lipidosis. Glycogen

storage
The disease is not a lipidosis.
It does not occur in glycogen storage diseases.
(Answer A)
Often seen in cherry red macula: GM1 gangliosidosis, GM2 gangliosidosis,
sialidosis,
galactosialidosis
Cherry-red macula can be seen: Farber, Nieman-Pick, Krabbe, Metachromatic
leukodystrophy, Wolman, Mucolipidosis
Cherry-red macula: Gaucher, Mucolipidoses, Fabry, Fucosidosis, Mannsidose
10.
I. chylomicron
II. LDL
III. IDLE
IV. VLDL
What are the increased lipoproteins in type V hyperlipoproteinemia? (April 99)
Get
B) II
C) 1-IV
D) III-III
E) III-IV
Type V increases VLDL and chylomicrons. Changes in other hyperlipoproteinemias as
follows
It happens.
WHO (Fredricson) classification:
Type 1: Familial Lipoprotein lipase deficiency (O. R) or its cofactor Apo CII is
missing. chylomicrons
increases.
Type III: Familial hypercholesteromy (LDL receptor deficiency) LDL increases.
Type IIB: LDL and VLDL increase.
Type III: Familial dysbetalipoproteinemia, β-VLDL increases.
Type IV: Familial hypertriglyceridemia, VLDL increases.
Type V: Familial hypertriglyceridemia, chylomicron and VLDL are increased.
In type 1, chylomicron increases in plasma whereas in type II, cholesterol
increases.
(Answer C)
hyperlipoproteinemia
Familial hypercholesterolemia: LDL increases. LDL receptor mutation due to LDL cell
entry is reduced and serum levels are increased. Tendon xanthams and early coronary
artery disease
It is seen. Heterozygous form is one of the most common single gene diseases. The
frequency is 1/500. Total
cholesterol is between 350-550 mg / dL. homozygous for 500-1200 mg / dL.
triglycerides
levels are normal, HDL cholesterol is low, LDL cholesterol is increased
excessively.
Familial defective Apo B 100: LDL increases. Dominant passes. Coronary heart
disease increases. Treatment is like hypercholesterolemia.
Cytocyticolemia: Plant sterol absorption is increased from the intestines. OR
passes. Ezetimibe or bile in the treatment
acid-binding resins. HMG Co A reductase inhibitors are useless.
103
PEDIATRICS
Polygenic hyper cholesterolemia: It is the most common of all types in adults and
adolescents.
Familial combined hyperlipidemia: It is the most common pirmer lipid disorder. OD
passes. Tg and LDL increases,
HDL decreases. There are no xanthomas. It is associated with metabolic syndrome.
Familial dysbeta lipoproteinemia (type III): Apo E defect. LDL and Tg increase. HDL
is normal. Tuberoeruptif xanthomas and peripheral vascular disease are increased.
Palmar xanthomas are typical. Wide beta
band is seen.
Familial hyperchylomicronemia (type I): Increased triglyceride is very prominent.
Hepatosplenomegaly, pancreatitis
and eruptive xanthomas.
11th. What is familial hyperlipidemia that produces broadband in protein
electrophoresis?
(September 95)
A) Type l
B) Type ll
C) Type III
D) Type lV
E) Type V
The type of hyperlipidemia that forms broadband in protein electrophoresis is Type
III.
(Answer C)
12. What is the substance that accumulates in liver and brain in Refsum disease?
(September 95)
A) Phytic acid
B) Prostanoic acid
C) Nervomic acid
D) Arachidonic acid
E) Linoleic acid
Refsum disease, a peroxisomal disease, accumulates phytic acid in various tissues.
Classical Refsum disease: Peroxisomal type of deficiency with a single enzyme.
Phytanyl has a lack of CoA hydrolase.
Phytic acid accumulation
Ataxia, peripheral neuropathy and retinitis pigmentosa findings in the second
decade
starts with.
Intelligence is normal.
The infantile form is a peroxisome biogenesis defect.
Infantile Refsum: Moderate dysmorphic features. They can live 2 decades or more.
They walk broadly and ataxically.
Heavy MRI. Sensorineural hearing loss and pigmentary degeneration of the retina are
present in all.
Early hypotonia, hepatomegaly and liver dysfunction may occur.
Chondrodysplasia punctata and renal cysts are absent.
(Answer A)
104
METABOLISM
13. Which enzyme deficiency is involved in Gaucher's disease? (April 95)
A) Hexoaminidase A
B) Sphingomyelinase
C) Beta glucosidase
D) Aryl sulfatase
E) Beta-galactosidase
Glucocerebrozidase (beta glucosidase) enzyme is missing in Gaucher's disease.
(Answer C)
14. Apoprotein-E deficiency and chylomicron residues cannot be removed; which type
of lipid
is metabolic disorder? (April 93)
A) Type l
B) Type ll
C) Type III
D) Type lV
E) Type V
There are 3 subgroups of Apoprotein-E, and when all of these subgroups are
together, Apoprotein-E
functions. Since only Apoprotein E2 is found in type III hyperlipidemia,
chylomicron from plasma
The residues cannot be completely cleaned and the plasma appears turbid. Physical
examination sign on palm
There are "xantoma striata palmaris" in the form of yellow blisters.
(Answer B)
15. Which of the following arylsulfatase A deficiency is observed? (September 92)
A) Krabbe
B) Metachromatic leukodystrophy
C) Niemann-Pick
D) Von Gierke
E) Gaucher
Metachromatic leukodystrophy = SULFATIDE LIPIDOSIS
Late infantile type: 1-2 years old gait disorder, knee hyperextension (genu
rekurvatum) begins with.
Ataxia, peripheral neuropathy and hypotonia are seen. PSMG, convulsion, optics with
table progression
atrophy, quadriparalysis, bulbar paralysis and respiratory problems. CSF protein is
high. Nervous message
speed is slow. PAS (+) metachromatic bodies are observed in nerve biopsies and
white matter. Cranial
demyelination and white matter atrophy are evident in imaging. They die at 2-4
years of age.
Juvenile type starts at age 5-7.
Adult type begins after puberty. There is no visceral and bone marrow involvement.
SAP-1 (Sphingolipid activator protein) may also be due to deficiency.
(Answer B)
105
PEDIATRICS
16. Adrenal calcification, hepatomegaly and fatty diarrhea

Seen? (April 92)
A) Whipple
B) Wolman's disease
C) Intestinal lymphangiectasia
D) Celiac
E) Cystic fibrosis
WOLMAN'S DISEASE
Cholesterol esters and triglycerides are stored in histiocytic foam cells of
visceral organs. The first of life
Developmental retardation, severe vomiting, steatorrhea, abdominal distention and
HSM are seen in the first week. Calcification of adrenals is typical. It has
hyperlipidemia. Cachexia, peripheral edema and heart failure
death occurs within 6 months. No specific treatment.
Mild cholesterol ester depot disease (KEDH) is only hepatomegaly and early
atherosclerosis
can be diagnosed with adulthood. There is no adrenal calcification.
(Answer B)
17. Which enzyme is missing from Nieman-Pick? (April 92)
A) Gangliosidase
B) Cerebrozidase
C) Sphingomyelinase
D) Iduronidase
E) Phosphorylase
Nieman-Pick disease is lacking sphingomyelinase enzyme. There are 3 types of the
disease.
NİEMAN PİCK DISEASE type A (neuronopathic form): It is the most common type.
Askhenazi is common in Jews. Around six months psychosocial motor retardation
begins with hepatomegaly. YD period
prolonged jaundice may be taken. PSMG progresses further, spasticity, deafness and
optic atrophy develop. CT
and MRI shows degeneration, demyelination and cerebellar atrophy in gray matter.
There is no cure.
NİEMAN PİCK DISEASE type B (nonneuropathic form) CNS involvement is not present.
Intelligence is normal. Start
age is variable. HSM (first finding splenomegaly), pulmonary involvement
(reticulonodular infiltration,
bronchopneumonia, cor pulmonale), in some cherry red macula.
NİEMAN PİCK DISEASE type C (chronic neuronopathic form): There is often prolonged
neonatal jaundice.
They are normal until 1-2 years. Slow progressive neurodegeneration begins.
Behavior changes,
loss of acquired skills, PSMG, ataxia, spasticity, convulsions develop. HSM is
lighter.
Sphingomyelin and cholesterol accumulation in the lysosome due to cholesterol
transport disorder
secondary partial sphingomyelinase activity is low.
(Answer C)
106
METABOLISM
18. Niemann-Pick, Tay-Sachs, Fabry and Gaucher disease deficiency which

metabolic pathways? (September 91)
A) Glycoprotein synthesis
B) Glycolipid degradation
C) Phospholipid synthesis
D) Cholesterol synthesis
E) Glycogen degradation
Enzymes responsible for glycolipid degradation in Niemann-Pick, Tay-Sachs, Fabry
and Gaucher diseases
There are shortcomings.
In Niemann-Pick disease; Sphingomyelinase enzyme
In Tay-Sachs disease; Hexosaminidase-A enzyme
In Gaucher's disease; Beta glucosidase enzyme
Fabry disease; Alpha-galactosidase enzyme responsible for degradation of alpha-
galactosyl glycolipids
It is missing.
(Answer B)
19. What type of hyperlipidemia occurs when lipoprotein lipase activity decreases?
(September 91)
A) Type l
B) Type ll
C) Type III
D) Type lV
E) Type V
In type 1 hyperlipidemia, lipoprotein lipase activity, which is responsible for the
first stage of triglyceride hydrolysis, is decreased.
(Answer A)
20. Which is missing in Tangier's disease? (April 91)
A) VDL
B) HDL
C) Free fatty acid
D) Abetalipoproteinemia
E) Lecithin cholesterol acyl transferase
107
PEDIATRICS
In homozygous patients, HDL levels are both decreased in quantity and structurally
abnormal. Clinical manifestations are usually found in childhood and cholesterol
esters in various tissues
storage. Orange color change is typical in tonsils.
•
Large, yellow-orange tonsils
splenomegaly
Peripheral neuropathy
hepatomegaly
lymphadenopathy
Diffuse corneal infiltration

(Answer B)
21. Which enzyme is missing in Tay-Sachs disease? (April 91)

A) Sphingomyelinase
B) Hexoaminidase A
C) Arif sulfatase
D) Glucose-6-phosphatase
E) Glycoserebrosidase
Hexoaminidase A enzyme is deficient in Tay-Sachs disease in the lipid storage
diseases group.
See question 3
(Answer B)
22. Serum in patients with Type 1 hyperlipidemia with familial lipoprotein lipase
deficiency
What is the characteristic finding? (April 91)
A) Plasma like milk
B) LDL increase
C) HDL increase
D) Cholesterol increase
E) VLDL decrease
In type I hyperlipidemia (Hyperchylomicronemia), lipoprotein lipase enzyme
(triglyceride hydrolysis)
stage) is missing.
In type 1 hyperlipidemia, serum total cholesterol is normal or moderately
increased, serum triglyceride
LDL normal, HDL normal or decreased.
In this disease referred to as OR, the blood sample taken from the patient is thick
and cream on the top of the tube.
The presence of a plasma layer such as the type 1 hyperlipidemia diagnosis.
(Answer A)
108
METABOLISM
23. Non-absorbable substance used in type III hyperlipoproteinemia

Which of the following? (April 90)
A) Cholestyramine
B) Gemfibrozil
C) Nicotinic acid
D) Fish oil
E) Ethyl alcohol
Cholestyramine and clofibrate are used to treat type III hyperlipoproteinemia.
Cholestyramine is an anion exchange basic resin. Not absorbed in the intestine.
Bind bile acids in the intestine
prevents their absorption.
(Answer A)
24. Which of the following is the substance accumulated in Niemann-Pick disease?
(September 89)
A) Glycoprotein
B) Ganglioside
C) Sphingomyelin
D) Sphingoglycolipid
E) Mucopolysaccharide
See 17. Question
(Answer C)
25. Which of the following has ganglioside deposition? (September 89)
A) Tay-Sachs
B) Nieman-Pick
C) Gaucher
D) Pompe
E) Cori-Forbes disease
Tay-Sachs disease due to insufficiency of hexosaminidase A isoenzyme, a lysosomal
enzyme
as a result of the defect in the destruction of GM2 ganglioside.
(Answer A)
26. Which type of hyperlipoproteinenemia occurs? (September 88)
A) Plasma appearance of milk
B) VLDL decreases
C) Glycolipid synthesis increased.
D) HDL decreases.
E) LDL and VLDL decrease.
109
PEDIATRICS
Hyperlipidemia and hyperlipoproteinemia syndromes are related to the properties of

plasma lipoproteins.
according to 6 types.
Serum total cholesterol is normal or moderate in type 1 hyperlipoproteinemia
(hyperchylomicronemia).
serum triglyceride significantly increased, LDL normal, HDL normal or decreased.
Dense band is seen in electrophoresis.
In this autosomal recessive disease, the blood sample taken from the patient, thick
upper part of the tube
and the presence of a plasma layer such as cream is diagnosed as Type 1
hyperlipoproteinemia.
(Answer A)
27. Which of the following is missing in abetalipoproteinemia? (April 88)
A) Phospholipid
B) Sphingomyelin
C) Chylomicron
D) HDL
E) Gamaglobulin
Autosomal recessive abetalipoproteinemia is characterized by severe fat
malabsorption observed from birth. Due to peripheral neuropathy, deep tendon
reflexes cannot be taken. 10
At the end of the year intestinal symptoms are reduced. Ataxia develops, senses of
position and vibration disappear.
There is a conventional tremor. Retinitis pigmentosa may occur during adolescence.
In the diagnosis, the presence of acontocytes in peripheral blood smear and low
plasma cholesterol level
(Less than 50 mg / dl) is important. In addition, plasma chylomicron and very low
density lipoprotin
(VLDL) fraction cannot be detected. The low-density lipoprotein (LDL) fraction was
also significantly reduced.
There is significant accumulation of triglycerides in the duodenal mucosa and
villus enterocytes.
(Answer C)
110
METABOLISM
AMINOACITE METABOLISM
DISORDERS
one. Transitional tyrosinemia in newborn infants
Which is true? (May 2011)
A) Vitamin C is used in the treatment
B) It is more common in premature babies than premature babies.
C) Usually improves within the first week of life
D) Infants fed high protein are less likely to develop the disease
E) Although it is transient, it has a severe clinical course.
Vitamin C of tyrosine metabolism disorders is vitamin C. One of the easiest
questions of the exam, former TUS
the question is
Transient tyrosinemia: 4 In the first 2 weeks of life in some newborns due to
transient insufficiency of HPDD
plasma tyrosine may rise.
Most patients are asymptomatic. Metabic acidosis, malnutrition and prolonged
jaundice are rarely seen. They are known to have high levels of phenylalanine in
the Guthrie screening test.
Even if they are not treated, they recover in 1 month. Restriction of protein from
short-term diet and diet and vitamin C
recommended.
(Answer A)
2nd. Which of the following is a clinical finding of phenylalanine hydroxylase
deficiency?
is not one? (May 2011)
A) Heavymental retardation
B) Eczematous rash
C) Epilepsy
D) Hyperactivity
E) Decrease in muscle tone
One more frequently asked issue in metabolism questions is the increase in tonus
finding, which is not in phenylketonuria.
tonus reduction in the form of questions asked.
Phenylketonuria: The missing enzyme is phenyl alanine hydroxylase. It is clinically
related to enzyme level. The cofactor of the enzyme is tetrahydrobiyopterin. The
toxicity of phenylalanine elevation is on the nervous system.
Patients are normal at birth. Mental retardation, increased tonus, hyperactivity,
increased tendon reflexes,
convulsions (hypipsarrymia, infantile spasm), self mutilation, autistic behaviors,
atetosis and parkinsonism
visible. EGG disorders are more common than convulsions. Microcephaly. Seborrheic
or
eczematous skin rash, light skin and eye color. Skin rashes pass over time.
111
PEDIATRICS
Classic PKU diagnosis

• Blood phenylalanine level higher than 20 mg / dl
• Normal / low plasma tyrosine level
• Increased urinary phenylalanine metabolites
• Cofactor tetrahydrobiopterin is normal (cofactor after detection of
hyperphenylalaninemia)
BH4 loading test must be performed to rule out deficiency)
Treatment: Lifetime Phe restricted (not protein restricted) diet (demyelination in
advanced age). With regular diet and follow-up, you thrive normally. Phenylalanine
deficiency growth restriction as a result of excessive restriction,
anorexia, rash, anemia, diarrhea and death. In addition, tyrosine is essential in
these patients.
has become.
(Answer E)
3. Urinary discoloration or unusual odor symptoms are not helpful in diagnosing

which of the following congenital metabolic diseases? (September 2009)
A) Alkaptonuria
B) Tryptophan metabolism disorder
C) Maple syrup urine disease
D) Pompe disease
E) Porphyria
Pompe disease does not change color or odor in the urine. Pompe disease type II
glycogen storage
and glycogen storage disease due to a single lysosomal enzyme deficiency.
(Answer E)
URINARY FINDINGS IN OBSTETRIC METABOLISM DISEASES
URINE COLOR
•
Homogeneous aciduria: black
Tryptophan malabsorption: blue
Porphyria: red
Uric acidopathy: yellow-orange
URINARY ODOR
•
Glutaric acidemia type II: sweaty foot
Isovaleric acidemia: Sweaty foot
Phenylketonuria: Mold or dead mouse
MSUD: burnt sugar, fenugreek
Trimethyl aminuria: rancid fish
Trozinemia: Cress oil and cabbage

•
Metionine me: Cabbage
Multiple carboxylase deficiency: Tom cat urine
Hyperammonemia: Ammonia
Hawsikinsuri: Swimming pool chlorine
112
METABOLISM
4. Which is one of the ocular signs of classic homocystinuria

A) Lens subluxation
B) Glaucoma
C) Cataract
D) Myopia
E) Optic neuritis
Cystathionine B synthase is lacking in classical homocystinuria. It is the most
common congenital methionine disorder. OR
It passes. Patients are normal at birth
Eye findings:
•
Lens subluxation (ectopia lentis)
astigmatism
myopia
Glaucoma
Cataract
•
Retinal detachment
Optical atrophy
Diagnosis is usually made after the age of 3 with lens subluxation (ectopia
lentis).
Progressive mental retardation, epilepsy, skeletal disorders similar to Marfan
syndrome and elbow
- knee joint restriction, - pes cavus deformity. There are blue sclera, malar
flush. Thromboembolic events (MI, SVA) are seen. Thromboembolic complications are
the most common causes of death.
Laboratory findings: Increased methionine and homocysteine levels in body fluids
are diagnostic. Fresh
urinary nitroprusside test is positive. Enzyme in liver biopsy or fibroblast
cultures
deficiency. Osteoporosis is detected on radiography.
Treatment: High dose B6 (200-1000 mg / day), folic acid, diet + betaine
(Answer E)
5. Which is one of the findings of untreated classical phenylketonuria
It is not? (April 2008)
A) Mental retardation
B) Convulsions
C) Exematoid skin lesions
D) Hypoactive deep tendon reflexes
E) Microcephaly
PKU Clinical Findings
There are projective vomiting in the early period resembling pyloric stenosis.
The clinic becomes prominent after 1 year of age. Mental retardation, microcephaly,
spasticity and deep tendon
increased reflexes, hyperactivity, convulsion (hypipsarrymia, infantile spasm),
self mutilation, autistic
behaviors, atetosis and parkinsonism.
Seborrheic or eczematous skin rash, light skin and eye color are seen.
Hypotonicity is not an expected finding.
113
PEDIATRICS
Diagnostic criteria for calcic phenyl ketonuria

Blood phenylalanine level above 20 mg / dl
Normal / low plasma tyrosine level
Increase in phenylalanine metabolites in urine
Normal cofactor tetrahydrobiopterin (cofactor after detection of
hyperphenylalaninemia)
BH4 loading test must be performed to rule out deficiency)
(Answer D)
6. Which congenital metabolic disease does not have its own
given together with clinical findings? (September 2005)
Disease
Finding
A) Galactosemia
Cataract
B) Peroxisomal disease
Dysmophic face view
C) Cystinosis
hyperthyroidism
D) Mitochondrial diseases
cardiomyopathy
E) Tyrosinemia
Cirrhosis
The fact that the galactosemia is a cataract is already classic.

Even in the neonatal period, dysmorphic facial appearance is caused by peroxisomal
diseases (similar to Down syndrome in Zelweger syndrome). Mitochondrial diseases
fatty acid oxidation defects, which are the most typical example, lead to
cardiomyopathy.
Tyrosinemia leads to liver damage and cirrhosis.
Cystinosis is hypofunction due to cystine crystals deposited in endocrine organs.
Hypothyroidism is not detected, but not hyperthyroidism.
(Answer C)
cystinosis
Lysosomal development due to deficiency of carrier protein in cystine transport
from lysosomal membranes
warehouse disease. Cystine crystals in the reticuloendothelial system and
parenchymatous organs
It is stored.
Infantile nephropathic type: Fanconi syndrome, hypothyroidism, light color on skin
and hair, photophobia (cornea
accumulation), develops chronic renal failure at the age of 10 years.
Transplantation after CRF
no accumulation of cystine in the kidney; however, vision loss, DM, hypogonadism
and neuropathy occur.
Cystine crystals also accumulate in the cornea and conjunctiva, with early
photophobia.
Cysteamine prevents accumulation of intracellular cystine, eye drops with
cysteamine
used for recovery.
Amino acid diseases due to transport disorders:
•
cystinuria
cystinosis
Hartnup disease
•
Blue Gland Syndrome (Indikanuria)
Lysinuric protein intolerance
HHH (hyperamonemia-hyperornitinemia-homocytullinuria syndrome)
114
METABOLISM
7. A 5-year-old boy presented with developmental delay and mental retardation.

thin and longer than normal extremities and arachnodacty, scoliosis and
flushing (malar flush) is detected. She was operated on with lens subluxation,
his brother had similar findings, and it is learned that his parents are healthy.
Most
Possible diagnosis is: (April 2005)
A) Marfan syndrome
B) Alkaptunuria
C) Phenylketonuria
D) Homocystinuria
E) Nonketotic hyperglycinemia
There are findings similar to classical homocystinuria Marfan syndrome. Progressive
mental in this
presence of retardation It is important that there is no mental retardation in
Marfan syndrome.
(Answer D)
8. With the laboratory findings of the previous patient (question 5)
Which of the following statements is true?April 2005)
A) Increase in methionine and homocystine concentration in body fluids
B) Increase in plasma phenylaline concentration
C) Pending urine dark color is helpful in diagnosis
D) Sodium nitroprusside test in urine is negative
E) Glycine level in cerebrospinal fluid is higher than serum
(Answer A)
9. Hypoglycemia in the neonatal period which of the following metabolic diseases
can not wait? (September 2004)
A) Von-Gierke
B) Galactosemia
C) Phenylketonuria
D) Fructose intolerance
E) Panhipopituitarism
Metabolic diseases leading to hypoglycemia in HD:
•
Glycogen storage disease (0-1-3-4)
Organic acidemias
Fatty acid oxidation defects
galactosemia
Fructose intolerance
tyrosinemia
Hypoglycemia seen in YD
A. Decrease in glucose production
•
prematurity
Intrauterine malnutrition
Not enought feeding
asphyxia
115
PEDIATRICS
B. Low glucose stores and increased use

•
PM
Intrauterine malnutrition
•
Not enought feeding
asphyxia
C. Hormone deficiencies: Panhipopituitarism, isolated growth hormone deficiency,

ACTH
, Addison's disease, Glucagon insufficiency
Hyperinsulinism: Diabetic mother child, Erythroblastosis fetalis, Sudden
discontinuation of LV glucose, Other causes of hyperinsulinism: Nesidioblastosis,
Beta-cell hyperplasia -Beta-cell adenoma, BeckwithWidemann syndrome, Leucine
susceptibility, P. falciparum malaria
(Answer C)
10. Infants with exfoliation in which of the following metabolic diseases
common erythematous rashes? (April 2004)
A) Maple syrup urine (Maple Syrup Urine) disease
B) Methylmalonic acidemia
C) Propionic acidemia
D) Isovaleric acidemia
E) Multiple carboxylase deficiency
MULTIPLE CARBOXYLASE DEFICIENCY
All carboxylases in the body (pyruvate carboxylase, propionyl CoA carboxylase, 3-
methylcrotinyl CoA
carboxylase and acetyl CoA carboxylase) cofactor biotin. Holocarboxylase synthetase
enzyme biotin
binds to apoproteins of carboxylase enzymes.
The biotinidase enzyme allows biotin to be separated from these proteins and
dietary proteins in the intestine. This
deficiency of enzymes or biotinidase dysfunction of all carboxylases and organic
acidemia
table.
Treatment is given biotin.
Deficiency of holocarboxylase synthetase
Respiratory problems (tachypnea, apnea), vomiting, hypotonia, convulsions and
development in the first few weeks
retardation begins.
It has a special urine smell similar to male cat (tomcat) urine.
Skin findings (generalized erythematous rash, exfoliation and alopecia totalis) are
seen.
There is psychomotor retardation. Ketoacidosis, which may result in hearing loss,
optile atrophy, coma and death
organic aciduria is observed. Lactic acid and ammonia levels increase. Dermatitis,
total allopsy, ataxic
There are seizures and signs of immune deficiency.
(Answer E)
116
METABOLISM
11th. Treatment of transient tyrosinemia in newborn infants

available? (September 2003)
A) Vitamin A
B) Vitamin B12
C) Thiamine
D) Riboflavin
E) Vitamin C
Transient Tyrosinemia of Newborns: 4-OH phenylpyruvic acid, usually in premature
infants
It causes mild hyperphenylalaninemia and pronounced hyperthyrosinemia due to
immaturity of dioxenease (4-OHPPD). Plasma tyrosine may increase in some newborns
during the first 2 weeks of life.
Most patients are asymptomatic. Metabic acidosis, malnutrition and prolonged
jaundice are rarely seen. They are known to have high levels of phenylalanine in
the Guthrie screening test. Untreated
they even recover in 1 month. It is recommended to limit protein for a short time
and to give vitamin C through diet.
Disease
Vitamin
Methylmalonic acidemia
B12
Propionic acidemia
biotin
Multiple carboxylase
biotin
MSUD
thiamine
the Hawkinsür
C vitamin
Transient tyrosinemia
C vitamin
Glutaric aciduria
Vitamin B2
Homocysistinuria
B6 and folate
Hartnup disease
Niacin
Girat atrophy of the retina
Vitamin B6
Deficiency of pyruvate dehydrogenase
thiamine
(Answer E)
12. Which of the following diseases does not clinically resemble tyrosinemia type-
1? (April 2003)
A) Galactosemia
B) Hereditary fructose intolerance
C) Giant cell hepatitis
D) Transient tyrosinemia of the newborn
E) Homocystinuria
117
PEDIATRICS
Tyrosinemia is caused by a lack of type-1 fumaroyl acetoacetate hydrolase. Acute

and chronic forms
has.
ACUTE THYROSINEMIA: Asymptomatic in the first 6 months. Growth and developmental
delay, irritability, vomiting,
diarrhea and fever are early signs. Hepatomegaly, hepatic insufficiency, jaundice,
hypoglycemia, sepsis, renal tubulopathy, bleeding tendency (melana, hematuria and
ecchymosis) are common findings. Two
They die of liver failure before age.
Diseases mimicking tyrosinemia type 1: Galactosemia, Hereditary fructose
intolerance, hemochromatosis,
biliary atresia and giant cell hepatitis.
CHRONIC THYROSINEMIA: Growth and developmental retardation after one year,
progressive liver damage
(cirrhosis), renal tubular dysfunction (Fankoni syndrome), nephromegaly,
nephrocalcinosis and vitamin D resistant rickets.
Peripheral neuropathy and abdominal pain and muscle weakness mimic acute porphyria.
Around 10 years
they die of liver failure and hepatocellular carcinoma.
Causes of acquired tyrosinemia: hepatic insufficiency, vitamin C deficiency,
hyperthyroidism
(Answer E)
THYROZINEMIA LABORATORY FINDINGS:
Normocytic normochrome anemia
Increased serum bilirubin (direct + indirect)
Elevation of liver enzymes (AST, ALT, alkaline phosphatase, GGT)
Alpha-fetoprotein (hepatoma!) and increase in ALA level
Plasma tyrosine, methionine and p-hydroxyphenyl pyruvic acid increase
Generalized aminoaciduria, glucosuria, phosphaturia
The increase in serum and urinary succinylacetone is diagnostic.
Treatment: NTBC (liver transplantation requirement is reduced. Reduce the risk of
hepatoma development ??)
13. Which of the following cannot be one of the diagnostic criteria of classical
phenylketonuria?
(April 2003)
A) Plasma phenylalanine level above 20mg / dl
B) Normal plasma tyrosine level
C) Increased urinary phenylalanine metabolites
D) Positive Guthrie test
E) Increased concentration of cofactor tetrahydrobiopterin
Phenylketonuria
Diagnostic criteria in classical PKU;
•
Blood phenylalanine level above 20 mg / dl
Plasma tyrosine level is normal
Increased urinary phenylalanine metabolites (phenylpyruvic acid and

hydroxyphenylacetic acid). (First
phenylpyruvic acid may not be present in the urine for several days).
Normal cofactor tetrahydrobiopterin
Positive Guthrie test
118
METABOLISM
Diagnosis and treatment of phenyl ketonuria

Mouse carcass smell in urine: Phenylacetate
FeCl3 positive: Phenylpyruvate
YD screening test: Guthrie (48-72 hours later; minimum 4 hours later)
No YD screening test: FeCI3 (useful only in classical PKU in older ages)
The enzyme level is not required for diagnosis.
Treatment: a lifetime Phe-restricted (not protein-restricted) diet is given
Follow-up: Phe 2-6 mg / dl; then keep <12 mg / dl until adulthood
Prognosis: Normal (with regular diet and follow-up)
Deficiency of phenylalanine can lead to growth retardation, anorexia, rash, anemia,
diarrhea and death.
(Answer E)
14. Growth retardation, cataract, lens subluxation, psychiatric disorders, skeleton
abnormalities in a patient with osteoporosis and thromboembolic attacks
A) Phanconia syndrome
B) Galactosemia
C) Marfan syndrome
D) Homocystinuria tip1
E) Mucopolysaccharidosis
Clinical findings are related to homocysteine elevation. Methionine-free cyst rich
in treatment
They feed. Betaine (involved in the remethylation of homocystine to methionine as a
methyl donor)
pyridoxine (B6), vitamin B12 and folic acid supplementation is required.
See question 4
(Answer D)
15. Seborrheic dermatitis, alopecia, ataxia, hypotonia, myoclonic seizures and
growth retardation
Which of the following enzymes can be considered deficiency in a child diagnosed?
(September 2001)
A) Galactokinase
B) Biotinidase
C) Cystationin synthase
D) Phenylalanine hydroxylase
E) Epimerase
119
PEDIATRICS
Biotinidase deficiency (multiple carboxylase deficiency juvenile form): with the

first week of onset
2 years of age. Initial findings include myoclonic seizures and hypotonia (due to
lactic acidosis).
Atopic or seborrheic dermatitis, alopecia, ataxia, growth retardation,
keratoconjunctivitis, hearing loss and
immunodeficiency may occur. There may also be attacks of metabolic acidosis.
Only skin findings may be present in partial enzyme deficiency (treatment-resistant
atopic dermatitis)
Psychomotor retardation, optic atrophy and deafness develop in late diagnosis.
Excretion of hydroxylisovelarate in urine is typical
Biotin is used in the treatment.
Biotininase deficiency was included in the screening program in our country.
Response to biotin if caught early
is very good.
(Answer B)
16. What is the most common and widely used test for screening phenylketonuria?
(April 2001)
A) Sweat test
B) Guthrie
C) FeCl3
D) Phenylalanine level
E) Investigation of ketone in urine
Phenylketonuria
Phenylalanine metabolites;
•
Phenyl pyruvic acid
Phenyl lactic acid
Phenyl acetic acid
Phenyl acetic acid is glutamine
Since the transaminases that make up metabolites have not yet been synthesized in
the newborn, they
FeCl3 test is not used.
Phenylketonuria is a Guthrie test (a B. subtilis test), a bacterial test used in
newborns.
(Answer B)
17. If a microcephalic baby cannot be diagnosed in the examinations, which of the
following examinations should be performed? (September 2000)
A) Serum B12 level
B) Serum iron level
C) Maternal Phenylalanine level
D) Homocysteine level
D) Histidine level
120
METABOLISM
MATERNAL PHENYLKETONURY: Infant exposure to high phenylalanine in the intaruterine

period
microcephaly, mental retardation and congenital heart anomalies
It happens. Infant is not phenyl ketonuria. The mother is diagnosed by looking at
the level of phenyl alanine. If mothers with phenylketonuria start diet before
conception and continue throughout pregnancy
hazards can be eliminated.
(Answer C)
Classical PKU: Enzyme activity <1%; plasma phe> 20mg / dl.
Mild PKU: Enzyme activity 1-5%; plasma phe 10-20 mg / dl
Benign HPA: Enzyme activity> 5%, Plasma phe <10 mg / dl
Maternal PKU: There are dysmorphic findings similar to low birth weight,
microcephaly, MR, cardiac anomaly, corpus callosum agenesis, fetal alcohol
syndrome. Plasma during pregnancy
phe <6mg / dl.
Malignant PKU (cofactor deficiency): Poor response to diet. The most common 6-
pirovoil
tetrahydrobiopterin synthase (PTPS) deficiency. Despite diet, hypertonia, myoclonic
convulsions,
Symptoms of dysphagia, infantile parkinsonism develop. Dopamine deficiency in
patients with BH4 deficiency
hyperprolactinemia. TMPSXZ and methotrexate, which inhibit dihydropteridin
reductase enzyme, are contraindicated. Prolactin levels in follow-up, CSF Phe and
amine metabolites
measurement is used. Diet in treatment, BH4 replacement, L-dopa carbidopa, 5HT
replacement and folinic
acid is used.
18. Which of the following uses a high-protein diet to treat?
(September 2000)
A) Alkaptonuria
B) Tyrosinemia
C) Hartnup disease
D) Phenylketonuria
E) Homocystinuria
HARTNUP DISEASE
Neutral amino acids (tryptophan, alanine, serine, threonine, leucine, isoleucine,
histidine, phenyl alanine, tyrosine
kidney and intestinal absorption disorder. Clinical findings are due to tryptophan
deficiency.
Pellegra-like photodermatitis, episodic ataxia, tendency to depression, emotional
instability and suicide
trend is seen. Their intelligence is usually normal.
Excretion of proline, hydroxyproline and arginine is normal (differential diagnosis
with Fanconi)
Treatment: High protein, niacin treatment and sun avoidance is recommended.
(Answer C)
121
PEDIATRICS
19. It appears to be healthy after birth, but at the age of 3 days sucking,
vomiting, tachypnea,
In the patient with lethargy and convulsions, which should be considered first
is not one of the situations you need? (September 99)
A) Organic acidemia
B) Sepsis
C) Urea cycle enzyme defects
D) Homocystinuria
E) Meningitis
Non-symptomatic diseases that are not diagnosed as sepsis in the neonatal period;
aminoket disorders such as phenylketonuria, histidinemia, hartnup disease, and
homocystinuria. in these
hypoglycemia.
One of the amino acid disorders is tyrosinemia with hepatic involvement.
(Answer D)
20. Photosensitive skin lesions, episodic ataxia attacks and a normal intelligence
Which of the following is considered in a child? (April 99)
A) Hartnup disease
B) Biotidinase deficiency
C) Trozinemia
D) Acrodermatitis enteropathica
E) Phenylketonuria
See 18. Question
(Answer A)
21. Alopecia, mental retardation and metabolic changes in a 6-month-old child with
respiratory distress
acidosis and deafness, which is the most likely diagnosis? (April 99)
A) MSUD
B) Isovaleric acidemia
C) Biotidinase deficiency
D) Phenyletonuria
E) Hartnup disease
In biotinidase deficiency symptoms may not occur for months or years. isovaleric
In acidemia, symptoms begin in the first days of life. If lethargy, convulsions,
coma and treatment are not given, death occurs. Vomiting is severe. It has a ayak
sweaty foot ”smell.
MSUD: Lethargy and coma develops in the child who is normal at birth.
Hypertonicity, muscle stiffness
and heavy opistotonus. Mixes with tetanus.
Phenylketonuria: The baby is normal at birth. No acidosis.
Acidosis is caused by MSUD, isovaleric acidemia and biotidinase deficiency.
(Answer C)
122
METABOLISM
22. Which is used in the patient described in the above question? (April 99)
A) Biotin
B) Vitamin B12
C) Vitamin C
D) Branched-chain amino acid-free diet
D) Gluten-free diet
(Answer A)
23. Which is not absorbed from kidney and intestine in Hartnup's disease?
(September 98)
A) Neutral amino acids
B) Lactose
C) Vitamin
D) Fatty acids
E) Bile acid
See 18. Question
(Answer A)
24. Which enzyme is missing in alkaptonuria? (September 98)
A) Glucose-6-phosphatase
B) Sphingomyelinase
C) Phenylalanine hydroxylase
D) Homongentisic acid oxidase
E) Tyrosinemia
Alkaptonuria is a tyrosine metabolic disorder. Homogentisic acid oxidase is
missing. Ochronosis develops.
There is ochronosis (darkening of tissues, especially ear cartilage and sclera) and
arthritis.
The only finding in childhood may be black color when urine is kept waiting and
alkalized.
Ochronotic arthritis occurs in spins, hip and knee joints. Radiological findings
typically include osteoarthritis
It shaped. Cap valve diseases are common.
Diagnosis: It is confirmed by homogentisic acid measurement in urine. Homogentisic
acid Fehling and Benedict
reducing the reagents.
There is no effective treatment.
(Answer D)
25. Which of the following is not a disease that can be diagnosed and prevented by
screening in the newborn period? (April 98)
A) Phenylketonuria
B) Homocystinuria
C) Hypothyroidism
D) Galactosemia
E) Congenital rubella
123
PEDIATRICS
Diseases that can be diagnosed and treated with screening tests in the newborn
period are as follows;
•
Phenylketonuria
•
Congenital hypothyroidism
galactosemia
Sickle cell anemia and other hemoglobinopathies
Homocysistinuria
Congenital rubella occurs when the baby is exposed in the first trimester. To
expectant mothers
vaccination.
(Answer E)
26. What is the most reliable test for the diagnosis of phenylketonuria in a three-
day-old baby? (September 97)
A) phenyl purivic acid in urine
B) Lactic acid in urine
C) FeCl3 test
D) Guthrie test
E) Phenylacetic acid in urine
Blood phenylalanine level in the first 4 hours in sick infants where feeding is
started immediately after birth
Guthrie test (+) to increase (> 4 mg / kg) increases.
Phenylalanine metabolites (phenylpurivic acid) increase in urine. However, FeCl3
test in the first week of life (+)
You can not do it.
(Answer D)
27. High doses of pyridoxine have been shown to be experimentally effective in
treatment
Which is the disease? (September 96)
A) Homocystinuria
B) Galactosemia
C) Galactokinase deficiency
D) Phenylketonuria
E) Hartnup disease
In homocystinuria caused by cystathionine synthetase deficiency, high dose vitamin
B (pyridoxine)
treatment provides a rapid recovery.
(Answer A)
28. Mental retardation, microcephaly, seborrheic skin lesions, convulsion, open
hair
color and blue eye in which of the following metabolic disorders? (September 95)
A) Cystic fibrosis
B) Hurler syndrome
C) Mucolipidosis
D) Phenyl ketonuria
E) Albinism
See 13. Question
(Answer D)
124
METABOLISM
29. The disorder with long thin limb arachnodacty, lens subluxation and recurrent
thromboembolic attacks is one of the following? (September 95)
A) Homocystinuria
B) Hartnup
C) Cystinosis
D) Fanconi syndrome
E) Isovaleric acidemia
Methionine metabolism is the most common disorder.
(Answer A)
30. Which enzyme is lacking in albinism? (April 95)
A) Tyrosinase
B) Tryptophan hydroxylase
C) Dopa decarbosilase
D) Homogentisic acid oxidase
E) Phenylalanine hydroxylase
There are 3 genetic types of albinism.
Oculocutaneous (generalized albinism, OKA): The most common type is tyrosinase-
positive albinism.
Localized albinism: Piebaldism, Wardenburg syndrome
Ocular albinism (Nettleship Falls type)
(Answer A)
Generalized albinism:
OKA1 tyrosinase deficient type
OKA2 tyrosinase positive type: There is some pigmentation at birth. Then continue
to increase
would.
OKA3 (Rufus type, red OKA)
Hermansky Pudlak syndrome: platelet dens body deficiency, accumulation of seroid-
like material,
There are bleeding disorders. Substance accumulation inflammatory bowel syndrome,
restrictive lung
disease, renal failure and cardiomyopathy.
Chediak Higashi syndrome (there are macromelanosomes). There are giant peroxisome
positive granules.
There is an increased tendency to infections. The risk of lymphoreticular
malignancy is increased.
31. Which of the following increases urinary excretion in alkaptonuria? (April 95)
A) Melanin
B) Phenyl acetic acid
C) Homogentisic acid
D) Phenyl purivic acid
E) Phenyl lactic acid
In Alcaptonuria; It has symptoms such as ochronotic arthritis and darkening of the
urine upon waiting. First
The only finding in this period is discoloration in urine. See question 22
(Answer C)

125
PEDIATRICS
Tyrosine metabolism disorders: Type I tyrosinemia, type 2 tyrosinemia, tyrosinemia

type
3, transient neonatal tyrosinemia, Hawkinsinuria, alkaptonuria, tyrosine
hydroxylase
deficiency (infantile parkinsonism, dopa-responsive dystonia) and albinism.
RICHNER-HANHART SYNDROME-OCULOCUTANEOUS (type 2) THYROZINEMIA
Tyrosine aminotransferase (TAT) deficiency.
First finding: Excessive watery eyes, redness, pain and photophobia, bilateral
herpes-like corneal ulceration.
Later on: Palmar and plantar painful hyperkeratosis
Mild mental retaration (50%), microcephaly, selfmutilation are seen.
Plasma tyrosine levels are high. Unlike tyrosinemia type 1, liver, kidney functions
and
serum concentrations of other amino acids are normal. Restricted diet (tyrosine and
phenylalanine)
eye per week; skin findings every few months; long term MR regresses)
Hawkinsinuria: OD passes. 4-OH phenyl pyruvate dioxygenase (4 HPPD) dysfunction.
tyrosinemia
type 3 and transient trozinemia.
The disease is symptomatic only in infancy.
Severe metabolic acidosis, ketosis, growth retardation, hepatomegaly, hemolytic
anemia and abnormal odor
(the smell of the swimming pool).
Mental development is normal.
Treatment: tyrosine and phenylalanine restricted diet. High doses of vitamin C can
be given.
32. Which one does not indicate amino acid metabolism disorder? (April 93)
A) Abnormal odor in urine and sweat
B) Lethargy
C) Mental retardation
D) Low birth weight
E) Nausea and vomiting
Common clinical findings in amino acid metabolism disorders;
•
Lethargy
Absorption weakness, non-absorption
Convsulsion
Vomiting, nausea
hypoglycemia
•
hypocalcemia
Abnormal odor in urine and sweat
Mental retardation
Coma
hepatosplenomegaly
Low birth weight is unrelated to amino acid metabolism disorder.

(Answer D)
126
METABOLISM
33. Which is considered in a 4-year-old child with lens subluxation? (September 93)
A) Galactosemia
B) Tyrosinemia
C) Phenylketonuria
D) Homocystinuria
E) Albinism
See question 4
(Answer D)
34. What is the finding that is not seen in the first 24 hours in a patient with
phenylketonuria? (April 92)
A) phenyl lactic acid in blood
B) Guthrie test positivity
C) FeCl3 test positivity
D) phenylalanine over 10 mg
E) Increase in urine phenyl purivic aist
When a few drops of 10% ferric chloride are added to the urine, the blue-green
color is
phenylketones. It is negative in the first weeks of life. Reliable after one month
results.
(Answer C)
35. Which is missing in albinism? (September 91)
A) Dopamine β-hydroxylase
B) Dopa-decarboxylase
C) Tyrosinase
D) Phenylalanine hydroxylase
E) Phenylalanine pyrrolase
Oculocutaneous albinism is a generalized type. Impairment of melanin pigment
formation
There are different variants of the disease.
The most common type is tyrosinase enzyme deficiency (tyrosinase negative).
There is tyrosinase type 2 (tyrosinase positive), the most common type.
(Answer C)
36. What do you think if the child's urine is staining the diaper with black?
(April 91)
A) Alkaptonuria
D) Tryptophanuria
B) Phenylketonuria
E) Hemoglobinuria
C) Hepatic porphyria
See question 24
(Answer A)
127
PEDIATRICS
37. Which amino acid metabolism disorder is seen in Blue Diaper syndrome?
(September 89)
A) Threonine
B) Tryptophan
C) Methionine
D) Valine
E) Leucine
Since tryptophan is not absorbed from the gastrointestinal tract for various
reasons,
due to activity it is converted to indole.
Indole undergoes absorption and then undergoes oxidation and sulfation
secreted as substance.
Indicuria occurs in conditions such as blind loop syndrome or Hartnup's disease.
Blue diaper syndrome is a familial disease characterized by hypercalcemia,
nephrocalcinosis, and indicuria.
Disease name, indent substance, after contact with air oxidation and indigo blue
It takes due to turn into.
(Answer B)
38. What is the most common finding in an 8-year-old untreated phenylketonuria
child? (April 89)
A) Sleepiness
B) Gushing vomiting
C) Infantile eczema appearance
D) Skin is lighter than family members
E) Mental motor retardation

Vomiting can be severe enough to mimic pyloric stenosis and occurs early. Other
The early symptom is that urine smells like a mouse carcass. Severe intelligence in
most untreated children
retardation is detected. There are hyperactivity and hypertonicity in their
reflexes. Convulsive seizures and tremor
can. Untreated patients are often overweight and light in comparison to their
relatives. The decrease in pigmentation is due to inhibition of melanin synthesis
due to the accumulation of phenylalanine. Skin
symptoms are usually mild and do not appear in advanced childhood. More mentally in
older ages
retardation is in the foreground.
(Answer E)
39. How do you make the definitive diagnosis of phenylketonuria? (Nisan89)
A) Blood phenylalanine level
C) Ferric chloride test

E) Determination of mental retardation

B) Urine phenylalanine enzyme level
D) Phenylalanine uptake control
128
METABOLISM
Plasma phenylalanine level is slow at the earliest 4 hours after the start of
feeding after birth
as it rises.
Discarding urine phenylketones is later. Phenylalanine elevated in the blood in
newborn
Bacterial inhibition test of Guthrie, a screening test.
In infants with positive Guthrie test, plasma phenylalanine level should be
determined by chromatographic methods after the first week and
hyperphenylalaninemia should be confirmed.
Diagnostic criteria for classical phenyl ketonuria. Metabolic diseases are the most
frequently asked questions
again.
one. Plasma phenylalanine level above 20 mg / dl and tyrosine level normal
2nd. Increased metabolites (phenylpyruvic and O-hydroxy-phenylacetic acid) in urine
3. Increase in plasma levels by re-administration of phenylalanine, which has been
removed from the diet
4. Plasma cofactor is based on the criteria that the concentration of
tetrahydrobiopterin is normal.
(Answer A)
40. Which of the following diseases is seen in the increase of homogenstic acid in
urine?
(September 87)
A) Phenyl ketonuria
B) Pompe disease
C) Hartnup disease
D) Alkaptunuria
E) Albinism
See question 24
(Answer D)
129
PEDIATRICS
OTHER METABOLIC DISEASES
one. Which of the following is not one of the lysosomal storage diseases? (April
2007)
A) Infantile Refsum disease
B) Fabry disease
C) Mucolipidosis
D) GM1-gangliosidosis
E) Gaucher's disease
Refoxum disease peroxisomal due to failure of alpha oxidation of phytic acid
Disease.
Cynic retinitis pigmentosa, ataxia, ichthyosis, hearing and vision problems may be.
Neurological damage and
peripheral neuropathy.
There are peroxisomes in the whole body except erythrocytes.
Anabolic task: Plasma, bile acid and cholesterol biosynthesis.
Catabolic task: Fatty acids (beta), phytic acid (alpha), glutaric acid and
pipecolic
oxidation of acids.
They are examined in two groups. Infantile Refsum disease is a peroxisome
biogenesis defect.
(Answer A)
PEROXISOMAL DISEASES
Group 1
•
Peroxisome is little or no. Peroxisome is a biogenesis defect.
Multiple enzyme defects occur.
Zelweger syndrome
Neonatal adrenoleukodystrophy
Infantile Refsum Disease
Rhizomelic chondrodysplasia
Group 2
•
Peroxisome is normal. There is only one enzyme defect.
X-linked adrenoleukodystrophy
Classic Refsum disease

•
Glutaric aciduria III
3-oxoacyl CoA thiolase deficiency 'pseudo-Zelweger syndrome
acatalasia
130
METABOLISM
Lysosomal storage diseases:

Only type 2 from glycogen stores (Pompe disease)
Mucopolysaccharidosis
Mucolipidosis (I cell = mucolipidosis II)
Sphingolipidosis: Fabry, Farber, Gaucher, GM1, GM2 gangliosidosis,
galactosialidosis, Niemann Pick
A, B, metachromatic leukodystrophy, Krabbe
Lipid storage diseases: Niemenn Pick C, Wolman's disease and seroid lipofuccinosis
Oligosaccharidosis: Fucosidosis, mannosidosis, sialidosis
Disease
Enzyme
Accumulated substance
Gaucher
β-glucosidase
Glucosyl ceramide
Nieman Pick
Acid sphingomyelinase
sphingomyelin
Metachromatic LD
Aryl sulfatase A
Cerebrozide sulfide
Fabry (linked to X)
Alpha galactosidase A
Seramidtriheksozid
GM1-gangliosidosis
Beta galactosidosis
GM1-ganglioside
Tay-Sachs (GM2 gangliosidosis)
Beta hexaminaminidosis A
GM2-ganglioside
Sandhoff (GM2-gangliosidosis)
Beta-hexosaminidase A / B
GM2-ganglioside
Krabbe
Galaktoserebrozidaz
Galactosyl ceramide
Faber disease
ceramidase
Ceramide
Wolman's disease
Lysosomal acid lipase
Cholesterol ester
2nd. Which of the following does not cause hyperamonemia? (April 2004)
A) Histidinemia
B) Citrulline
C) Arginine
D) Propionic acidemia
E) Lysinuric protein intolerance

Causes of congenital hyperammonemia
Urea cycle defects (most common causes)
•
Carbamoyl phosphate synthase (CPS) deficiency
Ornithine transcarbamylase (OTC) deficiency
Arjininosuccinate lyase (AL) deficiency (Arjininosuccinic acidemia)

•
Arginine succinate synthase (AS) deficiency
Arginine deficiency (hyperarginemia)
N-acetyl glutamate synthase deficiency
Transport disturbance of urea cycle metabolites

•
Lysinuric protein intolerance
HHH you.
Organic acidemias
Fatty acid oxidation defects
Congenital hyperinsulinism with hyperammonemia
Hisitidinemia is caused by a lack of histiadase and is usually asymptomatic.
Metabolic
Also, hyperammonemia is not seen in phenyl ketonuria.
131
PEDIATRICS
Urea cycle enzyme defects are the most common genetic cause of hyperammonemia in
infants. Newborn babies with hyperammonemia are often misdiagnosed as having
sepsis.
Others linked to OTC X are autosomal recessive.
Causes of acquired hyperammonemia
•
Transient hyperammonemia of newborn
Reye's syndrome
Valproate treatment
Liver failure
Urease positive bacterial infections

(Answer A)
3. Which of the following applies to the treatment of organic acidemia in newborn
infants
used? (September 2003)
A) Carnitine
B) Pyridoxine
C) Biotin
D) Glycine
E) Vitamin B12
Organic acidemias
MSUD (maple syrup urine disease, maple syrup disease): Valine, leucine, isoleucine
Methyl malonic acidemia (MMA): valine and isoleucine
Propionic acidemia: Valine and isoleucine
Isovaleric acidemia: Leucine
3-Methylcrotonyl aciduria: Leucine
3-Hydroxyisobutyric acidemia: Valine
Beta ketothiolase deficiency: isoleucine
Multiple carboxylase deficiency
Due to the secondary carnitine deficiency, carnitines are used. Glycine with
isovaleric acid
It is given because it increases urinary excretion by esterification.
Biotin is given in the treatment of propionic acidemia. Propionyl CoA carboxylase
is lacking.
Vitamin B 12 is used in MMA.
B6 is used in the treatment of homocystinuria.
Common findings in organic acidemia:
•
Refuse to feed
Vomiting
acidosis
dehydration
neutropenia
hypoglycemia
Ketosis detected and without characteristic odor: Methyl malonic acidemia,

Propionic
acidemia, betaketothiolase deficiency (mixed with aspirin intoxication)
132

METABOLISM
Multiple carboxylase deficiency with characteristic skin manifestation
Odor: MSUD, Muttiple carboxylase deficiency and isovaleric acidemia
Non-ketosis of organic acidemias: 3 hydroxy, 3 methyl glutaric aciduria, immediate

CoA dehydrogenase deficiency, HMG CoA synthase deficiency
(Answer B)
4. Which of the following findings of mitochondrial fatty acid oxidation defects

a)
Hypoglycemia following hunger and life-threatening acute coma
B)
Chronic cardiomyopathy and skeletal muscle weakness
C.)
Sudden baby death
D)
Dysmorphric findings
E) Clinical picture mimicking Reye's syndrome

Dysmorphic findings are seen in peroxisomal diseases. For a detailed explanation of
the problem, see lipid
metabolism 2 and 3. Description of the problem.
Common findings in peroxisome biogenesis defects:
•
Absence or decrease in the number of peroxisomes
Determination of catalase in cytosol
Disruption of plasmalogen synthesis and decrease in tissue
Phytanic acid oxidation degradation and age-related accumulation
Bile acid synthesis disorder and accumulation of bile acid intermediate metabolites
•
Pipecolic acid oxidation disorder and accumulation
Urinary dicarboxylic acid increase

(Answer D)
5. Which of the following in the treatment of hyperammonemia in the newborn baby

used? (September 2002)
A) Sodium benzoate
B) Glutamine
C) Arginine
D) Phenylbutyrate
E) Phenylacetate
TREATMENT OF HYPERAMONYEMIA
Protein-restricted diet
Sodium benzoate, sodium phenylbutyrate
Arginine (Arginine is not given in hyperammonemias secondary to arginase deficiency
and organic acidemia)
Strullin (in the absence of OTC and CPS)
Since sodium benzoate and phenylacetate are deficient in carnitine, carnitine
should be added in chronic treatment.
Hyperamonemic coma treatment: Glucose, IV sodium benzoate, sodium phenylbutyrate,
arginine hydrochloride.
If there is no decrease in ammonia level, dialysis is performed.
Glutamine is composed of glutamate depending on the elevation of ammonia.
133
PEDIATRICS
The first compound used is sodium benzoate. Hippurate which is rapidly excreted
conjugated with benzoate glycine
create. The others are phenylacetate and phenylbutyrate. Phenylbutyrate is twice as
effective as benzene.
(Answer B)
6. Dehydration, acidosis, ketosis and neutropenia were detected in a three-day-old
infant who was brought to the hospital because of vomiting.
A) Homocystinuria
B) Emergency CoA dehydrogenase deficiency
C) Hyperphenylalaninemia
D) Methylmalonic acidemia
E) Tyrosinemia
Acidosis, ketosis and neutropenia are characteristic of organic acidemias. They
give symptoms in the early period. sepsis
confuse with. The only organic acidemia in style is methyl malonic acidemia.
Emergency Co A Dehydrogenase deficiencies lead to fatty acid oxidation disorders.
Most common type
moderate chain acyl-CoA dehydrogenase (MCAD) deficiency. After prolonged fasting,
it becomes symptomatic, but ketosis and severe acidosis are not expected.
If hyperphenylalaninemia had symptoms at 3 days, screening would not have been
necessary. It is asymptomatic in the early period.
Homocystinuria presents with lens subluxation around 3 years of age. Recurrent
thromboembolic
events, Marfonoid appearance. There is no acidosis or ketosis.
Tyrosinemia also does not cause the above table.
MMA:
Tubulointerstitial nephritis and CRF development
Metabolic stroke: Basal ganglia and internal capsule infarcts
Acute or recurrent pancreatitis
(Answer D)
7. In the 5-day-old baby who was brought with complaints of sucking and vomiting,
the physical findings were normal except for moderate dehydration and neutropenia
in laboratory examination.
acidosis and ketosis. Notice the smell of sweaty feet in the urine
What is the most likely diagnosis of this infant? (September 2000)
A) Multiple carboxylase deficiency
B) Isovaleric acidemia
C) Methyl malonic aciduria
D) Propionic aciduria
E) Phenyl ketonuria
Neutropenia and thrombocytopenia may be seen in organic acidemia. The specific clue
here is the smell of sweaty feet. There are two diseases where sweaty foot odor is
seen.
One is organic acidemia, isovaleric acidemia, and the other is glutaric aciduria
type 2.
134
METABOLISM
Isovaleric acidemia occurs due to isovaleryl CoA dehydrogenase deficiency in the

leucine oxidative pathway
is an oraganic acidic acid.
Usually in the first few days of life, feeding difficulties, metabolic acidosis,
convulsions “urine
sweaty foot odor and coma.
(Answer B)
8. Which is not seen in carnitine deficiency? (September 98)
A) Hypoglycemia
B) Hepatomegaly
C) Hepatic encephalopathy
D) Splenomegaly
E) Free fatty acid increase
Carnitine deficiencies in the transport of fatty acids to mitochondria will be
impaired for fat
acid oxidation defects. Periodic hypoglycemia periods due to decreased
glyconeogenesis due to degraded fatty acid oxidation are observed. Plasma free
fatty acids are increased, ketogenesis is impaired. Muscle weakness, heart problems
and lipid
accumulation is observed.
Lack of carnitine intake: Malnutrition, prematurity, total parenteral nutrition,
vegetarian diet
Carnitine losses: dialysis, renal tubular diseases
Excess use: Organic acidemias, intoxications, chronic drug use, severe acute
and chronic disease.
When toxic metabolites accumulate in the body, they are esterified with carnitine
and excreted in urine.
Periodic hypoglycemia periods due to decreased glyconeogenesis due to degraded
fatty acid oxidation are observed. Increase in plasma fatty acids reduces ketone
formation. Lack of carnitine
splenomegaly is not seen.
(Answer D)
9. Acidotic infant with hyperammonemia, vomiting and lethargy and convulsions
Which is the most likely diagnosis? (April 96)
A) Urea cycle defect
B) Mastocytosis
C) Phenyl ketonuria
D) Neonatal hepatitis
E) Organic acidemia
All organic acids are intermediate metabolites and, apart from transaminases, are
enzymes involved in degradation.
the lack of each leads to acidosis.
Acute neonatal form: Sepsis-like picture in neonatal period, acidosis,
hyperammonemia
and coma. Different types of special odors and clinical, although all of them
acidosis, ketosis,
ammonia height and cytopenia.
Uresiklu defects show alkalosis, not acidosis, despite high ammonia.
Neonatal hepatitis tyrosinemia is a differential diagnosis of direct
hyperbilirubinemia.
Mastocytosis involves proliferation of mast cells in the skin or internal organs.
(Answer E)
135
PEDIATRICS
10. Urinary methyl malonate excretion

Seen? (September 95)
A) Folic acid
B) Vitamin B12
C) Ascorbic acid
D) pyridoxine
E) Tyramine
Vitamin B12 deficiency causes megaloblastic anemia and neuropathy in peripheral
nerves. Methyl in urine
increase in malonic acid appears.
Megaloblastic anemia can also be seen in methyl malonic aciduria. Vitamin B12 is
used in the treatment.
(Answer B)
11th. Which of the following enzymes is missing in Lesch-Nyhan syndrome? (April 95)
A) Hypoxanthine guanine phosphoribosyl transferase
B) Adenosine phosphoribosyl transferase
C) Xanthine oxidase
D) Purine nucleoside phosphorylase
E) Adenosine deaminase
Lesch-Nyhan syndrome has hypoxanthine guanine phosphoribosyl transferase enzyme
deficiency. X
connected recessively. Causes marked hyperuricemia. Thinking of self-harm
important clue.
Other important findings;
•
Retardation in motor development
Extrapyramidal choreoatetoic movements
hyperreflexia
Clonus
Spasticity of feet
Do not hurt yourself
Gout
Gout arthritis
It causes non-radiopaque urate stones in urine.

(Answer A)
12. Which of the following does methyl malonic aciduria occur? (April 95)
A) Vitamin B1
B) Pyridoxine
C) Vitamin B6
D) Vitamin B12
E) Ascorbic acid
See question 10
(Answer D)
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METABOLISM
13. In a 5-day-old baby boy whose brother had previously died from consanguineous
marriage
vomiting, lethargy, convulsions are developing. Ammonia in the blood in laboratory
findings,
The level of orotic acid in the urine is high. The patient has cirrhosis. Most
likely
What is the diagnosis? (April 95)
A) Substrulinaemia
B) Lack of ornithine carbamoyl transferase
C) Orotic aciduria
D) Galactosemia
E) Phenylalanine hydroxylase deficiency
Clinical findings in urea cycle defects
Clinical findings are associated with hyperammonemia in urea cycle disorders other
than arginase deficiency.
Hyperammonemia, low urea, absence of acidosis or alkalosis, encephalopathy and
liver
There should be important tips on growth.
YD period: After protein intake (24 hours after milk feeding), signs of sepsis and
transient
mild respiratory alkalosis. Ammonia level is too high because ammonia cannot be
converted to urea.
high and low urea level.
Cerebral and pulmonary hemorrhage are lost without treatment. Neurological sequelae
remain in the living.
Infancy: Anorexia, vomiting, inability to weigh, developmental delay, hepatomegaly
(GER, cow's milk intolerance, hepatitis until they develop) are diagnosed.
Older children: They present as the most common episodes of metabolic
encephalopathy. Migraine or cyclic
vomiting and headache. The cause of death is usually due to cerebral edema.
It happens.
(Answer B)
Urea cycle defects
•
Carbamoyl phosphate synthase (CPS) deficiency
Ornithine transcarbamylase (OTC) deficiency
Arjininosuccinic acidemia: Deficiency of argininosuccinate lyase (AL)
Subtilinemia: Argininin succinate synthase (AS) deficiency
Hyperarginemia: Arginine deficiency
N-acetyl glutamate synthase deficiency
Arginase deficiency: Arginase deficiency is the most different from the others.
Hyperammonemia episodes
none / mild. It progresses insidiously with spastic diplegia, choreoatetosis and
convulsions.
Arginosuccinic aciduria (Calcic citrulinemia): Fragile hair (trichorexis nodosa),
erythematous maculopapular rash and chronic hepatomegaly are seen.
In OTC deficiency, 20% of heterozygous girls may be symptomatic.
In the absence of carbamoyl phosphate synthetase or ornithine carbamoyl transferase
(ornithine tarnscarbomoylase)
In addition to hyperammonemia, abnormalities in plasma amino acids cannot be
detected due to hyperammonemia. OTC deficiency is associated with a significant
increase in orotic acid in urine from carbomoylphosphate synthetase deficiency.
It is distinguished by increase.
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PEDIATRICS
14. Which one does not suggest hereditary metabolic disorder in the newborn?
(September 94)
A) Reducing substance in urine B) Odor disturbance in urine
C) Fecal occult blood
D) Metabolic acidosis
E) Vomiting
Considering metabolic disease or infection in the presence of one or more of the
following findings:
The baby is evaluated.
Nutritional deficiency
Vomiting
lethargy
Unanswered convulsions of glucose or calcium
Coma
Plasma ammonia and blood gas are the first tests. Ammonia and anion deficit is
normal
aminoacidopathy or galactosemia.
Urea cycle defect is considered if ammonia is high pH normal or alkalotic.
If ammonia and anion gap is increased, organic acidemias are considered.
Reductant in urine is significant for galactosemia.
For odor disorders, see amino acid metabolism disorders 1. Question.
(Answer C)
Clinical and laboratory findings of hereditary metabolism disorders;
•
Acute encephalopathy
•
causes.
ICP is either primary or metastatic. Headache, vomiting, hypertension, papillary
edema, coma.
Corticosteroid, chemotherapy, radiotherapy should be performed emergency
ventriculostomy.
Superior vena cava syndrome is associated with lymphomas. Venous due to superior
mediastinal masses
your turn is broken. Edema, cyanosis, proptosis and Horner may also be seen.
Tracheal compression: depends on the compression of mediastinel masses, causing
respiratory distress.
16. Chromosome analysis of a 6-year-old boy presented with abdominal mass
t (8; 14). What is the most likely diagnosis? (April 2001)
A) Wilms tumor
B) Burkit's lymphoma
C) Neuroblastoma
D) Ewing's sarcoma
E) Lymphoblastic lymphoma
Non Hodgkin's lymphoma (NHL) 60% of childhood lymphomas are NHL. This is the most
common
Burkitt is lymphoma. Burkitt lymphoma cells are L3-type cells that contain abundant
vacuoles and multiple nucleoli in the broad basophilic cytoplasm.
Endemic (African type) Burkitt lymphoma: It begins with a mass in the maxilla and
mandible, while sporadic Burkitt
often causes abdominal disease. Sporadic Burkitt is frequently seen in our country.
T (8; 14) is typical in Burkitt's lymphoma. c-myc is oncogene positive.
(Answer B)
513
PEDIATRICS
17. Which of the above patients should be considered? (April 2001)

A) Hypokalemia
B) Hyperuricemia
C) Hypercalcemia
D) Hyponatremia
E) Hypophosphatemia
(Answer B)
18. An ALL patient with a white blood cell count of 100 with thirty-nine degrees
fever
petechiae. What should be the next step? (September 2000)
A) Cultures are taken and broad-spectrum antibiotic treatment is initiated
B) Granulocyte transfusion
C) Cultures are taken and results are expected, antibiotics are started according
to these results
D) High-dose steroid and antipyretic treatment
E) Immediate antifungal treatment is initiated
Neutropenia with fever febrile neutropenia requires immediate evaluation in
malignant patients. Neutropenia may develop as a side effect of treatment or due to
bone marrow infiltration. Neutropenic with fever
patients are treated inpatient. After the patient's examination, all cultures were
taken and large
Spectral antibiotics are started. Candida and aspergillus if fever does not fall
within 7 days
antifungal should be added to the treatment.
Since neutropenic patients may have life-threatening pneumonia due to P. jiroveci
(P. carini), trimethoprim sulfometaxazole prophylaxis is performed.
If the patient is in contact with chickenpox, varicella zoster immunoglobulin is
performed. No vaccination.
If a rash occurs, hospitalize and give acyclovir.
If the condition is appropriate granulocyte, macrophage colony stimulating factor
is given.
(Answer A)
19. Six-year-old male for two weeks increased abdominal distension, abdominal pain,
weakness, loss of appetite
with the complaint. In FM, diffuse mass, ascites and scrotal edema are detected.
Acid liquid
In the cytology, L3 type, immunophenotype was compatible with B cell and
cytogenetic examination revealed t (8; 14).
What is the most likely diagnosis in this patient? (April 2000)
A) Lymphocytic non-Hodgkin's lymphoma
B) Large cell non-Hodgkin's lymphoma
C) Burkitt's lymphoma
D) Hodgkin's lymphoma
E) Malignant histiocytosis
Sporadic Burkitt emerges most often from the abdomen. It is less associated with
EBV. B is of cell origin and t (8; 14) is typical.
(Answer B)
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ONCOLOGY
20. What is the cancer that cannot be determined to be associated with EBV?
(September 99)
A) Kaposi's sarcoma in AIDS patients
B) Burkitt's lymphoma
C) Hodgkin's lymphoma
D) Leiomyosarcoma in immunocompromised patients
E) Nasopharyngeal cancer
Malignant proliferation of EBV
Nasopharynx carcinoma (common in Asia)
Burkitt's lymphoma (common in Africa)
Hodgkin's disease
Duncan (X-linked lymphoproliferative syndrome): primary infection is
uncontrollable, disseminated lymphoproliferation develops. It is fatal or develops
B cell lymphoma / hypogammaglobulinemia.
Leiomyosarcoma (occurs in immune suppresses, HIV and organ transplantation, not
healthy)
T cell lethal midline lymphoma
B cell lymphoma (especially in the nervous system, immunodeficiencies)
Kaposi's sarcoma in AIDS patients is associated with Human herpes virus 8.
(Answer A)
21. Empirical treatment in a child with leukemia with a neutrophil count below 500
What is the most important reason for starting? (April 99)
A) Sepsis protection
B) Gastroenteritis protection
C) Prevention from aseptic meningitis
D) Convulsion protection
E) Protection from urinary tract infection
A neutrophil count below 500 is severe neutropenia and carries a risk of sepsis.
(Answer A)
22. What do you think of a child with abdominal mass and jaw swelling? (April 96)
A) Burkit's lymphoma
B) Neuroblastoma
C) Retinoblastoma
D) Wilms tumor
E) Osteosarcoma
(Answer A)
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PEDIATRICS
23. What is the most common non-Hodgkin's lymphoma in a child? (April 96)
A) Burkitt's lymphoma
B) Anaplastic
C) Diffuse large B cell lymphoma
D) Mycosis fungoides
E) Lymphoblastic lymphoma
NHL in children and adolescents
Burkitt Lymphoma (40%)
Lymphoblastic lymphoma (30%)
Diffuse large B cell (20%)
Anaplastic large cell lymphoma (10%)
Non Hodgkin's lymphoma (NHL) 60% of childhood lymphomas are NHL.
Burkitt lymphoma is B cell-derived, typical of t (8; 14)
Most lymphoblastic lymphoma and anaplastic large cell lymphomas are of T cell
origin. t (2; 5) are translocations detected in anaplastic large cell lymphoma.
Clinic: BL endemic type is associated with EBV and emerges sporadically from the
abdomen in the mandible. Tumor is the most common cause of lysis syndrome.
Lymphoblastic lymphoma: Intrathoracic interest. It causes superior vena cava
syndrome.
BL and LL bone marrow and CNS involvement are common.
Manifestations requiring NHL emergency treatment: V. Cava superior syndrome, acute
paraplegia, tumor lysis
syndrome.
Bilateral bone marrow aspiration - biopsy and CSF sampling
It should be done.
Treatment: Chemotherapy. (If HH, radiotherapy and chemotherapy can be used)
Radiotherapy is used in VCS syndrome and paraplegia.
24. What is the most common type of cancer in children with HIV?September 95)
A) Leukemia
B) Lymphoma
C) Neuroblastoma
D) Retinoblastoma
E) Rabdomyosarcoma
(Answer B)
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ONCOLOGY
25. T-cell-mediated non-Hodgkin's disease in childhood, often located in the

mediastinum, leading to cough, dyspnea, pleural effusion, superior vena cava
syndrome
lymphoma type Which of the following? (April 95)
A) Lymphoblastic lymphoma
B) Burkitt's lymphoma
C) Follicular lymphoma
D) Small lymphocytic lymphoma
E) Immunoblastic lymphoma
(Answer A)
26. What is the most common cancer triad in childhood? (April 92)
A) Retinoblastoma, leukemia, liposarcoma
B) Wilms, leukemia, osteosarcoma
C) Osteosarcoma, Hodgkin, Wilms tumor
D) Leukemia, lymphoma, brain tumors
E) ALL, Hodgkin, neuroblastoma
Tumors originating from embryonal cells are mostly observed in infants and infants.
Tumors such as retinoblastoma, nephroblastoma, neuroblastoma and hepatoblastoma
were first diagnosed at the age of 4,
Hodgkin's disease, gonadal tumors and bone tumors more in older children and young
adults
is common.
The most common leukemia is brain tumor in developed countries, followed by
lymphoma and brain tumor.
It shaped.
(Answer D)
27. Where is non-Hodgkin's lymphoma most commonly localized in a child? (April 92)
A) Mediastinum
B) Abdomen
C) Waldeyer
D) Cervical
E) Inguinal
NHL emerges most frequently from the abdomen.
(Answer B)
28. In which disease do Reed-Sternberg cells appear? (April 89)
A) Acute lymphoblastic leukemia
B) Hodgkin's disease
C) Sarcoidosis
D) Tuberculosis
E) Pneumonia
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PEDIATRICS
A large owl-like nucleus that helps diagnose Hodgkin's disease

They are cells.
(Answer B)
29. Where does ALL most metastasize? (September 88)
A) Testis
B) Liver
C) Lung
D) Over
E) Central nervous system
ALL is most commonly metastasized to the nervous system then to the testicle.
(Answer E)
30. In which leukemia is disseminated intravascular coagulopathy most common?
(September 87)
A) Acute promyelocyte leukemia
B) Acute lymphoblastic leukemia
C) Monocytic leukemia
D) Erythrolleukemia
E) Hairy cell leukemia
DIC is most commonly seen in AML M3.
Another malignancy with DIC is neuroblastoma.
(Answer A)
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ONCOLOGY
neuroblastoma
one. Which of the following tumors can secrete a peptide that causes diarrhea? (May
2011)
A) Neuroblastoma
B) Wilms tumor
C) Rhabdomyosarcoma
D) Hepatoblastoma
E) Adrenocortical carcinoma
Tumor without passing PAS in almost all exams: Neuroblastoma. This time the
vasoactive intestinal peptide
(VIP) secreted to cause diarrhea was questioned. Every feature of this tumor can be
questioned. because this
The most common malignancy of the first year of tumor !!!
neuroblastoma
• Most common solid tm
• tm 50% in infant period (<1 year MOST FREQUENCY MALIGNITY)
• Frequent under two years of age, more frequent in men
• 1 p deletion, N myc amplification
• Ganglioneuroma-ganglioneuroblastoma
• It can emerge from any place with neural crest
-
70% of the abdomen (usually from the adrenal gland)
20% from the thorax (posterior mediastinum)
10% of the body can come from any part of the
• The most common metastases are long bones - the skull and bone marrow, lymph
nodes, liver and subcutaneous tissue.
Metastases at least AC
• Spontaneous regression of <1 year (especially Stage IVs)
Clinical features
• Abdominal mass
• Horner syndrome
• Hypertension
• Spinal cord compression, Bone pain
• Orbital ecchymosis
• Subcutaneous nodules
• Bleeding, infection, VERTICAL
• Thoracic mass (posterior mass)
• Cervical mass (most often left)
• Hepatomegaly, Lower extremity edema
• VIP release and diarrhea
• OLFACTOR NEUROBLASTOMA (ESTHESIONONEUROBLASTOM): Severe malignant neuroblastoma
originating from the olfactory nerve.
• Presence of good prognosis in opsoclonus-myoclonus syndrome
(Answer A)
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PEDIATRICS
2nd. A two-year-old girl is brought with a complaint of abdominal distention. Left

physical examination
7x8 cm mass in the upper quadrant palpated child's bone marrow rosette
Blasts forming.
What is the most likely diagnosis for this child? (December 2010)
A) Lymphoma
B) Rhabdomyosarcoma
C) Neuroblastoma
D) Hepatoblastoma
E) Ewing tumor
The classic question of neuroblastoma, which was previously similar. Neuroblastoma
is the most common malignancy of the west especially in the first two years of age
in children. In particular, unlike Wilms tumor;
Metastasis sites (NBL most commonly in bone and bone marrow).
On the other hand, with an abdominal mass; periorbital ecchymosis, pseudorozet in
bone marrow (Homer–
Wright) formation, subcutaneous nodules, intratumor hemorrhage and necrosis,
midline trait
opsomyoclonus, Horner syndrome, paraplegia and DIC.
should bring.
(Answer C)
3. Which of the following is a valuable finding in the diagnosis of neuroblastoma?
(September 2009)
A) Increased urinary catecholamines
B) Increased serum α-fetoprotein level
C) Increased sedimentation
D) Serum LDH increase
E) Serum β-hCG increase
The increase in catecholamine increases in neuroblastoma, ganglioblastoma and
pheochromocytoma.
Alfafetoprotein: in hepatoblastoma, hepatocellular carcinoma, malignant teratoma
and yolk sac tumors
increases.
HCG: Increases in choriocarcinoma.
Neuroblastoma (NB): It is an embryonal tumor originating from the peripheral
sympathetic system. Mean age at diagnosis
2. Congenital cardio may be associated with vascular anomalies. Non-differentiation
ganglioneuroblastoma containing mature ganglion cells from a round cell tumor
(neuroblastoma)
can be in different specrum. May show spontaneous regression.
Most often comes from the abdomen (adrenals).
Metastatic disease includes fever, irritability, proptosis and periorbital
ecchymosis.
The most common metastases are: long bones and skull, bone marrow, liver, lymph
node and skin. In contrast to Wilms' tumor, lung metastasis is rare.
Neurological findings: Upper cervical chain dislocation Horner syndrome, (ptosis,
anhidrosis, myosis and
enophthalmitis), paraspinal areas, compression of spinal nerves, paraneoplastic
syndrome
opsomyoclonus (dancing eyes-feet).
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ONCOLOGY
Diagnosis: A mass that can cross the midline on CT and contains calcification.
Tumor indicators: Homovalinic acid and vanilla mandelic acid are increased.
Demonstration of neuroblasts in bone marrow and biopsy with increased homovalinic
acid, vanillary mandelic acid
can be diagnosed without NB.
Metaodobenzylguanidine (MIGB) scintigraphy is used to assess the extent of the
disease.
The most important factors determining prognosis are stage, age and N-myc. N- Myc
amplification stage and age
independent predictor of poor prognosis.
(Answer A)
4. The most probable diagnosis for a 2.5-year-old child with abdominal mass,
proptosis and periorbital ecchymosis and positive for vanillyl mandelic acid in
urine is as follows:
A) Wilms tumor
B) Lymphoma
C) Retinoblastoma
D) Rhabdomyosarcoma
E) Neuroblastoma
Proptosis is seen in periorbital ecchymosis (raccoon eye) metastatic disease. Bone
marrow without biopsy
aspiration and increased catechol amine.
See question 2
(Answer E)
5. Which of the following is the most common site of neuroblastoma?
(September 2007)
A) Abdomen
B) Chest
C) Pelvis
D) Neck
E) Intracranial
See 2. Question.
(Answer A)
6. Which of the following is the least likely to metastasize to neuroblastoma?
(April 2006)
A) Bone marrow
B) Liver
C) Bone
D) Lung
E) Leather
While Wilms tumor is the most common metastasis to lung, lung metastasis in
neuroblastoma is rare.
See 2. Question.
(Answer D)
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PEDIATRICS
7. Right orbital proptosis, periorbital ecchymosis and opsomyoclonic contractions

is considered first in a child aged 6 years? (September 2005)
A) Neuroblastoma
B) Viral encephalitis
C) Myasthenia gravis
D) Rabdomyosarcoma
E) Langerhans cell histiostosis
Opsoclonus myoclonus (dancing eyes, feet) is seen as paraneoplastic syndrome. tumor
response and positively affect prognosis.
Tumor neuroblastoma is the most common paraneoplastic disease in childhood.
(Answer A)
8. Physical examination of a 1-year-old boy who presented with a complaint of
abdominal distention
Examination revealed a midline abdominal mass, proptosis, periorbital ecchymosis
and oxomyoclonus. Rosette formation was observed in bone aspiration.
Three standard deviations of normal catecholamine levels in 24-hour urine
It was found to be above.
What is the most likely diagnosis for this child? (September 2003)
A) Wilms tumor
B) Neuroblastoma
C) Hodgkin's disease
D) Non-Hodgkin's lymphoma
E) Hepatoblastoma
The calcified mass that crosses the midline is important in differentiating from
Wilms. Other findings classic
Neuroblastoma. See 2. Question.
(Answer B)
9. Ecchymosis around the eye, abdominal mass and blastic forming a rosette in the
bone marrow
What is the most likely diagnosis for a 4-year-old patient with infiltration?
(September 2001)
A) Lymphoblastic leukemia
B) Orbital rhabdomyosarcoma
C) Neuroblastoma
D) Retinoblastoma
E) Burkitt's lymphoma
See 2. Question
(Answer C)
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ONCOLOGY
10. Which of the following is an indicator of good prognosis in neuroblastoma?

(April 2001)
A) NSE activity
B) be less than 1 year
C) Retroperitoneal adrenal location
D) Differentiation of cells
E) High ferritin
The most important factors determining prognosis are stage, age and N-myc. N- Myc
amplification stage and age
independent predictor of poor prognosis.
Increased NSE, LDE, Ferritin and neuropeptide Y are also indicative of poor
prognosis.
(Answer B)
Good prognosis
Poor prognosis
Cervical / thoracic placement
Abdominal placement
<1 year
> 1 year
I hyperdiploidy
N-myc amp,
Opsoclonus-myolonus
1p del
Stage 4S, 1-2
Stage 3-4
The amount of stroma, the mitosis-free index, the degree of differentiation, and
the presence of significant nucleolus are histological factors that affect
prognosis. (The Shimada classification is divided into favorable / unfavorable).
11th. Childhood neuroblastoma, which does not have a poor prognosis criterion?
(April 2000)
A) N myc copy number increase
B) be older than 1 year
C) Stage IV
D) Abdominal placement
E) Stage IV S
Stage 4S: <1year, stage 1-2, liver, skin and bone marrow metastasis. Bone
involvement and bone marrow
There should be no more than 10% involvement. Since stage IV S may spontaneously
regress, patients are monitored without treatment.
See 8. Question.
(Answer E)
Neuroblastoma staging
Stage1: Localized to the organ of origin
Stage 2: It may have been out of the organ, not crossing the midline, and lymph
node involvement.
Stage 3: Localized tumor opposite the midline, bilateral lymph node involvement in
the midline
lymph node metastasis.
Stage4: Far from metastasis
Stage 4S: <1year, stage 1-2, liver, skin and bone marrow metastasis.
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PEDIATRICS
12. If a child with a neck mass has ptosis, myosis, enophthalmus and anhidrosis
What is the most likely diagnosis if VMA increases in urine? (April 99)
A) Retinoblastoma
B) Neuroblastoma
C) Hodgin Lymphoma
D) Leukemia
E) Wilm's tumor
Horner syndrome has been described with ptosis, myosis, enophthalmus and
anhidrosis. Cervical placement
tumor. See question 2
(Answer B)
13. Abdominal palpable mass, subcutaneous nodules and histopathological examination
in the bone marrow
What do you consider first in a 2-year-old child with a badge formation?
(September 98)
A) Pheochromastoma
B) Wilms tumor
C) Nephroblastoma
D) Neuroblastoma
E) Polycystic Kidney
Malignancy should be considered in children until any abdominal mass is proven
otherwise.
Wilms tumor, Neuroblastoma, Non-Hodgkin's lymphoma, germ cell tumor, teratoma,
rhabdomyosarcoma,
hepatoblastoma is the cause of abdominal mass.
Preschool children have neuroblastoma, Wilms tumor, hepatoblastoma.
Adolescents have hepatocellular carcinoma and germ cell tumors.
Germ cell tumors and teratomas may also occur in young children.
NHL occurs above 1 year of age, is recognized by invagination at> 2 years, elevated
urinary acid, and bone marrow aspiration.
Rhabdomyosarcoma can be of any age, sarcoma botrioides, vaginal bleeding,
paratesticular mass, GIS and
genitourinary obstruction is detected.
Hepatoblastoma: 0-3 years, large hard liver and increased AFP.
Hepatocellular carcinoma: It occurs in older children. It is related to cirrhosis
and HBV. AFP increases.
Germ cell tumor: abdominal pain and vaginal bleeding in girls, new hydrocele and
testis in boys
comes with the mass.
Neuroblastoma diarrhea, GIS, GIS obstruction, raccoon eye, myoclonus opsoclonus, in
young children
skin nodules, VMA in urine, increased HMA, calcification of the mass are detected.
(Answer D)
14. Which of the following is not seen in neuroblastoma? (April 95)
A) Horner syndrome
B) Aniridi
C) Opsomyoclonus
D) Hypertension
E) Diarrhea
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ONCOLOGY
Horner syndrome occurs in cervical sympathetic chain tumors

Hypertension is due to increased catecholamines.
Diarrhea is caused by the release of vasoactive intestinal peptide. Resistant
secretory diarrhea and hypopotasemia are seen.
It is called Kerner Morrison syndrome.
Opsoclonus myoclonus occurs due to autoimmune / immunological response.
Aniridi accompanies the Wilms tumor.
(Answer B)
15. Chronic diarrhea, abdominal mass, bone marrow rosette formation in the patient
Possible diagnosis is: (September 94)
A) NonHodgkin's lymphoma
B) Neuroblastoma
C) Wilms tumor
D) Hepatoblastoma
E) Rhabdomyosarcoma
Abdominal mass in children is considered malignant until otherwise detected.
Invagination in NonHodgkin's lymphoma
Hemihypertrophy and aniridia in Wilms tumor
Large hard liver in hepatoblastoma
Sarcoma botrioides, vaginal bleeding and paratesticular mass are detected in
rhabdomyosarcoma.
See question 12
(Answer B)
16. Which of the malignant diseases in children has the best chance of recovery?
(April 94)
A) Neuroblastoma
B) Wilms tumor
C) Rabdomyosarcoma
D) Osteosarcoma
E) Ewing's sarcoma
Spontaneous regression is characteristic of neuroblastoma.
Neuroblastoma treatment:
Untreated follow-up in stage 4S.
It can be used in chemotherapy, radiotherapy and surgical treatment.
Stage 1-2 surgery is performed.
Retinoic acid and stem cell transplantation can also be used in treatment.
Another malignancy using retinoic acid is AML M3.
(Answer A)
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PEDIATRICS
17. TA: 170/110 mmHg, large, common mass lobulated in the abdomen, and come with
severe diarrhea
What is considered in a two-year-old child with lobular formation in the bone
marrow?
(April 94)
A) Wilms tumor
B) Whiple disease
C) Neuroblastoma
D) Retinoblastoma
E) Non Hodgkin's disease
Malignancies that cause hypertension in children
•
Neuroblastoma,
Pheochromositoma
Wilm's tumor
Diare in child: neuroblastoma, ganglioneuroma

(Answer C)
18. Which of the following increases in urine in neuroblastoma? (September 90)

A) Vanyl mandelic acid
B) 17 hydroxy progesterone
C) 5 hydroxy indoleacetic acid
D) Epinephrine
E) Immune globulin light chain
Catecholamines cannot be detected in the urine since their half-lives are very
short. metabolites
increases. Homovalinic acid, vanilla mandelic acid and normetanephrine are
increased.
In neuroblastoma, catecholamine metabolites increase in urine.
Dopamine degradation product: homovalinic acid
Norepinephrine degradation product: Normetanephrine
Vanil mandelic acid is a degradation product of norepinephrine and epinephrine.
5 OH indoleacetic acid is a breakdown product of seratonin and increases in
carcinoid tumors.
17 OH progesterone is used for screening congenital adrenal hyperplasia. Looks in
the blood. urine
increases pregnantriol.
The immune globulin light chain is increased in multiple myeloma. I think - Jones
proteinuria is seen.
(Answer A)
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ONCOLOGY
WILMS TUMOR
one. Which of the following is not one of the congenital anomalies associated with
Wilms' tumor? (April 2009)
A) Aniridi
B) Hemihypertrophy
C) Dextrocardia
D) Genitourinary anomalies
E) Beckwith-Wiedeman syndrome
There is no examination without Wilms tumor (WT) or neuroblastoma. Congenital
malformations
is tumor WT. Although cardiac anomalies may accompany neuroblastoma, they do not
accompany WT.
(Answer C)
Syndrome associated with Wilms tumor
WAGR: WT, Aniridi, genitourinary anomaly, mental retardation
Danys Drash: Renal insufficiency, male pseudohermaphrodism, increased risk of WT
Backwith-Wiedemann: Organomegaly (liver, kidney, adrenal, pancreas), macroglossi,
omphalocele, hemihypertrophy, increased risk of WT
Hemihypertrophy, sporadic aniridia, genitourinary anomalies, renal rest
Neurofibromatosis, Sotos syndrome, von Willebrand disease
Wilms Tumor (WT): Stroma, blastem, epithelial-containing complex embryonal tumor. I
nephroblastoma
also called.
The most common primary renal tumor in children is abdominal solid tumor after NB.
Most often 2 - 5 years
It is seen. Family members tend to be younger and bilateral.
The most common presentation is due to abdominal mass. Hypertension and hematuria
may also occur.
Polytherapy due to erythropoietin release, acquired vWH-induced bleeding diathesis
is less common
the findings.
The most common site of metastasis is the lung. The WT gene is localized at 11p.
2nd. The most probable diagnosis in a 3-year-old child with abdominal mass and
hemihypertrophy
Which of the following? (September 2008)
A) Hepatocellular carcinoma
B) Neuroblastoma
C) Wilms tumor
D) Teratoma
E) Lymphoma
513
PEDIATRICS
Abdominal mass, hemihypertrophy suggests WT. See 1. Description of the problem.

(Answer C)
3. Which chromosomal anomaly is typical for Wilms tumor?
(April 2008)
A) 13q14 deletion
B) t (8; 14)
C) Trisomy 21
D) 11p13 deletion
E) t (2; 5)
Chromosomal disease
Tumor
Chromosome 11 p- / sporadic
aniridia
WT / WT1 gene
Chromosome 13 q-
Retinoblastoma, Sarcoma (osteosarcoma)
Trisomy 21
AML / ALL (400 times the risk of AML). Sensitivity to chemotherapy was increased.
Klinefefelter s
Breast cancer and extra gonadal germ cell tumor
Noonan syndrome
Juvenile myelomonocytic leukemia
Trisomy 8
my Prelöse
Monosomy 5/7
Myelodysplastic syndrome
Genetic disorders of Wilms tumor

WT1 gene
Beta catenin may be associated with the WT mutation.
P 53 mutation: Anaplastic type is common. There are 80% of Wilms tumors.
The Wilms tumor gene is located on 11 chromosomes.
Down syndrome: The risk of AML increases 400-fold. Especially acute megakaryocytic
leukemia,
increased sensitivity to chemoteopathics and transient leukomoid reaction. The risk
of ALL is also increased.
Chromosome 13 is related to q-: retinoblastoma and osteosarcoma.
t (8; 14): Burkitt is seen in lymphoma. It is a mutation that has no effect on
prognosis in ALL.
t (2; 5): typical of anaplastic type non Hodgkin's lymphoma.
(Answer D)
4. In a patient with Wilms tumor, which of the following is associated with a poor
prognosis?
(April 2007)
A) Aniridi
B) Gender
C) Hemihypertrophy
D) Detection of anaplasia
E) Age
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ONCOLOGY
Poor prognosis criteria

•
Anaplastic histology (most important)
Large tumor mass (> 500 g)
Advanced stage (3-4)
Histopathological examination revealed a three-fold increase in the nuclear size of

hyperchromasia, hyperdiploid mitotic figures
indicates anaplasia. Anaplasia shows poor prognosis in Wilms tumor (except stage I)
(Answer D)
5. Which of the following diseases can be seen most frequently in polycythemia?
(April 2004)
A) Rabdomyosarcoma
B) Lymphoma
C) Hypernephroma
D) Ewing's sarcoma
E) Neuroblastoma
Polycythemia due to WT erythropoietin production and hemorrhage due to acquired von
Willebrand disease
visible.
See 1. Question.
Malignancies causing polycythemia
•
Wilms tumor (hypernephroma)
Cerebellar hemangioblastoma - von Hippel - Lindau
Hepatocellular carcinoma
Masculinizing ovarian tumors

(Answer C)
6. Which of the following tests is most helpful in diagnosing a child with

suspected Wilms tumor? (September 2002)
A) Thorax computed tomography
B) Intravenous pyelography
C) Abdominal ultrasonography
D) Kidney scintigraphy
E) Abdominal computed tomography
See 1. Question
(Answer E)
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PEDIATRICS
7. Aniridia was detected in a 3-year-old boy who had a right abdominal

The mass was palpated. Hematuria was obscured during urinalysis. Most likely for
this patient
What is the diagnosis? (April 2002)
A) Neuroblastoma
B) Rabdomyosarcoma
C) Renal cell carcinoma
D) Wilms tumor
E) Non-Hodgkin's lymphoma
See 1. Question
(Answer D)
8. Which is one of the most common anomalies in patients with Wilms' tumor
A) Hemihypertrophy
B) Polycystic kidney
C) Urinary system anomalies
D) Aniridi
E) Genital anomalies
Wilms' tumor is associated with aniridia, genitourinary anomalies and
hemihypertrophy.
(Answer B)
9. A three-year-old boy comes with abdominal distention and abdominal pain.
Hematuria is detected in the examinations. Aniridi, intraabdominal
The contour has a mass not exceeding the midline. What is the most likely
diagnosis? (September 2000)
A) Neuroblastoma
B) Rhabdomyosarcoma
C) Hodgkin's disease
D) Wilms tumor
E) Teratoma
(Answer D)
10. A 2.5-year-old boy with in coin yon lesions on chest X-ray showed abdominal
What is the most likely diagnosis if the upper quadrant mass is palpated?
(September 99)
A) Wilms tumor
B) Neuroblastoma
C) Hepatoblastoma
D) Mesonephroid nephroma
E) Hodgkin's lymphoma
Abdominal mass coin lesion in lung is seen in Wilms tumor.
(Answer A)
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ONCOLOGY
11th. What is the most common renal tumor in a child? (September 98)
A) Wilm's tumor
B) Neuroblastoma
C) Renal cell cancer
D) Hypernephroma
E) Nephroblastoma
Wilms tumor is the most common renal tumor in childhood. It is the second most
common abdominal tumor following neuroblastoma.
(Answer A)
12. Abdominal mass, hematuria, aniridia
which should be considered? (April 97)
A) Wilms tumor
B) Neuroblastoma
C) Renal cell carcinoma
D) Hepatoblastoma
E) Lymphoma
(Answer A)
13. Where does Wilms tumor most often metastasize? (September 96)
A) Lung
B) Liver
C) Bone
D) Brain
E) Spleen
Coin lesions in the lung. The difference from neuroblastoma is the frequent
metastasis to the lung. See 1.
Question.
(Answer A)
14. Which one is not seen in Wilms' tumor? (September 95)
A) Aniridi
B) Hemihypertrophy
C) Exophthalmitis
D) Genitourinary anomalies
E) Hypertension
513
PEDIATRICS
Ocular findings in childhood tumors

Retinoblastoma: Leucocori
Neuroblastoma: Periorbital ecchymosis, Horner syndrome, iris heterochromia,
opsoclonus, myoclonus
Wilms' tumor: Aniridi.
Exophthalmitis is seen in orbital tumors. Like rhabdomyosarcoma and lymphoma.
(Answer C)
15. If the child has hemihypertrophy, which of the following diseases do you
consider?
(September 93)
A) Fibrosarcoma
B) Lymphoma
C) Nasopharyngeal cancer
D) Wilms tumor
E) Thyroid cancer
Other conditions related to hemihypertrophy
•
Adrenocortical tumor
Hepatic tumor
hamartomas
Backwith-Wiedemann
Neurofibromatosis
Silver syndrome
(Answer D)
16. Hemihypertrophy, hypertension, hematuria, GUS anomaly and abdominal mass

complaints
What do you think of a 4-year-old child who comes with the patient? (April 93)
A) Wilms tumor
B) Neuroblastoma
C) Lymphoma
D) Teratoma
E) Rabdomyosarcoma
(Answer A)
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ONCOLOGY
17. What is the disease in which Ebstein Barr virus is not involved? (September 92)
A) Burkitt's lymphoma
B) Nasopharyngeal carcinoma
C) Wilms tumor
D) Infectious mononucleosis
E) B cell lymphoma
EBV virus is a DNA virus from the herpes virus family. Infection in childhood
usually causes a self-limiting picture. EBV can also cause virus-associated
hemophagocytic syndrome and malignancies.
Diseases related to EBV
Benign proliferation:
Lokoplaki in adults with AIDS
Interstitial pneumonia in children with AIDS
Malignant proliferation:
Nasopharynx carcinoma (common in Asia)
Burkitt's lymphoma (common in Africa)
Hodgkin's disease
Duncan (X-linked lymphoproliferative syndrome): primary infection is
uncontrollable, disseminated lymphoproliferation develops. It is fatal or develops
B cell lymphoma / hypogammaglobulinemia.
Leiomyosarcoma (occurs in immune suppresses, HIV and organ transplantation, not
healthy)
T cell lethal midline lymphoma
B cell lymphoma (especially in the nervous system, immunodeficiencies)
(Answer C)
18. A 4-year-old male patient with an anterior mass without a midline on the left
which of the following should be considered? (April 91)
A) Non-Hodgkin's lymphoma
B) Wilms
C) Neuroblastoma
D) Pheochromocytoma
E) Hepatomegaly
(Answer B)
513
PEDIATRICS
BRAIN TUMORS
one. Which of the following central nervous system tumors in childhood has a better
prognosis than others? (September 2006)
A) Pons glioma
B) Juvenile pilocytic astrocytoma
C) Atypical teratoid rhabdoid tumor
D) Anaplastic astrocytoma
E) Choroid plexus carcinoma
The factors determining the prognosis in central nervous system tumors are grade
and localization of the tumor.
Pons glioma is related to vital structures such as respiratory and circulatory
centers due to its location and is not suitable for surgery.
Embryonal tumors: Primitive neuroectodermal tumors (PNET).
· Medulloblastoma
· Supratentorial PNET
· Atypical teratoid / rhabdoid tumor
· Epandimoblastoma
It is the largest group of brain tumors in childhood. They're all Grade IV.
Glial tumors: Astrocytes, epandymal cells and tumors originating from
oligodendroglial cells.
Juvenile pilocytic astrocytoma: The most common (highest frequency alone) brain in
childhood
The tumors. She likes the cerebellum and Rosenthall fibrils are seen. Grade I
tumor.
Anaplastic astrocytoma and glioblastome multiforme belong to malignant astrocytoma
group. GBM most adult
common tumor and grade IV.
Choroid plexus carcinoma: The most common tumors under 1 year of age are choroid
plexus papilloma / carcinoma.
Carcinoma is Grade III. Transthyretin (prealbumin) positivity is important in the
diagnosis. Associated with Li-Fraumeni syndrome and Simian virus SV-40
(Answer B)
2nd. In children, which of the following brain tumors is more common than others
Seen? (April 2006)
A) Ependymoma
B) Medulloblastoma
C) Craniopharyngioma
D) Oligodendroglioma
E) Germ cell tumor
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ONCOLOGY
Juvenile pilocytic astrocytoma, which is the most common brain tumor

If you have found the answer. The frequency alone is 20%. If you have PNET in the
style that medulloblastom
the total frequency is still 20%. Other types of astrocytomas
The most common tumor is astrocytoma. However, because the frequency varies with
age, the situation is different if given age.
Age and frequency:
0-1 years: Most often settle in supratentorial. The most common tumor type Choroid
plexus tumors later
teratoma
1-10 years: Most often infratentorial settle. The most common types of tumors are
juvenile pilocytic astrocytoma and
medulloblastoma
> 10 years: The most common supratentorial places. Diffuse astrocytoma is the most
common tumor.
Frequencies by place of residence (all childhood)
Hemispheric tumor (37%): Glial tumors are the most common. Of these, low-grade
astrocytomas (23%) most
stylish.
Midline tumors (14%): more common in children. Craniopharyngioma is the most
common. Optical chiasm glioma
> tumors of the pineal region
Posterior fossa tumors (49%): Cerebellar astrocytoma, brain stem glioma,
medulloblastoma equal
frequency (15%). Ependymoma is a posterior fossa tumor.
(Answer B)
3. Which of the following is mutated in Li-Fraumeni syndrome? (April 2005)
A) 13q14
B) P53 gene mutation
C) 17q.
D) 22q
E) p56 gene
Diseases that create risk for CNS tumors
NF-1: Optic glioma, astrocytoma, neurofibroma, malignant peripheral nerve tissue
tumors. 17. Kr NF- 1
gene.
NF-2: Vestibular schwannoma, meningioma, spinal cord ependymoma, astrocytoma. 22 kr
NF 2 gene.
Tuberosclerosis: Subepandimal giant cell astrocytoma, cortical tuber. 9/16 kr
tuberin and hamartin
gene
von Hippel- Lindau: Hemangioblastoma
Li-Fraumeni Syndrome: Astrocytoma, PNET. 17. Kr P 53 gene
Turcot Syndrome: Medulloblastoma, Glioblastoma. 5. kr APC (familial polyposis coli)
gene
Nevoid basal cell carcinoma: Medulloblastoma
Cowden syndrome: cerebellar dysplastic gangliocytoma
(Answer C)
4. A 5-year-old boy has headache, nausea, vomiting, consciousness in the morning
changes occur. If cerebellar mass is detected on MRI
What is the possible diagnosis? (September 99)
A) Metastatic cancer
B) Oligodendroglioma
C) Medulloblastoma
D) Pyloric stenosis
E) Meningioma
513
PEDIATRICS
Medulloblastoma: It is the most common embryonal tumor. It is most commonly located

in the cerebellar vermis. Fourth ventricle
Clogging symptoms such as nausea, vomiting, headache, hypertension and cerebellar
function
disorder ataxia, dysmetria, such as makes. The incidence increases in 4-6 years.
All CNS tumors
is the tumor with the most extranural spread. Rapid obstruction of the fourth
ventricle
supratentorial with symptoms such as vomiting, headache, cranial nerve paralysis,
papilla edema.
earlier than tumors. It is recognized by the positivity of synaptophysis and the
Homer-Wright badges.
(Answer C)
5. In which region is the most common brain tumor in children? (April 96)
A) Infra tentorial
B) Supra tentorial
C) Intramedullary
D) Pituitary
E) Midline
The most common tumors in children originate from the posterior fossa. So the
tentorium is under the cerebellum.
(Answer A)
6. Drinking too much water, urination, bilateral temporal hemianopsis
Suprasellar calcification was detected in a radiograph taken in a young female
patient. This
What is the possible diagnosis in a patient? (September 95)
A) Histiocytosis
B) Nephrogenic diabetes insipitus
C) Craniopharyngoma
D) Prolactinoma
E) Medulloblastoma
In histiocytosis, central diabetes insipitus due to ADH deficiency may be seen, but
lytic lesion in the head bones is expected instead of suprasellar calcification. In
nephrogenic diabetes insipidus
There is no ADH deficiency. ADH receptor mutation or impaired response to ADH is
characterized.
Prolactinoma is the most common pituitary tumor in adults and galactorrhea comes
with amenorrhea.
Craniopharyngioma: It is a pituitary tumor that develops from Rathke's scraps.
Suprasellar in the region
settles and shows calcification. Visual field defects (most commonly bilateral
hemianopsia), endocrine
panhipopituitarism, including inadequacies ADH and HG deficiency. Solid with MR,
a mass with cystic areas and a mass with calcification are detected on CT.
Calcification is not seen on MRI. The treatment is surgical. Chemotherapy has no
place.
(Answer A)
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ONCOLOGY
BONE AND
SOFT TISSUE TUMORS
one. A rigid mass in the rectal examination of an 8-month-old child with
constipation
Which of the following should be considered first? (September 2011)
A) Non-Hodgkin's lymphoma
B) Rectal carcinoma
C) Hodgkin's lymphoma
D) Teratoma
E) Wilms tumor
Let's ask a different question, and the complaint of constipation and rectal mass
in the 8-month
fictionalized The teratoma that likes the typical sacrococcygeal location is the
answer.
There is not much choice except.
Because Nonhodgkin lymphoma most commonly occurs in the ileal and anterior
mediastinum, Hodgkin lymphoma is the most common mass in the cervical-mediastinal
region and in the WILMS. Of course I'm 8 months old
If you say I want to mark the carcinoma of the rectum.
Tumor
Age
Clinical findings
Lab. finding
Wilms
Pre-school
Mass in unilateral flank, aniridia, hemihypertrophy

The hematuria; bone
scintigraphy
I sarcosine)
neuroblastoma
Pre-school
GI / GU obstruction, raccoon eyes,

VMA, HVA, ferritin
myoclonus-opsoclonus, diarrhea, skin nodule- increased, dotted mass
countries (infants)
calcification, KI positive
Non-Hodgkin 1.
> 1 year
Intussusception> 2-year-old
Increased urate, Ki positive
Rabdomyosarkom Everyone Everyone
GI / GU obstruction, sarcoma botrioides,

vaginal bleeding, paratesticular mass
Germ cell /
teratoma
Pre-school/
adolescents
Girl: abdominal pain, vaginal bleeding
hepatoblastoma
First 3 years
Large, hard KC
AFP increased
hepatoma
School / adolescent Large, hard KC, hepatitis B, cirrhosis
AFP increased
hCG, AFP increase
Male: testicular mass, new hydrocele

Sacrocoxiegeal mass
(Answer D)
513
PEDIATRICS
2nd. A 14-year-old boy presented with a swelling on his left upper arm.
Radiographic examination shows a lytic lesion in the left humeral diaphysis. Lesion
periosteum reaction (onion skin appearance) is detected around. For this patient
Possible diagnosis is: (May 2011)
A) Osteoid osteoma
B) Osteosarcoma
C) Ewing's sarcoma
D) Langerhans cell histiocytosis
E) Simple bone cyst
Again, a question asked in different ways in previous exams. Lytic lesion and onion
membrane in the diaphysis
Ewing's sarcoma Ewing's sarcoma
• Histologically uniform blue round cell tumors
-
Tumor tissue contains glycogen - PAS (+)
t (11; 22)
MIC-2 antibody positivity
• Femur and pelvis are most commonly involved

• Lytic lesions in the diaphysis of long bones
• Onion skin appearance
• Ewing sarcoma usually metastasizes to the lung and bone, less frequently to the
bone marrow and central nervous system
• The main finding is pain, fever and tenderness, soft tissue mass => Mixed with
osteomyelitis
Treatment of surgery, RT and CT
Doxorubicin, vincristine, cyclophosphamide side effects in CT
• Metastatic disease
• Bone and Ki involvement
Pelvic and sacral involvement
• LDH increase
IMPORTANT TO KNOW THE DIFFERENCES OF OSTEOSARCOMA (OS) AND EWING SARKOM (ES) !!!
• OS consists of spindle cells containing osteoid, ES consists of small round cells
• OS predisposing disease, no ES
• ES exits from the OS diaphysis
• OS is usually sclerotic lesion and ES lytic lesion.
• OS periorst reaction is daylight, Codman triangle, ES onion skin.
• OS RT is ineffective in treatment. ES is effective.
• Systemic symptoms such as ES fever weighing loss occur and are mixed with
osteomyelitis.
(Answer C)
3. What is the most common subtype of pediatric rhabdomyosarcoma?
(September 2008)
A) Embryonic
B) Alveolar
C) Pleomorphic
D) Andifferentiated
E) Desmoplastic
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ONCOLOGY
RMS is the most common soft tissue sarcoma in children. The most common location in
children is the neck. This
monitors the genitourinary system (especially under 10 years) and extremities. Live
settlements and types
changes depending on. Neurofibromatosis with familial multiple malignancy syndrome
(Li-Fraumeni syndrome)
can be together. Embryonic and botroid RMSs in bladder and vagina in infants,
extremity and trunk localized alveolar RMS are common in older children. There are
four types of RMS.
one.
2nd.
Embryonal: It settles in head and neck and genitourinary system. The most common
type.
Botroid type: It shows polyopoid growth in the form of bunch of grapes. Most often
from the bladder and vagina
interest.
3.
Alveolar type has the worst prognosis. It is more common at> 10 years of age. Deep
of limb and trunk
muscles.
4.
Pleomorphic type is the rarest type in children, mostly seen in adulthood. This is
prognosis
type is also bad.
Makes metastasis in the early period. Lung (most common) and bone metastases are
seen. Respiratory distress or
Symptomatic hypercalcemia.
(Answer A)
4. Following recovery in a child with hereditary retinoblastoma, which of the
following is most likely to develop secondary? (September 2005)
A) Rabdomyosarcoma
B) Wilm's tumor
C) Non-Hodgkin's lymphoma
D) Fibrosarcoma
E) Osteosarcoma
In hereditary retinoblastoma (RB), there is inactivation of the retinoblastoma gene
on 13 chromosomes. Gen
retinoblastoma protein (pRB) is a tumor suppressor gene.
Hereditary RB:
Tend to be bilateral and multifocal
Interest at a younger age
Secondary tumor is the most common osteosarcoma.
Retinoblastoma: Exits the nuclear layer of the retina. Most are unilateral and
sporadic.
Trilateral retinoblastoma: Describes the coexistence of bilateral RB and pineal
retinoblastoma.
(Answer E)
513
PEDIATRICS
Important information in retinoblastoma

Retinoblastoma: Exits the nuclear layer of the retina. Most are unilateral and
sporadic.
Inherited patients have inactivation of the retinoblastoma gene on 13 chromosomes
and
together. The double-hit hypothesis is the first mutation resulting from the
germline mutation. So you are at birth.
The second mutation occurs in somatic retinal cells. The classic finding is
leucocoria. Strabismus initially
has. In advanced disease, hyphema and pupillary disorder are seen. There is no pain
until glaucoma develops.
Biopsy for the diagnosis is contraindicated. Ocular examination under general
anesthesia, orbital USG, MRI
Speak BT used BT used. Makes rosette formation in bone marrow.
Differential diagnosis of retinoblastoma
Hyperplastic primary vitrea
Retinopathy of premature
Choroid coloboma
Cataract
Coats' disease (exudative retinitis, retinal telangiectasia)
Visceral larva migrans
5. Laboratory investigations of a 2.5-year-old boy with a solid mass in the right

lobe of the liver showed high serum α-fetoprotein levels. The most likely in this
patient
What is the diagnosis? (Apr 2004)
A) Liver adenoma
B) Hepatocellular carcinoma
C) Angiosarcoma
D) Hamartoma
E) Hepatoblastoma
Elevated AFP and a palpable mass in the liver suggest hepatocellular carcinoma or
hepatoblastoma.
The fact that the mass is unique and being in a small child is the clues leading to
hepatoblastoma.
Hepatoblastoma: It is the most common primary malignant tumor of the liver. Most
are <3 years old.
Risk factors:
Familial polyposis parcel
Backwith Wiedemann syndrome
Low birth weight are increased risk factors. It is usually on the right and in the
form of a single mass. Alpha fetoprotein (AFP) increased in almost all of them.
HBV, HCV are negative. Which cannot be surgically removed
liver transplantation can be done to patients.
Hepatocellular Carcinoma: Tends to be multifocal. HBV, HCV, aflatoxin, hereditary
tyrosinemia, galactosemia, glycogen storage disease, cirrhosis and alpha 1
antitrypsin deficiency is more common.
It may cause acute abdominal crisis due to ruptured tumor.
(Answer E)
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ONCOLOGY
6. Where is the most common teratoma in infants? (April 2001)

A) Mediastinal
B) Cervical
C) Retroperitoneal
D) Intraabdominal
E) Sacrococcygeal
Teratomas are tumors originating from all 3 germ leaves. This tendency to settle in
the midline
tumors originate most from the sacrococcygeal region. It's more common in girls.
Sacrococcygeal teratomas
While it is rarely malignant under 2 months, half of it is malignant over 4 months.
Intrauterine may begin
can be detected at birth.
(Answer E)
7. Posterior mediastinum tumor in childhood is one of the following?
(September 98)
A) Thymoma
B) Neurogenic tumor
C) Teratoma
D) Lymphoma
E) Neuroblastoma
Let's remember the anterior mediastinal tumors with 4 T.
•
Thymus
teratoma
Thyroid
T cell lymphoma
Moderate mediastinal masses:

•
Mediastinel-hilar lymph node enlargement
Bronchial masses
•
Aortic aneurysm
Cardiac cysts
Posterior mediastinal tumors are of neurogenic origin.

(Answer B)
8. What is the most common localization of rhabdomyosarcoma in childhood?
(September 95)
A) Head and neck
B) Bile duct
C) Limb
D) Bladder-prostate
E) Brain
513
PEDIATRICS
Places in rhabdomyosarcomas:
•
25% of the most common head and neck
22% genitourinary
18% limb
See 1. Question.
(Answer A)
9. Where do sarcomas metastasize most often? (September 95)
A) Lung
B) Liver
C) Bone
D) Brain
E) Leather
In rhabdomyosarcomas, metastasis is seen early in the hematogenous way. This
situation is sometimes primary
it causes problems in detection of tumor localization. The most common site of
metastasis is the lung.
See 2. Question.
(Answer A)
10. What is the most common malignant soft tissue tumor in childhood? (September
94)
A) Osteosarcoma
B) Liposarcoma
C) Rhabdomyosarcoma
D) Neuroblastoma
E) Retinablastoma
Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood.
If the most common nonrabdomyosarcoma soft tissue sarcomas were asked, things would
change.
Nonrabdoid soft tissue sarcomas most commonly arise from the trunk and lower
extremities. Mean age at diagnosis
12 and the most common type is 42% synovial sarcoma. Others fibrosarcoma> malignant
fibrous histiocytoma
> neurogenic tumors.
Rhabdomyosarcoma emerges most commonly from the head and neck, is more common under
14 years of age, and is most common
It is seen.
(Answer C)
514
ONCOLOGY
Tissue
Tumor
Property
Adipose tissue
liposarcoma
Rare in the child. It originates from retroperitoneum and extremity.
fibrosis
fibrosarcoma
<1 is the most common soft tissue sarcoma at age. The prognosis of congenital
fibrosarcoma is good. Exits the extremity and trunk,
makes rare metastasis. Poor prognosis at age 4 years.
Malignant fibrous histiocytoma
It emerges from the deep tissue of the trunk and extremities. Anjiyomatoid
type occurs in young children.
HPC
It emerges from the retroperitoneum and lower extremity. Causes hypoglycemia and
hypophosphatemic rickets.
angiosarcoma
Rare in children. Most common skin> soft tissue> liver,

breast, bone. Vinyl chloride exposure is important.
Smooth Muscle
leiomyosarcoma
GIS occurs most frequently. It is related to EBV in immune deficiencies.

(AIDS is included in immunodeficiencies)
Synovia
Synovial sarcoma
The most common nonrabdoid sarcoma. Squeeze on knees and hips
Peripheral nerve
I neurofibrosarcoma
Malignant peripheral nerve sheath tumor. It relates to NF. Kr 17, 22

and P53 mutations are seen
vascular
11th. Exophthalmos, diabetes insipitus, hepatosplenomegaly, widespread skin rash

A 3-year-old boy admitted to hospital with lytic lesions of the head bones. What is
the most likely diagnosis in this patient? (April 93)
A) Neuroblastoma
B) Histiocytosis X
C) Multiple myeloma
D) Lymphoma
E) Ewing carcinoma
It may be asked again for changes in the classification of histiocytosis.
Old Histiocytosis is called X Class I histiocytosis. Acute monocytic leukemia (FAB
classification)
AML M5) class 3.
Diseases formerly with histiocytosis X:
I. Eosinophilic granuloma: There are lytic lesions localized to the bones, most
commonly the skull.
II. Hand-Schüler-Christian disease: Exophthalmitis, diabetes insipidus and bone
lesion
DUdUr triamine.
III. Letterer-Siwe: It is common histiocytosis and occurs in young children (<2
years). Seborrheic rash on the skin,
bone marrow, lung and liver involvement.
Histopathological features of Class I histiocytosis (Langerhans cell
histiocytosis): seen in tuberculosis
It should not be confused with Langhans type giant cells. They are antigen
presenting cells of the skin.
• Birbeck Granules positivity (racket-like granules in Langerhans cells)
• CD 1 a positivity
• CD 207 (Langerin) positivity is important.
(Answer B)
551
PEDIATRICS
Class
Property
Langerhans cell histiocytosis

CD1 a and Birbeck granule positive langerhans cell, localized
The disease is treated with surgery and disseminated chemotherapy.
II
Familial hemophagocytic lymphohistiocytosis

Infection-related hemophagocytosis
The erythrocyte phagocytosed morphology is treated with normal reactive

macrophages, chemotherapy and bone marrow transplantation.
III
Malignant histiocytosis
Acute monocytic leukemia
Chemotherapy involving anthracycline group
12. Which alpha-fetoprotein increases? (September 92)

A) Wilms tumor
B) Neuroblastoma
C) Lymphoma
D) Hepatocellular tumor
E) Hodgkin's lymphoma
AFP increases in liver tumors.
(Answer D)
13. Proptosis, chemosis and ocular paralysis in a 4-year-old child with orbital
tumor
Respectively. Which is the most likely diagnosis in this patient (September 92)
A) Hodgkin's lymphoma
B) Wilms tumor
C) Ewing's sarcoma
D) Leiomyosarcoma
E) Rabdomyosarcoma
The findings of rhabdomyosarcoma vary depending on the region of origin. Orbital
origin
early recognition. Pproposis, periorbital edema (mixed with orbital cellulitis),
ptosis and vision problems are seen.
The most common first finding is pain.
(Answer E)
14. If a child has osteosarcoma, which is the most common tumor together? (April
92)
A) Wilms
B) Medulloblastoma
C) Retinoblastoma
D) Leukemia
E) Ewing's sarcoma
(Answer C)
552
ONCOLOGY
15. Which is the most inherited tumor? (September 88)

A) Hepatoblastoma
B) Retinoblastoma
C) Nephroblastoma
D) Medullablastoma
E) Neuroblastoma
It is the most inherited retinoblastoma.
(Answer B)
16. Which of the following congenital anomalies together with the risk of cancer
It is too much? (April 88)
B) Cryptoorchid
C) PDA
D) Cleft palate
E) Pyloric stenosis
Undescended testis carries an increased risk of malignancy.
Undescended Testis: It is the most common sexual differentiation defect in boys.
More often in preterms
It is seen. Most undescended testes descend at 3 months. Undescended testicle if it
has not yet landed in the fourth month
It is considered. Most are in the inguinal canal. Testes are normal at birth but
changes
6- It starts in 12 months. Similar changes occur in the other testis at the age of
4-7.
Congenital adrenal hyperplasia, phenotype female, bilateral testicle
testicular feminization should be considered.
Treatment: Optimal correction time is 6 months.
Testicular torsion or hernia incarceration if inguinal pain or swelling develops in
a child with undescended testis
It should be considered.
Retractile testis: It depends on the survival of the cremasteric reflex.
Undescended in children over one year
miscible The risk of malignancy and infertility was not increased.
Complications of undescended testis
and pathological changes
Infertility
Reduction in germ cell count
Malignancy (seminoma)
Reduction in germ cell maturation
Herni (indirect)
Reduction in Leydig cell count
torsion
Seminar tubular hyalinization
(Answer B)
551
PEDIATRICS
552
NEFROLOGY
PAYMENT, PROTEINURE AND

NEPHROTIC SYNDROME
one. Which is the treatment of a child with primary nephrotic syndrome
does not take place? (May 2011)
A) Abundant protein diet
B) Corticosteroids
C) Diuretics
D) Albumin
E) Alkylating agents
A well constructed question about the treatment of nephrotic syndrome. Primary
nephrotic syndrome
are well-known drugs in the treatment. However, in case A, there is a clearer
alternative to “abundant protein diet”.
wrong. Na restriction should be used in the treatment of nephrotic syndrome. Age-
appropriate protein
support. A low protein diet (1 g / kg / day) is recommended for adult information.
eventually
“Abundant protein diet yeri has no place in the treatment of nephrotic syndrome.
Nephrotic syndrome
The cause of nephrotic syndrome in children (90%) is primary glomerular diseases.
Of these, the most common minimal lesion disease (85%) was in second place.
focal glomerulosclerosis and mesangial proliferation. Amyloidosis and secondary
diseases
Hepatitis B is the first.
Components of nephrotic syndrome:
Proteinuria (> 3.5 g / day in adults,> 40 mg / m2 / hour in children)
• Hypoalbuminemia (<2.5 g / dl)
• Edema (a pale, cold, nodding edema)
• Hyperlipidemia
• Lipiduria
Causes of secondary nephrotic syndrome
Membranous nephropathy Membranoproliferative GN Postinfectious GN
• SLE
• Henoch Schönleain purpura
• Infections: HBV (mebranous nephropty), HCV, HIV (Frequently focal segmental
• glomerulosclerosis), malaria, style, toxoplasma. Malignancies (Hodgkin's lymphoma
and minimal
Allergic-immunological: food allergy, bee sting, castleman
Disease, Kimura's Disease
Glomerular hyperfiltration: Morbid obesity, oligonephronia, adaptive response to
reduced nephron count
Medicines
• Penicillamine, captopril, gold salts, NSAID => Membraneous glomerulopathy
• Probenezide, etosuximide, methimazole, lithium => Minimal lesion disease
Procaainamide, chlorpropamide, phenytoin, timetadion => Proliferative GN
555
PEDIATRICS
Minimal change disease (Nile Disease, Lupoid nephrosis, MDH):

• Childhood is the most common cause of nephrotic syndromes.
• Does not form a nephritic table. No pathology can be detected on the light
microscope. The electron microscope shows improvement in the protrusions. There is
no accumulation.
• Complement is normal. It is most commonly seen in men aged 2 to 6 years.
• Vaccination is associated with / Hodgkin's disease.
Clinical findings:
• The first noticeable finding is edema of the periorbital and lower extremities.
• Anorexia, abdominal pain, diarrhea, irritability are common.
• Hypertension, macrasocopic hematuria are rare.
• No asymptomatic proteinuria. There is massive poteinuria. Proteinuria is
selective. Steroide is the best answer
is the cause of nephrotic syndrome.
• PPD should be performed before steroid treatment.
• Does not progress to kidney failure.
Findings that remove minimal change from the disease-biopsy
Results:
• Family history,
• NS occurring in <1 year and> 8 years
• Macroscopic hematuria
• Persistent hypertension
• Signs of systemic disease
• Pulmonary edema, extrarenal manifestations (arthritis, rash, anemia)
• Renal failure symptoms not attributable to hypovolemia
• Low serum C3 level
• Steroid-resistant cases not responding to four-week steroid treatment
• Patients with suspected MDH can be treated without biopsy.
There's proteinuria on the nephrotic level.
A-2 increased globulin; albumin and y decreased globulin.
• Usually have hypercholesterolemia.
• Sometimes triglyceride and phospholipid levels also increase.
• LDL and VLDL increased, HDL normal.
• No macroscopic hematuria.
• Transient microscopic hematuria in 25% of cases
• Erythrocyte sedimentation rate is high.
• Serum C3 and C4 normal
• Urea and creatinine values are normal, renal failure is not expected.
MDH treatment
Salt restriction
• Corticosteroid: The cause of nephrotic syndrome that responds best to steroid.
Corticosteroid treatment 4 weeks. Klinik Steroid-sensitive erse if clinical
findings regress after 4 weeks, z steroid-resistant se if they do not respond.
is called çık steroid dependent bağımlı.
Albumin infusion: symptomatic edema or acid-effusion, renal failure secondary to
hypovolemia
without. Diuretics are given after albumin infusion.
Those who do not respond to steroids are given other immunosuppressive agents such
as cyclophosphamide.
(Answer A)
556
NEFROLOGY
2nd.
Serum albumin level in a child with edema of the lower extremities without heart
disease
normal.
What is the most likely cause of edema in this child? (September 2009)
A) Lymphatic obstruction
B) Cystic fibrosis
C) Nephrotic syndrome
D) Malnutrition
E) Cirrhosis
In childhood, nephrotic syndrome should be ruled out. The major component is
massive proteinuria and associated low albumin. Low albumin level
in the absence of cardiac edema and lymphatic edema. Question of cardiac disease
specified. Therefore, the correct response should be lymphatic obstruction.
(Answer A)
3. What is the most common cause of nephrotic syndrome in childhood? (September
2009)
A) Focal segmental glomerulosclerosis
B) Membranoproliferative glomerulonephritis
C) Membranous nephropathy
D) Minimal change disease
E) Acute poststreptococcal glomerulonephritis
Minimal change disease (Nile Disease Lupoid nephrosis, MDH)
It is the most common cause of childhood nephrotic syndromes. Does not make
nephritic painting. Electron microscopy showed an improvement in the protrusion.
There is no accumulation. Most common 2 - 6
seen in men. It is associated with vaccination / Hodgkin's disease.
The first finding was edema in the periorbital and lower extremities. Anorexia,
abdominal pain, diarrhea, irritability
is common.
Hypertension, macroscopic hematuria are rare.
No asymptomatic proteinuria. There is always massive poreinuria. Selective
proteinuria occurs. steroid
nephrotic syndrome. PPD should be performed prior to steroid treatment.
It does not progress to kidney failure.
Family history, <1 year, acute / chronic renal failure, hematuria, hypertension,
low complement
In the case of pulmonary edema, extrarenal symptoms (arthritis, rash, anemia), MDH
is removed.
Patients with suspected MDH can be treated without biopsy.
(Answer D)
557
PEDIATRICS
4. Which of the following does not lead to acute nephritic syndrome? (September
2008)
A) Henoch-Schönlein nephritis
C) Minimal lesion disease
D) Postinfectious glomerulonephritis
E) IgA nephropathy
(Answer C)
5. The following statements about nephrotic syndrome due to minimal lesion disease
which is wrong? (April 2008)
A) It can usually be seen between 2-6 years of age.
B) Hypertension is rare.
C) Hyperlipidemia is common.
D) Histopathological examination shows C3 deposition.
E) Responds to steroid treatment.
The only finding in minimal change disease is flattening of the foot protrusions.
See 2.
Description of the problem.
(Answer D)
6. A 16-year-old man who presented with edema of the feet and periorbital region.
4+ proteinuria is detected in a young girl. Time since the age of 6-7
When the joint and abdominal pain, pain relief and 3-4 days after the last
pain is accompanied by fever learned.
Which of the following is the most likely diagnosis in this patient? (April 2007)
A) Nephropathy secondary to autoimmune hepatitis
B) Membraneous glomerulonephritis
C) Systemic lupus erythematosus
D) AA type amyloidosis
E) Sjogren's syndrome
Familial Mediterranean Fever (FMF): FMF is caused by a mutation in the MEFV gene on
the short arm of chromosome 16. It is an autosomal recessive disease. The MEFV gene
encodes a protein called pirin or merenostrine. This protein is overexpressed by
inhibiting neutrophil activation and chemotaxis.
suppresses inflammation. It is one of the periodic fever syndromes. Seizures are
spontaneous in a few days
It will be alright.
The symptoms accompanying fever in order of frequency:
Peritonitis
Arthritis
pleuritis
Erysipelas-like skin rash
558
NEFROLOGY
Myalgia (especially in calves) may occur between seizures. Joint involvement is

mostly arthralgia
but it can also be seen as arthritis in large joints. Arthritis is usually
oligoartricular and asymmetric.
It may persist longer than other symptoms of attacks. Amyloidosis develops in
patients without colchicine prophylaxis.
AA type, secondary amyloidosis is seen. It is characterized by massive proteinuria
and progressive renal failure.
Treatment: Symptomatic treatment is performed during an attack. Colchicine is given
for prophylaxis.
Occasionally there is joint and abdominal pain, and these pains last for three to
four days.
It should make the FMF think. Massive proteinuria indicates amyloidosis.
(Answer D)
7. Which of the following is seen in idiopathic nephrotic syndrome in childhood
more likely? (September 2005)
A) Macroscopic hematuria
B) Massive proteinuria
C) Hypertension
D) Arthritis
E) Complement C3 low
Nephrotic syndrome:
Proteinuria (> 3.5 g / day in adults,> 40 mg / m2 / hour in children)
Hypoalbuminemia (<2.5 g / dl)
Edema
It is characterized by hyperlipidemia.
It is more common in childhood than adults. Idiopathic, secondary and congenital
nephrotic syndrome
separated. Most are idiopathic. The most common minimal change in children is
disease (2. Question).
Pathophysiology:
Proteinuria occurs due to increased permeability of the glomerular capillary wall.
Edema; hypoalbuminemia-induced plasma oncotic pressure decreases, fluid shifts into
the interstitial space, renin angiotensin aldosterone system is activated due to
decreased intravascular volume and Na
reabsorption increases.
Increase of lipids; increased synthesis of lipoproteins in the liver for
hypoalbuminemia compensation,
lipoprotein lipase is caused by loss of urine and decreased metabolism.
Idiopathic nephrotic syndrome; minimal changes include disease, focal segmental
glomerulosclerosis, and mesengial proliferation.
(Answer B)
559
PEDIATRICS
8. A 3-year-old male patient had godes on eyelids and legs after URI
edema, decrease in the amount of urine, abdominal swelling.
In the physical examination, blood pressure was normal, abdominal ascites,
laboratory tests showed 4+ proteinuria, serum albumin level was 1,8 gr / dl.
Which of the following diseases is best suited for the above case? (April 2004)
A) Membranoproliferative glomerulonephritis
C) Minimal change disease
D) Focal segmental glomerulosclerosis
E) Acute pyelonephritis
(Answer C)
9. The first procedure in the patient described in the previous question is:
A) 60 mg / m2 / 24 hours oral prednisolone + salt-free diet
C) Abundant protein diet
D) 3 g / kg Na albumin infusion per day
E) Isotonic fluid replacement
It is sufficient to know that only steroids are given. See 2 questions.
(Answer A)
10. The amount of urine decreases thoroughly after admission, hematuric urine and
abdomen
The pain begins. In addition, palpable in both lumbar regions not detected at the
first examination
increase in BUN and creatinine levels. Which of the following complications is most
likely to develop in this patient? (April 2004)
A) Retroperitoneal abscess
B) Bilateral renal vein thrombosis
C) Hydronephrosis
D) Pyelonephritis
E) Renal hematoma
Complications of nephrotic syndrome
Infections: NS is the most common complication and the most common cause of
mortality. The most common spontaneous bacterial
peritonitis. S.pneumonia> E. coli. Cellulitis, sepsis, pneumonia and urinary tract
infection
can.
Those with NS should be given pneumococcal, varicella vaccine and annual influenza
vaccine in remission.
Thromboembolism: Arterial and venous. Fibrinogen, increased platelets,
hemoconcentration,
catheter insertion, immobility, and protein C / S in urine due to antithrombin III
loss. Most often
renal vein.
560
NEFROLOGY
Hyperlipidemia: HMG CoA Reductase inhibitors are used.

Treatment of steroid unresponsiveness / frequent relapsing
available. The most commonly used is cyclophosphamide.
Renal Vein Thrombosis (RVT)
The thrombus starts in the intrarenal circulation and proceeds to the vena cava.
Endothelial damage (hypoxia, endotoxin, contrast agent), hypercoagulobility
(nephrotic syndrome and Factor V Leiden mutation), hypovolemia and decreased blood
flow, thrombosis occurs due to stasis.
In newborn and young children; asphyxia, dehydration, shock, sepsis, diabetic
mother
It is seen.
Older children; nephrotic syndrome (most commonly in the mebranous), cyanotic heart
disease, occurs after contrast agents.
RVT should be considered in the presence of sudden macrasocopic hematuria, single
or bilateral mass. The disease is usually
unilateral. Bilateral acute renal failure develops. Diagnosis is made by Doppler /
USG.
Hydronephrosis, cystic disease, Willms tumor, abscess and hematoma
It should be separated.
(Answer B)
11th. The most common cause of primary peritonitis in children with nephrotic
syndrome
A) Escherichia coli
B) Staphylococcus aureus
C) Neisseria gonorrhoeae
D) Streptococcus pneumoniae
E) Pseudomonas aeruginosa
The most common infection is spontaneous bacterial peritonitis. The most common
agent is pneumococcus. See question 2.
(Answer D)
12. Which of the following is not a typical symptom of minimal lesion disease?
(April 2001)
A) Common edema
B) Hypoalbuminemia
C) Hypercholesterolemia
D) Hypogammaglobulinemia
E) Hypocomplementemia
See question 2
(Answer E)
13. Which of the following diseases in childhood is rarely seen macroscopic
hematuria? (April 98)
A) Renal vein thrombosis
B) Sickle cell anemia
C) Idiopathic nephrotic syndrome
D) Membranoproliferative glomerulonephritis
E) IgA nephropathy
561
PEDIATRICS
Common causes of macroscopic hematuria in children: Infections, meatal stenosis,

perineal irritation, trauma, stones, coagulopathy, tumors, glomerular diseases.
Glomerular diseases: IgA nephropathy, Alport syndrome, thin glomerular basal
membrane disease,
postinfectious glomerulonephritis, Henoch Schönlein purpura, SLE.
Glomerular diseases with isolated recurrent macroscopic hematuria: IgA nephropathy,
Alport syndrome, thin glomerular basal membrane disease
See 2 questions
(Answer C)
14. Which one is not seen in minimal lesion disease? (September 97, September 95,
April 93)
A) Selective proteinuria
B) Hyperlipidemia
C) Hypoalbuminemia
D) Macroscopic hematuria
E) Hypocalcemia
See 3. Question
(Answer D)
15. Which kidney disease is most effective for steroid use? (September 97)
A) Goodpasture syndrome
B) Membranoproliferative glomerular nephritis
C) Nephritic syndrome
D) Minimal change disease
E) Kimmel-Steel Wilson syndrome
See question 3
(Answer D)
16. Hypotension in a 5-year-old child with generalized edema in the body, 2 grams
of urine
protein, hypoproteinemia and hypoalbuminemia.
Which of the following is seen in this patient's kidney histopathology? (April 95)
A) Minimal change nephropathy
B) Membranous nephropathy
C) Mesenchial proliferation
D) Membranoproliferative glomerulonephritis
E) Focal glomerulosclerosis
See question 3
(Answer D)
562
NEFROLOGY
17. Which is the earliest sign of diabetic nephropathy? (April 95)

A) Hypertension
B) Nephrotic syndrome
C) Kidney atrophy
D) Papillary necrosis
E) Microalbuminuria
Diabetic nephropathy
Diabetes is the most common cause of CRF in adults.
Pathology: There are 5 stages of diabetic nephropathy. one.Hypertrophy stage: due
to hyperglycemia
hyperfiltration and GFR increase. The kidneys grow. 2nd.Quiet phase: Basal membrane
thickened.
3. Microalbuminuria stage: Urine albumin level is 20-200 micrograms / minute.
Kidney
is the stage where the insufficiency can be reversed. 4. Significant diabetic
nephropathy: decreased GFR
It began. Proteinuria increases. 5. Chronic renal failure.
Pathological findings
Diffuse glomerulosclerosis: This is the most common lesion. The first pathological
finding was the basement membrane
It is thickening.
Kimmelstiel-Wilson syndrome: Typical for diabetes. There is a nodular formation in
the mesangium.
Ermany-Ebstein body: Tubular glycogen accumulation is the only type of reversible
pathological lesion.
Hyaline deposition in afferent arterioles.
Nephrotic syndrome is present in diabetic nephropathy. ACE inhibitors in the
treatment of proteinuria
It slows.
(Answer E)
18. Which of the following does not occur in childhood nephrotic syndrome?
(April 92)
A) Recurrent infection
B) Plasma oncotic pressure increase
C) Hyperviscosity
D) Hypercoagulability
E) Hyperlipidemia
(Answer B)
19. Which is the most common cause of nephrotic syndrome in children? (April 89)
A) Glomerulonephritis
B) Lupoid nephrosis
C) Rapidly glomerulonephritis
D) Poststreptococcal glomerulonephritis
E) Berger's disease
(Answer B)
563
PEDIATRICS
NEFRITIC TABLES
one. Which of the following systemic diseases is associated with glomerulonephritis
in children?
not seen? (September 2011)
B) Rheumatoid arthritis
C) Lupus nephritis
D) Henoch-Schönlein purpura
E) Vasculitis
Easy question.
Because Goodpasture syndrome, SLE, Henoch Schönlein purpura and vasculitis may be
renal involvement and
in particular, this group causes rapid progressive crescentric glomerulonephritis.
In juvenile rheumatoid arthritis (especially systemic JRA), visceral organs of the
eyes, liver, spleen and
Although pericardial and pleural involvement is present, glomerulonephritis is not
expected.
(Answer B)
2nd. Reduction in urine volume and gastroenteritis in a 4-year-old girl
Tracked. Laboratory examination for anemia, thrombocytopenia and serum creatinine
1.7 mg / dL
is detected.
2011)
A) Postinfectious glomerulonephritis
B) Interstitial nephritis
C) Rotavirus nephritis
D) Hemolytic uremic syndrome
E) IgA nephropathy
Nice and easy question.
Acute renal failure, anemia and thrombocytopenia after diarrhea in a child under 5
years of age =>
HEMOLITHIC UREMIC SYNDROME
Hemolytic Uremic Syndrome (HUS)
Triad:
• Microangiopathic hemolytic anemia
• Thrombocytopenia
• Characterized by acute renal failure
Hemolytic uremic syndrome is the most common renal cause of acute renal failure
(ARF) in young children.
It usually occurs in children between 4 months and 4 years.
564
NEFROLOGY
The most common cause of HUS is enterohemorrhagic E. coli (0157: H7) and Shigella
dysanteriae type 1 gastroenteritis
okay then.
Typically HUS is used for postdiareal ones. 5-10 days after sudden onset of
oliguria, pallor, excessive irritability,
lethargy, convulsion, dehydration or edema, HSM and jaundice in a few patients.
The primary event is endothelial cell damage, leading to localized coagulation of
capillaries and arterioles. Localized damage
As a result, microangiopathic hemolytic anemia and thrombocytopenia develop.
• DIC is not usual.
Thrombotic thrombocytopenic purpura different features:
In addition to HUS triad, fever and severe CNS findings are seen and form the
pentad.
TPP occurs mostly in young women, with a low history of diarrhea and slow onset.
Antibiotic treatment in AGE increases the risk of HUS.
• Hb is generally in the range of 5-9 g / dl.
• Reticulocytosis is seen.
• Plasma haptoglobulin decreases, hemoglobin increases.
• Schistocytes are seen. Coombs test is negative.
• Significant leukocytosis and thrombocytopenia.
• PT and APTT are normal. Elongation, if present, is due to vitamin K deficiency
(due to AGE) rather than DIC.
• Urine has minimal hematuria and proteinuria.
• Kidney failure may be mild or require dialysis.
complications
• Anemia, volume overload, hypertension, uremia
• Acidosis
• CNS findings (convulsions, coma)
• Colitis (melena, perforation)
• Diabetes mellitus and pancreatitis
• Rabdomyolysis
(Answer D)
3. Which of the following statements about acute poststreptococcal
glomerulonephritis is incorrect? (December 2010)
A) Serum C3 levels are low.
B) Nephritis is usually self-limiting and has a good prognosis.
C) Recurrence is common.
D) It is common between the ages of 5-12.
E) Microscopic hematuria.
Acute Poststreptococcal Glomerulonephritis (APSGN):
It is a classic example of acute nephritic syndrome.
GABS develops following nephritogenic strains following skin or throat infection.
1-2 months of throat infection in cold months,
In warm months, nephritic picture develops 3 to 6 weeks after skin infection
(latent period).
It is most commonly seen between 5 and 12 years of age and is rare before 3 years
of age.
565
PEDIATRICS
Usually sporadic. Penicillin prophylaxis is not required. Repetition is very rare

possible.
Epidemic cases can be seen after serotype 12 in throat infection and serotype 49 in
skin infection.
• Classic features: Sudden onset hematuria, edema, hypertension and renal failure.
•
IgA nephropathy is the most common cause of macroscopic hematuria in childhood.

This
APSGN tracks.
• The most common cause of hematuria is urinary tract infection when there is no
distinction between glomerular and extrraglomerular.
Clinic:
It can present with asymptomatic microscopic hematuria and renal failure. Depending
on the degree of renal involvement, oliguria, hypertension and edema are seen.
• Sudden onset macroscopic hematuria
• Edema
• Hypertension and encephalopathy
• Kidney failure
• Heart failure
Improvement times in APSGN clinical findings
• Diuresis starts in 1-2 weeks.
• Macroscopic hematuria 1–3 weeks
• Microscopic hematuria lasts for 6–12 months, up to 2 years, the last symptom.
• Proteinuria and HT 4–6 weeks
• Hypocomplemantemia 6–8 improves
Urinary erythrocyte and erythrocyte cylinders and mild proteinuria are seen.
There is a moderate increase in BUN and creatinine.
Normocytic normochrome anemia (due to dilution).
Serum C3 and CH 50 were found to be low and C 4 was found to be normal
N).
Streptococcal infection findings: Throat culture is positive. Increased ASO titer;
but
skin infections may not increase ASO. Anti DNase B antibodies are more reliable in
this case.
Streptozyme test against ASO, anti DNase B, hyaluronidase and nicotine amide
adenine dinucleotidase
detect antibodies.
Indications for APSGN biopsy
• Renal biopsy is not required for diagnosis.
• Biopsy cases are as follows;
• Lack of hypocomplemantemia
• Persistence of hematuria and / or proteinuria
• Nephrotic syndrome
• No evidence of streptococcal infection
• Impairment of kidney function
• C3 persists for 2 months from the onset of the disease.
566
NEFROLOGY
Treatment
•
Antibiotic treatment is applied for 10 days to prevent spread.
Restriction of activity in the acute phase is unnecessary except for hypertensive

encephalopathy.
During ARF and hypertension, salt and fluid restriction is applied.
•
HT treatment; Due to volume load, the first choice is diuretics.
Furosemide is particularly preferred.
Vasodilators, calcium channel blockers and ACE inhibitors are other options.
Complications of APSGN:
• Acute renal failure (most frequent)
• Congestive heart failure
• Hypertensive encephalopathy
95% of patients recover without sequelae.
If the acute phase is very severe and causes glomerular hyalinization, it may
progress to chronic renal failure.
(Answer C)
4. Which is one of the diseases that cause hematuria in children
A) Alport syndrome
B) Polyarteritis nodosa
C) Polycystic kidney disease
D) Nephronoftisis
E) Acute glomerulonephritis
A beautiful nephrology question that tests the causes of hematuria in children.
About nefronoftizis
we may not know. However, all other options are well-known causes of hematuria in
children.
it will not be difficult to find the right answer.
Acute glomerulonephritis, Alport syndrome, PAN and Polycystic kidney disease cause
hematuria in children
diseases.
Juvenile Nephronoftisis; It is an autosomal recessive disorder with chronic
interstitial nephritis. Avrupd to
Although it constitutes 10-20% of renal failure, it is rare in the USA. Typically
polyuria in late childhood and adolescence, growth retardation, unexplained anemia
and chronic
they present with renal failure.
(Answer D)
5. Red urination and decrease in urine
complaints brought to the emergency room. Edema of the eyelids and leg front
blood pressure was 135/85 mmHg, serum C3 level was low and BUN level was found.
has increased.
What is the most likely diagnosis for this child? (April 2010)
A) Acute poststreptococcal glomerulonephritis
B) Immunoglobulin A nephropathy
C) Goodpasture syndrome
D) Idiopathic rapidly progressive glomerulonephritis
E) Alport syndrome
567
PEDIATRICS
The case described in the question is typical Acute poststreptococcal

glomerulonephritis (APSGN). Easy question.
The patient's age is between 5-15 years. Presence of hematuria, oliguria, edema,
hypertension and renal failure
indicates nephritic syndrome. The only hypocomplementemic nephritis in stylish
cases is APSGN.
(Answer A)
6. Which of the following is true about Goodpasture?
(April 2009)
A) It is associated with cataract and deafness.
B) It is the most common cause of nephrotic syndrome.
C) BUN and serum creatinine levels are normal.
D) Occlusion in the glomerular capillaries and fibrin thrombi in the renal
arteries.
E) IgG deposition in the glomerular basement membrane.
Goodpasture disease: It is characterized by the development of antibodies against
alveolar membrane and GBM type 4 collagen. IgG is stored linearly in the glomerular
basement membrane.
(Answer E)
7. Low levels of serum complement C3 are associated with the following types of
glomerulonephritis:
which is not a typical feature? (April 2008)
B) Lupus nephritis
C) Membranoproliferative glomerulonephritis
D) Shunt nephritis
C3
•
•
•
•
•
low nephritis
Acute poststreptococcal glomerulonephritis
Membranoproliferative glomerulonephritis
Systemic lupus erythematosus
Shunt nephritis
Bacterial endocarditis
(Answer A)
8. Brown urine, headache and swelling of the eyelids brought about

Which of the following should be considered first in a boy aged?
(September 2007)
A) Cystitis
B) Nephrocalcinosis
C) IgA nephropathy
D) Acute poststreptococcal glomerulonephritis
E) Polycystic kidney
568
NEFROLOGY
Acute Poststreptococcal Glomerulonephritis (APSGN): This is a classic example of
acute nephritic syndrome.
APSGN classic features: Sudden onset hematuria, edema, hypertension and renal
failure. Pee
cola or tea color. Headache due to hypertension.
GABS nephritogenic strains develop in the cold months for 1-2 weeks after throat
infection, and in hot months for 3-6 weeks after skin infection. It is most
commonly seen at 5- 12 years of age.
The kidneys grew symmetrically. All glomeruli are enlarged and relatively
bloodless, with an increase in cells in the mesengial matrix. Granular glomeruli in
immunofluorescence microscopy
Ig G and C3 deposition in the basement membrane and mesengium. Electron microscopy
electron dense accumulation (subepithelial hump) is monitored.
Clinical Features: Asymptomatic microscopic hematuria >>> BY. Depending on the
degree of renal involvement
oliguria, hypertension and edema.
Hypervolemia-related edema, anemia, congestion, HT (50-90%), encephalopathy and
convulsions may occur.
(Answer D)
9. Diarrhea, dehydration, anuria, impaired renal function, pallor, thrombocytopenia
hemolytic uremic syndrome in a 4-year-old child admitted to hospital
Which of the following is most likely to develop? (September 2007)
A) Cortical necrosis
B) Renal artery thrombosis
C) Renal vein thrombosis
D) Acute tubular necrosis
E) Prerenal insufficiency
Cortical necrosis: Common endpoint of severe renal injury. It is usually bilateral.
Newborn
most common cause of hypoxia ischemia (perinatal asphyxia, ablation placenta, twin
to twin or
fetomaternal transfusion).
Later, it is related to severe sepsis or HUS. Pregnancy, trannexamic acid and snake
bite
other reasons. Cortical necrosis is caused by endothelial damage and decreased
cortical blood flow.
Acute renal failure, hematuria and thrombocytopenia are detected. Cortical necrosis
of tubular necrosis
on the contrary it does not improve and renal scar develops.
Hemolytic Uremic Syndrome
It is the most common cause of ARF in young children. Triad microangiopathic
anemia, thrombocytopenia and uremia.
If severe, renal cortical necrosis is seen. The most common cause of E.coli O157:
H7 strain producing shiga like toxin
It is responsible. Diare + is called HUS. May cause epidemics. Prognosis of others
is good. The thrombotic event may also occur in the brain, heart, pancreas, colon,
adrenals and lung. Clinical findings: Most common between 4 months and 4 years.
Bloody AGE is followed by fewer URIs. 5-10
day after sudden onset of oliguria, pallor, excessive irritability, lethargy,
convulsion, dehydration or
edema, HSM and jaundice in a small number of patients. Disease thrombotic
thrombocytopenic purpura
with similar features, but TPP occurs more often in young women with fever and
severe CNS
findings.
Antibiotic treatment in AGE increases the risk of HUS.
Laboratory findings: Hb is usually 5-9 g / dl. Reticulocyte increases. Plasma
haptoglobulin decreases, hemoglobin increases. Schistocytes are seen. There are
prominent leukocytosis and thrombocytopenia. Coagulation tests
It is normal.
569
PEDIATRICS
HUS should be recovered with bilateral RVT. Following gastroenteritis, dehydration,

pallor, microangiopathic hemolytic anemia, thrombocytopenia and renal failure
develop in two diseases. USG in the kidneys
Thrombosis is recognized by marked growth and absence of flow in the renal vein.
(Answer A)
10. A 15-year-old boy was brought with complaints of swelling of feet, dark
urination, blurred vision and hearing loss. The story of his uncle 4
hemodialysis treatment for years.
A) IgA nephropathy
B) Alport syndrome
C) Fabry disease
D) Lowe syndrome
E) Systemic lupus erythematosus
Alport Syndrome (AS, Hereditary Nephritis)
X-linked dominant inheritance (OR or OD transition less). It is more severe in men.
Basal membrane
There is a defect in type IV collagen which is the main component.
AS Clinical Features:
URTIS Asymptomatic microscopic hematuria is the most common finding after 1-2 days.
Extrarenal findings:
Bilateral neurosensory hearing loss; never starts congenital, it is progressive.
Ophthalmic findings: Lenticonus (anterior chamber shelling of the anterior lens) is
a pathognomonic finding,
macular freckling and corneal erosion,
Leiomyomatosis and platelet abnormalities.
Kidney biopsy findings: Light microscopy findings were minimal in the first decade.
Electron microscopy
thickening, dissociation and lamination of the basement membrane. Mesengial
proliferation and capillary
thickening, progressive glomerulosclerosis. Tubular atrophy, interstitial
inflammation and
fibrosis occurs as the disease progresses. Immunofluorescence tests are negative.
Prenatal disease
can be diagnosed.
The disease is progressive. Men enter end-stage renal failure in 2-3 decades.
Specific treatment
They do not.
(Answer B)
11th. Blood pressure was 140/95 mmHg, drowsiness and edema were detected in a 6-
year-old girl who was brought in due to darkening of urine color.
protein 6 mg / m2 day, 20-25 erythrocytes (40%, dysmorphic) is determined.
A) Ig A nephropathy
B) Acute glomerulonephritis
C) Alport syndrome
D) Hypercalciuria
E) Idiopathic hematuria
570
NEFROLOGY
Acute poststreptococcal glomerulonephritis (APSGN) is the most common cause of

nephritic syndrome in childhood.
The question for us is its value.
Laboratory: Urinary dysmorphic erythrocyte and cylinders, mild proteinuria,
increased density and osmolality, increased BUN and creatinine, normocytic
normochrome anemia, decreased serum C3 and CH 50
(C 4 normal).
Streptococcal infection findings: Throat culture, increased ASO titer, skin
infections, anti
DNase B is more reliable.
Renal biopsy is not required for diagnosis.
Biopsy: Lack of hypocomplemantemia, persistence of hematuria and / or proteinuria,
kidney
decreased C3 or 2 months after the onset of the disease
done in the event.
Complications are due to renal failure and hypertension. Acidosis, hyperpotasemia,
hyperphosphatemia, hypocalcemia, seizures, uremia, heart failure and pulmonary
edema.
Treatment: Antibiotics for 10 days to prevent spread. Restriction of activity in
the acute phase is unnecessary except for hypertensive encephalopathy. During ARF
and hypertension, salt and fluid restriction is applied.
Macroscopic hematuria lasts 1-3 weeks and microscopic hematuria lasts 1-2 years.
Hypertension and edema resolve in 4- 6 weeks. C3 abortion should improve at the
latest 8-10 weeks.
Continuation of abortion is an indication for biopsy.
HT treatment; Due to volume load, the first choice is diuretics (furosemide).
Vasodilators, calcium
channel blockers and ACE inhibitors are other options.
95% of patients with prognosis recover without sequelae.
(Answer B)
12. Ten-year-old child swelling of the eyelids and body, the amount of urine
He had a generalized convulsion in the emergency department where he was admitted
with complaints of headache, decreased urine, and tea color. Cryptic tonsillitis 10
days before history
It was learned.
What is the most likely diagnosis in this child? (September 2002)
A) Minimal change disease
C) Acute poststreptococcal glomerulonephritis
D) Diabetic nephropathy
E) Membraneous glomerulonephritis
See questions 5 and 8
(Answer C)
13. Clinical findings of acute poststreptococcal glomerulonephritis
A) Hematuria
B) Edema
C) Myalgia
D) Hypertension
E) Central nervous system symptoms

(Answer C)
571
PEDIATRICS
14. Which of the following does not have signs of acute poststreptococcal
glomerulonephritis? (September 97)
A) Anuria
B) ANA positivity
C) Peripheral edema
D) Hypertension
E) Hyperpotasemia
(Answer B)
15. Hematuria, proteinuria, drop in C3 and eye following upper respiratory tract
infection
What is the first diagnosis to be considered in the patient with swelling of the
eyelids? (September 90)
A) Rapidly progressive glomerulonephritis
C) Nephrotic syndrome
D) Acute poststreptococcal glomerulonephritis
E) Nile disease
(Answer D)
16. Which is not indicated for hospitalization in acute glomerulonephritis?
(September 88)
A) Edema
B) Hypertension
C) Azotemia
D) Renal failure
E) Microscopic hematuria
Microscopic hematuria is the last finding. It lasts up to two years and is not an
indication for hospitalization.
(Answer E)
572
NEFROLOGY
KIDNEY FAILURE AND

HYPERTENSION
one. Which of the following is not one of the causes of anemia detected in patients
with chronic renal failure?
A) Folate deficiency
B) Reduction of erythrocyte life
C) Iron deficiency
D) Tubular damage
E) Reduction of erythropoietin production
One of the major problems in chronic renal failure is anemia. Many causes of anemia
There. The most important is the reduction of erythropoietin production.
Pathophysiology of Chronic Kidney Disease
acidosis
Acid excretion, ammonium synthesis, low bicarbonate absorption
Na retention
↑, oliguria of renin production
Na loss and concentration defect
Tubular damage, solute diuresis
hyperkalemia
GFHJ, uptake ↑, met. acidosis
Renal osteodystrophy
Decreased dvit production, hyperphosphatemia, hypocalcemia, hyperparatoid
Growth retardation
Low calorie intake, GH resistance, anemia, renal osteodystrophy,

Metabolic acidosis
Anemia
Erythropoietin, iron, folic acid, vit.B12 low, erythrocyte life

shortening
Pericarditis / cardiomyopathy
Fluid load, uremia, hypertension
Neurological findings
Uremia, Al tox., HT
Anemia in CRF: The main cause of anemia in CRF is the insufficiency of

erythropoietin synthesis in the kidney.
Erythropoietin treatment is used. Eritorpoetin and darbopoetin are used to treat
anemia. in together
iron support should be made.
Erythropoietin treatment
Side effects: hypertension, pure red cell anemia (due to EPO antibodies),
convulsion, iron deficiency
tendency to coagulate after vascular interventions.
Benefits of EPO treatment
•
Reduction of transfusion requirements
Reduction in sensitization to histocompatibility antigens

•
Iron overload protection
Reduction in infections
Appetite exercise tolerance and sleep improvement

(Answer D)
573
PEDIATRICS
2nd. Physical examination of a 1-year-old girl with severe gastroenteritis revealed

blood
pressure 95/60 mmHg, pallor, lethargy, bufissure edema observed, urine volume 0.5
ml / kg / h.
To determine the physiopathological cause of acute renal failure in this child
Which of the laboratory tests is most important? (September 2006)
A) Urine volume
B) Urine osmolarity
C) urine protein-creatinine ratio
D) Hemogram
E) Urine sediment
In this question, the question is whether renal failure is renal or prerenal.
For this, urine density or osmolarity should be checked.
Fractionated Na excretion is the best parameter in the differentiation of
dehydration and acute tubular necrosis.
Distinguishing causes of acute renal failure
hypovolaemia
ATN
glomerular
disease
obstruction
Sediment
Normal
Granular silene
Erythrocyte wipers
Normal / bloody
Protein
No
No / low
> 100 mg / dl
Low
Urine Na mEq / L
<20
> 30
<20
<20 (acute)
> 40 (chronic)
osmolarity
> 400
<350
> 400
<350
Fractional Na excretion
(%)
<1
> 1
<1
<1,> 1
(Answer B)
3. Which of the following is the urinary parameter observed in prerenal renal
failure?
is not one of the values? (September 2003)
A) Urine osmolality> 500
B) Urine sodium <20 mEq / L
C) Fractionated sodium excretion <1%
D) Renal insufficiency index> 1
E) Urine density> 1020
574
NEFROLOGY
Acute Renal Failure (ARF)

ARF is a clinical syndrome characterized by sudden decrease in renal function. It
is most commonly caused by prerenal reasons. The most common renal cause in the
first 4 years is HUS and glomerulonephritis in older children.
Prerenal insufficiency; there is no parenchymal damage; Volume replacement in
treatment
makes. Urinary density and osmolality increased, FNa excretion, urine Na and renal
insufficiency index
It is low.
Renal insufficiency index = urine Na x serum creatinine / urine creatinine
ATN is often caused by exposure to nephrotoxic agents or ischemic damage in
severely ill children
is the cause of intrinsic renal insufficiency. It is the most common cause of
intrinsic ARF in adults.
Intrinsic kidney as a result of obstruction of uric acid crystals in tubules in
tumor lysis syndrome
develops failure.
Postrenal insufficiency; posterior urethral valve, ureteropelvic junction stenosis
in young children, in adults
Hemorrhagic cystitis is caused by neurogenic bladder, stones and tumors. Bilateral
obstruction for renal insufficiency
required.
(Answer D)
4. Which of the following is not one of the causes of hypertension in infancy?
(April 2003)
A) Congenital adrenal hyperplasia
B) Essential (primary)
C) Aortic coarctation
D) Polycystic kidney disease
E) Hydronephrosis
Congenital adrenal hyperplasia makes 11 beta hydroxylase and 17 alpha hydroxylase
deficiency HT.
Essential HT is the most common cause of HT in adolescents.
Renal artery thrombosis is the most common cause of neonatal period, while aortic
coarctation in infants>
renovascular diseases> renal parenchymal diseases. Renal parenchymal diseases up to
the age of twelve are> renovascular diseases.
(Answer B)
5. What is the most common cause of chronic renal failure in children? (April 2001)
A) Vesico ureteral reflux
B) Post streptococcal glomerulonephritis
C) Hemolytic uremic syndrome
D) Alport syndrome
E) Minimal change disease
The most common congenital anomalies under the age of 5 in developed countries
(Renal hypoplasia or
dysplasia, obstructive uropathy, posterior urethral valve)
diseases and Alport syndrome are more common.
The most common cause in developing countries is VUR.
(Answer A)
575
PEDIATRICS
6. Which is not important in the etiology of renal vein thrombosis in children?

(September 2000)
A) Hypovolemia
B) Anemia
C) Sepsis
E) Polycythemia
Renal Vein Thrombosis (RVT): Endothelial damage (hypoxia, endotoxin, contrast
agent), hypercoagulobility (nephrotic syndrome and Factor V Leiden mutation),
stasis (hypovolemia and decreased blood flow)
thrombosis occurs due to polycythemia.
Older children; nephrotic syndrome (most commonly in the mebranous), cyanotic heart
disease causing polycythemia
hyperviscosity is seen after contrast agents.
RVT should be considered in the presence of sudden macrasocopic hematuria, single
or bilateral mass. The disease is usually single
It is biased. Bilateral acute renal failure develops. Diagnosis is made by
Doppler / USG.
(Answer B)
7. Which is not seen in renal osteodystrophy due to chronic renal failure?
(September 2000)
A) Hypocalcemia
B) Secondary hyperparathyroidism
C) Hyperphosphatemia
D) High alkaline phosphatase level
E) Increase in serum 1.25 D3
Pathophysiology of chronic kidney disease
acidosis
Acid excretion, ammonium synthesis, bicarbonate absorption ↓
Na retention
↑, oliguria of renin production
Na loss and concentration defect
Tubular damage, solute diuresis
hyperkalemia
GFR ↓, uptake ↑, metabolic acidosis
Renal osteodystrophy
↓ Vit D production, hyperphosphatemia, hypocalcemia, hyperparathyroidism
Growth retardation
↓ caloric intake, GH resistance, anemia, renal osteodystrophy, met. acidosis
Anemia
Erythropoietin, iron, folic acid, vit.B12 ↓, shortening of erythrocyte life
Pericarditis / cardiomyopathy
Fluid load, uremia, hypertension
Uremia, Al toxicity, hypertension
Renal osteodystrophy: Used to describe bone disorders. The most common cause of
hyperparathyroidism is increased bone turnover. As a result of reduced activity of
1 α hydroxylase in the kidney
D3 level of 1, 25 vit decreases. Ca drops, Phosphorus, PTH and ALP increases. Bone
pain, deformities,
rickets, femoral epiphysis shift. Subperiostal bone resorption is seen due to
hyperparathyroidism. P is restricted in treatment. P-binders and vitamin D are
used.
(Answer E)
576
NEFROLOGY
8. Which type of renal failure is more likely to improve renal function? (April
2000)
A) Prerenal renal failure
B) Acute tubular necrosis
C) Bilateral renal and thrombosis
D) Fast progressive glomerulonephritis
E) Cortical necrosis
Prerenal recovery with rapid fluid replacement.
(Answer A)
9. Which of the following is not used in a child's hypertensive crisis? (September
99)
A) Diazoxide
B) Hydralazine
C) Furasemide IV
D) Prazosin
E) Na-Nitroprusside
Drugs used in hypertensive emergency:
Na nitroprusside IV perfusion is performed. Protect from light. Causes
methemoglobinemia and cyanide toxicity.
Nifedipine is used sublingually.
diazoxide
Labetolol is alpha and beta blocker, IV (heart block, heart failure is definite
contraindication)
furosemide
hydralazine
Prazosin is an alpha blocker and has no place in acute treatment.
(Answer D)
10. Peritoneal dialysis in a child with acute renal failure
or is not an indication for hemodialysis? (April 99)
A) Hyperkalemia unresponsive to treatment
B) Hypervolemia unresponsive to diuretics
C) Acidosis unresponsive to sodium bicarbonate treatment
D) Encephalopathy accompanying uremia
E) Increasing the BUN to 70 mg / dl
Indications for dialysis in acute renal failure
Diuretic unresponsive volume overload (HT / pulmonary edema, heart failure)
Resistant metabolic acidosis, hyperkalemia, hypnatremia, Ca / P imbalance
BUN> 100-150 mg / dl (or rapid increase)
> 24 hour anuria
(Answer E)

577
PEDIATRICS
11th. Dilated bladder, bilateral hydronephrosis and oligohydramniosis on antenatal

USG
If a child has pulmonary hypoplasia, which
Considered? (September 95)
A) Bilateral polycystic kidney
B) Neurogenic bladder
C) Bilateral ureteropelvic stenosis
D) Posterior urethral valve
E) Wilms tumor
Posterior urethral valve (PAV): The most common and serious lower urinary tract
obstruction in boys
Why it is. Bladder hypertrophy and trabeculation occurs because the flow becomes
difficult. Increased bladder pressure
Bilateral VUR and hydronephrosis develop. Oligohydramniosis, pulmonary
hypoplasia and renal dysplasia. Drop-in urination and urinary retention may occur.
(Answer D)
12. If bilateral hydronephrosis, dilatemesane, oligohydroamnios are detected in
maternal ultrasonography, which is the most likely diagnosis? (April 95)
B) Bilateral ureteropelvic stenosis
C) Neurogenic bladder
D) Congenital vesicoureteral reflux
E) Posterior urethral valve

PUV is the most common and most serious cause of lower urinary tract obstruction.
(Answer D)
13. Which is the cause of acute renal failure in the newborn? (April 94)
A) Sepsis

C) Renal vein thrombosis
B) Hemoglobinuria
D) Prematurity
E) Hypoxia
Renal failure in the newborn occurs due to sepsis hypoxia and aortic coarctation.
Prematurity is not the cause of renal failure. Hypoxia and sepsis cortical necrosis
or renal vein
thrombosis causes kidney failure.
(Answer D)
14. Which disease does not cause hypertension in children? (September 90)
A) Aortic coarctation
B) Chronic pyelonephritis
C) Polycystic kidney disease
D) Renal artery stenosis
E) Amyloidosis
Since amyloidosis causes nephrotic syndrome, hypertension is not expected. See
nephrotic
syndromes.
(Answer E)
578
NEFROLOGY
URINARY TRACT INFECTIONS

AND SHOOT
one. After urinary ultrasonography in children with frequent urinary tract
infections
Which of the following is the most appropriate examination? (September 2011)
A) Voiding cystourethrography
C) Magnetic resonance urography
D) Contrast abdominal computed tomography
E) DTPA renal scintigraphy
USG should be performed first in all pediatric patients with recurrent urinary
tract infections.
In the next step, urinary anomalies, especially VUR, are common in children.
Voiding cystourethrography should be performed after seeing that the urine culture
is sterile.
After reflux is detected, the upper urinary tract should be monitored for
scarring / anomaly.
USG, CT, dimercapto succinic acid (DMSA) can be used.
DMSA; scar is the most appropriate method used for. However, it is not reliable in
detecting hydronephrosis.
(Answer A)
2nd. Which of the following is not a risk factor for the development of urinary
tract infections? (December 2010)
A) Voiding dysfunction
B) Constipation
D) Pregnancy
E) Hypertension
URINARY TRACT INFECTIONS
Urinary tract infections are common in girls except in the first year. Congenital
malformations associated with this period make it more common in males.
The most common cause is 75–90% E.coli.
Bacteria reach the urinary tract most often through the hematogenous pathway, so
sepsis
acceptable.
In other periods it reaches the assendan way.
Acute pyelonephritis (PN): P fimbria (pyelonephritis associated fimbria / type II
fimbria / mannose resistance
fimbria). Indicates renal involvement. Upper urinary tract infection.
579
PEDIATRICS
Clinical findings:
•
Repetitive chills and fever attacks, back and flank pain,
Costovertebral angle sensitivity,
Colic-type abdominal pain, nausea, vomiting
The kidneys are large and edematous.
Sometimes it can even cause a DIC table.
Nutrition, hypothermia, hyperthermia, weight loss, development in newborns and

young children
retardation, vomiting, diarrhea, jaundice, sepsis.
Asymptomatic bacteriuria: No findings other than culture positivity.

It should be treated only when seen during pregnancy. Because premature labor may
cause complications such as preterm labor.
Cystitis: Bladder infection. Dysuria, frequent urination, urgency, suprapubic pain
happens. Fire and
kidney damage will not occur.
E. coli with type I fimbria (S fimbria) is the most common agent. This type of
E.coli also causes neonatal meningitis.
Risk factors for urinary tract infections
•
Female gender
Male uncircumcised
Anatomical anomalies
Neurogenic bladder, VUR
Voiding dysfunction,
Rock
•
Obstructive uropathy
E. vermicularis infestation
Constipation
Pregnancy is.
VUR is not a risk for cystitis. Tamm – Horsfall glycoprotein, sIgA, has a
protective effect on urine flow.
Diagnosis of urinary tract infection
Pyuria, nitrite and leukocyte esterase reaction supports URI; however, the
definitive diagnosis is culture.
In mid-stream urine 100,000 or more than 10,000 in symptomatic children, 10,000 in
probes and
single colony is considered significant in suprapubic aspiration.
Multiple pathogens suggest contamination and should be repeated.
USG hydronephrosis, renal and perirenal abscess should be performed to exclude
structural anomalies. Every urine
pathway is made undergoing infection.
In acute phase, photopenic areas are seen in DMSA.
It is the most sensitive method for the detection of renal scars.
(Answer E)
3. The highest rate of renal scars in a baby with febrile urinary tract infection
display method showing? (April 2010)
A) Ultrasonography
C) Voiding cystogram
D) DMSA scintigraphy
E) Tomography
580
NEFROLOGY
Pediatrics was one of the most beautiful and quality questions. DMSA, a commonly
used test in pediatric practice
knowledge tested.
In children, especially in the renal parenchyma after urinary tract infections
(acute pyelonephritis)
The most sensitive method for showing scars is 2,3 dimercaptosuccinic acid scan
(DMSA). DMSA
confirmed the diagnosis of acute pyelonephritis when performed in the acute phase
of infection. from infection
after it shows the scars formed kidney.
(Answer D)
4. A four-year-old girl with recurrent urinary tract infections
therefore, she was treated in hospital once.
Renal injury (scar) is thought to be the most useful examination in this child
A) Intravenous pyelography
B) Uroflowmetry
C) Urination cystourethrogram
D) Dimercaptosuccinic acid (DMSA) scintigraphy
E) Determination of creatinine clearance level
Imaging methods
USG: Hydronephrosis, renal and perirenal abscess should be performed to exclude
structural anomalies.
In the acute phase of DMSA pyelonephritis, photopenic areas are seen. For the
detection of renal scars
sensitive method. It is unreliable to detect hydronephrosis.
Voiding cystoureterogram (VCUG): Bladder contours, vesicourethral reflux,
provides evaluation of urethral anatomy. VCUG male except direct appearance by
cystoscopy
is the only method used in the diagnosis of posterior urethral valve in children.
The degree of renal parenchyma and pyelonephritis cannot be evaluated.
Intravenous pyelography (IVP): It is useful in evaluating the anatomy of the kidney
and collecting system.
It gives information about the perfusion and filtration functions of the kidney;
but kidney function
evaluation is not enough test. Shows caliectasis. Does not indicate infection.
(Answer D)
5. Mention cystourethrogram for which of the following urinary system disorders
no diagnostic value? (April 2003)
A) Vesicoureteral reflux
B) Anatomical disorders of the bladder
C) Posterior urethral valve (in boys)
D) Acute pyelonephritis
E) Ureterocele
2. See the description of the problem.
(Answer D)
581
PEDIATRICS
6. Which of the effects of childhood urinary tract infection on stone formation

it causes? (September 2000)
A) P.mirabilis
B) E. coli
C) S.saprophyticus
D) S.agalactiae
E) N.gonorrhea
Urinary tract infections
It is common in girls except in the first year. The most common cause (75-90%) is
E.coli. Frequency of uncircumcised boys
P. mirabilis, which is related to increasing and struvite formation.
S.saprophyticus in adolescent girls
frequency increases.
Acute pyelonephritis (PN): There are systemic symptoms such as fever, nausea,
vomiting, abdominal pain. P protein (fimbria) is caused by E. coli.
Acute lobar nephritis (nephronia): Localized infection involving multiple lobes.
Early stage of the abscess
or PN complications.
Renal abscess; PN or hematogenous S. aureus.
Perinephritic abscess: infection of the neighboring region (osteomyelitis / psoas
abscess) or pyelonephritis capsule
it becomes spread out.
Asymptomatic bacteriuria: No findings other than culture positivity. Only seen in
pregnancy
should be treated. Because it can cause preterm labor or miscarriages.
Cystitis: Dysuria, frequent urination, urgency, suprapubic pain occurs. No fever
and kidney damage.
Stone formation was questioned in the question; but if it was emphasized that this
was a struvite stone.
would be a better question.
(Answer A)
7. Which urinary stone is made of alkaline urine for treatment? (September 99)
A) Oxalate
B) Calcium
C) Citruvite
D) Uric acid
E) Magnesium ammonium
UROLITHIASIS (URINARY STONES)
Calcium stones are most common.
Increasing stone formation; metabolic disorders (most commonly hypercalciuria),
obstruction-malformation,
UTIs are.
Reducing stone formation; citrate, magnesium, diphosphate.
The stones are 90% radiopaque.
Radiopaque stones: Calcium and strivut (magnesium ammonium phosphate) stones.
Radiolucent stones: Uric acid and xanthine stones.
The cystine stones appear foggy (weakly radiopaque). The best imaging modality is
non-contrast CT.
Small stones and ureteral stones cannot be seen on USG and direct radiography.
These are not diagnostic
can be used for purpose.
(Answer D)
582
NEFROLOGY
KIDNEY STONES
Calcium Stones
The most common stones are calcium oxalate and calcium phosphate stones. The most
common cause of stone formation
metabolic disorder is normocalcemic hypercalciuria. Other reasons;
hyperparathyroidism, vitamin
Excess D is sarcoidosis, furosemide, hyperoxaluria, hyperuricosuria, heterozygous
cystinuria and RTA.
Secondary hyperoxaluria: Malabsorption (IBD, pancreas, biliary diseases), vitamin C
excess
pyridoxine deficiency and ethylene glycol intoxication. Over tea, coffee and
spinach
oxalate.
Cystine Stones
Cystinuria: Transport of dibasic amino acids - cystine, ornithine, arginine and
lysine - is impaired. Water
It is also responsible for stone formation since it is the cystine which has the
lowest solubility. Cystine stones do not form in heterozygotes.
Struvite Stones
Bacteria that break down urea; especially Proteus, Klebsiella, E. coli and
Pseudomonas. urine
it causes alkalization and excessive ammonia formation and causes ammonium-
magnesium phosphate (struvite) stone. Struvite stones fill the renal calyx and form
"antlers"
Identified.
Uric Acid Stones
It is suspected if persistent urate crystals are seen and acid urine is detected.
Myeloproliferative diseases are caused by Lesch-Nyhan syndrome, glucose-6-
phosphatase deficiency, short bowel syndrome (especially those with ileostomy),
chronic dehydration and acidosis. indinavir
stone
It is due to indinavir, a protease inhibitor used in the treatment of HIV.
Abundant fluid is taken in the treatment. The underlying metabolic disorder is
corrected.
Acid urine: treatment of calcium and citruvitis stones
Alkaline urine: used for the treatment of uric acid and cystine stones.
8. Urinary tract infection is detected in the newborn. For diagnosis, the following
Which of the examination methods is not done? (April 95)
B) Ultrasonography
C) Cystourethrography
D) Magnetic resonance imaging
E) Kidney scintigraphy
(Answer A)
9. Which is not the cause of congenital VUR? (April 93)
A) Double collector system
B) Urethorocele
C) Trabeculation
D) Trigonal insufficiency
E) Posterior urethral valve
583
PEDIATRICS
Vesicourethral Reflux (Shoot)

Urine is the escape from the bladder back to the ureter and kidney. Increases
tendency to infection. Recurrent infections result in renal scarring. Reflux alone
if increased bladder pressure and no infection
does not cause renal damage. Genetic predisposition is important.
Primary VUR (congenital VUR): Ureterovesical valvular mechanisms, insufficiency,
trigonal insufficiency, ureter duplication-ectopia, PUV is caused by.
Secondary VUR: In cases of increased bladder pressure (neuropathic bladder leading
to trabeculation, bladder outlet obstruction), inflammation (cystitis, stone,
foreign body) and uretero vesical
junction after surgical intervention.
Diagnosis: Voiding cystoureterogram (VSUG)
tense It is divided into five phases. in Bladder
Reflux while full of low pressure
(passive) reflux, while urinating
called high pressure (active) reflux. reflux
Upper urinary tract scar after detection
/ anomaly.
Spontaneous recovery occurs at age 6.
The possibility of recovery; low-grade reflux, primary
reflux, unilateral reflux and younger
It is high. Stage I-II improves spontaneously. Stage III,
it may spontaneously heal if unilateral and patients are younger. Treatment is
prophylaxis or surgery.
(Answer C)
10. Which of the following is the most common cause of urinary tract infection in
children?
(April 88)
a)
Proteus
B) S. aureus
C.)
Klebsiella
D) E. coli
TO)
Pseudomonas
E.coli is the most common cause of urinary system infections at any age.
Risk factors for urinary tract infections; female or uncircumcised male, anatomical
abnormalities, neurogenic bladder, VUR, voiding dysfunction, stone, obstructive
uropathy, E.vermicularis infestation, constipation
and pregnancy. VUR is not a risk for cystitis.
Tamm-Horsfall glycoprotein, sIgA, is effective in protecting urine flow.
Pyuria, nitrite and leukocyte esterase reaction supports UTI, but the definitive
diagnosis is made by culture. Medium current
urine 100,000 or more than 10,000 in symptomatic children, 10,000 in probes and
single colonies are considered significant in suprapubic aspiration. Multiple
pathogens in suprapubic aspiration
contamination and should be repeated.
Treatment
In acute cystitis, treatment is given if symptoms are high. 3-5 days trimethoprim-
sulfomethoxazole / nitrofurantoin /
Ampicillin can be used.
PN treatment is 10-14 days. Patient age <1 month, vomiting-dehydration is the
indication for hospitalization.
If there are recurrent infections, neurogenic bladder, VUR, stone, obstruction,
prophylaxis is performed with trimethoprim-sulfamethoxazole / nitrofurantoin 1/4
-1/3 of the normal dose.
(Answer D)
584
NEFROLOGY
RENAL TUBULAR ACIDOSIS AND OTHER

KIDNEY DISEASES
one. Which of the following diseases does not lead to renal tubular dysfunction?
(September 2006)
A) Cystinosis
B) Galactosemia
C) α1 antitrypsin deficiency
D) Wilson's disease
E) Lowe syndrome
Apart from alpha 1 antitrypsin deficiency, other options are the cause of proximal
tubular dysfunction (Fanconi syndrome). α1 antitrypsin deficiency cholestasis and
non-smoking panacinar emphysema
It is seen.
Renal tubular disorders:
one.
Renal tubular acidosis; distal RTA (type1 RTA), proximal (type 2 RTA),
mineralocorticoid
deficiency (type 4 RTA)
2nd.
Bartter, Gitelman syndrome
3.
Nephrogenic DI
4.
Other tubular dysfunction: Liddle, Cystinuria (impaired transport of dibasic amino

acids), Dent's disease (X-linked nephrolithiasis)
Proximal Renal Tubular Acidosis (pRTA)

Proximal renal tubular dysfunction; proximal RTA with isolated bicarbonate
reabsorption defect
or generalized proximal dysfunction (glycosuria, aminoacituria, low molecular
weight)
proteinuria, as a component of Fanconi syndrome with phosphaturia.
Hereditary Fanconi syndrome: Cystinosis, Lowe syndrome, galactosemia, trosinemia,
Wilson, mitochondrial
pRTA may be secondary to hereditary diseases such as Dent disease.
Secondary Fanconi syndrome: Heavy metal intoxication (lead, mercury) may be seen in
the use of antineoplastic agents such as tetracyclines, cyclosporine and
ifosfamide.
Distal Renal Tubular Acidosis (dRTA)
H + secretion from distal tubule to lumen is impaired. Ammonogenesis is also
impaired (H + -ATP less,
HCO3-Cl anion exchanger, aldosterone pathway defect). Hypercalciuria and
nephrolithiasis are common. Rickets
without bone demineralization.
Secondary dRTA: Interstitial nephritis, obstructiveuropathy, VUR, pyelonephritis,
transplant rejection, sickle cell
anemia, lupus nephritis, Ehlers-Danlos syndrome, nephrocalcinosis, medullary sponge
kidney. Amphotericin B, Li, toluene, can be seen due to the use of cisplatin.
Type 4 Renal Tubular Acidosis
Ammonia excretion from the distal tubule was disrupted secondary to
hypoaldosteronism. Normal
anionic span metabolic acidosis. Cardinal sign is hyperkalemia and urinary acidity
is normal.
(Answer C)
585
PEDIATRICS
2nd. Anion in a child with growth retardation, acidosis, hypokalemia and

hyperchloremia
If the gap is normal, which is the most likely diagnosis? (April 2000)
A) Bartter syndrome
B) Finnish type nephrotic syndrome
C) Renal tubular acidosis
D) Conn's syndrome
E) Hypophasphatemic rickets
RTA has normal anion opening metabolic acidosis. Normal anion opening is high Cl
indicates that. Hyperpotasemia exists only in type IV. Hypopotasemia in other than
It is seen.
See the description of question 1 for the RTA.
(Answer C)
3. What is not seen in Fanconi syndrome? (April 99)
A) Hyperpotasemia
B) Hyperchloremia
C) Generalized aminoaciduria
D) Glycosur
E) Hyponatremia
Generalized proximal tubular dysfunction is called Fanconi syndrome.
Glucosuria, aminoaciduria, low molecular weight proteinuria, phosphaturia,
hyponatremia, hypokalemia, hyperchloremia are seen. Hyperpotasemia and uric acid
are not elevated.
(Answer A)
4. Which of the following is not a cause of polyuria and polydipsia in a child?
(September 98)
A) Hypochloremia
B) Hypercalcemia
C) Diabetes mellitus
D) Hypokalemia
E) Diabetes insipidus
The causes of polyuria and polydipsia are:
one. Diabetes mellitus
2nd. Diabetes insipidus
3. Hypopotassemia
4. hypercalcemia
5. Acute tubular necrosis
6. Mandatory polyuria of chronic renal failure
7. Use of diuretics
8. Psychogenic polydipsia
(Answer A)
586
NEFROLOGY
5. Which of the following is not one of the signs of Fanconi syndrome? (April 98)
A) Generalized aminoaciduria
B) Hyperuricemia
C) Glucosuria
D) Proximal RTA
E) Phosphatics
(Answer B)
6. Influencing the proximal tubule and causing renal tubular acidosis
A) Hyperoxaluria
B) Hypercalciuria
C) Cystinosis
D) Cryoglobulinemia
E) Hartnup
(Answer A)
7. Blood in a patient with growth retardation, polydipsia and nephrocalcinosis
pH: 7.29, urine pH: 6.8 and blood K: 2.9 mEq / lt
You think? (September 94)
A) Chronic diarrhea
B) Distal renal tubular acidosis
C) Batter syndrome
D) Hypoaldesteronism
E) Proximal renal tubular acidosis
(Answer B)
8. Urine pH: 7.1, blood pH: 7.1 in a patient with rickets and aminoaciduria
detected
what is your possible diagnosis? (September 88)
A) Fanconi syndrome
B) Cystinuria
C) Distal tubular acidosis
D) Chronic renal failure
E) Type IV renal tubular acidosis
See explanations of questions 1 and 3.
(Answer A)
587
PEDIATRICS
588
LIQUID ELECTROLITE
LIQUID-ELECTROLITE AND ACID-BASE

BALANCE
one. Which of the following is the anion gap within normal limits? (September 2003)
A) Lactic acidosis
B) Diabetic ketoacidosis
C) Amino aciduria
D) Salicylate poisoning
E) Renal tubular acidosis
METABOLIC ACIDOSIS
Occurs irrespective of respiration. H + ions are increased as a result of
metabolism or the growth of acids caused by other reasons, or bicarbonate for
various reasons.
loss of ions. The HCO3 value falls below 22.
Some cases of excessive bicarbonate ion loss:
· Acute renal failure (most common cause)
· Heavy diarrhea
· Diuretic treatments
· GIS fistulas
· Liver failure
· Hypoxia
· Excess acid (iatrogenic)
· Excess transfusion
· Chronic renal failure, decreased HCO3 production
· Dibetes Mellitus
Possible causes of metabolic acidosis:
· Inadequate disposal of metabolic acids in the body as a result of impaired renal
function
· Formation of metabolic acid above the disposable capacity of the body
· Absorption of metabolic acids from the gastrointestinal tract
IV administration of metabolic acids
· Diarrhea from body fluids, ureterosigmoidostomy, diuretics, excess aldosterone
due to excessive loss of base.
When H + ions increase and HCO3 ions decrease, ie metabolic acidosis develops,
immediate respiratory rate
and by increasing the depth, the lungs begin to excrete large amounts of CO2. On
the other hand
kidneys help to compensate for this by removing H + (acidic urine) and holding
HCO3.
tries to be; but this is a mechanism that emerged later.
Severe diarrhea is the most common cause of metabolic acidosis. Significant amount
of gastrointestinal secretions
sodium bicarbonate. Diarrhea with a significant amount of base will be missing due
to beating
develop metabolic acidosis. The most common cause of metabolic acidosis in surgical
patients; acute kidney
league-is not enough. It is caused by insufficient HCO3 formation in the tubules.
589
PEDIATRICS
Glucose metabolism is normal due to inadequate insulin release from the pancreas in
diabetes mellitus
It is not. Thus, instead of glucose in tissues, acetoacetic
acid becomes used. In this case, the ratio of acetoacetic acid in extracellular
fluid is very high and H +
ion concentration increases.
Lactic acidosis, severe shock, thorough deterioration of sepsis circulation,
manifested by deep anoxia in tissues
is an emerging situation.
Metabolic acidosis is classified according to the amount of Anion Gap:
Anion gap normal ones
· The most common cause is excessive diarrhea.
· Loss of bicarbonate
· Treatment with carnonic anhydrase inhibitors
· Renal tubular acidosis
· Ureterosigmoidoscopy
Anion Gap High Ones
· The most common cause is acute renal failure
· Chronic renal failure
· Lactic acidosis: Most commonly seen after shock and sepsis.
· DKA
· Salicylate poisoning (metabolic acidosis followed by respiratory alkalosis).
Treatment
There are three main issues in treatment. one. Correction of cause, 2. Chemical
buffer therapy, 3. Fluid and Electrolyte
Disorder correction.
· Correction of excess H + production and excess HCO3 loss.
Insulin is given in diabetic ketoacidosis.
· Lactic acidosis should be prevented by correcting tissue perfusion.
· Fight against acidosis by giving HCO3 as IV.
(Answer E)
2nd. Which of the following is not one of the signs of inappropriate ADH syndrome?
(September 2001)
A) Hyponatremia
B) Reduced urine sodium
C) Decreased serum osmolality
D) Increased urine osmolority
E) Increased plasma vasopressin levels
Inappropriate ADH syndrome is the most common cause of praolemic hyponatremia in
childhood. ADH
water is retained due to the increase in secretion.
GFR is increased to prevent hypervolemia. Sodium reabsorption in proximal tubules
decrease in urine leads to an increase in Na excretion.
Sodium excreted in urine is more than sodium intake.
(Answer B)
590
LIQUID ELECTROLITE
3. Diarrhea occurs in a six-month-old child. Which of the following is the least

valuable in determining dehydration in this child? (April 2000)
A) Characteristics and frequency of feces
B) Eyeball depression
C) Fontanel depression
D) Reduction of skin turgor
E) Dry and pale mucosa
Clinical symptoms in a patient with dehydration:
· Circulatory disturbance
· Skin changes
· Eye and fontanel depression
· Oliguria
· CNS findings
· Change of consciousness
· Muscular hypertension
· Increase-decrease in reflexes
· Unconsciousness
· Acidosis
· Abdominal distension
· Muscle weakness
· Dry and pale mucosa
· Tetany, convulsion
(Answer A)
4. Which is not seen in inappropriate ADH release? (April 97)
A) Hyponatremia
B) Increased urine osmolority
C) Hypertension
D) Convulsion
E) Hypouricemia
Due to inappropriate ADH secretion syndrome, meningitis, encephalitis, brain tumor
and abscess, head trauma, pneumonia, tuberculosis, acute intermittent porphyria,
cystic fibrosis, perinatal asphyxia and drugs,
antidiuretic hormone (ADH).
Clinical features:
· Hyponatremia
· Hypochloremia
· Continuation of Na excretion from urine despite serum hyponatremia
· Hypoosmolarity in serum
· Hyperosmolarity in urine
· Hypouricemia
Since serum sodium is low, hypertension is not seen.
(Answer C)
589
PEDIATRICS
5. What is the cause of intracranial hemorrhage in a child? (April 89)

A) Hypocalcemia
B) Hyponatremia
C) Hypernatremia
D) Hyperglycemia
E) Hyperuricemia
Causes of intracranial hemorrhage in children;
· Birth trauma or asphyxia
· Primary hemorrhagic diseases
· Congenital vascular anomalies
· DIC
Thrombocytopenia
· Prematurity
· RDS
· Hypoxic ischemic damage
· Excessive decrease or increase in cerebral blood flow
· Pneumothorax
· Hypervolemia
· Hypernatremia
· Hypertension
(Answer C)
6. Which of the following is not a sign of moderate dehydration?
(April 2002)
A) Dryness of mucous membranes
B) Front fontanel depression

C) Low blood pressure
D) Anuria
E) Depression of the eyeballs

Grading of dehydration and clinical features
Clinical findings
Light
Middle
Serious
Weight Loss
5%
10%
15%
Loss of TSV (ml / kg)
50 ml / kg
100 ml / kg
150 ml / kg
Loss of TSV (%)
7%
14%
21%
general situation
Normal
Irritable, lethargic
Consciousness off
Respiratory
Fast
Fast, deep, superficial
Mucous membranes
Damp
Dry
Very dry
Tears
decreased
No
Front fontanel
Collapsed
Very collapsed
Skin turgor
Slightly decreased
decreased
Urine extraction
decreased
Very little / no
Pulse
Fast
Fast, weak
Blood pressure
Low
KDZ
2 sec
> 2 sec
(Answer D)
590
LIQUID ELECTROLITE
7. What is the daily liquid, Na and K requirement of a 10 kg child? (April 98)

Liquid
NA
A) 1000
25
20
B) 1000
75
10
C) 1000
145
40
D) 1500
75
60
E) 1500
115
45
Daily fluid requirement up to one age 100cc / 1kg, fluid requirement after one age
maintenance 1500cc / m2
Normally, a one-year-old baby will weigh 10 kg.
100cc = 1000 cc.
Sodium requirement: 2-3 mEq / kg (average 20-30 mEq / lt for 10 kg)
Potassium requirement: 1-2 mEq / kg (average 10-20 mEq / lt for 10 kg)
Cl requirement: 2-3 mEq / kg (average 20-30 mEq / lt for 10 kg)
(Answer A)
8. Which two of the following anions and cations have the highest value in plasma?
(September 92)
A) Mg-Cl
B) K-Cl
C) Na-Cl
D) Na-K
E) K-Na
The highest concentration of anion in plasma is chlorine and the highest
concentration of cation is sodium.
(Answer C)
589
PEDIATRICS
590
NEUROLOGY
CONGENITAL CENTER
NERVOUS SYSTEM ANOMALIES,
HYDROCEPHALUS,
HEAD ENVIRONMENTAL ANOMALIES
one. Which of the following is not one of the causes of hydrocephalus?
(April 2007)
A) Congenital aquaductal stenosis B) Chiari malformation
C) Dandy-Walker syndrome
D) Meningitis
E) Trisomy 18
'' Which one…. The reason is not? '' If you find it difficult to answer the
questions in the style of the first thing you have to do is to reverse the question
and look for the cause of the opposite situation.
In this question, "Which is the cause of microcephaly?" thinking in the form will
greatly facilitate your work.
The majority of CSF is produced in the choroid plexus in the lateral, 3rd and 4th
ventricles. Normal production in children
It is 20 ml / h and the total amount is 50 ml.
Occlusive = noncominican hydrocephalus: It is called hydrocephalus caused by
ventricular obstructions.
Non-occlusive = communic hydrocephalus: It is called hydrocephalus caused by
insufficient absorption as a result of disturbances in subarachnoid cisterns or
arachnoid villi.
Occlusive hydrocephalus is more common in childhood and is often due to aquaduct
stenosis.
Subarachnoid hemorrhage is the most common cause of non-occlusive hydrocephalus.
Especially pneumococcal and
obstruction and leukemic infiltrations in the basal cisternas in tuberculous
meningitis
hydrocephalus.
Clinic: The most prominent finding in infants is the rapid increase in head
circumference. Width in front fontanelle,
the veins become clear and the eyes deviate downward (setting sun landscape) is
seen.
In older children, headache is a significant symptom.
An increase in DTR, spasticity, clonus, and Babinski signs are observed. Skull in
hydrocephalus
percussion “crack test” sound (Macewen sign) and transillumination can be detected.
Most common cranial nerve paralysis as a result of ICP: N. abdusens
Chiari malformation
Type I; Displacement of the cerebellar tonsils into the cervical canal. Often
associated with hydrocephalus
It is not. It is associated with stretched cord and syringomyelia. Type II;
Inferior cerebellar vermis, pons and
displacement of the medulla to the cervical canal. Progressive hydrocephalus and
myelomeningocele
It is characteristic.
Dandy-Walker malformation: Cystic enlargement of the Fourth Ventricle. Posterior
cerebellar vermis and corpus callosum agenesis. Rapid increase in head
circumference and marked occiput
It is seen.
Trisomy 18 has microcephaly.
(Answer E)
595
PEDIATRICS
Komunika
•
Achondroplasia
Bacilli Impression
Benign subarachnoid space enlargement
Meningeal malignancy
Meningitis / Posthaemorrhagic
Choroid plexus papilloma
noncommunicating
•
Aquaduct Stenosis (X-linked, infectious)
Chiari / DandyWalker malformation
Klippel-Feil syndrome
•
Mass lesion: Abscess, hematoma, tumor, neurocutaneous syndromes, Galen vein

malformation
2nd. Which is not the cause of microcephaly? (April 2005)

A) CMV
B) Radiation
C) Aquaductal stenosis
D) Trisomy 21
E) Fetal alcohol syndrome

A question that can be solved with the same logic. Aqua duct stenosis
noncommunicated / obstructive / obstructive hydrocephalus
It makes. Enlarges the head circumference.
The head circumference is below the 3rd percentile.
Primary microcephalus are those of genetic origin. They accompany syndromes.
Secondary microcephalus is caused by harmful agents.
When the etiology of microcephaly is not found, maternal phenylalanine should be
examined.
Karyotype analysis should be performed if chromosomal syndrome is considered
(Answer C)
Primary causes
•
Family (OR, OD)
Down syndrome
Edward syndrome
Cri-du-chat syndrome
Cornelli de Lange syndrome
Rubistein-Taybi syndrome
Smith-Lemli-Opitz syndrome
Secondary causes
•
Radiation
•
TORCH infection
malnutrition
Metabolic (Hyperphenylalaninemia)
hyperthermia
596
NEUROLOGY
3. A 15-year-old fat girl with headache for a week,

vomiting, double vision and slipping of the eyes. on examination
papillary edema. Cranial magnetic resonance imaging showed slight narrowing of the
ventricles and no mass was detected. The most likely diagnosis for this patient
A) Brain tumor
B) Tentorial herniation
C) Syringomyelia
D) Pseudotumor cerebri
E) Leukodystrophy
Pseudotumor cerebri: A clinical picture resembling brain tumors. Without space-
occupying lesion
increased intracranial pressure. Increased intracranial pressure (> 20 cm H2O in
infants,> 25 cm in children
H2O) is cataracterized with normal CSF findings. MRI is normal.
Etiology:
Metabolic diseases; Galactosemia, after refeeding syndrome in severe malnourished
children, A
hypo / hypervitaminosis
Endocrine: Hypoparathyroidism, pseudohypoparathyroidism, hypophosphatasia, long-
term steroid use or
abrupt discontinuation of steroids, growth hormone therapy, Addison's disease,
obesity, menarche, OX
use, pregnancy.
Infections; Rozeola infantum, chronic otitis and mastoiditis, Gullian-Barre
syndrome
Medicines; Nalidixic acid, tetracycline, doxycycline, minocycline, nitrofurantoin,
isotretinoin. Especially acne
tetracycline and isotretionin.
Hematologic; Polycythemia, hemolytic anemia, iron deficiency, Wiskott-Aldrich
syndrome
Impairment of intracranial venous drainage; Lateral sinus and posterior sagittal
sinus thrombosis
Head trauma
Superior vena cava obstruction
Attacks are called idiopathic intracranial pressure increase if no underlying cause
can be found.
Clinical: The most common symptom is headache. Non-persistent vomiting, diplopia
due to abducens nerve palsy,
papillary edema and blind spot enlargement. There is no focal neurological finding.
LP performed after cranial imaging is both diagnostic and therapeutic.
It is often a self-limiting condition.
The most important complication is optic atrophy and blindness. In the treatment of
CSF discharge with LP, acetazolamide and
steroids available.
(Answer D)
4. Which of the following central nervous system defects is the result of migration
defects
It occurs? (September 99)
A) Lissencephaly
B) Myelomeningocele
C) Spinal bifida occulta
D) Encephalocele
E) Anencephaly
597
PEDIATRICS
Neuronal migration defects

Lysencephaly (AGRI): It is characterized by the absence of cerebral folds and
lesser formed silvian fissure.
The cortex is 4 layers instead of 6 layers. Enlargement of lateral ventricles and
heterotopies in white matter are seen.
Miller-Dicker syndrome: 17. Deletion of the LIS-1 gene is present on the
chromosome. Dislocated forehead, bitemporal pitting, nostrils facing out, large
upper lip and micrognathy are seen.
Schizencephaly: Cerebral hemispheres have unilateral or bilateral cleft. Unilateral
congenital hemiparesis.
Porenseafli: There is cyst or cavity in brain tissue. Cysts are the most common
site of silvian fissure.
Holoprosencephaly: Inability to distinguish prozensaphalone is a defect. As alobar,
lobar and semilobar
Classified. The most severe form is the alobar type. Facial abnormalities are often
accompanied. Single incisor tooth,
midline anomalies such as cyclops. It is associated with maternal diabetes.
No neuronal heterotopia is small.
(Answer A)
5. Which of the following is not the cause of pseudotumor cerebri? (April 88)
A) High-dose vitamin A
B) High-dose vitamin B
C) Hypoparathyroidism
D) Low-dose vitamin A
E) Use of tetracycline
(Answer B)
598
NEUROLOGY
convulsions
one. Which of the following seizure types is not one of the seizure types seen in
the neonatal period? (September 2011)
A) Tonic
B) Myoclonic
C) Generalized tonic-clonic
D) Multifocal clonic
E) Focal clonic
Now a really classic minor and TUS question. Generalized tonic clonic from neonatal
brain
guard does not come !!!
NEWBORN CONVULSIONS
Generalized tonic clonic seizure is the most common seizure in the newborn
amorphous seizures. In general, the most common cause of seizures is hypoxia-
ischemia.
•
There are autonomic changes such as tachycardia and increase in blood pressure.
Seizures do not change when the baby stops when the seizures are stopped.
Sensory stimuli and non-seizures are triggered, whereas seizures are not affected.
Non-seizure aroxismal disorders; Jitternes and beningn are neonatal sleep

myoclonis.
(Answer C)
2nd. Which of the following best describes infantile spasm? (December 2010)
A) Suddenly the motor activity or speech is interrupted, the face becomes
meaningless expression and winks.
B) Occasionally there are seizures with tonic and clonic contractions and loss of
consciousness and cyanosis throughout the body, which can be aura period.
C) Body tone is lost, short – symmetrical muscle contractions, the patient forward
is a type of epilepsy in which it tends to fall.
D) It is a type of epilepsy in which short etrik symmetrical muscle contractions
occur in the neck, trunk and extremities and hypipsarrhythmia is seen in EEG.
E) Repetitive episodes of torticollis are observed with paleness, agitation and
vomiting.
599
PEDIATRICS
Typical findings of West syndrome are hypsa rhythm, infantile spasm and mental
retardation.
Infantile spasms: head and neck, short-term contraction of the extremities. There
could be hundreds.
–– Flexor
–– Extensor (minimum)
–– Karma (most often)
Hypersarrhythmia in EEG (diagnoses)
–– Hypsarrhythmia: High voltage chaotic pattern, bilateral asynchronous slow wave
activity.
Cryptogenic (10–20%). Development is normal until the disease begins. CT / MRI is
normal. prognosis
is good.
(Answer D)
3. Which of the following is a complicated febrile convulsion criterion? (April
2010)
A) Febrile seizures lasting more than 15 minutes
B) Concomitant infection
C) febrile seizures before 1 year of age
D) Recurrent febrile seizures
E) Generalized tonic-clonic seizures
One more question. It takes more than 15 minutes or 24 hours for complicated
convulsions
recurrence or focal seizures or postictal focal findings should be observed.
(Answer A)
4. Which of the following statements about complicated febrile seizures is
incorrect? (September 2009)
A) Seizures exceeding 15 minutes.
B) Focal findings are seen in the postictal period.
C) Repeated frequently within 24 hours.
D) The incidence of epilepsy increases in the future.
E) Generalized tonic-clonic seizures.
Febrile convulsions (FK): It is the most common seizure in children. Often between
5 months to 5 years (most commonly 14-18 months)
It is seen. It is seen in febrile infections other than central nervous system
infections. Family trend
has.
(Answer E)
600
NEUROLOGY
Simple FK
•
Fever ≥39 oC
Generalized tonic is clonic
Postictal period is short
•
Takes less than 15 minutes
Not repeated within the same day
Complex FK
•
Seizure of focal character
Postictal focal finding
Lasts more than 15 minutes
Repeats on the same day
5. Which of the following means that a child with a febrile seizure may later
become epileptic?
is not one of the factors that increase the risk? (April 2008)
A) Complicated febrile seizure
B) Family history of epilepsy
C) An underlying neurological disorder
D) Seizure after 2 years
E) Retardation in developmental stages
The risk of febrile convulsion in developing epilepsy: during seizure or postictal
period
complex features, family history of epilepsy, first febrile convulsion before 12
months
and retardation of neuromotor development. Anticonvulsant use increases the risk of
developing epilepsy
It does not. The risk of epilepsy in complicated febrile convulsions is 9%, whereas
it is simply 1%.
Factors that increase the risk of seizure recurrence: Under one year, complicated
character
having a history of febrile convulsions in the family.
Intellectual functions are not impaired in FK children. The risk of epilepsy is
increased according to the population.
In approximately 30-50% of patients, febrile convulsions recur in the event of
subsequent fever. antipyretic
treatment does not reduce the risk of recurrence.
(Answer D)
6. Which of the following is not one of the characteristics of participation bouts?
(September 2007)
A) There are two forms, cyanotic and palpable.
B) Interictal EEG is defective.
C) It is most common at 2 years of age, rare after 5 years of age.
D) It is triggered by falling and tapping the head.
E) Bradycardia, asystole, apnea periods can be seen.
601
PEDIATRICS
Conditions mimicking seizures in children vary with age.

Neonatal period: Jitternes, benign sleep myoclonia
Infant: Breath holding attacks, sleep disorders are common causes. Benign
paroxysmal vertigo,
paroxysmal torticollis, dystonic drug reaction and GER with dystonia are other
causes.
Childhood: Breath-holding attacks, migraine and migraine equivalent (cyclic
vomiting, recurrent abdominal
pain), day dreams, sleep disorders (nightmare, sleeper mobility) frequent causes,
teak, psychogenic
seizures, syncope, beningn paroxysmal vertigo, masturbation are other causes.
Adolescent: Syncope, migraine, daytime dreams, sleep disturbance (night myoclonus,
narcolepsy)
Breath holding (Participation) bouts:
Cyanotic seizures; Although it is seen between 6 months and 5 years, it peaks at 2
years old. Triggered when the baby gets angry or scolded. Forced expiration and
apnea after short treble crying
It is seen. Cyanosis, loss of consciousness, generalized clonic jumps, opistotonus
and bradycardia are seen.
Not at night. Iron deficiency can cause anemia. Interictal EEG is normal.
Pale seizures; Breathing after painful stimulation, such as falling, bumping, or
suddenly startling
failure, unconsciousness, pallor, hypotonicity, tonic contractions, bradycardia or
2 sec short asystole
It is seen. Interictal EEG is normal. Thanks to the ocular cardiac reflex (afferent
5. Cranial, efferent
vagus) can be created in the laboratory. Atropine is used for treatment.
Syncope
It is usually caused by a decrease in brain blood flow as a result of systemic
hypotension.
Simple syncope; It is seen as a result of vasovagal stimulation. Long standing,
warm weather, pain
Stimulates fear. Differential diagnosis is made by tilt test. Beta blockers are
used in the treatment.
Cough syncope; Waking up from sleep, consciousness after excessive cough,
especially in children with asthma
loss, hypotonia, upward deviation of the eyes, and short-term clonic contractions.
Long QT syndrome; Sudden loss of consciousness occurs during exercise and stress.
Sudden death can be seen
(Answer B)
7. A seven-year-old girl, 20-25 times a day, stagnation not exceeding ten seconds,
staring at a point and not responding to questions in the form of
seizures are observed.
What kind of seizures are observed in this child? (April 2006)
A) Generalized clonic
B) Simple partial
C) Generalized myoclonic
D) Generated atonic
E) Absence
Absence (Petit mal): An empty motor with short-term motor activity or sudden pause
in speech.
It is characterized by facial expression and cropping of the eyelids. Then from
work to work
continues. Short time (rarely> 30 sec). It is common in girls and is rare before
the age of 5 years. Aura and
postictal period is not seen. Hyperventilation and seizure are triggered by light.
3 hertz bumps per second
Wave is typical. Etosuximide is used for treatment. The complex should be separated
by partial seizure.
(Answer E)
602
NEUROLOGY
PARTIAL SEIZURES
*
Simple Partial Guard
- Engine
- Sensory
- Autonomic
- Psychic.
* Complex Partial Seizure
- Disruption of consciousness after simple partial
- Unconscious at the beginning
* Secondary generalized partial seizures
GENERALIZED SEIZURES
-
absence
Typical
atypical
Generalized tonic-clonic
Tonic
clonic
myoclonic
atonic
-
Infantile spasm
8. Which of the following types of epilepsy have EEG hypipsarrhythmia?September

2003)
A) Petit goods
B) Myoclonic
C) Infantile spasm
D) Grand merchandise
E) Occipital
I wish B had never been ...
Infantile spasm (West syndrome): Short-term symmetrical contractions of the neck,
trunk and extremities, which are usually seen between 4-8 months. Contractions
flexor, extensor or flexor + extensor (mix)
can. The most common type is mixed type. Screaming before or after spasm can occur
and
infantile colic.
There is no underlying disease in cryptogenic West. Symptomatic West has an
underlying disease. Hypoxic ischemic encephalopathy, periventricular leukomalacia,
lysenfeali, schizencephaly, metabolic diseases,
neurocutaneous syndromes (tuberous sclerosis), head trauma and subdural hematoma.
Vaccines are not caused.
Prognosis is poor.
Hypergarrhythmia (high voltage chaotic pattern, bilateral asynchronous slow wave
activity) is seen in EEG.
ACTH and steroids are used in the treatment because CRH increase causes
hyperexcitability and seizures.
(Answer C)
9. Which type of seizure is not seen in the newborn? (April 93)
A) Multifocal clonic
B) Subtile seizure
C) Myoclonic
D) Generalized tonic-clonic seizure

E) Tonic
603
PEDIATRICS
The branching of axons and dentrites and myelinization in the newborn period is not
completed. This
therefore there is no generalized tonic-clonic seizure. The most common seizures
are subtle (amorphous) seizures.
Subtle seizures: such as pedaling, swallowing, swallowing, apnea.
etiology
Hypoxic ischemic encephalopathy is the most common cause in newborns.
Metabolic disorders (hypoglycemia, hypocalcemia, hypomagnesemia,
hypohypernatremia),
Congenital metabolic diseases: Galactosemia, urea cycle defects, hyperglycinemia
infections
Trauma
Structural disorders
Glucose, calcium, magnesium, electrolytes in blood in infants who have seizures in
the neonatal period
and BUN should be looked after. LP and cranial imaging in seizures not related to
metabolic causes
must be done.
Traumatic PL: Bloody CSF to be clear after centrifugation
Subarachnoid / intraventricular hemorrhage: CSF xanthochromic color.
(Answer D)
10. Mouth sneezing, swallowing, visual or auditory hallucinations
Which types of seizures should be considered? (September 90)
A) Petit goods
B) Grand merchandise
C) Focal motor
D) Complex partial
E) Absence
Complex partial seizures
- The most common cause of seizures in adults.
- Automatism is seen.
-
Aura is seen. Epigastric complaints, digestive system such as chewing, swallowing,

lip smacking
symptoms and fear.
- Seizures last for 1-2 minutes.

EEG has a spike wave in the interictal anterior temporal.
Benign partial epilepsy with centrotemporal spikes (Rolandic epilepsy)
- 2-14 years (average 9-10 years) occurs.
- Seizures are often seen in sleep, partial and mostly localized in the face.
- There is no neuropathological lesion, prognosis is good.
- EEG has a typical rolandic focus (centrotemporal).
- The first choice is carbamazepine.
Rasmussen Encephalitis:
- It is often seen before the age of 10. Epilepsy is the cause of continuous
parsialis. Previously
nonspecific viral infection.
- It is thought to be associated with cytomegalovirus.
(Answer D)
604
NEUROLOGY
11th. Which of the following increases the risk of epilepsy in febrile convulsions?
(April 89)
A) Before the age of three
B) Coexistence with viral infection
C) With fire
D) Frequent repetition
E) Generalize
The risk of epilepsy increases if the seizure becomes complicated.
(Answer E)
605
PEDIATRICS
NEUROCUTANEOUS SYNDROMS
one. Which of the following statements is true about tuberous sclerosis? (September
2011)
A) The diagnosis criterion is the presence of more than 5 cafe-au-lait spots of
0.5-1 cm in size.
B) Shows autosomal dominant transition
C) The gene has not yet been determined
D) It is a disease involving only skin and brain
E) The percentage is port-wine nevus
A question questioning that tuberous sclerosis is inherited by AUTOSOMAL DOMINANT.
Other options
“Cafe-au-lait stains => Neurofibromatosis type I”
Typical for “Port-wine nevus => Sturge weber syndrome..
Tuberous sclerosis may involve many tissues (especially RABDOMIOMI in the heart)
outside the skin and brain.
TUBEROZSKLEROZ (Bourneville disease, TS)
TSC-1 gene hamartin protein, TSC-2 tuberin protein encoding the mutation in the
genes formed OD
is a passing disease. From asymptomatic to severe mental retardation and seizures
clinical spectrum. The earlier signs and symptoms begin, the greater the risk of
mental retardation.
is high. In addition to brain and skin, heart, kidneys, eyes, lungs and bones.
Causes rhabdomyoma in the heart.
Rhabdomyoma in the heart: It can be detected by fetal ECO. It is most commonly
located in the left ventricular apex. Indicates spontaneous regression. Arrhythmia
and heart failure.
Diagnosis: Diagnosis is made with two major or one major and two minor findings.
•
Major findings: Skin, eye and brain findings, tumors (rhabdomyoma in the heart,
kidney and
lung tumors)
Minor findings: Bone cysts, rectal polyps, extra-renal hamartomas, multiple renal
cysts, retinal
achromic patch, gingival fibroma.
Skin findings: The most common finding is hypopigmented stain. There must be at
least 3. Trunk and extremities
It settles. It is detected by Wood light.
Adenoma sebaseum: Malar region and is common in the jaw. They grow and unite over
time.
Shagreen patch: Most commonly occurs in the lumbosacral region. Causes the
appearance of an orange peel.
Subungal and periungal fibromas: develop in adolescence.
606
NEUROLOGY
Retinal and brain lesions: Retinal lesions, mulberry-like tumors, hamartomas,

achromic stain.
Brain lesions: Characteristic brain lesions are tubers. Tubers in the folds of the
cerebral hemispheres and
settles in the subependimal region. Subepandimal ones may extend into the ventricle
(dripping)
candle image). As tuber count increases, neurological prognosis worsens. Foramen
Monro can block the hydrocephalus. Brain tumors are less than NF.
•
Tubers can return to subepandimal giant cell astrocytoma (SEGA).
Other organ lesions:

•
Renal angiomyolipoma, renal cysts
Lymphangiomyomatosis is a classic lesion in the lung.
Infantile spasm in infancy, hypariarrhythmic EEG pattern, hypopigmented areas of

skin and cranial
CT shows periventricular calcified tubers.
It is often diagnosed in childhood with generalized seizures and pathogonomic skin
lesions.
(Answer B)
2nd. A 2-year-old boy had 7 café-aulait spots on the body, each measuring 0.5 to 1
cm in size. Other systemic findings were normal.
numerous café-au-lait stains were also observed.
2009)
A) Fanconi aplastic anemia
B) Neurofibromatosis type I
C) Tuberous sclerosis
D) Neurofibromatosis type II
E) Ataxia-telangiectasia
Neurocutaneous syndromes are an important issue in pediatric neurology and are
frequently asked.
Primitive ectoderm developmental defect. Heterogeneous characterized by skin and
central nervous system abnormalities
is a group of diseases.
Diseases in this group;
-
Neurofibromatosis
Tuberous sclerosis
Sturge-Weber disease
Von Hippel-Lindau disease
-
PHAM by
Ataxia telangiectasia
Linear nevus syndrome
Ito hypomelanosis
Incontinence pignentosa
Neurofibromatosis (NF) passes through OD. There are two types of NF. The most
common type is NF-1. 17. in chromosomes
neurofibromin gene mutation.
The presence of the following 2/7 criteria for NF-1 diagnosis makes the diagnosis.
one-
cafe-au-lait stains: 5 mm in prepubertal period, 15 mm in postpubertal period

Having six or more large numbers is significant. It is present in all patients.
These stains
are present at birth, increase and grow with age. It can be seen in every part of
the body except the face.
2nd-
Axillary or inguinal freckling
607
PEDIATRICS
3-
Lisch nodules: Two or more. Iris hamartomas. They are best seen with a slit lamp.
While 70% is seen in NF1, it is not seen in NF-2.
4-
Two or more neurofibromas or one plexiform neurofibroma.
Neurofibroma: It appears in adolescence and pregnancy. It has hormonal effect.

Plexiform neurofibroma: likes the temporal and orbital regions. There is at birth.
Bone deformity and
It is the cause of excessive growth in the extremity.
5- Bone lesion: Sphenoid dysplasia (cause of pulsatile exophthalmitis), cortical
thinning of long bones
(pseudoarthrosis +/-). Scoliosis is the most common orthopedic problem. However, it
is not a diagnostic criterion.
6-
Optical gliomas: Most are asymptomatic. Due to visual problem or invasion of
hypothalamus
early puberty.
7-
First degree relatives with NF-1 diagnosis

(Answer B)
3. Which of the following diseases is not one of the neurocutaneous syndromes?

(April 2008)
A) Incontinentia pigment
B) Ataxia-telangiectasia
C) Epidermolysis bullosa
D) Sturge-Weber syndrome
E) von Hippel-Lindau syndrome

(Answer C)
4. Which is one of the diagnostic criteria in neurofibromatosis type 1
is one of the tumors? (April 2008)
B) Optical glioma
C) Lymphoma
D) Wilms tumor
E) Neuroblastoma
Optical glioma is the diagnostic criteria for NF 1.
Malignancy risk in NF1:
- A neurofibroma can sometimes develop into a neurofibrosarcoma or malignant
schwanoma.
- The incidence of pheochromocytoma, rhabdomyosarcoma, leukemia and Wilms tumor
increased in NF-1.
- There is a rare association between NF-1 and myeloid leukemia and juvenile
xanthogranuloma.
Central nervous system tumors are the most important causes of mortality and
morbidity.
(Answer B)
5. In which of the following diseases does Lisch nodules occur? (September 2006)
A) Neuroblastoma
B) Retinoblastoma
C) Neurofibromatosis type I
D) Cystic fibrosis
E) Myotonic dystrophy
608
NEUROLOGY
Lish nodules are iris hamartomas.

(Answer C)
6. Which one is not seen in neurofibromatosis type 1? (April 2005)
A) Cafe au lait
B) Optical glioma
C) Acoustic neurinoma
D) Scoliosis
E) Axillary freckling
Although scoliosis is the most common orthopedic problem, NF1 has no diagnostic
criteria. Other options acoustics
except for neurinoma.
Neurofibromatosis type 2 (NF-2): Gene 22. There chromosomes.
The presence of one of the following for the diagnosis of NF-2
1-Bilateral eighth nerve mass (Bilateral acoustic neuronomes). It is the most
decisive finding.
Family history of 2-NF-2 and unilateral 8th nerve mass or the presence of two of
the following; neurofibroma,
meningioma, glioma, schwannoma, juvenile posterior subcapsular lenticular opacity
ATTENTION
-cafe-au-lait spots and neurofibromas are rare in NF-2.
In NF-2, central nervous system tumors (schwannoma, glial tumor, meningioma) are as
common as NF-1.
(Answer C)
7. The most probable diagnosis in an infant with hypopigmented skin spots and
infantile spasms
A) Neurofibromatous
B) Tuberous sclerosis
C) Incontinentia pigment
D) Pityriasis rosea
E) Psoriasis
TUBEROSIS SCLEROSIS (TS)
The TSC-1 gene encodes the hamartin protein and the TSC-2 tuberin protein. Except
brain and skin, heart, kidney,
eye, lung and bones.
Diagnosis: Diagnosis is made with 2 major or 1 major + 2 minor findings.
Major findings: Skin, eye and brain findings, tumors (heart, rhabdomyoma, kidney)
angiomyolipoma and lymphangiomyomatosis in the lung)
Minor findings: Bone cysts, rectal polyps, extra-renal hamartomas, multiple renal
cysts, retinal
achromic patch, gingival fibroma.
Clinical manifestations
one. Skin findings
Hypopigmented stain: The most common finding. Reasonable. There must be at least 3.
It is located in the trunk and extremities. It is detected by Wood light.
Adenoma sebaseum: Malar region and is common in the jaw. They grow and unite over
time.
Shagreen patch: Most commonly occurs in the lumbosacral region. Causes the
appearance of an orange peel. subungal
and periungal fibromas: develop in adolescence.
609
PEDIATRICS
2nd. Retinal and brain lesions:
Retinal lesions mulberry-like tumors and hamartomas.
Brain lesions: Characteristic brain lesions are tubers. Tubers in the folds of
cerebral hemispheres
and subepandimal region. Subepandimal ones may extend into the ventricle and show
calcification (dripping wax appearance). As tuber count increases, neurological
prognosis worsens.
They can make hydrocephalus by blocking Foramen Monro. Brain tumors are less than
NF. they Tube
They may return to subepandimal giant cell astrocytoma (SEGA).
3. Other organ lesions:
Rhabdomyoma in the heart: It can be detected by fetal ECO. It is most commonly
located in the left ventricular apex. Spontaneous
shows regression. Arrhythmia and heart failure.
Renal angiomyolipoma, renal cysts
Lymphangiomyomatosis is a classic lesion in the lung. It is common in women.
The most common neurological manifestation in TS is behavioral disorder including
seizures, cognitive impairment and autism.
Most are mentally retarded.
Infantile spasm in infancy, hypariarrhythmic EEG pattern, hypopigmented areas of
skin, cranial
CT shows periventricular calcified tubers.
It is often helpful in diagnosis with generalized seizures and pathogonomic skin
lesions in childhood.
(Answer B)
8. Hypopigmented macules on the skin are seen in a child with mental retardation
convulsions. What is the most likely diagnosis? (September 2000)
A) Niemann Pick
C) SLE
D) Neurofibromatosis
E) Leukodystrophy
(Answer B)
9. 6-year-old girl with brown spots on her body
eye examination revealed iris lisch nodule. Which of the following
is the appropriate diagnosis? (April 2000)
A) Neurofibromotasis
C) Oster-Weber-Rendu
D) Sturge Weber
E) von Hippel-Lindau
(Answer A)
610
NEUROLOGY
Sturge-Weber Syndrome: There is a facial nevus at birth. Top 5. The nerve fits the
ophthalmic branch. Same
Buftalmus and glaucoma are common. Seizures have focal tonic clonic character and
opposite of nevus
side is.
Diagnosis: On cranial radiographs or CT, “railway” or kals serpentine ”parallel
calcifications are seen in the occipito-parietal region. CT shows cerebral atrophy
and enlargement of the lateral ventricle.
von Hippel – Lindau: OD passes. Cerebellar hemangioblastoma (EPO secreting causes
polycythemia
and retinal angioma are typical characteristic neurological features. Cerebellar
involvement
Spinal involvement causes sensory, gait disturbances and bladder dysfunction. Since
the periphery is usually involved in the retina, vision is not affected. von Hippel
in Lindau disease
kidney, pancreas, liver, epididymal cysts and pheochromocytoma (the most common
neurocutaneous syndrome of Feo). The most common death is renal cell carcinoma.
PHACE SYNDROME
Posterior fossa anomalies, Hemangiomas, Arterial anomalies, Aortic Coartation and
other cardiac
defects and E'ye (eye) anomalies. Dandy Walker malformation is seen as a posterior
fossa anomaly. Hemangioma of the face is on the same side as the aortic arch
anomaly.
611
PEDIATRICS
CEREBRAL PALSY AND MOVEMENT

DISORDERS
one. Which of the following is not one of the etiological risk factors for cerebral
palsy?
(September 2008)
A) Maternal infection
B) Kernicterus
C) Hypoxic ischemic encephalopathy
D) Neonatal hepatitis
E) Low birth weight

Most children with CP were born on time and without complications. Intapartum in
less than 10%
asphyxia. 80% are responsible for antenatal factors.
Increased intracerebral hemorrhage and PVL, especially in infants born under 1000
grams
There is a risk of CP.
CP risk in infants with normal birth weight: Chorioamnionitis, malodorous amniotic
fluid, maternal
urinary tract infection, umbilical cord or placenta inflammation, maternal sepsis
and
There is fever> 38 ° C at birth.
Especially kern icterus, which is an increased risk for atetoid type, occurs due to
hyperbiluribinemia. Neonatal hepatitis
It is not a risk because it causes direct bilirubin elevation.
Major causes and classification of cerebral palsy
Motor syndrome
neuropathology
Why is that
Spastic hemiplegia
Stroke (inuter / newborn)
Thrombophilic disorder, periventricular

hemorrhagic infarction, genetics
Spastic diplegia
PVL
Prematurity, Ischemia / Infection

Endocrine (thyroid)
Spastic quadriplegia
PVL, Multicystic encephalomalacia

malformation
Ischemia / infection
Endocrine (thyroid), Genetics
Extrapyramidal (atetoid, dsikinetic)
Putamen, globus pallidus, thalamus, basal

ganglion damage
Kern icterus
Mitochondrial disease, Asphyxia
(Answer D)
2nd. Which of the following statements about Sydenham chorea is incorrect?
(September 2008)
A) Most patients have hypotonia.
B) Emotional lability accompanies the event.
C) The disease can last from a few months to 1-2 years.
D) Diazepam, valproic acid, phenothiazine group drugs can be used in treatment.
E) Penicillin prophylaxis is required in patients throughout life.
612
NEUROLOGY
Korea: Irregular, fast, uncontrolled, involuntary movements. It is caused by

excessive functional activity of the dopaminergic system.
Sydenham's chorea; is the most common cause of acquired chorea in childhood. ARA.
GABHS strains of
developing antineuronal antibodies against neurons of subthalamic, caudate nucleus
and cerebral cortex
cross-react with cytoplasm.
The three main signs of Sydenham's chorea are chorea, hypotonia and emotional
lability. Stress increases, asleep
It disappears. Although sudden onset can be seen, chorea progresses slowly. From
several months to 2 years
takes. In mild cases, stress is avoided. In severe cases, diazepam, valproate,
phenothiazine or
haloperidol is used. The latter two can cause tardive dyskinesia as a side effect.
Penicillin prophylaxis is performed until adulthood due to increased risk of
carditis.
Another pathology related to streptococcal infection is PANDAS.
PANDAS: Pediatric autoimmune neuropsychiatric disorders associated strepcococcal
infection. Tic
and obsessive-compulsive disorder.
(Answer E)
3. Which of the following is not found in Freidrich's ataxia? (April 93)
A) Kyphoscoliosis
B) Loss of deep tendon reflexes in lower extremities
C) Ophthalmoplegia
D) Cardiomyopathy
E) Nystagmus
FRIEDREICH ATAXIA
OR passes. There is triple repeat increase. There is a gene defect encoding
frataxin. Spinoserebellar tract,
dorsal colon, pyramidal pathways, cerebellum and medulla.
Ataxia; ataxia is a little later than telangiectasis and before the age of 10
years. Ataxia progresses slowly and
the lower extremity is more prominent than the upper. The Romberg test is positive.
DTR not received and plantar
The response is extensor. Explosive dysarthric speech and nystagmus are seen.
Although they seem apathetic, their intelligence is normal. Position and vibration
due to posterior spinal cord degeneration
his sense disappears. Skeletal anomalies such as pes cavus, hammer finger and
kyphoscoliosis are seen. Brain
Stalk evoked potentials are distorted.
The cause of death is hypertrophic cardiomyopathy leading to heart failure.
There is no mental retardation and ophthalmoplegia.
(Answer C)
4. How long is antibiotic prophylaxis given in Sydenham's chorea? (September 88)
A) 1 year
B) 2 years
C) 5 years
D) Lifetime
E) Up to adulthood
Penicillin prophylaxis is given until 21 years of age.
(Answer E)
613
PEDIATRICS
NEUROMUSCULAR DISEASES,
FRONT HORN DISEASES AND
NEUROMUSCULAR JUNCTION DISEASES
one. A nine-year-old boy was brought to the hospital with complaints of difficulty
climbing up and down the stairs. On physical examination, deep tendon reflexes were
absent and muscle strength was proximal to the lower extremity. gastrocnemius
hypertrophy.
Serum creatine phosphokinase level is very high (10,000
Find U / L) fits. It is learned from his family history that his uncle also had
muscle disease. This
What is the most likely diagnosis for the child? (May 2011)
A) Myotonic dystrophy
B) Duchenne muscular dystrophy
C) Congenital myopathy
D) Emery-Dreifuss muscular dystrophy
E) Fasioscapulohumeral muscular dystrophy
Child with uncle's muscle disease, calf pseudohypertrophy, CK level is very high,
most likely
Of course, Duchenne muscular dystrophy is the most common muscular dystrophy of
course.
Duchenne Muscular dystrophy (DMD): The most common in children of all ethnic groups
and races
muscular disease. 1/3600. X-linked recessive (XR) inheritance. Half is a denova
mutation.
The dystrophin gene is a cell skeleton protein. It's a big gene. Mutations in the
form of deletions are most common.
DMD babies are rarely symptomatic at birth and in early infantile period (head
control in those with
weak). There are no symptoms during intrauterine period. This feature is separated
from the SMA.
Basic clinical findings in DMD:
• Muscle weakness (Gowers' sign, duckling) Pseudohypertrophy (typical of
pseudohypertrophy of the calf)
• Contractures (most commonly ankle)
• Scoliosis
• Cardiomyopathy (independent of skeletal muscle involvement)
• Mental retardation (occurs in all, <70% in 20%, independent of skeletal muscle
involvement)
CK is very high (the most important clue). It is also high at birth and
asymptomatic period. Carrier
mother is also high. It may fall because there is no muscle tissue to degenerate in
the late period. Eyebrow
enzymes CK, aldolase and AST are detected high.
Diagnosis: Diagnosis is made by muscle biopsy and DNA analysis from peripheral
blood.
(Answer B)
614
NEUROLOGY
2nd. Two month old baby girl inactivity, difficulty sucking, sleeping in frog
position
with complaints. On physical examination, hypotonia (+), reflexes cannot be
obtained, smile and follow-up, tongue fasciculations are detected. Most likely for
this baby
What is the diagnosis? (May 2011)
A) Spinal muscular atrophy
B) Congenital hypothyroidism
C) Myotonia congenita
D) Peripheral neuropathy
E) Congenital muscular dystrophy
Easy and old question, tongue fasciculation type I SMA
Spinal muscular atrophy (SMA) involves the anterior horn cells. SMN (Survival Motor
Neuron) gene deletion
has. Most OR passes, normally SMN inhibits motor neuroblastta apoptosis. Upper
motor neuron
It is normal.
SMA types: Clinical types; onset age, weight of muscle weakness and clinical
course. Muscle biopsy is indistinguishable from Type I and II or even type 3.
SMA type 0: severe fetal type, very rare, die in perinatal period, muscle biopsy is
similar to myotubular disease.
Clinical findings in type 1 SMA: Cardinal sign is hypotonia. Generalized weakness,
thin muscle mass,
DTRs are lost.
Tongue, face, jaw muscles are involved, extraocular muscles and sphincters are
preserved. Diaphragm ragma is kept late.
Congenital contractures occur, ranging from arthrogriposis to simple pes
equinovarus. Fetal movements
It decreased. They often die before the age of 2.
Muscular fasciculations are specific signs of denervation. It appears in the best
language. Subcutaneous tissue
It is well seen because of the absence. Deltoidde, bicepste and rarely quadrisepde
in weak children
visible.
SMA
Invisible
SMA
Myalgia is not seen in SMA.
Fasciculation and muscle weakness
The heart is not involved in SMA and intelligence is normal.
DTR loss
Even brighter than their peers.
Tremor may occur in the fingers.
Sphincter and eye muscles are not involved.
Dependent on fasciculation and muscle weakness
No sense defects.
Not to be confused with Srebellar tremor
The simplest and most accurate diagnostic test is the SMN gene deletion (chromosome
5). No treatment stops progress. Supportive treatment is provided.
(Answer A)
615
PEDIATRICS
3. Genetic transmission and gene defect in Duchenne muscular dystrophy: (December

2010)
A) Autosomal dominant, 17q21
B) No genetic transmission.
C) X-linked recessive, Xp21
D) Autosomal dominant, 13q12
E) Autosomal recessive, 15q
Duchenne Muscular dystrophy (DMD): The most common in children of all ethnic groups
and races
muscular disease. 1/3600. X-linked recessive (XR) inheritance. Half is a nova
mutation.
Basic clinical findings in DMD:
• Muscle weakness (Gowers sign, duck-type walking)
• Pseudohypertrophy (typical of pseudohypertrophy in the calf)
• Contractures (most commonly ankle)
• Scoliosis
• Cardiomyopathy (independent of skeletal muscle involvement)
Mental retardation (occurs in all, <70%, independent of skeletal muscle
involvement)
(Answer C)
4. A ten-month-old baby girl is brought with complaints of laxity and stiffness in
her hands.
Neurological examination does not allow deep tendon reflexes and contractures in
the upper extremities. The patient was thought to have a preliminary diagnosis of
muscle disease.
Electromyographic examination showed primary muscle fiber involvement. Cranial
magnetic resonance imaging shows hyperintense signals in the white matter.
Which of the following is the most likely diagnosis for this patient? (April 2009)
A) Benign congenital hypotonia
B) Myotonia congenita
C) Congenital muscular dystrophy
D) Polymyositis
E) Dermatomyositis
Congenital muscular dystrophy: It consists of a group of diseases. OR is inherited.
Severe involvement at birth
Although it is seen later in benign course.
Clinic: Arthrogriposis at birth, diffuse hypotonia, atrophy of the trunk and
extremity muscles. Head
control is poor. Facial muscles are kept light.
Fukuyama type cardiomyopathy and brain malformations are seen.
Ullrich type 6 collagen mutation. Contracture of the wrist is very common.
Mental state and neurological findings are the most variable features in congenital
muscular dystrophies. Cerebral
involvement may be severe such as holoprosencephaly, lysencephaly or heterotopy in
white / gray matter (hyperintense lesion on MRI), agenesis of corpus callosum, and
mild such as cerebellar hypoplasia.
Laboratory: CK. increased. Myopathic changes are detected on EMG.
616
NEUROLOGY
Diagnosis is made by muscle biopsy. The absence of merosin can be detected. The
presence or absence of merozin
When myopathy does not correlate with the severity.
Myotonia congenita (Thomsen's disease): Hercules / bodybuilders are similar to the
image.
OD passes. Myotoni has. There is no weakness. Cl is canalopathy.
Polymyositis and dermatomyositis are autoimmune diseases. In dermatomyositis,
Gottron papules are typical on the skin.
Benign congenital hypotonia: for children with unknown and non-progressive
hypotonia
used. There is no weakness or developmental retardation. DTRs were normal /
slightly decreased. Intelligence is normal.
Cranial imaging and muscle biopsy were normal. Contracture does not develop.
Excluding other reasons
is diagnosed. Prognosis is good, no treatment is required. Frequent recurrent
subluxations secondary to hypotonia
(especially on the shoulder). Circus employees or gymnasts should be kept in mind
as an example.
(Answer C)
5. The story of an 8-year-old child who had been unable to walk for the last two
days
It was learned that he was completely healthy but had gastroenteritis 10 days ago.
Neurological examination revealed symmetrical proximal muscle weakness in the lower
extremities, four
biased areflexia.
2007)
A) Muscular dystrophy
C) Myasthenia
D) Congenital hypomyelination neuropathy
E) Guillain-Barré syndrome
Guillain Barre syndrome → Mainly motor but sometimes also involving sensory and
autonomic nerves
postinfectious polyneuropathy. It can be seen at any age and is not hereditary.
Clinical: Non-specific upper respiratory tract infection or specific infections
after 10 days.
GIS infection Campylobacter jejuni and H. pylori
Respiratory system infections: Mycoplasma pneumonia
Vaccines: Rabies, influenza, oral polio, conjugated meningococcal vaccines can also
be seen.
The involvement is symmetrical. The start is gradual and progresses within days or
weeks. Especially sudden onset
muscle pain is seen in cases. The weakness starts especially in the lower
extremities and progresses towards the upper side. The last bulber involvement.
DTRs disappear early. Papillary edema may occur but vision is not impaired.
Extraocular muscle involvement is rare.
Signs of autonomic nerve involvement: changes in blood pressure and heart rate,
postural hypotension, sudden
bradycardia and rarely asystole.
Miller - Fisher syndrome → External ophthalmoplegia, ataxia and areflexia are
detected.
CSF evaluation is essential for diagnosis. Albuminocytological dissociation is
detected. (CSF proteins two
more than 10-fold, glucose is normal and pleocytosis is less, less than 10
leukocytes in mm3)
has.
Motor nerve conduction velocities have decreased in EMG and sensory nerve
conduction velocities have generally slowed down.
EMG shows signs of acute denervation.
617
PEDIATRICS
CK is normal or slightly increased.

Antiganglioside antibodies (GM1) are positive in some.
Muscle biopsy and sural nerve biopsy are not required for diagnosis.
The demonstration of H. pylori and Campylobacter does not affect treatment and
course.
Treatment: Early hospitalization. Respiratory muscles can be involved for 24 hours.
IVIG, plasmapheresis, immunosuppressives and interferon can be used for fast
progressive ascending paralysis. Steroid
It is ineffective. Infection treatment is not required and infection treatment does
not change the course of polyneuropathy.
Prognosis: The clinic is usually benign and spontaneously resolves in 2-3 weeks.
The improvement is from the pattern,
first bulbar functions improve. The most recent function is deep tendon reflexes.
The most common deaths are due to respiratory muscles and bulbar involvement.
Cranial nerve involvement, intubation and loss of maximum disability at admission
indicate poor prognosis.
Prognosis in chronic form is worse than in acute forms.
Diseases causing acute loose paralysis
Brain stem stroke and encephalitis
Acute anterior polyomyelitis (polio virus and other neurotropic viruses)
Acute myelopathy: Acute transverse myelitis, space-occupying lesions
Peripheral neuropathy: Guillain Barre, rabies vaccine neuropathy, diphtheria
neuropathy, heavy metals and
intoxications, acute intermittent porphyria
Neuromuscular conduction disorder: Myasthenia gravis, biological toxins
Muscle disorders: Hypokalemia, hypophosphatemia, periodic paralysis, inflammatory
myopathies, rhabdomyolysis.
(Answer E)
6. Which of the clinical manifestations of Duchenne Muscular Dystrophy (DMD)
A) Lordotic walk
B) Fasciculation of the tongue
C) Gowers sign
D) Pseudohypertrophy of calf muscles
E) Severe mental retardation
DUCHENE AND BECKER MUSCULAR DISTROPHIES
Duchene muscular dystrophy (DMD) is the most common neuromuscular disease in all
races and ethnic groups.
XR passes. Becker muscular dystrophy is milder. Both are associated with dystrophin
protein. in DMD
there is a complete deficiency of this protein, while a partial deficiency is seen
in BMD.
Clinic: Male infants are rarely symptomatic at birth and in early infantile period.
Rough motor
their development is usually earned on time or with slight delay.
The first symptom of weakness in infancy is weakness in head control.
Difficulty in sitting and getting up stairs as muscle involvement is evident in
proximal muscles
It happens. To compensate for weakness in the gluteal muscles while standing during
play childhood
They increase lordosis.
Gower's sign (use hands to stand up, showing proximal muscle weakness)
3 years old, exactly 5-6 years old. During this period Trendelenburg walk / duck
vari
walk is also seen. Pseudohypertrophy is typical in calves. The most common language
after calves and more
then hypertrophy of the forearm.
618
NEUROLOGY
They are sentenced to wheelchairs after the age of 7-12.

Respiratory muscles, pharynx muscles can be involved. Contractures of ankles,
knees, hips and elbows
It is seen. Scoliosis is common.
Cardiomyopathy is a constant feature in this disease. Persistent tachycardia and
heart failure. Intelligence
retardation occurs in all patients, but in 20-30% of patients, intelligence is
below 70. There is no correlation between skeletal muscle involvement and cardiac
involvement and mental retardation.
Late DMD findings:
No tongue fasciculation
Involvement of extraocular muscles
Myalgia and muscle spasm are not seen
Loss of function of the distal muscles
Late term: Anal and urethral sphincter involvement and cerebral atrophy may occur.
Death usually 18
years, respiratory failure, heart failure, pneumonia and aspiration occurs.
In Becker muscular dystrophy, they survive until the end of puberty and early
adulthood. Pseudohypertrophy, CK elevation, cardiomyopathy are like DMD. Learning
defects are less frequent. Death
20s sometimes 40s.
(Answer B)
7. Proximal muscle weakness, Gowers sign, muscle hypertrophy and very high serum
5-year-old patient with creatine kinase level and uncle had similar findings.
What is the most likely diagnosis for a boy?April 2003)
A) Spinal muscular atrophy
B) Duchenne type muscular dystrophy
C) Myasthenia gravis
D) Guillain-Barre syndrome
E) Congenital myotonia
The patients are only boys, except girls with Turner syndrome because DMD passes
XR. Involvement proximal
happens in the muscles.
Laboratory findings: CK is very high. It is high even at birth. Late in the disease
is no longer
degenerated muscle tissue can be detected as low.
Myopathic involvement is detected on EMG. There is no denervation in EMG, nerve
conduction velocities are normal. ECG and ECO are performed for cardiomyopathy. EMG
shows characteristic myopathic features. But this is DMD
is not specific for.
619
PEDIATRICS
Diagnosis: Diagnosis is made by muscle biopsy and DNA analysis from peripheral
blood. Connective tissue in muscle biopsy
proliferation, scattered degenerate and regenerated muscle fibers and mononuclear
cell infiltrations
It is seen.
Muscle biopsy should be performed in the first case even if the clinical features
are typical.
Muscle biopsy if family history (uncle diagnosed), typical clinical and high CK
values
It is not necessary and can be diagnosed by DNA analysis from peripheral blood.
Treatment: Supportive treatment is important. Excessive vitamin use should be
avoided. of obesity
It must be protected. Calcium supplements should be given against osteoporosis. Fl
support is done. Physiotherapy and steroids are used in the treatment.
(Answer B)
8. Hypotonic with marked weakness of the extremities and fasciculations of the
tongue
It was learned that a newborn baby was inactive during intrauterine period. This
baby
What is the most likely diagnosis for?September 2002)
A) Infantile spinal muscular atrophy
B) Duchenne type muscular dystrophy
C) Myotonic dystrophy
D) Myasthenia Gravis
E) Nemalin myopathy
SPINAL MUSCULAR ATROPHY (SMA): It is a degenerative second motor neuron disease
which starts in fetal period and continues in infancy and childhood. 1. The motor
neuron is normal. Duchenne
is the most common neuromuscular disease after muscular dystrophy. SMN (Survival
Motor Neuron) gene
deletion.
SMA type I (Werning-Hoffman's disease) → Early infantile type
SMA type II → Late infantile type
SMA type III (Kugelberg-Walender disease) → Juvenile type
Fazio-Lande disease → A variant of SMA with progressive bulbar palsy and brain stem
and spinal
neuronal degeneration is seen in the cord.
Typical diagnosis is made according to clinical condition and age of onset. Muscle
biopsy with Type I and II
indistinguishable.
Clinic
Type I; Severe hypotonia since the newborn period, generalized weakness, thin
muscle mass,
DTRs are lost. Tongue, face, chin, extraocular muscles and sphincters are involved.
Arthrogriposis is seen in 10% of cases. They often die before the age of 2.
Type II; Complaints are seen in late infantile period. At school, they are
wheelchair bound.
Scoliosis is common.
Type III; It is the lightest form. They may be normal at birth. Progressive
weakness is proximal. 25% of this type
instead of atrophy, hypertrophy of the muscles is seen. Musculatory fasciculations
The findings. Best seen in the language.
Myalgia is not seen in SMA. The heart is not involved and intelligence is normal.
Laboratory: CK is normal or slightly elevated (around faces). Motor nerve
conduction rates of disease
normal until the last stages (This feature distinguishes peripheral neuropathy).
Denervation in EMG
It is seen.
620
NEUROLOGY
Diagnosis: The simplest and most accurate diagnostic test is the SMN gene deletion
(on chromosome 5). Muscle biopsy shows a perinatal denervation pattern. Slight
neuropathic changes in surural nerve biopsy
It is seen. Neuronal degeneration is seen in the anterior horns of the spinal cord
and the motor nuclei of the brainstem.
Treatment: Supportive. No treatment affects progression.
(Answer A)
OTHER MOTOR NEURON DISEASES
Poliomyelitis and other enterovirus infections
Amyotrophic lateral sclerosis → Loss of upper and lower motor neurons is evident.
Progressive and deadly.
Pontocerebellar hypoplasia → SMA is similar, but the SMN gene is normal.
Motor neuron gangliosis → Tay-Sachs disease
Motor neuron seroid lipofuscinosis → Batten's disease
Motor neuron glycogenosis → Pompe disease
9. A five-year-old girl has been weak for several months

reduction and low eyelids. Swallowing from time to time
Difficulties and respiratory distress. Physical examination ptosis
and ophthalmoplegia. Intravenous edrofonium chloride for 2-3 seconds
improvement in pathological findings lasting 1-2 minutes.
What is the most likely diagnosis for this child?April 2002)
A) Myasthenia gravis
C) Organophosphate poisoning
D) Leukodystrophy
E) Miller-Fisher disease
MYASTENIA GRAVIS (MG): Circulating acetylcholine receptors are caused by
antibodies. Characteristic
property is the fast fatigue seen in the muscles. When left untreated, it is
progressive and
they die from aspiration. MG Hashimoto's thyroiditis, collagen diseases, thymus
hyperplasia and
associated with thymoma.
Clinic: 3 different types of congenital myasthenia, transient neonatal myasthenia
and juvenile myasthenia
has.
Congenital myasthenia: Familial. It does not show progress and improvement. It is
associated with episodic apnea.
Transient neonatal myasthenia: Babies born from myasthenic mothers show transient
myasthenia due to acetylcholine receptor antibodies passing through the mother.
Shortness of breath, absorption and swallowing
The difficulty becomes hypotonicity.
Juvenile myasthenia: Occurs in late infancy and childhood. Earliest and most common
signs
ptosis and weakness in extraocular muscles. Older children may have diplopia.
Dysphagia, facial weakness, feeding difficulty (cardinal finding in infancy) and
head control
weakness is seen. Involvement is frequently seen in the bulbar innervated muscles,
but
Disease.
Non-MG findings: Musculatory fasciculation, myalgia and sensory symptoms. Loss of
IR, (MG light reflex is maintained). Loss of DTRs (decreased). Smooth muscle
involvement, cardiac involvement, CPK elevation.
621
PEDIATRICS
Eaton-Lambert Paraneoplastic accompanying lung carcinomas, especially small cell

carcinoma
The forms. The difference is that Eaton-Lambert has hypertrophy, not atrophy in the
muscles.
Post-infectious MG: It occurs after varicella infection.
Laboratory: In EMG, it is seen that muscle contraction decreases with repeated
stimuli. Anti-Ach antibodies
used in diagnosis. Cholinesterase inhibitor as a diagnostic test (prostigmine in 2
(Edrofonium) test can be done to older people. A long-acting drug used orally in
the test
pyridostigmine is not used. Atropine ready for use if muscarinic effects occur
during testing
It should be maintained.
Treatment: In mild cases, no treatment is required. Cholinesterase inhibitors are
used in the treatment. pyridostigmine
and neostigmine is used. Cholinergic crisis occurs in overdose. Muscarinic effects
improve with atropine but nicotinic effects do not. Also steroids, thymectomy, IVIG
and plasmapheresis in treatment
available.
Complications: Apnea may occur with anesthetic agents and muscle relaxants.
Aminoglycosides increase the risk of myasthenic crisis. Ca gluconate is given for
treatment.
Other causes of neuromuscular blockade: aminoglycosides, organophosphates, botulism
(the most common source of honey,
tick paralysis. See also question 2 for Miller-Fisher's disease.
(Answer A)
10. Six years old boy tired for 2 years
There is difficulty. Duck-like gait in FM, Gower's sign, calf hypertrophy and deep
There is a decrease in tendon reflexes. What is the most likely diagnosis? (April
2000)
A) Duchenne muscular dystrophy
B) Myastenia Gravis
C) Congenital myotonic dystrophy
D) Poliomyelitis
E) Transverse myelitis sequelae
(Answer A)
11th. In a baby with low intrauterine movement and reflexes
It should be considered? (April 91)
A) Kugelberg-Wellender
B) Congenital muscular dystrophy
C) Duchenne muscular dystrophy
D) Myasthenia gravis
E) Spinal muscular atrophy
Spinal muscular atrophy in early onset type of intrauterine period of movement,
polyhydramniosis
It is determined. Since the second motor neuron is involved, reflexes cannot be
removed.
4. See description of problem
(Answer E)
622
NEUROLOGY
12. What is the clinical finding that does not occur in paralytic poliomyelitis?
(April 91)
A) Hyperesthesia
B) Sensory loss
C) Facial paralysis
D) Fasciculation
E) Achilles loss of reflex
Poliomyelitis involves anterior horn motor neurons and does not cause sensory
defects. Causes loose paralysis.
(Answer B)
623
PEDIATRICS
CENTRAL NERVOUS SYSTEM

Infections
one. Which one of the following bacteria in the newborn period (0–1 months) acute
meningitis most
often causes? (December 2010)
A) Streptococcus pneumoniae
B) Haemophilus influenzae
C) Salmonella
D) Group B streptococcus
E) Neisseria meningitidis
In the first month of life, the prominent agents of bacterial meningitis in
neonatal period, B
group streptococci, Gr negative bacteria, especially e coli, nzocomial agents,
klebsiella, and so on. S aureus, Listeria, salmonella bacteria can be isolated. The
most common factor is GBS.
(Answer D)
2nd. Which of the following is not a complication of acute bacterial meningitis?
(September 2009)
A) Peripheral circulatory failure
B) Improper ADH release
C) Pancreatitis
D) Pneumonia
E) Pericardite
Central nervous system complications of meningitis during treatment
one. seizures
2nd. ICP
3. Cranial nerve paralysis
4. Stroke
5. herniation
6. Subdural effusion (most commonly in young children and due to H. influenza.)
7. Dural venous thrombosis
sequels
Deafness (most commonly due to sequelae and most commonly due to S. pneumonia)
Other sequelae include mental retardation, seizures, delay in language development,
visual disturbances.
Bacterial is the most common sequelae of sensorineural hearing loss (S. pneumonia>
N. meningitidis).
(H. influenza) meningitis.
624
NEUROLOGY
Other complications of meningitis

Inappropriate ADH syndrome (SIADH) occurs in most cases of meningitis. Hyponatremia
and
low serum osmolarity. The risk of brain edema and hyponatremic convulsions
increases.
Prolonged fever: In bacterial meningitis, fever decreases 5-7 days after treatment.
> Fever of more than 10 days
if it continues; Concomitant viral infection or secondary bacterial infection,
thrombophlebitis or drug reaction should be considered. Secondary fever: Rise again
after fever falls,
nosocomial infection.
Pericarditis and arthritis: It can be seen by the immune complex mediated mechanism
due to N. meningitidis.
Hematologic findings: Thrombocytosis, eosinophilia and anemia may occur.
DIC: Activation of the coagulation cascade due to endotoxins and severe hypotension
It occurs. There is both bleeding and thrombosis. Symmetrical purpura and shock.
There is no precise information about pneumonia in textbooks; however, factors such
as pneumococci with meningitis
it is also a common cause of pneumonia. Complications in secondary bacterial
infections
as it can develop. This can be taken as secondary infection.
(Answer C)
3. Which of the following causes ventricular shunt infections most frequently?
(September 2008)
A) L. monocytogenes
B) GBS
C) E. coli
D) P. aureginosa
E) Coagulase negative staphylococci

The most common cause of bacteremia and sepsis is S. epidermidis (coagulase
negative staphylococci) in cases with ventriculoperitoneal shunts or cases with
catheters in the body. The same methicillin treatment
glycopeptide group (vancomycin) antibiotics such as resistant staphylococci.
(Answer E)
4. Which of the following occurs during the treatment of acute bacterial meningitis
is not one of the complications of the central nervous system? (April 2006)
A) Convulsion
B) Cranial nerve paralysis
C) Hearing loss
D) Cerebral herniation
E) Dural venous sinus thrombosis

2. See the description of the problem. This question was more appropriate and
correct. Deafness is the most common streptococci
develops depending on.
(Answer C)
5. Which of the following is a poor prognosis criterion for meningococcal sepsis?
(September 2005)
A) Hyponatremia
B) Leukocytosis
C) Arthritis
D) Pneumonia
E) Thrombocytopenia
625
PEDIATRICS
The criteria for poor prognosis in meningococcemia are:

one. hypothermia
2nd. Hypotension
3. Purpura fulminans
4. Septic shock
5. leukopenia
6. thrombocytopenia
7. No signs of meningitis in CSF (indicating that inflammation cannot be limited)
8. DIC
9. Case <1 year
10. Low sedimentation rate
Meningitis in meningococcemia also means that the infection is localized and is a
good prognostic indicator.
(Answer E)
6. Which of the following is contraindicated in lumbar puncture? (September 2005)
A) Suspected intracranial lesion
B) Meningitis
C) Encephalitis
D) Non-Hodgkin's lymphoma
E) Demyelinating disease
LUMBER PUNCTION: Equivalent to an imaginary line where both anterior superior iliac
lines are joined
from L3-L4 or L4-L5.
Contraindications to LP:
one-
In case of suspicion of mass (m. Spinalis or brain) and symptoms of increased

intracranial pressure (prior to fundus / CT)
2nd-
If there are signs and symptoms of cerebral herniation (desebre, decortic position,
generalized)
tonic seizure, abnormal pupil response, lack of oculocephalitis response, fixed
oculomotor eyes
deviation, apnea, Cheyne-Stokes respiratory disorders).
3-
Skin infection at the site of LP
4-
Thrombocytopenia (risk of subarachnoid and subdural hemorrhage if thrombocyte

<20,000)
5-
In case of serious illness (rare case)
(Answer A)
7. Characteristic CSF findings of acute bacterial meningitis in a 3-year-old child

which of the following is correctly given? (April 2002)

Cells / mm3
Protein (mg / dl)
CSF / blood glucose
A) 500 lymphocytes
one thousand
0.30
B) 10 lymphocytes
one hundred
0.60
C) 800 granulocytes
200
0.30
D) 4 lymphocytes
40
0.75
E) 80 lymphocytes
50
0.60
626
NEUROLOGY
In normal CSF, the cell is <5 and most are lymphocytes. Protein 20-45 mg / dl and
CSF sugar 75% of blood sugar
or above 50 mg / dl. So it is compatible with option D.
A variant of the protein is very increased sugar has fallen, increased cells
lymphocytes. This picture is consistent with tuberculous meningitis.
In preterm infants, the upper limit of cells is normal up to 25. After a month, it
becomes <10. Protein limit
higher. So option B is suitable for the newborn.
In viral meningitis, cell increase is less than 1000, residues are lymphocytes
(exception increases too much in lymphocytic choriomeningitis virus), sugar is
usually normal / slightly low (exception mumps meningitis)
sugar can be <40).
In case D, viral meningoencephalitis in this table increases cell lymphocytes and
protein very close to normal and sugar.
is compatible with.
Granulocyte number> 1000-10000 should be thought of amebic meningitis Naegleria.
In bacterial meningitis, neutrophils increase, sugar falls and protein increases.
Increased erythrocyte in CSF (with temporal lobe involvement) should also suggest
HSV.
(Answer C)
8. Which is one of the contraindications of lumbar puncture
A) Fontanel which gives pulsation during infancy period
B) Unconsciousness, paralysis of 3rd and 4th cranial nerves
C) Respiratory disorder, hypertension, bradycardia
D) Shock to be heard that may require cardio-pulmonary resuscitation
E) Infection of the lumbar puncture site
Fontanelin bulging and pulsatile in infancy is significant in terms of meningitis
and lumbar
puncture.
Other non-contraindicated findings: Nuchal rigidity, Kerning and Brudzinski
positivity, meningitis such as fever
are the findings seen in the course. See question 5.
(Answer A)
9. Sore throat in a five-year-old child, left hemiparesis 3 days after high fever
and convulsions. Right temporal hemorrhage in CT and EEG
low wave pattern, which is considered in a child with erythrocytes in LP?
(April 99)
A) Bacterial meningitis
B) Subdural hematoma
C) Herpes encephalitis
D) Brain abscess
E) Cerebrovascular disease
627
PEDIATRICS
Temporal involvement and hemorrhagic CSF are characteristic of HSV. HSV-induced

encephalitis in newborn
except HSV type 1. Acyclovir is used for treatment.
Viruses held in the brain:
Arboviruses the whole brain
The HSV temporal lobe tends to retain rabies basal structures.
Acyclovir is given in herpes encephalitis.
(Answer C)
Meningoencephalitis: The most common cause is enteroviruses. Besides,
herpesviruses, CMV, EBV,
mumps and rabies can also be a factor.
Enteroviruses occur in summer and autumn in a warm climate. Herpes makes sporadic
meningitis.
The onset is usually acute. There is mild subfebrile fever ahead. Irritability in
infants and children
Lethargy, headache and hyperesthesia in adolescents are the initial complaints.
Retrobulbar pain is common in adolescents. Fever, nausea, vomiting, photophobia,
neck, back and leg pain are common
It is seen.
Diagnosis: CSF pressure is normal or slightly increased, protein is normal or
increased, sugar is usually normal
(Mumps are low in meningitis).
10. What is the most common cause of meningitis in children older than five years?
(April 94)
A) S. pneumoniae
B) Group B streptococci
C) Hemophilus influenza
D) E. coli
E) Neisseria meningitidis
Group B streptococci> E. coli is the most common cause of meningitis in the
newborn.
- common pathogens in the first newborn; group B, D streptococci, gram negative
bacilli and L.
It is monositogenesis. Group B, D streptococci and listeria as important pathogens
for up to three months
It remains.
- Children between 2-12 years; S. pneumonia, N. meningitis and H. influenzae type
B. (pneumococcal and hemophilus influenza vaccination in developed countries from 2
months
The most common factor was meningococci.
-
Pseudomonas aeroginosa, Staf. aureus,

The risk of meningitis due to coagulase negative staphylococci, salmonella and L.
monocytogenesis is increased.
See description of problem 4 in neonatal infections.

(Answer A)
628
NEUROLOGY
11th. Congenital immunodeficiency in a patient with recurrent meningococcal

meningitis
Considered? (April 93)
A) Chronic granulomatous disease
B) Di George syndrome
C) Humoral immunodeficiency
D) Cellular immunodeficiency
E) Lack of Complement
The risk of meningococcus increases especially in the absence of complement.
Meningocele also increases the risk of infection with staphylococci and gram-
negative bacteria.
The development of basilar fractures and CSF leakage as a result of head trauma
increases the risk of pneumococcus after otitis media and splenectomy.
Ventriculoperitoneal shunt is the most common cause of S. epidermidis.
Functional splenic disorder or asplenide increases the risk of pneumococcal, Hib
and rarely meningococcal.
The risk of L. monocytogenesis meningitis increases in T lymphocyte deficiencies.
Recurrent meningococcal infections in C5-C8 deficiency, fatal in properdin system
disorder
There is a risk of meningococcal disease.
Pneumococcal meningitis: Anatomic / functional asplenia (sickle cell anemia), HIV
infection, otitis, sinusitis,
pneumonia, otorrhea, rhinorrhea, chronic Graft versus host disease after BMT.
(Answer E)
12. If a patient with meningitis with hyponatremia and related convulsions has low
plasma osmolarity and high urinary osmolarity, whichever is
It should be considered? (September 88)
A) Adrenal insufficiency
B) Cerebral salt loss
C) Diabetes insipidus
D) Improper ADH release
E) Brain abscess
Although plasma osmolarity does not increase during the course of meningitis, ADH
is released and causes inappropriate ADH syndrome. ADH effect increases water
uptake in the kidney and hyponatremia develops. from kidney
urine osmolarity and Na increases because water is retained and Na is not retained,
osmolarity and Na decrease in plasma.
(Answer D)
629
PEDIATRICS
13. Fever, vomiting, nuchal rigidity in the infant with high CSF pressure in LP,
200 cells, most of which are mononuclear, protein: 50 mg, sugar: 60 mg
(simultaneous blood sugar: 90 mg). What is your diagnosis? (April 88)
A) Bacterial meningitis
B) Aseptic meningitis
C) Tuberculous meningitis
D) Meningococcemia
E) Poliomyelitis
(Answer B)
14. Which of the following is not a cause of recurrent meningitis? (April 88)
A) Ventriculoperitoneal shunt
B) Otitis media
C) Meningocele

D) Splenectomy
E) Recurrent urinary tract infections
See 10 for a description of other options. Question. Tendency to bind
immunodeficiency
urinary tract infection is very common in children and immunodeficiency
is not an infection to suggest. Immunodeficiency of those with frequent urinary
tract infections
does not need to be evaluated in terms of.
(Answer E)
15. Hypervolemia, hyponatremia and high-density urine after meningitis
Which of the following should be considered in the first event?September 87)
A) Cushing's syndrome
B) Acute adrenal insufficiency
C) Improper ADH release
D) Acute nephropathy
E) Septic shock
(Answer C)
630
INTERNAL MEDICINE
CONTENTS
INTRODUCTION TO
CARDIOLOGY ................................................ .......................
........................... .................. 7
HEART FAILURE AND MYOCARDIAL DISEASES .............................................
............................... 27
HYPERTENSION................................................. .....................
............................. ....................... 45
ISCHEMIC HEART
DISEASES ............................................... ..........................
........................ ....... 55
HEART VALVES
DISEASES ............................................... ..........................
..................... 65
ARRHYTHMIAS ................................................. .....................
............................. ................................ 85
ENDOCARDIAL
DISEASES ........................................................ .................
................................. ........ 97
OTHER HEART
DISEASES ............................................... ..........................
........................ ........ 107
RESPIRATORY
SYSTEM................................................ ............................
...................... .................. 117
CHRONIC OBSTRUCTIVE PULMONARY
DISEASES .............................................. ...........................
... 129
TUBERCULOSIS................................................. .....................
............................. .......................... 143
RESPIRATORY SYSTEM
INFECTIONS ............................................... ........................
................. 153
RESPIRATORY FAILURE AND PULMONARY
EMBOLISM ............................................. ............................
. 171
LUNG TUMORS AND MEDIASTINAL
MASSES ............................................. ...........................
185
INTERSTITIAL LUNG
DISEASES ............................................... ..........................
.............. 193
Pleural
Diseases ................................................ .........................
......................... ............. 201
OTHER RESPIRATORY
DISEASES ............................................... ..........................
....................... 209
GENERAL
INFORMATION ................................................ ......................
............................ ....................... 215
Anemia
in ................................................. ..............................
.................... .............................. 221
Leukocyte
Diseases ................................................ .........................
......................... ........... 261
PLASMA CELL
DISEASES ............................................... ..........................
........................ . 289
Bleeding
diathesis ................................................ ........................
.......................... ................... 301
THROMBOEMBOLIC
DISEASES ................................................ .........................
....................... 313
OTHER HEMATOLOGICAL
DISEASES ............................................... ..........................
.................. 319
GENERAL INFORMATION
ONCOLOGY ............................................... ..........................
........................ .. 323
PARANEOPLASTIC
SYNDROMS ................................................ .........................
..................... 331
ONCOLOGICAL
EMERGENCIES ........................................................ ..............
.................................... ............... 337
INTRODUCTION TO
GASTROENTEROLOGY ................................................ .................
................................. .. 343
ORAL AND ESOPHAGUS
DISEASES .............................................. ...........................
................... 349
STOMACH DISEASES AND PEPTIC
ULCER ............................................. ...............................
............. 357
SMALL BOWEL DISEASES AND MALABSORBSION
SYNDROMS ............................................ 367
COLORECTAL
DISEASES .................................................... .....................
............................. ....... 379
PANCREAS DISEASES AND
TUMORS .............................................. .............................
........ 393
HEPATITIS
on ................................................. ..............................
.................... ............................. 397
OTHER LIVER
DISEASES ............................................... ..........................
..................... 405
BALL SURGERY AND CHANNEL
DISEASES ............................................. ............................
........... 423
INTRODUCTION TO
NEFROLOGY ................................................ ........................
.......................... ................. 427
LIQUID, ELECTROLITE BALANCE AND
DISORDERS ............................................ ............................
.... 435
ACID - BASE BALANCE AND
DISORDERS ............................................ ............................
............. 443
KIDNEY
FAILURE ................................................ ..........................
........................ .............. 451
GLOMERULAR
DISEASES ................................................ .........................
......................... ..... 469
OTHER NEPHROLOGIC
DISEASES ............................................... ..........................
..................... 481
GENERAL INFORMATION IN
RHEUMATOLOGY ................................................... ..................
............................... 497
SYSTEMIC LUPUS
ERYTHEMATOSIS ............................................... .....................
............................ 499
VASCULITIS
on ................................................. ..............................
.................... .......................... 511
ROMATOID ARTHRITIS AND
OSTEOARTHRITIS .............................................. .....................
....................... 519
OTHER
ARTHRITES ........................................................ ................
.................................. ..................... 535
OTHER ISSUES OF
ROMATOLOGY ............................................... ........................
.................... 545
IMMUNOLOGY................................................. .......................
........................... ......................... 553
HYPOTHALAMO - HYPOPHYSICAL
DISEASES ................................................... ......................
................ 565
THYROID
DISEASES ................................................ .........................
......................... ............... 579
PARATHYROID DISEASES AND CALCIUM
METABOLISM ............................................. ........... 593
DIABETES
MELLITUS ................................................ .........................
......................... ................. 605
ADRENAL
DISEASES ................................................ .........................
......................... .......... 631
OTHER ENDOCRINE
DISEASES ............................................... ..........................
...................... 651
SYMPTOMS AND FINDINGS IN INFECTIOUS
DISEASES ............................................. .................. 659
INTRODUCTION TO CARDIOLOGY
one. Which of the following is the electrocardiogram above?

(April 2010)
A) Hyperpotasemia
B) Hypercalcemia
C) Hypothermia
D) Hypopotasemia
E) Tricyclic antidepressant intake
An ECG question with only limb leads. September 2009 hypocalcemia, April 2010
hypercalcemia.
Pointed T, broad QRS can not be hyperkalemia.
No U wave, no hypokalemia.
Hypothermia and tricyclic antidepressants were not found stylish. Short QT
hypercalcemia is the typical expected ECG question.
(Answer B)
INTERNAL MEDICINE
2nd. The electrocardiogram trace above is

which is associated with? (September 2009)
a)
hyperkalemia
B) Hypercalcemia
C.)
hypokalemia
D) Hypocalcemia
TO)
hyponatremia
Yes, one of the sine qua non of TUS; ECG

Interpretation of electrolyte and ECG is of course important both verbal and
verbal. This shaped form
if you can't play a pencil on ECG questions, let's examine your theoretical
knowledge.
It can be said that the ECG has no clear effect.
Then potassium;
Hyperkalemia is a large QRS, does not have T-spikes da (no T wave is seen between
us, ECG is still bad)
Hypokalemia U wave doesn't have that either…
Remaining calcium ECG depends on age, sex and heart rate. But 300-450 ms is normal.
Calcium QT is inversely proportional.
Hypocalcemia QT long
Hypercalcemia QT short
(Answer D)
3. Which is one of the causes of syncope secondary to a drop in heart rate
A) Atrial myxoma
B) Heart tamponade
C) Aortic stenosis
D) Long QT syndrome
E) Carotid sinus sensitivity
In our Tustime notes, which are included in the new generation TUS questions, one
of the important issues arranged according to new textbooks:
SYNCOPE
Atrial myxoma usually has a stalked mass in the left atrium.
Tamponad increases the right pressures collected sudden fluid around the heart
cavities. Veins when right pressures increase
can not return to the right heart, if there is no blood returning to the heart, of
course there will be no flow, so the flow will fall.
Blood pressure will drop. The result is syncope ...
Aortic stenosis is probably the first valve disease that comes to mind when it
comes to syncope. The aorta is narrow and this is already
immediately explains the low flow.
Long QT is important. The action potential time of the ventricle. Arrhythmia from
the ventricle
The probability increases, which reduces the flow rate. The result .....
Carotid sinus sensitivity is a rare cause of syncope yes it does syncope but not by
lowering the flow rate
peripheral resistance as the sensitivity of the baroreceptors in the carotid sinus
is increased
syncope occurs due to fall.
Now let's come to the scientific explanation of this work TUS approach to you about
the solution, the first four hearts
The corresponding E option is the question of which is different from the cause of
the non-heart.
(Answer E)
4. A 50-year-old male patient with perspiration for an hour
She is admitted to the hospital because of chest pain. Blood in physical
examination
pressure 90/60 mmHg, pulse 108 / minute and heart sounds deeply
The electrocardiogram trace taken is as follows.
A) Variant angina
B) Acute pericarditis
C) Anterior myocardial infarction
D) Heart tamponade
E) Cardiomyopathy
Yes, the first question was again started with ECG. This time on the case, fifty
years old man with chest pain
myocardial infarction (MI) should be considered first. Isn't that so in real life?
Let's generalize that before all chest pains MI should be ruled out. MI's ECG
What we'll see is that there are ST elevations in the V1-6, D1- aVL is clearly
seen. ST elevation is not enough, the localization of MI is also important.
Derivatives and localizations to be learned from this question;
V1-6 → Anterior
D1-aVL → High lateral
D2-3 –aVF → Derivatives to look for transmural infarction in the inferior wall.
So what do we do for the posterior and right ST1 elevation not for these regions
and /
or V2, the R / S ratio should be greater than 1.
Let's come to the most incorrectly marked answer Tamponad…. Why is that! Here comes
the heart sounds deeply.
The clinical and fundamental difference here is that the heart sounds in the
tamponade can come from deep. What about sick
obesse, or pulmonary disease in the chest anteroposterior diameter of the ST
increased in someone who has tamponade
it's pointless to think, it's important to work in the spotlight but we should
comment.
It's not pericarditis because it's not localized, but there would be ST elevations
everywhere in the pericarditis.
If the variant (vasospastic angina) is angina, the ECG is completely elevated by ST
(
It is a type of angina that usually develops after stress.
(Answer C)
INTERNAL MEDICINE
5. Which of the following is the electrocardiogram trace above?

(September 2008)
A) Left ventricular hypertrophy
B) Right ventricular hypertrophy
C) Acute anteroseptal myocardial infarction
D) 3rd degree AV block
E) Right axle deviation

Yes again ECG again must be heavenly questions for us not nightmares. Now excited
if you have the ECG question before
Let's look at the heart rate. 300 / RR distance has about 4 frames speed: 75
beats / min
gone. The heart rate in the block (bradyarrhythmia) on the full block name: will be
below 40.
Nice, stayed 4 chic. C option MI and anterior v1-6 to be anteroseptal judging from
the question V1-6 V1-3
Is there any ST elevation? But the objections would be that the V4-6 ST crash
didn't mean that either:
ST depression and T negativity should be remembered non-Q or non ST elevation with
new terminology
It diagnoses MI and does not localize in non Q MI.
3… Axis calculation is always discussed. We can immediately understand that this is
not the answer. Why axes calculation The heart's posture in a 2-dimensional plane
is often associated with extremity leads
can be found. Especially D1 and aVF .. Well, the question is just chest leads göğüs
2 is actually the advantage of such contrasting TUS advantage, why? The answer is
either
or not 2 'side….
It is very simple V1-2 rather than the right ventricle which will understand how
the ventricle; V1 to V6
left ventricle is seen more. So V1-2 should also increase right ventricle, if there
is dominance of R
If the Rs increase towards V5-6, the left ventricle is enlarged.
ACADEMIC PART OF THE WORK
10
Right ventricular hypertrophy

R is greater than S in V1 or R wave greater than 7 mm in V1
(Answer A)
6. Which of the following statements about mitral stenosis is wrong? (September
2008)
A) The most important hemodynamic marker of the disease is increased left
atrioventricular pressure gradient.
B) Exercise dyspnea in patients develops due to increased pulmonary arterial and
venous capillary pressure.
C) Left ventricular diastolic pressure is usually increased in isolated mitral
stenosis.
D) Mitral valve opening sound and hard 1st sound are characteristic auscultation
findings.
E) In ECG II. notched P wave in the lead is characteristic.
WHAT TO KNOW ABOUT MITRAL STENOSIS
Etiology: RKH (Most common), Myxoma, congenital
Clinic: Dyspnea, PND, Hemoptysis, Cough, Embolism, Right HF
FM: S1 hard
Mid-late diastolic murmur
Presystolic exacerbation
MAS
(Sign of Drozies)
Graham Steel murmur
Pulmonary HT: P2 hard
Findings of right ventricular hypertrophy
ECG: P mitrale (notched P wave)
Right ventricular hypertrophy
Tele: Pulmonary congestion, Double contour on right (due to growing left atrium)
Treatment: Balloon valvuluplasty, Comissurutomy, Replacement
Complications:
Atrial fibrillation (most common), infective endocarditis, systemic embolism,
pulmonary edema, right heart failure.
Left ventricular hypertrophy or pressure increases are not expected in mitral
stenosis. our business
left atrium, pulmonary veins, lung, pulmonary artery, and from there to the right
heart.
(Answer C)
11th
INTERNAL MEDICINE
7. Eisenmenger in a patient with ventricular septal defect

Diagnoses the syndrome? (April 2008)
A) Right to left shunt
B) Shunt from left to right
C) Increased pulmonary artery pressure and approach to systemic blood pressure
D) Pulmonary valve stenosis
E) Continuous murmur
With pulmonary artery pressure approaching systemic pressure in all left to right
shunt diseases
dramatic scenario Eisenmenger syndrome is also important for pediatric cardiology
As one of the information can always be asked.
(Answer C)

(September 2007)
A) Right bundle branch block
B) Left bundle branch block
C) First degree AV block
D) AV full block
E) Atrial fibrillation
ECG before we start again quickly, the average speed is around 100, so let's
eliminate the blocks.
P waves in ECG cannot have atrial fibrillation equal RR intervals even if
compression is poor.
Again, they are not either, or someone is the answer…
12
Seeing rabbit ears branch block, right if you see V1-2, left if you see elsewhere
branch block ...
(Answer B)
9. Electrode location of the following precordial leads
is not specified in the face? (April 2007)
Precordial derivation
Electrode location
a)
V1 Sternum right
4. Intercostal space
B)
V3 Sternum solu
4. Intercostal range
C.)
V3
V2 to V4
D)
V4 Midclavicular line
5. Intercostal space
TO)
V5 Midaxillary line
5. intercostal space
Bipolar Unipolar
D1 - Right-left arm difference aVR - heart from right shoulder
D2 - Right arm-left foot difference aVL - heart from left shoulder
D3 - Left arm-left foot difference aVF - sees the heart from below
Unipolar breast leads
V1 - 4th intercostal space to the right of the sternum
V2 - 4th intercostal space to the left of the sternum
V3 to V2 to V4
V4 - 5th intercostal space in the midclavicular line
V5 - anterior axillary line
V6 - mid axillary line
(Answer E)
10. Which is a patient with a blood potassium level of 7.2 mEq / L
is not one of the electrocardiography findings that can be detected? (September
2006)
A) Increase in T wave height
B) Contraction of T wave base
C) First degree atrioventricular block
D) P wave disappearance
E) Narrow QRS waves

One of the classic questions about electrolyte and ECG association
ECG of HYPERCHALEMIA; (Potassium normal value; 3.5-5.5 mEq / L)
T taper, (first finding)
QRS expands,
P can expand and flatten and disappear,
PR prolongs,
ST can sometimes rise,
QT prolongs
(Answer E)
13
INTERNAL MEDICINE
11th. Which of the following drugs has little effect on plasma lipoproteins
Since it has no place in the treatment of current hypercholesterolemia? (September
2006)
A) Cholestyramine
B) Nicotinic acid
C) Pravastatin
D) Probucol
E) Cholestipole
It's actually a good question about treating hyperlipidemia but it's a bit of a
logical error. Answer Probukol
ok, but because it does not reduce lipid Long QT can cause sudden death is not
used.
Current lipid lowering drugs;
•
Statins for lowering LDL
Fibric acid derivatives for lowering triglycerides.
Niacin (Nicotinic acid), which also raises the broadest spectrum of HDL for
combined hyperlipidemias
Bile resins (cholestyramine, cholestipol) can be given to lower LDL.

(Answer D)

(April 2006)
A) Supraventricular tachycardia
B) Wolff - Parkinson - White syndrome
C) Ventricular parasystole
D) Atrial flutter
The most common chronic arrhythmia in the community is atrial fibrillation;
indispensable of elderly patient flutter questions
answer. Absence of P wave and QRS irregularity in the ECG
It leads. It is necessary to admit that this question is not even distracting.
The SVT (supraventricular tachycardia) ECG in question may be one of the possible
TUS questions:
When the young patient comes with palpitations, it should first come to mind. QRS
intervals are regular and P wave at each beat
different configuration.
WPW has a short PR interval, wide QRS and pathognomonic delta wave
Atrial flutter is separated by sawtooth-like atrial activity and QRS interval
equality.
Ventricular parasystole is the sign of finding a stylish topic.
(Answer E)
13. Total cholesterol value 280 mg / dl, HDL-cholesterol value 60 mg / dl,
triglyceride level
What is the LDL cholesterol value of a patient with 250 mg / dl? (April 2006)
A) 130
B) 150
C) 170
D) 190
E) 220
Math question
Total cholesterol: HDL + LDL + VLDL (VLDL: TG / 5)
It's a question like chickpea for those of us who do so much math and win medical
school. A word a process
which number can be obtained from the above.
(Answer C)
14
14. Which of the following exerts significant pressure on the esophagus? (September
2005)
A) Aorta ascendens
B) Pulmonary artery
C) Vertebral lesions
D) Left atrium
E) Right ventricle
Among the anatomical structures in the chic, the left atrium is adjacent to the
esophagus. Enlarge the left atrium
In pathologies (eg mitral stenosis) compression of the esophagus occurs.
(Answer D)
15. Which of the following heart sounds is heard in the systole? (September 2004)
A) Third heart sound
B) Fourth heart sound
C) Mitral opening sound
D) Ejection sound
E) Pericardial knock
Although heart sounds seem to be the simplest issue, we should not miss them. With
the head of systole
S1 (atrioventricular closure) starting at the beginning of diastole S2 (semilunar
closure) is expressed
would.
Pericardial beat sound in constrictive pericarditis, diastole,
Mitral opening sound mitral stenosis in diastole,
S3 is the most common heart failure at the beginning of diastole,
S4 is the sounds produced by the atrial cystole at the end of diastoline.
However, ejection sounds are the vibrations of large vessels when they are opened
(aorta and pulmonary). And big
vessels should be open in the systole.
(Answer D)
16. Two QRSs at equal intervals on an electrocardiogram taken at a rate of 25 mm /
sec.
Among the complex are 15 small squares.
According to this electrocardiography, what is the heart rate per minute?
(September 2004)
A) 50
B) 100
C) 150
D) 200
E) 300
Let's not count this question as an ECG question Distance between 1500 / RR (small
square) or 300 / RR distance
(large square) = Heart rate
(Answer B)
17. Electrocardiography shows no P waves, regular RR distances and a speed of 60 /
min. (April 2004)
A) Atrial fibrillation
B) Wolff-Parkinson-White syndrome
C) AV full block
D) Atrial flatter
E) Nodal rhythm
Verbal ECG question that looks like a pile. I say no AF, but the QRS intervals are
equal. You know, so to speak
There's a jerk in the question.
Let's look at your heart rate now 60, beautiful
Sinus node 60-100
AV node 40-60 means that it has no P, not sinus or nodal sinus. So nodal rhythm,
why QRS
Equal always comes from the same place.
If you think about it a little bit, there's an answer.
(Answer E)
15
INTERNAL MEDICINE
18. LDL-cholesterol in an elderly male patient with hypertension and infarction

with diabetes mellitus requiring initiation of drug therapy for
hypercholesterolemia
value and the targeted LDL-cholesterol value in which of the following? (September
2003)
Requires treatment
objective
Requires treatment
objective
LDL cholesterol value
LDL-cholesterol value
a)
> 130
<100
B)
> 150
<120
C.)
> 160
<130
D)
> 190
<130
TO)
> 200
<160
In 2009, he started to remind the ATP III guide he had asked. For atherosclerosis
in the patient
Let all the risk factors available LDL level below 100 and start the drug over 130.
For 2003
the answer is.
But now let's get out of these 130 and 100's. Target value, especially DM, CAD and
peripheral artery
If the disease was withdrawn under 70. If more than 100 is the limit of starting
medication…
Indication of drug therapy in hyperlipidemia
Parameter
LDL-cholesterol *
Target level *
Coronary artery disease and other atherosclerotic diseases
> 130
<100
No coronary artery disease but 2 major risk factors
> 160
<130
No coronary artery disease and risk factor less than 2
> 190
<160
(Answer A)
19. Short systolic murmur of second degree severity in the left 4th intercostal
space in one patient
It is heard. This murmur is exacerbated by expiration, straining and standing up,
It is found that the fingers are slowed by the opening and closing movement
(isometric handgrip).
Which of the following is the most likely diagnosis in this patient? (September
2003)
A) Tricuspid insufficiency
B) Ventricular septal defect
C) Mitral insufficiency
D) Aortic stenosis
E) Hypertrophic cardiomyopathy
The most frequent cause of death of young athletes is the disease, whose murmur
changes with maneuvers; IHSS is also known as hypertrophic cardiomyopathy.
The only disease that inversely changes the murmur character with the maneuvers
that increase and decrease venous return;
What does Inverse Proportion Mean?
Inspiration, squatting and isometric exercise (punching) venous return increases,
murmur is reduced.
Expiration, standing, valsalva and isotonic exercise venous return is reduced,
murmur is increased.
There is another disease such as MVP, but not in options.
(Answer E)
16
20. In a patient with venous fullness in the neck, the pulses of the venous wave
If not, which is the most likely diagnosis? (April 2003)
A) Congestive heart failure
B) Constructive pericarditis
C) Vena cava superior syndrome
D) Tricuspid regurgitation
E) Cardiomyopathy
This is one of the interesting questions.

Neck venous fullness: All veins of the body flow into the right heart, including
the neck veins. Having BVD
must not flow. It is the most important physical examination finding of right heart
failure. behold
in fact, all of the sores have venous fullness but there are waves. Subclavian
and / or
jugular vein catheter and we will watch the waves. Vena cava superior syndrome
(most commonly
small cell lung cancer)
There are obstacles. In other words, even if there is fullness, the wave does not
reflect on the veins, so it is not seen.
(Answer C)
21. Which of the following is paradoxical mating? (April 2001)
A) Pulmonary stenosis
B) Aortic stenosis
C) Mitral stenosis
D) Atrial septal defect
E) Pulmonary hypertension
Rule: Right ventricular pathologies are wide, left ventricular pathologies paradox
makes S2 mating. Pace
the situation is the opposite in makers.
(Answer B)
22. In electrocardiography, which T wave indicates: (April 2000)
A) Repolarization of interatrial septum
B) Ventricular repolarization
C) Ventricular depolarization
D) Atrial depolarization
E) Atrial repolarization
electrocardiogram Me
one. P wave
•
Corresponds to atrium depolarization. Atrial repolarization remains within the QRS

complex.
P wave does not include atrial repolarization.
2nd. PR range
•
Q wave from the beginning of atrial depolarization (ventricular depolarization

is the range from the beginning of the
When the atrioventricular (AV) conduction rate slows, the PR interval is extended.
(As in the heart block) Heart
rate: When the heart rate increases, the PR interval becomes shorter.
3. QRS complex
•
Corresponds to ventricular depolarization.
4. QT range
•
It is the interval from the beginning of the Q wave to the end of the T wave.
Corresponds to all ventricular depolarization and repolarization.
17
INTERNAL MEDICINE
5. ST segment
•
It is the segment extending from the end of the S wave to the beginning of the T
wave.
İzoelektri is. This is the period during which the entire ventricle is depolarized.
6. T wave
•
Ventricular repolarization.
(Answer B)
23. Which of the following is not seen in hypokalemia? (April 99)

A) Arrhythmia
B) Long PR
C) Areflexia
D) T-tapering
E) U wave
Hypokalaemia;
Clinic:
Fatigue,
Myalgia,
Weakness in lower extremities
Paralysis can be seen.
Paralytic ileus may develop after involvement of smooth muscles.
The first findings on ECG were T wave negativity, marked U waves and ST segment
depression.
In the case of severe K deficiency, the PR distance increases.
Sharp T is unique to hyperkalemia.
(Answer D)
24. Stimulation of receptors on the endocardial surface of ventricular walls in the
heart
Which of the following causes? (September 97)
A) Increasing the frequency of the heart
B) Increased diastolic pressure
C) Reduction of peripheral resistance
D) Reduction of vagus effect on the heart
E) Increased vascular tone
Again the joint production of physiology and cardiology: Bezold-Jarish reflex
should be known.
Stressing of the receptors in the left ventricle causes systemic arterial pressure
and heart rate decreases. These stress receptors in the left ventricle are
and keeping heart rate low during rest
It is thought to have played. The result is apnea, hypotension and bradycardia
(BezoldJarish reflex) ..
(Answer C)
18
25. Double contours to the right of the heart on the telecardiogram in which case
has? (September 97)
A) Increased left atrium volume
B) Increased right atrium volume
C) Decreased left ventricular volume
D) Hiler fullness
E) Aortic elongation
In cases where dilatation of the left atrium, such as mitral stenosis, leads to the
right heart
double contour is tracked.
(Answer A)
26. Which of the following is not the fourth heart sound? (April 97)
A) Aortic stenosis
B) Mitral stenosis
C) Coronary heart disease
D) Systemic hypertension
E) Pulmonary hypertension
This question is one of the wrong questions.

S4 is the atrial cystol and the sound of the atrium that forcibly clogs the
ventricle in the last 1/3 of the diastole. It can be heard in any case that
increases ventricular pressure, voltage. It is most commonly heard in hypertension.
Aorta
stenosis, pulmonary HT, coronary heart disease can all cause S4. But isolated
mitral stenosis is also atrial
Because there is a possibility of fibrillation, we may hear less than others. But
in mitral stenosis
If pulmonary hypertension develops we will hear again S4. So in some questions the
truth in that question
We need to seek adventure.
(Answer B)
27. Which of the following is the most common ECG sign of hyperkalemia? (April 97)
A) Pointed high P wave
B) Shortening of PR interval
C) Pointed T wave
D) Narrowing of the QRS interval
E) Supraventricular extrasystole
Question similar to April 99

hyperkalemia
-
Pointed T
Wide QRS
(Answer C)
28. Which of the following are ECG findings of hypercalcemia? (September 96)
A) QRS expansion
B) ST collapse
C) QT shortening
D) QT elongation
E) Pointed T wave
Electrolyte disturbance and ECG findings in TUS

hyperkalemia
-
Pointed T
Wide QRS
ST collapse
PR elongation
hypokalemia
-
U wave
-
ST collapse
PR elongation
19
INTERNAL MEDICINE
hypocalcemia
-
QT elongation
hypercalcemia
-
QT shortening
(Answer C)
29. Which of the following diseases does the “a” wave not occur in the jugular
vein? (September 95)
A) Pulmonary stenosis
B) Tricuspid stenosis
C) Right atrial myxoma
D) Pulmonary hypertension
Waves in the jugular vein:

A wave (+) is a presystolic wave. Shows the systole of the atria. a wave is large
Pulmonary stenosis, pulmonary hypertension and tricuspid stenosis. a wave atrial
disappear with fibrillation.
C wave (+) is a wave. Bending of the tricuspid valve into the right atrium at the
systolic border
result.
X wave: (-) wave. The tricuspid valve is formed by sliding the valve towards the
ventricle.
V wave: (+) is a late systolic wave. The vena of the blood with the closure of the
tricuspid valve during systole
cava is the result of accumulation in the superior.
Y wave: (-) is a wave. The tricuspid is formed by opening the lid.
(Answer E)
30. Which of the following is not a therapeutic catheter application?
(September 95)
A) Balloon atrial septostomy
B) Endomyocardial biopsy
C) Blade atrial septostomy

D) Embolization of abnormal arterial structures
E) Pulmonary valve dilatation

The question of reading comprehension is also diagnosed by biopsy as soon as it is
treated.
(Answer B)
31. In addition to ventricular depolarization during the QRS wave in
electrocardiography, which of the following occurs? (April 95)
A) Ventricular repolarization
B) Atrial depolarization
C) Hyperpolarization of the atrium
D) Atrium repolarization
E) Ventricular polarization
Normal waves on ECG
P-wave; Depolarization of atria.
QRS wave; Depolarization of ventricles and repolarization of atria.
T wave; Repolarization of ventricles.
Atrial repolarization cannot be seen on a normal ECG record. QRS, the ventricle
The amplitude in the depolarization cannot be seen because it is small.
(Answer D)
20
32. Which of the following cannot be demonstrated by nuclear medicine techniques in

pediatric cardiology? (April 95)
A) Anatomical structure of the heart cavities
B) Determination of intracardiac shunt, direction and amount
C) Imaging of large vessels
D) Bacterial endocarditis
E) Determination of myocardial structure integrity
NUCLEAR MEDICINE METHODS:
Anatomical structure of the heart,
Pressure and volume measurements
It can be used in congenital heart diseases. Endocarditis is a valve disease. Cover
diseases most
reliable diagnostic method: ECOCARDIOGRAPHY.
(Answer D)
33. Which of the following does central cyanosis not occur? (April 94)
A) Heart failure
B) Right to left shunt
C) Chronic obstructive pulmonary diseases
D) Hereditary methemoglobinemia
E) Arterial O2 pressure drop

The question of classical physiology and cardiology: The heart does not care about
external appearance. Heart failure
blood perfusion of vital organs
organs. Peripheral cyanosis. However, in end-stage heart failure
can be both peripheral and central, mixt type cyanosis.
(Answer A)
34. Best method to determine the degree of obstruction of valvular aortic stenosis
A) Electrocardiography
B) Doppler Echocardiography
C) Scintigraphy
D) Telegraphy
E) PA chest radiography
Doppler echocardiography is the best method to determine the degree of obstruction

of valvular aortic stenosis. However, cardiac catheterization is needed to make
more accurate evaluation.
must.
(Answer B)
35. Which of the following does not have a continuous murmur? (September 92)
A) Patent ductus arteriosus
B) AV fistula
C) Ventricular septel defect + Aortic insufficiency
D) Peripheral artery stenosis
E) Aortic stenosis
Continuous murmurs are called systolodiastolic murmurs. Causes;
•
Patent ductus arteriosus (Gibson murmur),
Aortic coarctation,
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Valsalva sinus (space between aortic valves) aneurysm,
AV fistulas and peripheral (femoral, renal) artery stenosis.
• It can be heard in the presence of two separate pathologies (VSD + AY) that cause
systolic and diastolic murmur.
In aortic stenosis, only systolic murmur is heard.
(Answer E)
36. In which of the following cases does the wave (a) occur? (September 91)
B) Aortic closure
C) Ventricular cystole
D) Pulmonary valve closure
E) Atrium cystole
Waves in the jugular vein:

a → The wave reflected upwards (towards the jugular vein) during atrial
contraction.
c → the vibration wave in the jugular vein due to the closure of the tricuspid
valves;
v → It is due to upward curvature of the tricuspid valve after ventricular
contraction.
x → It is caused by the downward movement of blood in the jugular due to right
atrium enlargement.
y → It is caused by atrial and jugular blood coming down due to opening of the
tricuspid valve.
Waves observed in the jugular vein and its relationship with heart sounds
Positive waveforms; a, c and v
Negative waveforms; x and y
'a' wave: tricuspid stenosis, right ventricular hypertrophy, pulmonary stenosis,
pulmonary hypertension and
pulmonary embolism. It disappears in atrial fibrillation.
(Answer ??)
37. Which of the following conditions develop cyanosis? (September 91)
A) Methemoglobinemia
B) Oxy Hemoglobin increase
C) CO intoxication
D) Reduced Hemoglobin increase
E) None
Cyanosis is defined as a reduced hemoglobin level above 5 g / dl in the blood.

(Answer D)
38. II. Which of the following makes the heart sound? (April 91)
A) Opening of atrioventricular valves
B) Closure of atrioventricular valves
C) Opening of aortic and pulmonary valves
D) Closure of aortic and pulmonary valves
E) Opening snap
April 89 Similar Question
(Answer D)
22
39. What is the definitive diagnosis of pericardial effusion? (April 91)
A) Echocardiography
B) Electrocardiography
C) Thallium 201 scintigraphy
D) Fluoroscopy
E) Telecardiography
September 88 same question

(Answer A)
40. Which of the following is the first heart tone weak? (April 90)
A) Mitral stenosis
B) Aortic stenosis
C) Mitral regurgitation
D) Heart failure
E) Tricuspid stenosis
I. Conditions that reduce heart tone severity: obesity, emphysema, pleural and
pericardial effusions,
pneumothorax, severe myocardial disorders, severe heart failure, mitral valve very
calcified
(severe mitral stenosis), bradycardic cases, mitral and tricuspid valve failure and
It decreases when prolonging the PR interval (conventionally occurs with acute
rheumatoid fever).
I. Conditions that increase the intensity of heart sound: Short PR interval,
tricuspid and mitral stenosis,
opens quickly and then closes by hitting. The severity of the first heart sound
also causes tachycardia
also increases (fever, exercise, thyrotoxicosis, pheochromocytoma, anemia).
II. Conditions that reduce heart sound severity: Calcified aortic stenosis, aortic
insufficiency, pulmonary
stenosis and I. are the conditions that reduce the intensity of sound.
II. Conditions that increase heart tone: Increases blood pressure in the aorta and
pulmonary artery
conditions are pulmonary and systemic hypertension.
(Answer C)
41. What is the ECG finding in hypocalcemia? (April 90)
A) QT shortens
B) QT prolongs
C) T taper
D) ST depression
E) QRS expands
ECG findings in hypocalcemia: QT interval is prolonged, T wave suppression and

negativity can be seen.
ECG in hypocalcemia
QT prolongs
T wave may become negative
ECG Changes in Potassium-Related Conditions
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Hyperkalemia: T sharpness, QRS expands, P disappears

Hypokalemia (hypomagnesemia also makes similar changes to hypokalemia)
Hypokalemia: U wave appears, T wave makes a notch on U

(Answer B)
42. What is the ECG finding in hypercalcemia? (September 89)
A) QT shortens
B) QT prolongs
C) PR prolongs
D) PR does not change
E) QRS shortens
ECG findings in hypercalcemia: QT interval is shortened. T wave expansion and dome,

PR
and QRS durations. Rhythm disorders are seen.
ECG in hypercalcemia
QT shortens
QRS expandable, PR extensible
(Answer A)
43. Which of the following components make up S1 sound? (April 89)
A) Aortic-pulmonary
B) Aortic-mitral
C) Mitral-pulmonary
D) Mitral-tricuspid
E) Aortic-tricuspid
I.
Clostridium species
Aspergillus species
Fusobacterium species
Other mold fungi (Fusarium, Pseudallescheria boydii, Scedosporium,

Rhizopus, Mucor)
Propionibacterium species
viruses
parasites
Herpes simplex virus
Strongyloides stercoralis
Varicella-zoster virus
Respiratory tract viruses
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INTRODUCTION TO GASTROENTEROLOGY
one. A fifty-five-year-old, obese, non-smoking woman with no previous complaints
The patient presented with cough lasting more than 3 weeks. ACE inhibitor
Lunggraphy was evaluated as normal. This
What is the most likely diagnosis for the patient? (May 2011)
A) Chronic obstructive pulmonary disease
B) Bronchogenic carcinoma
C) Pulmonerembolism
D) Left heart failure
E) Gastroesophageal reflux
The patient talks about chronic cough. The misleading part is the onset of the
problem;
may bring to mind adenokanseri. However, the lung graph is normal and pneumonia is
not seen in the clinic.
He says he doesn't take an ACE inhibitor and doesn't mean anything to prolong the
question. Lack of weight loss and
If we consider obesity, reflux is the only remaining stylish cough in our hands.
(Answer E)
2nd. He presented to the emergency department with abdominal distention and failure
to remove gas-stools.
First radiological imaging method in a 60-year-old patient
A) Computed tomography
B) Ultrasonography
C) Magnetic resonance imaging
D) Direct abdominal X-ray
E) Barium column graph
DIAGNOSIS METHODS IN GASTROINTESTINAL DISEASES
one. Direct X-ray: Direct abdominal X-ray is the first step that should be
requested from the patient with acute abdomen.
Direct abdominal X-ray shows air fluid level in intestinal obstruction and
paralytic ileus.
Detection of free air under the diaphragm is a very important finding in
perforations. Direct radiography
calcifications may occur. Opaque stones in gallbladder, pancreatic calcification in
chronic pancreatitis, calcification in cyst hydatid cyst, aortic calcification in
aortic aneurysm can be seen.
2nd. Abdominal ultrasonography: Gall bladder, biliary tract, liver fattening,
cirrhosis, liver
tumors, cysts. Its specificity and sensitivity is around 80-90%. Noninvasive
diagnostic method is the first step to evaluate hepatobiliary pathologies. Most
important
disadvantage of retroperitoneal organs with intestinal gases and the part of the
trunk and tail of the pancreas
The results in the evaluation are not very sensitive.
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3. Esophageal gastric-duodenal radiography with barium: barium examination,

inflammation, tumor,
used in the diagnosis of motility disorders. To show that the lesion causes
stenosis or obstruction
It is beneficial. According to endoscopic examinations, the diagnostic value is
low. Cheaper in terms of cost and more
is a less invasive diagnostic method. Couple in the diagnosis of esophageal,
stomach, small intestine and colon lesions
contrast barium radiographs have higher diagnostic value. The most reliable
diagnosis of diverticulum
The diagnostic method is barium graphy.
4. Enteroclysis: Endoscopic examinations in the evaluation of small bowel
pathologies and barium
radiographs do not give very good results. In this case enteroclysis is performed.
Enteroclysis is used for the following purposes:
Partial mechanical obstruction of small intestine, cases suspected of peritoneal
tumors,
radiation enteritis, recurrent lower gastrointestinal bleeding of unknown origin,
small intestine
malabsorption syndromes.
5. Endoscopic examinations (upper GIS endoscopy and colonoscopy): Endoscopic
examinations are used for both diagnosis and treatment. Sensitivity of endoscopic
examinations is 90%,
specificity is about 100%. Endoscopic examination of varicose veins bleeding
correction of biliary tract pathologies with the help of ERCP;
local intervention, opening of gastrostomy, treatment of vascular lesions,
treatment of internal hemorrhoids
In many cases such as treatment is used.
a) Gastroesophageal reflux: Not necessary for diagnosis. It is performed if there
is dysphagia due to reflux, odynophagia, regurgitation, weight loss, bleeding and
frequent vomiting.
b)
Dysphagia: underlying cancer and Pllummer Vinson syndrome in esophageal dysphagia,

Schatzki
Endoscopic examination is performed for the diagnosis of mechanical lesions such as
ring.
c) Dyspepsia: Endoscopy is performed in patients with recurrent dyspepsia lasting

more than three months.
The most important cause of dyspepsia is H. pylori. Dyspepsia gastritis, ulcer,
biliary tract diseases and
gastric cancer.
D)
Upper gastrointestinal bleeding: Endoscopically, the focus of bleeding can be
detected in 95% of cases. Gives information about severity of bleeding and
treatment plan.
to)
Lower GIS bleeding: Colonoscopic examination of lower GIS bleeding in general

bleeding
It is recommended to do after stopping. Some authors disagree with this opinion and
bleeding
recommend colosnoscopic examination without any preparation. Hidden
should be done in all patients with iron deficiency due to bleeding.
f)
Other endoscopy indications: Patients with suspected cancer, chronic diarrhea,

foreign
removal of objects, gastrostomy, ERCP can be done.
6. Doppler ultrasonography: treatment of portal hypertension and portal venous

thrombosis
It is used.
7. Magnetic Resonance Cholangiopancreatography (MRCP): The diagnostic use of ERCP
has taken place. The bile duct is used to evaluate the head of the pancreas and the
channels of the pancreas.
Endoscopic retrograde cholangiopancreatography (ERCP): This method is used for the
treatment of vascular, biliary and pancreatic pathologies. Abandon diagnostic use
It was. The obstruction due to choledocholithiasis is opened by sphincterotomy and
the strictures
The stent is placed and bile flow is provided. Complications: bleeding (most
common), pancreatitis,
Perforation.
8. Percutaneous Transhepatic Cholangiography: demonstrating dilation of
intrahepatic biliary tract
using for. It is rarely used today.
344
9. Endoscopic ultrasonography (Endosonography): Diagnosis of esophageal, gastric

and intestinal wall lesions, pathology of pancreas and lymph nodes
evaluation. Fine needle aspiration biopsy from suspicious lesions with this method
done. The most important place is the diagnosis of pancreatic cancer. The
diagnostic value of pancreatic cancer is over 95%. Preoperative surgery for
esophageal and pancreatic cancer
tumor staging. Nervous plexus nerve for pain treatment in pancreatic cancer
blockade can be performed with the help of endoscopic ultrasound.
(Answer D)
3. A 38-year-old female patient presented with a 6-month history of dyspepsia.
had similar complaints in his family.
with epigastric pain from sleep at night for 1 month, rarely
retrosternal burning and 4 kg weight loss has been learned in the last 2 months.
Which of the following is the most important indication for upper gastrointestinal
system endoscopy in this patient? (April 2007)
A) Age
B) Complaint time
C) Medication of the complaint
D) Weight loss
E) Family history
He was given a patient with a stomach cancer clinic. The most important indication
for endoscopy was asked. Adult
If the patient is weakened, the first diagnosis that will come to mind is cancer.
The indisputable answer is attenuation.
(Answer D)
4. What should be the first radiological examination for diagnosis of acute
abdomen? (September 2001)
A) Abdominal radiography of standing and lying
B) Abdominal tomography
C) Abdominal MRI
D) Column graph with barium
E) Radiograph of esophageal gastric duodenum with barium

Direct radiographs show gas distribution in the small and large intestines. The
presence of air fluid levels in the dilated intestines on outpatient radiographs of
intestinal obstruction
diagnosis.
Soft tissues such as the liver, spleen and kidney can be outlined. Pancreas, blood
vessels
and calcifications in lymph nodes. Abdominal radiography with gastrointestinal
bleeding
does not help in cases.
Subdiaphragmatic radiographs of the chest in the presence of perforation
free air can be detected. Unexpected pulmonary problems such as pleural effusion
It helps.
The first thing that should be done in patients with acute abdomen
abdominal radiograph.
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INTERNAL MEDICINE
Method
Area of use
Drawbacks
USG
Abdominal masses (cyst, tumor, abscess, etc.) Organomegaly Acid Biliary tract
enlargement Bile
stones Fine needle aspiration and biopsy
Sensitivity to small lesions is low. The value of the functions is small. USG
engaged
depends on the doctor's interpretation. Gas and obesity
image quality decreases.
IT
Evaluation of pancreatic diseases Hepatic tumors Tumor staging Lesions
assessment of vascularity
It is expensive. High radiation exposure

Some tumors are lower than they are
(eg esophagogastric)
MRI
Tumor staging MRCP (magnetic resonance imaging)

pelvic, perianal and
Crohn's disease fistulas
It will take long. It cannot be used in claustrophobic ones.

The role of GIS in the diagnosis of diseases
It could be detected.
(Answer A)
5. Which of the following is indicative of a liver dysfunction
A) Direct increase in bilirubin in blood
B) Decrease in fibrinogen in plasma
C) Acid phosphatase increase in serum
D) Inhibition of bromosulfatein (BSP) with glutathione
E) Increased 5'-nucleotidase in serum
LIVER FUNCTION TESTS
Liver function tests are examined in different subgroups. These;
a. Determining liver's ability to transport and metabolize organic anions and drugs
Tests: direct and indirect bilirubin, bromosulfoftalein test, indocyanine
clearance, aminopyrine breath test
b. Tests for hepatocyte damage: ALT, AST and LDH
c. Cholestase tests: Alkaline phosphatase, GGT, 5'nucleotidase, leucine
aminopeptidase.
However, these four enzymes can increase in liver diseases as well as biliary
pathologies.
D. Tests measuring liver synthesis capacity: Albumin, prothrombin time,
to. Other tests: Immunoglobulins, autoantibodies
(Answer C)
6. Which of the following is upper gastrointestinal endoscopy contraindicated?
(April 92)
A) Acute myocardial infarction
B) Acute upper gastrointestinal bleeding
C) Pyloric obstruction
D) Systemic infections
E) After abdominal operation
346
Contraindications of upper gastrointestinal endoscopy;

•
Acute Myocardial Infarction
•
Abdominal aortic aneurysm
Severe valve disease
Perforation of upper GIS organs (esophagus, stomach and duodenum)
Aortic dissection and
Respiratory failure (COPD, ARDS, etc.)

(Answer A)
7. What is the most valuable enzyme in the diagnosis of cholestasis? (September 91)
A) Transaminases
B) Lactate dehydrogenase
C) Glutamate dehydrogenase
D) Isocitrate dehydrogenase
E) Alkaline phosphatase
The most common cause is stone obstruction of the common bile duct. Cholestasis
findings in patients; AST, ALT, ALP, GGT,
increase in bilirubin, Leucine amino peptidase, 5 'nucleotidase (most specific to
cholestatic jaundice)
enzyme).
(Answer E)
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348
ORAL AND ESOPHAGUS DISEASES
ORAL AND ESOPHAGUS

DISEASES
one. A 47-year-old patient diagnosed with diffuse systemic sclerosis
He had complaints of pyrosis, regurgitation and dysphagia for the last year.
Upper gastrointestinal endoscopy shows ulcers surrounding the lumen of the distal
esophagus. Which of the following causes of this condition in the patient
can one be? (September 2005)
A) Acceleration of gastric emptying
B) Hypocontractility in esophageal smooth muscles
C) Lower esophageal sphincter pressure greater than 15 mmHg
D) Loss of visceral sensitivity
E) Lower esophageal sphincter relaxation disorder
Scleroderma esophageal involvement is 90%. Scleroderma is also involved in the
middle and lower esophagus. Smooth muscles
loss of function and dysmotility develop. In this clinic, gastroesophageal reflux,
esophagitis, dysphagia and
regurgitation occurs.
As internal organ involvement; GIS, Lung, kidney and heart involvement are
prominent. The most common involvement in GIS
place esophagus. hypocontractility of the esophageal muscles and relaxation of the
lower esophageal sphincters
It is characterized by. Esophageal hypocontractility occurs in patients with
scleroderma and esophageal
The muscles are replaced by a fibrous tissue. This is the most responsible for
esophagitis.
(Answer B)
2nd. A 63-year-old male patient with 10-year history of pyrosis and regurgitation
References. The last two months he has had difficulty swallowing solid food for the
past three months.
It is learned that within 3 kg weakened. Hemoglobin level in laboratory
examinations
11 g / dL and hematocrit value was 33%. Couples started 10 days ago
dose of proton pump inhibitor treatment
Cuts the drug. Two weeks after discontinuation of the drug, the symptoms resumed
he is admitted to the hospital again.
Which of the following information is related to this case
endoscopy is not one of the indications? (September 2004)
A) Long-term pyrosis
B) Weight loss for the last 2 months
C) Difficulty swallowing solid foods
D) 33% hematocrit and hemoglobin level 11 g / dL
E) Recurrence of symptoms when proton pump inhibitor is discontinued
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If an adult male patient comes with anemia, endoscopy should be performed for
gastric carcinoma. that
Other signs such as weight loss, resistance to treatment, difficulty in swallowing
require endoscopy.
Complications:
one. Esophageal carcinoma,
2nd. esophagitis
one. Esophageal carcinoma findings;
one. Difficulty swallowing solid foods
2nd. Anemia (Hb 11 g / dl) (lower limit in males 13. 5 g / l)
3. 3 kg slimming
2nd. Findings of esophagitis; 10 days of proton pump inhibitor treatment of the
patient's complaints
relief, symptoms increase again when the drug is discontinued Which case is called
endoscopy indication is not related to this case? Slimming, anemia and difficulty
swallowing against solid foods in this patient
Typical for esophageal cancer. In this case, endoscopy should be performed
precisely. Two chic leaves remain.
A and E.
Indications for upper gastrointestinal endoscopy include gastroesophageal reflux
Endoscopy is not recommended for diagnosis. Because gastroesophageal
There is reflux. The sensitivity and specificity of endoscopy in demonstrating
gastro-oesophageal reflux is low.
Therefore, pH'metry is the most reliable diagnostic method in the diagnosis of
reflux.
one. Patients refractory to medical treatment
2nd. Patients with signs of complications
one. Gastroesophageal reflux: Endoscopy has low diagnostic value. Dysphagia is
performed in the following cases:
odynophagia, regurgitation, weight loss, bleeding and frequent vomiting.
Gastroesophageal reflux
is performed for follow-up in patients developing Barret epithelium. Reflux lasting
more than 5 years
It is recommended in patients with.
2nd. Dysphagia: Dysphagia
3. Upper gastrointestinal bleeding: To perform endoscopy for both diagnosis and
treatment
must.
4. Lower GIS bleeding: Sometimes upper GIS bleeding is not found in patients with
lower GIS bleeding
endoscopy. Bleeding may be caused by upper GIS in 10% of cases
It is forgotten.
5. Iron deficiency anemia of unknown cause: Iron deficiency due to occult bleeding
anemia. Varicose veins, esophagitis, esophageal hernias, atrophic gastritis,
ulcers, benign and malignant
tumors, vascular pathologies can cause anemia by occult bleeding.
6. Other causes: Foreign body, cause nausea and vomiting should be done.
(Answer A)
3. A 45-year-old male patient with dysphagia for 3 years, occasional substernal
chest
pain and coughing, especially at night. In the endoscopic examination, the lower
end of the esophagus was normal, the esophagus was enlarged and
residues.
2003)
A) Gastroesophageal reflux
B) Diffuse esophageal spasm
C) Achalasia
D) Unstable angina
350
E) Scleroderma
achalasia
Paradoxical dysphagia is the most common symptom. Dysphagia develops slowly and is
usually intermittent. dysphagia
increases with solid foods, liquids are easier to drink. Patients stand up and move
after a meal
feel the need to.
The hypertonic sphincter prevents gastro-esophageal reflux, so no burning occurs.
Pulmonary aspiration develops at night. The most common cause of death in achalasia
is aspiration pneumonia.
Achalasia is a predisposing factor for squamous cell carcinoma of the esophagus.
Diagnostic methods
Direct X-ray: Enlargement of the mediastinum due to esophageal enlargement
There are signs of aspiration pneumonia.
Barium graphy: “The lower end thins and causes a bird's beak appearance.
In the late stages of the disease, esophageal dilated peristaltic waves disappear
and are full of food.
Air fluid level can be seen.
Manometric pressure measurement: It is a definitive diagnostic method. Pressure
increased.
(Answer C)
4. Thirty-five-year-old female patient with fatigue, slimming, and eating for two
days
Regurgitation, fluid and solid food swallowing.
In the manometric study, pressure increase in the lower end of esophagus was
detected and which of the following is the most likely diagnosis? (April 2003)
A) Achalasia
B) Esophageal Cancer
C) Plummer Vinson Syndrome
D) Barret
E) Reflux esophagitis
Achalasia disease does not loosen the lower esophageal sphincter as a result of
injury to the plexus myentericus
occurs. Pressure increase at the lower end of esophagus is detected in manometric
study. There is dilatation in the upper esophageal segments. Difficulty swallowing
against both solid and liquid foods.
PA chest X-ray shows air fluid level due to food retention. Accumulated foods
dysplasia of the mucosa and subsequent development of squamous cell carcinoma. In
Achalasia
frequent death is aspiration pneumonia.
(Answer A)
5. Peristalsis disorder in the proximal part of esophagus 1/3
which one? (September 2000)
A) Dermatomyositis
B) Scleroderma
C) Crest syndrome
D) Achalasia
E) Chagas disease
dermatomyositis; The etiology is unknown. Papovaviruses and orthomyxoviruses in

etiology
It is accused. In muscle there is a reaction to cellular immunity. More in women
Fuck. The risk of malignancy is increased. Epidermal atrophy, basal cell
liquefaction and degeneration are vascular dilatations and lymphatic infiltrations
in the dermis. Proximal muscle weakness,
muscular tenderness or pain, rash, polyarthralgia, Raynaud's phenomenon, dysphagia,
fever, loss of strength
symptoms. It causes dysphagia and regurgitation, especially by holding 1/3 proximal
part of esophagus.
(Answer A)

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6. Which of the following does not cause hyperplasia in gingiva? (April 2000)
A) Pemphigus vulgaris
B) Pregnancy
C) Cyclosporine use
D) Acute monocytic leukemia
E) Phenytoin use
Gingiva hyperplasia is seen in:

• Idiopathic
• Phenytoin use
• Cyclosporine use
• Use of nifedipine
• Regional enteritis
• Diabetes mellitus
• Leukocyte diseases
• Scorbut
• Pregnancy
(Answer A)
7. Which of the following factors reduces gastroesophageal reflux?
(April 99)
A) Smoking
B) Coke
C) Alcohol
D) Protein
E) Fatty foods
Factors that increase gastroesophageal reflux include smoking, alcohol, chronic

aspirin intake, dietary fat,
spices, chocolate, caffeinated or decaffeinated coffee, cola, tea, tomato juice,
orange juice and other
citrus products.
Conditions Affecting Lower Esophageal Sphincter Pressure
increase in
gastrin
motilin
Hormonal
Pharmacological agents
Diet
reducing
cholecystokinin
Estrogen
progesterone
glucagon
secretin
Alpha-adrenergic agonists
Beta-adrenergic agonists
Cholinergic agonists
domperidone
Metaklopromid
PGF 2
anticholinergics
B2 agonists
Calcium channel blockers
Caffeine, theophylline
diazepam
PGE1 and PGE2
Nicotine
nitrates
Protein foods
Chocolate, coffee, ethanol, oil
(Answer D)
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8. The most common pathology of reflux in the esophagus in the gastrointestinal

tract
A) Complete intestinal metaplasia
B) Barret metaplasia
C) Intestinal metaplasia
D) Transitional metaplasia
E) Epidermoid metaplasia
Gastroesophageal reflux leads to esophagitis, stricture, ulceration and metaplasia
of the epithelium. Esophagus very
The cylindrical metaplasia of the folded squamous epithelium is called the Barret
esophagus. Risk of adenocarcinoma
It carries.
(Answer B)
9. The most objective and sensitive examination method in gastroesophageal reflux
is
A) Acid perfusion test
B) Esophageal radiography with barium
C) Manometric examination
D) pH monitoring
E) Endoscopy
April 94 similar question
(Answer D)
10. Which is the most objective method in the diagnosis of gastroesophageal reflux?
(April 94)
A) Esophageal manometer
B) Barium graphy
C) Ultrasonography
D) Acid perfusion test
E) pH monitoring (24 hours)

Various methods can be used in the diagnosis of gastroesophageal reflux
The standard method is 24-hour pH monitoring.
(Answer E)
11th. Which of the following is not given in the treatment of reflux-esophagitis?
(September 92)
A) H2 receptor blocker
B) Sucralfate
C) Omeprazole
D) Antacid
E) Anticholinergic
Various drug therapies can be used in the treatment of reflux esophagitis. The
mechanisms of action are different.
Proton pump inhibitors and H2 receptor blockers. These
sucralfate and antacids can also be used in the treatment of reflux. Playing a role
in the etiology of reflux
One of the most important factors is the decrease of lower esophageal sphincter
pressure. Anticholinergic drugs
reflux esophagitis as it may cause lower reflux esophageal sphincter pressure
not used in the treatment or even contraindicated
(Answer E)
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INTERNAL MEDICINE
12. What is the role of Barret in the esophagus? (September 92)

B) Paraesophageal hiatus hernia
C) Hyperacidity
D) Gastric hypertrophy
E) Stomach cancer
Barret esophageal squamous epithelium of the esophagus due to gastroesophageal

reflux to the columnar epithelium
occurs with the transformation. Barret in the metaplasic region for esophageal
diagnosis
goblet cells should be observed microscopically.
(Answer A)
13. Which of the following is not a complication of reflux esophagitis?
(April 92)
A) Esophageal stricture
B) Barret ulcer
C) Duodenal ulcer
D) Hidden bleeding
E) Supurative lung diseases
Reflux esophagitis is a pathology caused by gastric contents escaping back to the

esophagus. Most
Barret esophagus is the predominant complication of adenocarcinoma, while esophagus
is the most common complication of esophagus. The only distressing option for
reflux esophagitis complications is suppurative lung
diseases. Only aspiration of reflux causes suppurative lung disease
It is enough to find that the duodenal ulcer is the correct answer.
(Answer C)
14. Which of the following is the result of upper esophageal sphincter dysfunction?
(April 92)
A) Achalasia
B) Zenker diverticulum
C) Esophageal stricture
D) Reflux esophagitis
E) Epiphrenic diverticulum
Pulse and traction type diverticula are observed in esophagus. Pulse-type

diverticula is more common and the most common cause of this is Zenker
diverticulum.
Zenker diverticulum cricopharyngeal as a result of upper esophageal sphincter
dysfunction
from the region. Barium graphy is sufficient in the diagnosis, and treatment is
diverticulectomy. Caution as untreated may cause squamous cell carcinoma
pathology. Epiphrenic diverticulum is observed in lower esophageal sphincter
dysfunction. Similarly, barium x-ray can be used in the diagnosis, while
diverticulectomy is used in the treatment.
It should be applied.
(Answer B)
15. Which of the following is a female patient who has difficulty swallowing but
can swallow?
is considered a diagnosis? (September 91)
A) Akalazia
B) Zenker diverticulum
C) Esophageal carcinoma
D) Globus hystericus
E) Diffuse spasm of esophagus
Globus hystericus is characterized by sudden swallowing difficulty, which is more

common in women. No accompanying pathology is observed in the esophagus. inability
to swallow
Hyperventilation and Respiratory Symptoms
Alkalose is observed.
(Answer D)
354
16. Which of the following does not have macroglossia? (September 89)
A) Cretenism
B) Amyloidosis
C) Myxedema
D) Acromegaly
E) Pernicious anemia
Table question from Harrison. Macroglossi development of a syndrome such as Down

syndrome
as well as a tumor such as hemangioma or lymphangioma.
Acromegaly or Cretenism may develop due to a metabolic disease such as primary
amyloidosis
may also develop due to. Pernicious anemia is characterized by megaloblastic anemia
due to vitamin B12 deficiency. The language-related pathology in pernicious anemia
is not macroglossic.
In pernicious aenm, glossitis is characterized by pain and hyperemia in the tongue.
(Answer E)
17. What is the first diagnostic procedure in Boerrhave syndrome? (September 89)
A) Chest X-ray
B) Esophagoscopy
C) Esophagography
D) Manometric examination
E) Ultrasound
Boerhave syndrome is characterized by rupture of the left posterolateral of the

esophagogastric region due to severe vomiting. The first examination to make the
diagnosis of lung
X-ray is. In particular, the presence of air in the mediastinum should be a
stimulus for diagnosis. For definitive diagnosis
The procedure is to be taken with an opaque substance is a graph. Boerhave syndrome
rupture emergency
Since it is a pathology that needs to be corrected, its treatment is surgical.
(Answer A)
18. In peptic esophagitis, which of the following is the definitive diagnosis?
(April 89)
A) Endoscopy
B) Barium graphy
C) Endoscopy + biopsy
D) Cytology
E) Arteriography
The most common cause of peptic esophagitis is gastroesophageal reflux.

Verification of esophagitis
Eosinophil infiltration should be observed in biopsy. Therefore, the most accurate
diagnosis
results in endoscopy and biopsy. pH monitoring in diagnosis of peptic esophagitis
This is the most accurate method to show reflux. But pH monitoring
It is not as valuable as endoscopy and biopsy.
Peptic esophagitis causes Barret esophagus, a precursor of adenocarcinoma
is a pathology that needs attention and treatment.
(Answer C)
19. Which of the following does Mallory-Weis syndrome most commonly occur? (April
88)
A) Duodenum
B) Jejunum
C) In the esophagogastric junction
D) Ileum
E) Stomach Antrum
Mallory Weiss Syndrome is a pathology associated with vomiting and esophageal

mucosa damage, which is characterized by a bright red hematemesis.
The most common cause is severe alcoholic vomiting. The definitive diagnosis was
made by endoscopy.
esophageal linear tears. Esophageal rupture
It is not. The condition in which rupture is observed is called Boerhave Syndrome.
In Boerhave syndrome, rupture is most commonly seen in the left postero-lateral
aspect of the cardia.
(Answer C)
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INTERNAL MEDICINE
356
Gastric Diseases And Peptic Ulcer
STOMACH DISEASES
AND PEPTIC ULCER
one. Which of the following is not a risk factor for the development of
adenocarcinoma of the stomach?
(December 2010)
A) Helicobacter pylori infection
B) Excessive salt consumption
C) Pernicious anemia
D) Smoking
E) Blood group is 0
A question that requires attention. In this question settled as classical

knowledge; O of the blood group; stomach ulcer
should be remembered as a risk factor for the development of gastric cancer in the
blood group should be remembered an increased risk.
Conditions that pose a risk to the development of gastric adenocarcinoma are
summarized below.
Risk Factors for Gastric Adeno Cancer:
• Diet: Low fat and protein intake, steamed food, no refrigerator use, vitamins A
and C
deficiency, well water, Nitrosamines
• Cigaret
• Alcohol
• Tire and coal mine worker
• A blood group (genetic disposition)
• Low socioeconomic status
• Adenomatous polyps
• Pernicious anemia
• Atrophic gastritis, achlorhydria
• Immune deficiency, Helicobacter pylori, Postgastrectomy (bilroth II).
(Answer E)
2nd. Regarding the approach of bleeding due to Mallory-Weiss tears
Which statement is true? (April 2009)
A) There is usually no need for specific treatment.
B) Sengstaken-Blakemore tube should be inserted.
C) Patients should receive early surgery.
D) Parenteral H2 receptor blocker should be given.
E) Antacid should be given per hour.
Mallory-Weiss are submucosal tears in the distal esophagus due to excessive
vomiting. Most often
The reason is the use of alcohol. It can also be seen in pregnant women. May cause
upper GIS bleeding.
No specific treatment is required. It may require treatment only if it causes
severe upper GIS bleeding.
(Answer A)
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3. A 38-year-old female patient presented with a 6-month history of dyspepsia.

had similar complaints in his family.
with epigastric pain from sleep at night for 1 month;
Which of the following is the most important indication for upper gastrointestinal
system endoscopy in this patient? (April 2007)
A) Age
B) Complaint time
C) Medication of the complaint
D) Weight loss
E) Family history
The classic question of weight loss malignancy. Weight loss should be questioned in
GIS malignancies. Hele
If this persists despite antacid treatment, an overlooked stomach adenocarcinoma
should come to mind
endoscopy and biopsy should be performed immediately.
(Answer D)
4. A 63-year-old man with pyrosis and regurgitation for 10 years
with complaints. Difficulty swallowing solid food for the past three months
3 kg in the last two months of weight loss is learned. Hemoglobin level is 11 g /
dL and hematocrit value is 33%.
The patient discontinued the drug because of complaints that he had completely
recovered with the double dose proton pump inhibitor treatment initiated 10 days
ago. 2 weeks after discontinuation
with the resumption of his complaints, he goes to the hospital again.
Which of the following information is related to this case
endoscopy is not one of the indications? (September 2004)
A) Long-term pyrosis
B) Weight loss for the last 2 months
C) Difficulty swallowing solid foods
D) 33% hematocrit and hemoglobin level 11 g / dL
E) Recurrence of symptoms when proton pump inhibitor is discontinued
It's actually a patient who looks like esophageal cancer. Symptoms progressive
after reflux-like started
increased. This long paragraph is almost always done for endoscopy complications,
especially for reflux in the esophagus. The possible fear here is malignancy.
Anemia
Weight Loss
Resistance to treatment
Dysphagia (especially solid) are indications for endoscopy.
However, pyrosis is already a symptom of all reflux patients.
(Answer A)
358
5. A 45-year-old male patient with dysphagia for 3 years, occasional substernal

chest
pain and bouts of cough, especially at night. Endoscopic examination
the lower end of the esophagus looks normal, the esophagus is enlarged and the food
remains
Respectively. Which of the following is the most likely diagnosis for this patient?
(April 2003)
B) Diffuse esophageal spasm
C) Achalasia
D) Unstable angina
E) Scleroderma
Dysphagia, chest pain enlargement of the lower esophagus, increased intra-

esophageal pressure due to food residues lower
esophageal sphincter pressure increase and result.
Father of esophageal primary dysmotility
achalasia
Loss of peristalsis in the distal esophagus and inadequate relaxation of the lower
esophageal sphincter (LES)
(tonus increase) caused by a motility disorder. Ganglion
degeneration of the cells as a result of lymphocyte infiltration and loss of
neurons in the myenteric plexus play a role in the pathogenesis. Inhibitor neurons
containing VAP and NO are mainly affected, while advanced
In cases affected by cholinergic neurons. Primary (idiopathic) achalasia is the
most common, secondary
achalasia is due to causes such as carcinoma, lymphoma, Chagas disease.
Clinic: Although it is seen at any age, it is between 20-45. The most important
symptom is dysphagia and
against both solid and liquid foods. Dysphagia may show a slight progression over
months and years (progressive dysphagia). Maneuvers such as valsalva that increase
intra-esophageal pressure
Easier. The first taken donuts are attached to the lower end of the esophagus and
When it increases, it passes to the stomach. Fluid intake may facilitate this
transition by increasing intra-esophageal pressure.
Substernal pain and regurgitation may occur after meals. In advanced cases,
vomiting may occur and
It is typical for esophageal diseases because it contains undigested nutrients.
Nocturnal in 1/3 of patients
cough and aspiration due to regurgitation. Weight loss due to oral intake disorder
visible. There is no significant physical examination finding. GIS malignancy in
achalasia
incidence increased.
Diagnosis: The most important test is barium esophageal radiography. Smooth-edged
contraction at the lower end of the esophagus
(birdbill or pencil tip view), proximal enlargement of the stenosis (mega esophagus
or
loss of peristalsis in the esophagus and air-fluid level. Direct lung
X - ray shows double contour and loss of gastric air chamber.
The aim of endoscopy in achalasia is to rule out a malignant disease (secondary or
pseudoac
or for treatment (such as dilatation, injection).
In suspicious cases, definitive diagnosis can be made by esophageal manometry
(Basal LES pressure is normal or
increased; Inability to relax or incomplete relaxation in LES; smooth muscle in
distal 2/3 of esophageal trunk
decrease in amplitude of contractions lar classical achalasia am or amplitude and
contraction time
elongation (vigorous achalasia).
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INTERNAL MEDICINE
Treatment: The aim is to reduce LES pressure:

I-Calcium channel blocker for medical treatment, nifedipine (Kardilat, adalat)
3x10-20mg oral
30 min from meals. before or as meals sublingual nitrate (isordil) 3x5-10mg
5-10 min. can be applied before. Mild cases or some patients as initial treatment
It is useful. However, it is ineffective in long-term and progressive cases.
II-Dilatation therapy; endoscopy-guided balloon application (pneumatic dilatation)
or
rupture of LES using spark plug mechanically. Balloon dilatation in achalasia
treatment
is the first method to choose.
III-Injection therapy; Endoscopic injection of botulismus toxin inhibits
cholinergic stimulation in the sphincter. The duration of action is short and may
cause fibrosis.
IV-Surgical treatment; laparoscopic or classic in patients who do not respond to
other methods
methods (Heller myotomy + Nissen fundoplication).
(Answer C)
6. Which of the following tests is used to detect the presence of Helicobacter
pylori infection in a patient with active duodenal ulcer?
(September 2002)
A) Rapid urease test in endoscopic biopsy material
B) Urea-breath test
C) Culture examination of endoscopic biopsy material
D) Detection of specific IgG antibodies in serum
E) Histological examination of endoscopic biopsy material
Diagnostic tests for H. pylori
Test
Sensitivity (%) (sensitivity)
Specificity (%) (specificity)
comment
Urea test
80-98
93-98
Requires endoscopy
Histology
93-99
95-99
Requires endoscopy
culture
77-92
97-100
Requires endoscopy
ELISA (Specific IgG)
88-99
86-95
Not suitable for tracking
Urea-breath test
90-100
89-100
Ideal for diagnosis and follow-up
(Answer C)
7. Which of the tests used to detect the presence of Helicobacter pylori infection
in a patient with active duodenal ulcer has the lowest sensitivity? (April 2002)
A) Rapid urease test in endoscopic biopsy material
B) Urea-breath test
C) Culture examination of endoscopic biopsy material
D) Detection of specific IgG antibodies in serum
E) Histological examination of endoscopic biopsy material
(Answer C)
360
8. Which of the following is secreted from the main cells in the gastric mucosa?
(September 2001)
A) Pepsinogen
B) Gastrin
C) Elastase 1
D) Enterokinase
E) Trypsin
Hydrogen ions accompany hydrogen-potassium ATPase ('proton pump') activity and

chlorine ions
parietal cell secreted from the apical surface.
HCl (Hydrochloric acid) makes the upper gastrointestinal tract sterile and converts
pepsinogen to pepsin.
Pepsinogenesas is a protein secreted from cells. Responsible for vitamin B12
absorption
intrinsic factor in glycoprotein structure is secreted from parietal cells with
acid.
Gastrin hormone is produced in G cells in the antrum. Somastostatin D
secreted from the cells. Both hormones work together to improve gastric secretion
and motility.
They edit it. Gastrin; while stimulating acid secretion, somatostatin suppresses.
Somatostatin inhibits the release of gastrin.
(Answer A)
9. Which of the following may develop in patients hospitalized in intensive care
units?
is not a major risk factor for stress ulcers? (April 2000)
A) Mechanical ventilation
B) Head injuries
C) Coagulopathy
D) Ileus
E) Heavy burn
Risk factors for stress ulcers in ICU patients; burns, severe trauma, mechanical
ventilation and coagulopathy. Coagulopathy, stress ulcer, especially if it develops
secondary to sepsis
even more serious.
(Answer D)
10. Which of the following is wrong for the relationship between smoking and
duodenal ulcer?
(September 99)
A) Smoking delays healing of duodenal ulcer
B) Smoking accelerates gastric emptying
C) Pancreatic secretion and duodenum contents increase regurgitation to stomach
D) Peptic ulcer shows frequent recurrence in smokers
E) Improvement rate of smoking cessation increases
Smoking increases the development of peptic ulcer disease. Non-smoking peptic ulcer
healing rate
reduces morbidity and mortality.
Pancreatic HCO3 secretion decreased in the duodenum due to the decrease in
duodenum, decreased pH of duodenum as a result of acceleration in gastric emptying,
serum pepsinogen I
Increased reflux into the stomach as a result of increased levels or decreased
pyloric sphincter pressure
Can play.
(Answer C)
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INTERNAL MEDICINE
11th. Which of the following in the pathogenesis of ulcers of nonsteroidal

antiinflammatories?
is not effective? (April 99)
A) Bile reflux
B) Direct toxic effect on mucosa
C) Reduction of prostaglandins
D) Disrupting the barrier by reducing mucus secretion
E) Increased back diffusion of H +

NSAIDs have a direct toxic effect on gastric mucosa. Inhibition of prostaglandin
synthesis
endogenous protective prostaglandins, suppress gastric mucus production, gastric
and reduce duodenal bicarbonate secretion and stimulate gastric acid secretion.
also
The reduction of mucosal prostaglandins disrupts the regeneration of epithelial
cells after injury.
Diseases associated with H. pylori
Disease
Degree of relationship
Duodenal ulcer
+++++
Gastric ulcer
++++
Gastric cancer
+++
Gastric B cell lymphoma
+++
Non ulcer dyspepsia
Gastroesophageal reflux / esophagitis
(Answer A)
12. Which of the following is the most useful test in a patient with stomach
perforation? (September 97)
A) Ultrasonography
B) Direct X-Ray lying down
C) PA chest radiography
D) Baryed OMD
E) Computed tomography
During perforation of the stomach, direct abdominal X-ray is expected to show air
under the diaphragm.
The diaphragm should be seen on the posterior-anterior chest X-ray. perforation
presence of air under the diaphragm is seen on the PA chest radiograph.
(Answer C)
13. Urease seen in the gastric biopsy from the stomach in an electron microscope
Which of the following is compatible with (+) small pleated microorganisms?
(September 92)
A) Camphylobacter pylorii
B) Camphylobacter jejunii
C) Camphylobacter fuzi
D) Camphylobacter cruzi
E) E. coli
Helicobacter pylori (Camphylobakter pylori) settles especially in the antrum of the

stomach.
type gastritis is the most common cause. Gr (-), microaerophilic spiral shaped and
flagella
urease (+) is a bacterium. The only known reservoir of the pathogen clearly unknown
It is human. It should not be forgotten that it may cause MALToma and it has been
especially emphasized in recent years.
(Answer A)
362
Properties of chronic gastritis

Property
Plug
tipb
Localization
corpus
Antrum
etiology
autoimmune
Helicobacter pylori
Frequency
5%
20%
inflammation
atrophic
superficial
Acidity
Decreased / achlorydria
Normal or slightly decreased
gastrin
increased
Normal or slightly increased

Related situations
Pernicious, anemia, gastric ulcer, gastric carcinoma
Dyspepsia, ulcer
14. Why is sucralfate given to patients in intensive care?

(September 92)
A) Prevents the growth of Gram (-) bacteria
B) Rises above pH 4
C) Mucus decreases
D) Long-acting
E) Increases acid
Sucralfate activates in acidic environments and gains negative charge. With this
feature, it is used in patients with stomach ulcers, neutralizes hydrogen ions and
collapses. Affinity to fibrin network
especially in patients with hemorrhage
used to prevent bleeding. Risk of Cushing's ulcer in patients in ICUs
sucralfate can be applied to neutralize the acidic environment.
(Answer B)
15. Gastric tube is contraindicated in which of the following situations?
(September 92)
A) Lack of larynx reflex
B) Pancreatitis
C) Enterocutaneous fistula
D) Blind loop syndrome
E) Peritonitis
Gastric tube administration is contraindicated in patients undergoing nasogastric
drainage because the risk of aspiration increases if there is no laryngeal reflex.
Other options
drainage can be applied to relieve the patient.
(Answer A)
16. Which of the following methods is most accurate in the diagnosis of gastritis?
(September 92)
A) Story
B) Radiological examination
C) Endoscopy + biopsy
D) Physical examination
E) Biochemical tests
Gastritis is divided into acute and chronic. The most common cause of acute
gastritis
H. pylori infection is the most common cause of chronic gastritis, while NSAID drug
use. The GOLD standard method for the diagnosis of gastritis is ENDOSCOPY.
(Answer C)
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INTERNAL MEDICINE
17. Which of the following should not be given steroid treatment if it has been
passed before? (September 89)
A) Pneumonia infection
B) Tuberculosis infection
C) Pancreatitis
D) Cholecystitis
E) Peptic ulcer
Steroid therapy is known to increase the frequency of peptic ulcers. Therefore
steroid treatment peptic
ulcer in patients who have ulcer re-aggravated
is required.
(Answer E)
18. What is not in the pathogenesis of acute erosive gastritis?
(September 87)
A) Increase in gastrin level
B) Impairment of gastric mucosa blood flow
C) Decreased mucus secretion
D) Impairment of H + ion reabsorption
E) Aspirin use
Gastritis is divided into acute and chronic. Etiology of acute gastritis
reduction or deterioration of gastric mucus secretion for any reason involved
gets. NSAIDs are the most common cause of secretion reduction. The effects of NAIDs
blocking PGE2 synthesis with antacid effect by covering gastric mucosa
Show. Misoprostol, a PGE2 analogue, may be used for treatment. PGE2 acute
In the treatment of erosive gastritis, both mucosa and antacid
is also indicated by reducing the H ion secretion. Chronic gastritis
Ave B type. Type A is more commonly observed in the corpus and fundus, whereas B
type is mostly observed in the antrum. Autoimmune gastritis role in the etiology of
atypia chronic gastritis
H. pylori plays the most common role in the etiology of chronic gastritis type B.
(Answer D)
364
GASTRITIS
ACUTE GASTRIT
• It is an acute inflammatory event in the superficial gastric mucosa, dominated by
neutrophils.
• Acute gastritis is often erosive and hemorrhagic.
• Acute erosive gastritis:
• Disruption of gastric mucosal integrity is essential in pathogenesis.
• The most common causative agents are NSAIDs.
• Increased gastronomy, decreased mucous blood flow, decreased mucus
• It differs from the ulcer with less tissue depth.
• The most common causative agent of acute suppurative gastritis is staphylococci.
• Streptococci are the most common causes of acute phlegmanous gastritis. Fatal
course.
• Neutrophils in acute gastritis; lymphocytes and plasma cells predominate in
chronic gastritis.
• Aspirin causes acute gastritis when taken with alcohol
CHRONIC GASTRIT
• Infiltration of lamina propria with lymphocytes and plasma cells
• Parietal and major cell loss, atrophic changes in the mucosa, followed by
intestinal
Metaplasia may develop.
• H. pylori is the most common agent. Stomach antrum and holds the body.
• H. pylori causes hypertrophic infectious gastritis.
Chronic A Type Gastritis (Autoimmune Gastritis)
• Fundus and corpus are involved, the antrum is preserved.
Parietal cell antibodies, autoimmune gastritis
• Serum gastrin level elevation
• Presence of pernicious anemia
• Hypo or achlorhydria
• Coexistence with other autoimmune diseases
• Holds all floors
Chronic B Type Gastritis
• Holds the antrum.
• Normal acid level, normal gastrin
• The most common causative agent is reflux of H. pylori or duodenal biliary
secretions.
• There may be antibodies against gastrin-producing cells.
• Superficial
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366
SMALL BOWEL DISEASES AND MALABSORBSION SYNDROMS
SMALL BOWEL DISEASES AND

MALABSORBSION SYNDROMS
one. A patient who presented with chronic diarrhea and weight loss
and small bowel biopsy shows Celiac's disease.
Which of the following is the most suitable diet to recommend to this patient?
(April 2009)
A) Restricted diet of carbohydrates
B) Rice flour and corn starch restricted diet
C) Banana and lactose-rich diet
D) Protein restricted diet
E) Restricted diet of barley, wheat, rye and its products
CELIAC DISEASE (GLUTEN SENSITIVE ENTEROPATHY)
Etiology:
Gluten; wheat, barley, rye and oats. Gluten is absent in corn and rice. the gluten
a large number of gliadine peptides (a, b, g and o) are formed by dissolution in
alcohol. Gliadin a small intestine
most toxic to the mucosa. It is similar to an immunological reaction. Jejunal
mucosa overload
IgA secreting cells and circulating antibodies against gliadin and endomysium. T
cell dysfunction and a strong association with HLA-B8, DR17 and DQ2 have been
shown.
Pathology:
The disease begins in the proximal small intestine. In severe cases, mucosal
surface completely flattened by losing villi. Histologically, subtotal villous
atrophy is seen. This includes crypt hyperplasia and
plasma cell and lymphocyte predominance in lamina propria.
Clinical features and concomitant diseases:
It can be seen in all age groups, especially in young people. Weaned cereal in
infants
is seen when you start receiving. Weakness, weight loss, or loss in patients with
fluoride malabsorption
Anemia can be seen. The most common finding is dermatitis herpetiformis. Both
diseases
also has gluten - sensitive enteropathy in its etiology.
Diagnosis:
Jejunal biopsy; Gold is the standard. The most common indications for jejunal
biopsy in childhood are diarrhea, growth
retardation and short stature. Although colon dilatation is an early finding in
radiography, it is most common
dilatation of small intestine.
Antibodies; In most untreated cases, serum antigliadine (screening test is used)
(especially IgA) and antiendomycium antibodies (definitive diagnosis) can be
detected. Other antibodies
antireticulin and tissue transglutamase antibodies.
Hematology and biochemistry; Full blood count due to iron deficiency or folic acid
deficiency
microcytic or macrocytic anemia and hypersplenism cause target cells, spherocytes
and HowellJolly bodies. Biochemical tests of serum calcium, magnesium, total
protein,
albumin or vitamin D levels decrease.
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INTERNAL MEDICINE
Treatment:
-
Gluten-free diet should be followed. Corticosteroids are used in resistant cases.
Ideally, after 6 months of gluten-free diet, the small intestine returns to normal.
- If the gluten-free diet does not improve, secondary lactose intolerance should be
considered.
Prognosis and complications:
Small bowel carcinoma and esophageal squamous, especially T cell lymphoma
increased risk of cell carcinoma.
(Answer E)
2nd. Endoscopy in a person with gastroesophageal reflux disease
Does not constitute an indication to be done? (April 2009)
A) Retrosternal burning that responds to treatment
B) Dysphagia
C) Painful swallowing
D) Gastrointestinal bleeding
E) Weight loss
Gastric and esophageal diseases are always considered endoscopy. This may be right
for the stomach. Alone
Some endoscopy in the esophagus is usually performed for the determination of
complications. Reflux at 24 hours
pHmetry, manometric pressure measurement in achalasia are gold standard diagnostic
methods. When is endoscopy? Of course, when weight loss, malignancy suggests
It should be done. Dysphagia, odynophagia (painful swallowing) and GIS bleeding
is necessary.
(Answer A)
3. Which of the following conditions causes malabsorption can be diagnosed by small
bowel biopsy? (April 2008)
A) Bile acid diarrhea
B) Whipple disease
C) Folate failure
D) Radiation enteritis
E) Lactase deficiency
WHIPPLE DISEASE
Wandering joint pain, abdominal pain, diarrhea, weight loss, fever,
lymphadenopathy, cardiac abnormalities and
is a disease characterized by neurological dysfunction. Characteristic
histopathological finding is fine
macrophages filled with PAS (+) bodies in the lamina propria of the intestine. made
research is a bacterium in the actinomyces group phylogenetically
and was named Tropheryma whippleii.
Initially, parenteral ceftriaxone 2x1g + streptomycin 1x1g may be administered for
two weeks followed by TMPSMX fort 2x1 or cefixime 400 mg / day for one year.
(Answer B)
368
4. Which of the following findings of inflammatory bowel disease Crohn

seen more often in the disease? (April 2008)
A) Pyoderma gangrenosum
B) Perianal disease
C) Rectal involvement
D) Erythema nodosum
E) Sacroileitis
We will see more of this table as long as TUS. The disease does not heal especially
anal
fissure, fistula style Crohn suggests.
Pathological and Clinical Features of IBD
Features
Ulcerative colitis
Crohn's disease
segmental
++
Transmural involvement
+/-
++
granulomas
+ / ++ (50%)
fibrosis
++
pseudopolyps
++
Fissure, fistula
+/-
++
Mesenteric fat, lymph node involvement
++
Diarrhea
++
++
Rectal bleeding
++
Abdominal pain
++
Palpable mass
++
Fistula
+/-
++
stricture
++
Small bowel involvement
+/-
++
Rectal involvement
++ (95%)
+ / ++ (50%)
Extraintestinal disease
++
++
Toxic megacolon
+ / -
Recurrence after colectomy
Malignancy (long term disease)
+ / -
Pathological Features
Clinical Features
(Answer ??)
5. Which of the following is responsible for the etiopathogenesis of a bacterial
infection? (September 2007)
A) Whipple disease
B) Ulcerative colitis
C) Crohn's disease
D) Celiac disease
E) Chronic graft-versus-host disease
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INTERNAL MEDICINE
Celiac, ulcerative colitis, Crohn's and graft-versus-host four are autoimmune

diseases, whereas Whipple
causative agent of the disease; Tropheryma is a bacterium called whippleii.
(Answer A)
6. As a result of malabsorption of the nutrient given,
the findings mentioned in the face are not seen? (September 2002)
Foodstuff
Finding
a)
Oil
Watery diarrhea + weight loss
B)
Carbohydrate
Edema + muscle atrophy
C.)
Vitamin B12
Anemia + peripheral neuropathy
D)
Iron
Glossite + spoon nail
TO)
Vitamin A
Hyperkeratosis + night blindness
One of the good malabsorption questions of the exam;

Malabsorption means weight loss + diarrhea and signs of deficiency of non-
absorbable substance.
Physiology of absorption of nutrients:
·
Oils: The major absorption site is the proximal small intestine. Medium chain (6-12
carbon) oils mycelium
It is directly absorbed without forming and connected to the albumin and mixes with
the portal system into the blood. Vitamins in ADEK
Saffron is absorbed with the effect of fat and transported to the lymphatic system
with chylomicrons. Absorption of oils
disorder leads to steatorrhea and weight loss.
Carbohydrates: Major absorption site is proximal and middle small intestine,

glucose and galactose
With Na-dependent active transport, fructose is absorbed by facilitated diffusion.
Lactose; glucose + galactose
sucrose; glucose + fructose, maltose; divided by glucose + glucose. Glucose and
sodium with a common carrier
Absorbed. Calorie deficiency is in the foreground in the absorption disorder of
carbohydrates so cachectic
edema is not expected if protein absorption is normal in the patient. Muscle
atrophy may occur.
Protein: The major absorption site is the intestine. It is carried with four
different systems. Clinic in absorption disorder
edema is in the foreground.
Water: Absorption of the small intestine and colon, especially the cecum is
absorbed. Na + jejenum and ileum with H +,
in the ileum is replaced by Cl- and HCO3-.
Calcium: Absorption in the proximal small intestine, largely due to active vitamin
D
It takes place.
Iron: Iron is absorbed from the duodenum, folic acid from the duodenum and jejenum.
In order to absorb inorganic iron, it must form soluble iron complexes. It is
caused by stomach acidity. Iron
absorption capacity increases as needed (eg pregnancy, active erythropoiesis, iron
deficiency). ferrous
The form (Fe ++) is better absorbed.
Vitamin B12: Absorbed from terminal ileum. B12 in the stomach, first secreted from
the stomach to the protein R
binding (cobalophylline). Pancreas proteases break down the bond between B12-R to
expose B12,
then the B12 terminal ileum that binds in the duodenum with IF secreted from the
stomach and
transcobalamin II. Vitamin B12 is separated from IF and absorbed by endocytosis.
Etiology of malabsorption: As mentioned above, any pathology and systemic disease

affecting gastrointestinal tract and pancreas-gallbladder functions can lead to
malabsorption. These;
·
Luminal digestive disorder
Gastric hyperacidity
370
Postgastrectomy
Exocrine pancreatic insufficiency (chronic pancreatitis)
Decrease in intestinal bile salt concentration
Liver diseases (cholestasis)
Bacterial overgrowth (diverticulitis)
Impairment of enterohepatic circulation (terminal ileitis)
Medications (cholestramine, neomycin)
Reduction of absorption surface (regional enteritis)
Lymphatic obstruction (lymphangectasis)
Cardiovascular diseases (intestinal edema)
Primary mucosal absorption defects (inflammatory diseases, infection)
Endocrine and metabolic diseases (diabetes, hyperthyroidism)

Clinic: Malabsorption; diarrhea, weight loss and multrition. The stool is too much,
smells bad
and floating in the toilet. Furthermore, which part of the intestine is affected
and which substance is absorbed
if it is corrupted, there will be findings.
Other systemic symptoms:
·
gastrointestinal; glossitis, stomatitis, gas, abdominal pain
Genitourinary; nocturia, azotemia, hypotension, amenorrhea, decreased libido
Hematopoietic; anemia, hemorrhagic diathesis
Musculoskeletal; bone pain, osteoarthropathy, tetany, paresthesia, weakness
Skin; eczema, purpura, dermatitis, hyperkeratosis
Laboratory: The levels of each substance in which the absorption is impaired may be
reduced in the blood. Hypocalcemia,
hypoalbuminemia, anemia, magnesium and zinc deficiency, prolongation of PT.
Malabsorption tests: The first tests to be performed in a patient suspected of
malabsorption are serum
carotene measurement and qualitative fat determination in stool (with Sudan dye).
These are sensitive
however, they are non-specific tests. They are therefore used as screening tests.
Pathology in these
if it is detected, it must be verified by specific tests.
Serum carotene measurement: If oral intake is good, most useful serum screening for
malabsorption diagnosis
Test. Pancreatic insufficiency may be normal. Especially due to small intestinal
mucosa damage
malabsorption.
Qualitative fat determination: This is the most practical test for fat
malabsorption, but it is a subjective test. Scanning
is made in order. Sudan III + ethyl alcohol triglycerides (pancreatic steatorrhea);
III + acetic acid from water release
fatty acids (small bowel disease).
Quantitative fat absorption test: Free fat diet (diet should be more than 100 g
fat)
three-day stool is collected. The amount of stool oil should be less than 7 g / day
on average for three days. Oil
is the best test to show the absorption disorder.
D-Xyloz test: After taking 25 g D-Xyloz oral 5-hour urine D-Xyloz more than 5 g
should be. This test reflects the integrity of the small bowel mucosa. Usually in
pancreatic disorders
normal, small bowel diseases are damaged. Carbohydrate malabsorption is a screening
test.
If D-xyloz test is normal in a patient with fat malabsorption test, pancreatitis
and D-xyloz test
If it is impaired, absorption of small intestine should be considered in the
foreground.
Bentiromide test: It is the easiest and specific test for the diagnosis of
pancreatic insufficiency. Bentiromide, PABA and
synthetic peptide compound. The bond is broken down only with pancreatic
chymothyrosine. Following oral intake of 500 mg bentiromidine, the amount of
arylamine in the 6-hour urine should be greater than 50%. scarcity
suggest exocrine insufficiency of the pancreas.
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INTERNAL MEDICINE
Secretin test: Pancreatic exocrine functions to assess the most sensitive but
complicated
It is a test. Analyze pancreatic secretion by stimulating with secretin and
collecting with the help of a duodenal tube
It is. It is the most sensitive test in the diagnosis of chronic pancreatic
insufficiency.
Schilling test: In the first stage, radiolabeled cyanocobalamin is given orally in
urine within 24 hours.
if the radioactivity is low, the test is defective (B12 absorption is impaired). To
find the cause of the test other
stages are done. The diagnosis is pernicious anemia if the test improves when IF is
added. Chronic pancreatitis improves when pancreatic extract is given, and
excessive bacterial growth if it improves with antibiotic treatment.
has. If the cause of B12 deficiency is ileal disease, the test does not improve.
Vegetarians and
the test is normal.
H2 respiration test: Used to assess lactose intolerance.
C14- Xyloz Respiratory Test: Used to diagnose excessive bacterial growth

Small bowel biopsy:
There are three diseases in which biopsy is always diagnostic;
·
Abetalipoproteinemia, immune deficiency syndrome (agammaglobulinemia), Whipple's

disease
Although biopsy is diagnostic in some diseases, it is always

biopsy is not pathological;
·
Crohn's disease lymphoma.
Although biopsy is abnormal in some diseases, it is not specific for that

pathology;
·
Infectious enteritis, radiation enteritis, gluten sensitive enteropathy
Sometimes biopsy may be normal;

·
Functional bowel disease, liver disease, pancreatic insufficiency, disaccharidase

deficiency, ulcerative
colitis.
(Answer A)
7. Which of the following is not expected to have secretory diarrhea?

(September 2001)
A) Zollinger-Ellison syndrome
B) Diarrhea due to Vibrio cholerae
C) Enterotoxigenic Escherichia coli infection
D) Villous adenoma
E) Excess lactulose intake

Causes of Osmotic Diarrhea;
• Disaccharidase deficiencies
• Lactulosis, mannitol, sorbitol intake
• Magnesium intake
• Sulfate, phosphate uptake
• Sodium citrate intake
• Steatorrhea (pancreatic insufficiency)
• General absorption disorder
• Small bowel mucosal disease
• Bacterial overgrowth
Diarrhea due to motility disorder;
• Irritable bowel syndrome
• Scleroderma
• Diabetic diarrhea
372
Causes of secretory diarrhea;

• Cholera
• VAP secreting tumors
• Bile salt enteropathy
• Fatty acid diarrhea
• Enterotoxigenic
• E. coli infections
• Villous adenoma
Causes of inflammatory type diarrhea
• Ulcerative colitis
• Shigellosis
• Amibiosis
(Answer E)
8. In the treatment of Whipple's disease, the use of which is usually
provides clinical remission? (September 2001)
A) Trimethoprim-sulfamethoxazole
B) Corticosteroid
C) Folic acid
D) Gluten-free diet
E) Vitamin B12 preparations

April 2008 same question
(Answer A)
9. The patient with a gluten-sensitive enteropathy is given a gluten-free diet.
Patient
Healing. Which of the following is not expected in this patient? (April 2001)
A) Weight increase
B) Steatore disappears
C) D-xylose test can be detected in blood and urine following xylose treatment
D) Intestinal biopsy improves findings
E) If there is no improvement, lymphoma development should be considered.
Celiac Disease (Gluten enteropathy); gluten, which is found in cereal products such
as barley wheat, is caused by the hypersensitivity of the intestines to the gliadin
fraction. Most often 2
age begins to give symptoms. It is the most common malabsorption syndrome in
childhood.
Increased incidence of celiac disease in type I diabetes mellitus, IgA deficiency
and Down syndrome
play.
Clinical; diarrhea, constipation, vomiting, abdominal pain, growth and
developmental retardation (the most common finding),
weight loss, anemia and vitamin deficiencies (deficiencies of fat-soluble vitamins
are common). There are steatore. Dehydration, shock, acidosis, rickets and
osteomalacia may occur.
Diagnosis; The most effective method is intestinal biopsy. Antigliadin antibody,
antireticulin antibody
and antiendomisium antibody. D - Xylose absorption
It is corrupted.
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INTERNAL MEDICINE
Gluten-free diet is recommended for treatment. Clinical improvement with treatment

is seen in 1 week and histological improvement occurs in 3-12 months. D-xylose
absorption disorder despite treatment
not recover.
The risk of malignant lymphoma in the small intestine is increased in older and
untreated patients.
(Answer C)
10. All steps of the Schilling test performed on a patient with vitamin B12
deficiency
That's normal. Which of the following is true? (September 99)
A) Pernicious anemia
B) Bacterial growth
C) Pancreatic insufficiency
D) Vegetarian diet
E) Ileal disease
In the stomach of intrinsic factor necessary for the absorption of vitamin B12
insufficiency in pernicious anemia
can not be done, or dysfunction occurs. B12 vitamin pepsin in the diet
and bind to the protein called R-linkers in saliva and gastric fluid. R-B12
complex is transported to the duodenum, disintegrated by pancreatic proteases, and
the released B12 parietal
It is bound to intrinsic factor secreted by cells. IF-B12 complex intrinsic factor
to distal ileum
receptor and is absorbed through vitamin B12. The absorbed B12 is eluted with
transcobalamin-II.
Event in vegetarians B12 vitamin deficiency occurs due to lack of vitamin B12
intake.
Schilling test is carried out in 4 stages.
Stage I: Inadequate intake (vegetarianism is in this group)
Stage II: Pernicious anemia
Stage III: Extreme bacterial growth
Stage IV: Pancreatic insufficiency
If all four stages of the test were normal, the lesion was in the terminal ileum.
In this question, the four stages of the test are normal. Then the answer is E.
(Answer E)
11th. D-Xyloz test to investigate the etiology of malabsorption
If positive, which of the following do not consider differential diagnosis?
(September 96)
A) Intestinal absorption disorder
B) Chronic pancreatitis
C) Renal failure
D) Excess bacteria in the intestine
E) The presence of acid
D-Xylose is absorbed from the small intestine without the need for pancreatic
enzymes.
a pentose mono saccharide. Excreted by the kidneys. If renal pathology exists,
glomerular filtration
Any fluid that reduces the rate of electrolyte disturbance and prevents absorption
from the intestine
If there is a condition the amount of urine will come out little. However, it is
not affected by pancreatic pathologies.
374
MALABSORBSION TESTS
one. The provocation test of secretin and cholecystokinin: showing exocrine
secretion of the pancreas
It is an insensitive test. It is the first test to be performed in a patient who
has pancreatitis.
2nd. Bentiromide test: A specific test (impaired only in pancreatic insufficiency).
3. Amount of fat in stool:> 6 g indicates fat malabsorption.
4. 25 hydroxy vitamin D: Degradable in cases of fat malabsorption. Pancreas, bile
sac decreases in proximal small bowel pathologies
5. Prothrombin time: to show the deficiency of clotting factors due to vitamin K
used. Prolonged gallbladder, pancreas, proximal small bowel pathologies
6. Calcium, phosphorus, alkaline phosphatase: pancreas, gallbladder, proximal small
intestine
The level of malabsorption decreases.
7. D-Xylose test: Malabsorption due to small bowel diseases, pancreas
disease is normal.
8. Tests for excessive bacterial growth in the intestine: 14 C Xylose test, Cholyl
1 14C
glycine test, Lactulose H2 formation, small intestine culture, Schilling test.
9. Lactose H2 Formation: Lactase deficient.
10. Serum iron, iron binding capacity, ferritin: Iron deficiency anemia-like
findings in proximal small bowel pathologies
(Answer B)
12. Which of the following does not occur in Zollinger Ellison syndrome? (April 95)
A) Excess acid secretion that cannot be suppressed by secretin
B) Unexplained diarrhea
C) Anastomosis ulcer
D) High acid secretion
E) Primary jejunum ulcer
Zollinger Ellison Syndrome occurs as a result of malignant transformation of G
cells in the pancreas.
It is the most common islet cell tumor after insulinoma. This islet cell tumor is
most commonly observed in multiple endocrine neoplasms.
Hypergastrinemia, hyperacidity, primary duodenal, gastric, ileal, esophageal and
jejunal ulcers, with secretin
There is non-suppressing acid secretion.
(Answer C)
13. Which of the following is not appropriate for the patient to be given
purgative? (April 93)
A) In patients with low urine density
B) Hypothyroidism
C) In bowel sounds
D) High blood sugar levels
E) In hypocalcemia
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INTERNAL MEDICINE
The ileus is divided into mechanical and paralytic. Mechanical causes mostly
obstructions
paralytic ileus fluid electrolyte irregularity. Advanced stages of ileus
fluid electrolyte imbalance is further increased due to intestinal sounds.
State. Therefore, in cases where bowel sounds cannot be obtained, administration of
purgatives
purgative administration is not appropriate since it increases the secretion of
liquids and electrolytes from the lumen.
(Answer C)
14. Which of the following is not a basis for the diagnosis of Zollinger-Ellison
syndrome?
(April 93)
A) Hypergastrinemia
B) Constipation
C) Hypercalcemia
D) Fulminant ulcer diathesis
E) Gastric hypersecretion
The most common clinical manifestation in Zollinger Ellison syndrome is peptic
ulcer. To suspect gastrinoma
The most important finding that may cause ulcers is spread to various regions.
Ulcers may persist despite anti-acid surgery and may reappear despite anti-acid
medication.
The second most common form of presentation is diarrhea. The cause of diarrhea is
inactivated in an extremely acidic environment
malabsorption due to pancreatic enzymes. accompanying
One of the pathologies is hypercalcemia. Concomitant MEN component is thought to be
the cause of hypercalcemia. Gastric secretions due to increased serum calcium
levels
increasing.
(Answer B)
15. Which of the following increases Zollinger Ellison syndrome? (September 92)
A) Insulin
B) Glucagon
C) Gastrin
D) Serotonin
E) Histamine
Zollinger Ellison Syndrome is characterized by increased release of gastrin from
pancreatic G cells.
(Answer C)
16. How many grams of feces to be able to say that the person taking 100 grams of
fat has steatorrhea
fat should be found? (September 92)
A) 1 g
B) 2 g
C) 3 g
D) 4 g
E) Over 6 g
For the diagnosis of steatorrhea, an individual fed with 100 gr
The result of collection can be put with the presence of 7 grams and more fat.
(Answer E)
376
17. If diarrhea persists despite gluten-free diet in celiac,

which one is tried? (April 92)
A) Medium chain oil
B) Lactose-free diet
C) Short chain oil
D) Sucrose-free diet
E) Lean diet
The most common deficiency secondary to destruction of the small intestine
epithelium in celiac disease is LACTASE. Therefore, if diarrhea persists despite
gluten-free diet
lactose should be temporarily restricted.
(Answer B)
18. Which of the following is the safest method for the definitive diagnosis of
gluten enteropathy?
(April 92)
A) Small intestine biopsy
B) Barium graphy
C) D-xylose test
D) Schiling test
E) Fecal oil
The most valuable method in the diagnosis of gluten enteropathy is the most common
involvement of the jegenum
small bowel biopsy. In biopsy, atrophy in villi, hyperplasia in crypts and
lymphocyte infiltration in lamina propria are expected. Anti-endomisium IgA is the
most valuable antibody in diagnosis.
(Answer A)
19. What is the finding not seen in Zolinger Ellison? (April 92)
A) Diare
B) Beta cell adenoma
C) Hyperacidity
D) Multiple duodenal ulcers
E) Hypergastrinemia
Zollinger Ellison syndrome is characterized by increased gastrin release. Most
commonly in the pancreas
together in different regions. It is released from G cells in the pancreas.
Endoultrasonography which is one of the current methods is important in diagnosis.
Some of the information to remember
Insulinoma is the most common tumor in the pancreas, while gastrinoma is the most
common malignant tumor.
(Answer B)
20. Which of the following increases in urine in a carcinoid tumor? (September 90)
A) Valine mandelic acid
B) Melatonin
C) 5 Hydroxy indole acetic acid
D) 17 OH steroid
E) 17 OH ketosteroid
377
INTERNAL MEDICINE
Serotonin is mostly secreted in carcinoid tumor. Synthesized from tryptophan. Liver

5
OH indole is converted to acetic acid and excreted in urine. 5-OH indole acetic
acid in urine in carcinoid syndrome
acid increases.
(Answer C)
21. Which of the following does not occur in celiac disease? (September 88)
A) Hypoalbuminemia
B) Increased blood carotene
C) Iron deficiency anemia
D) Bleeding time prolongation
E) Intestinal epithelial disease
Celiac disease is characterized by a circle formed by antibodies against gluten and
gliadine, and
is a disease accompanied by systemic pathologies. It is most common when traveling
with small bowel involvement alone.
the region of involvement is jejenum. The gold standard for diagnosis is small
bowel biopsy. biopsy
hyperplasia in atrophy crypts in villi and lymphocyte infiltration in lamina
propria. Gluten
and the most specific of antibodies to gliadine is anti-endomisium IgA.
malabsorption
and diarrhea, and hypoalbuminemia may be observed due to loss of protein by circle.
May cause a decrease in the absorption of iron
may cause prolongation of bleeding time. Damage caused by intestinal epithelium
not due to the increase in carotene in the blood can actually decrease.
(Answer B)
378
COLORECTAL DISEASES
COLORECTAL DISEASES
one. A 75-year-old male patient with fever and acute onset of left lower quadrant
with the complaints of pain. Physical examination revealed abdominal distention and
localized peritonitis. The leukocyte count is 14 000 / mm3. This
which is the most appropriate method for diagnosing the patient? (May 2011)
A) Abdominal computed tomography
B) Abdominal magnetic resonance imaging
C) Barium column radiography
D) Colonoscopy
E) Standing abdominal radiography
Attention and differential diagnosis question. In this table, 3 diagnoses may be
considered; 1-Ischemic colitis 2- Toxic megacolon 3- Acute diverticulitis in the
colon. Abdominal pain, localized peritonitis, fever and
If leukocytosis is present, it should be considered diverticulitis first.
Colonoscopy in acute diverticulitis
and barium radiographs are contraindicated. If the first examination is asked, it
should mean abdominal radiography.
abdominal computed tomography is the correct answer since the most appropriate
diagnostic test is asked.
(Answer A)
2nd. The most common cause of severe lower gastrointestinal bleeding in adults
older than 60 years
Which of the following is the etiology? (December 2010)
A) Internal hemorrhoids
B) Colonic diverticulosis
C) Anal fissure
D) Colon cancer
E) Ischemic colitis
The most common cause of lower GIS bleeding in all age groups is anal diseases,
while massive over 60 years of age
The most common cause of bleeding is diverticulosis. Etiological causes of bleeding
according to severity in the elderly
the reasons are given below.
Causes of lower GIS bleeding:

Severe acute bleeding
Moderate subacute or chronic bleeding
· Diverticular disease
· Angiodysplasia
· Ischemia
· Meckel's diverticulum
· Anal diseases
· Inflammatory bowel diseases
· Carcinoma
· Large polyps
· Angiodysplasia
· Radiation enteritis
· Solitary rectal ulcer
(Answer B)
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INTERNAL MEDICINE
3. In the initial treatment of severe ulcerative colitis, which of the following

drugs most
suitable? (April 2010)
A) Sulfasalazine
B) Mesalamine
C) Metronidazole
D) Prednisolone
E) Cyclosporine
Ulcerative colitis treatment:
In mild cases: Topical or oral sulfasalazine or meselamine (Sulfasalazine;
sulfapyridine and 5-ASA)
mesalamine consists of only 5 ASAs).
In severe cases: oral and IV support feeding, oral mesalamine + steroid, if not
sufficient IV steroid is given.
In fulminant cases: Oral feeding is stopped and Total Parenteral Feeding is
performed. IV steroid is started,
surgical consultation is requested. If there is a risk of toxic megacolon, broad-
spectrum antibiotics are added.
(Answer D)
4. Which of the following pathological findings is not characteristic of Crohn's
disease?
(September 2009)
A) Uniform involvement of the entire intestinal mucosa
B) Involvement of all layers of intestinal wall
C) Intact mucosal areas
D) Perianal involvement
E) Presence of fistula
A simple question of gastroenterology Ulcerative colitis Crohn's differences than
what they ask s.
380
COLORECTAL DISEASES
Features
Ulcerative colitis
Crohn's disease
segmental
0
++
Transmural involvement
+/-
++
granulomas
+ / ++ (50%)
fibrosis
++
pseudopolyps
++
Fissure, fistula
+/-
++
Mesenteric fat, lymph node involvement
++
Diarrhea
++
++
Rectal bleeding
++
Abdominal pain
++
Palpable mass
++
Fistula
+/-
++
stricture
++
Small bowel involvement
+/-
++
Rectal involvement
++ (95%)
+ / ++ (50%)
Extraintestinal disease
++
++
Toxic megacolon
+ / -
Malignancy (long term disease)
+ / -
Pathological Features
Clinical Features
(Answer A)
5. Which of the following findings is not seen in left side colon cancer? (April
2008)
A) Melena
B) Hematocesia
C) Colic pain
D) Changes in intestinal habits
E) Intestinal obstruction
Left side colon cancers come with a more noisy picture, while right side colon
cancers are usually in feces.
hidden bleeding and anemia may come with the clinic.
(Answer A)
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INTERNAL MEDICINE
6. Which of the following findings of inflammatory bowel disease Crohn

seen more often in the disease? (April 2008)
A) Pyoderma gangrenosum
B) Perianal disease
C) Rectal involvement
D) Erythema nodosum
E) Sacroileitis
Again, an easy question is the finding of perianal lesions Crohn's disease.
Pyodermia gangrenosum,
rectal involvement, erythema nodosum, sacroileitis in both Crohn's disease and
ulcerative colitis
visible.
Inflammatory Bowel Diseases
Features
Ulcerative Colitis
Crohn's Disease
Age
15-35
10-30
Genus
Both breeds
Both breeds
Cigaret
Less drinkers
More drinkers
Epidemiology
White, Jewish
White, Jewish
Frequency
6-8 / 100. 000
2 / 100,000
etiology
Unknown
Unknown
held in
Column
All of GIS
Most common involvement
Rectum
Terminal ileum
Type of involvement
Diffuse
segmental
Degree of involvement
superficial
transmural
Initial finding
Crypt abscess (PMNL infiltration)
Aphthous ulcer
Second term
Pseudopolip, goblet cell loss
Gronuloma (original)
Chronic phase
Lead pipe (loss of haustration)
Structure, sausage-like loops
Pathology:
382
COLORECTAL DISEASES
Inflammatory Bowel Diseases

Features
Ulcerative Colitis
Crohn's Disease
Most often
Rectal bleeding
Abdominal pain, rectal bleeding less
Other
Diarrhea ++
Diarrhea ++
malabsorption
No
There is
Papable mass
No
There is
Fistula
+/-
++
Fibrosis
+/-
++
Mesenteric lymph node
No involvement
Involvement
Terminal ileum
Backwash ileitis +
++
Sclerosing cholangitis
+++ (Colony carcinoma)
Erythema nodosum
+++
Aphthous ulcer
+++
Clubbing
+++
Pelvic osteomyelitis
+++
Osteomalasia
Seronegative spondylitis
+++
uveitis
++
Rock
Uric acid stone in kidney
Ca oxalate in kidney, Gallbladder

rock
Lab
Iron deficiency anemia (first and original)

Ca, Mg, Fe, Vit B12, folate, ADEK
minus
Radiologic
View of comb tooth in column
Sign of ip in terminal ileum
Psödopolid
Abscess, fistula, fissure, stricture
Lead pipe view
nodularity
Complication
Toxic megacolon (case question)
Fistula, fissure, obstruction, stricture
Secondary malignancy
Column ca,
Carcinoma of the small intestine colon adeno
(-)
(+)
Clinic:
Extraintestinal symptom:
(Answer B)
7. Which of the following causes toxin and pseudomembranous enterocolitis?
(September 06)
A) Yersinia enterocolitica
B) Campylobacter jejuni
C) Enterotoxogenic E. coli
D) Clostridium difficile
E) Aeromonas
Pseudomembranous enterocolitis is caused by the use of broad-spectrum antibiotics.
Ampicillin, clindamycin, cephalosporins develop due to the use of antibiotics.
Active Clostridium
It is difficille. Toxin A and B have two toxins. Diagnosis is made by toxin
determination. treatment
metranidazole is the first choice. Toxins: Diagnosis is made by demonstrating toxin
in stool. C. difficile produces two types of toxins. These are toxin A
(enterotoxin) and toxin B (cytotoxin). Most sensitive diagnosis
method is to show toxins in culture. But because it is expensive and lasts long
Diagnosis is made by demonstrating toxins by rapid enzyme immunassay (EIA) method.
(Answer D)
383
INTERNAL MEDICINE
8. What is the most common site of colorectal cancer? (April 2005)

A) Transverse column
B) Outgoing column
C) Descending column
D) Rectosigmoid colon
E) Cecum
Rectosigmoid region is the most common site of colorectal cancer. Being one of the
most common malignancies of general surgery and gastroenterology requires knowledge
of this localization. Cecil 23.
38% in the cecum and ascending colon, and 35% in the rectosigmoid region. But in
the question
Since both the cecum and the ascending colon are separate, the response is
rectosigmod. ATTENTION!!!
(Answer D)
9. A 32-year-old female patient with bloody-mucus diarrhea 8-10 times a day for
three months
He is admitted with abdominal pain and fever. Physical examination of blood
pressure
100/70 mmHg, pulse 98 / minute, fever 37. It is measured at 8 ° C and abdominal
sensitivity is detected. As a result of laboratory tests, the amount of hemoglobin
is 10.9%,
leukocyte count 14 200 / mm3, hematocrit value 31% and sedimentation rate 42 mm /
It's in hours. Abundant leukocytes and erythrocytes are seen in the stool.
Colonoscopic examination of the rectum mucosa diffuse edema, hyperemia and loss of
vascularity
Which of the following should be considered first in this patient? (April 2004)
A) Active ulcerative colitis
B) Diverticulosis
C) Crohn's disease
D) Giardia infection
E) Pseudomembranous colitis
Bloody diarrhea 8-10 times a day, ie colon-type diarrhea, if the small bowel type
and blood was not expected. Anemia, leukocytosis, inflammatory aspect of the
disease and biopsy work
Finish diffuse involvement makes the diagnosis of ulcerative colitis. Crohn's jerky
aphthous lesions
proceeds with a table that is not more noisy.
(Answer A)
10. A patient with AIDS develops bloodless diarrhea with watery mucus that lasts
more than a month. Microscopy doesn't reveal anything. Ziehl-Nielsen staining shows
acid-resistant oocysts.
What is the most likely factor in this patient? (April 2001)
A) Mycobacterium avium intracellulare
B) Cryptococcus neoformans
C) Isospora specific
D) Mycobacterium tuberculosis
E) Cryptosporidium parvum
Cryptosporidium parvum is a protozoan that infects humans and pets.
Fecal - taken orally. The incubation period is 7-10 days, followed by diarrhea and
abdominal cramps. The disease is usually spontaneous. However, especially in AIDS
patients severe and
characterized by persistent diarrhea and weight loss. Cryposporidium in these cases
can affect the biliary system and cause acalculosis cholecystitis and sclerosing
cholangitis.
Pancreatitis and respiratory infections may also occur. Diagnosis of fecal oocysts
Threads. In staining with Ziehl Nielsen, oocysts are acid-resistant staining.
384
COLORECTAL DISEASES
It should be aimed to improve the immune system in patients with immune system
deficiency. In HIV (+) patients, the CD4 count needs to increase above 180 mm3 in
order to relieve the disease. One
antiviral combination with protease inhibitor yields successful results.
Paromamosin, clarithromycin, and rifabutin may also be used. Treatment resistant in
AIDS patients
diarrhea C. parvum should come to mind.
(Answer E)
11th. A patient with acute diarrhea has a white blood cell
which is not seen? (September 2000)
A) Giardiasis
B) Shigella
C) Amebiasis
D) Campilobacter jejuni
E) Salmonella
E. histolytica; Causes of amoebic dysentery and liver abscess. Infection cannot

immunize.
Cysts open in the cecum and colon and turn into trophozoites. Ulcers tear and
flasks in the colon
It shaped. Red blood cell sphere is positive in dysentery in his dysentery, but no
leukocytes.
(Answer C)
12. Treatment of secondary peritonitis after perforated appendicitis
Which of the following is the most appropriate antibiotic available? (April 2000)
A) Ceftriaxone
B) Crystallized penicillin
C) Cefoxide
D) Amikacin
E) Cefazolin
Effective antibiotics should be applied to anaerobic and aerobic organisms

secondary to acute appendicitis. Therefore, antibiotics are started preoperatively
for each patient and an appropriate period is continued after the operation.
Perforated appendicitis or non-perforated appendicitis
The most prominent drug (cefolosporin with the strongest antianaerobic effect) is
cefoxitin.
(Answer C)
13. Which of the following causes bloody diarrhea? (April 99)
A) S. aureus
B) B. cereus
C) C. perfiringes
D) C. jejuni
E) S. pneumonia
Campylobacter jejuni infection is most common in children younger than 5 years and
young adults. Disease spectrum Life-threatening colitis and toxicity from
asymptomatic carriage
megacolons. After 1 to 6 days of incubation, fatigue and myalgia begin and 24
hours. This is followed by nausea, vomiting, loss of appetite, abdominal cramps and
diarrhea. Diare juicy or bloody
can. It is not uncommon to have 10 or more defecations per day.
Abdominal pain and tenderness may mimic acute appendicitis. Tenesmus in 25% cases,
proctocolitis 80%
seen in the case. Recurrent Campylobacter infection with hematocesia, idiopathic
ulcerative colitis or Crohn's disease.
(Answer D)
14. A 70-year-old patient with recurrent lower gastrointestinal bleeding and
tenesmus
Which of the following should be considered first in the patient? (April 99)
B) Crohn's disease
C) Column diverticulum
D) Rectal cancer
E) Internal hemorrhoids
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INTERNAL MEDICINE
An important finding of rectal cancer is the presence of bowel movement and
bleeding. Rectal bleeding
Although hemorrhoids are present in all cases, cancer should not be forgotten.
Blood can be mixed with mucus and stool
or do not interfere. There is a feeling of tenesmus and complete discharge. Until
the anal canal is invaded
The pain is not apparent.
American Cancer Society, rectal touch every year since the age of 40
occult blood and sigmoidoscopy; if the results are negative,
repetition.
(Answer D)
15. Which of the following is not a complication of ulcerative colitis? (September
97)
A) Toxic megacolon
B) Pyoderma gangrenosum
C) Erythema nodosum
D) Alopecia
E) Sclerosing cholangitis
2-3. decadent, bloody, mucous diarrhea, tenesm, colic-style pain-giving ulcerative

colitis, rectum
Starts. 80% are in the rectum and rectosigmoid region. 10% holds the entire column.
As in Crohn's
protected sites are not present in ulcerative colitis. There is nonspecific
inflammation. Colon ulcers rarely
passes through the submucosa. Fibrosis is very small.
The risk of developing cancer is higher. Ankylosing spondylitis is HLA-B27 (+).
Pyoderma gangrenosum, erythema nodosum, sclerosing cholangitis, iritis can be seen.
Morphologically
rarely exceeds submucosa, edematous surface may develop pseudopolip, ulcers rarely
they can go deeper and sometimes cause pericholic abscess fistula, perianal and
ischiorectal abscesses. A rare case is the toxic dilatation of the colorectum.
Microscopically
nonspecific inflammation, acute vasculitis, crypt abscesses. Fissure is absent in
ulcerative colitis. steroid
and responds better to surgical treatment than Crohn's. Alopecia is not seen.
(Answer D)
16. Which of the following is used to treat ulcerative colitis? (September 97)
A) Sulfasalazine
B) Sulfacetamide
C) Sulfisoxazole
D) Morphanyl
E) Sulfinpyrazone
Anti-inflammatory agents, sulfasalazine, adrenal corticosteroids and ACTH are used

for medical treatment of ulcerative colitis. Sulfasalazine is broken down by
bacteria in the colon. Revealed
5-aminosalicylate is thought to act by inhibiting prostaglandin synthesis.
Sulfasalazine is used to prevent recurrences of ulcerative colitis. Open activity
in acute phase
It is not. The therapeutic dose is 4-6 g / day.
Ulcerative colitis does not improve after surgery:
- Sacroileitis - Sclerosing cholangitis
(Answer A)
17. What is the most common symptom in rectal cancer? (September 97)
A) Hematocesia
B) Diarrhea
C) Weight loss
D) Tenesmus
386
E) Colic pain
COLORECTAL DISEASES
The first and most common symptom in rectal cancer is bleeding. Usually less
and is seen after defecation. Mimics internal hemorrhoids. Tenesmus is also
important
is an early symptom. The patient has difficulty in defecation and feels incomplete
defecation.
Changing bowel habits is a common symptom. Diarrhea and constipation can be seen.
Constipation in annular carcinomas and morning diarrhea are seen in vine leaf
polypoid lesions.
Pain is a late symptom and is caused by invasion of the sacral plexus. Weight loss
should suggest hepatic metastasis.
(Answer A)
18. Which of the following is not characteristic of Crohn's disease?
(April 96)
A) Transmural involvement
B) Segmentary involvement
C) Granulomatous lesions
D) Pseudopolyps
E) Muscle nerve hypertrophy
Characteristic findings of Crohn's disease

• Terminal ileum involvement
• Segmentary involvement
• Granulomas
• Transmural involvement
• Hiros sign
• Bird beak-shaped contraction
• String sign
• (rope marking)
• Fistulas
• Perianal abscess
• Hypertrophy of the mucous nerve and muscles.
• Paving stone appearance
• Patch style involvement
Pseudopolip is seen in ulcerative colitis.
(Answer D)
19. Hospitalized due to constipation, headache, fever, general condition disorder
Analgesic was initiated and continued for 3 days in a young male patient
Although the fever does not fall. Fever is 39.6 ° C, TA = 120/80 mmHg, Pulse = 84 /
min.
The liver crosses the 3 cm costa. Spleen 2 cm comes in hand. Bone marrow smear
Gram-negative bacteria are detected.
Which of the following is the most likely causative pathogen? (April 95)
A) Brucella mellitensis
B) Hemophilus influenza
C) Escherichia coli
D) Salmonella typhi
E) Pseudomonas aeroginosa
The most common cause of typhoid fever is Salmonella typhid. From the large
intestine to the peyer plaques and from there
systemic circulation.
Symptoms and signs;
• Headache
• Fire (Stair style)
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INTERNAL MEDICINE
• Hepatosplenomegaly
• Leukopenia
• Relative bradycardia
• Constipation
• There are stool mononuclear cells.
The stool microscope contains gram (-) cells. TMP-SMX, 3rd generation
cephalosporins,
quinolones or ampicillin sulbactam is used.
(Answer D)
20. Which of the following is wrong for polyps in Peutz-Jeghers syndrome?
(April 95)
A) A single pleotropic gene is responsible for the formation of polyps
B) Polyps have adenoma structure
C) 50% polyp in colon and rectum
D) Most commonly found in the jejunum and ileum
E) Resection of complicated polyp or intestinal part is sufficient in treatment
Peutz Jegher syndrome is a disease with hamartomatous polyps. Polyps
common ileum and jejunum. But there are also hamartomatous polyps in the stomach.
There are hyperpigmentations in mucocutaneous areas. Since the polyps are
hamartamatous, there is no possibility of developing malignancy. However, it should
be remembered that GIS and ovarian tumors in Peutz-Jeghers
increase from normal.
Only polyps in the site of complications are removed. Most GIS is polyp
It is not possible to remove them all. If polyps are small, they can all be
removed. Autosomal dominant inheritance
and may be associated with GIS and ovarian tumors.
(Answer B)
21. Seventy-year-old jaundice with large intrahepatic bile ducts and alkaline
phosphatase
Which of the following do you consider, in particular, in a patient with a high
incidence? (September 93)
B) Cholangiocarcinoma
C) Prostate carcinoma
D) Colon carcinoma
E) Renal carcinoma
Cholangiocarcinoma, especially in males 6-7. from the epithelium of the biliary
tract observed in the decade
malignancy with poor prognosis. It is compatible with pancreatic head
adenocarcinoma in terms of clinical features. While early surgery can be performed,
the effectiveness of surgery in late stages
It has been shown. The most specific marker in cholestasis is 5 'nucleotidase,
while the most sensitive marker is GGT.
(Answer B)
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COLORECTAL DISEASES
22. Which of the following is the best diagnostic method for ulcerative colitis?
(September 93)
A) Sigmoidoscopy and mucosal biopsy
B) Column radiography
C) Barium graphy
D) Laparoscopy
E) Tomography
Observation of pseudopolyps in rectosigmoidoscopy for the diagnosis of ulcerative

colitis and and
Only mucosal and submucosal involvement was observed in biopsy.
is the best method. Findings in biopsy
•
Crypt abscess
Inflammation progresses only with diffuse lesions in the mucosa and submucosa.
No granuloma
(Answer A)
23. Which of the following is not a complication of colitis ulcerosis? (April 93)
A) Pseudopolyposis
B) Massive bleeding
C) Toxic megacolon
D) Column perforation
E) Gastritis
The most common site of ulcerative colitis involvement is the rectum. Ulcerative
colitis can only
submucosal involvement, but only the colon. Therefore ulcerative colitis
accompanied by gastritis
is not expected. Distal toxic megacolon colon perforation can be observed in
abdominal rectal bleeding in the abdomen.
(Answer E)
24. A 34-year-old male patient had diarrhea, rectal bleeding, subfebrile fever for
the last month
and has mild weight loss. Deletion of pseudopolip and haustralar on colon
radiograph
It was observed.
What is the possible diagnosis in this patient? (September 92)
A) Crohn
B) Giardia intestinalis
C) Colitis ulcerosis
D) Short colon syndrome
E) Entomoeba histolytica
In the above case, deletion in pseudopolip and haustralar leads us primarily to

ulcerative colitis in diagnosis. Ulcerative colitis starts most commonly from the
rectum and is observed only with colon involvement. The most feared complications
are toxic megacolon and colon adenocarcinoma.
Radiological findings in ulcerative colitis:
•
Transverse column flattening
Expansion in column
Haustralarda deletion
pseudopolyps
Lead pipe is land

(Answer C)
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INTERNAL MEDICINE
25. Which of the following is the most common microorganism in tourist land?
(April 92)
A) Salmonella species
B) Shigella species
C) Campylobacter
D) Enterotoxigenic Escherichia coli
E) Giardia
The most common cause of the tourist office is enterotoxogenic E. coli. Because it
causes non-invasive diarrhea
leukocytes are not observed in feces. Hydration should be considered in the
treatment. As antibiotic therapy
TMP-SMX or Tetracycline may be preferred.
(Answer D)
26. Fever, a small number of maculopapular rashes of 2-4 mm in diameter in the
upper abdomen,
bradycardia and abdominal tightness, which of the following infections can be
symptoms? (April 92)
A) Cholera
B) Amoebic dysentery
C) Shigellosis
D) Meningitis
E) Typhoid
The above features are compatible with typhoid. Fever caused by infection under
normal conditions
tachycardia accompanies only bradycardia in the above case. In such a case
If infection is suspected, first typhoid fever should be considered. Maculopapular
rashes in the umbilical region are consistent with Tache rosea. Physics in terms of
accompanying pathologies
Headache, diarrhea or constipation should be considered.
One of the points that we want to draw your attention here is the maculopapular
rash
The factor obtained from punch biopsy can be produced in culture.
(Answer E)
27. Which of the following is the least radiological finding of ulcerative colitis?
(September 91)
A) Lead pipe land
B) Flattening in column
C) Pseudopolip
D) Expansion in column
E) Fistula
Ulcerative fistula formation as inflammation is transmural in Crohn's disease

colitis. Radiologic condition in Crohn's disease is stricture due to transmural
involvement
Is the presence. In ulcerative colitis, the pathology to be considered is toxic.
is the presence of megacolon. Radiological findings that may accompany toxic
megacolon
• Transverse column flattening
• Column expansion
• Deleting in Australia
• Pseudopolip
• Lead pipe is the land
(Answer E)
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COLORECTAL DISEASES
28. Which disease is the most common symptom of Pyoderma gangrenosum? (April 91)
A) Scleroderma
B) Dermatomyositis
C) Crohn
D) Colitis ulcerosis
E) Rheumatoid arthritis
Pyoderma gangrenosum is accompanied by ulcerative colitis, especially from
inflammatory bowel diseases. Topical steroids may be sufficient for treatment.
(Answer D)
29. Severe anemia in the patient who presented with long-term weakness, loss of
appetite and constipation
If it is found, which of the following would you think about your profession?
(April 88)
A) Shoe maker
B) Paint worker
C) Accumulator maker
D) Mine worker
E) Textile worker
The most common signs of lead intoxication are weakness, anorexia, constipation and
anemia. Bullet
ALA can cause anemia because it inhibits dehydratase enzyme. Especially for
batteries and
The battery is observed in workers working in the industry. Therefore, especially
those working in this industry
When the above clinical findings are observed, caution should be exercised in terms
of lead intoxication.
(Answer C)
30. Which of the following is the criterion for starting antibiotics in diarrhea?
(April 88)
A) Leukocytosis
B) Fire
C) Fecal erythrocytes
D) Fecal leukocytes
E) Reproduction in stool culture

The presence of leukocytes in the stool is indicative of the presence of invasive
infection. Especially Salmonella and Shigella
infections should be cautious because antibiotic is indicated.
(Answer D)
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INTERNAL MEDICINE
392
PANCREAS DISEASES AND TUMORS
PANCREAS DISEASES AND

TUMORS
one. A 70-year-old patient with no abdominal pain presented with jaundice for 2
weeks. Ultrasonography shows a stretched gallbladder. Which of the following is the
most likely diagnosis?
(September 2006)
A) Choledocholithiasis
B) Chronic pancreatitis
C) Pancreatic cancer
D) Acute cholecystitis
E) Benign stricture of the biliary tract

The most important physics of painless gallbladder pancreatic cancer in general
surgery
examination findings.
Pancreatic Cancer
Risk factors: Age, male sex, smoking, chronic pancreatitis, non-polyposis colon
cancer
Syndrome is a definite risk. High cholesterol and linoleic acid, such as
naphthalamine and benzidine
chemical toxins probably increases your risk.
Clinic: Weight loss is the most common symptom. Pain, jaundice, glucose intolerance
and superficial thrombophlebitis (Troussou syndrome) can be seen. Courvoisier sign
(handle of gallbladder in deep inspiration
can be found).
Diagnosis: The most sensitive test for diagnosis is endoscopic retrograde
cholangio-pancreotography (ERCP). USG and CT
diagnosis is helpful. The diagnosis is made by fine needle aspiration biopsy and
histopathological examination of the lesion detected in the pancreas. The most
common type is ductal adenocarcinoma.
CEA and Ca-19-9 are tumor markers that can be found in pancreatic cancer. However,
they are not specific for the pancreas. They are used for follow-up rather than
diagnosis.
In recent years, endoscopic USG has been used for staging and portal vein
involvement and lymph node involvement.
is the most useful test.
Treatment: Whipple operation in limited cases and conservative follow-up in
metastatic cases.
It is one of the worst cancers.
(Answer C)
2nd. Which of the following statements about pancreatic pseudocysts is incorrect?
(April 2006)
A) More than two thirds of the pancreas is located in the body and tail.
B) Histologically, the inner surface of the cyst contains an epithelial layer.
C) Most cases have a history of acute pancreatitis.
D) Those with a diameter longer than 5 cm and lasting more than six weeks should be
drained.
E) It can be seen after pancreatic duct injury.
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INTERNAL MEDICINE
The most obvious indicator of crowding, that is, the question of attention is the
most important local
definition of pseudocyst. Leave the pancreatitis already pseudo to have the inner
face
epithelium should not be true cyst. Other options stolen from surgery…
(Answer B)
3. Vagotomy and hemigastrectomy were performed to treat bleeding duodenal ulcer.
endoscopically marginal at 9 months following operation in a 9-year-old male
patient
Ulcer is detected. The patient had dyspeptic complaints as well as recurrent
diarrhea.
It says. Plasma calcium level in laboratory examination was 9.8 mg /
It's in DL. As a result of gastric secretion tests 24-hour gastric fluid
volume of 2500 cc, basal acid emission is measured as 28 mEq / h.
2003)
A) Zollinger Ellison
B) Hyperparathyroidism
C) Residual antrum
D) Incomplete vagotomy
E) Systemic mastocytosis
Atypical, treatment-resistant, complicated, multiple ulcer, renal stone, ulcer with
elevated calcium
Zollinger Ellison syndrome should be considered in patients with high and gastrin
levels. Zollinger
Endoscopic imaging is the most sensitive imaging modality in Ellison syndrome
It is ultrasonography. Tumor most commonly metastasizes to the liver. Surgery is
contraindicated if there is metastasis to the liver. If there is no metastasis, the
main treatment is surgery.
(Answer A)
4. Which is one of the systemic complications of acute pancreatitis
A) Respiratory failure
B) Acute renal failure
C) Sepsis
D) Hypoglycemia
E) Hypovolemic shock
The most important complications of acute pancreatitis are; infection, bleeding,
shock, cardiopulmonary,
renal and hepatic insufficiency. These pathologies usually coexist. Serum calcium
in prognosis
levels also play a role. The higher the calcium value, the higher the mortality.
The question questions the Ranson criteria for the diagnosis of acute pancreatitis.
These include: Hyperglycemia, advanced
age, elevated AST, leukocytosis and LDH increase.
(Answer D)
5. Which of the following is not a cause of hypoglycemia due to hyperinsulinism?
(April 94)
A) Alcohol
B) Erythroblastosis fetalis
C) Diabetic mother child
D) Beta cell nesidioblastosis
E) Asymmetric growth retardation
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PANCREAS DISEASES AND TUMORS
The causes of hypoglycemia due to hyperinsulinism are:

•
Hypoglycemia following meal (2-4 hours later)
After hyperalimentation
After gastrectomy
Functional hypoglycemia
Alcohol-induced hypoglycemia
Pancreatic islet tumor, nesidioblastosis

•
Children born from diabetic mother
Lack of anti-insulin hormones
Neonatally treated erythroblastosis fetalis
Beckwith Wiedemann syndrome
Hyperinsulinism and hypoglycemia are not observed in asymmetric growth retardation.
Leucine sensitivity
(Answer E)
6. Which of the following is the first increased enzyme in pancreatitis? (April 92)
A) SGOT
B) Pityalin
C) Leucine amino peptidase
D) Alkaline phosphatase
E) Amylase
The first laboratory test used to diagnose acute pancreatitis is serum amylase
level. Elevated serum amylase levels usually return to normal levels within 48-72
hours. Serum
serum amylase levels may increase in various pathologies, especially in acidemias;
more specific for the diagnosis of pancreatitis. Increased AST and LDH levels were
poor in studies
prognosis.
RANSON CRITERIA
During admission or diagnosis
Within 48 hours
Age is greater than 55

The UK has more than 16,000
Glu is higher than 200mg
LDH higher than 400 IU
AST is higher than 250 U
BUN greater than 45mg / dl (or 5 mg / dl increase)

Albumin less than 3.2
Ca less than 8 mg
PO2 is less than 60
Fluid deficit; More than 4 liters
Hct reduction of more than 10%
(Answer E)
7. Which of the following causes the vasoactive intestinal peptide? (April 90)
A) Pancreatic cholera
B) Stone of gallbladder
C) Crohn's disease
D) Mucovicidosis
E) Celiac disease
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INTERNAL MEDICINE
VIPoma is a rare islet cell tumor of the pancreas. With somatostatinoma

are the most malignant islet cell tumors of the pancreas.
VIPoma is also called Werner Morrison Syndrome. WDHA syndrome, also called
hypopotasemia secondary to excessive diarrhea, excessive HCO3 and K + loss.
There are aqueous diarrhea, hypokalemia and aclorhydria.
Surgery is performed in the treatment. Streptozocin can be used in inoperative
cases. Deficits are replaced.
The most common cause of death is ventricular arrhythmias due to hypopotasemia. It
is also called pancreatic cholera.
Complication
Reasons
one. Systemic complications

Shock and renal failure
Secretion of quinine, increased vascular permability, paralytic ileus, vomiting
hypoxia
Adult respiratory distress syndrome
hyperglycemia
Inability to release insulin and glucagon due to islet cell damage
hypocalcemia
Due to fat necrosis
Decrease in albumin level
Increased capillary permability
2nd. Pancreatic complications

Absa
Resection of necrotic pancreatic tissue
pseudocyst
Obstruction of pancreatic ducts
Pancreatic acid and pleural effusion
Demolition of pancreatic ducts (high amylase)
3. Gastrointestinal system complications

Upper GIS bleeding
Erosion in the duodenum and stomach
Lower GIS bleeding
Gantry due to pressure increase
Duodenal obstruction
Compression of pancreatic masses
Obstructive jaundice
Compression of pancreatic masses
(Answer A)
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hEPATITIS on
hEPATITIS on
one. A fifty-five-year-old female patient presented with occasional itching and
fatigue for 5-6 months.
complaints. Physical examination revealed hepatosplenomegaly and xanthelasma of the
eyelids. Serum alkaline phosphatase level in laboratory investigations: 480 U / L
(Normal: <130 U / L) and ALT level: 45 U / L (Normal: <40 U / L).
2011)
A) Autoimmune hepatitis
B) Choledocholithiasis
C) Cardiac cirrhosis
D) Primary biliary cirrhosis
E) Sarcoidosis
The itchy lady + ALP height is of course primary biliary cirrhosis of course. ALT
is normal. Hepatosplenomegaly, xanthelesma fits everything. Only USG didn't say
normal. A good basic hepatology information question. Maybe autoimmune hepatitis is
confusing. But ALT is normal. The only thing that may suggest choledocholithiasis
in the patient is no data other than the height of ALP.
(Answer D)
2nd. One of the following hepatitis viruses
most likely to have fulminant hepatitis in a woman? (May 2011)
A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D
E) Hepatitis E
Perhaps the simplest question of internal medicine is pregnancy and hepatitis.
An easy question for TUS. A frequently highlighted spot information when describing
hepatitis
He was asked. Hepatitis E, which is asymptomatic in normal
high mortality (20-40%) with an epidemic RNA virus
Fecal oral contamination, incubation time of 2-9 weeks, Anti-HIVVI after 2 weeks
positive, anti-HEVIgG at the same time to begin to increase and protective for
later
It should be recalled.
(Answer E)
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INTERNAL MEDICINE
3. One of the following hepatitis viruses

most likely to have fulminant hepatitis in a woman? (May 2011)
A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D
E) Hepatitis E
Perhaps the simplest question of internal medicine is pregnancy and hepatitis.
An easy question for TUS. A frequently highlighted spot information when describing
hepatitis
He was asked. Hepatitis E, which is asymptomatic in normal
high mortality (20-40%) with an epidemic RNA virus
Fecal oral contamination, incubation time of 2-9 weeks, Anti-HIVVI after 2 weeks
positive, anti-HEVIgG at the same time to begin to increase and protective for
later
It should be recalled.
(Answer E)
4. It is necessary for a person with HBsAg (+) to be evaluated as an inactive
carrier.
Which serum biomarker results are given together?
(April 2010)
LOWER
HBeAg
Anti-HBe
HBV DNA
A) Normal
B) High
+
-
C) Normal
D) Normal
E) High
Hepatitis B is one of the questions of TUS. Easy question of inactive carrier.

Inactive
liver function tests are meant as normal.
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hEPATITIS on
HBV Serology Pattern

comment
HBsAg
antiHBs
Anti-HBc
HBeAg
antihb to
Acute HBV infection
IgM
+
-
Chronic HBV infection
IgG
2nd. Window period
IgM
+/-
+/-
Carrier
+/-
Immunity after infection
IgG
+/-
Immunization with vaccine
-
-
HBsAg
antiHBs
Anti-hbcıgm
Delta
Co-infection (Hptt B + D)
Superinfection (Hptt B + D)
one. Acute HBV Infection
(Answer A)
5. A patient known to be a carrier of hepatitis B virus weakness, fatigue quickly
with complaints. Serum AST and ALT levels in normal
It's higher than the floor.
Which of the following explains the height of the enzyme in this patient
A) Hepatitis D virus super infection
B) Seroconversion of HBeAg
C) Precursor mutation of hepatitis B virus
D) Development of hepatocellular cancer
E) Portal hypertension, development of esophageal varices
Why does the hepatitis B patient get worse and the enzymes have run out?
Cancer
Increase in replication
Delta infection
Or mutation of the virus
Where esophageal variceal hemorrhage, painless upper GIS bleeding clinic as well as
no major problem anywhere
no. Already in GIS bleeding, why AST and ALT increase ....
(Answer E)
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INTERNAL MEDICINE
6. Serum of an immunized patient undergoing acute viral hepatitis B infection
antigen and antibody levels are given in the graph below.
The curve indicated by X in this graph shows the level of which of the following?
(September 2007)
A) HBsAg
B) Total anti-HBc
C) IgM anti-HBc
D) Anti-HBs
E) HBeAg
Now that they are tired of asking verbally, they have drawn graphs (note that TUS
graphics are in the foreground)
Window period and IgM anti HBc ...
(Answer C)
7. Serum detection of acute hepatitis B infection
is the indication that the window is in the period? (April 2006)
A) HBs antigen
B) HBe antigen
C) Anti-HBs antibody
D) Anti-HBe antibody
E) Anti-HBc IgM antibody

Anti –HBc Ig M for window period and acute hepatitis B infection is probably our
collar since traineeship
do not leave. We need to love hepatologists… ..
They also often ask which replica indicates. HBe antigen, let's keep this in mind.
(Answer E)
8. A healthcare worker who has injected the injection needle into the hands of a
patient known to be a HBsAg and HBeAg carrier after having been bled has previously
received 3 doses of hepatitis B vaccine.
It says. Anti-HBs antibody titer 5 mlU / ml in laboratory examinations
is detected.
Regarding the measures to be applied to these health personnel,
Which statement is true? (September 2005)
A) No additional prevention is necessary as antibody titer is sufficient
B) Single dose hepatitis B vaccine
C) 0.06 ml / kg hepatitis B hyperimmunoglobulin should be administered
D) A single dose of hepatitis B vaccine with 0.06 ml / kg hepatitis B
hyperimmunoglobulin should be given.
E) 3 doses of hepatitis B vaccine should be given at intervals of one month.
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hEPATITIS on
Now in everyday life, we will not want to happen if the antibody titer is below 10
and
If HBe Ag is positive, only vaccine will not be sufficient plus immunoglobulin will
be required.
Another condition requiring such immunoglobulin and vaccination is the baby born
from a mother with hepatitis B. In this question
is an important entity for pediatrics.
(Answer D)
9. Serological examination results of Hepatitis B virus (HBV) infection in a
patient with normal serum transaminase levels are given in the table below.
Serological examination
Result
HBs antigen
HBe antigen
Anti-HBe antibody
Anti-HBs antibody
IgG anti-HBc antibody
IgM anti-HBc antibody
Based on the information in the table, which of the following judgments about this
patient
accessible? (September 2004)
A) Acute HBV is undergoing infection.
B) Chronic HBV carrier.
C) Previously encountered HBV
D) Full immunity to HBV
E) Vaccine is fully immune to HBV
HBsAg negative, antiHBe and IgG anti-HBc antibody + that is the virus encountered.
Why is that
We did not say immune-acquired: Anti-HBs antibody (Answer C)
10. The most accurate diagnosis of liver dysfunction is:
with which one? (September 2000)
A) Alanine transaminase (ALT)
B) Aspartate transaminase (AST)
C) Alkaline phosphatase (ALP)
D) Gamma glutamyl transferase (GGT)
E) Prothrombin time (PTZ)
Prothrombin time; fibrinogen, prothrombin and factors VII, IX and
X is a test based on the relationship between. Most useful in demonstrating liver
dysfunction
It is a test. The factor with the shortest half-life is FVII. Elongation in PTZ as
FVII level decreases rapidly
occurs early.
Other tests given in the question are more useful to show liver damage.
(Answer E)
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INTERNAL MEDICINE
11th. The serological results of a nurse who stabbed a needle four months ago are
as follows;
Hbs Ag: (-)
Anti Hbs: (-)
Anti HAV IgM: (-)
Anti HAV IgG: (+)
Anti HBc IgM: (+)
Anti HBe: (+)
A) Hepatitis A infection in progress
B) Hepatitis B infection years ago
C) Window circuit for hepatitis B infection
D) Healing Hepatitis B infection
E) Acute Hepatitis E infection
Since the patient had Anti HAV Ig G (+), this was
Interpreted. HBs Antigen and Anti HBs are negative and HBc IgM is positive
the patient is in the window phase, Anti HBe is positive that the hepatitis B virus
infectiousness is very low.
Approximate percentages of antinuclear, anti-smooth muscle and antimitochondrial
antibodies in chronic liver diseases without chronic hepatitis virus infection
Disease
Antinuclear antibody
(%)
Anti-smooth muscle antibody

(%)
Antimitochondrial antibody (%)
Autoimmune hepatitis
80
25
40
Primary biliary cirrhosis
70
35
> 90%
Cryptogenic cirrhosis
15
95
15
(Answer C)
12. Which of the following is the most likely diagnosis in a patient whose serology
is as follows? (September 98)
HBsAg: +
AntiHBs: AntiHBcIgM: +
HBeAg: +
AntiHBe: A) Carrier
B) Chronic active hepatitis
C) Persistent hepatitis
D) Acute hepatitis
E) Hepatitis D superinfection
Chronic persistent hepatitis and chronic active hepatitis can be said as a result
of biopsy. This
HBsAg (+), antiHBcIgM type antibody and antiHBe (-)
acute hepatitis. Carrier or chronic hepatitis to go through longer
It is necessary.
(Answer D)
402
hEPATITIS on
13. Which of the following does not cause chronic hepatitis? (April 98)
A) Hepatitis A virus
B) Hepatitis C virus
C) Alpha1 antitrypsin deficiency
D) Wilson
E) Alpha-Methyl dopa
Causes of Chronic Hepatitis

one. Viruses: Hepatitis B, C, D (Most common Hepatitis C)
2nd. Alcohol
3. Medicines: Methyl Dopa, amiadorone, aspirin, propit thiouracil, phenytoin
4. Other: Wilson's disease, alpha 1 antitrypsin deficiency, autoimmune hepatitis
5. Cryptogenic hepatitis
(Answer A)
14. What is the indication for hepatitis B vaccine? (April 98)
HBsAg
antiHBs
AntiHBc Total
a)
-
B)
C.)
D)
TO)
People with hepatitis B vaccine indications are those with HBs (-) AntiHBs (-)
AntiHBc (-).
(Answer A)
15. Indication of vaccination in people at risk for hepatitis B
which one is more suitable? (April 94)
A) HBs (+), anti HBs (-)
B) HBs (-), anti HBs (+)
C) HBs (-), anti HBs (-)
D) HBs (+), anti HBc (-)
E) HBs (+), anti HBs (+)
The patient carrying anti HBs antibody is considered to be immune and no

vaccination is required. hBs
In patients with Ag (+), there is disease or carriage and vaccination is not
performed. Hepatitis B vaccine
should be performed in patients with both HBs Ag negative and anti HBs antibody
negative.
(Answer C)
16. Clinical type with the highest serum alkaline phosphatase level in viral
hepatitis
A) Anicteric
B) Cholestatic
C) Acute icteric
D) Fulminan
E) Subacute
There are 5 forms of acute viral hepatitis.

• Asymptomatic form
• Cholestatic form
• Sporadic form
• Parenteral form
• Fulminan type
Alkaline phosphatase is a marker of cholestasis, most commonly in cholestatic type
acute viral hepatitis.
increases. The most common cause of cholestatic type viral hepatitis is hepatitis
A.
(Answer B)
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INTERNAL MEDICINE
17. A patient undergoing viral hepatitis-A is most likely to spread the virus
around
What is the circuit? (April 93)
A) First week after receiving the virus
B) Last week of incubation period
C) First two weeks after icter
D) Convalescent circuit
E) Last 6 months as a porter

Most cases are asymptomatic (subclinical). For 2-3 weeks after the period of
incubation
stool may contain virus (highest infectious period) and when enzymes reach maximum
Fecal virus isolation decreases rapidly. First Anti HAV IgM - then Anti HAV IgG is
formed, and IgGantiHAV remains for years, indicating a previous infection.
IgMantiHAV cannot be detected 3-6 months after the acute period. Hepatitis A virus
does not become chronic and does not turn into cirrhosis. Hepatitis A
The most common cause of death is hepatic coma due to fulminant hepatitis.
(Answer B)
18. Which of the following is the radionuclide agent that best shows the liver
cell?
(April 89)
A) Gallium
B) Tc99 scintigraphy
C) Gold colloid
D) Iodine131
E) Iodine131 + Rose bengal
Technetium 99-m is most commonly retained by the liver, thyroid and salivary
glands. This
therefore, Tc99-m is most commonly used for imaging of these organs.
(Answer B)
19. Which of the following drugs causes hepatitis of the cholestatic type? (April
88)
A) Anticonvulsants
B) Tranquilizers
C) Analgesics
D) Antibiotics
E) Oral contraceptives
Cholestatic jaundice drugs;

•
Anabolic steroids
Anti-inflammatory (sulindac)
Anti-thyroid drugs (methimazole)
Antibiotics (erythromycin, nitrofrontain, rifampin, amoxicillin-clavunate,

oxacillin)
Oral contraceptives
Oral hypoglycemics (chlorpropamide)
Tranquilizers (chlorpromazine)
Oncotherapeutics (busulfani tamoxifen)
Anticonvulsants (carbamazapine)
•
Calcium channel blockers (nifedipine, amlodipine)

(Answer E)
404
OTHER LIVER DISEASES

one. What is the most common cause of pyogenic liver abscesses?
(December 2010)
A) Acute appendicitis
B) Liver cancers
C) Traumas
D) Biliary tract infections
E) Acute pancreatitis
Pyogenic Liver Abscess: It is mostly due to the underlying cholecystitis and

cholangitis. Most common grams
(-) cause enteric bacteria, especially E. coli. It settles mostly in the right
lobe, being multiple
tend. Fever, leukocytosis, tenderness, jaundice and hypoechoic lesion are seen on
USG.
Diagnosis: Needle aspiration is made with gram stain and culture.
Treatment: Ampicillin + aminoglycoside + metranidazole and drainage (mostly
external)
(Answer D)
2nd. Which of the following is not associated with nonalcoholic steatohepatitis
(NASH)?
(September 2008)
A) Obesity
B) Metabolic syndrome
C) Type 2 diabetes mellitus
D) High triglyceride, low HDL levels
E) Acetaminophen toxicity
For this question, what needs to be known is the increase in triglyceride that
lubricates the liver. DM (Type 2), Obesity,
Metabolic syndrome, option D already explains the reason. Acetaminophen is a
pharmacological agent capable of causing fulminant hepatitis in the liver.
LIVER LUBRICATION
pathogenesis:
If the amount of triglycerides in hepatocytes is more than 5% of liver weight,
causes. Lubrication occurs due to increased serum triglyceride levels or impaired
fat metabolism. Liver steatosis is a pathological term. Parenchymal infiltration in
biopsy
and if there is hepatic necrosis it is called fatty hepatitis or steatohepatitis.
Liver Grease
fibrosis may occur in the liver. Recent studies have demonstrated that fatty liver
may be the etiology of cryptogenic liver cirrhosis.
Etiology:
It is examined in two groups.
macrovesicular
- Alcohol (the most common cause)
- Obesity
- Diabetes
- Protein-calorie malnutrition
- Total parenteral nutrition, jejenoileal bypass
- Medicines; methotrexate, aspirin, vitamin A,
- Glucocorticoids, amiodarone and estrogen
- HCV
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INTERNAL MEDICINE
droplet
- Reye's syndrome
- Acute fatty liver of pregnancy
- Medicines; valproic acid, tetracycline and salicylates. It's more serious.
(Answer E)
3. Which of the following drugs is used to treat cystic disease due to Echinococcus
granulosus? (April 2007)
A) Albendazole
B) Metronidazole
C) Ornidazole
D) Dihydroemetine
E) Primetamine
In the treatment of hydatid cyst, the first choice drug is albendazole or
mabendazole.
Hydatid Cyst
Characterized by cysts formed by larvae of Echinococcus granulosus and E.
multilocularis
is a disease. E. granulosus unilocular, E. multilocularis multilocular (alveolar)
cysts are formed. Clinical and epidemiological features are different.
E. granulosus
They are found in the intestines of canine, such as adult dogs and wolves. Normally
the dog is a sheep-dog-shaped loop, while human arachonacs can continue. Infection
it is by taking the eggs extracted from the dog. Eggs open in the digestive system,
oncospheres
crosses the intestine and circulates.
It is usually kept in the liver, about 10-30% reaching the lungs. It spreads to
other organs / tissues (brain, eye, kidney, muscle, bones) in smaller proportions.
Cyst, 1-2
develops protoscolexes over the years. Protoscolexes (hydatid sand) in clear cyst
fluid
germination membrane, other than cuticle layer. Developed as a result of the
outermost host response
There is a fibrous capsule.
In some cases, very large cysts, sometimes a large number of cysts can be
identified. Secondary when cysts explode
cysts may occur. Occasionally, the cyst content can be emptied and healed by
calcification.
Clinical findings may vary depending on cyst, size, host response. Although
jaundice is detected in the presence of hydatid cyst in the liver, it is often
diagnosed by random examination.
Cough, hemoptysis and urticaria may occur when a cyst occurs in the lung. Chest X-
ray
masses in the form of sınırlı cannonball net with clear boundaries. If some amount
of cyst is emptied
water lily image or double arc sign may be observed. Fibrous bone involvement
a structure consisting of a large number of vesicles with no clear borders
Observed.
Imaging methods are very useful in diagnosis. Antibody response by UAV, ELISA, IFA
methods
ascertainable. Serological diagnosis is not always beneficial in non-liver
locations and sometimes
cross-antibodies may occur in other helminth infections. Complement coupling test
(Weinberg) is no longer preferred. Casoni skin test is now nonspecific
is not preferred. Protoscolexes or hooked structures in a suspected cyst
diagnosis.
Treatment is surgery. Albendazole, mebendazole treatment are quite successful.
(Answer A)
406
4. A 68-year-old patient with hepatic cirrhosis secondary to hepatitis B infection

liver mass in right lobe and high alpha fetoprotein level in blood.
A) Hepatocellular adenoma
B) Hepatocellular carcinoma
C) Metastatic colon carcinoma
D) Angiosarcoma
E) Focal nodular hyperplasia
HEPATOCELLULAR CARCINOMA
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the
liver. Africa and south-east
It is common in Asia, but rare in temperate regions. Cancer-related deaths all over
the world
1/3 in males and 1/7 in females are due to HCC.
The most common tumor of the liver is secondary malignancies.
Etiology:
-
Hepatitis B (Most common cause virus)
Hepatitis C
Alcohol
Aflatoxin (common in tropical regions)
-
Cirrhosis (most common)
Hemochromatosis (disease most likely to develop)
Wilson's disease, alpha 1 antirypsin deficiency
Smoking.
Other causes: Toxins such as toratrast and arsenic usually cause angiosarcoma, rare
hepatocellular carcinoma. Estrogens, androgens and anabolic steroids can cause
adenoma and rarely hepatocellular carcinoma.
In children, HCC usually develops on the basis of a metabolic disease such as HBV
infection or tyrosinemia.
Pathology:
Microscopically, well-differentiated malignant cells of the trabecular structure
resemble hepatocytes. Tumor
The secretion of bile in cells is characteristic. Tumor cells into portal vein and
inferior vena cava
intravascular invasion. The tumor is mainly used for local lymph nodes, lungs and
bones.
metastasis. If the clinical picture of a patient with cirrhosis worsens,
hepatocellular carcinoma should be considered.
Clinic:
semptomlarbulgu on
-
Abdominal pain-Hepatomegaly
Weight loss-murmur on the liver
Abdominal swelling-Acid
Jaundice-splenomegaly, jaundice, slimming, fever
Note: Symptoms and signs are written in order of frequency.
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INTERNAL MEDICINE
Hepatocellular cancer may cause symptoms of paraneoplastic syndrome. These;
one.
Hypoglycemia: Depending on the use of glucose in the tumor or ILGF production
2nd.
Polycythemia (due to erythropoietin production)
3.
Hypercalcemia: PTH due to rp release
4.
Gynecomastia, feminization: FSH due to LH production
5.
Clubbing
6.
Others: Osteoporosis, thyrotoxicosis, polymyositis, neuropathy
7.
Skin: Dermatomyositis, Laser-trelate mark, ptriasis rotunda
Diagnosis:
one.
Increased serum alpha-fetoprotein levels may be helpful in the diagnosis.
2nd.
Radiological examination:
a.
USG: The most commonly used radiological method.
b. Tomography: Isodense and less than 2 cm, to show metastasis to surrounding

structures
is an important diagnostic method.
c.
MRI: Better imaging than tomography.
Treatment:
Surgical resection is rarely possible but not cirrhosis and tumor is confined to a
single lobe
applicable. The presence of metastatic lesions is a definite contraindication for
surgery. Most common metastasis
lungs and bones. Patients with pain may be given arterial embolization with or
without local chemotherapeutic agent injection (chemoembolization) for palliative
purposes.
There were no successful results with chemotherapy. Small tumors not suitable for
local resection
liver transplantation.
Prognosis:
The prognosis is poor. Surgery can prolong life expectancy; however, the proportion
of patients
10%. A small number of patients live more than a year.
(Answer B)
5. Cirrhotic patient with significant acid is admitted to hospital with
deterioration in general condition.
The number of acid polymorphonuclear leukocytes was 500 / mm3. The patient had no
evidence of surgical treatment, and E. coli grows in acid culture. Most
Possible diagnosis is: (September 2006)
A) Spontaneous bacterial peritonitis
B) Tertiary peritonitis
C) Secondary peritonitis
D) Peritonitis carcinomatosis
E) Chylous acid
Spontaneous bacterial peritonitis
Infection in acid fluid without any interference (eg, paracentesis) leading to
infection is defined as 'primary peritonitis' or 'spontaneous bacterial peritonitis
(SBP)'. SBP most common cirrhosis
bound acid. Patients are usually decompensated or advanced liver disease.
The most common pathogen in adults is E. coli (enterobacteria). Pneumococci are
causative agents in children. The patient had fever, chills, abdominal pain and
tenderness, hypotension, hypothermia encephalopathy and
or may be non-specific symptoms.
More than 500 leukocytes (more than 50% PMN) and acidic pH are sufficient for
diagnosis.
Culture should be performed to isolate the agent and to make a definitive
diagnosis.
408
Antibiotic therapy should be initiated immediately in patients with SBP. Usually

3rd generation cephalosporin
or other broad-spectrum antibiotics. Duration of treatment is 7-10 days. Mortality
rate%
It is around 30. In recovering cases, a repeat SBP attack can occur within 70% of a
year. Acidic liquid
protein is low and patients with long PT have a higher risk of recurrent infection.
Risk of recurrence
long-term prophylaxis of norfloxacin is recommended in patients with high levels.
(Answer A)
6. Bilirubinuria and hyperbilirubinemia were detected in a patient who presented
with chronic, recurrent jaundice. Liver needle aspiration biopsy specimen is
evaluated microscopically in dark green color. As a result of histopathological
examination
pigment appears to be stored in centrilobular hepatocytes and Kupffer cells.
A) Dubin - Johnson syndrome
B) Rotor syndrome
C) Crigler - Najjar type I
D) Crigler - Najjar type II
E) Wilson's disease
This question is a question previously questioned in pathology, once bilirubin in
urine is directly bilirubin
weighted thinking. We're eliminating the head Crigler Najars. Wilson Copper
Accumulation
however, the absence of neurological symptoms may result from copper in the urine.
it excludes this option. The famous Dubin-Johson and Rotor remain. No pigmentation
in the rotor is expected to be normal USG. However, in Dubin-Johnson, pigmentation
and Bromsulfoftalein test are disturbed.
DUBIN JOHNSON'S DISEASE
Case question: Direct bilirubin elevation (> 10 mg / dl). Liver function tests are
normal. Hepatitis markers are negative. What's your diagnosis?
-
It is autosomal recessive. It's more common in Jews.
Pathology: ATP-dependent canalicular bilirubin secretion is defective.

Clinic: Jaundice usually occurs around the age of 20. There is jaundice showing
ripple. Generally
asymptomatic. Some patients may have pain, nausea and vomiting in the right upper
quadrant. Physical examination
The liver may be slightly larger.
Laboratory: Liver function tests are normal. Direct bilirubin both
Bilirubin also increases. There is an increase in urinary coproporphrin release.
Bromsulfoftalein test was impaired.
Bromsulfoftalein test results in a secondary increase in 60-90 minutes. This is
Dubin-Johnson syndrome
is typical for. The response to phenobarbitol is minimal. Cholecystography cannot
display the pouch.
Liver biopsy: Macroscopically, the liver is black-dark green. in biopsie
pigmentation may be observed in centrolobular cells.
Treatment: Benign course. No treatment required. It has a normal life span.
Estrogen in these patients
containing oral contraceptives increase jaundice.
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INTERNAL MEDICINE
ROTOR SYNDROME
It is autosomal recessive.
Pathology:
There is a partial defect in ATP-dependent canalicular bilirubin secretion.
Clinic:
Jaundice usually occurs before the age of 20. It is usually asymptomatic.
Epigastric in some patients
may be pain, nausea. Rarely, fever and abdominal pain may occur.
Lab:
Liver function tests are normal. Increases both bilirubin, mainly direct bilirubin
however, total bilirubin is generally less than 10 mg / dl. Bromsulfoftalein test
is normal. There is a response to phenobarbitale. Coproporphyrin level in urine is
normal. Cholecystography displays the sac.
Liver biopsy:
The liver is normal macroscopically and microscopically.
Treatment:
Benign course. No treatment required.
(Answer A)
7. Hepatic encephalopathy in chronic liver disease
is not one of the factors that facilitate development? (September 2005)
A) Esophageal variceal bleeding
B) Constipation
C) Excess protein diet
D) Sedative drug use
E) Use of lactulose
They used lactulose as a precipitant used in treatment. They often do a
This is a number.
Hepatic Encephalopathy
It is a reversible neuropsychiatric condition due to portosystemic shunt and liver
failure. The pathogenesis is not fully known. Ammonia and mercaptans, pseudo-
neurotransmitter increase
(octopamine, phenylephrine), increased GABA, disruption of blood brain barrier is
suggested in the pathogenesis.
Clinical: The most important clinical picture of hepatic encephalopathy is mental
disorder, which varies depending on the severity of underlying disease and
precipitating factors. The first symptoms are a decrease in work performance,
difficulty in driving and drawing (subclinical encephalopathy). With the
progression of encephalopathy
significant behavior and personality disorder, confusion, stupor and mental
disorders progressing to coma. Neuromuscular irritability is another important
finding of hepatic coma.
and the most reliable indicator of flapping tremor (asteriskis) identified as
rough, asymmetric hands
and non-rhythmic vibrations.
There is often a cause that precipitates encephalopathy. There is no specific
laboratory finding. Below
Increased serum ammonia levels can be detected with underlying liver dysfunction.
It is divided into 4 stages according to the severity of neurological findings;
410
Precipitating factors of encephalopathy

Gastrointestinal bleeding
Varicose veins, portal gastropathy, gastric / duodenal ulcer, Mallory-Weis tear
Medicines
Diuretics, trancilisants, sedatives, morphine, hepatotoxic agents
infections
Spontaneous bacterial peritonitis, urinary infections, pulmonary infections
Electrolyte and acid-base imbalance
Metabolic alkalosis, hypopotasemia, vomiting, diarrhea, hyponatremia
Excessive protein intake by diet
azotemia
constipation
Phase
Mental state
Neuromuscular disorder
I-Prodrome
Mood changes, mild confusion, speech disorder,

tendency to sleep, difficulty in attention
Impairment of writing, muscles

coordination disorder, mild
tremor
II- Light
coma
Lethargy and apathy, inappropriate behavior, thoughtfulness, stage I

increased symptoms
Flapping tremor, ataxia,

increase in reflexes
III- Stupor
Significant confusion, continuous drowsiness, meaningless

speeches, amnesia clonus, Babinski,
Nystagmus, rigidity in addition to stage 2
IV- Coma
Unconscious, no response to painful stimuli (initially

can not be taken late, pupils may respond)
No flapping, reflexes
expansion
Treatment: The aim of hepatic encephalopathy treatment is to provide normal

neurological functions and
It is maintained. The first step in the treatment of encephalopathy precipitates or
increases the reasons
should be corrected. In addition, the patient's ammonia and other nitrogenous
toxins
may be accompanied by elevation. PTZ is prolonged, enzymes are elevated, bilirubin
is usually above 5.
Mortality is high. Pregnancy is terminated and treated. It does not recur in
subsequent pregnancies.
Pregnancy cholestasis: It is seen in the last 4 months. Repeats every pregnancy. It
presents with clinical pruritus. prognosis
prematurity may cause postpartum hemorrhage. Increased bile acids
It depends. Only in severe forms does the enzyme and bilirubin increase.
HELLP syndrome: Hemolysis may be associated with elevated liver enzymes. PTZ
prolonged, enzymes
elevated, bilirubin is usually above 5. Mortality is high. Pregnancy termination
It is. It does not recur in subsequent pregnancies.
Pregnancy cholestasis: It is seen in the last 4 months. Repeats every pregnancy. It
presents with clinical pruritus. prognosis
prematurity may cause postpartum hemorrhage. Increased bile acids
It depends. Only in severe forms does the enzyme and bilirubin increase.
HELLP syndrome: Hemolysis, Elevated Liver enzymes, oz (2x30 ml) or lactylol (2x10-
15 g) to use
Go on.
Consider bromocriptine and flumazenil in patients unresponsive to treatment.
Patients who do not improve with medical treatment and whose liver function is
severely impaired
Evaluate for transplantation program.
(Answer E)
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INTERNAL MEDICINE
8. Which of the following is the most common macrovesicular fat in the liver?
The reason is? (April 2005)
A) Tetracycline toxicity
B) Reye's syndrome
C) Pregnancy
D) Salicylate intoxication in children
E) Alcoholic liver disease
LIVER LUBRICATION
pathogenesis:
If the amount of triglycerides in hepatocytes is more than 5% of the liver weight,
the liver
lubrication. Increased serum triglyceride level of fat or fat
metabolism disorders. Liver steatosis is a pathological term. If the biopsy shows
parenchymal infiltration and hepatic necrosis, this may include fatty hepatitis or
called steatohepatitis. Liver fibrosis due to fatty liver may occur, but cirrhosis
It does not develop.
Etiology: It is examined in two groups.
macrovesicular
Alcohol (the most common cause)
- Obesity
- Diabetes
- Protein-calorie malnutrition
- Total parenteral nutrition, jejenoileal bypass
- Medicines; methotrexate, aspirin, vitamin A,
- Glucocorticoids, amiodarone and estrogen
droplet
- Reye's syndrome.
- Acute fatty liver of pregnancy
- Medicines; valproic acid, tetracycline, salicylate
Liver fat is due to triglycerides.
Clinic
It is usually asymptomatic. Right upper quadrant pain and fullness may occur due to
hepatomegaly.
Diagnosis
The most common cause of ALT elevation in the population is fatty liver. Liver
echogenicity in USG
There is an increase.
The definitive diagnosis is made by liver biopsy. Lubrication occurs most often in
Zone 3.
Treatment
It is for the underlying cause. Triglyceride-poor diet is given.
(Answer E)
412
9. Twenty-seven-year-old woman with gravida 1, money 0 seven months pregnant,

severe itching
due to. Physical examination revealed a skin dryness
not detected. After 4 weeks, the patient presented again with complaints of mild
jaundice, darkening of urine color and acolic stool. Abdominal pain since first
admission
2 kg weight loss.
physical examination revealed that the uterus was 8 cm above the umbilicus and the
liver and spleen
the size is observed to be normal. Serum as a result of laboratory tests
total bilirubin level 7 mg / dL, direct bilirubin level 5 mg / dL, AST level 33 U /
L,
The alkaline phosphatase level is 210 U / L and prothrombin time is 12 seconds.
2004)
A) Acute viral hepatitis
B) Gallstone
C) Dubin-Johnson syndrome
D) Pregnancy cholestasis
E) Acute fatty liver due to pregnancy
PREGNANCY AND LIVER
Acute fatty liver of pregnancy: microvesicular liver usually in the third trimester
occurs with fat storage and liver failure. It is more common in twin pregnancy. It
is thought to be due to mitochondrial fat oxidation disorder. With pre-eclampsia
can be together. PTZ is prolonged, enzymes are elevated, bilirubin is usually above
5. Mortality is high. Pregnancy is terminated and treated. It does not recur in
subsequent pregnancies.
Pregnancy cholestasis: It is seen in the last 4 months. Repeats every pregnancy.
Clinical finding with pruritus
Data. Prognosis is good, but premature birth can lead to postpartum hemorrhage.
Bile
acids. Only in severe forms does the enzyme and bilirubin increase.
HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelet. With preeclampsia
or eclampsia
can be together. It is caused by microangiopathic damage. The clinic is similar to
the fatty liver of pregnancy; PTZ,
It is distinguished by normal PTT and fibrinogen. It usually improves with birth.
(Answer D)
10. Which of the following does not cause fatty liver? (September 2004)
A) Systemic lupus erythematosus
B) Diabetes mellitus
C) Total parenteral nutrition
D) Jejunoileal bypass
E) Protein-calorie malnutrition
Other than systemic lupus erythematosus, fatty liver is seen in the cases
mentioned. Systemic
lupus erythematosus may cause hepatitis but not hepatosteatosis.
(Answer A)
413
INTERNAL MEDICINE
11th. A 25-year-old male patient presented with abdominal pain and abdominal
distention.
References. Her history reveals that she had a fever rising at night. As the
physical examination revealed acid, the leukocyte count in the acid fluid was
determined by paracentesis.
It is observed that exudate is 7.000 / mm3 and 90% is lymphocyte.
What is the most likely diagnosis for this patient? (April 2004)
A) Spontaneous bacterial peritonitis
B) Mesothelioma
C) Tuberculous peritonitis
D) Cirrhosis of the liver
E) Carcinomatous peritonitis
If a patient with ascites has fever and abdominal pain, the diagnosis is
peritonitis. Diagnosis paracentesis fluid examination +
put with culture. The diagnosis is tuberculous peritonitis since it is dominated by
lymphocytes.
ACID CAUSES
one.
Portal hypertension 90% (the most common cause is cirrhosis)
2nd.
Alcohol: Alcoholic users may have acid before cirrhosis develops. When alcohol is
released, the acid disappears.
3.
Acute liver failure due to acute viral hepatitis: Mortality is high.
4.
Tumors: Ovarian, colorectal, gastric, pancreatic and breast cancers, lymphomas
5.
Infections:
a) Tuberculosis: 50% of patients with tuberculous peritonitis have acid.
b) HIV
c) Fitz Hugh-Curtis syndrome: Perihepatitis
6.
Pancreatitis: It is seen in acute and chronic pancreatitis. Amylase is high
7.
Chylosis acid: may be due to lymphoma, cirrhosis, tuberculosis and sarcoidosis
8.
Bile acid: It is due to fistulas that occur due to surgical or gallbladder stones.
9.
Collagen tissue diseases: Rheumatoid arthritis, lupus, Familial Mediterranean Fever
10. Endocrine diseases: Hypothyroidism,

11th. Cardiac causes: Pathologies of the right heart and pericardium
12. Renal diseases: Nephrotic syndrome, chronic renal failure
Differential diagnosis according to the findings in acid fluid
Neutrophil dominance: Bacterial infection
Lymphocyte dominance: in favor of tuberculosis
Erythrocyte predominance: Hepatoma, tuberculosis
Amylase increase; pancreatitis
Increased adenosine deaminase; Especially tuberculosis (higher than 50-60 U / L is
important for diagnosis)
Triglyceride increase; Malignant chylose acid
(Answer C)
414
12. 25-year-old woman presenting with jaundice

that she noticed yellowing in her family's sclera and
previously had similar findings. Pathological findings in physical examination
not detected. Total bilirubin 3 mg / dl, indirect bilirubin in laboratory tests
0.7 mg / dl. Serum, ALT, AST, alkaline phosphatase, GGT levels,
Complete blood count and abdominal USG are normal. The most likely diagnosis for
this patient
A) Gilbert syndrome
B) Rotor syndrome
C) Crigler-Najar Type I
D) Dubin-Johnson syndrome
E) Primary biliary cirrhosis
The response is either Rotor or Dubin-Johnson because it is followed by familial
and direct hyperbilirubinemia. AST-ALT, ALP
and GGT levels were normal and abdominal USG was normal.
He's doing Rotor syndrome right.
Direct bilirubin <10 mg / dl in rotor syndrome and in Dubin Johnson syndrome
as a rule> 10 mg / dl. Bromsulfoftalein is the most widely used test for the
differentiation of two diseases
Test. Dubin-Johnson is also prolonged. Because in Dubin-Johnson syndrome gall
bladder
anomalies are observed. Gallbladder is normal in Rotor.
(Answer B)
13. Which of the following diseases directly increases blood bilirubin? (September
97)
A) Gilbert syndrome
B) Hereditary spherocytosis
C) Mushroom poisoning
D) Criggler-Najjar syndrome
E) Dubin-Johnson syndrome
Dubin Johnson syndrome is generally used in patients with a history of oral
contraceptive use and in pregnant women.
it occurs. There is a defect in direct excretion of bilirubin from the liver.
Synthesis of caprobilinogen
There is a black liver because it deteriorates. Physical examination shows
hepatomegaly.
Bile ducts are normal on abdominal USG.
(Answer E)
14. Which factor does not increase hepatic encephalopathy? (September 96)
A) Gastrointestinal bleeding
B) Excess protein intake
C) Hyperkalemia
D) Constipation
E) Hypovolemia

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INTERNAL MEDICINE
Those who increase the risk of hepatic encephalopathy;

• Paracentesis
• Hypokalemia
• Hypocalcemia
• Hypomagnesemia
• Hypovolemia, hyponatremia
• GIS bleeding
• Use of morphine and opiate
• Infection
• Shunt operations
• Excess protein-rich diet
• Constipation
• Acute renal failure, congestive heart failure, prerenal or renal azotemia,
alkalosis and
It is hypoxia.
(Answer C)
15. The level of one of the following factors in a patient with hepatic
insufficiency
affected? (September 96)
A) Factor 2
B) Factor 7
C) Factor 8
D) Factor 12
E) Factor 1
Factor 8 is synthesized in the vascular endothelium and monitored by aPTT and acts
intrinsically. That's why
In disorders of liver function tests it is not affected. F8, with blood von
Willebrand factor
Converge. The first test for prolonged bleeding diathesis in liver failure is PT.
Factor 7 is the most rapidly affected factor.
(Answer C)
16. Which of the following does not show indirect hyperbilirubinemia? (September
95)
A) Criggler-Najjar
B) Toxic hepatitis
C) Hemolysis
D) Gilbert syndrome
E) Infective erythropoiesis
Peripheral conjugate due to defects in conjugation in Criggler Najjar and Gilbert
syndrome
indirect biluribine accumulates. Demolition is very high in hemolysis and
inefficient erythropoiesis
becomes indirect hyperbiluribinemia. In toxic hepatitis, only direct bilirubin is
elevated and hyperbiluribinemia occurs until the effect of obstructive toxin is
passed (if the patient does not die).
(Answer B)
416
17. Conjugated hyperbilirubinemia causing non-pigmentation of liver

A) Criggler-Najjar type I
B) Criggler-Najjar type II
C) Gilbert syndrome
D) Rotor syndrome
E) Dubin-Johnson syndrome
In Dubin Johnson and Rotor syndromes, there is a defect in the excretion of
conjugated bilirubin in the liver.
Coproporphyrin due to defect in porphyrin synthesis in hepatocytes in Dubin-Johnson
syndrome 3
accumulation. Therefore the liver is brown-black. In Rotor syndrome, liver is
normal in color since there is no accumulation of corpoporphyrin.
(Answer D)
18. Which of the following disorders is involved in Wilson's disease? (April 94)
A) Copper
B) Iron
C) Zinc
D) Magnesium
E) Calcium
Wilson's disease is a genetic disorder with autosomal recessive transmission. ATP7B
protein from the biliary tract
It is involved in copper disposal. Copper in a defect in the synthesis of ATP7B
protein
will be reduced and will begin to accumulate in the body. Serum ceruloplasmin in
Wilson's disease
and serum Cu levels are low. The popular Kaiser Flascher ring can be observed in
30-50% of cases. The absence of the ring does not exclude the diagnosis of Wilson's
disease. Wilson's disease
The gold standard method for the diagnosis is quantitative copper level with liver
biopsy.
(Answer A)
19. Which of the following conditions is seen in indirect bilirubinemia? (September
93)
A) Gilbert's disease
B) Iron deficiency anemia
C) Diabetes mellitus
D) Pancreatic head cancer
E) Colon diverticulum
Decreased UDP-glucuronyl transferase activity in physiopathogenesis of Gilbert
syndrome
play. UDGPT enzyme plays a role in uptake and conjugation of indirect bilirubin to
the liver.
Total Bilirubin level does not exceed 5 mg / dl. Jaundice disease occurs in cases
like hunger stress
interest. Phenobarbital can be used for treatment.
(Answer A)
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20. Which of the following matches the pathology in Criggler-Najjar disease?

(September 92)
A) Bilirubin excretion is impaired
B) Bilirubin conjugation is impaired
C) Direct bilirubin excretion is impaired
D) Pigment accumulation in liver
E) Reduction of bilirubin intake to liver
Criggler Najjar disease has two different forms, type-1 and type-2. Pathology in
this disease
UDP-glucuronyl transferase is a complete or partial deficiency of the enzyme. Type-
1 enzyme completely
is autosomal recessive and usually results in death. Type 2 is also
shows the autosomal dominant inheritance, which is the partial absence of the
enzyme. Treatment of type-2
phenobarbital can be tried.
(Answer B)
21. Which of the following is palmar erythema and spider nevus? (September 91)
A) Chronic liver failure
B) Chronic renal failure
C) Wilms tumor
D) Hemangioma
E) Acute liver failure

This question is actually a question asked to measure our knowledge of
prophylactic. Granted
findings are physical examination findings of chronic liver failure.
Chronic Liver Failure Findings
•
palmar erythema
spider nevus
clubbing
hair loss
testicular atrophy
fetor hepaticus
peripheral neuropathy
Palmar Dupuytren
fluid accumulation in the pleura

•
dilatation of collateral veins in the abdominal wall

(Answer A)
22. What is the cause of extrahepatic portal hypertension?

(April 91)
A) Sarcoidosis
B) Vena porta thrombosis
C) Cirrhosis
D) Alcohol hepatitis
E) Schistosomiasis
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Portal hypertension is the most common cause of sinusoidal region while cirrhosis
is the most common cause. Localization is divided into three groups as
presinusoidal, sinusoidal and post sinusoidal:
Presinusoidal: Schistosomiasis, idiopathic portal fibrosis, portal vein occlusion
Sinusoidal: The most common cause of portal hypertension is sinusoidal cirrhosis.
The most common cause of viral (HBV)
liver diseases. Drugs (Alcohol, methotrexate, INAH, vitamin A, amiadorone, alpha-
methyl dopa,
perhexilene maleate, oxyfenacetin), brucella, echinococcus, congenital, syphilis,
autoimmune hepatitis, chronic
passive congestion, Hereditary hemorrhagic telangiectasia, metabolic diseases
(Wilson, hemachromatosis,
alpha-1-antitrypsin deficiency), biliary obstruction (primary biliary cirrhosis,
secondary biliary cirrhosis), jejunoileal
by-pass sinusoidal portal hypertension.
Postsinizoidal: Venococclusive disease, Budd-Chiari syndrome, heart failure
(Answer B)
23. If the child has fatty liver and convulsions, which
You think? (April 91)
A) Viral hepatitis
B) Alcoholic cirrhosis
C) Reye's syndrome
D) Nieman-Pick
E) Galactosemia
Influenza or varicella infection is particularly common in children younger than 15
years of age.
Reye's syndrome leading to liver damage and convulsions due to the use of a drug
It called. Microvesicular fat is observed in the liver.
(Answer C)
24. Which of the following is not expected fatty liver? (April 91)
A) Alcoholic cirrhosis
B) Viral hepatitis
C) Lead intoxication
D) Wilson's disease
E) Niemann-Pick disease
Fatty liver may be in microvesicular or macrovesicular form. Both
Among the causes in the form of alcohol is the most common cause of fat.
macrovesicular
•
Obesity
Alcohol (most often)
Diabetes
Protein-calorie malnutrition
Total parenteral nutrition, jejunoileal bypass
Medicines; methotrexate, aspirin, vitamin A, glucocorticoids, amiodarone and

estrogen
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INTERNAL MEDICINE
droplet
•
Reye's syndrome
Acute fatty liver of pregnancy
Medicines (valproic acid, tetracycline, salicylate)

(Answer C)
25. What is the defect in Gilbert syndrome? (September 90)

A) In transporting bilirubin to liver
B) Conjugation and uptake deficiency
C) Biliary obstruction
D) Excess degradation of erythrocytes
E) In the excretion of conjugated bilirubin to bile
Decreased UDP-glucuronyl transferase activity in physiopathogenesis of Gilbert
syndrome
play. UDGPT enzyme is involved in uptake and conjugation of indirect bilirubin to
the liver.
Total Bilirubin level does not exceed 5 mg / dl. Jaundice disease occurs in cases
like hunger stress
interest. Phenobarbital can be used for treatment.
(Answer B)
26. In hemochromatosis, which is more likely than others for definitive diagnosis
It helps? (September 90)
A) Liver function tests
B) Liver size
C) Serum iron and iron binding capacity saturation
D) History and physical examination
E) Liver biopsy and serum iron studies
Hemochromatosis is a genetically
Disease. It accumulates in various parts of the body and causes pathologies.
Pigmentation of the skin
hypothyroidism, hypogonadism, restrictive cardiomyopathy, parkinsonism and diabetes
mellitus. Hepatocellular carcinoma is the disease that most increases the risk of
development. Serum in the diagnosis
high iron and transferrin levels, low serum iron binding capacity
It is stimulating. The most reliable diagnostic method is genetic mutation.
(Answer E)
27. Which of the following is not the cause of edema in liver cirrhosis? (September
89)
A) Water-salt retention
B) Lymphatic obstruction
C) Hypoalbuminemia
D) Hyperbilirubinemia
E) Secondary hyperaldosteronemia
420
Several different mechanisms play a role in the formation of edema in cirrhosis.

Cirrhosis in developing cases
It is known that liver production and destruction functions are affected. Albumin
levels in the liver decrease in cirrhosis cases. In cases of hypoalbuminemia, edema
occurs due to decreased intravascular oncotic pressure. Aldosterone in the liver
collapsed. Aldosterone also acts by increasing Na and water uptake and K excretion.
Hyperaldosteronism develops secondary to the reduction of aldosterone destruction
in cirrhosis. Water and salt
The increase in retention increases due to hydrostatic pressure and causes edema.
In lymphatic obstruction
edema occurs due to increased hydrostatic pressure in the veins while
hyperbilirubinemia
edema is not observed.
(Answer D)
28. Cirrhosis of the liver, degeneration of the brain and fundoscopic examination
of the disease with KaiserFlascher ring Which of the following? (September 89)
A) Niemann-Pick
B) Hemochromatosis
C) Glycogen storage disease
D) Wilson's disease
E) Hemosiderosis
Wilson's disease is an autosomal recessive genetic disorder. ATP7B protein from the
biliary tract
It is involved in copper disposal. Copper in a defect in the synthesis of ATP7B
protein
will be reduced and will begin to accumulate in the body. Serum ceruloplasmin in
Wilson's disease
and serum Cu levels are low. The popular Kaiser Flascher ring can be observed in
30-50% of cases. The absence of the ring does not exclude the diagnosis of Wilson's
disease. Wilson's disease
The gold standard method for the diagnosis is quantitative copper level with liver
biopsy.
Tests related to liver metabolic diseases
Disease
Primary test
Supportive testing
Definitive diagnosis
hemochromatosis
Serum ferritin> 400mg /

dL
Iron saturation>
55%
Iron storage index> 2
C282, H63D homozygous
Alpha 1 antiripine deficiency
alpha 1 antitrypsin level
Phenotype (P type)
Liver histology
PAS-positive diastasis
resistant granules
Wilson's disease
Ceruloplasmin <10mg / dl
Urine / Serum Cu> 80

mg / 24 hours
Liver biopsy
quantitative copper> 50
mg / g
(Answer D)
29. Which of the following is used for the definitive diagnosis of alcoholic
cirrhosis? (April 88)
A) SGOT
B) SGPT
C) Lactic dehydrogenase
D) GGT
E) Alkaline phosphatase
Two laboratory tests that are particularly useful in the diagnosis of alcoholic
cirrhosis are GGT and AST. GGT
It is more sensitive than AST because it is released from mitochondria of liver
cells.
It should be noted that GGT level will increase in cholestatic pathologies.
ALP and 5 'nucleotidase elevation in cholestatic pathologies
help us in the point of making.
(Answer D)
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INTERNAL MEDICINE
422
BALL SURGERY AND CHANNEL DISEASES
BALL SURGERY AND CHANNEL

DISEASES
one. The first method of imaging for obstructive jaundice is:
A) Ultrasonography
B) Computed tomography
D) Biliary scintigraphy
E) Direct abdominal radiography
The internal medicine questions of this exam were cake. Let go of jaundice jaundice
liver and bile
pathways is the first ultrasonography.
(Answer A)
2nd. Which of the following is the most common cause of secondary biliary
cirrhosis? (September 97)
A) Cholangiocarcinoma
B) Stenosis of the biliary tract
C) Hydatic cyst
D) Pancreatic carcinoma
E) Choledochal cyst
Secondary biliary cirrhosis, long-term partial or total
Occurs with obstruction. The adult is caused by obstruction, postoperative
stenosis, or gallstones and usually has infectious cholangitis. Biliary stenosis
and secondary to chronic pancreatitis
may cause cirrhosis. Secondary biliary in patients with pericholangitis or
idiopathic sclerosing cholangitis
may develop cirrhosis.
In malignancies of ductus biliaris communis or pancreas origin, patients will
usually develop cirrhosis
can not live as long. Congenital biliary atresia and cystic fibrosis in children,
secondary biliary cirrhosis is one of the leading causes. Choledochal cysts can
also be diagnosed if
can cause cirrhosis.
In summary, primary sclerosis is the most common intrahepatic cause of secondary
biliary cirrhosis in adults.
Cholangitis is the most common extrahepatic cause of choledocholithiasis. The most
common intrahepatic cause in children
cystic fibrosis, biliary atresia, extrahepatic cause.
(Answer B)
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INTERNAL MEDICINE
3. Starting late at night after a heavy and greasy dinner, without diminishing
Pain lasting 30-60 minutes localized to the right hypochondrium and caused by
nausea
Fever was 38 ° C and leukocyte was 10.000 / mm³.
Which is the most likely diagnosis? (April 97)
A) Liver abscess
B) Infected liver hydatid cyst
C) Intestinal obstruction
D) Peptic ulcer perforation
E) Acute cholecystitis
After heavy fatty meals in the right hypochondrium occasional colic-style, plateau-
shaped peak pain
acute cholecystitis or cholangitis is considered in the patient with fever and
leukocytosis. Most often
the agent is E. coli. Often with stones.
Treatment; emergency surgery. Cholecystectomy is performed by antibiotic
prophylaxis in stonyacute cholecystitis.
The triad, which is also pain, fever and jaundice, is called the Charcot triad,
typical for acute cholangitis and cholecystitis.
(Answer E)
4. In a patient suspected of having gallstones, the
which do you do? (September 96)
B) Ultrasonography
C) IV cholangiography
D) Oral cholangiography
E) Magnetic resonance imaging
(Answer B)
5. What is the best indicator of prognosis in the follow-up of primary biliary
cirrhosis? (April 93)
A) LDH
B) SGOT
C) Alkaline phosphatase
D) Bilirubin
E) Antimitochondrial antibody
Bilirubin was the first line of prognosis and immunoglobulin E level was associated
with prognosis.
(Answer D)
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BALL SURGERY AND CHANNEL DISEASES
6. What is not seen in primary biliary cirrhosis? (September 90)

A) Hypokalemia
B) Hypercalcemia
C) Hypercholesterolemia
D) Hyperlipidemia
E) Antimitochondrial antibodies
Metabolic disorders in primary biliary cirrhosis
•
hypocalcemia
hypomagnesemia
hypokalemia
hypernatremia
hypercholesterolemia
Lipoprotein X increase
IgE height
Anti inner membrane mitochondrial antibody positivity.

(Answer B)
7. Which of the following is specific in primary biliary cirrhosis? (April 90)

A) Antimitochondrial antibody
TO ME
C) Anti-smooth muscle antibody
D) Anti DNA
E) LE cell
It is the progressive damage of medium sized intrahepatic bile ducts. 90% is seen
in women. First emerging
The finding is itchy. Occasionally, asymptomatic patients can only present with
elevated ALP. Other
Results: jaundice, skin pigmentation, HSM, bleeding diathesis bone pain. Prognosis
The important factor is serum bilirubin level. Antimitochondrial antibodies (“AMA”
m2
type) is highly detected. Diagnosis is made by liver biopsy. Ursodeoxycholic acid
of the disease
It is widely used because it slows the progress. The definitive treatment is liver
transplantation.
It may be associated with Sjogren's syndrome (70%).
(Answer A)
8. Which of the following is the most common cause of benign biliary obstruction?
(April 89)
A) Cholangitis
B) Choledocholithiasis
C) Acute cholecystitis
D) Cholesterolosis
E) Adenomyomatosis
The most common cause of benign biliary obstruction is falling stones in the bile
duct. 80% of gallstones
cholesterol stones, 20% are pigment stones (Ca bilirubinate). Stones are mostly
formed in the fundus of the gallbladder. Gallstones are also the most common cause
of acute cholecystitis, pancreatitis and acute cholangitis.
(Answer B)
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INTERNAL MEDICINE
426
INTRODUCTION TO NEPHROLOGY
one. Mm3 in mid-flow urine to diagnose pyuria in urinary tract infections
How many leukocytes should be at least? (September 2011)
A) 10
B) 100
C) 1000
D) 10,000
E) 100,000
One of the interesting questions. Semiology questions. As far as we understand here

bacteria with leukocytes. Because most of our friends think of bacteria as 'd' and
'e'
directed. However, the question says leukocyte. 10 leukocytes are sufficient for
pyuria.
(Answer A)
2nd. The most sensitive method for determining glomerular filtration rate is
Which is? (December 2010)
A) Creatinine clearance
B) Urea clearance
C) Inulin clearance
D) Scintigraphy
E) Renal angiography
The free distribution of the ideal substance in the circulation, which can be used
to measure GFD, is easily measurable
should be freely filtered from the glomeruli, but not reabsorbed or secreted. These
terms
The ideal substance that can provide is inulin. Therefore, the determination of
glomerular filtration rate
sensitive method is Inulin Clearance.
(Answer C)
3. Which of the following is the blood pressure and glomerular during the second
trimester of pregnancy?
shows the normal physiological condition that occurs at the filtration rate?
(September 2009)
Blood pressure
Glomerular filtration rate
a)
rises
Increases
B)
rises
decreases
C.)
drops
Increases
D)
Constant
decreases
TO)
drops
Constant
Blood pressure drop and GFR increase from the second trimester on pregnancy
physiology are the expected findings.
Let's say you can't remember the GFR, everyone knows that the blood pressure of
pregnant women will drop. (pregnant women)
Even if it is necessary to increase the GFR renal blood flow increases in GFR
increases....
(Answer C)
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INTERNAL MEDICINE
4. Which of the following is not the cause of color increase? (September 2006)
A) Salt restriction
B) Tilt position
C) Dehydration
D) Hypokalemia
E) Renal artery stenosis
Factors that increase renin release

•
Vasodilatation in afferent arteriole
Decrease in renal perfusion (Hypotension, hypovolemic shock)
Reduction of Na + and Cl- concentrations in tubule lumen
Beta adrenergic stimulation
prostaglandins
Renal artery stenosis
ACE inhibitor (Enalapril, Lisinopril)
Loop diuretics
Vasodilating agents
-
hydralazine
minoxidil
-
Na nitroprusside
Alpha-blockers
Angiotensin receptor blockers (Saralazine, Losartan)
Factors that reduce renin release

•
Vasoconstriction in afferent arteriole
Increased renal perfusion
Angiotensin II
ADH
aldosterone
Potassium
Beta blocker (such as Propranolol)
Sympathetic denervation in the kidney
Indomethacin (and some NSAIDs)
With clonidine and methyldopa (sympatholytic) action
Glucagon (increases kidney blood flow)
ANF
•
Adenosine release from macular densa
PAF
NO
(Answer B)
5. Glomerular ultrafiltrate is most common in an adult with normal renal function.

which of the following reabsorbs? (September 2005)
A) Proximal tubule
B) Descending part of Henle club
C) The henle handle
D) Distal tubule
E) Collector channels
Again, a simple general nephrology question: all electrolyte ions and particles
except magnesium
proximal tubule.
(Answer A)
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6. Which of the following is less likely to have hematuria than others?

(September 2005)
A) Amyloidosis
C) Analgesic nephropathy
D) Renal vein thrombosis
E) Alport syndrome
The essence of the problem is to know the difference between nephritic and
nephrotic syndrome. Hematuria in nephrotic syndrome
and hypertension is not an expected finding in nephritic syndrome. Amyloidosis
nephrotic syndrome
and hematuria is not observed much compared to others.
(Answer A)
7. Which of the following conditions has decreased urinary potassium excretion?
(April 2005)
A) Chronic metabolic alkalosis
B) Proximal renal tubular acidosis

C) Ureterosigmoidostomy
D) Bartter syndrome
E) Adrenal cortex insufficiency

It is a question that separates the connoisseur, which is seen as complicated now.
Addison adrenal insufficiency aldesterone,
cortisol nothing. Aldesterone does what potassium throws. Otherwise it will not
throw excretion of excretion
It decreases. Other fashions are fancy, so let's be afraid of the question !!!
(Answer E)
8. In which of the following conditions is an increase in blood urea level, the
main factor is the increase in urea synthesis? (September 2004)
A) Use of diuretics
B) Hepatorenal syndrome
C) Severe diarrhea
D) Acute renal failure
E) Multiple trauma
Diuretic and diarrhea already makes relative elevation due to dehydration and other
electrolyte loss. Hepatorenal and renal failure are problems in excretion and
metabolism. But in trauma, the protein excreted by the muscles that are destroyed
is metabolized to urea.
(Answer E)
9. Which is one of the findings of classical distal (type 1) renal tubular
acidosis?
is not one? (April 2004)
A) Hypopotasemia
C) Urine pH higher than 5.5
B) Normal anion gap acidosis

D) Nephrolithiasis
E) Hypercalcemia
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INTERNAL MEDICINE
Distal type renal tubular acidosis more precisely renal tubular acidosis to be
known for pediatrics and internal medicine
they ask as they get bored.
Renal tubular acidosis (RTA): It can be divided into three main groups:
Proximal RTA (type II): Proximal tubules develop due to HCO3 absorption defect.
urinary
HCO3 loss is greater than 15% of the filter fraction. Hyperchloremic, hypokalemic
metabolic
goes with acidosis. Isolated proximal RTA is rare. Often all proximal functions are
impaired
is a component of Fankoni syndrome. It may be idiopathic or cystinosis (in children
most common), Wilson's disease, galactosemia, multiple myeloma (most common in
adults), heavy metals,
rickets, amyloidosis and Sjögren serdrome. Anorexia, malnutrition, growth
problems, volume deficiency, symptoms of hypopotasemia and osteomalacia.
In proximal RTA, urine pH is initially above 5.5, but as acid secretion is normal
in the distal tubule, urine pH may drop below 5.5 despite acidosis after some time.
But
When HCO3 is given to correct metabolic acidosis, there is a significant loss of
bicarbonate (alkaline urine).
Response to bicarbonate loading test (given bicarbonate cannot be absorbed from
proximal tubule, test
urine pH increases during pregnancy). HCO3 replacement is performed in the
treatment. HCO3 given for the purpose of treatment
loss of HCO3 (10-25 mEq / kg / day) is needed. Most important
Complications are osteomalacia and rickets.
Classic distal RTA (type 1): There is H + secretion disorder in the distal tubule.
It may be idiopathic as well as collagen tissue diseases [Sjögren (most common),
RA, SLE], autoimmune diseases (biliary cirrhosis, thyroiditis, chronic
active hepatitis, etc.), hypergammaglobunemia (MM, amyloid), genetic connective
tissue diseases (Marfan,
Ehlers-Danlos), nephrocalcinosis, Vitamin D intoxication and drug-induced
(amphotericin-B, lithium)
can be seen as. Briefly, any disease that may affect the distal tubule may lead to
distal RTA.
Nephrolithiasis and nephrocalcinosis are common (both cause and result of the
disease). Hypokalemia and
There are symptoms of acidosis. Osteomalacia is more rare. HCO3 loss in urine is
low (filter
less than 10% of the fraction).
Urine pH> 5.5 (in the presence of metabolic acidosis) can be diagnosed easily.
Because of the distal acidification defect, the acidification of the urine is
impaired and therefore the pH is above 5.5. If the bicarbonate loading test is
performed, the response is negative (urine because HCO3 will be absorbed
proximally)
pH does not change significantly). The required dose of HCO3 is 1-2 mEq / kg / day.
Generalized distal RTA (voltage dependent) (Type IV): The main disorder is
aldosterone insufficiency or
It is the lack of. Addison, 18 and 21 hydroxylase deficiencies, hyporeninemic
hypoaldosteronism (DM, tubulointerstitial disease, analgesic nephropathy,
nephrosclerosis, NSAIDs, AIDS), drugs (ACE inhibitors, spironolactone, amiloride
triamterene) are among the main diseases that may be the cause.
Urine pH is below 5.5. HCO3 loss in urine is low (less than 10% of the filter
fraction).
Clinical findings may be related to the underlying disease. Unlike other RTAs,
aldesterone deficiency
There is hyperkalemia due to. Although alkali replacement can be performed in
treatment, the main treatment is mineralocorticoid (fludrocortisone).
(Answer E)
10. Daily urine volume is 4 lt. plasma osmolality 270 mOsmL, urine osmolality 100
What is the free water clearance of a patient with mOsml in ml / min? (April 2003)
A) 0.7
B) 1.0
C) 1.3
D) 17
E) 2.0
Free water clearance = (24-hour urine volume / 1440) x (1-urine osm / serum osm)
= (4000/1440) x (1-100 / 270)
= 1, 7
(Answer D)
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11th. Which causes overflow type (overflow) proteinuria? (April 2003)

A) Diabetic nephropathy
B) CHF
C) Multiple myeloma
D) Interstitial nephritis
proteinuria
Normally, the amount of protein in the 24-hour urine is <150 mg. The amount of
albumin is <30 mg. 150-500
proteinuria between mg cannot be detected with sticks. However, in 24-hour urine by
Esbach method
It can be determined.
Proteinuria: The amount of protein in the 24-hour urine is measured by the ESBACH
method. According to this;
Functional proteinuria:
•
Fever due to congestive heart failure, epilepsy, prolonged standing
Depends on increased filtration or reduced reabsorption
Amount of protein <2 g / day
Overflow proteinuria:
•
It occurs in paraproteinemias.
It depends on the increase of plasma proteins.
The amount of protein is variable.
Glomerular proteinuria:
•
Nephrotic syndrome
•
Glomerular damage
Urine protein> 3.5 g / day
Tubular damage:
•
It is seen in tubular diseases.
It is due to inability to absorb tubular proteins.
The amount of protein is <2 g / day.

(Answer C)
12. Serum sodium level 140 mg / L chlorine: 103 mEq / L and serum bicarbonate value
13
How many mEq / L is the anion gap of a patient with Meq / L? (September 2001)
A) 18
B) 20
C) 22
D) 24
E) 26
The anion gap = Na- (HCO3 + Cl).

Anion gap = 140 - (103 + 13)
Anion gap = 24
(Answer D)
13. Plasma sodium level 150 mEq / L, potassium level 5 mEq / L, blood sugar level
90
mg / dL, plasma osmolality of a patient with blood urea level 28 mg / dL mOsm / L
A) 260
B) 315
C) 325
D) 350
E) 285
Plasma osmolality is calculated as follows:

Serum osmolality:
Osm = 2 (Na + K) + glucose / 18 + BUN / 2. 8
= 2. (150 + 5) + (90/18 + 28/2). 8
= 310 + 5 + 10
= 325
(Answer B)
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INTERNAL MEDICINE
14. If BUN is 40 mmol / L, what is the blood urea nitrogen mg / dL in this patient?
(Urea molecular weight = 60, Nitrogen = 14) (September-98)
A) 40
B) 56
C) 60
D) 112
E) 224
40 = x. 10/14
56 = x.
(Answer B)
15. Which of the following reduces plasma renin release? (September 97)
A) NSAIDs
B) Diuretics
C) Beta agonists
D) Vasodilators
E) ACE inhibitors
Factors that increase renin secretion: Decreased perfusion pressure in afferent

arterioles, distal
decreased sodium concentration and sympathetic stimulation in pleural tubule, PGE2
and PGI2. the Rhine
Reducing the release of potassium: Increased amount of potassium taken by diet,
Angiotensin II
feed-back inhibition, atrial natriuretic peptide and PG synthesis inhibitors.
Diuretics hypokalemic and antihypertensive effect, vasodilators reducing afferent
arteriolar pressure,
ACE inhibitors by reducing the level of Angiotensin II and with the direct effect
of Beta agonists (Beta 1)
increases renin release. NSAIDs by inhibiting prostaglandin / prostacyclin
synthesis in the kidney
they increase the tendency to salt and water retention and reduce renin release.
NSAIDs are antihypertensive and
reduce the effect of diuretic drugs.
(Answer A)
16. Which of the following is the endogenous substance that shows the glomerular
filtration rate?
(September 95)
A) Mannitol
B) Creatinine
C) Sorbitol
D) Inulin
E) Uric acid
Glomerullary filtration will be best demonstrated only by glomerular filtration,

secretion and
should not be reabsorbed. Inulin is the most ideal substance for this, while
endogenous
The most ideal agent is creatinine. Glomerular filtration as creatinine is also
secreted
speed is slightly higher than the clearance.
Tubular clearance is the best inulin exogenous substance and consists of fructose.
Paraaminohippürik
acid indicates kidney blood flow. Inulin is an exogenous substance and is made only
of fructose.
polysaccharide.
(Answer B)
17. Which inhibits renin release? (September 93)
A) Low plasma sodium
B) Natriuretic factor
C) Low plasma potassium
D) Renal artery stenosis
E) Hypovolemia
432
Agents and factors that reduce or inhibit renin release are as follows;
• Increase in blood pressure
• ADH increase
• Hypopotasemia
• Hypercalcemia
• Hypernatremia
• Angiotensin II increase
• Alpha-methyl dopa
• Clonidine
• Indomethacin
However, if the blood pressure is severe advanced hypertension, renal
vasoconstriction
renin release may increase. Low plasma potassium inhibits renin release,
height.
(Answer C)
18. Which of the following is not seen in Bartter syndrome? (September 92)
A) Hypertension
B) Hyperreninemic-hyperaldosteronism
C) PGI2 increases
D) Juxtaglomerular cell hyperplasia
E) Hypopotasemic metabolic alkalosis
Bartter syndrome is the dysfunction of the ascending arm of the handle. Potassium,
hydrogen, sodium and chlorine cannot be reabsorbed and excreted in the distal
tubule.
Patients have hypokalemia and metabolic alkalosis. Blood pressure for excretion in
sodium and chlorine
normal, no edema. PG I2 synthesis was increased. Renin angiotensin due to loss of
sodium
system is activated. There is hyperreninemic hyperaldosteronism.
•
Hyperemimetic hyperaldesteronism
Hypokalemic alkalosis
Juxtaglomerular cells
No hypertension and edema
Treatment: Indomethacin and potassium supplements.

(Answer A)
19. Which of the following does not show aminoaciduria? (April 90)
A) Rickets
B) Fanconi aplastic anemia
C) Wilson cirrhosis
D) Tubular acidosis
E) Hartnup
Diseases causing aminoaciduria; Cystinosis, Fanconi syndrome, Rickets, Hartnup's
Disease, Wilson's Disease and Renal tubular acidosis. Fanconi aplastic anemia in
the first decade pancytopenia, hereditary bone marrow hypoplasia, spleen
hypoplasia, radius
is a syndrome characterized by absence, microcephaly and mental reterdation.
(Answer B)
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INTERNAL MEDICINE
20. Which of the following has a high protein level? (September 89)
A) Nephrotic syndrome
B) Minimal change disease
C) Burn
D) Dehydration
E) Hypervolemia
Describes hypoalbuminemia and hyperlipidemia with intense protein excretion (> 3.5
g / day / 1.73 m2) in nephrotic syndrome. Minimal change in disease
nephrotic syndrome is common and sometimes seen at nephritic level. Burns have
protein loss from the skin due to extravasation of albumin. Dilutional hypo-
proteinemia is present in hypervolemia.
If secondary to dehydration, the amount of protein due to hemo-concentration is
determined.
(Answer D)
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LIQUID, ELECTROLITE BALANCE AND DISORDERS
LIQUID, ELECTROLITE BALANCE

AND DISORDERS
one. A 54-year-old male patient was admitted to the emergency department with
nausea and vomiting.
On physical examination, pulse rate was 44 / min and arrhythmic, and blood pressure
was 90/60 mmHg.
It is found to be present. In laboratory examinations urea 240 mg / dL, creatinine
12 mg / dL, sodium 128
mEq / L and potassium 7, 2 mEq / L.
In order to prevent cardiac arrest, this patient should first
It should be applied? (September 2011)
A) Emergency hemodialysis
B) Intravenous calcium gluconate
C) Insulin / Dextrose
D) Oral potassium-sparing resin
E) Sodium bicarbonate
The question seems to be the co-production of nephrology and cardiology. The
patient is a classic kidney failure hyperkalemia case question. Patients will also
have arrhythmic bradycardic hyperkalemia.
The usual heart stops at diastole. So let's get calcium and start the heart first.
First dialysis of Ca gluconate, definitive treatment.
(Answer B)
2nd. In order to diagnose hypertonic hyponatremia
level should be measured? (April 2010)
A) Glucose
B) Potassium
C) Bicarbonate
D) Calcium
E) Phosphorus
Causes of hypertonic hyponatremia

Hyponatremia due to increased serum osmolarity
a. Psodohyponatremia: It is seen in paraproteinemia, hyperproteinemia and
hyperlipidemia.
b. Hyperosmolar hyponatremia: Generally due to hyperglycemia and sometimes IV
mannitol
develops (sodium decreases 1.6 mEq / L at an increase of 100 mg / dL in glucose).
(Answer A)
3. Which of the following is not one of the signs of chronic severe hypopotasemia?
(April 2007)
A) Shortening of PR distance in ECG
B) Hypoventilation
C) Rhabdomyolysis
D) Paralytic ileus
E) Nephropathy

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INTERNAL MEDICINE
The clinical and laboratory conditions of hypokalemia are as follows.

Neuromuscular system:
- Fatigue, fatigue,
- Muscle cramps,
- Spreading paralysis from bottom to top
Symptoms of GIS:
- Constipation, paralytic ileus
Respiratory system:
- Paralysis of respiratory muscles
Muscles:
- Rhabdomyolysis
Cardiovascular system:
- ECG: U wave, P wave amplitude increase, ST depression, T wave flattening
- The first finding is T flattening.
Kidney: antagonizes the effect of ADH, polyuria, polydipsia.
Loss of chlorine. Causes metabolic alkalosis.
Another clue after this question is that both hyperkalemia and hypokalemia prolong
the PR distance.
(Answer A)
4. Plasma osmolality in which of the following conditions cause hyponatremia
It is high? (April 2006)
A) Uncontrolled diabetes mellitus
B) Mannitol administration
C) Gastrointestinal fluid and sodium loss
D) Primary polydipsia
E) Glucocorticoid hormone deficiency
Asked with 2 correct answers.

hyponatremia
Plasma Na is less than 135 meq / l. It is the most common electrolyte disorder.
False hyponatremia: Occurs in hyperlipidemia, hyperglycemia and paraproteinemias.
Devices measure lower than normal.
one. Hypovolemic hyponatremia
Prerenal: Urine sodium <10 mEq / L: Vomiting, diarrhea, burns, peritonitis,
pancreatitis.
Renal: Urine sodium> 20 mEq / L: Salt-losing nephritis, diuretic use and osmotic
diuresis.
Clinic: There are signs of hypovolemia.
Treatment: In hypovolemic hyponatremia, since circulating volume and sodium are
low, treatment is started with isotonic fluid. If successful, 3% sodium is given.
2nd. Eutolemic hyponatremia
Total body water and intravascular volume increased. Serum sodium decreased
diluently.
The prototype is inappropriate ADH syndrome. Sodium is low.
Causes: Glucocorticoid deficiency, hypothyroidism and inappropriate ADHS.
Clinic: There are signs of brain edema.
Treatment: Fluid limitation, democlosicline, lithium can be used. Sodium may be
used as a last resort.
436
3. Hypervolemic hyponatremia
Both fluid increased and sodium increased. But the increase in fluid is more.
Reasons:
Prerenal: urine sodium <10 mEq / L: CHF, nephrotic syndrome, cirrhosis
Renal: Urine sodium> 20 mEq / L: seen in ARF and CRF.
Treatment: Furosemide group is given diuretics.
General clinical symptoms of hyponatremia are the degree of hyponatremia, the rate
of development and the underlying
cause varies. The most common symptoms are brain edema. Nausea,
gastrointestinal symptoms such as loss of appetite are seen primarily. Later,
lethargy, apathy, disorientation, agitation, convulsions, Cheyne stokes respiration
and coma are seen.
Sodium requirement is calculated by the following formula;
Total requirement = (Normal sodium - Patient sodium) x 0.6 x Weight
Sodium to be given in 24 hours = (Targeted sodium - Patient sodium) x 0.6 x Weight
Hyponatremia should be corrected slowly. Not more than 0.5 meq / l / hour or 12 meq
/ l / 24 hours.
If sodium is raised rapidly, it causes demyelination in the puncture.
(Answers A and B)
5. Which of the following conditions has decreased urinary potassium excretion?
(April 2005)
A) Chronic metabolic alkalosis
B) Proximal renal tubular acidosis
C) Ureterosigmoidostomy
D) Bartter syndrome
E) Adrenal cortex insufficiency

In adrenal cortical insufficiency (Addison's disease) aldosterone is reduced. Water
and sodium are discarded. Potassium
It kept. Because potassium is retained, urine potassium is reduced.
(Answer E)
6. In the physical examination of a patient who was severely dehydrated; 124 mEq /
L, potassium: 3.7 mEq / L, urine sodium: 43 mEq / L and
urine density was found to be 1011. In this patient, the most likely diagnosis
leading to this condition
A) Excessive diarrhea
B) Pancreatitis
C) Ileus
D) Cirrhosis
E) Chronic renal failure
Urine sodium is above 20 mEg / L and urine density is 1011 (isostenuria).
suggest that it is kidney-derived. Low serum sodium may cause salt loss
It suggests that it developed as a result of a situation. These include cystic
kidney disease, obstructive uropathy, reflux
nephropathy and tubulointerstitial disease.
These patients should be given additional salt treatment. Unless systemic or
pulmonary edema develops
need to continue treatment.
(Answer E)
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INTERNAL MEDICINE
7. Which of the following is not used to treat hyperkalemia? (April 2001)

A) Glucose + insulin
B) Bicarbonate
C) Calcium
D) Kayekselat
E) Beta blocker
Hyperkalemia; Most of the potassium is in the cell and the intracellular potassium
passes into the plasma,
Significantly affects the plasma potassium concentration. Na + / K + ATPase
potassium cell
it also transports sodium out of the cell.
Causes of Hyperkalemia;
• Increased purchase
• Tissue destruction
• Bleeding
• Hemolysis
• Rhabdomyolysis, catabolic conditions
• Leakage of potassium outside the cell
• Tissue damage (ischemia, shock)
acidosis:
• Insulin deficiency
• Aldosterone deficiency
Beta-adrenoreceptor antagonists
• Extracellular fluid hypertension
• Insufficient excretion
• Kidney failure
• Inadequate tubular potassium secretion (systemic lupus erythematosus,
amyloidosis,
Aldosterone antagonists
• Addison's disease
• NSAI
• ACE inhibitors
Treatment, 10% calcium gluconate, glucose and insulin, salbutamol, calcium resonium
(kayekselat),
sodium bicarbonate. If there is no result, hemodialysis / hemofiltration or
peritoneal dialysis is performed.
(Answer E)
8. Which of the following diuretics can cause metabolic alkalosis? (April 2000)
A) Thiazides
B) Triamteren
C) Amiloride
D) Acetazolamide
E) Ciprofloxacin
Thiazide diuretics lead to electrolyte imbalance. In particular, it causes
hypokalemia, hyponatremia and hypochloremic metabolic alkalosis. Serum urate for
competing against the same organic acid carrier
level. They may cause hyperglycemia, especially in diabetics. Sometimes
hypersensitivity reactions may be observed.
(Answer A)
438
9. Which of the following increases renin release? (September 99)

A) Alpha adrenergic agonists
B) Angiotensin II
C) NSAIDs
D) Hyperkalemia
E) Hypokalemia
From the juxtaglomerular apparatus localized between afferent and efferent
arterioles of renin glomeruli
is a hormone secreted. The secreted renin activates the renin-angiotensin-
aldosterone system.
Decreased arterial pressure, decreased sodium reaching the cortex, increased sodium
in the distal tubule, sympathetic
stimulation of activity hyperkalemia increases renin release.
(Answer D)
10. Which of the following does not occur in hypercalcemic nephropathy? (September
96)
A) Kidney stones
B) Normal renal perfusion
C) Urine pH increase
D) Combined renal tubular disease
E) Normal glomerular filtration rate
In hypercalcemic nephropathy, a decrease in nephrotic pH (which forms an acidic
environment) may cause pyelonephritis or tubulointerstitial nephritis. Renal
perfusion and glomerular filtration rate may be normal. Full
glomerular filtration rate decreases in renal perfusion after obstruction.
(Answer C)
11th. Which of the following increases urinary potassium excretion? (April 96)
A) Hyperaldosteronism
B) Metabolic alkalosis
C) Spironolactone
D) Angiotensin II inhibitor
E) Beta-blocker
Hypopotasemia occurs in metabolic alkalosis, while indirect urinary excretion
decreases. spironolactone
potas-yum and thus makes hyperpotasemia. Angiotensin II inhibitors again
aldosterone
antagonism and potassium uptake may cause hyperpotasemia. In beta blockers, they
reduce renin secretion, and thus again aldosterone sodium to keep the task of
removing potassium
they cause hyperpotasemia.
(Answer A)
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INTERNAL MEDICINE
12. A chronic alcoholic patient with convulsions is brought to the emergency

department. Serum
nystagmus and atetoid movements in the patient with low calcium and high phosphate
has. Which of the following would you consider first in this patient? (September
95)
A) Pseudohypoparathyroidism
B) Destruction of parathyroids by metastasis
C) Idiopathic hypoparathyroidism
D) Vitamin D deficiency
E) Hypomagnesemia
Hypomagnesemia is very common in alcoholics. Chronic alcoholic, convulsion and
serum
calcium, phosphate values and nystagmus and atetoid movements suggest
hypomagnesemia. The most common cause of hypomagnesemia is protein calorie
malnutrition. Inadequate in chronic alcoholism
It is due to excess magnesium loss in the urine along with magnesium intake.
Hypocalcemia, hypopotasemia and hyperphosphatemia are observed in the patient with
hypomagnesemia. Drowsiness in the clinic,
nausea, vomiting, weakness, nystagmus, neuromuscular irritability and tonic-clonic
seizures in later stages. IV magnesium salts are given for treatment.
Causes of magnesium deficiency
The underlying mechanism
Clinical status
Protein-energy malnutrition
Low reception
Long-term administration of magnesium-free intravenous fluid

Chronic diarrhea (malabsorption, laxative)
Loss with GI tract
Fistula, Aspiration of Gl content

Extrarenal factors affecting kidney
Drugs: Loop diuretics, gentamicin, cisplatin
ketoacidosis
Chronic alcoholism
Primary or secondary
aldosteronism
Lost in urine
Kidney Disease
Gitelman syndrome, Post obstructive diuresis
Diuretic phase of acute tubular necrosis
Renal tubular acidosis
Various acute pachretitis
Excess lactation
Diabetes mellitus
(Answer E)
13. In the patient with cirrhosis who did not improve the acid despite the salt-
free diet
which one do you use? (September 95)
A) Ethacrinic acid
B) Acetazolamide
C) Thiazide
D) Spiranolactone
E) Mannitol
440
In spite of unsalted diet, the patient could not correct the acid;
•
Liquid is restricted
Albumin replacement
Diuretic added
Secondary hyperaldosteronism has a major role in the etiology of ascites in

cirrhosis. So diuretics
spironolactone, which is an aldosterone antagonist.
(Answer D)
14. Hypopotasemia occurs in which of the following diseases? (September 95)
A) Addison's disease
B) Congenital adrenal hyperplasia
C) Bartter syndrome
D) Rabdomyolysis
E) Aldosterone synthesis defect
Henle is the dysfunction of the handle of the handle. Bartter syndrome occurs as a
result of juxtaglomerular hyperplasia. Secondary hyperaldosteronism occurs and
potassium is discarded while retaining sodium. eventually
hypopotasemic metabolic alkalosis occurs. However, while potassium is excreted in
the urine, it is excreted in hydrogen. This
It is called paradoxic aciduria. Spironolactone, NSAID drugs, B blockers and
Angiotensin II
antagonists are used.
(Answer C)
15. The most common cause of hypertension leading to a decrease in renin levels is
A) Renovascular hypertension
B) Primary hyperaldosteronism
C) Terminal period chronic renal failure
D) Pheochromocytoma
E) Essential hypertension
Primary hyperaldosteronism (Conn syndrome): Adrenal adenoma (65%), idiopathic
bilateral hyperplasia (30%), unilateral adrenal hyperplasia or adrenocortical
carcinoma
and excessive aldosterone secretion. HT (usually mild), Hypokalemia (nocturia,
weakness, polyuria, polydipsia, paresthesia, muscle weakness), Alkalosis, Postural
hypotension and reflex
tachycardia (due to blinding of baroreceptors due to severe hypokalemia), Latent
tetany
(due to alkalosis), Plasma color is low, (distinguishes from secondary
hyperaldosteronism), 24
hourly urine aldesterone is high (the best test for aldesterone excess). Despite
the alkalosis,
There is paradoxical aciduria because hydrogen secretion increases.
(Answer B)
441
INTERNAL MEDICINE
442
ACID - BASE BALANCE AND DISORDERS
ACID - BASE BALANCE

AND DISORDERS
one. Chronic obstructive pulmonary disease exacerbation
arterial blood gas analysis; pH: 7, 30, PaO2: 50 mmHg, PaCO2: 55
mmHg and HCOs: 25 mEq / L.
What is the acid-base balance disorder in this patient? (September 2011)
A) Chronic respiratory acidosis
B) Acute respiratory acidosis
C) Metabolic acidosis
D) Acute respiratory alkalosis
E) Chronic respiratory alkalosis
I wish all the acid and base questions were short-cut like blood gas of acute
exacerbation of COPD, though
question. Because there is nothing compensated nor simple type of things. Acute
exacerbation of the head
will be acute anyway. It is also clear that blood gas acidosis will be respiratory
in the lung patient. Finally
Let us keep in mind,
HCO3 normal value 22-26 mEq / L
PCO2: 35-45 mmHg
PO2: 75-95 mmHg
Ph: 7. 35-7. 45
(Answer B)
2nd. Which is one of the findings of classical distal (type 1) renal tubular
acidosis?
A) Hypopotasemia
B) Normal anion exposure
C) Urine pH higher than 5.5
D) Nephrolithiasis
E) Hypercalcemia
Renal tubular acidosis type I:
one. Classical distal renal tubular acidosis: (type 1, gradient dependent)
Pathogenesis: Distal acidification defect.
The secretion of the hydrogen ion is impaired. Hydrogen ion accumulates in the
body. Non anion gap metabolic
acidosis occurs.
Instead of hydrogen ion, potassium, calcium and citrate are lost. Blood citrate
level drops
Hypochloremic hypokalemic metabolic acidosis occurs as a result of potassium loss
due to renal tubular acidosis type II.
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INTERNAL MEDICINE
Nephrocalcinosis and nephrolithiasis develop due to calcium loss. Hypocalcemia

occurs. Hypercalcemia is not seen.
Secondary hyperparathyroidism due to hypocalcemia develops. Rarely causes
osteomalacia and rickets
It happens.
Diagnosis: A patient with metabolic acidosis is diagnosed with a urine pH of 5.5.
2nd. Proximal renal tubular acidosis Type II (Fanconi syndrome)
• Since the lesion is located proximal to the tubule, the defect is still present
by the handle and collecting channels.
compensated. Therefore, the clinic is lighter.
•
The main pathology is disruption of the reabsorption of bicarbonate from the

proximal tubule.
Fanconi syndrome: reabsorbed from the proximal tubule with bicarbonate

If the absorption of sodium, potassium, chlorine, calcium, phosphorus, glucose and
amino acids is impaired, the name of the disease is Fanconi syndrome.
3. Renal tubular acidosis type IV: Hyporeninemic hypoaldosteronism: Aldosterone

deficiency or
develops due to aldosterone resistance. Sodium, chlorine and water are discarded,
potassium is kept. renal
is the only tubular acidosis with hyperpotasemia.
Hyperkalemic metabolic acidosis occurs due to this.
(Answer E)
Differential diagnosis in renal tubular acidosis
Type I
Type II
Type IV
Test
(Distal RTA)
(Proximal RTA)
(Hyperkalemic Type)
Serum HCO3
Severe
Usually moderate
Light
(10 mEq / L ↓)
(14-18 mEq / L)
(15-20 mEq / L)
Serum K +
Moderate or severe ↓
Moderate ↓
Moderate or severe ↑
Serum Cl
Aminoaciduria,
phosphaturia
Osteomalasia
nephrolithiasis
nephrocalcinosis
+ -
+ -
F HCO3 Excretion
<5%
> 15%
<15%
During acidosis
> 6
<5,5
<5,5
> 5,5
<5
<5,5
Urine pH
Urine pH with NH4Cl loading
3. Which acid-base disorder is expected in a patient with excessive nausea and

vomiting? (September 2002)
A) Hyperchloremic-Hypokalemic metabolic acidosis
B) Hyperchloremic-Hyperkalemic metabolic acidosis
C) Normochloremic-Normokalemic metabolic acidosis
D) Hypochloremic-Hypokalemic metabolic alkalosis
E) Hypochloremic-Hyperkalemic metabolic alkalosis
444
METABOLIC ALKALOSIS
It is less common than metabolic acidosis. Plasma bicarbonate level increases, [H
+] decreases and compensation
due to slight increase in PaCO2. Plasma HCO3 increases in healthy individuals,
filtered HCO3,
load exceeds tubular reabsortive capacity and urinary excretion of HCO3- increases
rapidly. This
therefore, metabolic alkalosis is very difficult when renal function is normal.
The most common causes of metabolic alkalosis are:
The underlying mechanism
•
Sodium, chlorine, hydrogen and water loss (extracellular fluid volume depletion)
Clinical status
•
Vomiting or aspiration of gastric contents
•
Congenital chloridonea 1
Use of diuretics (Thiazides, furosemide, bumetanide)
Excessive mineralocorticoid activity

•
Primary aldosteronism
Cushing's syndrome
Bartter syndrome
Adrenal enzyme defect
Secondary aldosteronism
Giving licorice
carbenoxolone
Exogenous alkali administration

•
Oral or IV HCO3 citrate
Gluconate acetate lactate administration

(Answer D)
4. Serum sodium level 140 mg / L chlorine: 103 mEq / L and serum bicarbonate value
13
Anion gap of a patient with mEq / L as mEq / L
A) 18
B) 20
C) 22
D) 24
E) 26
The anion gap = Na- (HCO3 + Cl).
Anion gap = 140 - (103 + 13)
Anion gap = 24
(Answer D)
5. In which of the following metabolic acidosis conditions is the anion gap normal?
(September 2001)
A) Hypovolemic shock
B) Aspirin intoxication
C) Renal tubular acidosis
D) Diabetic ketoacidosis
E) Methanol intoxication
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INTERNAL MEDICINE
Causes of Metabolic Acidosis;

Normal Anion Gap
•
Bicarbonate losses
Extra-renal
Small bowel drainage

Diarrhea
•
renal
Proximal renal tubular acidosis

Carbonic anhydrase inhibitors
•
Inability to regenerate bicarbonate
Distal renal tubular acidosis
Aldosterone deficiency
Addison's disease
Hyporeninemic hypoaldosteronism
•
Insensitivity to Aldosterone
Interstitial renal disease
Aldosterone Diseases
my Üreteroileosto
Acidifying salts
Ammonium chloride
Lysine and arginine hydrochloride
Diabetes mellitus (healing phase)
Increased conditions;
•
Reduction in acid excretion
Renal failure
Overproduction of acids
ketoacidosis
-
diabetic
Alcohol-bound
Hunger
•
Lactic acidosis
Taking toxins
-
Methanol
Ethylene glycol
salicylates
paraldehyde
Isopropyl alcohol
(Answer C)
446
6. PH: 7.49, PCO2: 40 in a patient with hypertension and on thiazide diuretics

mmHg, PO2: 75 mmHg.
Which of the following is true in this patient? (September 99)
A) Metabolic Alkalose
B) Respiratory Alkalose
C) Respiratory Acidosis
D) Metabolic Acidosis
E) Hyperchloremic metabolic acidosis
Thiazide group diuretics increase the intake of salt and water into the collecting
channels, and this increase in potassium and
It increases the renal secretion of hydrogen and causes hypokalemic metabolic
alkalosis. This
toxicity is indicative of the magnitude of the diuretic effect and reversed by
replacement of potassium and correction of hypovolemia.
(Answer A)
7. Na: 139 mg / dl K + 2.9 mg / dl, HCO3: 38 mg / dl and pH: 7.51 urine Na: 10 Cl-:
85 K +: 60
In a patient with urine density 1017, which of the following would you consider?
(April 99)
A) Use of diuretics
B) Vomiting
C) Hypoventilation
D) Aspirin use
E) Lead intoxication
Combination of metabolic alkalosis and hypokalemia in a normotensive, non-edematous
patient
Bartter syndrome, magnesium deficiency, vomiting, exogenous alkali intake or
diuretics.
may be connected.
If urine alkali, urine sodium, potassium increased, chlorine decreased, diagnosis
vomiting or alkaline substance
It is buying. If urine acid and sodium potassium and chlorine are low
concentrations,
vomiting, posthypercapnic condition or prior diuretic intake.
On the other hand, if urine sodium, potassium, chlorine concentrations are not
decreased, the diagnosis is magnesium.
deficiency, Bartter syndrome or still diuretic use. The patient had normal serum
sodium,
potassium decreased, HCO3- increased, chlorine decreased. Excretion of sodium and
chlorine in urine decreased. Metabolic alkalosis is present.
This picture of the patient, HCl loss with vomiting, extracellular fluid loss (loss
of gastric juice with NaCl)
It was formed. Potassium deficiency due to secondary aldosteronism rather than loss
with gastric fluid
developed as a result of loss of potassium from the kidney. If the table occurs as
a result of diuretic use,
loss of sodium and chlorine would be expected.
(Answer B)
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INTERNAL MEDICINE
8. Which of the following is the electrolyte excreted from the kidneys in

respiratory alkalosis? (April 99)
B) Na +
A) K +
C) Cl-
D) H +
E) Mg ++
In respiratory alkalosis, renal response is slow but important. Persistent

hypocapnia
leads to HCO3-loss in urine. Bicarbonaturia occurs in the first 2-3 hours of
respiratory alkalosis
however, it does not increase to the maximum level before 2-3 days. As HCO3-
reabsorption decreases, hydrogen secretion from the kidney decreases and cell pH
increases. Hydrogen lowers plasma HCO3,
Increases CO2. Every 10 mmHg increase in pCO2 decreases plasma HCO3 by 5 mEq / L.
In chronic hypocapnia, chlorine is used to maintain electroneutrality instead of
discarded bicarbonate.
will be absorbed, chlorine with sodium + will be kept and potassium will be
discarded.
(Answer A)
9. In a patient with hypochloremic-hypokalemic metabolic alkalosis, which diuretic
is the side effect of your diagnosis? (September 96)
A) Thiazide
B) Acetazolamide
C) Triamterene
D) Spironolactone
E) Amiloride
Triamteren, spironolactone and its derivatives are potassium-sparing and cause

hyperpotasemic acidosis
can. Acetozolamide excretes potassium, hypopotasemia due to HCO3-clearance
potassium, hypo
HCO-3 and compensatory hyperchloremic acidosis occur.
Thiazides throw sodium. It is excreted in sodium and potassium and chlorine.
Hydrogen secretion
a relative reduction occurs. This leads to hypochloremic, hypopotasemic,
hyponatremic and hypercalcemic acidosis.
Loop diuretics and thiazides cause metabolic alkalosis.
(Answer A)
10. What is your diagnosis in a patient with metabolic acidosis without anion
deficit? (April 93)
A) Methanol intoxication
B) Salicylate intoxication
C) Diabetic ketoacidosis
D) Hyperchloremic acidosis
E) Lactic acidosis
The anionic GAP is calculated by the formula Na - (Cl + HCO3). The normal range is
8-12.
There are two main causes of acidosis without anion deficit;
one. → Chlorine excess
2nd. → Loss of HCO3
Causes of Acidosis According to Anion Gap
Normal Anion Gap
(HCO3-rich liquids are lost)
a. Diarrhea
b. Pancreatic or biliary drainage or fistulas (loss of HCO3)
c. Hyperparathyroidis
D. Acetazolamide use
to. Total parenteral nutrition (amino acid)
f. Renal tubular acidosis
448
g. HCl use or oral exposure,

h. Oral CaCl2
I. Obstructive uropathy,
j. hypoaldosteronism
Increased Anion Gap
·
Occurs as a result of exposure or increase in acid load in organic structure

a. Ketoacidosis (diabetes, hunger, alcohol)
b. Lactic acidosis (shock, tissue perfusion “oxygenation” disorders)
c. Uremia
D. Salicylate, methyl / ethyl alcohol, ethylene glycol and paraldehyde poisoning
Chronic renal failure

(Answer D)
11th. Your diagnosis in a patient with urine pH 6.5 and nephrocalcinosis is

A) Distal tubular acidosis
B) Proximal tubular acidosis
C) Hypophosphatasia
D) Vitamin D resistance rickets
E) Familial rickets
Distal type RTA (Type 1 renal tubular acidosis); H + secretion was decreased in the
distal tube. hypokalaemia
and symptoms of acidosis. Phosphaturia-related rickets, hypercalciuria and
nephro-rocalcinosis. The urine pH is above 5.5.
(Answer A)
12. Urine pH <5.5 and diagnosis in a patient with rickets and aminoaciduria
A) Fanconi syndrome
B) Cystinuria
C) Distal tubular acidosis
D) Chronic renal failure
E) Type 4 renal tubular acidosis
Distal type RTA (Type 1 renal tubular acidosis); H + secretion was decreased in the
distal tube. hypokalaemia
and symptoms of acidosis. Toluene, amphotericin B, lithium, Sjogren's syndrome,
hypergammaglobulinemia (Multiple myeloma) and sickle cell disease.
Proximal Type RTA (Type 2 renal tubular acidosis); HCO3 absorption defect in
proximal tubules
develops depending on. It goes with hyperchloremic and hypokalemic metabolic
acidosis. Often Fanconi
syndrome (proximal tube defects, glycosuria, uricosuria, phosphaturia, osteoporosis
/ osteomalacia;
aminoaciduria), myeloma, cystinosis (not cystinuria), lead, tetracycline and
acetazolamide
is associated with.
Proximal type urine pH may decrease below 5.5 (proximal type urine acidification
does not deteriorate),
In distal type, urine pH does not decrease below 5.5.
(Answer A)
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INTERNAL MEDICINE
450
KIDNEY FAILURE
KIDNEY FAILURE
one. The probability of developing anuria in the following acute renal failure
conditions
is the lowest? (May 2011)
a)
Acute tubular necrosis due to septic shock
B) Bilateral acute cortical necrosis

C.)
Fast progressive glomerulonephritis
D)
Bilateral renal artery occlusion
TO)
Radiocontrast nephrotoxicity
Again, the question of logic rather than information. Acute tubular necrosis in all
other forms
it's either itself or its reasons. However, in case E, he says radio-contrast
nephrotoxicity. Of course
ATN can do anuria, very low rate. After all, all drugs that are nephrotoxic
opaque materials would not be possible if we used frequent anuria. Attention when
reading the question
A question that shows that it is important.
(Answer E)
2nd. A 42-year-old man with numbness and muscle cramps in his hands and feet for
the past year.
Trousseau sign was positive in the examination of the female patient. Lab
Hemoglobin level 9.8 g / dL, serum calcium level 7.1 mg / dL,
serum phosphorus level was 5.6 mg / dL and serum parathyroid hormone level was 140
pg / ml (normal: 10-65 pg / ml).
What is the most appropriate diagnostic approach for this patient?April 2010)
a)
Bone densitometry
B)
Tc99m sestamibi parathyroid scintigraphy
C.)
Determination of urinary cyclic adenosine monophosphate level
D)
Determination of serum magnesium level
TO)
Determination of serum creatinine level
Paresthesias, muscle cramps, Trousseau sign (midwife hand formation when blood
pressure cuff swells) are all signs of hypocalcemia. Already in order to extend the
question of low calcium, high in phosphorus
It is given. Has the patient undergone thyroid surgery? parathormon thinking
given high level. So we want to know that the cause of secondary
hyperparathyroidism is CRF.
(Answer E)
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INTERNAL MEDICINE
3. The following physical examination findings in a patient with acute renal

failure
which is an indication for emergency dialysis treatment? (September 2009)
A) Pericardial frotment
B) Bilateral pretibial 2+ edema
C) Coarse crackles in both lungs
D) Increased intensity of heart sounds and S4 hearing
E) Hepatomegaly with costa crossing 2 cm
Indications for acute renal failure dialysis
The presence of uremic symptoms in ARF alone is indicated for dialysis, while other
conditions include nonresponsiveness to medical treatment.
Indications for dialysis in ARF
Therapy resistant K height
Treatment-resistant heart failure
Treatment-resistant metabolic acidosis
Treatment-resistant hypervolemia
Uremic lung, pericarditis, encephalopathy and bleeding diathesis
The crucial point in this question has hidden the uremic pericarditis in the
frotman. Why FROTMAN
The sound of pericardial friction is typical for pericarditis. Nice question....
(Answer A)
4. The presence of one of the following in a patient with renal dysfunction as
strong evidence for the diagnosis of chronic renal failure
Evaluated? (April 2008)
A) Hyperphosphatemia
B) Hypercalcemia
C) Osteitis fibrosis
D) Anemia
E) Hyperkalemia
Symptoms and signs of uremic bone disease in the patient rather than electrolyte
disorder
strong evidence. Already B is an atmation. Hypocalcemia occurs in CRF.
Useful findings in the distinction of acute and chronic renal failure
Finding
comment
Previously known creatinine height

The most reliable finding of CRF
Kidney sizes small
KRG
Daily increase of oliguria and urea / cretin
Acute exacerbation in ARF or CRF
Eye band keratopathy
KRG
my normocytes
ARF
Subperiostal erosion
KRG
Chronic symptoms and signs
KRG
(Answer C)
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KIDNEY FAILURE
5. Which of the following is not a cause of hypocalcemia in chronic renal failure?

(September 2006)
B) Reduction in active vitamin D
C) Reduction in calcitriol production
D) Impairment of intestinal calcium absorption
E) Hypercalciuria
Electrolyte imbalances in CRF are indicated below. Causes of low serum calcium
Hyperphosphatemia, vitamin D metabolism disorders, parathyroid disorders are the
most important causes.
Serum potassium: High (total body potassium may be less).
Serum sodium: Low, even in the last period can be kept within normal limits.
Acidosis: It has a high anion opening acidosis.
Calcium: Hypocalcemia tendency, secondary and tertiary hyperparathyroidism, PTH
resistance may be. In the proximal tubule, vitamin D cannot be converted to active
form. Vitamin D deficiency may develop.
Phosphate: High. Hyperphosphatemia is the most important cause of renal
osteodystrophy.
Magnesium: High.
Aluminum: High. The phosphorus binder depends on the use of aluminum as an antacid.
Depending on aluminum, the following develops:
a. dementia,
b. Bone disease,
c. Hypochrome microcytic anemia.
(Answer E)
6. Which diet should be included in an advanced chronic renal failure patient?
(April 2006)
A) Vitamin A
B) Essential amino acid
C) Potassium-rich foods
D) Foods rich in saturated fatty acids
E) Foods rich in phosphorus

Treatment of chronic renal failure:
one. Treatment of phosphate height: calcium carbonate (best), calcium acetate,
aluminum
poor diet of hydroxide and phosphorus,
2nd. Hypocalcemia: Calcium carbonate is the best treatment option.
3. Height of uric acid: Allopurinol,
4. Congestive heart failure: It is due to hypervolemia. Dialysis treatment is
ideal. Serum
ACE inhibitors are not given to creatine levels above 3 mg / dl.
5. Hypertension: Direct vasodilator drugs can be given. Hydralazine, minoxidil.
6. Hyperlipidemia: Gemfibrozil and HMGCoA reductase inhibitors may be given.
Saturated fat
poor diet of acids.
7. Anemia: Erythropoietin, iron, folate and vitamin B12 replacement should be
performed.
8. Dialysis dementia: No phosphorus binders containing aluminum.
9. Treatment of uremic hemorrhage diathesis: 25 micrograms of desmopressin is given
as an infusion every 8-12 hours.
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INTERNAL MEDICINE
10. Pruritus: Parathyroidectomy is performed in cases of low phosphorus level and

resistant cases.
11th. Diet: contains 0.6 g / kg of protein, 60% of which must be rich in essential
amino acids.
12. Dialysis: In cases where uremic symptoms cannot be controlled by conservative
treatment, dialysis and
transplantation treatment is planned if possible.
(Answer B)
7. Which of the following radiological imaging of the kidney
not expected to be? (September 2005)
A) Polistic kidney disease
B) Acute renal vein thrombosis
C) Leukemic infiltration of kidney
D) Amyloidosis
E) Hypertensive nephropathy
Kidneys are small in chronic renal failure.
TUS likes exceptions:
Amyloidosis
Leukemic infiltration
scleroderma
Diabetes mellitus
hydronephrosis
Myeloma kidney
Polycystic kidney
In cases of acute renal vein thrombosis, the kidney is large.
(Answer E)
8. Which of the following drugs may lead to acute tubular necrosis leading to renal
failure?
is the highest risk of exposure? (September 2004)
A) Ciprofloxacin
B) Cefotaxime
C) Rifampin
D) Amphotericin B
E) Penicillin G
Amphotericin B is an effective agent especially in systemic fungi (especially

aspergillus). Most important side effects
Acute tubular necrosis.
(Answer D)
9. What is the most common cause of death in ARF? (April 2004)
A) Hyperkalemia
B) Respiratory failure
C) Heart failure
D) Infection
E) Bleeding
Currently, infection is the most common cause of death in patients with acute renal
failure. Spot the question to our business
It will work.
(Answer D)
454
KIDNEY FAILURE
10. In patients with acute renal function loss

does it suggest that a glomerular pathology plays a role? (September 2003)
A) Fractionated sodium excretion <1
B) Spot urine sodium <10 mEq / L
C) Eosinophiluria
D) Erythrocyte silencers
E) Use of aminoglycosides
URINARY CYLINDERS
Tamm-Horsfall protein; granular and cellular elements.
Tamm Horsfall protein is the protein produced from the distal tubules and the
ascending arm of the handle.
Its task is to prevent invasion of bacteria into the urinary system.
Hyaline silencers: Exercise, congestive heart failure, kidney diseases
Erythrocyte cylinders: Acute glomerulonephritis, cortical necrosis
Leukocyte cylinders: Acute pyelonephritis, interstitial nephritis
Wax waxers: Acute glomerulonephritis, Acute tubular necrosis
Fat wipers: Nephrotic syndrome
Large cylinders: Chronic renal failure, prerenal azotemia
(Answer D)
11th. Which of the following conditions is the most common cause of acute renal
failure? (September 2002)
A) Prerenal azotemia
C) Acute interstitial nephritis
D) Acute tubular necrosis
E) Postenal azotemia
Crowd attention question:

ARF is the most common cause of prerenal hypovolemia. If renal were the most common
cause, then the answer was acute.
tubular necrosis.
(Answer A)
12. A 19-year-old female patient complaining of dyspnea for 2 days
References. Gallop rhythm in the heart in physical examination, widespread
crepitant in the lungs
Rales and bilateral pretibial (++) edema were detected. Serum BUN = 98, mg / dl Cre
= 5.8,
mg / dl K = 6 mg / dl and erythrocyte cylinders in urine sediment. Two days
The amount of urine is 200-250 ml per day. It was also learned that IV 200 mg
furosemide was given to the patient 4 hours ago. To this patient, which
A) Oral digital
B) Oral and parenteral digital
C) Emergency parenteral digital + 2nd dose furasemide + aminophylline
D) High dose parenteral steroid
E) Emergency dialysis
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INTERNAL MEDICINE
The patient has a history of heart failure and acute renal failure. Emergency for
heart failure
Since furosemide was given 2 hours ago,
It is important to lower it as soon as possible. Because dialysis is indicated,
emergency dialysis should be taken first and then
other treatments should be switched to.
Indications for hemodialysis:
•
Symptomatic uremia despite treatment
Fluid loading (diuretic resistor)
•
Refractory hyperkalemia (treatment resistant,> 6.5 mEq / l)
Decrease in quality of life (long-term complications, neuropathy, pericarditis)
Metabolic acidosis (treatment resistant)
• End-stage renal failure symptoms; glomerular filtration rate <10 ml / min and
serum
•
Creatinine level above 12 mg / dl
Intoxications and high dose drug intake
Treatment-resistant hyponatremia
(Answer E)
13. In the physical examination of a patient who was severely dehydrated; 124 mEq /
L, potassium: 3.7 mEq / L, urine sodium: 43 mEq / L and
urine density was found to be 1011. In this patient, the most likely diagnosis
leading to this condition
A) Excessive diarrhea
B) Pancreatitis
C) Ileus
D) Cirrhosis
Urine sodium is above 20 mEg / L and urine density is 1011 (isostenuria).

suggest that it is kidney-derived. Low serum sodium suggests that the event was
caused by a salt-losing condition. These include cystic kidney disease, obstructive
uropathy, reflux nephropathy and tubulointerstitial disease.
These patients should be given additional salt treatment. Unless systemic or
pulmonary edema develops
need to continue treatment.
Cirrhosis can be given to the question due to hyponatremia; but 1011 density
(isostenuria) chronic
renal failure. In chronic renal failure, sodium is low and potassium is high.
(Answer E)
14. Twenty-four-year-old female patient with bloody urine and small red
due to stains. She had abdominal pain for 3 days.
Learned. Laboratory tests showed erythrocyte, 1.5 g / day proteinuria in urine and
serum urea level was 68 mg / dl and serum creatinine level was 3.5 mg / dl.
2001)
B) Fulminant lupus nephritis
C) Berger's disease
D) Immune thrombocytopenic purpura
E) Henoch-Schönlein purpura
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KIDNEY FAILURE
Henoch-Schönlein characterized by arthritis, typical rash, colic abdominal pain and

renal involvement
Purpura (also known as anaphylactoid purpura), an IgA-mediated, holding small
vessels
Vasculitis. The disease occurs in school-age children and is usually accompanied by
an upper respiratory infection or
streptococcal pharyngitis.
Henoch-schönlein purpura is the most common vasculitis in childhood.
Henoch-Schönlein Purpura typically begins with urticaria-like skin rashes,
especially localized on the lower extremities and buttocks, within a few days of
progression of inflammation,
damage to the vessel walls, bleeding into the skin and palpable petechial and
purpuric rash
Results. Approximately half of the cases in addition to the rash in the hands, feet
and periorbital areas
angioedema, arthritis in 85%, GIS involvement in 60-85%, renal involvement in 10-
50%
It is seen.
HSP arthritis, especially in the lower extremities of the large joints and is
mobile. At a great rate
Heal without sequelae. GIS involvement; vasculitis and bowel wall edema
It is characterized by colic-style abdominal pain and secondary occult or gross GI
bleeding.
Invagination (usually ileocolic) is a feared complication of HSP and bowel
infarction
and may cause perforation. Renal disease, hypertension, pronounced in HSP
characterized by proteinuria and hematuria. Hypertension, prominent proteinuria and
nephrosis are poor prognostic findings of renal involvement.
The more rare findings of HSP are; scrotal edema and hemorrhage, pulmonary
vasculitis and
hemorrhage and CNS involvement.
HSP terminates within 6 weeks. Treatment is symptomatic. NSAIDs can be used to
treat arthritis.
Corticosteroids are indicated in cases with GIS involvement or complications.
(Answer E)
15. Which of the following is not involved in the metabolism of uremic disease?
(September 2000)
A) Carbohydrate intolerance
B) Triglyceride concentration increases
C) Hyperuricemia
D) High density lipoprotein increase
E) Lipoprotein (a) increase
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INTERNAL MEDICINE
Complications of uremia syndrome;

Central Nervous System
•
Unrest
Insomnia
Lethargy
Anorexia
Coma
Peripheral nervous system

•
Socks and gloves style neuropathy
Skin
•
Itching
Yellow color change
Endocrine metabolism
•
amenorrhea
impotence
hyperlipidemia
Increase in insulin resistance

•
Hipeparatiroidizm
Gastrointestinal
•
the anorexia
Nausea
Vomiting
Peptic ulcer
Gl bleeding
Gastritis
Peritonitis
pancreatitis
Acid
Cardiovascular
•
cardiomyopathy
arrhythmias
pericarditis
Hypertension
•
Heart failure
Pulmonary edema
Accelerated atherosclerosis
Anemia
Hematological-immunological
•
lymphocytopenia
Bleeding diathesis
Decreased immune resistance
An increase in lipoprotein (a) increases the risk of atherosclerosis. HDL, which

reduces the risk of atherosclerosis
level decreases.
(Answer D)
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KIDNEY FAILURE
Electrolyte changes in uremic patients

All tests are normal
GFR> 30 ml / min
Creatinine and urea elevation (first rising)
GFR <30 ml / min
Phosphorus rise, Ca fall
GFR <20 ml / min
K promotion
GFR <10 ml / min
Na and Cl falls (most recently affected)
GFR <5 ml / min

ACUTE KIDNEY FAILURE
• Sudden, rapid and potentially reversible change in renal function.
•
Almost always with uremia.
Causes of acute renal failure
Prerenal causes, renal causes, postrenal causes
Renal function is more likely to improve in renal failure.
ACUTE TUBULAR NECROSIS

•
The most common cause is rhabdomyolysis, renal ischemia develops.
Other causes are toxins and drugs.
In ischemic tubular injury, the tubular basement membrane was torn; toxic In acute
tubular necrosis, the tubular basement membrane is intact; necrosis in proximal
tubule cells
has.
Ischemic tubular injury:
Glomerular contraction
Reflex afferent arteriolar spasm
Proximal tubular dysfunction
Obstruction of tubule
Predisposing factors:
•
Heroin use
Pressure necrosis
Rhabdomyolysis with trauma and myoglobinemia and hemoglobinemia
Brown pigmented cellular cylinders and multiple tubular epithelium in 75% of

patients
cells are observed.
The most important cause of death in acute tubular necrosis is secondary infections
and
It is hyperkalemia.
Acute tubular necrosis is the most common cause of acute renal failure.
There is obstruction in pathogenesis.
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INTERNAL MEDICINE
STAGES OF ACUTE KIDNEY FAILURE

•
Oliguric period (10-14 days), polyuric period (1 week)
Recovery phase (3-12 months)
In the oliguric phase of Acute Renal Failure
Glomerular filtration rate ↓
Water-salt accumulation
•
Potassium ↑, calcium ↓, PO4- ↑
hypomagnesemia
Hyperuricemia
Normochrome normocytic anemia
thrombocytopenia
Disorders of the cardiovascular system (arrhythmia)
Neurological disorders
GIS disorders (pain, bleeding)
Metabolic acidosis
Serum urea and creatinine increased suddenly.
Renal function improves in 7-21 days.
Causes of prolonged oliguric period (> 4 weeks): senility, renal vasculitis,

diffuse cortical necrosis,
occlusive disease, rapidly progressive glomerulonephritis
In the polyuric period (10L / day), urine is dilute, electrolyte loss is high.
The first function that improves in acute renal failure is dilution ability.
•
Concentration of function most recently recovered in acute renal failure
The ability.
The main event in acute renal failure is tubular epithelial necrosis.
The most common death occurs in the polyuric period.
Acute cortical necrosis

•
It is due to renal hypoperfusion.
Glomerular filtration rate ↓
• Causes of acute tubular necrosis are severe or long-term cortical necrosis

makes
•
It is bilateral.
The most common acute renal failure is vascular endothelial system or coagulation
If the system is accompanied by disorders develops. (Hemolytic uremic syndrome,
Disseminated intravascular coagulopathy)
Medullary ischemia is healed by regeneration. Glomerular ischemia with

glomerulosclerosis
recover. Irreversible cortical necrosis develops in cortical ischemia in the long
term.
16. Which of the following causes prerenal acute renal failure? (April 99)
A) Renal cortical insufficiency
B) Acute poststreptococcal glomerulonephritis
C) Acute tubular necrosis
D) Hypovolemia
E) Renal vein thrombosis
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KIDNEY FAILURE
Causes of acute renal failure:

prerenal:
•
Fluid-electrolyte deficiency
Bleeding
Septicemia
Heart failure
Liver failure
Heat shock (myoglobinuria + - lack of liquid electrolyte)
Burn (Fluid / electrolyte deficiency + myoglobinuria and hemoglobinuria)
Postrenal: Prostatism, bladder, pelvic, retroperitoneal tumors

Renal: Acute tubular damage (ischemia, toxins, contrast agents, hemoglobinuria,
myoglobinuria)
•
Acute glomerulonephritis
Disseminated intravascular coagulopathy with cortical necrosis
Arterial - venous obstruction
Acute tubulointerstitial nephritis (hypercalcemia, urates, myeloma protein)

(Answer D)
17. Thirty years old male patient is given captopril as a treatment for
hypertension.
After a while, the patient develops renal failure.
What is the possible diagnosis in this patient? (September 98)
A) Primary hyperaldosteronism
B) Bilateral renal artery stenosis
C) Hyperthyroidism
D) Hyperparathyroidism
E) Heart failure
Renovascular hypertension is a common cause of secondary hypertension. It should be

investigated in the following cases:
one. Development of sudden hypertension
2nd. Multiple control of well controlled blood pressure becomes difficult
3. Hypertension with acute oliguric renal failure if ACE inhibitor is given
4. Hypertension showing abdominal or side pains
5. Renal insufficiency known to be atherosclerotic
6. Occurs in young people
Inhibitors of ACE and ATII antagonists with unilateral renal increases with single
kidneys or bilateral
Contraindicated in cases with renal artery stenosis and in pregnant women.
ACE inhibitors and / or ARBs are not given to pregnant women with bilateral
stenosis.
(Answer B)
18. Which of the following is not seen in renal osteodystrophy? (September 98)
B) Hypocalcemia
C) ALP increase
D) Hyperparathyroidism
E) Hypomagnesemia
Renal osteodystrophy is a metabolic bone disease. Impaired vitamin D metabolism,

decreased calcium absorption, phosphate retention, secondary hyperparathyroidism
and metabolic acidosis. Hypomagnesemia is not seen in renal osteodystrophy.
Hypermagnesemia is seen. The most common cause of hypermagnesis is renal failure.
(Answer E)
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INTERNAL MEDICINE
19. Which of the following is the decreasing hormone in plasma in chronic renal
failure? (April 98)
A) 1,25 di OH cholecalciferol
B) Glucagon
C) Gastrin
D) PTH
E) Insulin
Insulin, gonadotropic hormones, PTH, glucagon are hormones that break down in the
kidney. Chronic
increases in renal failure. Erythropoietin and 1.25 dihydroxycholecalciferol in the
kidney
and their levels are very low or absent in chronic renal failure.
(Answer A)
20. Which of the following is seen in acute tubular necrosis? (April 97)
A) Anuria or oliguria
B) Hypercalcemia
C) Hypokalemia
D) Hypernatremia
E) Low urine sodium
Acute tubular necrosis is the most common cause of acute renal failure. The most
common cause is acute
They are ischemia. It may cause drugs, urine amount, BUN and creatinine are normal,
in later stages
BUN increases creatinine, and a decrease in urine output occurs. It usually goes
below 400 cc.
Sometimes anuria may even develop. Then the patient entered the polyuric phase and
increased urine output
it occurs. This happens when the kidney gains dilution ability.
Differential diagnosis of prenetal - renal - postrenal renal failure
Disease
prerenal
renal
Postrenal
Acute
glomerulonephritis
etiology
Insufficient renal
perfusion
Ischemic or toxic
obstruction
glomerulonephritis
Bun / Creatinine
rate
> 20: 1
<20: 1
> 20: 1
> 20: 1
Urine sodium
<20
> 20
variable
<20
Fractionated Na
ekskreksiyo the
<1
> 1
variable
<1
Urine osmolarity
> 500
250-300
<400
Variable
Urine microscopy
Benign hyalene wipers
Granular and tubular

casts
Normal, erythrocytes,
leukocyte wipers
and crystals
Erythrocytes and erythrocytes

casts
Treatment
Fluid therapy
Fluid restriction
Treatment of cause
Treatment of cause
(Answer A)
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KIDNEY FAILURE
21. Which of the following is not a sign of prerenal acute renal failure?
(April 96)
A) Urine sodium excretion is above 40 mmol / l
B) Urine sediment is usually normal
C) Fractionated sodium excretion is less than 1
D) Urine osmolarity above 500 mOsm / kg / H2O
E) Urine creatinine / plasma creatinine above 40
See description for April 97
(Answer A)
22. Which of the following laboratory findings does not occur in renal
osteodystrophy? (September 95)
A) Hypoparathyroidism
B) Hyperphosphatemia
C) Hypocalcemia
D) Alkaline phosphatase elevation
E) Decrease in vitamin D levels of 1-25 (OH) 2

In renal osteodystrophy, phosphorus cannot be removed if the glomerular filtration
rate has dropped below 25 ml / min.
PTH is automatically increased to remove phosphorus. This increases osteolysis in
the bones. It's alkaline.
Phosphatase increases. Chronic renal failure is reduced by the production of
vitamin D3. Hypocalcemia as this will reduce calcium resorption from the bones and
absorption from the intestines.
it occurs.
(Answer A)
23. Which of the following is not seen in prerenal renal failure? (September 94)
A) Urine osmolarity is above 500 mOsm / lt
B) Urine sodium is above 40 mEq / lt
C) Urine / plasma creatinine above 40
D) Traces of hyaline granular silene appear in urine
E) The amount of fractionated sodium is less than 1%
(Answer B)
24. Which of the following does not occur in uremic patients? (April 94)
A) Carbohydrate intolerance
B) Increase in lipoprotein lipase activity
C) Polyneuropathy
D) Cardiomyopathy
E) Hypocalcemia
Lipoprotein lipase activity decreases in CRF. There is a tendency to
hyperlipidemia. Due to insulin resistance
glucose intolerance, ischemic or dilated cardiomyopathy, B2 microglobulin and
uremia
polyneuropathy and calcuria-induced hypocalcemia due to PTH unresponsiveness
They are conditions.
(Answer B)
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INTERNAL MEDICINE
25. Which of the following is a sign of prerenal azotemia? (September 93)
A) Urine osmolarity is less than 400
B) erythrocyte cylinders in urine
C) Fractionated sodium excretion is less than 1%
D) Plasma creatine / urine creatinine above 10
E) Urine / plasma osmolarity is less than 1.1
(Answer C)
26. The cause of carbohydrate intolerance in chronic renal failure is
A) Reduction of insulin release
B) Increased intracellular potassium
C) Insulin resistance
D) Distortion of absorption
E) Glucagon reduction
In chronic renal failure, breakdown of insulin and glucagon is also impaired. Also
uremia
Depending on the peripheral insulin resistance also develops. This results in
glucose intolerance.
(Answer C)
27. Which of the following is not a sign of prerenal acute renal failure?
(April 93)
A) Urine sodium excretion is above 40 mmol / l
B) Urine sediment is usually normal
C) Fractionated sodium excretion is less than 1
D) Urine osmolarity above 500 mOsm / kg / H2O
E) Urine creatinine / plasma creatinine above 40
Laboratory for Differential Diagnosis of Renal Failure
prerenal
renal
Urine osmolatility (mOsm / L)
> 500
<350
Urine / plasma creatinine ratio
> 40
<20
BUN / plasma creatinine ratio
> 20
<15
Urine Na (mEq / L)
<10
> 40
Fractional sodium excretion
<1%
> 3%
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KIDNEY FAILURE
Urinary Findings in Acute Renal Failure

Normal
• Prerenal ABY
• Arterial thrombosis-embolism
• HUS / TTP
• Scleroderma crisis
• Postrenal ABY
Granular silencers
• ATN
• Glomerulonephritis
• Vasculitis
• Interstitial nephritis
Erythrocyte wipers
• Glomerulonephritis
• Vasculitis
• Crystallopathies
• Malignant hypertension
Leukocyte wipes
• Acute interstitial nephritis
• Heavy pyelonephritis
Eosinophiluria (> 5% on urine microscopy)

• Allergic interstitial nephritis
• Cholesterol embolism
Telescopic urine sediment

• Lupus Nephritis
(Answer A)
28. The main cause of renal osteodystrophy in chronic renal failure
A) Decreases 1.25 (OH) vitamin D3
B) 24-25 (OH) increases vitamin D3
C) Increased parathormone release
D) Hyperphosphatemia
E) Calcium increase
The rate of glomerular filtration rate of osteodystrophy in chronic renal failure
is 30 ml / min.
when it falls below. Mainly in the development of uremic bone disease in CRF
Lack of calcium, degradation of phosphorus metabolism and the presence of metabolic
acidosis.
Stimulation of PTH and vitamin D deficiency are secondary conditions.
(Answer D)
29. Which of the following causes prerenal urea? (September 92)
A) Pregnancy
B) Ureteral stone
C) Corticosteroid
D) Cirrhosis of the liver
E) Bladder stone
During pregnancy, total body water and GFR increase, urea is low. Bladder and
ureter stones
are the cause of postrenal ARF, impaired urea synthesis in liver cirrhosis, blood
level
It is low. Corticosteroids increase muscle breakdown and proteolysis, leading to
increased urea.
(Answer C)
30. Which of the following does not increase in BUN? (September 91)
A) Liver failure
B) GIS bleeding
C) Dehydration
D) Renal failure
E) Shock
Ammonia cannot be converted to urea in liver failure, so BUN is low, not high.
All other causes cause BUN elevation due to pre-renal component.
(Answer A)
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31. Which of the following does not improve despite dialysis? (September 91)
A) Uremic lung
B) Encephalopathy
C) Renal osteodystrophy
D) Acid
E) Pericardite
When the glomerular filtration rate drops below 30 ml / min, the PO4 level now
begins to rise. This
PTH rises. However, a vicious circle is entered. Finally, renal osteodystrophy
occurs.
Brown cysts, osteoporosis, anemia, neutropenia and thrombocytopenia and
myelofibrosis
It develops. Osteodystrophy by dialysis does not improve. Uremic complications
improve with dialysis.
(Answer C)
32. The most recent renal function in acute renal failure is:
A) Concentration of urine
B) Bicarbonate reabsorption
C) Acidification of urine
D) Sodium uptake
E) Amino acid reabsorption

The most common cause of acute renal failure is pre-renal. Acute renal failure is
usually
Available in 3 periods. These;
one.
Oligo-Anuric period; urine amount is below 500 cc / day.
2nd.
Polyuric period; In the recovery period, polyuria due to solitary diuresis and
concentration defect due to hypopotasemia is seen.
3.
Recovery and recovery of urine concentration.

(Answer A)
33. The most effective treatment of hyperkalemia in acute renal failure is

A) 10% calcium-gluconate administration
B) Diuretic
C) Hydration
D) Giving bicarbonate
E) Dialysis
Hyperkalemia is a serious clinical condition especially seen in patients with renal
insufficiency. cardiac
is a serious risk factor for arrhythmias (especially ventricular arrhythmias).
Treatment: Ca Gluconate is used intravenously to antagonize membrane effects.
Sodium bicarbonate and glucose + insulin solutions are administered IV to increase
the passage of serum potassium into the cell.
Maintenance via potassium-sparing resins and oral K restriction and correction of
chronic acidosis, if any
treatment is applied. If treatment does not respond, finally dialysis (most
effective potassium-lowering)
method).
(Answer E)
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KIDNEY FAILURE
34. Which of the following is not an indication for dialysis? (September 88)
A) Acid-base disorder
B) Hyperkalemia
C) Azotemia
D) Severe edema
E) Hypoalbuminemia
Indications for Emergency Dialysis
one. hypervolemia
Unresponsive to diuretics. If there is pulmonary edema.
2nd. Uremic symptoms
Encephalopathy, pericarditis, nausea and vomiting
3. hyperpotassemia
> 6.5 mEq / L

Presence of 5.5 - 6.5 mEq / L + ECG findings
4. Hypertension
Unresponsive to antihypertensives
5. hyponatremia
If neurological symptoms are present, unresponsive to treatment.
6. Metabolic Acidosis
Treatment resistant pH <7.1
7. poisoning
Phenobarbital, bismuth, salicylate, ethylene glycol, methanol, theophylline
8. hypercalcemia
Treatment resistant
(Answer E)
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GLOMERULAR DISEASES
GLOMERULAR DISEASES
one. A 14-year-old male patient had decreased urine volume and brown discoloration
following a febrile upper respiratory tract infection one week earlier;
Periorbital and pretibial edema. Physical examination
blood pressure was 160/105 mmHg. Serum in laboratory examinations
creatinine 2.1 mg / dL, BUN: 70 mg / dL, serum potassium 5.6 mEq / L, protein in
urine
the amount of 1 g / day and urine microscopy is abundant erythrocytes, pyuria
and erythrocyte cylinders.
Which of the following is not a priority in the diagnosis of this patient?
(September 2008)
A) Bosphorus culture
B) Serum ASO titer
C) Serum complement levels
D) Renal biopsy
E) Determination of rheumatoid factor
For infection and hematuria, APSGN is probably not an issue.
ACUTE POSTSTREPTOCOXIC GLOMERULONEPHRITIS (APSGN)
Etiology:
-
Group A beta-hemolytic streptococcus occurs with nephrogenic M types (throat type

12, skin type 49).
It can be seen after both skin and throat infections. The latent period is longer
in skin infections.
Pathology:
There are subepithelial IgG and complement storage. Hump-like nodular storage
a.
creates.
b.
Neutrophil and monocyte infiltration
c.
Proliferation is seen in mesengial and epithelial cells. As a result, diffuse

glomerular lesion
It occurs. Reduction in blood flow and glomerular filtration rate due to these
three pathological changes
reduction occurs.
C3 and total hemolytic complement are low, C4 is normal and C1q is normal.
Clinic:
-
Beta hemolytic streptococcal infection occurs 6-20 days after history.
The male / female ratio is equal.
It is most commonly seen in 3-12 years old children.
There is a decrease in the amount of urine and urine in the form of meat wash
water. There are signs of hypervolemia.
(Nephritic syndrome clinic)
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Laboratory: Hematuria is the most important finding.

Diagnosis: It is made clinically and serologically. Kidney biopsy is not required
initially. 1 month pass
If there is no clinical and serological improvement, renal biopsy is performed.
Treatment:
-
Supportive therapy
Glomerulonephritis is the best prognosis. The order of improvement of the findings

is as follows; urea and creatinine
improvement, normalization of complement level, improvement of hematuria and
improvement of proteinuria
The most recent finding is proteinuria in adults. Penicillin prophylaxis is not

required.
Early complications; Hypertensive encephalopathy is CHF and RPGN.
(Answer D)
2nd. Renal biopsy is performed in a patient with hemoptysis and acute nephritic
syndrome. Light microscopy shows crescent formation in 70% of glomeruli.
immunofluorescence
In this study, linear involvement of glomerular basement membranes was observed.
2007)
A) Wegener granulomatosis
B) Lupus nephritis
C) Goodpasture syndrome
D) Berger's disease
E) Poststreptococcal glomerulonephritis
The first disease that comes to mind when hemoptysis and acute nephritic syndrome
is mentioned is Goodpasture. Acute
Pulmonary involvement and hemoptysis are not expected in poststreptococcal
glomerulonephritis.
Pathologically; Subepithelial IgG and complement storage
storage, Neutrophil and monocyte infiltration, Mesenchial and epithelial cells
proliferation
It is seen.
C3 and total hemolytic complement are low, C4 is normal and C1q is normal. Lupus
nephritis
why not.
Focal necrotizing proliferative GN in the Wegener kidney is caused. Pulmonary
involvement in Berger's disease
and hemoptysis are not typical.
Pathology: Mesenchymal IgA storage. IgG and C3 may also be stored. This
Depending;
a. There is focal or diffuse mesenchymal cell proliferation
b. Crescent formation, sclerosis, interstitial fibrosis due to release of
inflammatory mediators
It develops. As a result, glomerular filtration rate is reduced.
Hemoptysis and cough are seen in 50% of cases in Good pasture syndrome. Exercise
dyspnea, hematuria, oliguria, pallor, proteinuria are noteworthy. Causes nephritic
syndrome. Chest X-ray
Ticketeral has widespread infiltration findings. Pathological focal pathway in
Goodpasture
are proli-ferative and necrotic glomerulonephritis. In later stages, crescent
occurs. Fast-moving
glomerulo-nephritis is difficult to distinguish. Immune fluorescence along the
basement membrane and subendothelial linear
Ig G and C3 precipitate. The formation of antibodies against the glomerular
basement membrane itself
in question. There are Ig G antibodies against the basement membrane in the serum
and lung.
Anti-glomerular basement membrane antibodies produce lesions in both the lung and
renal basement membranes.
(Answer C)
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GLOMERULAR DISEASES
3. Treatment of the patient mentioned in the above question should be done first
A) Hemodialysis
C) Immunosuppressive treatment
D) Colchicine
E) ACE inhibitors
Corticosteroids, immunosuppressive therapy and plasmapheresis can be used in the
treatment of Goodpasture syndrome.
(Answer C)
4. C3 nephritic factor acting as autoantibody against C3bBb
Which of the diseases? (April 2006)
A) IgA nephritis
B) Antiglomerular basement membrane nephritis (Goodpasture syndrome)
C) Type II membranoproliferative glomerulonephritis
D) Glomerulonephritis due to Wegener syndrome
E) Henoch-Schönlein glomerulonephritis
MEMBRANOPROLIFERATIVE = MEZANGIO CAPILLERS GLOMERULONEPHRITIS (MPGN)
Etiology: They are rare. It may be associated with idiopathic, systemic diseases
and medications. Hepatitis
It can be seen in patients with C and SLE.
Pathology: Subendothelial immune complex has storage. Basal membrane
thickening, mesenchymal cells proliferation and diffuse damage occurs. This
pathological
blood flow and glomerular filtration rate decrease in glomerular capillaries.
Type 1: Immune complex disease. Storage of mesenchial and subendothelial granular
IgG and C3
It is seen. Cryoglobulinemia. Double stroke with silver paint (rail-tram track
view) capillary wall thickening can be seen. The classic complement path is active.
C3, C4, C1q
It is low. The main clinical feature is nephrotic syndrome.
Type II: Autoimmune disease is acceptable because circulating IgG antibodies from
C3 nephritic factor
(C3 convertase antibody). C4 is normal, C3, properdin and factor B are low. Dense
deposit
disease. The alternative complement path is active. Other features are similar to
type 1. Basis
The clinical manifestation is hematuria. The prognosis is poor in patients with low
C3 levels.
Clinical: Mostly nephrotic syndrome, sometimes asymptomatic microscopic hematuria,
proteinuria or
acute nephritic syndrome. Could be hypertension.
Treatment: One-third of patients develop CRF while others remain nephrotic
syndrome, with a small proportion
remission. There is no effective treatment.
(Answer C)
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5. If 1 mg proteinuria, hypertension, serum creatinine and BUN levels increase and

edema are observed in a patient who is being followed up with type I diabetes
mellitus, which of the following should be considered first? (April 2005)
A) Heart failure
B) Diabetic glomerulosclerosis
C) Arteriosclerosis
D) Pyelonephritis
E) Acute tubular necrosis
DIABETES AND KIDNEY
Hyperfiltration phase: Glomerular filtration rate increased, kidney large, no
proteinuria
Microalbuminuric phase: Glomerular filtration rate is normal or increased. The most
important finding is microalbuminuria.
The loss of albumin in urine at 30-300 mg / 24 h is considered microalbuminuria.
Intermedietal glomerulopathy: Proteinuria is evident. Blood pressure is high and
can be edema.
Advanced diabetic glomerulopathy: Azotemia, edema and hypertension. There are two
forms;
Nodular glomerulosclerosis is specific for Type 1 Diabetes Mellitus (Kimmelsteil -
Wilson).
Diffuse glomerulosclerosis: This is the most common finding.
Treatment of diabetic nephropathy:
one. Good blood sugar regulation (insulin is the most ideal option),
2nd. The arterial blood pressure should be lowered so that the diastolic blood
pressure is <80 mmHg.
3. ACE inhibitors are effective in the microalbuminuric phase.
4. Dialysis or transplantation should be performed in end-stage patients.
(Answer B)
6. A 19-year-old male patient with purpuric spots, epistaxis, and gum on his arms
and legs following an upper respiratory infection a week earlier
because of bleeding. Physical examination except petechiae and purpura
not detected. Whole blood examination of blood biochemistry and coagulation
Tests were normal and platelet count was 9000 / mL.
2004)
A) Idiopathic thrombocytopenic purpura
B) Myelodysplastic syndrome
C) Thrombotic thrombocytopenic purpura
E) Bernard-Soulier syndrome
Young patient Thrombocytopenia after UTI = ITP
Idiopathic or immune thrombocytopenic purpura
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GLOMERULAR DISEASES
The development of antibodies to platelets and as a result platelets in the spleen

and less
is an autoimmune disease characterized by phagocytosis of the liver. Childhood type
it usually begins acute following viral infections, while the adult type begins
more insidious.
Thrombocytopenia is chronic ITP if it lasts longer than 6 months and acute ITP if
it is shorter.
recognized.
Acute ITP is usually seen in children between the ages of 2-6 and is benign. It is
the most common cause of thrombocytopenia in children. Both sexes are seen equally.
Mostly in winter and spring
Encountered. He had a history of viral upper respiratory tract infection 1 1-66
weeks ago.
Chronic ITP is more common in adult women. Patients present to the clinic with
petechiae, purpura and ecchymosis, nose and gum bleeding, and metrorajia in women.
Serious as central nervous system
bleeding occurs in less than 1% of cases. There is no splenomegaly in adults.
The platelet count was decreased in the laboratory. It is generally below 20,000 mm
3. Mean platelet volume was increased. Young megakaryocytes in bone marrow
increased and platelet output
It decreased. Platelet auto antibodies are positive but have no specific
significance. Other ITP diagnosis
thrombocytopenia is excluded after exclusion.
Treatment:
·
Prednisolone is administered at a dose of 1 mg / kg / day.
Splenectomy (cases with no response to medication). Splenectomy in children younger

than 7 years
not recommended. Splenectomy has a 70% chance of success.
Immunosuppressive therapy can be applied in splenectomy resistant cases.
Intravenous IgG therapy and anti-D antibodies in pregnant women, patients

undergoing surgery and
life-threatening bleeding.
Platelet transfusion in life-threatening bleeding and surgery

It is given. Patients with platelet counts exceeding 50,000 / mm3 are operated in
the risk group.
(Answer A)
7. What is the most common kidney pathology in Wegener's granulomatosis? (April

2004)
A) Focal segmental necrotizing glomerulonephritis
C) Diffuse proliferative glomerulonephritis
D) Membraneous glomerulonephritis
E) Sclerosing glomerulonephritis
Wegener holds the lung most. The most common cause of death is renal failure.
Kidney
Focal segmental necrotizing glomerulonephritis is the most common cause of renal
failure.
Diabetes Mellitus is the most common cause of papilla necrosis. The most common
cause of diffuse cortical necrosis
Abruptio placenta.
(Answer A)
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8. A 24-year-old female patient with small red blood in urine and extremities
due to stains. She had abdominal pain for 3 days.
Learned. Laboratory tests showed erythrocyte, 1.5 g / day proteinuria in urine and
serum urea level was 68 mg / dl and serum creatinine level was 3.5 mg / dl.
It is found to be present. Which of the following is the most likely diagnosis for
this patient? (September 2001)
B) Fulminant lupus nephritis
C) Berger's disease
D) Immune thrombocytopenic puprura
E) Henoch-Schönlein purpura
Henoch-Shönlein Purpura
•
Mixed with a history of viral upper respiratory tract infection (+) (Berger (IgA
nephropathy) aneak
Hematuria in Berger 2-3 days after upper respiratory infection 1-2 weeks after HSV
it happens)
Teenager or child
Palpable purpura (due to small vessel vasculitis) is the most specific finding.
(Lower extremity and gluteal region)
•
hematuria
arthralgia
Gastrointestinal symptoms, abdominal pain
The findings are associated with acute proliferative glomerulonephritis similar to

IgA nephropathy. Mezengiu Me
IgE)
(Answer E)
9. Dramatic rapid response to steroid dramatically

A) Membranous nephropathy
B) Focal glomerulosclerosis
C) Minimal change disease
D) Hemolytic uremic syndrome
E) Henoch Schönlein nephropathy
Steroids contribute greatly to the tendency of minimal change disease to
spontaneously resolve. Treatment of prednisone (60mg / m2) daily or every other day
is highly effective. The first 4 weeks every day,
prednisone treatment is the first choice of treatment.
(Answer C)
10. Double contoured appearance in glomerular basement membrane for
The characteristic? (September 97)
A) Lipoid nephrosis
B) Berger's disease
D) Goodpasture syndrome
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GLOMERULAR DISEASES
Glomerular capillary folds of mesengial matrix in membraneanoproliferative

glomerulonephritis
by expansion into the basal membrane is divided into two layers. When painted with
silver
double-contoured appearance giving the impression of a tramway.
In membranous glomerulonephritis, the basement membrane in the late stage is again
two-fold, but it has the appearance of a railroad due to the protrusions in
between. Extensions of podocytes in lipoid nephrosis
There are mergers.
Immunofluorescence staining on glomerular capillary wall in poststreptococcal
glomerulonephritis
irregular IgG, IgA, C3 and fibrin deposits are observed.
Goodpasture syndrome shows linear IgG, IgM and C3 deposition. Rapidly progressive
glomerulonephritis shows crescent formation in all glomeruli.
In focal glomerulonephritis, IgG and IgA deposits in the mesengium in the affected
part of glomeruli
has.
(Answer C)
11th. Which of the following is not present in idiopathic nephrotic syndrome?
(April 96)
A) Edema
B) C3 deficiency
C) Proteinuria
D) Hyperlipidemia
E) Hypoalbuminemia
In idiopathic nephrotic syndrome, hypoalbuminemia, proteinuria,
hypertriglyceridemia,
edema, hypercholesterolemia, increase in apoprotein C and a, increase in acute
phase reactants, antithrombin
and immune globulins are increased and decreased in I-7-9-11-12. C3 reduction is
typical for poststreptococcal and membranoproliferative glomerulonephritis.
(Answer B)
12. Which of the following is seen in the diagnosis of minimal change nephrotic
syndrome?
(September 95)
A) Hypocomplementemia
B) Hypertension
C) Microscopic hematuria
D) Selective proteinuria
E) Hypercalcemia
Minimal change disease is the most common cause of nephrotic syndrome in children.
Hypoalbuminemia has hyperalbuminuria (selective proteinuria), hyperlipidemia,
hypercholesterolemia. However, the most diagnostic event is adhesion in foot
processes (foot protrusion) in renal biopsy.
(Answer D)
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13. In the kidney biopsy, an electron microscope examination revealed

There were no other findings until they were erased.
Which of the following can be the pathology here? (April 95)
A) Lipoid nephrosis
C) Nodular glomerulosclerosis
D) Poststreptococcal glomerulonephritis
E) Rapidly progressive glomerulonephritis
Minimal change disease is the most common cause of nephrotic syndrome in children.
Nile disease or
called lipoid nephrosis. This glomerular disease is the best response to steroid
treatment
The forms. That's why steroids are called sensitive glomerulopathy. Light
microscopy → normal; serum
the complement level is normal.
Pathology other than adhesions in foot processes of podocytes under electron
microscopy
They do not. Focal segmental glomerulosclerosis is the most common
interest.
(Answer A)
14. Guinea pig inoculation with blood urine for urine culture and tuberculosis
for definitive diagnosis of patient with negative, normal renal function and no
edema
Which of the following is done first? (April 93)
A) Ultrasonography
B) Renal biopsy
C) Angiography
D) IVP
E) Computed tomography
Renal biopsy is the most diagnostic test for hematuria lasting more than 6 months.
(Answer B)
15. Which of the following would you consider as a diagnosis for the patient in the
previous question?
(April 93)
C) Acute pyelonephritis
E) IgA nephropathy
As mentioned above, IgA nephropathy can only come with hematuria. Therefore,
etiology
Renal biopsy should be performed in hematuria that cannot be found.
Diseases with hematuria
· IgA nephritis
· Thin basal membrane disease
· Alport syndrome
(Answer E)
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GLOMERULAR DISEASES
16. Nineteen-year-old female released 250 cc of urine in two days. BUN 98,
creatinine 5.8 mgr /
Detecting dl. Rales in the lungs and gallop rhythm are heard in the heart. Urine
sediment
erythrocyte and erythrocyte cylinders were present and furosemide was given in the
last 4 hours. What is your diagnosis in this patient? (September 92)
A) Acute tubular necrosis
B) Acute renal failure
C) Acute glomerulonephritis
D) Bilateral cortical necrosis
E) Prerenal azotemia
In acute glomerulonephritis;
•
Active urine sediment (Erythrocyturia and erythrocyte silencers)
<2 g / day proteinuria

•
Impairment of renal functions (renal ARF)
Oliguria, anuria
Congestive heart failure
Findings of pulmonary edema or involvement may be detected,

(Answer C)
17. What is the disease with mesengial IgA storage? (April 92)
A) Berger
B) Lupus nephritis
C) Hemolytic uremic syndrome
D) Polyarteritis nodosa

In Berger's disease, IgA, C3 and properdin and fibrin deposits are observed in the
mesengium. HLA DR4
70% (+). Focal proliferative glomerulonephritis is most commonly observed. In
general, symptoms are dysuria and hematuria. It responds very well to treatment.
Prognosis is quite good. Also at IgA Henoch Schönlein
It happens. However, it is distinguished by the presence of skin findings.
(Answer A)
18. Which of the following increases in nephrotic syndrome? (April 92)
A) Prealbumin
B) Transferrin
C) Alpha 1 antitrypsin
D) Antithrombin III
E) Alpha-2 macroglobulin
Alpha2 globulins are high molecular weight proteins. While all protein types are
reduced, high molecular weight alpha2 globulins do not urinate. Therefore, patients
with nephrotic syndrome
blood levels are found to be high.
(Answer E)
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19. Which of the following does not occur in acute poststreptococcal

glomerulonephritis?
(September 91)
A) C3 level normality
B) Encephalopathy
C) Edema
D) Oliguria
E) Hypertension
Complement level is low in acute poststreptococcal glomerulonephritis.
(Answer A)
20. Hematuria, proteinuria, drop in C3 following upper respiratory tract infection
What is the first diagnosis to be considered in the patient with swelling of the
eyelids? (September 90)
A) Rapidly progressive glomerulonephritis
C) Nile disease

Acute poststreptococcal glomerulonephritis is the most common immune complex
glomerulonephritis. Glomerulonephritis has the best prognosis (95% spontaneous
recovery). One
pass a more proof. Poststreptococcal glomerulonephritis is usually group A beta
hemolytic
occurs with streptococci. Latent period 6-21 days (pharyngeal infection with
serotype 12) or
14-28 days (skin infection with serotype 49). Urine sediment is usually active
(hematuria,
pyuria, silenders), <3 g / day proteinuria and fractional sodium excretion <1%.
Total complement and C3 levels due to activation of the alternative complement
pathway for approximately 8 weeks
low course. Antistreptolysin-O in pharyngeal infections and anti-DNAse in skin
infections
B is found to be positive. If the diagnosis is wrong before 4 days.
(Answer E)
21. Complement level monitoring is important for the following diseases:
(September 90)
A) Pyelonephritis
B) Acute poststreptococcal glomerulonephritis
C) Henoch- Schölein purpura
E) Rapidly progressive glomerulonephritis
Glomerulonephritis with Low Complement Level
•
APSGN
Nephritis and Shunt Nephritis in Subacute Bacterial Endocarditis
Lupus Nephritis
Mixed Cryoglobulinemia
•
Membrano proliferative glomerulonephritis

(Answer B)
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GLOMERULAR DISEASES
22. Type of nephritis not associated with immune complex storage

A) Acute glomerulonephritis
B) Mesengioproliferative glomerulonephritis
C) Hereditary nephritis
D) Lupus nephritis
Immune complex deposition in all nephritis except hereditary nephritis and minimal
change disease
Monitored.
(Answer C)
23. Which of the following occurs in mesengial IgA storage? (September 89)
B) Goodpasture
C) Berger
E) Alport
Berger's disease (IgA Nephritis); is the most common type of primary
glomerulonephritis. Diffuse mesangial
Mesangio is a proliferative glomerulopathy characterized by IgA deposition.
Circulating clearance (clearance) of IgA is impaired. 50% progress to CRF in 15-20
years. Microscopic hematuria in the clinic
and mostly proteinuria at the nephritic level. Macroscopic hematuria is an
indicator of good prognosis.
(Answer C)
24. Hospitalization in acute glomerulonephritis without indication
A) Edema
B) Hypertension
C) Azotemia
D) Renal failure
E) Microscopic hematuria
Indications for hospitalization in acute glomerulonephritis:
·
Edema
Uncontrolled hypertension
Progressive impairment of renal function

·
Encephalopathy (hypertensive or uremic)
Accompanying serious infections
Severe electrolyte imbalance (hyponatremia, hyperpotasemia)
Accompanying comorbid diseases (heart failure)
Microscopic hematuria is not clinically important if the above conditions are not
present.
(Answer E)
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25. Which kidney disease does not cause nephrotic syndrome? (September 87)
B) Poststreptococcal glomerulonephritis
C) Sickle cell anemia
D) Systemic lupus erythematosus
E) Amyloidosis
Nephritic syndrome usually has proteinuria, hematuria and hypertension below 2 g /
day. The most typical form; Acute post-streptococcal glomerulonephritis (APSGN).
Other reasons
between;
•
vasculitis
Goodpasture syndrome
RPGN
HUS / TTP.
Nephrotic syndrome; It has hypoalbuminemia, edema and hyperlipidemia with

proteinuria over 3.5 gr / day / 1.73 m2. Nephrotic syndrome;
• Primary glomerular diseases Membranous glomerulonephritis, minimal change disease
and Focal
Segmental Glomerulosclerosis)
•
Amyloidosis
MPGN
Essential cryoglobulinemia.
(Answer B)
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OTHER NEPHROLOGIC DISEASES

one. A seventy-seven-year-old male patient presented with dyspnea, fatigue and back
pain.
Low back pain. Anemia, hypercalcemia,
Increased uricreatin, lytic lesions in the bones and paraproteinemia were detected.
This
What is the most likely cause of renal damage in a patient? (May 2011)
A) Glomerular damage
B) Urate nephropathy
C) Tubulointerstitial damage due to light chain
D) Vascular damage due to light chain
E) Infiltration of the kidneys by plasma cells
Elderly patient equals low back pain. Multiple myeloma.
Myeloma kidney due to light chain nephropathy, hypercalcemia, hyperuricemia,
amyloid
can. It is the most common light chain nephropathy. Multiple myeloma
clinical findings and mechanism
Clinical Findings
Subtitles
Pathogenic Mechanism
Hypercalcemia, pathological
Skeletal destruction
Tumor expansion; tumor cell-
fractures, spinal compression, lytic fractures
OAF (osteoclast activator)
mycotic lesions, osteoporosis,
factor)
bone pains
Kidney failure
Light chain proteinuria, hypercal-

Toxic effects of tumor products,
semi, urate nephropathy, interstitial
light chains, OAF, DNA destruction
amyloid glomerulopathy of nephritis,
products, hypo-gamaglobulinemia
pyelonephritis
Anemia
Myelophyticis,
Tumor growth, tumor cells-
increased destruction
antibody and inhibitor
infection
Hypogammaglobulin-mi, neutrophil
Construction due to tumor suppression
reduction of migration
deficiency, IgG
Neurological symptoms
Hyperviscosity, cryoglobulins,
Tumor products; M component
ami-loid storage, Hyperkal-
Features, light chains, OAF
production
Semi spinal compression

Bleeding
Mass lesion
Coagulation disorder, endothelium
Tumor products; clotting factor
amyloid damage, platelet dis-
antibodies, light chains platelets
function
antibodies
Tumor expansion
(Answer C)
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2nd. A 25-year-old, 2.5-month-old pregnant woman taken without any complaint

105 colony / ml Escherichia coli is produced in urine culture. With the treatment
of this patient
Which of the following statements is true about? (December 2010)
A) No treatment is required, urine culture is repeated after 2 weeks.
B) No treatment is needed, no culture monitoring is required.
C) Oral single dose 400 mg ofloxacin is given.
D) If the bacteria are susceptible, amoxicillin – clavulanate is given for 7 days.
E) Treatment is given only if the patient is symptomatic.
The patient described in the question has asymptomatic bacteriuria (ABU).
Asymptomatic bacteriuria in pregnancy
is the most common urinary infection and is often the causative agent of normal
perineal flora. Although the frequency of ABU varies with parity, race and
socioeconomic status in pregnancy, it is around 2-7%. A clean urinary
presence of> 100,000 / mL organism in the sample is considered to be diagnostic,
but possible risk of pyelonephritis
treatment is also recommended due to lesser concentrations.
Symptomatic urinary infection occurs in 25% of untreated pregnant women. Therefore,
the first prenatal
Asymptomatic bacteriuria screening is recommended during follow-up. In addition, an
increase in the frequency of preterm birth and low birth weight has been reported
in pregnancies without ABU treatment. However, the pregnancy of ABU
There are also studies reporting no negative effects on the results.
Nitrofurantoin (single dose 200 mg; 4X50 mg, 3 days or 2X100 mg, 7 days),
amoxicillin (single dose)
3 g; 3X500 mg, 3 days), ampicillin (single dose 2 g; 4X250 mg, 3 days),
cephalosporin (single dose 2 g; 4X250
mg, 3 days), ciprofloxazine (4X250 mg, 3 days) or levofloxazine (250 mg / day).
(Answer D)
3. A 25-year-old, 2.5-month-old pregnant woman taken without any complaint
105 colony / ml Escherichia coli is produced in urine culture. With the treatment
of this patient
Which of the following statements is true about? (December 2010)
A) No treatment is required, urine culture is repeated after 2 weeks.
B) No treatment is needed, no culture monitoring is required.
C) Oral single dose 400 mg ofloxacin is given.
D) If the bacteria are susceptible, amoxicillin – clavulanate is given for 7 days.
E) Treatment is given only if the patient is symptomatic.
482
The patient described in the question has asymptomatic bacteriuria (ABU).

Asymptomatic bacteriuria in pregnancy
is the most common urinary infection and is often the causative agent of normal
perineal flora. Although the frequency of ABU varies with parity, race and
socioeconomic status in pregnancy, it is around 2-7%. A clean urinary
presence of> 100,000 / mL organism in the sample is considered to be diagnostic,
but possible risk of pyelonephritis
treatment is also recommended due to lesser concentrations.
Symptomatic urinary infection occurs in 25% of untreated pregnant women. Therefore,
the first prenatal
Asymptomatic bacteriuria screening is recommended during follow-up. In addition, an
increase in the frequency of preterm birth and low birth weight has been reported
in pregnancies without ABU treatment. However, the pregnancy of ABU
There are also studies reporting no negative effects on the results.
Nitrofurantoin (single dose 200 mg; 4X50 mg, 3 days or 2X100 mg, 7 days),
amoxicillin (single dose)
3 g; 3X500 mg, 3 days), ampicillin (single dose 2 g; 4X250 mg, 3 days),
cephalosporin (single dose 2 g; 4X250
mg, 3 days), ciprofloxazine (4X250 mg, 3 days) or levofloxazine (250 mg / day).
(Answer D)
4. What is the most likely cause of nephrotic syndrome in a thirty-year-old woman
in the 28th week of pregnancy? (April 2010)
a)
Renal papillary infarction
B) Amyloidosis
C.)
Renal vein thrombosis
D)
Severe preeclampsia
TO)
Focal segmental glomerulosclerosis
Renal papillary infarction is characterized by flank pain, hematuria and impaired

renal function. It does not cause nephrotic syndrome. Amyloidosis can cause
nephrotic syndrome, but it does not start so quickly. There are also findings of
the disease that may cause amyloidosis (FMF, RA, Tbc, etc.). renal
vein thrombus is a disease that usually develops secondary to the underlying
nephrotic syndrome. proteinuria
worsening, hematuria and increased renal size on ultrasound. FSGS; normal
is the third most common cause of nephrotic syndrome in the population.
is not a case. Preeclampsia and eclampsia are the two most common causes of
nephrotic syndrome in the third trimester of pregnancy.
(Answer D)
5. A thirty-five-year-old dialysis patient urgently received hospitalization for
cadaver kidney transplantation
Calling. Which of the following is an obstacle for kidney transplantation in this
patient?
(April 2009)
A) The cadaver is 0 Rh (+) and the patient is A Rh (-)
B) Pre-transplant lymphocyte cross-match test positive
C) IgA nephropathy of the recipient's primary disease
D) Receiver blood pressure 160/100 mmHg
E) Recipient kidney transplantation
(Answer B)

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6. Which of the following statements about diabetic nephropathy is wrong?

(September 2008)
A) In the first stage, the glomerular filtration rate increases.
B) Microalbuminuria develops after hyperfiltration.
C) Glucosuria follows microalbuminuria.
D) Most patients have nephrotic syndrome at the stage of macroalbuminuria.
E) Retinopathy and neuropathy often accompany nephropathy.
Stages of diabetic nephropathy
•
Hyperfiltration phase: GFR increased, kidney large, no proteinuria. First

pathology: Capillary
thickening.
Microalbuminuric phase: GFR is normal or increased, microalbuminuria. 30-300 mg /

24
s level.
Intermedietal glomerulopathy: Proteinuria is evident, blood pressure is high and

edema may occur.
Advanced diabetic glomerulopathy: Azotemia, edema and hypertension. There are two
forms;
-
Nodular glomerulosclerosis is specific for Type 1 DM (Kimmelstiel - Wilson).
Diffuse glomerulosclerosis: This is the most common finding.
Glucosuria is not related to diabetic periods. It is seen in any case where blood
sugar is above 180 mg / dl.
(Answer C)
7. A 70-year-old man who had been followed up for 15 years with type 2 diabetes
mellitus has had elevated blood pressure for the last 6 months. Plasma creatinine
level 1.2
mg / dL and microalbuminuria was detected in angiotensin converting enzyme
Inhibitor treatment is started. Decrease in urine volume on the third day of
treatment,
dyspnea and orthopnea are developing.
Repeated creatinine level was 2.8 mg / dL.
Which of the following should be done first? (April 2008)
B) Abdominal tomography
C) Urinary ultrasonography
D) Renal artery Doppler ultrasonography
E) Echocardiography
He took an ACE inhibitor and it got worse. This is the acronym for the problem. So
why ? Bilateral renal
If there is stenosis of the artery, such a picture would be expected. Because ACE
inhibitors reduce renal blood flow and
as in the question can lead to the patient ARF table. Then the question became even
shorter: the renal artery
Doppler is performed before stenosis if an exact diagnosis would be angiography.
On the occasion of this question let's remember the situations in which ACE
inhibitors are contraindicated:
(Answer D)
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8. Which of the following drugs inhibits inosine monophosphate dehydrogenase enzyme

shows immuno-suppressive effect? (September 2007)
A) Azathioprine
B) Cyclophosphamide
C) Methotrexate
D) Mycophenolate mofetil
E) Leflunamide
Mycophelonate is a mofetil inosine monophosphate dehydrogenase inhibitor.
Intracellular guanosine
pool and stimulates T and B cell proliferation and autoantibody formation.
Low in the treatment of autoimmune rheumatic diseases besides solid organ
transplantations
dosage is used. It is especially used in patients with lupus nephritis.
Leflunamide is a primidine antagonist.
Cyclophosphamide is one of the alkylating agents.
Azothiopurine is also used in immunosuppressive therapy. The mechanism of action is
purine antimetabolite. However, the active metabolite of this drug, 6-
mercaptopurine, both adenylosuccinase and
de inosine monophosphate can inhibit the enzyme dehydrogenase. This detail makes
the question “controversial”
It brings.
Methotrexate is a dihydrofolate reductase inhibitor.
(Answer D)
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9. Which of the following is not one of the symptoms of Bartter syndrome?

(April 2007)
A) Hypokalemia
B) Increased plasma aldosterone activity
C) Hypercalciuria
D) Increased production of prostaglandin E2
E) Hypertension
Thanks to this question, it is useful to remember a few syndromes in nephrology:
Bartter's syndrome: Henle is hypofunction of the ascending arm
Increased synthesis of prostoglandin E2
Na, K, chlorine, calcium are excreted in urine that cannot be absorbed. Na falls
RAS is activated
Renin - aldesterone increases
Glomerular juxtaposition
apparatus hyperplasia
Low electrolytes in blood

High electrolyte in urine
No hypertension / edema
LIDDLE SYNDROME
Distal tube hyperfunction
Amilori-sensitive Na
beta and
delta subunits
the hyperfunction
Na, Cl, water is highly absorbed

Hypertension*
K disappears
alkalosis *
GİTELMAN SYNDROME
Distal tubules
Thiazide-sensitive Na-Cl transport system - Na-K ATPase
dysfunction of gamma subunits in system.
Clinical = Bartter syndrome
Differences; hypomagnesemia is characterized by hypocalcuria
(Answer E)
486
10. Potassium 2.9 mEq / L with hypertension and untreated patients

and 24-hour urine potassium has increased
2006)
A) Nelson's syndrome
B) Pheochromocytoma
C) Bartter Syndrome
D) Primary hyperaldosteronemia
E) Cushing's Syndrome
There are two possibilities for hypertension, hypokalemia and praolemia in two
patients. Liddle syndrome and primary hyperaldosteronism (Conn syndrome) should be
considered. Bartter syndrome does not show hypertension.
PRIMARY HYPERALDOSTERONISM (Conn's Syndrome)
(Case question: Hypertension + hypopotasemia given Conn.)
Description: Unilateral adrenal adenoma associated with excessive aldosterone
secretion
is a table.
Aldosterone is primarily responsible for Na + absorption and K excretion by weft
into proximal and distal tubules
It is the agent. Findings due to excessive Na and water reabsorption in
hyperaldesteronism and excessive K excretion
emerges.
Conn has no edema. There's hypertension.
Clinic:
-
Hypertension (usually mild)
Hypokalemia (nocturia, weakness, polyuria, polydipsia, paresthesia, muscle

weakness)
- No edema. Na is held, K is discarded. Polyuria due to hypopotesemia occurs

because K is low
revenue. No edema due to polyuria.
-
alkalosis
Postural hypotension and absence of reflex tachycardia (due to blinding of

baroreceptors due to severe hypokalemia)
Latent tetany (due to alkalosis)
** Low plasma color (distinguishes from secondary hyperaldosteronism)
High aldosterone in 24-hour urine (best test for aldosterone excess)
The low-sodium diet masks hypokalaemia. So with the measurement free sodium diet
It should be done.
Diagnosis:
Clinically suspected patient;
1. Measure urine aldosterone for 24 hours. Aldosterone level is greater than 20 mg
2nd. Standing test: Normally, standing increases renin. Standing renin level
there is hyperaldosteronism.
3. A salt infusion test should also be performed to separate it from essential HT.
Aldosterone is suppressed in essential HT by salt infusion. Not in the others.
Treatment:
It is surgery. Preparation for side effects such as spiranolactone (rash,
gynecomastia, impotence, epigastric tenderness)
effects) and amiloride can be used. Subtotal adrenalectomy can be performed in
hyperplasia.
(Answer D)
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11th. Which of the following is not a side effect of cyclosporine? (September 2006)
A) Hypokalemia
B) Hyperglycemia
C) Hypertension
D) Hyperlipidemia
E) Gingival hyperplasia
See section 3 (leukocyte diseases).

(Answer A)
12. Which of the following conditions is more likely to have hematuria than others
It is low? (September 2005)
A) Amyloidosis
C) Analgesic nephropathy
D) Renal vein thrombosis
E) Alport sedrom
Amyloidosis causes nephrotic syndrome. Hematuria and hypertension are not present
in nephrotic syndrome. glomerular
filtration rate is normal. Hematuria can be seen in other diseases.
the hEMATURIA
•
Erythrocytes normally: Pelvicaliceal, ureteral, bladder or urethral lesion

It depends.
Erythrocytes deformed: There is hematuria due to glomerular pathologies.
It is hematuria for women to have 5 erythrocytes in one field and more than 3 for
men.
The most common cause of hematuria is urinary infections.
Glomerulonephritis is the most common cause under the age of 20, and is most common
in men
The cause is benign prostatic hypertrophy.
Renal colic + hematuria = Kidney stone
Lumbar mass + hematuria = Renal cell carcinoma
Bladder cancer should be considered in painless hematuria.

(Answer A)
13. Which of the following radiological imaging of the kidney

not expected to be? (September 2005)
A) Polycystic kidney
B) Acute renal vein thrombosis
C) Leukemia infiltration
D) Amyloidosis
E) Hypertensive nephropathy
Except for hypertensive nephropathy, we expect the kidneys to be large. Kidneys due
to sclerosis are small in hypertensive nephropathy.
In cases of chronic kidney failure, a large kidney is seen;
a.
Polycystic kidney
b.
Amyloid kidney
c.
scleroderma
D.
Diabetes mellitus
to.
Myeloma kidney
f.
hydronephrosis
(Answer E)
488

14. The most common factor in out-of-hospital lower urinary tract infections
A) Pseudomonas
B) Klebsiella
C) E. coli
D) Proteus
E) Streptococcus
Gram (-) bacilli are the most common agents in non-hospital lower urinary tract
infections. These
E. coli is the most common.
(Answer C)
15. What is the most common side effect of cisplatin? (April 97)
A) Nephrotoxicity
B) Hepatotoxicity
C) Cardiotoxicity
D) Bone marrow suppression
E) Keratite
Cisplatin is one of the most powerful antineoplastic agents against solid tumors.
Dose-dependent nephrotoxicity. However, the most common side effects are nausea and
vomiting. Before reducing the nephrotoxic effect
the patient is hydrated and then given diuretics.
Cisplatin also has bone marrow depression and ototoxic side effects. Cisplatin
toxicity amifostin is used.
(Answer A)
16. Hospitalized and urinary tract complaints with fever up to 39 ° C
Which of the following do you do with the patient? (September 96)
A) Intravenous pyelogram is taken
B) Immediately start a broad-spectrum antibiotic
C) Urine culture sample is taken and antipseudomanol antibiotic is started
immediately.
D) Urine culture is taken and antibiotic is started according to the result.
E) Ultrasonography is done
The most common source of sepsis in the hospital � Genitourinary system. The most
common infections seen in hospital,
urinary tract infections that occur due to the frequent use of catheters.
The most common agents are gram (-) bacteria. Empirical antibiotics should be
initiated after receiving urine culture in patients with these complaints.
According to the result of culture then antibiotics
replaceable.
(Answer C)
17. Rapidly developing glomerulonephritis and pulmonary hemosiderosis
Seen? (April 96)
A) Alport syndrome
B) Goodpasture syndrome

D) Diabetic nephropathy
E) Malaria nephropathy
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Good pasture syndrome has anti-glomerular basement membrane and anti-alveolar

basement membrane antibodies. Pulmonary hemosiderosis, iron deficiency anemia and
rapidly progressive glomerulonephritis
There is secondary chronic renal failure. Hemoptysis and hematuria are present.
However, symptoms in the lung appear earlier than renal symptoms. Sputum for
hemosiderosis in the lung
There are macrophages loaded with hemosiderin.
(Answer B)
18. Which of the following is used in the definitive diagnosis of Goodpasture
syndrome?
(September 95)
A) Serum complement levels
B) Antinuclear antibody
C) Antiglomerular basement membrane antibody
D) C3 nephritic factor
E) Kidney function test

Good pasture syndrome is a type II hypersensitivity reaction associated with renal
and
Disease. There are antibodies against the glomerular and alveolar basement
membranes. There are hematuria and hemoptysis. Detection of these antibodies makes
the actual diagnosis. Focal proliferation, then diffuse proliferation, necrosis
followed by crescent occurs in the glomeruli. If it is
to hemodialysis-dependent patients by taking the patient to chronic renal failure
within 2-3 months
It brings.
(Answer C)
19. Which is the earliest sign of diabetic nephropathy? (April 95)
A) Hypertension
C) Kidney atrophy
D) Papillary necrosis
E) Microalbuminuria
The first microscopic findings of diabetic nephropathy in the glomerular basement

membrane
thickening and hyperfiltration, while the last clinically reversible stage is
microalbuminuria. Albuminuria values between 70 mg and 450 mg are called
microalbuminuria.
Thereafter, the patient's renal pathology becomes irreversible and progresses.
microalbuminuria
After HbA1c is under control, the progression of the patient stops. Medically
ACE inhibitors should be given to patients with microalbuminuria.
(Answer E)
20. Which of the following does not have renal papillary necrosis? (September 94)
A) Diabetes
C) Urinary infection
D) Analgesic nephropathy
E) Extreme hypoxia
Renal papillary necrosis

• Diabetes mellitus � is the most common cause
• Pyelonephritis and interstitial nephritis
• Analgesic nephropathy (most phenacetin)
• Sickle cell anemia
• Hypoxia
• Diseases occluding renal artery (thrombus, embolism)
(Answer B)
490
21. General anesthetic not used in kidney disease because it is toxic to kidney
Which of the following is the substance? (September 94)
A) Ether
B) Halothane
C) Isoflurane
D) Enflurane
E) Methoxifuran
Halothane and ether are hepato and cardio toxic. It has no effects on the kidney.
Fluorine general anesthetics
all may potentially cause renal toxicity. But of these, methoxiflurane renal
The toxic effect is most pronounced and can cause polyuric renal failure.
(Answer E)
22. Which type of stone is formed in alkaline urine? (April 94)
A) Calcium-oxalate
B) Magnesium-ammonium phosphate
C) Uric acid
D) Cystine
E) Calcium phosphate
Alkali substances in alkaline urine, acidic substances in acidic urine precipitate.

Alkaline Substances
Acidic Substances
Magnesium ammonium phosphate (Citruvite)
Calcium Oxalate
Calcium phosphate
Uric acid
cystine
(BE THE ANSWER)

23. IVP in a patient with hypertension, right renal small, collecting system
minimally deformed, cortex is thinner and irregularly limited.
Which of the following is considered in this patient? (April 94)
A) Renal artery stenosis
B) Chronic pyelonephritis
C) Hypoplastic kidney
D) Medullary cystic disease
E) Nephrolithiasis
In chronic pyelonephritis, the kidney has shrunk and the cortex is thinner.
Distortion of calyxes and pelvis in IVP
and disorder.
(Answer B)
24. Laboratory for the diagnosis of renovascular hypertension
Which of the findings is useless? (September 93)
A) Minute intravenous pyelogram
B) Increased plasma renin level
C) Renal angiography
D) Radioisotope imaging
E) Renal biopsy
The most common cause of renovascular hypertension; atherosclerosis in the elderly,
in young people
fibromuscular dysplasia. Renal angiography is the gold standard for diagnosis.
Plasma renin level
increased. CT and MR angiography, renal scintigraphy and IVP methods may help the
diagnosis. diagnosis
renal biopsy has no place.
(Answer E)
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25. Which of the following is the most common hyperkalemia in oliguric renal
failure?
effective treatment? (September 91)
A) Calcium gluconate (10%)
B) Sodium bicarbonate
C) Thiazide
D) Furosemide
E) Hemodialysis
Hemodialysis is the most effective treatment for hyperkalemia. Diuretics in the

acute treatment of hyperkalemia
They are not used. Calcium gluconan does not treat hyperkalemia, but only
antagonizes its effects at the membrane level. ECG is indicated if present. Sodium
bicarbonate; recovery of acidosis
and corrects hyperpotasemia by contributing to increased K entry into the cell.
(Answer E)
26. Which of the following is most important in the diagnosis of hepatorenal
syndrome? (September 91)
A) Hypoalbuminemia
B) Elevation in serum transaminases
C) Impairment of liver function tests
D) Hyperglobulinemia
E) Oliguria and hyperosmolar urine

Prerenal ABY is a similar picture. Sodium excretion in urine is less than 10 mEq /
L, fractionated sodium
excretion is below 1%. Urine osmolarity is> 500 mosm. The amount of urine decreased
and serum
Increased BUN and creatinine.
(Answer E)
27. Which of the following can develop as a complication of familial Mediterranean
fever?
(September 91)
A) Minimal change disease
C) Amyloidosis
E) Glomerulonephritis
Familial Mediterranean fever is an inherited autosomal recessive disorder. The most
serious complication is mainly
amyloid deposition, including the kidneys. Amyloidosis is of AA type. Renal
Amyloidosis; It is characterized by proteinuria (mostly nephrotic syndrome) and
progressive renal dysfunction.
(Answer C)
28. What is the characteristic finding of diabetic nephropathy? (April 91)
A) Lipoid nephrosis
B) Nodular glomerulosclerosis
E) Papillary necrosis
Pathology findings of diabetic nephropathy
Glomerular lesions; nodular glomerulosclerosis (Kimmelstiel-Wilson lesions)
glomerular lesion. The most common glomerular lesion is diffuse glomerulosclerosis.
Tubular lesions: Armani-Ebstein lesion (glycogen storage in the tubular epithelium)
characteristic tubular
Lesion. Tubular atrophy may also be observed.
Vascular lesions: Hyaline arteriosclerosis can be observed in glomerular
arterioles.
The incidence of papillary necrosis and pyelonephritis has also increased in DM.
(Answer B)
492
29. In the patient with normal BUN values, ADH was high, hypernatremia, sodium in
urine.
excretion and decrease in urinary osmolarity and increase in blood osmolarity. What
is your diagnosis in this patient? (April 90)
A) ADH failure
B) Kimmel-stiel-Wilson disease
D) Renal diabetes insipidus
E) Renal failure
In renal diabetes insipidus, despite high serum osmolarity and low urinary
osmolarity
ADH is high (renal nonresponsiveness). Sodium excretion increased. High serum
osmolarity and sodium
Although the amount of urine and hypotonic. The most common cause of nephrogenic
diabetes insipidus
electrolyte disorders (hypercalcemia, hypokalemia), and the most common cause is
amphotericin B.
Treatment; correction of cause.
(Answer D)
30. Which of the following results from the use of long-term phenacetin? (September
89)
A) Nephrocalcinosis
B) Acute cortical necrosis
D) Acute interstitial nephritis
The concentrations of phenacetin metabolites in the papilla are 10 times higher
than the cortex. Papillary ischemia, necrosis, fibrosis and calcification are the
most common causes of chronic interstitial nephritis (> 3 kg). The toxicity of use
with aspirin, acetaminophen and caffeine
It increases. In the etiology of acute interstitial nephritis, NSAIDs have been
implicated and are usually dose-independent.
and about 15 days after ingestion of the drug.
(Answer D)
31. Which of the following does not have radiological signs of chronic
pyelonephritis?
(April 89)
A) Sticking in calyxes
B) Scatrix
C) 1.5-2 fold growth
D) Shrinkage of neighboring papillae
E) Sclerosis in the cortex
pyelonephritis; kidney parenchyma infection. The most common cause of
pyelonephritis is E. coli. Vesico-urethral
reflux is the most common cause in the etiology. Whole kidney or kidney affected in
case of chronicization
segment causes fibrosis and scar (scatric) tissue development. Rods in calyxes,
thinning of the cortex and shrinkage of the papillae. The kidney usually shrinks.
Except for some rare cases, all diseases of the kidney shrink the kidney.
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Diseases that enlarge the kidney;

Diabetes mellitus
Polycystic kidney disease
hydronephrosis
Renal cell carcinoma
Infiltrative diseases of the kidney (Amyloidosis, leukemia, lymphoma)
Renal vein thrombus
(Answer C)
32. Which of the following is the disease with an increased incidence of urinary
infection?
(April 88)
A) Lymphoma
B) Diabetes mellitus
C) Pheochromocytoma
D) Diabetes insipidus
E) Hyperthyroidism
Diabetes mellitus tends to both immunosuppressive and hyperglycemic infections
is a disease that increases. In particular, an increase in genitourinary system
infections is observed. Also,
There is an increase in infections caused by staphylococci, pseudomonas, candida
and anaerobes.
(Answer B)
33. What is the most typical manifestation of hepatorenal syndrome? (September 87)
A) Hyperglobulinemia, hypoalbuminemia
B) Alkaline phosphatase increase
C) Impairment of liver function tests
D) Increase in liver enzymes
E) Oliguria, azotemia
The most common cause of hepatorenal syndrome is cirrhosis. It usually develops in
the hospital and is triggered by diuretics, gastrointestinal bleeding or
paracentesis. Hyponatremia, hypokalemia and hypoalbuminemia often accompany the
syndrome. Serious vasoconstriction to the pathogenesis of this disorder
accompanies. Prerenal ABY-like picture is dominant. It is often oliguric.
Endothelin level
10 times higher than normal. Laboratory findings; urine sodium <10 mOsm / L,
urinary osmarsity
> 500 mOsm / L and is only a temporary response to liquids. May develop into acute
tubular necrosis and heal
is only 10%. Therapies; liver transplantation, LaVeen shunt, dopamine and high dose
spironolactone (Aldactone).
(Answer E)
494

34. The most important procedure to be performed in the treatment of hyperoxaluria

is:
A) Alkalisation of urine
B) Oxalate-less, calcium-rich diet
C) Probenecid use
D) Acidification of urine
E) Calcium-poor diet
Primary hyperoxaluria is the most aggressive stone disease. Type 1, glycolic and
oxalic aciduria (glyoxylate carboxylase deficiency); type 2 due to L-glyceric and
oxalic aciduria (D-glyceric dehydrogenase deficiency)
It develops. Treatment; Liquids are pyridoxine (which modifies glycine metabolism,
an oxalate precursor), orthophosphates, and liver transplantation. In Oksalüri;
excess oxalate intake (cola, spinach,
beet, cocoa powder, chocolate, green leafy plants, snack products (especially
peanuts), dark tea, excessive
tea and excessive coffee habit) or reduced absorption from the intestine (low
calcium in the diet)
it has a big role. Therefore, the first thing to be done is to increase calcium
intake with food.
(binds oxalic acid in the intestine and is excreted in feces by forming complexes)
and oxalate in the diet
It is reduced.
Causes of Hyperoxaluria
- Foods containing excess oxalate
- Glycine metabolism disorder
- Pyridoxine deficiency
- Vitamin C excess
- Ethylene glycol poisoning
(Answer B)
35. Which disease does not cause kidney lesions? (September 87)
B) Henoch-Schönlein
C) Multiple sclerosis
D) Periarteritis nodosa
E) Diabetes Mellitus
Multiple sclerosis; It is an autoimmune disease that occurs against myelin. Plaques
in white matter and CSF
oligoclonal antibodies are characteristic. Eye involvement is usually the first
sign. Watching with attacks
It is a progressive disease. It only involves the CNS, not the medulla spinalis.
Other organs (kidney, etc.)
There is no involvement associated with.
(Answer C)
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GENERAL INFORMATION IN RHEUMATOLOGY

GENERAL INFORMATION IN RHEUMATOLOGY
one. Which of the following conditions does not cause pain in the bone? (September
94)
A) Leukemia
B) Vitamin D intoxication
C) Osteomyelitis
D) Osteoporosis
E) Milkman syndrome
Conditions causing bone pain;
•
Bone marrow infiltrating conditions (Leukemia, lymphoma, malignancy)
Bone metastases of malignancies
Metabolic diseases of bone (Paget, osteoporosis)
Infections (Osteomyelitis, Brucellosis)
Fractures (Milkman syndrome)
Sickle cell anemia

(Answer B)
DIAGNOSTIC ANTIBODIES USED IN RHEUMATOLOGY

SLA
•
MOTHER
Anti ds DNA: renal involvement
Anti smooth muscle (anti-SM)
Anti-histone antibodies: Drug-induced lupus
Mixed Connective Tissue Disease

•
Anti-RNP + ANA
Anti Phospholipid Syndrome

•
Anticardiolipin antibody IG M and IgG:
Lupus anticoagulant:
scleroderma
•
Anti SCL-70
Anti-centromere antibodies (CREST syndrome)
Polymyositis / dermatomyositis
•
Anti Jo-1
Sjogren's Syndrome
•
Anti Ro (SSA): Sjogren and Lupus
Anti La (SSB): Sjogren and Lupus
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Rheumatoid Arthritis
•
Rheumatoid factor
Anti CCP (cyclic citrulinated peptide)
Wegener
•
canca
Pan
•
panca
Good pasture syndrome

•
Anti-glomerular basement membrane antibody
2nd. Which of the following is not a positive acute phase reactant? (September 92)
A) Fibrinogen
B) C reactive protein
C) Albumin
D) Haptoglobulin
E) Amyloid A
CRP first rising; ceruloplasmin is the last rising acute phase protein.
Albumin, prealbumin and transferrin are negative acute phase reactants; all acute
phase reactants
they increase as inflammation decreases.
(Answer E)
2nd. Dupuytren's contracture does not occur in which of the following? (September
91)
A) Diabetes mellitus
B) Diabetes insipidus
C) Chronic alcoholism
D) Old age
E) Liver cirrhosis
Dupuytren's contracture; increased fibrosis in the palmar fascia associated with

age and white race of unknown origin, resulting in contracture of the hands and
fingers.
Disease. Treatment is fasiectomy.
The etiological factors are:
•
Trauma
Diabetes mellitus
Chronic alcoholism
Epilepsy
Pulmonary tuberculosis
After myocardial infarction
Chronic liver diseases (cirrhosis)
•
Advanced age
(Answer B)
3. Which of the following diseases does not have bone pain? (April 88)
A) Leukemia
B) Osteomyelitis
D) Vitamin D intoxication
E) Brucellosis
Vitamin D intoxication only leads to a pathology characterized by hypercalcemia and

increased calcification.
pain is not an expected complaint.
(Answer D)
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SYSTEMIC LUPUS ERYTHEMATOSIS

one. A 26-year-old female patient had wrist and proximal interphalan-geal
pain and swelling of the joints, recurrent ulcers in the mouth and breathing due to
She is admitted with increasing stinging side pain. In laboratory examinations,
cellular silencers in urine, proteinuria, hemoglobin level 10 g / dL, leukocyte
The number is 2500 / mm3. Which of the following autoantibodies has the highest
prevalence in this patient? (May 2011)
A) Antinuclear
B) Anti-Sm
C) Anti-Ro
D) Anti-phospholipid
E) Anti-La
In fact, the pain and swelling in the proximal interphalangeal joints immediately
makes you wonder if he asks for ro-matoid arthritis. However, oral aphthae shifts
the work towards SLE.
Pain in breathing indicates possible pleural involvement.
Cytopenia, while the job finishes. SLE'de shortens the question which antibody is
most common. Already
ANA which is the screening test for SLE is the definitive answer.
(Answer A)
2nd. Hematologic findings such as leukopenia, lymphopenia and thrombocytopenia
What is the disease? (April 2007)
A) Rheumatoid arthritis
B) Polyarteritis nodosa
D) Systemic sclerosis
E) Familial Mediterranean fever
(Answer C)
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3. Which of the following autoantibodies is responsible for thrombotic events

observed in systemic lupus erythromatosis? (April 2007)
A) Anti-ds DNA
B) Antihiston antibody
C) Anti-RNA
D) Anticardiolipin
E) Anti-SM

Autoantibodies in systemic lupus erythematosus and their clinical significance
autoantibodies
Frequency (%)
Clinical correlation
MOTHER
96-98
Screening test, staining pattern important
Anti-dsDNA
40-80
Lupus nephritis
Anti-histone antibodies
30-80
Drug-induced lupus
Anti-Sm
30-40
Nephritis? FAQ involvement?
Anti-Ro (SS-A)
25-40
Subacute skin lupus, Sjögren, Neonatal lupus
cardiolipin
20-40
Thrombosis, cytopenia, miscarriage

Anti-ribosomal P
FAQ lupus
Anti-neuronal
FAQ lupus
(Answer D)
4. Which of the following autoantibodies is responsible for thrombotic events in
systemic lupus erythematosus? (September 2001)
A) Anti-ds DNA
B) Antihiston antibody
C) Anti-RNA
D) Anticardiolipin
E) Anti-SM
(Answer D)
5. A 22-year-old patient comes with a complaint of miscarriage. Frequent history of
venous thrombosis
thrombocytopenia.
A) Behçet
B) Pancreatic cancer
C) Systemic Lupus Erythematosus
D) Idiopathic thrombocytopenic purpura
E) Polyarteritis nodasa
(Answer C)
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5. Which is among the diagnostic criteria of systemic lupus erythematosus

It does not get? (April 2000)
A) Psychosis
B) Malar rash
C) Uveitis
D) Lymphopenia
E) Photosensitivity
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE):
Chronic inflammatory course, with a wide clinical presentation and triggered by an
unknown cause
immunocomplex disease. In general, there are antibodies formed against nuclear
structures. Genetic, hormonal and environmental factors play an important role in
the etiopathogenesis of the disease. Numerous
affects the organ. The underlying cause of the disease is vasculitis caused by
immunocomplexes. SLE progresses with exacerbations and remissions.
Factors required for diagnosis:
one.
Malar rash: fixed, non-scarring erythema that leaves nasolabial grooves open in the
malar regions.
2nd.
Discoid lupus: erythematous, papular, keratotic, follicular plugs and atrophic sac
3.
Photosensitivity: Extreme skin reactions caused by sunlight.
4.
Oral ulcers: Painless oral or nasopharyngeal ulcers.
5.
Non-corrosive arthritis: Sensitivity, swelling or effusion detected in 2 or more

joints
6.
Renal findings: Proteinuria - 0.5 grams / day or 3 + prtoeinuria

Cellular silencers: Erythrocytes, hemoglobin, granular, tubular or mixed silencers
7.
Neurological findings: a- Epilepsy: should not be related to drug or metabolic

cause
b- Psychosis: not related to drug or metabolic cause
8.
Serositis: Pleuritic chest pain, pleural effusion, presence of pericarditis or

pleural effusion
9.
Hematologic findings:
a-
Hemolytic anemia-reticulocytosis is present.
b-
Leukopenia:
c-
thrombocytopenia
D-
lymphopenia
10. Immunological findings:

a-
Anti dsDNA
b-
Anti Sm positivity (anti smooth muscle antibody)
c-
Presence of anticardiolipin antibody
D-
Lupus anticoagulant positivity
to-
False positivity of VDRL
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11th. ANA positivity

For the diagnosis at the same time or at different times, 4 criteria are sufficient
to be positive.
Women with SLE are more frequently involved. The disease is milder in older ages
and the proportion of men and women
close to each other. Patients with HLA-B8, HLA-DR2, and HLA-DR3 positivity are at
increased risk.
Changes in the immune system are seen. Cellular immunity activity was decreased.
Especially T-suppressor
There is a decrease in the level. B-lymphocytes have an increase in activity.
Circulating immunocomplexes collapse on the glomeruli and skin and other organs,
causing symptoms.
Immunocomplexes bind the complement and the inflammatory process begins. Organ-
specific
antibodies can be seen. Antierythrocyte, antiplatelet, antilococyte, antineuronal
and antithyroid antibodies
visible. Immunocomplexes can cause vascular wall damage and may cause thrombosis
and hypertension in later stages.
Clinic:
SLE patients may have fever related to the disease but infection should be ruled
out in the presence of fever.
Infection should come to mind, especially if leukocytosis is accompanied by fever.
joints
It causes nondestructive arthritis. The frequency of avascular necrosis of the bone
is increased. Most common avascular
necrosis bones are femoral head, navicular bone and tibia.
Discoid lupus involves the face, scalp and extremities. May leave traces in the
affected area. Subacute cutaneous lupus
erythematosus is a subunit of SLE. And with annular erythema of the skin or a
psoriasiform rash
Characterized. Subacute LE is also ANA negative, while Anti SS-A (Ro) is positive.
502

Cardiopulmonary pericarditis, myocarditis, valve involvement, coronary vasculitis

and also coronary
aneurysm of the artery can affect the heart, while pleurisy, pleural effusion,
pneumonitis, pulmonary hypertension, pulmonary hemorrhage and diaphragmatic
dysfunction.
affected.
In the central nervous system, psychosis, convulsion and migraine-like attacks
may be affected. If LP is performed, increased IgG levels, pleocytosis and
antineuronal antibodies may be seen in CSF. MRI shows similar findings to MS.
Central nervous system in autopsy studies
neuron loss, vasculitis and microinfarcts.
When psychosis is seen in a patient with SLE, steroid side effects should be
considered.
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SLE is an immunocomplex disease

Multisystem involvement is seen as immunocomplexes can collapse in all organ
vessels
Antibody giving information about disease activity but not necessarily essential
for diagnosis
Anti dsDNA.
Hematologic findings include anemia, thrombocytopenia, leukopenia,
hypocomponentemia
A SLE subtype involving the skin primarily with psarioriform or erythematous
lesions is subacute
LE.
While ANA positivity was not observed in subacute LE, Anti SS-A was positive.
Central nervous system symptoms in SLE patients are due to vasculitis,
microinfarcts, antineural antibodies and neuronal loss.
When psychosis is seen in a patient with SLE, it may be due to primary disease or
steroid side effect.
It should come.
Immunocomplex detection in the choroid plexus is not specific for central nervous
system involvement.
MRI may not be very helpful in diagnosis because it shows nonspecific changes
In the presence of fever, infection should be considered.
The disease progresses with exerbations and remissions.
SLE during pregnancy:
The prevalence of abortion is quite high when SLE patients become pregnant. SLE
mother's child
hematologic abnormalities. Thrombocytopenia and leukopenia. Thrombocytopenia and
leukopenia are caused by passive antibodies from the placenta to the fetus.
Temporary skin lesions and transient
heart blocks can be seen.
Renal involvement in SLE:
Renal involvement mesangial, focal glomerulonephritis, membranous
glomerulonephritis, diffuse proliferative
glomerulonephritis, interstitial nephritis and renal vein thrombosis.
Renal involvement is determined by renal biopsy. Aggressive treatment is not
necessary only in patients with mesangial involvement. Treatment in patients with
diffuse proliferative glomerulonephritis
high-dose steroids and immunosuppressive agents. Membranous glomerulonephritis and
focal proliferative
Treatment in patients with glome-rulonephritis is controversial. There may be
crescent development. tubular
atrophy and scar formation. Renal involvement in patients with high anti-dsDNA
more likely.
Classification of lupus nephritis according to WHO:
I-
Normal or minimal disease

a- No evidence with all techniques
b- Normal deposits with light microscopy, deposits with EM and IF
II- Pure mesangial changes

IIIA- Focal segmental GNF,
IIIB- Focal proliferative GNF
IV-
Diffuse GNF (most common and worst)
V-
Diffuse membranous GNF
VI-
Advanced sclerosing GNF
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Laboratory:
Hemolytic anemia. Coombs is positive), chronic disease anemia, leukopenia,
thrombocytopenia, presence of anti-lymphocyte antibody, presence of anthrombocyte
antibody and immune thrombocytopenia, polyclonal
gammopathy can be seen. High sedimentation rate is associated with disease
activity. It gives information about the activity of hypocomponentemia disease. The
presence of anti-dsDNA is associated with kidney and skin involvement and disease
activity. Familial C2 deficiency is the most common complication in SLE
It is the lack of.
False positivity of VDRL due to cross-reaction of antiphospholipid antibodies in
SLE
has. It can be seen with the antibody formed against deoxyribonucleoproteins (DNP).
LE cell
most patients.
Anti dsDNA levels showed fluctuations with disease activity while other positive
The levels of antibodies (ribonucleoprotein, Sm, ANA) do not change with the
activity of the disease. lupus
ANA is positive in all patients.
Treatment and follow-up:
NSAIDs, steroids and other immunosuppressive agents are used for treatment.
Erythrocyte sedimentation rate, anti
dsDNA activity, C3 level, response to disease and relapses can be monitored.
The most common cause of death is renal involvement and related acute renal
failure.
Dose dependent
İdiosenkrazik
hydralazine
Acetylsalicylic acid
procainamide
penicilamine
Methyl dopa
propylthiouracil
INAH
reserpine
chlorpromazine
Quinine
primidone
phenylbutazone
the carbamazepine
griseofulvin
ethosuximide
Penicillin
ANA positivity is seen in the majority of patients with SLE. But it is not
specific.
Renal biopsy should be performed to plan treatment.
Steroid should be given to patients with diffuse proliferative glomerulonephritis.
Complement levels, sedimentation rate and Anti
This can be done with dsDNA levels.
Anti-dsDNA levels fluctuate in correlation with disease activity
Presence of hypocomponentemia and anti dsDNA in high rate kidney and skin
involvement
correlated with.
Drug-induced lupus:
Serological marker other than ANA positivity and not all clinical symptoms of lupus
positivity is a rare condition. The most strongly related drugs are hydralazine and
procainamide.
Clinically, arthralgia and polyarthritis are common. There may be fever and
pleural-pulmonary symptoms. Diffuse
interstitial pneumonitis and pericarditis. Central nervous system in drug-induced
lupus
and renal involvement. It has a better prognosis than SLE. LAP and myalgia may
occur.
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ANA positivity. Serum complement levels are normal. Anti-SM, SS-A, RNP and SS-B
rare
can be seen as. Antihiston antibodies are more common in drug-induced lupus than
SLE.
If acetylation reactions of patients taking INAH, procainamide and hydralazine are
slow, in these patients
drug-induced lupus is likely to occur. It is enough to stop the drugs in the
treatment.
Dose-dependent Idiosyncrazic Hydralazine Acetylsalicylic acid Procaineamide
Penicillamine Methyl dopa Propylthiouracil INAH Reserpine Chlorpromazine Kinin
Primidone Phenylbutazone Carbamezapine Griseofulvin
Etosuximide Penicillin
ANA-positive but complement levels are normal in patients with drug-induced lupus
and the anti dsDNA of the patients was negative.
Symptoms improve when the drug is discontinued
Drug-induced lupus does not involve central nervous system and kidney involvement
Overlap syndrome:
Overlap syndrome is a combination of multiple connective tissue diseases. The
coexistence of Sjögren's syndrome to an existing connective tissue disease is not
considered overlap syndrome. Kidney
The frequency of involvement is low. ANA and high titer anti-RNP positivity can be
seen. Reynaud's phenomenon
as seen.
Antiphospholipid syndrome:
Lupus anticoagulant and different phospholipid antibodies may cause recurrent
arterial and venous thrombosis.
why could it be. Antiphospholipid antibodies are IgG and IgM antibodies. the
anticardiolipin
as they are. Bleeding tests show elongation. The cause of elongation factor Xa or
calcium
binding is inhibited by the antiphospholipid antibody. aPTT is seen as long. PTZ
long
or normal. Serum IgM and IgG levels (antiphospholipid antibody) may be found to be
elevated.
Antiphospholipid antibodies not only in SLE but also in many malignant, autoimmune
and infectious diseases
visible.
In addition to recurrent venous and arterial thrombosis, TIA, MI, stroke, deep vein
thrombosis, brachial artery
thrombosis, retinal and hepatic vein thrombosis (may cause Budd-Chiari syndrome)
and pulmonary
may cause hypertension. Recurrent fetal losses, thrombocytopenia, coombs positive
hemolytic anemia, migraine, chorea, chronic leg ulcers, livedo reticularis and
especially aortic valve
heart valve diseases. The pathophysiology of thromboembolic events
not open. Inhibition of fibrinolysis, disruption of prostacyclin production,
plasminogen activator
decreased synthesis may help in diagnosis. Antiphospholipid antibody with high IgG
patients have a higher risk of recurrent thrombosis.
Warfarin should be given with PTZ (INR) monitoring. Low-dose aspirin or heparin in
pregnant patients
follow-up. Fetal losses in pregnant women can be reduced with this treatment
(Answer C)
6.
Which of the following is Libmann-Sacks endocarditis? (April 99)

B) Multiple myeloma
D) Amyloidosis
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Libmann-Sacks endocarditis non-bacterial verrucose in the heart of systemic lupus

erythematosus
Endocarditis. 1-3 mm wart-like multiple irregular deposits on both sides of the
valves.
Pericarditis is the most common cardiac involvement in systemic lupus
erythematosus. Not endocarditis!
Systemic lupus erythematosus multisystemic inflammatory mediated immune diffuse
complex
is a disease. Joints are most commonly involved (95%). Arthritis without deformity
is most common
The findings.
Arthralgia is the most common symptom. The proximal interphalangial joint, knee,
wrist, metacarpophalangial joint, elbow and foot joints are mostly involved.
(Answer C)
7. Systemic Lupus Erythematosus-like syndrome
A) INH
B) Indomethacin
C) Hydralazine
D) Procainamide
E) Alpha Methyldopa
Drugs that cause systemic lupus-like syndrome include:

Chlorpremazine, Penicillamine, Phenytoin, Labetolol, Asebutolol, asparaginase,
barbiturates, bleomycin,
cephalosporins, hydralazines, iodines, isoniazid, methyldopa, phenolphthalein,
phenytoin, procaineamide,
quinidine, sulfonamides and thiouracil. Indomethacin has no such effect.
(Answer B)
It goes with drug-induced lupus, arthritis and lung involvement. Antihiston
antibodies are 100% positive.
CLINICAL PROPERTIES IN SYSTEMIC LUPUS ERYTHEMATOSIS
JOINTS (90%)
•
Joint involvement is the most common clinical feature.
Symmetrical arthritis in small joints, mobile type
Most commonly, the upper extremities involve the small joints of the hand.
•
Joint is painful but does not cause bone erosion and destruction
Major joint deformity similar to rheumatoid arthritis is called Jaccoud's arthritis

and is rare.
Aseptic necrosis of the hip (rare)
myalgia
SKIN (75%)
•
Butterfly butterfly (most common), erythema (nasolabial line is normal)
Vasculitic lesions on the nail bottoms, purpura, urticaria
photosensitivity
Livedo reticularis, finger infarcts, palmar and plantar rash, pigmentation and
alopecia
Alopecia is diffuse, the earliest finding.
Discoid lesions are most commonly seen on the face, scalp, outer ear and neck.
Complement deposits are seen in immunofluorescence at the dermo-epidermal junction

(positive
band test)
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LUNGS (50%)
•
Bilateral recurrent pleurisy and pleural effusions (exudates) are most common.
Pleuritis is common.
Acute lupus pneumonia (line style atelectasis)
Restrictive lung disease, increase in diaphragm, volume loss in lung (Shrinking

lung
syndrome)
Pulmonary fibrosis (rare) pulmonary hypertension
CARDIOVASCULAR SYSTEM (25%)

•
Pericarditis is most common
Very little pericardial effusion is common with pericarditis.
Myocarditis and arrhythmia
Aortic valve lesions, cardiomyopathy
Noninfective endocarditis of the mitral valve (Libman-Sacks syndrome)
Raynould's, vasculitis, arterial and venous thrombosis may occur.
Congenital heart block is common in children with neonatal lupus; responsible for
anti-Ro and anti-La.
Coronary artery disease is associated with antiphospholipid antibodies.
It develops as a result of hypertension, steroid use and Chronic Renal Failure.
Kidney Involvement (40%)

•
glomerulonephritis
•
Mesengial, focal, diffuse, membranous all types are seen.
Proteinuria (> 1 g / day) is common
Hypertension due to nephrotic syndrome or renal failure
Diffuse proliferative glomerulonephritis is the most common and the prognosis is

the worst.
Focal proliferative glomerulonephritis is the second most common.
Immune complex accumulation and decrease in the complication.
NERVOUS SYSTEM (60%)

•
Depression, psychiatric disorders
Epilepsy, cerebellar ataxia, aseptic meningitis
Cranial nerve lesions, cerebrovascular events, polyneuropathy
Psychosis is associated with anti-Ribosomal P antibodies.
EYE
•
Retinal vasculitis can cause infarction (cytoid bodily), hard exudate, hemorrhage
Episcleritis, conjunctivitis, optic neuritis
• Secondary Sjögren's syndrome

GIS
• The most important lesion is mesenteric vasculitis (infarction, perforation)
Liver involvement is uncommon, but lupoid antibodies are present in autoimmune
hepatitis.
• Pancreatitis is rare.
• Aseptic peritonitis
BLOOD
• Anemia (chronic disease anemia or hemolytic Coomb's (+))
• Leukopenia
• Thrombocytopenia
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8. Coombs (+) hemolytic anemia, thrombocytopenia, hematuria, arthritis and

hepatosplenomegaly
Which of the following is considered primarily in a patient diagnosed? (September
97)
A) Henoch-Schönlein vasculitis
C) Dermatomyositis
D) Wegener granulomatosis
The most common presenting complaint of children with systemic lupus erythematosus
is arthritis and arthralgia. Often
weight loss, fever or rash. Arthritis mostly affects small joints and physics
There is severe pain incompatible with examination findings. Percent characteristic
butterfly in many patients
has redness. Renal involvement is almost always present. Hematological disorders
are also common and
reflects autoantibody development. Coombs (+) hemolytic anemia, leukopenia and
thrombocytopenia
visible.
(Answer E)
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one. A 55-year-old male patient had high fever, arthralgia and fatigue for 10 days.
with complaints. On examination, blood pressure 130/85 mmHg, pulse 96 / minute and
fever
38, 5 ° C. Urine test revealed protein (++), microscopic hematuria and granular
sands. The patient with serum creatinine level of 1.5, 5 mg / dL was creatinine
after 3 days
level is increased to 2.9 mg / dL. Kidney biopsy with crescent formation on light
microscopy
focal segmental necrosis is remarkable, but immunoglobulin in immunofluorescence
examination
and complement accumulation is not detected
Which of the following is the blood test required to diagnose this patient?
(September 2011)
A) Anti-glomerular basement membrane antibody
B) Cryoglobulin
C) Anti-neutrophil cytoplasmic antibody
D) Anti-dsDNA
E) Complement 3 and 4 levels
The patient had fever, weakness and joint pain. Then he went into kidneys. Typical
vasculitis
One of the questions. The question of crescent formation in the question is already
rapidly progressive glomerulonephritis
Typical for but then not enough, focal segmental also said. Four-quadruple Wegener
plus immune
No salt pepper in storage.
Let's not know the case. Embodiments
Cryoglobulin is the answer though C3-4 need to look at Cryoglobulinemia also drops.
Anti ds DNA lupus need to think 55 y male does not fit.
If he says hemoptysis for the antiglomerular basement membrane, maybe I will.
(Answer C)
It should be remembered that he can always do anything where there is a vasculature
for questions about vasculitis.
So if we can't diagnose the question, we should consider vasculitis. Spot questions
will be very useful
Key features of the disease are available.
2nd. Creatinine level 2.0 in a patient presenting with new onset asthma symptoms
mg / dL, proteinuria 2.5 g / day, hypereosinophilia and hematuria. Patient several
days
After creatinine level was found to be 3.0 mg / dL, urinary ultrasonography
revealed normal renal size.
Which of the following should be considered first in this patient? (April 2009)
A) Microscopic polyangiitis
B) Wegener granulomatosis
C) Churg-Strauss syndrome
E) Goodpasture syndrome
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Churg-Strauss vasculitis:
· Churg-Strauss syndrome involves small arteries, veins, arterioles and venules.
· Transient pulmonary infiltrates or nodules are characteristic.
· P-ANCA positivity can be seen.
· Eosinophilia improves with treatment.
The classic triad is asthma, peripheral eosinophilia and vasculitis.
Cytotoxic agents are used in the treatment.
(Answer C)
3. Which of the following is accepted internationally in the diagnosis of Behcet's
disease
is not one of the criteria? (September 2008)
A) Recurrent oral ulcers
B) Eye lesions
C) Recurrent genital ulceration
D) Arthritis without deformity
E) Positive pathergy test
Behcet 's disease
Description: It is a vasculitis described by Hulusi Behçet (1937) with multisystem
involvement. It is thought to be associated with HLA-B51 and has been reported in
some series in 70% of patients. B51 positivity is more frequent in patients with
vascular involvement, thrombosis and uveitis, or B51
being positive constitutes a tendency to more severe disease. Diagnosis requires 1
major and 2 minor criteria.
The disease goes with clinical exacerbations and periods of well-being and starts
on average at the age of 20-30 years.
Major finding: Recurrent oral ulcers (the most common finding), genital ulcers, eye
involvement
(uveitis, etc.), skin involvement (erythema nodosum, acne, etc.), thrombophlebitis.
Minor findings: Large vessel vasculitis, arthritis (most common knee joint),
phlebitis, meningoencephalitis, GIS
involvement.
Pathergy positivity is also pathognomonic.
Clinic:
Mucosa: Oral ulcers are painful, round, oval and multiple. There may be genital
ulcers but
It is not.
Skin: Erythema nodosum, pustular reaction to trauma (pathergy), photosensitivity.
Eye: In addition to uveitis, there may be secondary glaucoma, cataract, vitreous
hemorrhage, retinal vein thrombosis.
Vascular: Phlebitis and arthritis occur in 25% of patients. Aneurysms may occur
(pulmonary artery
is the only vasculitis causing aneurysm). There may be pulmonary vasculitis and
related hemoptysis.
FAQ: Involvement is the most common aseptic meningitis. Encephalitis, convulsions,
transverse myelitis,
ataxia, pseudotumor cerebri.
Treatment: There is no effective treatment. Various drugs are used (steroids,
colchicine, cyclosporine, azothiopyrine, interferon alpha, etc.).
(Answer D)
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4. Which of the following is a vasculitis where antineutrophilic cytoplasmic

antibodies (ANCA) are often positive? (April 2008)
A) Buerger's disease
B) Henoch-Schönlein vasculitis
C) Behcet's disease
D) Takayasu's arteritis
E) Microscopic polyangiitis
The question of memorization;
p-ANCA microscopic PAN, CHURG-STRAUSS SYNDROME
c-ANCA: Anti-neutrophil cytoplasmic antibody: Wegener
(Answer E)
5. The most specific serological test to diagnose Wegener's granulomatosis is:
B) Anti-neutrophilic cytoplasmic antibodies
C) Peripheral type anti-nuclear antibodies
D) Anti-Sm antibodies
E) Anti-citrulline peptide antibodies
Some antibody disease associations:
MAIN: SLE (screening test)
antids DNA: SLE (specific)
anti smith (anti-SM): SLE (specific)
RF: RA and Sjögren (may be positive in infectious and collagen tissue diseases)
Anti Ro: Sjogren and lupus
Anti La: Sjogren and lupus
anti-SCL70: Scleroderma
anti-centromere antibodies: CREST syndrome
Anti-JO-1: Polymyositis / dermatomyositis
c-ANCA: Anti-neutrophil cytoplasmic antibody: Wegener
p-ANCA: Microscopic PAN
Anti-histone antibodies: Drug-induced lupus
Anti-RNP: Mixed connective tissue disease
Anticardiolipin antibody IG M and IgG: Antiphospholipid antibody syndrome
Lupus anticoagulant: Antiphospholipid antibody syndrome
Anti-glomerular basement membrane antibody: Good-pasture syndrome, RPGN
Thyroid stimulant immunoglobulin: TSH receptor antibody: Graves' disease
Anti-tiroglubolin antibodies: Hashimoto (early)
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Anti-microsomal antibodies: Hashimoto (late), post partum thyroiditis

Islet cell antibodies: Type I diabetes mellitus (insulin dependent)
Anti-insulin antibody: Type II DM (insulin independent)
Anti-intrinsic factor: Pernicious anemia
Parietal cell antibodies: Pernicious anemia
Anti-mitochondrial antibody: Primary biliary cirrhosis
Acetyl choline receptor antibody: Myasthenia gravis
Anti-liver kidney microsomal antibody-1 (LKM-1): Autoimmune hepatitis Type 2
Anti-Smooth Antibody: Autoimmune Hepatitis Type 1
(Answer B)
6. The most specific serological test to diagnose Wegener's granulomatosis is:
B) Anti-neutrophilic cytoplasmic antibodies
C) Peripheral type anti-nuclear antibodies
D) Anti-Sm antibodies
E) Anti-citrulline peptide antibodies
C-ANCA is the most reliable diagnostic method in Wegener's granulomatosis. Easy
question.
WEGENER GRANULOMATOSIS
•
It is a necrotizing-granulomatous vasculitis involving the upper and lower

respiratory tracts and kidneys.
Clinic:
one.
Lung findings (97%): Cough, bloody sputum, dyspnea and chest pain
are the symptoms. Single or multiple cavitary lesions and nodules are seen on chest
X-ray. Granulomatous lesions and ulcers can be seen in the larynx and trachea.
2nd.
Upper respiratory tract findings: Otitis, sinusitis (90%), rhinitis, oral-nasal
ulcers, epistaxis,
perforation of the palate, pharyngitis and so on.
3.
Renal manifestations: Renal involvement is common in the systemic stage. Focal-

segmental
Glomerulonephritis may cause hypertension and nephritic syndrome. Untreated short
kidney failure develops in time.
4.
Ophthalmic findings: Keratoconjunctivitis and retroorbital granulomatous

inflammation may cause ptosis.
5.
Skin findings: Painful subcutaneous nodules, purpura, ulcers, pyoderma gangrenosum

and so on.
6.
Other findings: Heart involvement, mononeuritis multiplex, arthritis
Nodules are considered the most common and typical radiological lung findings in
Wegener
It is.
Laboratory:
one. There is an increase in acute phase reactants.
2nd. C-ANCA (anti-proteinase 3 antibody) in more than 90% of patients with
Wegener's granulomatosis
located. c-ANCA is a very important test in the diagnosis and follow-up of WG.
Specificity of active disease
98%.
3. Patients with renal involvement have pyuria, hematuria, sylinders and
proteinuria.
The most common renal pathology in wegener is focal segmental necrotizing
glomerulonephritis.
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vASCULITIS on
Treatment:
one. Cyclophosphamide (2-4 mg / kg / day) + high dose corticosteroid
administration.
2nd. There are publications reporting that trimethoprim-sulfomethoxazole is
effective.
c-ANCA is formed against proteinase-3, a serine prosthesis found in azurophilic
granules. Idiopathic
crescentic glomerulonephritis, Wegener's granulomatosis, microscopic polyangiitis
and Churg-Strauss syndrome.
p-ANCA occurs against myeloperoxidase and other neutrophil stoplasmic structures.
It is positive for idiopathic crescentic glomerulonephritis, microscopic
polyangiitis, Wegener's granulomatosis, ChurgStrauss syndrome and SLE.
(Answer B)
7. Which of the following vasculitic syndromes, both arterial and venous system
and it is different from other vasculitis because it can hold the vessel of any
diameter? (September 2005)
A) Cryoglobulinemic vasculitis
B) Classical polyarteritis nodosa
C) Rheumatoid vasculitis
D) Behcet's disease
E) Kawasaki disease
- In Behçet's disease, both veins and arteries can be involved. Vascular findings
in the disease
thrombosis in large veins such as thrombophlebitis, vena-cava, arterial occlusion,
arterial aneurysms and arterial bleeding. Pulmonary artery aneurysm Behçet
disease is the most common cause of death.
-
Ulcerations may also occur in the gastrointestinal tract, especially in the small
intestine and colon.
Pulmonary artery thrombosis, pleural effusion and hemorrhagic pneumonia may develop
in the lungs.
The disease is characterized by multiple central sclerosis-like clinical

manifestations, pseudotumor
cerebral, organic brain syndrome and meningoencephalitis. FAQ involvement
often aseptic meningitis.
Epididymitis may occur in male patients and may lead to infertility.
Laboratory: No specific laboratory findings. Erythrocyte sedimentation rate in

acute period,
Acute phase reactants such as CRP and alpha 1 globulin are elevated. Pathergy
phenomenon in all patients
Although not seen, it is quite characteristic for the disease when seen. Neutrophil
and
platelet hyperfunction.
Diagnostic criteria: In addition to recurrent oral ulcer, recurrent genital
ulceration, ocular involvement, skin involvement
or two more pathergy phenomena are considered sufficient for diagnosis.
Treatment: There is no proven drug. Local anesthetic solutions, topical steroids,
colchicine,
nonsteroidal anti-inflammatory drugs, low-dose corticosteroid may be given.
Immunosuppressive therapy may be given in severe cases.
The most common cause of death in Behçet's disease is pulmonary artery aneurysm
rupture.
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INTERNAL MEDICINE
Hulusi Turkey has produced one of the greatest scientists of Behcet's not to
mention mercy.
Excellent question. Vasculitis all have veins that they love. But selection in
Behçet
They do not. It can involve the artery, vein and vessels of any size.
BEHCET 'S DISEASE
•
It is a multisystemic disease. Disease other Mediterranean countries besides our

country
It is also common in Iran, Iraq, Pakistan and Japan. This geographic distribution
shape
Behçet's disease is sometimes called ek Silk Road Disease için.
Behçet's disease usually begins between the 2nd and 4th decades. Disease in both
sexes
however, it is more severe in young males.
Etiology: HLA-B5 (b51 allotype) is positive. Viruses and Streptococci (sangius) may
have a role
It is believed.
Clinic:
-
Oral aphthae
Genital ulcer (may leave scatris)
Skin findings: Erythema nodosum, papulo-pustular acneiform lesions, pyodermia,

dermography and Pathergy phenomenon. Erythema nodosum is a common disease
is one of the findings. Although it is mostly seen in pretibial areas and legs,
neck and upper extremities.
Pathergy phenomenon is a reaction that reflects the hypersensitivity of the skin to

non-specific stimuli and as a development of sterile papules or pustules after 24-
48 hours at the site of sterile needle entry.
Identified.
Eye involvement is one of the most important causes of morbidity in the disease.
Eye involvement
patients are at risk of developing severe visual loss. 20% of patients with eye
involvement
reported complete blindness. Eye involvement is more common in young men
seen and progresses more heavily. Iridocyclitis, the main eye findings seen in the
disease,
transient hypopyonic iritis, posterior uveitis, retinal vasculitis, retinal
detachment, chorioretinitis and
their complications.
- Arthritis is repetitive and usually does not leave deformity. Most arthritis
attacks are monoarticular. Oligoarticular and polyarticular involvement may also be
seen. The most commonly involved joint is the knee.
(Answer D)
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vASCULITIS on
8. What is the most common kidney pathology in Wegener's granulomatosis? (April

2004)
A) Focal segmental necrotizing glomerulonephritis
C) Diffuse proliferative glomerulonephritis
E) Sclerosing glomerulonephritis
(Answer A)
9. Which of the following does not cause mononeuropathy multiplex? (April 2003)
A) DM
B) Cryoglobulinemia
C) PAN
D) Rheumatoid arthritis
E) Tuberculous meningitis
Mononeuropathy is most often caused by DM. PAN is the most common vasculitis.
It can be seen in all vasculitic conditions.
(Answer E)
10. Which of the following characteristics for Wegener's granulomatosis
A) Paranasal sinusitis
B) Retroorbital mass and proptosis
C) Lower esophageal sphincter involvement
D) Perforation of the nasal septum
E) Serous otitis media

See September 2007 release
(Answer C)
11th. What is the most specific marker in the diagnosis of Wegener Granulomatosis?
(September 2001)
A) Anticardiolipin antibody
B) Anti DNA
C) C-ANCA
D) Anti Ro
E) Antinuclear antibody
See September 2007 release
(Answer C)
12. Which of the following is not a sign of temporal arthritis? (September 94)
A) Headache
B) Visual impairment
C) Erythema multiforme
D) Fire
E) Polymyalgia
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Temporal arthritis (Giant cell arthritis = Cranial arthritis = Granulomatous

arthritis)
It is usually seen in people older than 50 years. It is more common in women. Half
of patients
Polymyalgia rheumatica symptoms. The main branches of the aorta in the segmental or
patchy style
is a vasculitis. Ophthalmic artery and branches due to involvement of the optic
nerve
Ischemia may cause temporary or permanent blindness in patients. Segmental
involvement
The cross-sectional biopsy should not be removed from the entire temporal artery.
Steroids are used in the treatment.
Clinic of temporal arteritis
-
Fever, weight loss, fatigue
Symptoms of Polymyalgia rheumatica
Temporal headache
Chin or tongue cladikasi
Ocular symptoms: blindness, diplopia, ptosis
Sensitivity in head class
Redness and tenderness along the temporal artery trace
Dry Cough
-
Peripheral major vasculitis
Erythema multiforme is either a skin reaction due to drug hypersensitivity

(sulfonamide, phenytoin, barbiturate, penicillin and carbemezapine or infections
(HSV, mycoplasma).
(Answer C)
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ROMATOID ARTHRITIS AND OSTEOARTHRITIS
ROMATOID ARTHRITIS
AND OSTEOARTHRITIS
one.Which of the following joints is most likely to be involved in rheumatoid
arthritis?
(December 2010)
A) Metacarpophalangeal joints
B) Atlantoaxial joint
C) Shoulder joints
D) Distal interphalangeal joints
E) Temporomandibular joints
The only internal rheumatology question. Rheumatoid arthritis which does not
involve joints:
Distal interpharyngeal joint
Sacroiliac joint
Does not involve vertebrae except C1–2
(Answer D)
2nd. Which of the following 1987 American Rheumatism Association rheumatoid
arthritis classification
A) Morning stiffness lasting at least 1 hour
B) Presence of subcutaneous nodules
C) Rheumatoid factor positivity
D) Arthritis of wrist, metacarpophalangeal, proximal interphalangeal joints
E) Arthralgia in 3 or more joints
A question for rheumatoid arthritis is arthritis or arthralgia? Of course,
arthritis ...
Diagnostic criteria: Since there is no definitive diagnosis, some criteria have
been defined. For diagnosis
Criteria 1, 2, 3 and 4 should last more than 6 weeks and at least 4 criteria should
be positive. 2 or 3 criteria
RA is positive in the positive. These criteria are;
one. Morning stiffness lasting more than an hour,
2nd. Arthritis of three or more joints,
3. Arthritis of hand joints,
4. Symmetrical arthritis,
5. Subcutaneous rheumatoid nodules,
6. Serum RF (+),
7. Periartricular osteopenia (hand and wrist joint) on direct radiographs.
(Answer E)
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3. Which of the following is commonly involved in osteoarthritis but is very common

in rheumatoid arthritis
is a joint rarely kept? (September 2008)
A) Hand-wrist
B) Elbow
C) Foot-wrist
D) Metacarpophalangeal
E) Distal interphalangeal
Theoretically, rheumatoid arthritis does not involve the vertebra and sacroiliac
joints except DIF (Distal interphalangeal), C1-2. Besides, it can hold all the
snovial joints symmetrically. see two RA of the same TASS
question, so RA will be known… ..
(Answer E)
4. In a 35-year-old female patient with subcutaneous nodules with elevated serum
rheumatoid factor levels, which of the following should be considered first?
(September 2007)
A) Chronic hepatitis B infection
B) Psoriatic arthritis
C) Polymyalgia rheumatica
D) Sarcoidosis
E) Primary Sjogren's syndrome
Now a quality and really prepared question is one of the questions that will remind
us to think in the exam.
It is clear that chronic hepatitis B infection cannot occur.
35-year-old RF-positive nodules, RA immediately comes to mind Sjögren's syndrome is
the most common
do not jump to E, it is the secondary Sjögren with RA. Keep thinking,
RF positive cannot be Psoriatic arthritis.
Polymyalgia rheumatica elderly aching woman is not room
Sarcoidosis remains. Sarcoidosis is like the question of chest diseases, but from
what angle
attention should be remembered to have autoimmune and systemic reactions. RF in all
autoimmune events
may be positive. For those who say what is happening to the subcutaneous nodule,
they have erythema nodosum ... How to question good quality
is not it?
(Answer D)
5. Which of the following is extraarticular in rheumatoid arthritis patients
is not one of the changes? (April 2005)
A) Chorioretinitis
B) Vasculitis
C) Interstitial lung fibrosis
D) Polyneuropathy
E) Osteoporosis
The most common inflammatory arthritis in the world that gives its name to
rheumatology: RA dominates this issue with this question
Let's ....
ROMATOID ARTHRITIS:
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease associated
with joint destruction. 35-45
age peaks. The prevalence increases after the age of 65 years. Physiopathology of
RA
It is thought that an antigen which is not known exactly triggers the immune
response. Some microorganisms can cause chronic arthritis (EBV, HTLV-1, rubella,
CMV, HSV, Borellia, Whipple
bacillus, Neiserria gonorrhea).
Antigen-presenting cells of class II MHC antigens being a genetic predisposition
for RA
B cells are stimulated and introduced into plasma cells to express Ig.
They return. Many RA patients have been associated with HLA. The relationship
between HLA DR-4, HLA DR-1 and rheumatoid arthritis was quite strong. HLA DR-2
protects against rheumatoid arthritis
It was found. In patients with RA who carry HLA DR3, rheumatoid factor (RF) titer
is low
and the toxicity of gold and D-penicillamine was less in these patients.
520
The prevalence of RA is between 0.03% and 1.5%.

Patients with RA are generally HLA DR-4 and HLA DR-1 positive.
When one of the twins is RA, the chance of the other being RA is 30 times that of
the normal population.
People who are positive for HLA DR-4 are 4 times more likely than those who do not
have RA.
pathogenesis:
The immune reaction starts from the synovial membrane. The earliest finding due to
microvascular damage
deposition of inflammatory elements in the perivascular area with increased
permeability (plasma cell).
CD4 + T cells, Polymorphonuclear cells). Cytokine release occurs. Especially TNF-
alpha is effective. Inflammatory mediators cause proliferation and synovial
angiogenesis in synovial cells
It happens. Neutrophils accumulate in synovial fluid and plasma cells form from B
cells. Plasma cells
It starts to synthesize more IgM structure which is detected as rheumatoid factor.
Vascular permeability due to chemotactic agents released by activation of
complement
increases and opsonization develops. Release of lysosomal enzymes and phagocytosis
with collagen, cartilage
and elastic tissue destruction. Cell damage is caused by the release of free oxygen
radicals.
Proliferation in the synovium causes pannus formation and articular cartilage and
subchondral bone
destruction. the limits of inflammation by releasing collagenase and protease in
chondrocytes
They expand. Patients have pain, swelling and limitation of movement. Joint is hot,
painful, swollen, active
If inflammation is present, the patient does not move the joint. But redness in the
joint is not expected.
It is due to swelling, pain, joint stiffness, immune-mediated vascular damage,
angiogenesis in the synovium and cellular proliferation.
Rheumatoid factor (RF) is an antibody capable of binding other Igs in IgM
structure. rf
by binding other antibodies, immune complexes are formed.
Cytokines and immunocomplexes are the main factors that play a role in joint
damage.
Clinic:
85% of RA patients have joint complaints. Joints most commonly involved and usually
the first time inflammation begins
proximal interphalangeal joints and metacarpophalengeal joints. Other common joint
is the wrist. Joint involvement is almost always symmetrical and starts from small
joints. Knee, foot
wrist, shoulder, hip, elbow, acromioclavicular joint, temporomandibular joint can
be involved in other
regions are. Ear bones, sternoclavicular joint and cricoarytenoid joint are rare.
The affected joint is swollen and hot. Fluctuations due to fluid accumulation in
the joint space can be taken. joints
In the mornings there is over an hour of imprisonment. Imprisonment may occur after
rest.
Morning stiffness is usually long in rheumatoid arthritis.
Prolonged rest may result in stiffness.
The most commonly affected joints are interfalingeal, metacarpofalingeal and wrist
joints.
SACROILIAC JOINT
SPINE (Excluding C1-2)
DIP INVOLVEMENT IS NOT EXPECTED IN ROMATOID ARTHRITIS.
Fatigue, weight loss, muscle pain, excessive sweating, fever are other visible
symptoms.
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Musculoskeletal complications in RA:

Cervical vertebrae: half of the patients are affected. Subluxations may occur in
the cervical vertebrae.
Half of the patients have subluxation in the atlantoaxial joint. Pain in the
intrascapular region,
shoulder pain, pain in the occiput, and limitation of movement in the cervical
vertebrae.
Drowsiness and nystagmus may be seen in syncope, face, arms and cheek. First
cervical instability
signs of ataxia, weakness of the arms or frank tetraplegia. Vertebrobasiller
failure
Miscible. Stabilization of cervical vertebrae is recommended in cases of
subluxation exceeding 8 in C1 and C2.
Popliteal cyst:
The intra-articular pressure increases in the popliteal joint, especially during
flexion, which results in extra posterior
causes the formation of a pouch. This pouch formed in the posterior region of the
knee joint is called the Baker cyst.
USG can be easily diagnosed. Popliteal artery aneurysm should be differentiated
from lymphadenopathy, benign or malignant tumors and phlebitis. In patients with
cyst rupture into the calf
a clinical similar to phlebitis. This condition is called pseudophlebitis. Fever,
leukocytosis and knee joint
ecchymosis around. Treatment of ruptured cyst bed rest, ice application,
intararticular
steroid injection and leg elevation.
A popliteal cyst is called a baker's cyst.
If the ruptured cyst is ruptured into the calf
It is called pseudophlebitis because it occurs clinically.
USG is used for diagnosis.
tenosynovitis:
Tenosynovitis in the flexor and extensor tendons of the fingers is common in
rheumatoid arthritis.
Palpation shows swelling of the joints of the fingers. Other visible tenosynovites
are De-Quervain.
tenosynovitis is. Tenosynovitis in these areas can cause tendon rupture and
inactivity.
Treatment of tenosynovitis is by immobilization and warm application and NSAID
administration. Local corticosteroid injection may be beneficial.
Carpal tunnel syndrome:
RA is the second most common cause of carpal tunnel syndrome (pregnancy is the most
common cause). Innervating the median nerve
There is paresthesia in the region. Symptoms increase with prolonged flexion and
especially at night. Late
complications include thenar atrophy, loss of sensation, and thenar weakness.
Increasing incidence in RA patients
Another nerve trap is tarsal tunnel syndrome. Treatment of these two syndromes
use and control of inflammation. Local glucocorticosteroid injection may be
beneficial.
Surgical decompression may be useful in patients with persistent symptoms.
RA is the second most common cause of carpal tunnel syndrome.
The other entrapment neuropathy is tarsal tunnel syndrome.
In carpal tunnel syndrome, there is parasthesia in the median nerve innervation
region.
Extraarticular complications of RA:
Extraarticular complications are seen especially in patients with high RF titer.
extraarticular
The presence and severity of the findings are generally in line with the severity
of the disease.
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Rheumatoid nodules:
25-30% of patients are in. The extensor is seen on the faces and pressure-exposed
areas.
They can also be seen in the lung, heart, kidney and duramater. The histopathology
of the nodule is characteristic. In the plant, necrosis is surrounded by
fibroblasts and collagenous
capsule. Accumulation of chronic inflammation cells is seen in the perivascular
area.
Rheumatoid nodules are seen in extensor faces and pressure-exposed areas.
Histopathological appearance is characteristic.
Rheumatoid vasculitis:
It occurs in patients with deforming arthritis and high titer RF. Complement
activation
accompanying or not circulating immune complexes
Vasculitis. It may cause obliterative endarteritis by proliferation in intima and
media layers.
It may cause necrosis around the lower extremity malleoles and ulceration of the
skin. Secondary
polyarthritis is clinically and histopathologically similar to polyarteritis nodosa
and mononeuritis multiplex
causes. When arthritis is treated, vasculitis is treated.
Rheumatoid vasculitis occurs in patients with deforming arthritis and high levels
of rheumatoid factor.
It is a vasculitis resulting from circulating immunocomplex storage.
Neurological findings:
Moderate peripheral sensory neuropathy, mononuritis (vasculitis), entrapment
neuropathy (carpal tunnel)
syndrome), symptoms due to cervical vertebral subluxations, degeneration in the
odontoid process is due to basilar invagination (C2 enters the odontoid projection
into the brain).
Lung findings:
It is generally seen as restrictive lung disease. More frequent in patients with
keratoconjunctivitis
obstructive symptoms. Pleura is affected in 40% of patients. Pleural effusion may
be seen. pleural
liquid exudate style. Pleural fluid due to RA has a low glucose content. Because of
the pleura
glucose transport is impaired. The cells in the pleural fluid are of the
mononuclear type. Coin in case of lesion
pulmonary nodules may be seen. Nodules may cause bronchopleural fistula formation.
Rheumatoid
is seen in pneumoconiosis with pulmonary disease is called Kaplan syndrome. In this
case, severe fibroblast reaction and larger nodules are seen. Acute interstitial
pneumonitis
more rare. Interstitial fibrosis is a slow progressive condition. Listening
dry rales are the findings. Direct radiographs show reticulernodular consolidations
starting from the basal of the lungs. Diffusion capacity decreased. Progression
with smoking
Accelerated. In RA, bronchiolitis obliterans (with or without organized pneumonia)
can be seen.
Restrictive findings in rheumatoid lung disease respond to steroid treatment. High
in diagnosis
resolution CT is used. Methotrexate used in the treatment of RA causes fibrosis in
the lungs
dry cough occurs.
35% of patients with RA have restrictive lung disease. The most common thing is
pleura ....
Pleural fluid is exudate and has low glucose.
Rheumatoid nodules in the lungs can cause bronchopleural fistula.
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The best way to show pulmonary disease due to rheumatoid arthritis is high
resolution
CT.
Bronchiolitis obliterans can be seen.
Kaplan syndrome is a combination of rheumatoid lung disease and pneumoconiosis.
Cardiac findings:
In RA, pericarditis (the most common heart involvement) occurs in 50% of patients
(in autopsy studies). Rheumatoid nodule may be seen in the pericardium. Pericardial
effusion may be seen. Recurrent pericardial effusions
Constructive pericarditis. Coronary artery disease, conduction defects and valve
dysfunctions. Pericarditis is usually serous pericarditis.
Heart valve, myocardium, pericardium and coronary arteries may be affected.
Serous pericarditis can be seen.
Recurrent effusive pericarditis may cause constructive pericarditis.
Liver abnormalities:
ALT, AST, GGT and ALP elevation can be seen. Acute phase reactants may be elevated.
Negative
serum level of albumin, an acute phase reactant, decreases. Nonspecific liver
biopsy
changes are seen. Portal hypertension due to regenerative hyperplasia
hypersplenism. Elevated liver enzymes in agents used to treat RA
why could it be.
RA may also elevate liver enzymes. In particular, ALP is elevated.
Nodular liver hyperplasia can cause portal hypertension and hypersplenism
Depending on the drugs used in the treatment, the enzyme may be elevated.
Ophthalmic abnormalities:
Keratoconjunctivitis is a common ophthalmic complication of cyclic or secondary
Sjögren's syndrome. In addition, episcleritis, scleritis, uveitis and retinopathy
due to antimalarials used in treatment
visible.
The most common ophthalmic complication is keratoconjunctivitis
Sjogren's syndrome.
Severe scleritis can cause scleromalazia perforans and result in blindness.
Normocytic anemia, leukocytosis, thrombocytosis, hypoalbuminemia and
hypergammaglobulinemia.
In 90% of patients, RF (IgM structure) is positive. But months after the onset of
joint complaints or
may not reach the level to be tested in serum even after years. RF positivity is
specific to RA
It is not. It may also be positive in infective endocarditis and
lymphoproliferative diseases. RF other
also found to be positive in connective tissue diseases. 5% of the normal
population
RF may be found to be positive at low titer. Cryoglobulin and ANA positivity can be
found. eosinophilia
30% of patients. CRP and sedimentation rate can be used to monitor disease activity
and evaluate response to treatment. Plasma iron in RA patients with active disease
and the iron binding capacity is low. If the synovial fluid is aspirated, it
appears to be turbid.
Low viscosity. The number of cells in the synovial fluid is high and 60-65%
polymorphonuclear leukocytes
is seen. The synovial fluid has a low glucose content.

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INTERNAL MEDICINE
Anti-CCP is a non-standard term called citrulline which is not normally found in

peptides or proteins.
an Ig G type immune protein formed against a circular peptide comprising an amino
acid. citrulline
arginine which is one of the standard amino acids in the body.
intermediate. Anti-CCP is used in the diagnosis of rheumatoid arthritis.
Anti-CCP occurs early in the disease in patients with rheumatoid arthritis and in
the majority of patients
located. 90-95% probability of rheumatoid arthritis in patients with anti-CCP
detected in blood
has. Conventional blood such as Rheumatoid Factor with unexplained joint
inflammation
anti-CCP is very useful for diagnosis in patients with negative tests. Also anti-
CCP, rheumatoid
prognosis is associated with increased tendency to destructive forms of arthritis
There is also value.
RF (IgM vs. IgM)
RF (+) cases
RF (-) situations (GO-PARIS) *
Bacterial endocarditis
Gout
SLE, Sjögren, polymyositis, sarcoidosis
osteoarthritis
and vasculitis
Psoriatic arthritis
Syphilis, kala-azar
Ankylosing sopondylitis
Viral infections
Reiter syndrome
IV drug habit
IBD-associated arthritis
Cirrhosis
Still disease
Elderly and normal persons (rare)
Septic arthritis
Normocytic anemia, leukocytosis, thrombocytosis are common in RA.

RF is neither specific nor sensitive to rheumatoid arthritis.
CRP and sedimentation rate are correlated with disease activity.
Eosinophilia may be a sign of rheumatoid vasculitis or an agent used in treatment
may also be a sign of toxicity.
Cryoglobulin and ANA positivity are common in seropositive RA.
Radiographic findings:
There are no signs other than soft tissue swelling in the early period. Late
periarticular osteoporosis, symmetrically widening of the joint surface,
subluxation, joint destruction and joint
ankylosis.
4 out of 7 criteria of American Rheumatology Association for diagnosis of
rheumatoid arthritis
must be.
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Diagnostic criteria of the American Rheumatology Association:

-
Morning stiffness lasting 1 hour or more
Simultaneous arthritis of 3 or more joints
Arthritis of the joints around the wrist joint (metacarpofalingeal joints, PIP)
Symmetrical arthritis (arthritis in the joints of the same region in both halves of
the body)
The presence of rheumatoid nodule
Serum rheumatoid factor positivity
Presence of specific radiological images for rheumatoid arthritis (periarticular

osteoporosis, joint expansion, marginal erosion)
As the duration of the disease progresses, the loss of function of the patients
increases. Expected in people with rheumatoid arthritis
The life span is reduced to 7, 5 in men and 3, 5 years in women. Patients with
comorbid cardiovascular or
having another disease may affect prognosis.
Treatment:
The aim of the treatment is to relieve inflammation, relieve pain and gain lost
functions
or to protect existing functions. The basis of the physical approach is to protect
the joint from damage and
rest. Joint damage in exercises to protect joint movements
need to be careful not to give.
The first-line drugs to be selected for treatment are NSAIDs with antinflammatory
efficacy. glucocorticoids
may need to maintain functions. Disease modifying drugs are second-line drugs
should be preferred. Second-line drugs slow-acting effects occur after a long time
drugs that increase the quality of life. These drugs alone or with NSAIDs or
steroids
They can be used in combination.
Disease modifying drugs:
-
Methotrexate
the hydrochloro
penicilamine
sulfasalazine
Gold salts
leflunomide
the azathioprine
Cyclophosphamide is.
In patients who do not respond to one of these drugs or one of these drugs has
toxic effects
passable. Again, these drugs can be given in combination in patients who do not
respond. TNF Alpha
When we look at the place of the pathophysiology of rheumatoid arthritis TNF alpha
receptor blockers
etanercept rheumatoid, a TNF alpha antagonist, and
has been used in the treatment of arthritis.
Patients with uncontrolled pain or compression symptoms (may be rheumatoid nodule
compression)
surgery can be tried. Surgical interventions include: synovectomy, arthroplasty and
arthrodesis.

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INTERNAL MEDICINE
Conditions associated with rheumatoid arthritis:

Seronegative rheumatoid arthritis:
In rheumatoid arthritis with rheumatoid factor negative, no extraarticular findings
are seen. But arthritis
it is generally destructive and deforming. In people over 60 years of age, this
condition is characterized by sudden onset of polyarticular inflammation. Very good
response to low-dose steroid treatment. destruction
this group is less. Edema can be seen on the hands and feet.
(Answer A)
6. MTF joints, ankles, knee and hands PIF in both feet, in a 40-year-old woman
She is admitted with pain and swelling on her MKF and wrists. NSAIDs for a while
these complaints
The patient reported that his complaints did not diminish despite using
defines morning stiffness. Physical examination of joints subject to complaint
synovitis detected. Laboratory tests for diagnosis of this patient
which is given together? (April 2003)
A) ASO-erythrocyte sedimentation rate
B) ASO-uric acid
C) Rheumatoid factor-hand foot radiograph
D) ANA - ASO
E) ANA - ANCA
The same TUS was asked two rheumatoid arthritis questions.
(Answer C)
7. Which is one of the radiological changes seen in rheumatoid arthritis
A) Bone erosions
B) Soft tissue swelling
C) Narrowing of joint space
D) Juxtaperiarticular demineralization
E) Osteophytes
Osteophyte is a finding in osteoarthritis. It is not seen in rheumatoid arthritis.
Adult Still's disease:
Systemic juvenile rheumatoid arthritis is known as Still's disease. Fever peaks
during the day and back to normal
rotary. High fever values in Still's disease, arthritis, leukocytosis, rash,
lymphadenopathy, splenomegaly
and hepatomegaly.
In adult Still's disease, the classic triad: fever, rash and arthritis. Fever
usually peaks twice a day and
Over 39. Rashes are seen on the extremity or trunk. Most commonly involved joints:
shoulder, hand
wrist, hip and knee (most often). Joint involvement is destructive and progressive.
Adult Still Disease
It is seen in women aged 16-35 years. Patients may have sore throat. Weight
loss, lymphadenopathy, splenomegaly, pleurisy and abdominal pain.
Treatment for adult Still's disease is high-dose aspirin and indomethacin. Systemic
symptoms
corticosteroids may be useful.
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The classic triad is fever, rash and arthritis. (Ferritin height in laboratory)
RF and ANA are negative.
The most commonly involved joints are the wrist, shoulder, hip and knee.
Sore throat may occur.
Felty's syndrome:
The classic triad is rheumatoid arthritis, leukopenia and splenomegaly. Usually
from the onset of rheumatoid arthritis
It is seen after 12 years. It occurs in 1% of patients with RA. Bacterial
infections are usually seen in patients with Felty syndrome (most commonly in skin
and lung). The most common death due to cytopenia-related infection
Why it is. High titer RF positivity is the rule. ANA may be positive. In patients
with active vasculitis
hypocomplementemia. Reduced half-life of erythrocytes (splenomegaly and
inflammation)
hematopoiesis with suppressive effect). Bone marrow is usually hypercellular.
Patients may die from sepsis.
Treatment includes steroid, methotrexate, colony stimulating factor, gold,
erythropoietin and splenectomy.
Felty syndrome can cause portal hypertension and hypersplenism.
It occurs in less than 1% of RA patients.
Classic triad is rheumatoid arthritis, leukopenia and splenomegaly.
High titer RF positivity is the rule.
The most common cause of death is infection.
(Answer E)
8. A 40-year-old woman had MTF joints, ankles, knee and hands with PIF,
She is admitted with pain and swelling on her MKF and wrists. NSAID for a while
these complaints
The patient reported that his complaints did not diminish despite using
defines morning stiffness. Physical examination of joints subject to complaint
synovitis detected.
Laboratory tests to diagnose this patient include:
which is given together? (September 2003)
A) ASO-erythrocyte sedimentation rate
B) ASO-uric acid
C) Rheumatoid factor-hand foot radiograph
D) ANA - ASO
E) ANA - ANCA
In one case of rheumatoid arthritis, five of the diagnostic criteria were given.
They were left incomplete. The missing ones are rheumatoid factor and radiological
findings.
American Rheumatism Association's 1988 Rheumatoid arthritis classification criteria
***
one. Morning stiffness (at least 1 hour)
2nd. Arthritis in at least 3 joints
3. Arthritis of hand joints
4. Symmetrical arthritis
5. Rheumatoid nodule
6. Rheumatoid factor positivity
7. Radiological findings
• 4 criteria are sufficient for diagnosis.
(Answer C)
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9. Which of the following is the most rarely involved joint in rheumatoid

arthritis? (September 2002)
A) Knee
B) Proximal interphalangeal
C) Metacarpaphalangeal
D) Wrist
E) Distal interphalangeal
ROMATOID ARTHRITIS JOINT FINDINGS
Joint involvement in rheumatoid arthritis is polyarticular, symmetrical and
deformative. Joints
pain, morning stiffness, swelling, temperature rise and loss of function. In the
long run this
may cause various deformities in the joints. Both the onset and the course of the
disease
The most commonly involved joints during the procedure are proximal interphalangial
(PIF) joints, metacarpophalangial (MCF) joints, wrists, elbows, ankles,
metatarsophalangial (MTF) joints, knees, shoulders and hips. Cervical spine
It is very rare for it to involve the other sides of the spine. Joint pain,
swelling, rheumatoid arthritis
Although temperature increase and loss of function is seen, redness is rarely seen.
Affected joints
morning stiffness, stiffness and pain, the most common complaints in patients with
It is one.
Hand involvement: The most typical signs of rheumatoid arthritis are seen in the
hands. The first lesion in the hands is often tenosynovitis, which manifests as
fusiform swelling of the PIF joints or soft swelling of the back of the hand.
Other findings of small hand joints in rheumatoid arthritis
It is as follows:
one.
Diffuse symmetrical swelling of PIF and MKF joints.
2nd.
Flexion deformity and ulnar deviation in MKF joints.
3. Swan neck and boutonniere (buttonhole) deformity in the fingers of the

interosseous muscles
development of atrophy
4.
Due to the painful ulnar styloid in the wrist and tenosynovitis

flattening and loss of the normal angle between the phalanx
5.
Symmetrical swelling of the wrists and symmetrical wrist involvement are typical
for rheumatoid arthritis.
6.
Development of subluxation, dislocation and ankylosis in wrist joints.
Foot involvement: Small joints of the foot (especially MTF joints) and ankles in
frequently held. Apart from the swelling in these areas, hallux valgus, hammer
finger,
deformities such as planovalgus, low transverse arch, and lateral deviation of the
toes
can also be seen.
Knee involvement: Symmetric knee involvement is one of the most common
manifestations of rheumatoid arthritis. Rheumatoid
Another important finding in arthritis is the Baker cyst rupture. Pain and swelling
in the leg
This condition can be confused with thrombophlebitis. Aspiration and intra-
articular steroid injection
is treated with.
Elbow involvement: Development of flexion deformity in elbows with symmetrical
elbow involvement, rheumatoid
It is quite typical for arthritis. Symmetrical wrist and / or elbow involvement
should be considered as rheumatoid arthritis unless proven otherwise.
Hip involvement: Although not very common, it is important because it causes
serious disability.
(Answer E)
530
10. Which is one of the radiological changes seen in rheumatoid arthritis

A) Bone erosions
C) Narrowing of joint space
D) Juxtaperiarticular demineralization
E) Osteophytes
Osteophyte word is the most common rheumatologic disease in the world is specific
to osteoarthritis.
Radiological findings of RA:
Early period
one. Soft tissue swelling (initial finding)
2nd. Juxstaarticular osteoporosis
3. periostitis
4. Narrowing of joint space
5. Erosions and pseudocysts
Late term
one. Irregularity of joint surfaces
2nd. subluxations
3. General osteoporosis
4. Joint deformities
5. Degenerative changes
6. Destructive changes
7. Ankyloses (latest finding)
(Answer E)
11th. Which joint does not affect rheumatoid arthritis? (April 98)
A) Ankle
B) Subtas
C) Costovertebral
D) Knee
E) Proximal interphalangial
The most common joints in rheumatoid arthritis:
Proximal interphalangial, metacarpophalangial, wrist, knee, ankle,
metatarsophalangial joints.
Furthermore, cervical vertebra joints, subtalar joint, sacroiliac joint and
temporomandibular joint
can be kept in the joint. Costovertebral joint involvement has not been reported.
(Answer C)
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12. Which of the following is the most commonly involved joint in primary
osteoarthritis? (September 97)
A) Distal interphalangeal
B) Metacarpaphalangial
C) Wrist
D) Sacroiliac
E) Tiberias
Osteoarthritis is classified as primary and secondary. If there is no underlying

disorder
If there is an underlying pathological event such as primary, congenital hip
dysplasia is called secondary.
The most common joint involvement of osteoarthritis is DIF, PIF, 1st
carpometacarpal, hip, knee, 1st metatarsophalangeal, cervical and lumbar apophysial
joints. Pain increases with movement,
resting.
(Answer A)
13. Autoimmune non-organ specific systemic disease
A) Addison
C) Pernicious anemia
D) Myasthenia gravis
E) Vitiligo
Although rheumatoid arthritis mostly involves the diarthrodial joints,

is a disease.
(Answer B)
14. What is the typical symptom of rheumatoid arthritis in the hand? (September 94)
A) Distal interphalangial joint involvement
B) Ulnar deviation
C) Dupuytren's contracture
D) Carpal tunnel syndrome
E) Osteophatite
Involvement of hand joints in RA; There are no signs other than soft tissue
swelling in the early period.
PIF and MKF joint involvement is prominent. Late periarticular osteoporosis,
symmetrically
enlargement of the joint surface, subluxation, joint destruction and ankylosis of
the joint may occur.
Ulnar has deviation.
(Answer B)
15. Which of the following is not detected in the joint fluid in rheumatoid
arthritis?September 93)
A) Low glucose in the joint fluid
B) Protein decreases in joint fluid
C) Viscosity reduction in joint fluid
D) Complement drops
E) Neutrophil increases in joint fluid

Articular fluid in rheumatoid arthritis: If the synovial fluid is aspirated, it
appears to be cloudy. Low viscosity.
The number of cells in the synovial fluid is greater (5,000-20,000) and 60-65%
polymorphonuclear leukocytes
It is seen. The synovial fluid has a low glucose content. Complement level 30% more
than in serum
It is low. The amount of protein in the joint fluid increased.
(Answer B)
532
16. Which of the following does not occur in rheumatoid arthritis? (April 93)
A) Subluxation
B) Contraction of joint space
C) Osteosclerosis (around the joint)
D) Erosion on joint surface
E) Ankylosis
Pathogenesis of rheumatoid arthritis; The earliest finding is increased
permeability due to microvascular damage and deposition of inflammatory elements in
the perivascular area. Release of lysosomal enzymes
and phagocytosis and collagen, cartilage and elastic tissue destruction.
Proliferation in the synovium
pannus formation and articular cartilage and subchondral bone destruction
It happens. If left untreated, permanent joint damage, subluxation and flexion
deformities may occur.
Periarticular osteoporosis (not osteosclerosis! ..) First radiological examination
of rheumatoid arthritis
The findings.
(Answer C)
17. What is the rheumatoid factor? (September 87)
A) IgG versus IgG
B) IgM versus IgM
C) IgG against IgM
D) IgA versus IgG
E) Antibodies against smooth muscle cells
Rheumatoid factor is an IgM antibody to IgG.
(Answer B)
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OTHER ARTHRITIS
OTHER ARTHRITIS
one. Raynaud's phenomenon has been prevalent in the skin of the trunk and upper
extremities for two years.
45 years old female patient with complaints of thickening and tension
progressive shortness of breath. Physical examination revealed fever 36 ° C, pulse
72 / minute, respiratory rate is 26 / minute. In both lungs basal
thin rales are heard. In laboratory studies, ANA (+) and anti-scl-70
(antitopoisomerase-1) antibodies are found as (+).
What is the most likely lung pathology in this patient? (September 2009)
A) Interstitial fibrosis
B) Emphysema
C) Bronchiectasis
D) Pulmonary hemorrhage
E) Bronchiolitis obliterans
Raynaud is a female patient, which means scleroderma. Interstitial involvement of
the lung in these patients
that is, restrictive lung disease is expected. end-stage respiratory disease due to
pulmonary fibrosis
patient is lost due to insufficiency.
The most common cause of scleroderma dies is the respiratory failure. The question
is if scleroderma is not
if there was another rheumatoid disease or vasculitis, the answer would not change.
Rheumatic diseases
if they involve the lung, they may be able to produce interstitial fibrisos. salt
of the problem scl-70 antibody
Not to mention the word "pepper" to extend the paragraph.
(Answer A)
2nd. The presence of Raynaud's phenomenon in a patient
Inpatient connective tissue disease? (April 2009)
A) The patient is less than 30 years old and female
B) Raynaud's phenomenon in first degree relatives
C) Symmetric involvement
D) Capillary capillary microscopy is normal
E) Digital ulcers
Raynaud's phenomenon: It may be alone or other connective tissue, especially
systemic sclerosis.
can also with diseases. In particular, ulcers that disrupt tissue perfusion and do
not heal
requires research.
It is the most common and earliest sign of systemic sclerosis. In the course of the
disease
Raynaud 's phenomenon occurs in almost all cases. Event to the episodic
vasoconstriction of arterioles
It depends. Cold is the most important initiating factor.
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Conventionally there are 3 phases:

1- Coldness and whitening
2- Cyanosis
3- Erythema
Raynoud phenomenon can be seen in the following diseases:
one. Rheumatic diseases:
a. Scleroderma (95%, most common)
b. SLE (30-40%)
c. Dermatomyositis, polymyositis (30%)
D. Sjogren (30%)
to. Rheumatoid arthritis
2nd. Drugs: Chemotherapeutics, polyvinyl chloride, clonidine, ergotamines,
interferon, nonselective beta
blockers, estrogen
3. Agents that aggregate the Raynoud phenomenon: Nicotine, narcotin, cyclosporine,
cocaine and sympathomimetics
4. Trauma
5. Arterial diseases: Vasculitis, atherosclerosis, embolism, Buerger
6. Other: Hypothyroidism, malignancies, migraine, POEM syndrome, prinzmetal angina,
cryoglobulinemia,
cold agglutinin disease, reflex dystrophy, carpal tunnel syndrome.
(Answer E)
3. Which of the following is accepted internationally in the diagnosis of Behcet's
disease
A) Recurrent oral ulcers
B) Eye lesions
C) Recurrent genital ulceration
D) Arthritis without deformity
E) Positive pathergy test
Behcet 's disease
Description: It is a vasculitis described by Hulusi Behçet (1937) with multisystem
involvement. It is thought to be associated with HLA-B51 and has been reported in
some series in 70% of patients. B51 positivity is more frequent in patients with
vascular involvement, thrombosis and uveitis, or B51
being positive constitutes a tendency to more severe disease. Diagnosis requires 1
major and 2 minor criteria.
The disease goes with clinical exacerbations and periods of well-being and starts
on average at the age of 20-30 years.
Major finding: Recurrent oral ulcers (the most common finding), genital ulcers, eye
involvement
(uveitis, etc.), skin involvement (erythema nodosum, acne, etc.), thrombophlebitis.
Minor findings: Large vessel vasculitis, arthritis (most common knee joint),
phlebitis, meningoencephalitis, GIS
involvement.
Pathergy positivity is also pathognomonic.
Clinic:
Mucosa: Oral ulcers are painful, round, oval and multiple. There may be genital
ulcers but
It is not.
Skin: Erythema nodosum, pustular reaction to trauma (pathergy), photosensitivity.
Eye: In addition to uveitis, there may be secondary glaucoma, cataract, vitreous
hemorrhage, retinal vein thrombosis.
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OTHER ARTHRITIS
Vascular: Phlebitis and arthritis occur in 25% of patients. Aneurysms may occur
(pulmonary artery
is the only vasculitis causing aneurysm). There may be pulmonary vasculitis and
related hemoptysis.
FAQ: Involvement is the most common aseptic meningitis. Encephalitis, convulsions,
transverse myelitis,
ataxia, pseudotumor cerebri.
Treatment: There is no effective treatment. Various drugs are used (steroids,
colchicine, cyclosporine, azothiopyrine, interferon alpha, etc.).
(Answer D)
4. A 20-year-old male patient presented with complaints of pain in both heels and
lower lumbar region for 5 months. Before the story itself and
It is learned that there is no such finding in the family. Physical examination
revealed bilateral
heel sensitivity is detected. Erythrocyte sedimentation rate in laboratory tests
98 mm / h, CRP level 9.5 mg / dL, leukocyte count 6400 / mm3, serum albumin level
3.4 g / dL, serum globulin level 4.3 g / dL, uric acid level 5.9 mg / dL and anti-
DNA
antibodies are found to be negative.
A) Polymyalgia rheumatica
B) Behcet's disease
C) Rheumatoid arthritis
D) Ankylosing spondylitis
E) Gout
Heel pain = Entesopathy = Seronegative arthritis. Young patient have low back pain.
Acute phase reactants positive,
ANA is not negative, but also given anti-DNA DNA. A case of ankylosing spondylitis.
ATTENTION!
In ankylosing spondylitis, limitation of waist movements is determined by SCHOUBER
test.
Systemic findings in ankylosing spondylitis
Lung involvement
Bilateral apical lobe fibrosis-cavitation, restrictive lung dysfunction
Heart involvement
Aortic insufficiency, cardiomegaly, conduction defects
Renal involvement
Mesangioproliferative glomerulonephritis, IgA nephropathy, amyloidosis
Osteoporosis
Most prominently in vertebrae
Spinal fracture, spinal stenosis,
Chronic disease anemia
ATTENTION!
The most common death in AS is cardiac involvement
(Answer D)
5. The pencil-cup image observed radiologically in the distal interphalangeal
joints is a characteristic finding of which of the following?
(April 2006)
C) Osteoarthritis
D) Gout arthritis
E) Systemic sclerosis
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Pencil inking is characteristic of psoriatic arthritis.

PSYCHIATRIC ARTHRITIS
•
Psoriatic arthritis (PsA) has been reported in 6-42% of patients with psoriasis.
In patients with psoriasis, PsA usually begins after skin findings.
However, up to 15% of patients have PsA before psoriasis.
Osteoarthritis and psoriasis most commonly involve DIF.
Joint findings:
Arthritis in PsA is inflammatory. In addition to peripheral joints, sacroiliac
joint and axial involvement may be involved. Distal interphalangeal (DIF) joint in
PsA for separation of PsA from rheumatoid arthritis
involvement and asymmetric character.
Moll and Wright, who have important contributions to PsA, have identified 5
clinical types of the disease.
These types are:
one. Distal arthritis characterized by DIF joint involvement
2nd. Asymmetric oligoarthritis that holds asymmetrically small or medium-sized
joints
3. Symmetrical polyarthritis as in rheumatoid arthritis
4. Arthritis mutilans causing severe destruction and deformation
5. Spondyloarthropaties
Radiological findings:
one. Lack of periarticular osteoporosis as prominent as in RA
2nd. Lysis of terminal phalanx
3. Lack of symmetry and gross destruction in an isolated joint
4. Pencil inkwell (pencil-in-cup) view
5. Development of ankylosis
6. Development of soft periostitis
7. Sacroileitis and classical or atypical spondylitis
Treatment:
For skin lesions; tar, anthralin and corticosteroid, methotrexate in resistant
cases, PUVA, retinoic
acid or cyclosporine.
Treatment of arthritis; NSAIDs are used. The treatment of resistant cases is
similar to RA.
(Answer B)
6. A 47-year-old patient diagnosed with diffuse systemic sclerosis
He had complaints of pyrosis, regurgitation and dysphagia for the last year.
Upper gastrointestinal endoscopy shows ulcers surrounding the lumen of the distal
esophagus. Which of the following causes of this condition in the patient
can one be? (September 2005)
A) Acceleration of gastric emptying
B) Hypocontractility in esophageal smooth muscles
C) Lower esophageal sphincter pressure greater than 15 mmHg
D) Loss of visceral sensitivity
E) Lower esophageal sphincter relaxation disorder
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OTHER ARTHRITIS
Esophagus is the most common site of systemic sclerosis especially in the

gastrointestinal tract. Reduces response to swallowing wave in distal esophagus.
Thus, it causes dysmotility. Systemic sclerosis is the most common cause of
esophageal secondary dysmotility.
(Answer B)
7. Which is not a common feature of seronegative spondyloarthropathies? (April
2003)
A) Entesopathy
B) HLA-B27 positivity
C) Oculocutaneous symptoms
D) Sacroileite
E) Vasculitis
Seronegative RF and ANA negative, HLAB27 (+) patient group. The spine, sacroiliac
joint, eyes and tendons are involved. Vasculitis is not essential.
(Answer E)
SERONEGATIVE SPONDYLOARTROPATHIES
Seronegative spondyloarthropathies
one. Ankylosing spondylitis (AS)
2nd. Psoriatic arthritis
3. Reactive arthritis
•
Sexual transmission (Reiter's disease)
Post-dysenteric reactive arthritis
4. Ulcerative colitis / Crohn's (enteropathic) arthritis

ANKYLOSING SPONDYLITIS
•
The first manifestation is sacroiliac, episotic inflammation in the 10s-20s
Morning back pains, spine movement restriction alleviated by exercise.
Peripheral joint involvement is asymmetrical; Holds wide joints
Young men may present with lower extremity monoarthritis.
Erosive hip and shoulder involvement is common.
Axial skeletal involvement
Moves upward along the spine (at the first thoracolumbal junction)
ESR ↑, CRP ↑
Radiology:
The earliest finding is blurred vertebral margins

•
Sindesmophytes (bone ankylosis and limitation of movement)
• Bamboo cane appearance (intervertebral ligament calcification and disc fusion)

•
Periarticular sclerosis, closure of joint space
Extra-articular findings: anterior uveitis, aortic root inflammation (aortic

insufficiency, upper
lobe lung fibrosis, chronic prostatitis).
Anterior uveitis is associated with HLA-B27 association.
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PSORIATIC ARTHRITIS
•
Characterized by arthritis and enthesitis in people with psoriasis
distal interfalingeal arthritis (most typical)
• cutaneous lesion, interphalangeal joint synovitis and tenosynovitis form “sausage

fingers..
•
nail dystrophy is 85% (+).
• “sausage finger” or dactylitis pauci-articular psoriatic arthritis. (asymmetric

oligoarthritis)
•
symmetrical polyarthropathy
arthritis mutilans (telescopic finger)
Sacroileitis forms can be monitored.
methotrexate is very effective.

•
In DIF arthritis mutilation, intracerebral pen anomaly may be observed.
REITER SYNDROME
•
Reactive arthritis
It is observed in B27-positive young adults after sexual acquired infection

(nonspecific urethritis, non-specific cervicitis) or dysentery.
Salmonella, Shigella, Y. enterocolitica, Chlamidia trachomatis, Ureoplasma

ureolyticum plays a role in the etiology.
Acute, asymmetric, sub-region arthritis is typical. oligo are.
Entesopathy is common; leads to plantar fasciitis and achilles tendinitis

(characteristic)
Sacroiliitis and spondylitis develop.
Skin lesions: (common)
Circinata balanitis
keratoderma blenorrhagica
nail dystrophy
Bilateral conjunctivitis may develop; painless oral ulcers.
Classical Reiter syndrome; Urethritis, arthritis, conjunctivitis
Sausage is also seen in finger-reactive arthritis.

•
If urethritis is accompanied by tetracycline is used.
ENTEROPATIC ARTHROPATHY
•
Ulcerative colitis with Crohn
Mobile polyarticular involvement.
In ulcerative colitis, joint disease is also in remission with total colectomy.
Arthritis in Crohn's disease is permanent
8. Which of the following connective tissue diseases is the most common Raynaud's
phenomenon?
(September 2002)
A) Progressive systemic sclerosis
B) Systemic lupus erythematosus
C) Polyarteritis nodosa
D) Dermatomyositis
E) Wegener granulomatosis
Raynaud's phenomenon can occur in vasculitis in all rheumatologic diseases. But
most
common scleroderma (systemic sclerosis).
(Answer A)
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OTHER ARTHRITIS
9. Calcium pyrophosphate crystals in the joint with chondrocalcinosis

The most likely diagnosis of a patient detected is: (April 2002)
B) Systematic sclerosis
C) Ankylosing spondylitis
D) Pseuodogut
E) Gout
Gout; uric acid crystals or monosodium urate monohydrate crystals

It is a disease characterized by acute and recurrent attacks of arthritis. Calcium
pyrophosphate crystals in the joint
is characterized by accumulation.
(Answer D)
10. Cirsinate in an HLA B27 positive person with oligoartricular joint involvement
If balanitis and keratoderma blenorrhagia are detected, the most likely diagnosis
is
A) Reiter syndrome
B) Psoriasis
C) Ankylosing spondylitis
D) Wegener Granulomatosis
Reiter's syndrome:
It is asymmetric seronegative arthritis of the lower extremities. Urethritis,
dysentery, inflammatory eye disease (conjunctivitis or irritation), mucocutaneous
diseases (balanitis, oral ulcers, keratoderma)
may accompany several. Patients have a high HLA-B27 positivity. Keratoderma
blenorrhagicum is very helpful in differential diagnosis with psoriasis. DIP joint
may be affected. Sacroileitis and
irritation.
NSAID is used for treatment. Tetracycline in Reiter cases aggravated by chlamydial
infections
and erythromycin.
Reiter syndrome is associated with sacroiliac joint involvement and asymmetric
peripheral joint involvement with urethritis, dysentery,
is accompanied by inflammatory eye diseases or mucocutaneous diseases
(Answer A)
11th. Which of the following is not a sign of sacroiliitis? (April 99)
A) Polyarteritis nodosa
B) Ankylosing spondylitis
C) Psoriatic arthritis
D) Inflammatory bowel diseases
E) Reiter syndrome
Ankylosing spondylitis
Reiter
Psoriatic arthritis
Arthritis seen in inflammatory bowel diseases is known as seronegative arthritis.
seronegative
sacroiliac joint involvement is typical in arthritis. PAN does not involve
sacroiliac joint involvement.
(Answer A)
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12. Pain in shoulder and hip joints, prolonged morning stiffness, sedimentation
60-year-old female with a normal rate of 100 mm / h and alkaline phosphatase
which of the following would you consider? (September 93)
A) Scleroderma
B) Polymyositis
C) Dermatomyositis
E) Polymyalgia rheumatica
POLYMALGIA AND ROMA
Polymyalgia rheumatica is a syndrome characterized by sudden pain and morning
stiffness in the proximal region. RF is negative, ANA is negative, complement
levels are normal. Increase in sedimentation rate
It is important. Poimyaljiya rheumatica will be put after excluding other
inflammatory events
is a diagnosis. Women have prodominance. Never seen under the age of 50. Never say
never in medicine.
Dramatic treatment of both acute symptoms and acute phase reactants
improvement.
-
Polymyalgia rheumatica sudden onset pain and morning stiffness in the proximal
region
and sedimentation pulse.
ANA is RF negative and the complement level is normal.
Never seen under 50
The diagnosis is a diagnosis of exclusion.
Diagnosis:
In these patients, morning movement limitation is more disturbing than pain.
Especially in the mornings and long
while sitting becomes apparent stiffness. Weight loss, fever, sweating, loss of
appetite are other symptoms.
The presence of symptoms suggesting polymyalgia rheumatica over 70 years of age is
often accompanied by giant cell arteritis (temporal arteritis). Edema and synovitis
can be seen on the knee, shoulder and wrist. Accompanying vasculitis
granulomatous myocarditis and hepatitis may occur in non-polymyalgia rheumatism.
Type of these patients
II muscle fibers have atrophy. Polyarticular small joint arthritis is not an
expected finding. Depression
may accompany.
-
Polymyalgia rheumatic prolonged morning stiffness and long sitting

then seized.
Polymyalgia rheumatica after 70 years of age

shows togetherness
-
Edema and oligoarticular synovitis can be seen in extremities
Associated with HLA DR4.
Treatment: Low-dose steroid is sufficient if giant cell arteritis is not present.

Low dose steroid 3-5
very good response is received during the day. When to treat erythrocyte
sedimentation rate and symptoms
It is decided to start. Polymyalgia rheumatic relapses
(Answer E)
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OTHER ARTHRITIS
13. The cause of acute monoarthritis in a patient receiving diuretics is:

could it be? (September 93)
A) Septic arthritis
B) Acute rheumatic fever
E) Gout arthritis
Diuretics (especially thiazide) may impair metabolic parameters. They can cause
hyperlipidemia, hyperuricemia and hyperglycemia. Symptoms may be aggravated when
diuretics use gout arthritis.
(Answer E)
14. The most helpful method for the diagnosis of gout arthritis is to:
A) The exact response of symptoms to colchicine treatment
B) History of gout in other family members
C) High level of serum uric acid
D) Presence of mono sodium urate crystals in synovial fluid
E) The presence of a swollen, red and painful joint
GUT, as a result of disruption of purine metabolism, hyperuricemia, joint fluid and
tissues
is a disease characterized by accumulation of monosodium urate crystals and
recurrent severe acute arthritis. The toe is most affected. Monosodium urate
crystals seen in the synovial fluid sample are the most helpful test in clinical
diagnosis. Treatment of NSAIDs and colchicine
done with. Initiation of allopurinol in the acute phase or discontinuation if using
is contraindicated. Response
Short-term corticosteroid therapy may be used in cases that cannot be taken.
(Answer D)
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OTHER ISSUES OF ROMATOLOGY

one. Which of the following diagnostic methods should be used for chronic
obstructive pulmonary
does not help in the differential diagnosis of asthma and bronchial asthma?
(September 2011)
A) Measurement of IgE and eosinophils in blood
B)
Measurement of diffusion capacity
C.)
Eosinophil examination in sputum
D)
Chest X-ray
TO)
Pulmonary function test after bronchodilator inhalation
A good question questioning the differences in asthma and COPD. Allergic asthma of
course deserves IgE and eosinophilia
would. COPD also decreased DLCO (alveolar-capillary membrane integrity is
impaired), asthma
is also normal. While sputum is also important in eosinophil allergic asthma,
reversibility for asthma
is one of the methods examined. Perhaps PA AC was used as an imaging modality for
both patients.
but at least help. Ventilation, a sign of obstructive disease in both diseases
increase can be seen.
(Answer D)
2nd. In the treatment of a patient presenting with an attack of acute gouty
arthritis,
which is not a priority? (May 2011)
A) Colchicine
B)
Allo be purine
C.)
indomethacin
D)
prednisone
TO)
naproxen
A simple rheumatology question, approach to acute gout crisis:

Indomethacin or other NSAIDs should be
It is given up to 7-10 days. Renal failure, peptic ulcer or congestive heart
failure
contraindicated in patients with diabetes. It should not be used in patients with
nasal polyps or aspirin sensitivity because they can cause bronchospasm. The second
drug to be selected
you're colchicine. Colchicine can be used both in the treatment of acute gout
attacks and in chronic treatment. Oral
or the use of intraarticular corticosteroids is another alternative treatment.
Acute attack completely
Allopurinol and probenecid should not be given before reattachment.
Gastrointestinal side effects of colchicine
It is important. colchicine IV may cause less gastrointestinal side effects, but
Bone marrow suppression increases the side effect and if extravasated causes
infiltrates under the skin.
(Answer B)
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3. Which of the following is a disease, with no evidence of its own?

It has been awarded? (September 2009)
Disease
Finding
A) Gout
Tophi
B)
dermatomyositis
Gottron papule
C.)
Systemic sclerosis
telangiectasia
D)
Reactive arthritis
Succinate balanite
TO)
Acute rheumatic fever
Erythema nodosum
He made a crowd for ARA and erythema marginatum. I wonder if I can read and mislead
you fast.
Let's not be wrong, let's be slow ...
ARA major criteria
arthritis
carditis
Korean
Subcutaneous nodules
Erythema marginatum (not nodosum)
So nodosum can be on the extensor faces of the lower extremities where they are
usually accompanied by vasculitis. Again
tbc and sarcoidosis may also be nodosum.
(Answer E)
4. Which of the following is not one of seronegative arthropathies? (April 2008)
A) Ankylosing spondylitis
B) Reiter syndrome
C) Psoriatic arthritis
D) Enteropathic arthropathy
Seronegative means RF negative and ANA negative. RA is already the father of
seropositive. ending
a rheumatology question.
Seronegative spondyloarthritis:
one. Ankylosing spondylitis
2nd. Reiter syndrome / reactive arthritis
3. Psoriatic arthritis
4. Enteropathic arthritis
(Answer E)
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5. A 20-year-old male patient presented with complaints of pain in both heels and
lower lumbar region for 5 months. Before the story itself and
It is learned that there is no such finding in the family. Physical examination
revealed bilateral
heel sensitivity is detected. Erythrocyte sedimentation rate in laboratory tests
98 mm / h, CRP level 9.5 mg / dL, leukocyte count 6400 / mm3, serum albumin level
3.4 g / dL, serum globulin level 4.3 g / dL, uric acid level 5.9 mg / dL and anti-
DNA
antibodies are found to be negative.
B) Behcet's disease
D) Ankylosing spondylitis
E) Gout
Ankylosing spondylitis: (young men and low back pain)
Ankylosing spondylitis goes through chronic systemic inflammation, sacroiliac
joints, vertebrae and peripheral
holds the joints. The most commonly affected joint is the sacroiliac joint. Low
back pain is the most common symptom
limitation of spine movements and decrease in chest extension.
He has morning stiffness and improves with exercise.
Entesopathy is common. It usually holds the Achilles tendon and causes Achilles
tendonitis. Heel pain is typical. Radiographic findings: erosion of sacroiliac
joints, sclerosis on both sides of joint, joint distance
reduction, false expansions on the joint surfaces, syndesmophyte and bamboo cane
views.
Chronic disease anemia, increased sedimentation rate and HLA –B27 positivity are
laboratory findings.
Extraspinal Achilles tendinitis, costochondritis and plantar fasciitis may be seen.
Extra spinally
The most commonly involved areas are the knee and shoulder. If the extremities are
affected, the lower extremities are most commonly affected and
asymmetrically affected.
Non-skeletal involvement fatigue weight loss, low values of fever and iritis can be
seen. Strong presence of iritis
spondyloarthropathies.
Late complications include cord compression due to vertebral fracture, cauda equina
syndrome
(leg pain, neurogenic bladder and stool incontinence), fibrotic, cavity-containing
lesions in the lung,
complete heart block and amyloidosis.
In differential diagnosis, osteitis condensans province, osteitis pubis and
degenerative joint diseases should be considered.
Conditions that may affect the sacroiliac joint include tuberculosis, ankylosing
spondylitis and other seronegative arthropathies, gout, paget's disease, infections
(brucellosis, serratia, staphylococci) and metastatic diseases.
It is the most common aortic regurgitation in the heart. The most common cause of
death is cardiac.
The most common extraarticular involvement is eye involvement. Can cause anterior
uveitis.
Treatment:
Rehabilitation of the joint and thus the protection of joint movement and range of
motion
It should be taken. Exercise must be done in this. NSAIDs and especially peripheral
drugs
Methotrexate and sulfasalazine are useful in patients with joint involvement.
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90% HLA-B27 positivity in ankylosing spondylitis
Low back pain is characterized by limitation of spine movements and decreased

widening of the rib cage.
The most commonly involved peripheral joints are the knee and shoulder
The most commonly involved organ is the lung
It may cause cavitary lesions and fibrosis in the lung.
The main thing in the treatment of the exercise is the protection of joint
movements
Radiographically sclerosis of joint surfaces, closure of joint distance and
vertebral column
bamboo cane appearance by calcification of the surrounding ligaments is
characteristic.
·
Methotrexate and sulfasalazine are agents that may be useful in treatment.

(Answer D)
6. Pencil-cup in the distal interphalangial joint

Which characteristic is its appearance? (April 2006)
C) Osteoarthritis
D) Gout arthritis
E) Systemic sclerosis
Radiological rheumatology question, typical image of psoriatic arthritis involving
the distal interphalangial joint.
Seronegative is the place of involvement.
Psoriatic arthritis:
It occurs in some of the patients with psoriasis. Probability in patients with
severe skin lesions
higher. Joint involvement is very strong. Rheumatoid arthritis and
sausage, which is rarely seen in other seronegative arthritis, is almost
characteristic for finger psoriatic arthritis. Influence of DIP joint and erosion
of DIP joint unlike RA
psoriatic arthritis. NSAIDs, methotrexate and azathioprine are used for treatment.
·
Patients with pitting and severe skin lesions are at high risk of joint
involvement.
Hyperuricemia may occur in patients with psoriatic arthritis due to psoriasis
Characteristic penciin-cup appearance typical of sausage finger and dip joint

They are symptoms.
(Answer B)
7. Which of the following microorganisms most commonly causes pyomyositis? (April

2006)
A) Pseudomonas aeruginosa
B) Streptococcus pneumoniae
C) Escherichia coli
D) Staphylococcus aureus
E) Klebsiella pneumoniae
Pyomyositis is mostly seen in tropical regions and is purulent of skeletal muscle
caused by S. aureus.
Infection.
(Answer D)
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8. Which of the following connective tissue diseases is the most common Raynaud's
phenomenon?
(April 2003)
A) Progressive systemic sclerosis
B) Systemic lupus erythematosus
C) Polyarteritis nodosa
D) Dermatomyositis
E) Wegener granulomatosis
SYSTEMIC SCLEROSIS (scleroderma):
Microvessel instability and fibrosis
Diffuse cutaneous scleroderma
Limit scleroderma
Systemic sclerosis
It is a disease characterized by bilateral induration, sclerodactyly, pitting of

the finger and bibasilar pulmonary fibrosis.
The skin is thick. Reynoud phenomenon is present in almost every patient. Reynaud's
phenomenon skin involvement
can be seen before. Joint involvement is symmetrical and does not leave deformity.
There is an involvement in the lungs that reduces CO diffusion and causes diffuse
interstitial fibrosis. CREST variant
Pulmonary hypertension is frequently seen in patients. The most common conduction
defects are carotid.
The most commonly involved organ in the gastrointestinal tract is esophagus. The
way the kidneys are affected is the kidney.
failure to cause proteinuria and microangiopathic hemolytic anemia.
Antitopoisomerase I antibody (anti Scl-70) and antisentromer as laboratory findings
antibody positivity is common.
It is not possible to provide remission or cure treatment. D-penicillamine in
treatment
available.
M = F
40s
Gode-free edema
•
Raynoud phenomenon
Loss of skin folds
Esophageal, pulmonary, cardiac, renal involvement
Scl-70 (DNA topoisomerase 1)
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Raynoud phenomenon
Gode-free edema
CREST
Antiscentromer antibody
Visceral involvement without skin involvement
GIS involvement: The most common eosophagial hypomotility
Pulmonary involvement: Restrictive pulmonary disease, TY
Kidney: Hypertension and oliguria (renal crisis)

•
Heart: Silent pericardial effusion, fibrosis and band necrosis

visible.
Musculoskeletal system: RA-like arthritis, myopathy and muscle atrophy
Keratoconjunctivitis sicca (dry eye) and xerostomy (dry mouth)
CREST syndrome Calsinosis cutis, Reynaud phenomenon, Euosophagial dysmotility,

Sclerodactyly
Organ involvement is rare.
The most commonly involved organ is the lung.
Telangiectasis.
Esophagus is the most commonly involved organ in the gastrointestinal tract

(Answer A)
9. Pain in the shoulder hip belt in women over 50 years of age, with an increase in
erythrocyte sedimentation rate and a low response to low-dose steroid disease
B) Oranosis
C) Rheumatoid atritis
D) Gout
E) Osteoporosis
Polymyalgia Rheumatica diffuse pain in the shoulder and hip girdle muscles, morning
stiffness and
characterized by increased sedimentation.
•
It is rare under the age of 50 years.
The pain is greater at night and unrelated to joint movements.
No muscle atrophy
•
There is no objective physical examination.
Weakness, loss of appetite, weight loss, fever, headache, depression, consciousness

disorders can be found.
It may be associated with temporal arteritis.
The etiology is unknown, but some malignancies have polymyalgia rheumatism.

It is thought to have started.
Laboratory: Sedimentation increases, Alpha1-Alfa2 globulin increases, fibrinogen

increases, C-Reactive
protein (CRP) increases. Other biochemical and serological tests including muscle
enzymes
It is normal.
Treatment:
10-20 mg / day steroid
If sedimentation is> 100, or with temporal arteritis, a higher dose of steroid is
given.
(Answer A)
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INTERNAL MEDICINE
10. Which of the following is not used in Raynaud's disease? (September 94)
A) Alpha-methyl dopa
B) Beta blockers
C) Cold protection
D) Sympathectomy
E) Adrenergic receptor blocker
Raynoud Phenomenon: paleness, redness, and then cyanosis, numbness and
pain is a condition that manifests itself. Cold is the most common precipitating
factor. More women
It is seen. The most common cause is rheumatoid arthritis. Vasodilators and aspirin
may be used in the treatment.
Nerve blockade can be tried in patients with severe ischemia. Beta blockers in
patients with reynaud phenomenon
Contraindicated.
Scleroderma may also be associated with Sjogren's disease. In addition, CREST
syndrome (Calcinosis)
cutis, Reynoud Phenomenon, Eusophagial involvement, Sclerodactyly, Telangiectasia.
(Answer B)
9. Which of the following is the most sensitive laboratory test for the diagnosis
of polymyositis?
(April 2002)
A) Aspartate
B) Creatine phosphokinase
C) SGPT
D) Lactate dehydrogenase
E) Aldolase
Acquired and chronic unknown etiology characterized by inflammation of polymyositis
(PM) striated muscle
is a disease. Polymyositis dermatomyositis (DM) with characteristic skin rashes
is called. Dermatomyositis is more common in children. Polymyositis and
dermatomyositis are usually more common in women.
Clinical features are present in 89-100% of cases. Main muscles involved (proximal
muscles)
symmetrical) shoulder, hip and neck muscles. Any movements that require lifting the
arms
it has become difficult. Patient climbing stairs, sit up and squatting, crossing
legs
he has difficulty throwing and lifting his head out of bed. Muscle mass is usually
normal and
until the advanced circuitry: the facial muscles are weak. Distal muscle
involvement is also rare.
Difficulty in chewing dysphonia due to involvement of posterior pharyngeal and
esophageal upper 1/3 muscles,
dysphagia, nasal regurgitation and aspiration. It may be involved in heart muscle
and smooth muscle.
Elevation of creatine kinase is very valuable in the diagnosis.
(Answer B)
Adult polymyositis / dermatomyositis; can present with cancer. In women, the most
common over-breast, in men
most common GIS- lung cancer
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IMMUNOLOGY
IMMUNOLOGY
one. Frequency of infection caused by one of the following microorganisms:
not specifically associated with decreased T cell immunity? (September 2003)
A) Legionella pnomophila
B) Mycobacter tuberculosis
C) L. monocytogenesis
D) T. gondi
E) P. aeroginosa
In fact, the question asks which one is less common in patients with cellular
immunodeficiency?
Which other aspect can it not reproduce in the cell? P. aeroginosa does not grow in
cells,
therefore, it does not significantly increase the incidence of T cell dysfunction.
(Answer E)
2nd. Which of the following does not increase the risk of bacterial pneumonia?
(September 2002)
A) Chronic obstructive pulmonary disease
B) Pleural thickening due to tuberculosis
C) Cystic fibrosis
D) Neutropenia
E) Long-term unconsciousness
Pleural thickening due to Tbc may present as late sequelae. However, COPD, Cystic
fibrosis,
Bronchiectasis, Neutropenia, KT-RT, unconsciousness (risk for aspiration) bacterial
pneumonia
increases the risk.
(Answer B)
3. The development of autoantibodies against acetyl choline receptors leads to
opens? (September 2001)
A) Myastenia Graves
B) Infertility
C) Rheumatoid Arthritis
E) Pernicious Anemia
Antirceptor Antibodies
Functional acetylcholine receptors in post-synaptic muscle membranes in Myasthenia
Graves
There is a decrease in the number. Anti-acetylcholine antibodies were detected in
patients with myasthenia graves.
Lambert-Eaton syndrome against self-antigens in ion channels on neurons
autoantibodies were detected. As a result, acetylcholine release from the neuron is
impaired.
Autoantibodies Against Tissue Antigen
Autoantibodies against pancreatic islet cells were detected in autoimmune diabetes
mellitus.
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INTERNAL MEDICINE
Autoimmune diseases
Immune response type
Antibody against receptors
Against cell components

antibody
Cell-mediated
(T cells and macrophages)
Autoimmune disease
Target of immune response
Myastenia Gavis
Graves' Disease
Insulin-resistant diabetes
Lambert-Eaton myasthenia
Acetylcholine receptor
TSH receptor
Insulin receptor
Calcium channel receptor
Systemic Lupus erythematosus

Rheumatoid arthritis
Rheumatic fever
Hemolytic anemia
Idiopathic thrombocytopenic purpura
Goodpasture's syndrome
Pernicious anemia
Hashimoto's thyroiditis
Insulin-dependent diabetes mellitus
Addison's disease
Periarteritis Nodosa
Guillian-Barre Syndrome
DsDNA, histones
IgG in joints
Heart and joint tissue
Red blood cell membrane
Platelet membrane
Basal membrane of kidney and lung
Intrinsic factor-parietal cells
the Thyroglobulin
Islet cells
Adrenal cortex
Small and medium arteries
Myelin protein
Reaction against myelin protein

cause demyelination in the brain
It happens.
Allergic encephalomyelitis
(Answer A)
4. Which of the following cells does not play a role in delayed-type
hypersensitivity reactions? (September 2000)
A) B lymphocytes
B) T lymphocyte
C) Histiocyte
D) Epitheloid cells
E) Macrophage
T lymphocytes, histiocytes, epitheloid in delayed type hypersensitivity reactions

While cells and macrophages are effective, B is important in the humoral response
of lymphocytes and Ig
We must know that they are tasked with synthesizing.
(Answer A)
5. Which of the following does the alternative complement path start? (April 2000)
A) C1r
B) C1s
C) C1q.
D) C3
E) C2
The complement system is directed against a cell surface antigen of the antibody
that leads to lysis of target cells.
is a defense system. It starts with the activation of one of two ways:
one. Conventional complement pathway: Activated by IgG1, IgG2, IgG3 and IgM
antibodies
it starts with one connecting to the C1q region.
2nd. Alternative complement pathway: Some antigens (eg lipopolysaccharides,
endotoxin or
antigen-antibody complexes and start from C3.
(Answer D)
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IMMUNOLOGY
6. Which of the following expresses and carries on immunoglobulins?

(April 2000)
A) Monocyte
B) Plasma cell
C) B lymphocytes
D) T lymphocytes
E) Mast cell
Upon antigenic stimulation, B lymphocytes form plasma cells secreting

immunoglobulins. They are also mediators of humoral immunity. Of the five
immunoglobulin isotypes, IgG, IgA and IgM account for 95% of serum immunoglobulins.
Ig E artifact
An amount. Ig D is found mainly in the cell-bound type, B cell membrane. As is
known, B
The monomeric IgM present on the surface of the cells forms the antigen receptor in
B cells. Question
In fact, a question that is not entirely appropriate, in cases where one of the B
lymphocytes or plasma cells
It should take.
(Answer B)
7. Which of the following is wrong with selective IgA deficiency? (April 2000)
A) Regular monthly administration of gammaglobulin
B) Frequency of lung infections
C) Frequency of autoimmune disease development
D) Development of gluten-sensitive enteropathy
E) Anaphylaxis after blood transfusions
Selective IgA deficiency is the most common immune globulin deficiency. The
inherited ones are related to the gene encoding chromosome 14 IgA heavy chain.
Phenotypic IgA-bearing cells
stopped maturation is detected.
Recurrent respiratory or gastrointestinal infections, bacterial infections,
autoimmune and
Allergic diseases are seen. 30% of patients are asymptomatic.
Gamaglobulin should never be used in these patients. Anaphylaxis may develop due to
anti-IgA antibodies.
Broad-spectrum antibiotics are used for recurrent sinopulmonary infections.
If necessary, the patient's own blood or plasma may be frozen and given back to the
patient.
(Answer A)
8. What is the effect of the complement components C3a and C5a? (September 99)
A) Cell lysis
B) Smooth muscle spasm
C) C1a coupling
D) Combination of C2 and C4 Complements
E) Neisseria lysis
Effects of C3a and C5a complement components (Anaflatoxins):
•
chemotaxis
Histamine release
Smooth muscle contraction
Increased capillary permeability

(Answer B)
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INTERNAL MEDICINE
9. Acting in cytotoxic response and showing its effect through specific antibodies
which factor is the following? (September 99)
A) T4 lymphocytes
B) T8 lymphocytes
C) NK cells
D) B lymphocytes
E) Plasma cell
NATURAL KILLER CELLS
NK cells are cells that have previously exhibited cytolytic activity without the
need for sensitization with target cell antigens and unrelated to MHC molecules.
NK cells lysis virus-infected cells and tumor cells. Different from cytotoxic cells
have already established an association with target antigens for the cytolytic
effects of these cells.
and no interaction with cytokines.
NK cells protect the host against parasites and those undergoing bone marrow
transplantation
also plays an active role in the developing graft-versus-host reaction.
(Answer C)
10. Which of the following causes a type IV hypersensitivity reaction? (April 98)
A) Allergic flu
B) Urticaria
C) Allergic contact dermatitis
D) Serum disease
E) Hemolytic disease of newborn

Some of the type IV hypersensitivity reactions include:
•
Contact dermatitis
Allograft rejection
Granulomas due to intracellular microorganisms
Tuberculin skin test
Rabies encephalitis
(Answer C)
11th. The antigen most responsible for the type I hypersensitivity reaction is
A) IgM
B) IgG
C) IgD
D) IgE
E) IgA
In the Type I hypersensitivity reaction, the

Mast cells degranulate by binding IgEs to the antibody. Hay fever, asthma,
urticaria and systemic anaphylaxis are caused by this mechanism.
(Answer D)
12. Which vaccine is not administered in the immunocompromised patient?
(April 97)
A) Hepatitis B vaccine
B) Pneumococcal vaccine
C) Influenza vaccine
D) Tetanus vaccine
E) Measles, mumps, rubella vaccine
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IMMUNOLOGY
Live attenue virus vaccines are not administered to an immunosuppressed patient.

Measles vaccine,
Rubella vaccine,
Mumps vaccine,
Oral polio (sabin),
Yellow fever,
Varicella and Adenovirus vaccine.
(Answer E)
13. What is the most common immunodeficiency? (September 96)
A) Selective IgA deficiency
B) Bruton's disease
C) Di George
D) Common-Variable immunodeficiency
E) X-linked agammaglobulinemia
Selective IgA deficiency is the most common immunodeficiency. Its frequency is
between 1 / 700-1 / 3000. majority
asymptomatic. Atopy and autoimmune events are common in symptomatic patients. GIS
and and respiratory tract
infections are common. Local immunity is impaired and antigens that pass into the
blood cause autoimmune events.
they cause. Most patients have anti-IgA antibodies in the blood.
Di George syndrome has cellular immunodeficiency.
Bruton and X-linked agammaglobilenemia is associated with humoral immunodeficiency.
Common-variable immuno-deficiency
antibody production is generally impaired, and in some cases cellular immunity is
impaired.
(Answer A)
14. Immunoglobulin elevated early in acute infections
A) IgM
B) IgA
C) IgG
D) IgD
E) IgE
immunoglobulins
IgG
It constitutes 80% of normal human Igs. It is the only class of antibodies that can
cross the placenta. 3-4 of pregnancy.
from the month begins to the fetus. After birth, the baby starts to make its own
Ig.
IgG has 4 different subclasses, IgG1, IgG2, IgG3 and IgG4.
The complement fixing and adherence properties of IgG to monocytes are found in the
Fc section. An antigenic
Antibodies formed after stimulation are effective in precipitation, complement
assembly and toxin neutralization.
IgA
In addition to the presence of IgA in serum; coupled with the secretory part can
pass through the epithelial barrier and
secretions. After birth, the baby passed to the baby with IgA, breast milk and
colostrum.
protects the baby together with IgG.
IgA molecules exist in the form of monomers, dimers, or trimer. The secretory part
of IgA renders the antibody resistant to proteolytic enzymes; bacterial and viral
infections on mucosal surfaces.
also plays an active role in
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INTERNAL MEDICINE
Secretory IgA is capable of agglutination, opsonization and neutralization, while

serum IgA
not all of these features are available.
Ostearthritis and psoriasis most commonly involve DIF.
IgM
It is the first antibody produced in an immune response. Although it is synthesized
too much in the first antigenic stimulation, its amount decreases afterwards. B
cells can produce IgM without T cell response. Five separate Ig molecules
(There are five dimers). 10 antigen binding sites (Fab) of IgM
has. Fix your complement very well. Serum isohemagglutinin (anti-A, anti-B) natural
antibodies, Wasserman antibodies IgM class. IgM in the baby because IgM does not
pass through the placenta
an acute infection should be considered. It has the highest antigen binding
property.
IgA
Very little in serum. IgE does not bind complement and does not precipitate.
Adhesion to skin
It is called “reaginic antibody dolayı because of its property. The Fc end of IgE
binds to mast cells, Type I
Causes hypersensitivity reactions. High rates of allergy and parasitic infections
They are located.
IgD
Structurally similar to IgG. It is mainly involved in B cell differentiation. Low
levels in serum. But it is abundant in the membrane of lymphocytes in the cord
blood of newborns.
It is also synthesized in small amounts against antigens such as penicillin,
insulin and milk protein
(Answer A)
15. Antigen presenting antigen on cell surface and helper T cells
Which of the following is available? (April 96)
A) Immunoglobulin
B) Interleukin I
C) Selectin
D) CD3
E) Class II. MHC antigens
Antigen-presenting cells are macrophages and monocytes. These cells are class-II-
MHC antigens
Thanks to these, they present foreign antigens to T-helpers. T-helpers secrete IL-2
they stimulate their proliferation, as well as B-lymphocyte proliferation and
antibody production.
(Answer E)
16. Which of the following is not secreted in a Type I anaphylactic reaction?
(April 95)
A) Histamine
B) Bradikinin
C) PAF
D) Serotonin
E) C3a anaphylactoid
TYPE I EXTREMELY SENSITIVITY REACTIONS

ANAPHYLACTIC REACTION
Early hypersensitivity reaction is mediated by IgE. For this reaction to occur;
-
Person's encounter with allergen,
Expression of specific IgE against this allergen,
Binding of IgE to mast cells and basophils by Fc fragment,
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IMMUNOLOGY
Re-encounter with allergen, IgE and antibody antibody binding on the surface of
mast cells
not,
The release of mediators from these cells and the effects of mediators on the
target organs should emerge. Heredity, environmental factors and viral infections
are important in the emergence of allergies.
It is known.
In allergic inflammation, mast cells, eosinophils, basophils and neutrophils are
active cells and histamine,
mediators such as prostaglandins, leukotrienes and platelet activating factor (PAF)
are released.
(Answer B)
17. Which of the following is expected in patients with C2, C4 deficiency? (April
95)
A) Viral infections
B) Angiorotic anemia
C) Gr (-) bacterial infections
D) Autoimmune diseases
E) Cancer
The genetic deficiencies and clinical conditions of the complement system are as
follows;
C1q deficiency; hypogammaglobulinemia, severe combined immunodeficiency, Systemic
lupus erythematosus
and similar diseases.
C1r deficiency; Systemic lupus erythematosus, arthralgia, recurrent infections
C1s deficiency; Systemic lupus erythematosus
C2 deficiency; Systemic lupus erythematosus, tendency to infection
C3 deficiency; tendency to infections, partial lipodystrophy
C4 deficiency; Disseminated cutaneous lupus erythematosus
C5 deficiency; growth retardation, diarrhea, seborrheic dermatitis, tendency to
bacterial infections, leiner
disease
C6 deficiency; recurrent meningococcal meningitis
C7 deficiency; no disease
C8 deficiency; Neisseria
C1 esterase inhibitor deficiency; hereditary angioedema was observed.
Systemic lupus erythematosus and autoimmune diseases are seen in C2 and C4
deficiency.
(Answer D)
18. Anaphylactic reaction with blood, blood products and immunoglobulin
What kind of immunodeficiency occurs in the following? (April 95)
A) Di George syndrome
B) Selective IgA deficiency
C) Panhipogammaglobulinemia
D) Wiskott-Aldrich syndrome
E) Simple variable immunodeficiency

Selective IgA deficiency is the most common immunodeficiency. It has a frequency of
1 / 500-1 / 3000.
It is generally asymptomatic. Atopy, autoimmune events in symptomatic patients
Fuck. GIS and respiratory infections are common. Local immunity is impaired and
The antigens that elapse cause autoimmune events. Anti-IgA antibodies were
detected. Blood and
These antibodies can cause a variety of reactions.
(Answer B)
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INTERNAL MEDICINE
19. Which of the following causes a delayed-type cellular response? (September 93)
A) B cell
B) Macrophage
C) Monocyte
D) Eosinophil
E) T cell
TYPE IV EXTREMELY SENSITIVITY REACTIONS

Delayed type hypersensitivity reaction is a form of cellular immunity. Sensitive T
lymphocytes meet antigen, recognize it and respond with cytokine secretion. This
effector cells in the reaction are macrophages. The most important mediator is
interferon gamma.
Delayed type hypersensitivity cannot be transplanted with serum between
individuals, but normal with T lymphocytes
Transfer to individuals is possible.
Primary defense against intracellular bacteria occurs with this type of reaction.
Example of this type of reaction
intradermal injection of antigen in previously immunized individuals (Tuberculin
type)
reaction). A positive appearance indicates a cellular immune response.
(Answer E)
20. Which complement is the most common cause of lysis? (April 93)
A) C3b
B) C1q.
C) C8
D) C2
E) C3
C8, C9: Cell lysis

C6, C7: Chemotaxis
C5a: It is the most effective of anaphlatoxins and chemotactic for macrophages and
neutrophils.
C4a: Anaflotoxin.
C3a: Anaflotoxin. It causes histamine release from mast cells.
(Answer C)
21. When horse serum is given, the following symptoms in the person starting serum
disease
type reaction is seen? (September 92)
A) Type I
B) Type II
C) Type III
D) Type IV
E) Type V
Serum disease is a Type III hypersensitivity reaction. The antibodies formed

against the antigen combine with the antigens to form immune complexes. As these
immune complexes are generalized
they form reactions throughout the body. Kidneys, joints, vascular system, lymph
nodes are involved,
purpura occurs. Complement decreases, leukopenia occurs, serum disease, sera, drugs
and hepatitis virus antigen.
(Answer C)
22. Which of the following does not passive immunization? (April 92)
A) AIDS
B) Rabies
C) Hepatitis B
D) Tetanus
E) Botylismus
AIDS does not passive immunization.

(Answer A)
23. What is the immunoglobulin that prevents microorganisms from sticking to their
mucous membranes? (April 92)
A) IgA
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B) IgG
C) IgM
D) IgD
E) IgE
IMMUNOLOGY
IgE; high levels of external secretions such as milk, saliva, tears, respiratory
and intestinal secretions.
called secretory IgA.
It is made in lymphoid cells under the mucosa. Agglutination, opsonization and
neutralization capabilities
protect the mucosa from infections.
(Answer A)
24. To react with an immune response that does not produce an immune response alone
What is the following? (September 91)
A) Antigen
B) Allergen
C) Opsonin
D) Hapten
E) Endotoxin
It is not immunogenic alone but gains antigenic properties when combined with a
protein molecule
substances are called hapten.
(Answer D)
25. What is the local Ag-Ab reaction in the vein? (April 91)
A) Serum disease
B) Tuberculin reaction
C) Idiopathic thrombocytopenic purpura
D) Arthus reaction
E) Myasthenia gravis
Reactions with the antigen-antibody complex are Type III hypersensitivity
reactions. that
There are also 2 types; Serum disease and Arthus reaction. More in serum disease
antigen excess; the complex is more soluble and the event is generalized.
Kidneys, joints, vessels and lymph nodes are involved. Antibody in Arthus reaction
and the event is local. The local lesion is a sterile abscess and then
gangrene. Causes a vasculitis causing necrosis.
(Answer D)
26. What is the clinical finding not seen in anaphylaxis? (April 91)
A) Angioneurotic edema
B) Urticaria
C) Filiform pulse
D) Hypertension
E) Respiratory narrowing
Anaphylaxis is a type I hypersensitivity reaction. Mast cells in contact with
specific antigens
and mediators released by basophils. These substances lead to vasodilatation,
increased capillary permeability, contraction of smooth muscles and eosinophilia.
These
clinically; urticaria, angioedema, hypotension, bronchus, GIS and uterine muscles
contraction occurs. Hypotension due to vasodilation occurs in the vessels, even
hypotensive shock
can go up. No hypertension.
(Answer D)
27. Factor enabling transfer from one leukocyte to another in a late immune
response
A) Macrophage
B) Lymphocyte
C) Complement
D) Lymphokine
E) Transfer factor
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It is the transfer factor that allows the delayed immune response to be transferred
from one leukocyte to another. Humoral immunity is transferred from person to
person via lymphocytes.
(Answer E)
28. Which of the following is the main factor in type III immune response? (April
90)
A) Lysosome disintegration
B) Tc cells
C) Phagocytes
D) Macrophage
E) Antigen-antibody coupling
Type III hypersensitivity reactions; These include the formation of immune
complexes by combining the antigens with the antibody formed against the antigens
entering the organism and the subsequent events. The resulting immune
complexes stimulate the complement system and platelet aggregation.
Vascular permeability increases with the release of anaflatoxin and histamine by
stimulation of the complement system,
microtrombuses are formed by platelet aggregation. Serum disease if it goes with
excess antigen
If an excess of antibody predominates, the Arthus reaction occurs. Complement
reduction, leukopenia
It happens.
(Answer E)
29. Frequent lung infections with hyperplasia of small intestinal lymphoid
follicles
Lymphadenopathy was not detected and all immunoglobulins were low.
A) Bruton disease
B) Leukemia
C) Small intestine lymphoma
D) Empyema
E) Acute otitis media

The table described is a humoral immunodeficiency disorder. Bruton
agamaglobulinemia
almost no B-lymphocytes and all immunoglobulins are low, even none
absent.
Pneumococcal pneumonia was the most common lung infection, while pseudomonas,
staphylococcus,
Meningococcal H. influenza is also common. Hepatitis is very severe. An adequate
antibody response to a specific antigenic stimulation cannot occur.
(Answer A)
30. Which of the following is the most antigen binding Ig? (September 89)
A) IgM
B) IgA
C) IgD
D) IgE
E) IgG
IgG; (+) develops after the acute phase of the disease. They are blocking
antibodies.
IgE; plays a role in allergic events.
IgE; especially the component secreted from the mucosa is important.
IgD; His mission is unknown.
IgM; serum in the form of pentamer. It occurs early against most antigens.
Bacterial
infection is the first line of defense. IgM occurs against most of the
polysaccharide antigens. Most
very antigen-binding Ig.
The only immune globulin found in serum in the form of pentamer is IgM
(Answer A)
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IMMUNOLOGY
31. Which of the following is not a sign of serum disease? (September 89)
A) Fire
B) Leukopenia
C) Common urticaria
D) Bloody diarrhea
E) Arthritis
Serum disease is a Type III hypersensitivity reaction. They are reactions that
occur as a result of the accumulation of soluble immune complexes in the vessels or
tissues. Serum disease;
serum, drugs and hepatitis virus antigen.
The findings are as follows;
• C1, C2, C4 levels are low.
• Vasculitis occurs.
• Leukopenia
• Temporary albuminuria
• Fire
• Lymphadenopathy
• Arthritis
• Urticaria
Bloody diarrhea is not observed, the event is vasculitis, not hemorrhagic
diathesis.
(Answer D)
32. Which of the following does not occur with the Type III immune complex? (April
88)
C) Henoch-Schönlein
D) Polyarteritis nodosa
E) Myasthenia graves
Antigen-antibody due to excessive antibody formation in type 3 immunological
reaction
complexes collapse in various parts of the body to prevent immune complex diseases.
They did. The best examples are collagen tissue diseases;
Systemic lupus erythematosus, Poliarteritis nodosa, Henoch Schönlein, Rheumatoid
Arthritis, Scleroderma and
Polymyositis etc.
In type II immunological reaction, either cytotoxic or cytolytic effect with the
antibody formed
it occurs. Examples include ARA; Myasthenia Gravis, Good pasture syndrome,
autoimmune hemolytic anemia and erythroblastosis fetalis.
(Answer E)
33. Which of the following is the most common in the blood? (April 88)
A) IgA
B) IgG
C) IgM
D) IgD
E) IgE
The percentage and concentration of Igs in the blood are as follows.

% ML / dL
IgG: 70%
IgA: 10%
IgM: 5%
IgD: 10%
IgE: 1%
(Answer B)
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34. Which of the following immunodeficiency diseases is negative for skin tests?
(April 88)
A) Bruton disease
B) Selective IgA deficiency
C) Selective IgM deficiency
D) Di George syndrome
E) Transient hypogammaglobulinemia of infant
B-cell functions and Ig production and secretions in cases other than Di George
syndrome
There are defects. Skin tests are related to cellular immunity and T-cell functions
They are created with.
Di George syndrome has thymic hypoplasia or aplasia. Pharyngeal 3rd and 4th sac
anomalies of thymus, parathyroid, neck and esophageal vessels can be seen together.
T-cell
functions supressed. They usually die in the first year of life because of sepsis.
(Answer D)
35. Which of the following tests is used to measure the cellular immune response?
(September 87)
A) Sabin-Feldman test
B) Schick test
C) Mantoux test
D) Gruber-Widal test
E) Weil-Felix test
The Mantoux test is used to measure cellular immunity. Also known as PPD testing.
Type IV
hypersensitivity. Gruber-Widal test; Used in the diagnosis of typhoid.
Schick test; Diphtheria is used.
Dick test; Used in the diagnosis of scarlet fever.
Weil-Felix; Used in the diagnosis of rickettsia.
(Answer C)
36. Which of the following immunoglobulins Ig
located? (September 87)
A) IgA
B) IgD
C) IgG
D) IgM
E) IgE
High levels of IgA are found in external secretions such as milk, saliva, tears,
respiratory and intestinal secretions,
this is called secretory IgA. This IgA; It is made in lymphoid cells under the
mucosa. Agglutination,
opsonization and neutralization capabilities protect the mucosa from infections.
(Answer A)
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HYPOTHALAMO - HYPOPHISARY DISEASES
HYPOTALAMO - HYPOPHASER
DISEASES
one. Which of the following is not a feature of inappropriate antidiuretic hormone
syndrome? (May 2011)
A) urine sodium level is usually high
B) Serum cortisol level is normal
C) Serum albumin level is normal
D) Lack of postural hypotension
E) High plasma renin activity
A good endocrine question. Just RAA, which does not require us to know everything
about inappropriate ADH.
We know that the system is suppressed. Improper ADH release syndrome
Hyponatremia is a clinical condition characterized by hypouricemia and increased
total water without edema.
Etiology:
one. Malignant diseases; Pulmonary, Duodenum, Pancreas, Lymphoma, CNS tumors
2nd. Pulmonary diseases; Pneumonia, lung abscess, tuberculosis, aspergillosis
3. CNS diseases; Encephalitis, meningitis, brain abscess, Gullian-Barre syndrome,
intracerebral
bleeding, stroke
4. Medicines; Chlorpropamide, Vincristine, Vinblastine, Cyclophosphamide,
Carbamezapine, Narcotics
Pathogenesis: ADH hormone release normally stops when plasma osmolarity decreases.
In inappropriate ADH syndrome, although plasma osmolarity decreases, ADH continues
to be released.
Excessive secretion of ADH causes water retention and excretion of Na in urine.
eventually
plasma osmolarity and Na amount decreases. Urine sodium increases (urine osm> 300
mosm / L).
Hypervolemia suppresses the RAA system and the amount of Na in the urine is
generally above 20 mmol / L. Edema and hypertension are not expected despite
hypervolemia.
Clinic: Symptoms of brain edema due to hyponatremia, (loss of appetite, nausea,
vomiting, irritability
confusion, coma) Diagnosis: In suspected cases, the definitive diagnosis is made by
water loading test. Plasma
and urinary ADH levels are also helpful in diagnosis.
Treatment:
one. The first step is water restriction.
2nd. Democlosiclin is the most important drug that inhibits the effect of ADH.
3. If the serum Na <125 meq / L, Na is given. Na is not increased by more than 12
meq / L in 24 hours. In the presence of hyponatremia, demyelination occurs in the
puncture due to rapid Na increase.
Total body water was increased in inappropriate ADH release but patients were
clinically praolemic;
hypertension and edema are not seen. Hyponatremia is seen in laboratory
Hyponatermia-related brain edema and related findings may be seen. Serum osmolarity
It is low. Urine osmolarity was increased. Urine Na levels are generally above 20
mmol / l.
Hyponatremia seen due to inappropriate ADH or any other reason if fast (recommended
from 12 meq / l)
If it is corrected, it causes pontine myelonysis (pontine demyelination).
(Answer E)
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2nd. Tyrosine kinase receptors, which of the following in intracellular signal

transduction
does not take duty? (December 2010)
A) Growth hormone
B) Insulin
C) Epidermal growth factor
D) Insulin-like growth factor – 1
E) Nerve growth factor
The tyrosine kinase receptors have also jumped from physiology - pharmacology -
biochemistry to internal medicine. The growth hormone is already grinning. When
insulin tyrosine kinase relationship is known, others always
growth factor.
(Answer A)
3. Which of the following drugs used in the treatment of metastatic breast cancer
is an alkylating agent? (April 2010)
A) Vinorelbine
B) Cyclophosphamide
C) Etoposide
D) Paclitaxel
E) Doxorubicin
Which portion of the metastatic breast cancer problem is alkylating? Let's correct.
Answer Cyclophosphamide
(nitrogen mustard group).
(Answer B)
4. Which of the following symptoms does not cause hyperprolactinemia? (September
2009)
A) Amenorrhea
B) Osteopenia
C) Galactorrhea
D) Infertility
E) Hyperpigmentation
Hyperprolactinemia is the first symptom of amenorrhea and galactorrhea in women.
Male loss of libido and impotence is seen. This may result in infertility.
Osteoporosis and osteopenia in hyperprolactinemia
can. Hyperprolactinemia is not an expected finding in hyperpigmentation.
Hyperpigmentation internal practice in cases of increasing ACTH level (Example
Addison)
Peutz – Geugher (especially the hamartomatous polyps in the colon and small
intestine)
melanocytic freckles around lip.
(Answer E)
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5. A 52-year-old woman who had undergone total thyroidectomy one year ago
fatigue, weakness, constipation complaints for several months, these complaints 1-2
nausea and lethargy have been added since the day. In the physical examination of
the patient, blood
The pressure is 120/75 mmHg and the pulse is 80 / minute. In laboratory
examinations, plasma sodium level of 128 mEq / L, fasting blood sugar 92 mg / dL
and blood urea
nitrogen was 24 mg / dL and urine osmolality was 140 mOsm / kg.
Determination of the cause of hyponatremia in this patient
A) Plasma aldosterone level
B) ADH level
C) Plasma cortisol level
D) Plasma renin level
E) TSH level
One of the quiz's interesting but beautiful questions. The patient has already
undergone thyroid surgery, clinical hyponatremia
at the end. This patient's hyponatremia is due to hypothyroidism and TSH.
It should be requested. The most appealing teacher, why not ask for ADH patient is
not inappropriate ADH? OK
Let's call it ADH, let's call it high. Endocrine
classical knowledge The basal values of hormones such as ADH and GH have no value
for diagnosis. Inappropriate ADH
Water loading test should be done for diagnosis.
(Answer E)
6. Lethargy develops in a patient who was followed up for small cell lung cancer.
made
On physical examination, the patient had no signs of edema, orthostatic hypotension
or dehydration. In the laboratory examinations, serum sodium level was 118 mEq / L;
serum BUN, creatinine
and glucose levels are normal. Initial treatment of this patient
which of the following should be done? (September 2008)
A) Serum physiological
B) Fluid restriction
C) 5% dextrose infusion
D) Desmopressin treatment
E) Dialysis practice
The patient proudly presents endocrine + oncology of inappropriate lung cancer and
hyponatremia of course ADH.
Inappropriate ADH Syndrome
Definition and Etiology: Improper overexpression of ADH causes plasma osmolality
and Na
Concentrated urine (urine osm> 300 mosm / kg, density> 1010)
formation. Hypervolemia suppresses the RAA system and the amount of Na in the urine
is usually 20.
mmol / L (natriuresis despite hyponatremia). Edema and hypertension are not
expected despite hypervolemia. Inappropriate ADH syndrome occurs in the following
cases:
•
Malignant diseases; Pulmonary, Duodenum, Pancreas, Lymphoma, SSS,
Pulmonary diseases; Pneumonia, lung abscess, TB, aspergillosis,
CNS diseases; Encephalitis, meningitis, brain abscess, Gullian Barre syndrome,

intracerebral hemorrhage,
stroke,
Medicines; Chlorpropamide, Vincristine, Vinblastine, Cyclophosphamide,

Carbamezapine, Narcotics
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Clinical: There are clinical signs of hyponatremia (loss of appetite, nausea,

vomiting, irritability confusion,
coma).
Diagnosis: Serum sodium level is measured first. If low, hyperglycemia by measuring
plasma osmolality
differential diagnosis from hyponatremia caused by hyperosmolar conditions such as.
If serum
If sodium is normal and is still suspected of inappropriate ADH syndrome
diagnosis is made by water loading test. Plasma and urine ADH levels are also
helpful in diagnosis.
Treatment: The first step is water restriction. Democlosiclin is the most important
drug that inhibits the effect of ADH.
(Answer B)
7. A 23-year-old female patient with secondary amenorrhea had a prolactin level of
127 ng / ml. Magnetic resonance imaging shows a 7mm adenoma in the pituitary.
What is the most appropriate treatment for this patient? (September 2005)
A) Bromocriptine treatment
B) Cyclic treatment of estrogen-progesterone
C) Transsphenoidal microsurgery
D) Transfrontal surgery
E) Radiation therapy
For pituitary adenomas, the treatment in all over 10 mm and / or below is surgical.
But the exception is the use of dopamine agonists before treatment of prolactinoma
microadenoma (below 10mm). Answer for this question
bromocriptine, but the most effective now Cabergoline.
(Answer A)
8. Which of the following is not one of the clinical signs of acromegaly?
(September 2004)
A) Hypertension
B) Hypoglycemia
C) Column polyps
D) Sleep apnea
E) Cardiomyopathy
Acromegaly and gigantism:
Hypersecretion of growth hormone and associated overproduction of somatomedin C
from chronic, is a disease that causes the growth of organs and tissues. Clinical
symptoms of bone and
overgrowth of soft tissues, metabolic abnormalities and mass effects of tumor. Both
is seen equally in the sex. The cause is almost always the pituitary adenoma that
secretes growth hormone. If it starts before puberta, the epiphyseal lines do not
have much release of sex steroids yet.
because it is not closed is a clinical feature characterized by tallness.
Clinic: Findings in adults include: Shoe-glove-ring size growth,
coarseness and prognatism over time, large nose, thick lips and frontal
folds, visceromegaly, tongue growth and tooth formation, joint deformities and
arthropathy, partial hypertension, cardiomegaly and congestive heart failure,
carpal tunnel
syndrome, impotence, oily rough skin, excessive sweating, headache, joint pain.
Diagnosis: Hyperphosphatemia, hyperphosphaturia and hypercalciuria, increase in
growth hormone and somatomedin-C,
The diagnosis is made by not suppressing the growth hormone level in the glucose
suppression test. Sella with MRI
Evaluated. If an acromegalic patient has a large sella but no mass, it secretes
ectopic GH
tumor (visible in bronchial carcinoid or pancreatic tumors) should be considered.
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Treatment: Excision of the pituitary mass (selective treatment is transnasal

transsphenoidal pituitary adenomectomy). Pituitary radiotherapy (no effect in the
early period). Analogs of somatostatin
may need to be used. Patients with acromegaly usually die from cardiovascular and
cerebrovascular events.
•
Growth hormone hypersecretion gigantism if the pineal plaques appear before

closing.
•
Causes acromegaly if seen in adulthood
Visceromegaly is seen in acromegaly.
• Laboratory evidence of suspected hyperphosphatemia, urine

phosphorus excretion is increased, urinary calcium excretion is increased.
•
Serum GH and somatomedin C levels were increased.
Diagnosis is made by not decreasing GH level in glucose suppression test.
When evaluated by MRI, the sella was enlarged.

(Answer B)
9. In the treatment of patients with panhipopituitarism, first of the following
hormones
which should be replaced? (September 2004)
A) Cortisol
B) Thyroid hormone
C) Growth hormone
D) Gonadal steroids
E) Melatonin
hypopituitarism
It is caused by a decrease in the secretion of one or more pituitary hormones.
Primary pituitary
Diseases may occur as a result of hypothalamic diseases. generally
first GH and then gonadotropin TSH, ACTH and prolactin secretions disappear
respectively.
Causes of hypopituitarism:
Invasive: Tumors
•
Acquired adenoma (the most common cause of acquired hypopitiutarism)
Craniopharyngioma (the most common cause of congenital hypopitiutarism)
Metastasis (most commonly from breast)
infection
•
Mycosis, tbc, syphilis, histiocytosis,
•
Eosinophilic granuloma, sarcoidosis (most common among granulomatous diseases),
inflammation
•
Hemokromasitozis
Congenital
•
Pituitary aplasia
vascular
•
Ischemic necrosis; Sheehan syndrome (postpartum hemorrhage)

· Sickle cell anemia, temporal arthritis)
iatrogenic
•
Surgical
Radiotherapy
Systemic;
•
Diabetes, vasculitis,
Immunological
•
Lymphocytic hypophysitis (common in pregnant and postpartum women)
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INTERNAL MEDICINE
Idiopathic
•
Combined GH, PRL, TSH deficiency
Isolated hormone deficiencies
Kallmann syndrome
· Secondary Hypopituitarism
•
Hypothalamus diseases
· The most common cause of hypopituitarism is pituitary adenoma.
The most common metastasis to the pituitary is breast cancer.
Clinical: Symptoms vary according to the number of deficient hormones and

deficiency rate.
Growth hormone deficiency: Since the effects of GH deficiency in adults are unclear
(may be chronic fatigue syndrome), patients with hypopituitarism are more likely to
have LH / FSH deficiency in the clinic.
They application. Fasting hypoglycemia is common. In laron dwarfism, IGF-1 is low
but GH
high (insensitivity to GH).
•
Patients with growth hormone deficiency are mostly due to LH and FSH deficiency
symptoms.
In laron dwarfism IGF-1 is low but GH is high.
Gonadotropin deficiency: Impotence in men as a result of deficiency in adults,

decreased libido, in women
amenorrhea. Kallman syndrome is a form of GnRH deficiency that is associated with
anosmia or hyposmia, color blindness, and rabbit lip defects.
visible.
TSH deficiency: Secondary hypothyroidism. The hypothyroidism clinic is similar
here, but goiter is not expected. Symptoms are usually milder than primary
hypothyroidism and are often
Lack of hormones accompanies the clinical picture.
ACTH deficiency: Secondary hypocortisolism as a result of decreased cortisol
secretion from the surrenal gland
It develops. In contrast to Addison's disease, aldosterone secretion is usually
normal. Again in this hypocortisolemic condition, hyperpigmentation is not
expected.
Prolactin deficiency: The only finding is that women cannot give milk in the
postpartum period. males
There is no known physiological or clinical effect of the deficiency. Often Sheehan
syndrome or lymphocytic
observed in pituitary.
Laboratory: Hyponatremia (due to cortisol deficiency), hypoglycemia, anemia may
occur, potassium
normal (because, in contrast to primary adrenal insufficiency,
Remains).
Diagnosis: Insufficiency can be determined by measuring individual hormone levels.
But basal hormone levels
dynamic endocrine tests are used for diagnostic purposes since they are not
sensitive to diagnosis.
The best test is insulin used to evaluate GH and cortisol response to insulin
hypoglycemia.
tolerance test (insulin hypoglycemia test) to determine the pituitary reserve. In
normal people
In case of hypoglycemia, there will be an increase in GH and cortisol levels of
stress hormones. The absence of this increase despite a stress factor such as
hypoglycemia indicates pituitary insufficiency.
ACTH reserve can be determined by metirapone test. This drug inhibits 11-beta
hydroxylase in cortisol synthesis
suppresses endogenous cortisol formation and is expected to stimulate ACTH. Lack of
this increase
pituitary insufficiency.
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Gonadotropin release capacity is evaluated by GnRH test and clomiphene test.

Prolactin with TRH test
Evaluated.
Treatment: Replacement therapy is performed in the form of missing hormones.
cortisol,
T4 is replaced with estrogen-progesterone in women and testosterone in men.
Fertility
hCG and human menopausal gonado with LH and FSH-like activity in the intended
cases.
tropin (HMG) may be used. Growth hormone deficiency is also produced by recombinant
technique
growth hormone. It has only the parenteral form. Today
replacement therapy for growth hormone deficiency in adults is now being performed.
Steroid administration before thyroid hormones is very important in treatment.
Otherwise ill cortisol
deficiency of thyroid hormones (basal metabolism accelerates the need for
cortisol).
increased and lack of more obvious).
Goiter is not expected in secondary hypothyroidism.
• Hyperpigmentation is not expected in secondary adrenal insufficiency.
• Diagnosis of pituitary insufficiency can be made by measuring hormone levels but
dynamic tests are more guiding in diagnosis.
• The most helpful test for the diagnosis of pituitary insufficiency is insulin
tolerance test.
• The presence of ACTH insufficiency can be assessed by metiropan test.
(Answer A)
10. Which of the following inhibits growth hormone secretion? (September 2003)
A) Hypoglycemia
B) Uremia
C) Stress
D) High fatty acid level
E) Hunger
Growth Hormone (BH, Growth hormone)

Its secretion is induced by the GHRH effect from the pituitary. Effects of BH
itself and insulin-like growth factor
(IGF-1, Somatomedin-C). IGF-1 in all tissues, mainly liver
Ester. BH and IGF-1 effect increases protein synthesis. With the direct effect of
BH independent of IGF-1
decreased glucose uptake of cells (diabetogenic effect), insulin resistance occurs,
from adipocytes
mobilization of fatty acids and increased use by cells (lipolysis). On growth
hormone
Effective factors are also given in the table.
Effect
stimulation
inhibition
hypothalamic
GHRH
somatostatin
amines
α2-adrenergic stimulation (norepinephrine)
β-adrenergic stimulation
β-adrenergic blockers (propranolol)
α2-adrenergic blockers (yohimbine)
Dopaminergic stimulation (L-dopa, bromocriptine,

Apomorphine)
Dopaminergic blockers (chlorpromazine)
Serotonergic stimulation (L-tryptophan)
Serotinergic blockers (metisergid, ciproheptadine)
Reduction of IGF-I (SOM-C)
Increased IGF-I (obesity)
Estrogen, Vasopressin, Glucagon
Progesterone, Glucocorticoids
Hypoglycemia, amino acid (arginine) *
Acute hyperglycemia
Reduction in free fatty acids
Increase in free fatty acids
Exercise, Stress, Sleep
Muscarinic cholinergic antagonists (atropine)
Hormones
Metabolic
Other
Cholinergic (muscarinic stimulation) (pyridostigmine),

PG E2
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INTERNAL MEDICINE
GH is most commonly synthesized during REM sleep at night.
It causes insulin resistance with direct efficacy.
It acts through IGF 1.
IGF 1 is mostly synthesized from the liver.

(Answer D)
11th. Polyuria, polydipsia in the patient who presented with complaints of plasma
osmolarity 305
urinary osmolarity is 95. Water loading test and desmopressin (answer d) did not
change
It is found to be present. What is the most likely diagnosis in this patient?
(April 2001)
A) Nephrogenic diabetes insipitus
B) Psychogenic diabetes insipitus
D) Neurogenic diabetes insipitus
E) Pituitary ADH failure

Diabetes insipidus; Dilue urine in excess amounts and is characterized by thirst.
Two type
has. Central diabetus insipitus and renal tubules caused by ADH deficiency
nephrogenic diabetes insipidus.
Plasma osmolarity is high.
No change in urine osmolality and low after water restriction test and DDAVP
nephrogenic diabetes insiputus.
Urine osmolality> 600m Osm / kg after DDAVP suggests central diabetes insipidus.
Primary polydipsia seen in diabetes mellitus and psychiatric diseases should be
considered in the differential diagnosis.
Here, the chronic diuresis still leads to a continuous cleaning of the solute load.
Chronic
Because of diuresis, urine may be highly diluent but plasma osmolality is low
rather than high.
DDAVP should not be given to patients with primary polydipsia. Because it prevents
the excretion of water and sick water
If you continue to drink serious water intoxication develops.
(Answer A)
12. Thirty-eight-year-old amenorrhea and decreased libido, appetite and cold
intolerance complaints
in the history of a female patient who had these complaints after birth 5 years
ago.
it becomes apparent.
2000)
A) Primary hypothyroidism
B) Sheehan syndrome
C) Hyperprolactinemia
D) Addison's disease
E) Nelson syndrome
Sheehan syndrome; hypovolemia and shock induced pituitary necrosis in the early
peripartum period. Panhipopituitarism develops.
Postpartum lactation may not develop, the patient may complain of fatigue and loss
of axillary and pubis hairs may occur. FSH, amenorrhea due to LH deficiency, loss
of libido occurs. TSH deficiency
secondary cold intolerance due to T3 and T4 decrease. ACTH deficiency secondary to
adrenal insufficiency (orthostatic hypotension) occurs.
Treatment is in the form of replacement. Corticosteroid should be given first.
Because thyroxine first
may cause an adrenal crisis.
(Answer B)
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13. In the treatment of the above patient firstly

You use? (September 2000)
A) Thyroxine
B) Estradiol
C) Progesterone
D) Corticosteroid
E) Dopamine
CONCLUSIONS THE FIRST MEDICINE IN HYPOPHISARY FAILURE

Corticosteroids are.
Sheehan Syndrome:
Pituitary gland is more susceptible to hypoxemia because its mass and metabolic
need increase during pregnancy.
Vasospasm in the pituitary arteries in a woman with excessive bleeding during labor
postpartum
necrosis (Sheehan Syndrome). Hypopituitarism develops in 32% of patients. First
Symptoms include the absence of postpartum lactation and the recurrence of
menstrual cycles.
Hypotension, hypoglycemia, axillary, pubic hair loss due to ACTH deficiency in some
patients
and hypothyroidism due to TSH deficiency develops. Spontaneous hemorrhagic necrosis
in pituitary tumors
(pituitary apoplexy) can also lead to hypopituitarism
(Answer D)
14. FSH, LH and TSH in serum in the patient in the previous question (10)
values, which of the following do you expect? (September 2000)
FSH
LH
TSH
a)
B)
C.)
D)
TO)
Sheehan syndrome; As panhipopituitarism developed, all anterior pituitary hormones

levels fall.
(Answer D)
15. Which of the following is not a characteristic feature of inappropriate ADH
secretion syndrome? (April 2000)
A) Edema
B) Natriuresis
C) Hyponatremia
D) Volume expansion
E) Normal or decreased serum creatinine level

Improper ADH release syndrome
Treatment:
one.
The first step is water restriction.
2nd.
Democlosiclin is the most important drug that inhibits the effect of ADH.
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INTERNAL MEDICINE
3.
If the serum Na <125 meq / L, Na is given. Na is not increased by more than 12

meq / L in 24 hours. In the presence of hyponatremia, demyelination occurs in the
puncture due to rapid Na increase.
·
Total body water increased with inappropriate ADH release, but patients
as are praolemic; hypertension and edema are not seen.
Hyponatremia is seen in laboratory
Brain edema due to hyponatremia and related findings can be seen.
Serum osmolarity is low. Urine osmolarity was increased.
Urine Na levels are generally above 20 mmol / l.
Hyponatremia seen due to inappropriate ADH or some other

If it is corrected, it causes pontine myelonisis.
(pontin demyelination)
(Answer A)
16. Which drug is the cause of nephrogenic diabetes insipitus? (April 99)
A) Lithium
B) Methicillin
C) Neomycin
D) Furosemide
E) Phenacetin
Diabetes Insipudus
Excessive water intake and hypotonic urine is a disease characterized by polyuria.
Antidiuretic hormone
secretion or ineffectiveness at the level of the kidney. Polyuria, polydipsia and
excessive
There is a feeling of thirst. The amount of urine per day can reach 16-20 liters.
Serum if water is withdrawn
Osmolality increases but urine osmolality is low. Usually after pituitary-
hypothalamus surgery
it may develop temporarily or due to head trauma.
Diagnostic tests in polyuric syndromes
Power Plant DI
Nephrogenic DI
Primary polydipsia
Plasma osmolality
High
High
Low
Urine osmolality
Low
Low
Low
Urine osm.
No change
No change
rises
After ADH administration, urine osm.
rises
No change
rises
574
The etiology;
one. Central (hypothalamic):
•
Surgical,
idiopathic,
family,
tumor,
histiocytosis,
infection,
immunologically
2nd. nephrogenic:
•
Chronic pyelonephritis,
hypokalemia,
hypercalcemia,
sickle cell anemia,
Sjogren's disease
lithium, meancycline,
congenital, familial (common in men).
3. Psikojenijk (Potomani voluntary drinking water, primary polydipsia).

Clinic: If the patient drinks enough water, the patient watches without causing any
problem. There are only polydipsia and polyuria.
However, it is aggravated by loss of consciousness or thirst in the elderly and
causes hypernatremia and
confusion and coma may develop.
one.
Water restriction Test: The patient is left dehydrated for 8 hours, urine density
<1008 and urine
The plant has DI if osmolarity is <300 mosm. It is used to differentiate between
central and psychogenic DI.
(April 2001)
2nd.
Vasopressin test: Intranasal vasopressin is given. Urine density and osmolarity

increases
central DI is nephrogenic DI if not increased.
Treatment:
one.
Central DI: Replacement with DDAVP-dezmopressin (vasopressin analog).
2nd.
Nephrogenic DI:
-
Klorpropramid,
clofibrate,
Carbamazepine,
Thiazides,
Ibuprofen
Salt restriction may be used.
Sometimes it responds to high-dose DDAVP.
3. Psychogenic (primary): Water restricted

(Answer A)
575
INTERNAL MEDICINE
17. Which is the most common pituitary tumor? (April 98)

A) Prolactinoma
B) Somatostatinoma
C) GH release
D) VIPoma
E) TSH release
Pituitary tumors
Three important factors are important in the management of pituitary tumors
one-
Tumor size: microadenoma less than one centimeter, more than one centimeter
They are called macroadenomas.
2nd-
The relationship of the tumor with the surrounding tissue: tumors invading or
compressing the surrounding tissues
create a clinical clinic. For example, chiasma optic compression may result in
hemianopsia. Dura
conditions such as headache in tumor invasive tumors independent of tumor size
can be expected
3-
Whether the tumor is hormonal or not: Pituitary tumors secrete hormones

therefore, they can give signs and symptoms. Ultimately, the clinical picture is
due to over-produced hormone
change. Sometimes a mixed picture in which more than one trophic hormone is
secreted can also be observed.
For example;
a-
Growth hormone-secreting pituitary adenomas: Pre-pubertal gigantism, post-pubertal

Clinical signs of acromegaly
b-
Prolactin-secreting pituitary adenoma: It is the most common pituitary tumor.

prolactinomas
usually galactorrhea, menstrual irregularity or amenorrhea in women, libido loss in
men and
impotence.
c-
ACTH secreting pituitary adenoma: Pituitary causes Cushing's picture.
D-
Gonadotropin-secreting pituitary adenoma (FSH'oma): Previous to gonadotropinomas

It is considered to be a part of pituitary adenomas that are considered to be
nonfunctioning.
to-
Pituitary adenoma secreting TSH: TSHoma is rare; Although it is a clinical typical

thyrotoxicosis clinic, TSH also increases in addition to thyroid hormones and
goiter is common.
f-
Nonfunctioning pituitary adenomas: Generally the tumor grows and compresses

as a result of late recognition and therefore often caught in the form of
macroadenoma
tumors but become more common as a result of the widespread use of imaging methods.
It has come.
Operation, radiotherapy or hypersecretion and tumor development in the treatment of

pituitary adenomas
suppressing drugs are preferred. Hypersecretion in the treatment of pituitary
adenomas
to prevent, to correct the deficiency of other pituitary hormones and to control
adenoma growth.
one.
Operation: Transsphenoidal microsurgery is preferred. Transfrontal craniotomy is

required in patients with suprasellar mass extension. The success rate of surgical
treatment in microroadenomas is 90%.
Complications include nasal CSF (rhinorrhea), meningitis, diabetes insipitus,
vision
disorders and hypopituitarism.
2nd.
Radiotherapy: It is used in incomplete resection of large pituitary tumors.

As a complication, hypopituitarism develops in 50-60% of cases in 5-10 years.
3.
Medical treatment: Prolactinoma, dopamine agonists in acromegaly and Cushing's

disease, octreotide is used in adrenomas secreting acromegaly and TSH.
576
Surgical
RTA
medical
comment
Non-functional
++
+
pROLACTINOMA
++
Reduce dopamine agonist macroadenoma
Acromegaly
++
++
Oreotide and dopamine agonist do not reduce macroadenoma
Cushing's disease
++
Ketoconazole and others
fsh'o to
++
tsh'o to
++
Ocreotid
++ First treatment, + Next treatment option
(Answer A)
18. Which factor inhibits prolactin release in the hypothalamus?
(September 97)
A) Adrenaline
B) Noradrenaline
C) Dopa
D) Dopamine
E) Phenylethylamine
The hormone prolactin is released from the pituitary gland and works under the sole
inhibitory effect of the hypothalamus. prolactin
reduces the release dopamine.
(Answer D)
19. Edema without postural hypotension and dehydration but hyponatremia
and urinary osmolality of 300 mOsm / lt.
A) Dilutional hyponatremia
B) Improper ADH syndrome
C) Psychogenic polydipsia
E) Diabetes insipitus
Improper ADH release syndrome

Pathogenesis: ADH hormone release normally stops when plasma osmolarity decreases.
Inappropriate
Although plasma osmolarity decreases in ADH syndrome, ADH continues to be released.
Extreme
secreted ADH causes water retention and excretion of Na in urine. Ultimately plasma
osmolarity and Na amount decreases. Urine sodium increases (urine osm> 300 mosm /
L). Hypervolemia RAA
and the amount of Na in the urine is usually above 20 mmol / L. hypervolemia
Although edema and hypertension is not expected.
(Answer B)
20. Which of the following is not the cause of papillary edema? (April 93)
A) Hypertension
B) Brain tumor
C) Chronic emphysema
D) Pseudotumor cerebri
E) Hyperparathyroidism
Hypertension, intracranial masses such as pseudotumor cerebri or chronic emphysema

Papillary edema because it increases intracranial pressure (because it causes ADH
release)
they may cause. Chronic emphysema also increases the intracranial pressure due to
hypercapnia,
edema. Hyperparathyroidism does not increase intracranial pressure. So papil
does not cause edema.
(Answer E)
577
INTERNAL MEDICINE
21. Insulin hypoglycemia to investigate anterior pituitary hormone reserve

test, which of the following does not need to determine the amount of blood?
(April 92)
A) Prolactin
B) Insulin
C) Blood sugar
D) Cortisol
E) Growth hormone (GH)
The aim of insulin hypoglycemia test is to look at the level of hormones that work
in insulin
thus it is to control the pituitary reserve.
Insulin contraregular hormones:
• GH
• ACTH
• Insulin
• Glucagon
• Adrenaline
• Noradrenaline
There is no relationship between prolactin and blood sugar.
(Answer A)
22. Which of the following is injured in a patient with diabetes insipitus? (April
90)
A) Supraoptic, paraventricular nucleus
B) Anterior nucleus
C) Intermedial nucleus
D) Anterior pituitary
E) N. solitarius
ADH and oxytocin are synthesized in supraoptic and paraventricular nuclei in the
hypothalamus and then the hypothalamus is exposed to the pituitary axonal
conduction through neurophysic substances I and II.
moved. These two hormones come to the posterior pituitary and are stored here and
released from here if necessary.
Diabetes insipidus occurs in ADH deficiency. The most common cause of this is
idiopathic, but in children
hypothalamic tumors.
(Answer A)
23. Which disease does not cause papilla edema? (September 87)
A) Hydrocephalus
B) Hyperparathyroidism
C) Intracranial bleeding
D) Ependymoma
E) Medulloblastoma
Papillary edema is indicative of increased intracranial pressure. The non-central

event is clear in the case.
One of the simple questions.
(Answer B)
24. Hypervolemia, hyponatremia and high-density urine after meningitis
Which of the following should be considered in the first findings? (September 87)
A) Cushing's syndrome
B) Acute adrenal insufficiency
D) Acute nephropathy
E) Septic shock
See a description of question 16

(Answer C)
578
THYROID DISEASES
THYROID DISEASES
one. T3 in thyroid function tests in a patient with chronic renal failure
low, T4 normal, TSH low. Erythropoietin and calcium acetate
Thyroid gland is not palpated in physical examination.
The most likely cause and treatment of this condition is
It has been awarded? (September 2008)
Reason
treatment
a)
Primary hypothyroidism
L-thyroxine replacement
B)
Secondary hypothyroidism
L-thyroxine replacement
C.)
Euthyroid sick syndrome
Follow-up without treatment
D)
thyrotoxicosis
Propylthiouracil 150 mg / day
TO)
Drug effect
Follow-up without treatment
Especially in patients with chronic disease (CRF, malignancy; CHF, etc.) seen in
patients with euthyroid syndrome
The underlying disease should be treated.
Patient Euthyroid Syndrome
Sometimes non-thyroidal systemic diseases make a thyroid hormone
levels. Often low T3 levels sometimes associated with low T3 /
It is characterized by the T4 level. Although serum thyroid hormone levels are low,
these patients have no clinical signs and symptoms of hypothyroidism. Serum TSH
levels in these patients
within normal limits. These patients are considered euthyroid and the patient is
referred to as euthyroid syndrome.
It is named. However, to accept these patients as euthyroids - at least in some
tissues may be wrong. A wide variety of diseases can cause this condition. Patient
leads to euthyroid syndrome
cytokines are responsible for pathophysiologic mechanisms. Cytokines at the same
time
are reported to be affected by other endocrine organs. Clinically non-thyroidal
diseases caused by thyroid syndrome, true thyroid dysfunction
It is important to make differential diagnosis from thyroid diseases because
treatment approaches will be different.
(Answer C)
579
INTERNAL MEDICINE
2nd. A 38-year-old woman presented with fatigue, constipation, menorrhagia and

weight gain of 4 kg for 6 weeks. In physical examination, pulse 56 /
minutes, blood pressure is 150/94 mmHg, thyroid gland diffuse as large, skin dry
and deep
Tendon reflexes were detected to elongate in the relaxation phase. TSH levels are
high and free T4 levels are low. For this patient
which of the following is appropriate at the next stage?
(April 2008)
A) TRH stimulation test
B) Thyroid hormone replacement therapy
C) Thyroid ultrasonography
D) 123I uptake and scintigraphy
E) Fine needle aspiration biopsy
Female weight gain, menstrual irregularity, constipation, bradycardia, elevated
blood pressure and decreased DTR 's hypothyroidism was not enough to give a
laboratory question.
hypothyroidism
Definition and Etiology: Reduction of thyroid hormone production or peripheral
tissue resistance to thyroid hormone
develops as a result. Reduction of hormone production may be due to primary,
secondary or tertiary reasons.
one.
Primary [autoimmune (Hashimoto), thyroiditis, iatrogenic, thyroidectomy, iodine
deficiency, excess iodine,
drugs (lithium, antithyroid drugs, perchlorate) and congenital],
2nd.
Secondary (pituitary insufficiency),
3.
Tertiary (hypothalamus diseases),
4.
Peripheral resistance to the effect of thyroid hormone.
Primary hypothyroidism is the most common cause. The most common cause is
hypothyroidism caused by Hashimoto's thyroiditis. Thyroid gland may be atrophic
(thyropivic) or large (goiter).
Clinic: Hypothyroidism affects all organs and systems. Basal metabolism in organism
and many systems
functions slow down. Easy fatigue, weight gain, constipation, menstruation
irregularity (menorrhagia),
galactorrhea, muscle cramps, dry skin, swelling of the hand and face (non-linging
edema), hoarseness,
Decrease in DTR, decrease in hair, bradycardia, low voltage, pulmonary and
pericardial fluid, hypertension, decreased respiration, hypercapnia, hypoxia,
decreased glomerular filtration rate, water excretion
decreased, hyponatremia, anemia, cold intolerance.
Diagnosis: TSH elevation is the most important laboratory finding in the diagnosis
of primary hypothyroidism (TSH is the most important test to differentiate primary
hypothyroidism).T4, T3, sT4 and sT3 are expected to be low. In subclinical
hypothyroidism, T3 and T4 may be normal only TSH. Autoantibodies linked to
Hashimoto
(anti-TPO and anti-TG). There is an eccentric response to TRH stimulation. (normal
response of TSH
6 mIU / ml). Free T3 and T4 drops in secondary and tertiary hypothyroidism, TSH low
or is normal. Late response in tertiary form, while secondary response to TRH
stimulation test was absent
obtained
Treatment: Levothyroxine (T4) preparations are used. Steroids for treatment of
secondary hypothyroidism
is also added.
(Answer B)
580
THYROID DISEASES
3. A 28-year-old female patient presented with palpitations, tremor of hands,

irritability and insomnia for 10 days. Upper respiratory tract infection 3-4 weeks
ago
learned. On physical examination, the pulse rate was 134 / min. rhythmic, blood
pressure 145/70
mmHg, skin moist, thyroid gland 1.5-2 times enlarged, painful diffuse damage is
observed.
T3: 2.4 ng / ml, T4: 14.9 µg / dl, TSH: 0.01 IU / L, thyroid scintigraphy showed
gland suppression.
What is the most likely diagnosis and treatment of this patient?
(September 2006)
Diagnosis
Treatment
A) Subacute thyroiditis
Indomethacin-Proponalol
B) Job Basedow
methimazole
C) Graves
In the following esophageal pathologies, esophageal manometry is appropriate

plays a decisive role in the selection of surgical treatment? (April 2010)
a)
Zenker diverticulum
B)
Epiphrenic diverticulum
C.)
achalasia
D) Esophageal stricture
E) Esophageal scleroderma
Monometric studies for achalasia determine the type of treatment.
(Answer C)
4.
Which of the following indicates the superiority of endoscopy over barium graphies
in the evaluation of the upper gastrointestinal tract? (April 2010)
a)
Distinction of malignant - benign gastric ulcer
B)
Imaging of the diverticulum or fistula
C.)
Locating the strictures
D) Determining the size of hiatus hernia

E) Evaluation of gastric emptying
In the evaluation of the upper gastrointestinal system, biopsy that cannot be
obtained by barium radiography and according to this biopsy, it is possible to
distinguish malignant and benign by pathological examination.
Therefore, only the filling defect will be obtained on the barium graph or the
ulcer
barium filled with ulcer niche image obtained as a result will be seen. However,
biopsy and pathological diagnosis is not possible with barium radiography.
(Answer A)
5.
57-year-old male patient with dysphagia and pain behind the sternum
with the complaint. 1 year before the history of the complaints
increased in the last 3 months, smoked two packs of cigarettes and a double rakı
for 30 years
Learned. Vital signs in FM are within normal limits. made
esophagoscopy at 25 cm from the incisors to the lumen of the mucosa
a moving mass about 5 cm in diameter is detected. This audience
It is determined that there is not any disorder in the mucosa covering it.
A) Squamous cell carcinoma of esophagus
B) Lung carcinoma invading the esophagus
C) Esophageal leiomyoma
D)
Nonhodgkin's lymphoma
TO)
Benign polyp of the esophagus
127
GENERAL SURGERY
Leiomyoma:
- It is the most common benign tumor of the esophagus (> 50%).
- Most are in the lower esophagus (smooth muscle).
- It constitutes 10% of all GIS leiomyomas.
- Dysphagia, pain, weight loss, retrosternal fullness, ulceration and bleeding may
be.
- They should be removed by enucleation in case of malignant degeneration.
- In the diagnosis, submucosal localized, moving towards the lumen by barium
radiographs and endoscopy
as a mass.
- In the next stage, enucleation is performed by surgical method.
(Answer C)
6. Which of the following is best suited to the patient in the previous question?
(April 2009)
a)
Endoscopy at regular intervals
B)
Endoscopy and biopsy
C.)
Transhiatal esophagectomy
D) Right thoracotomy and enucleation of the mass

E) Esophageal resection after neoadjuvant chemotherapy
(Answer D)
7.
Which of the following is not detected in the esophageal manometry study in

achalasia? (April 2009)
A) Simultan contractions
B) Aperistaltism in the esophageal body
C) Increase in lower esophageal sphincter pressure
D)
Intraesophageal pressure is higher than stomach pressure
TO)
Incomplete lower esophageal sphincter relaxation
achalasia
• Aperistaltism in the distal part of the 2/3 of the esophagus, which often
contains the smooth muscle, and
as a result of relaxation disorder of lower esophageal sphincter (LES) synchronized
with peristaltism
is a clinical condition that occurs.
• Primary pathophysiological disorder is inhibitor innervation of LES.
• LES does not relax, there is aperistaltism and dilatation occurs proximal to LES.
Chagas' disease, degenerative diseases, chronic idiopathic pseudobstruction, trauma
(surgery
secondary achalasia may occur after vagotomy.
• Achalasia has 3 components (hypertensive lower esophageal sphincter,
aperistaltism, enlarged
esophagus).
• Keeps men and women equally, and usually in middle ages.
• Aperistaltism, relaxation in LES in esophageal synoradiography and manometric
studies
Lack of pressure, esophageal body and LES pressure increase.
(Answer A)
128
ESOPHAGUS-DIAPHRAGMATIC DISEASES AND SURGERY
8. What is the most useful method for local staging of esophageal cancer before
surgery? (September 2008)
A) Endoscopic ultrasonography
B)
Positron emission tomography
D)
Computed tomography
TO)
Mediastinoscopy
ESOPHAGUS MALIGNAL TUMORS:

• 1% of all cancers and 7% of GIS cancers.
- 60-80% epithelial carcinoma (squamous cell), 10-30% adenocarcinoma and 0, 5-1, 5
sarcoma
in the form.
Etiology:
Smoking, alcohol, foods with nitrosamine, hpv infections, vitamins A, C, E,
riboflavin, zinc, molybdenum deficiency, excessive hot food consumption, corrosive
strictures, autosomal dominant hand and foot
thickening of the base skin and esophageal cancer
It is accused.
Endoscopic ultrasonography tumor size, wall penetration and lymph node metastasis
is the most useful information about the investigation. Best local staging in the
preoperative period
It is examined.
Dysphagia and weight loss are the most common symptoms in patients with esophageal
cancer. patients
98% is the first symptom. The classical image on barium x-ray is ide shoulder sign
”. the Ösofagoskop
most effective in the diagnosis. After the diagnosis, whether the patient can be a
candidate for surgery
endosonography is the most appropriate examination to understand. Factors
determining the chance of curative resection
age, cardiopulmonary reserve, clinical, endoscopic ultrasonographic and operative
findings.
Dysphagia is the first finding in 98% of patients.
(Answer A)
9.
Which of the following is not necessary for examination of the esophagus by

manometry?
(Nisan2007)
A) In the presence of dysphagia
B) Prior to anti-reflux surgery
C) Esophageal tumors
D)
In the presence of achalasia
TO)
In case of motor dysfunction detected on barium x-ray
Motor functions of esophagus and sphincter are evaluated in esophageal manometric

studies.
Evaluation of gastroesophageal reflux disease, achalasia, motor dysfunction
It is beneficial. Endoscopy is the main examination, evaluation and diagnostic
method in esophageal tumors.
(Answer C)
10.
Which of the following is the most common benign tumor of the esophagus?
(April 2006)
A) Lipoma
B)
adenoma
C) Lymphongioma
D)
I leiomyoma
TO)
hemangioma
129
GENERAL SURGERY
The most common malignant tumor of the esophagus is squamous cell carcinoma. Benign
is the most common question
The answer is leiomyoma. See also 4. Question.
(Answer D)
11th.
A 42-year-old patient with sudden chest pain after nausea and vomiting
complaint. Physical examination of the left pleural space effusion and skin
six emphysema.
A) Esophageal rupture
B) Hydatic rupture of lung cyst
C) Paraesophageal hernia
D)
pancreatitis
TO)
Bronchial rupture
ESOPHAGUS PERFORATIONS
• 40-60% cervical, 40-50% thoracic, 10% abdominal region.
•
The anatomical location of the perforation is limited to early spread or spread of

infection.
is the main factor.
• The most common cause is iatrogenic (60-75%)

• Spontaneous (15%) may be due to foreign bodies and trauma.
• The cricopharyngeal muscle region is the narrowest of the esophagus and most of
the iatrogenic perforations
occurs in the region.
• Most spontaneous perforations are postemetic.
•
Malignant diseases or perforation of distal benign ulcers

as a result (non-barogenic).
• Perforation is usually proximal to the esophageal gastric composition, the left
side of the distal esophagus.
occurs in the posterolateral wall and is longitudinal.
•
Boerhaave syndrome if Mallory-Weiss is full coat if the tear is only in the mucosa
and submucosa
It called.
Perforations due to foreign bodies were penetrating or blunt trauma in 7.3%

perforations are seen in 4.9%.
• Symptoms and signs vary depending on the location of the perforation.

• Pain, fever, dyspnea and dysphagia are common symptoms.
• The first sign of cervical esophageal perforation is sensitivity and crepitation
in the cervical region.
• Resting of the heart during thoracic esophageal perforation with mediastinal
emphysema (Hammon
can be heard. Shock and cyanosis are mostly seen in the early period.
• Abdominal tenderness and acute abdominal findings are predominant in subphrenic
perforations.
• Diagnosis: Direct thorax radiography, water-soluble opaque material
(Gastrography) and esophagography and CT
used.
(Answer A)
130
12.
Jamming between 2 cars in a car accident the day before
because of
observation
under
received
and
hemodynamic
in terms of
STA
In a patient with biliary pain, neck pain, tachycardia, tachypnea, hypotension

develops. Subcutaneous emphysema is detected in the patient's neck.
2004)
A) Pulmonary embolism
B) Hemothorax
C) Retroperitoneal hematoma
D)
Esophageal perforation
TO)
Dissecting aortic aneurysm

(Answer D)
13.
In the patient mentioned in the previous question no.
Which of the following should be done? (September 2004)

B) Lung ventilation perfusion scintigraphy
C) Diagnostic laparoscopy
D)
Oesophagoscopy
TO)
Lung X-ray
In the diagnosis of esophageal perforations, direct thorax radiography, water-

soluble opaque (Gastrography) and esophagography and CT are used.
(Answer E)
14.
Follow-up with the diagnosis of liver failure due to chronic viral hepatitis
nen patients with sudden nausea and vomiting containing abundant blood is observed.
Physical examination revealed acid splenomegaly and a pulse rate of 120 / min.
What is the most likely cause of gastrointestinal bleeding in this patient? (April
2004)
A) Portal hypertension
B) Acute embolism
C) Gastritis
D)
Duodenal abscess
TO)
Tear at the esophagogastric junction
131
GENERAL SURGERY
The patient developed cirrhosis and hepatic failure secondary to viral hepatitis.
cirrhosis
In portal hypertension with complications, varicose dilatations occur at the lower
end of the esophagus, and these enlargements may bleed spontaneously due to causes
such as vomiting or when intraabdominal pressure increases.
Tear in the esophagogastric region, upper gastrointestinal bleeding at the level of
mucosa and submucosa
causes Mallory-Weiss syndrome. If the tear holds the entire wall, it causes
perforation. Perforation is usually just above the gastroesophageal junction and
left
lateral wall.
(Answer A)
15.
This is the most useful method to determine the location of bleeding in the patient
(question 13).

A) Esophagogastroduodenoscopy
B) Arteriography
C) Abdominal tomography
D)
the Özofagogastroduodenograf
TO)
Abdominal ultrasonography
The most useful method for determining the location of bleeding is

esophagogastroduodenoscopy.
Endoscopy can be performed after adequate fluid replacement in esophageal bleeding.
It is possible to see signs of a recent bleeding in esophageal bleeding. This
In this case, 'heater probe' method called hot application or dilated adrenaline
injection to the bleeding focus can be made.
In addition, treatment can be applied endoscopically in Mallory-Weiss tears.
(Answer A)
16.
A 45-year-old male patient with long-term alcohol use
due to the emergency room. In the patient's history,

later, it was learned that bloody vomiting and epigastric pain started.
2003)
A) Heir of the esophagus
B)
Mallory-Weiss syndrome
C) Duodenal ulcer
D)
Stress ulcer
TO)
Cushing's ulcer
Mallory Weiss syndrome, bright red blood after strong and prolonged vomiting
vomiting. This syndrome is responsible for 5% of upper gastrointestinal bleeding.
Bleeding is due to vertical tears of the cardioesophageal junction mucosa. Frequent
after food poisoning, vomiting due to pyloric stenosis and pregnancy vomiting
It is seen. Alcoholics are common.
(Answer B)
132
17. The first procedure for the diagnosis of the patient mentioned in the previous
question
Is aşağıdakilerdenhangi? (September 2003)
A) Esophageal passage graph
B) Angiography
C) Radionuclide scintigraphy
D)
Endoscopy
TO)
laparotomy
15. See the explanation of the problem.

(Answer D)
18.
Which of the following complications in paraesophageal hiatal hernias
most likely to be seen? (April 2002)

A) Incarceration
B) Strangulation
C) Gastric volvulus
D)
stricture
TO)
Bleeding
• The most common complications of paraesophageal hernia are bleeding,

incarceration, obstruction and strangulation.
• In all hiatal hernias, esophageal hiatus dilation and gastric fundus pass through
depending on the stomach is located in the thoracic cavity.
•
Retrosternal fullness, complains of a feeling of mass in the lower chest,

dysphagia, retrosternal
burning and regurgitation can be seen. Respiratory complications are dyspnea and
aspiration
recurrent pneumonia.
(Answer D)
133
GENERAL SURGERY
19. Long-term retrosternal burning complaint 58

-year-old male patient recently swallowing
difficulties and weight loss have arisen. in Review
esophagus
middle
1/3
in part
adenocarcinoma
Respectively. To explain the picture in this patient

What is the possible etiological cause? (April 2002)
A) Achalasia
B) Tilosis
C) HPV
D) Barret esophagus
E) Diverticulum of esophagus
BARRET OSEFAGUS
•
It is a case of columnar epithelium instead of normal squamous epithelium

(metaplasia).
Goblet cells are helpful in histopathological diagnosis. The risk of developing

adenocarcinoma is normal
higher than the population. Gastroesophageal reflux is the last stage of the
disease and in these patients
It is seen in 7-10%. Malignancy is seen in 7-10%.
Ulcers, bleeding, stricture and cancer may develop.
Barret esophagus is a premalignant lesion.

(Answer D)
20.
What is esophagoscopy after alkaline drinking that causes esophageal burn
When is it done? (April 2000)

A) After a few weeks
C) After a cure steroid treatment
TO)
B)
D)
Shortly after
If there is dysphagia
After starting antibiotics
CORROSIVE ESOPHAGUS BURNS

-
Ingestion of caustic substances can cause both acute and chronic injury. Acute
damage,
the type, concentration, amount, and duration of contact with the tissue of the
caustic substance.
It depends.
Alkalies; they dissolve and soften the tissue and penetrate deeper.
Acids limit their penetration as they cause coagulation necrosis.
Acute pain and hypersalivation, dysphagia and posterior sternum are observed.
Cicatrization is expected in the late period.
Oral feeding is stopped and antibiotics are started.
Vomiting is strictly contraindicated as it may increase damage.
If esophagoscopy has findings beyond mucosal hyperemia and edema, treatment is

surgical.
Resuscitation should be performed immediately after caustic ingestion and emergency

endoscopy should be performed.
(Answer B)
134
21.
What is the most objective and sensitive test for the diagnosis of gastroesophageal
reflux?
(September 99)
A) Barium graphy
B) Bernstein test
C) Biopsy
D)
manometry
TO)
24 hours pH monitoring test
GASTROOESOPHAGEAL REFLUX DISEASE

•
It is the most common disease of the esophagus. (75%)
Reflux esophagitis is associated with an abnormal prolongation of the esophageal

mucosa with normal gastric content.
is a chemical inflammation of the distal esophagus.
The difference between a healthy person and a patient with reflux esophagitis is
the frequency of reflux attacks and the
the length of time the material remains in the esophagus.
The most important reason is thought to be insufficiency in LES.
The first examination after history and FM is barium esophageal radiography.
Upper endoscopy should be performed if there is no response to 1 month medical

treatment.
If surgery is not necessary in cases that do not respond to treatment

should be evaluated and it should be determined that there is no motility disorder.
24 hour pH monitoring is the most specific and most sensitive diagnostic method.
Bleeding, stenosis, perforation, structure and aspiration, Barret esophagus may

occur as a result of gastroesophageal reflux.
(Answer E)
22.
Which is the most sensitive and specific test for gastroesophageal reflux?
(September 98)
A) Barium graphy
B) Endoscopy
C) Acid perfusion testing
D)
Manometer
TO)
24 hours pH monitoring
24-hour pH monitoring is the most specific and most sensitive diagnostic method.
(Answer E)
135
GENERAL SURGERY
23.
Which is given to reduce splanknic pressure in esophageal bleeding?
(September 98)
A) Vasopressin
B)
Adrenalin
C) Dopamine
D)
cortisol
TO)
Propranolol
Vasopressin has an efficacy of 70% when used in esophageal variceal bleeding.

Angina pectoris and myocardial infarction may occur as it reduces the blood flow to
the myocardium.
is contraindicated in coronary ischemia. The place of bleeding with selective
arteriography
located. This method is not useful if the amount is below 0.5 ml / min. Vasopressin
on the bleeding ground
pressure is tried to reduce.
(Answer A)
24.
Diaphragmatic hernia is the most common cause of bleeding complications
Which? (April 98)

A) Sliding hernia
B) Paraesophageal hernia
C) Bochdalek hernia
D)
Morgagni hernia
TO)
Traumatic hernia
OSEFAGEAL HİATAL HERNIAS:

• TYPE 1 (SLIDING HERNI): Cardia upward, posterior mediastinum
characterized by It is the most common type of hiatal hernia. During swallowing,
the esophagogastric junction slides upward, is frequently seen in older ages, and
is accompanied by reflux.
• TYP2 (ROLLING-PARAEOPHAGIA HERNIA): The gastric fundus around the cardia
characterized by upward displacement. Cardia is in normal anatomical position.
However, the angle between the fundus and the angle has disappeared. Over time, the
appearance of the hourglass stomach occurs.
The most common diaphragmatic hernia is paraesophageal hernia which causes bleeding
complications.
1/3 of the patients present with hematemesis because it causes recurrent bleeding
due to ulceration of the gastric mucosa in the herniated part of the stomach into
the diaphragm. Paraesophageal hernia
surgical treatment is indicative, even if asymptomatic.
• TYP3 (MIX HISTORY HERNIAS): Upward location of both gastric cardia and fundus
occurs with the replacement.
• TYPE4 (COMPLETED HISTORY HERNIAS): Whole stomach or other abdomen with stomach
internal organs of the diaphragm.
(Answer B)
136
25. The person with the Web in the upper esophageal junction most often
Would? (April 97)
A) Iron deficiency
B) Gastroesefegal reflux
C) Esophagitis
D)
Tracheal aspiration
TO)
Peptic ulcus
PLUMMER-VINSON SYNDROME;
•
It presents with sideropenic dysphagia.
• Classic components accompany atrophic oral mucosa and dysphagia, upper

oropharyngeal web, spoon nails
iron deficiency anemia.
•
Due to atrophic oral and pharyngeal mucosa
mucosa, hypopharynx and upper esophageal cancers.
(Answer A)
26.
Which of the following does not occur due to gastroesophageal reflux?
(September 95)
A) Esophagitis
B) Barret esophagus
C) Stricture
D)
Aspiration
TO)
achalasia

(Answer E)
27.
Retrosternal combustion, regurgitation of solid and liquid foods
What do you think of the patient with radiographs on the side? (September 93)
A) Sliding hernia
B) Paraesophageal hernia
C) Esophageal cancer
D)
scleroderma
TO)
achalasia
137
GENERAL SURGERY
Achalasia:
•
Aperistaltism in the distal part of the 2/3 of the esophagus, which often contains
smooth muscle
and lower esophageal sphincter (LES) synchronous with peristaltism as a result of
relaxation disturbance
is a clinical condition that occurs.
Primary pathophysiological disorder is inhibitor innervation of LES.
•
LES does not relax, there is aperistaltism and dilatation occurs proximal to LES.
Chagas' disease, degenerative diseases, chronic idiopathic pseudobstruction, trauma

(surgery
secondary achalasia may occur after vagotomy.
Achalasia is the most common disease of the esophagus after cancer.
Dysphagia, regurgitation, weight loss, pain, pneumonia (nocturnal regurgitation)

can be seen.
Especially dysphagia with cold and watery foods is more common (paradoxical
dysphagia).
Chest X-ray shows dilated esophagus and mediastinal enlargement.
Aperistaltism is detected on esophageal syneradiography.
There is a lack of relaxation in LES.
Esophageal manometric studies are the most valuable diagnostic method.
In endoscopy, the normal mucosa in the narrow segment is pathogonomic.
Barium graphy is typical of a bird's beak or colonized tortiose appearance.

(Answer E)
28.
What do you do to treat the patient in the previous question? (September 93)
A) Balloon dilation
B)
Famotidine is given
C) Surgical surgery
D)
GJ
TO)
Restoration of the esophagogastric junction
Balloon dilatation (mechanical, pneumatic, hydrostatic) can be used in Akalazyada

treatment. Helpful
otherwise, the spark plugs are tried and Heller myotomy is performed. Heller
myotomy: Myotomy (7-8 cm) from the anterior face of the distal segment of the
esophagus.
(Answer A)
29. Regurgitation, retrosternal burning, mouth water coming from, dysphagia and
is the diagnosis in a patient with radiographs? (April 93)
A) Sliding type hiatal hernia
B) Achalasia
C) Paraesophageal hernia
D)
Morgagni hernia
TO)
Esophageal cancer
See a description of question 21

(Answer A)
138
30.
Which part of the upper gastrointestinal tract in Mallory Weiss syndrome
injury and injury seen? (September 91)

A) In the prepyloric region
B) Small curvature of the stomach
C) Large curvature of the stomach
D)
Esophagogastric junction
TO)
On the front of the stomach
See the explanation of question 16.

(Answer D)
31. As a result of vomiting, belching or sobbing, sudden esophageal internal
pressure and unstable contractions may rupture the lower esophagus and upper
stomach.
This rupture can be defined by which of the following syndromes? (April 91)
A) Mallory-Weiss syndrome
B) Plummer-Winson syndrome
C) Paterson-Kelly syndrome
D)
Cushing's syndrome
TO)
Peutz-Jeghers syndrome
In severe retching and vomiting, esophagogastric junction, the lower end of the
esophagus starting from the stomach
Mallory-Weiss is responsible for bleeding due to ruptures that
Syndrome.
(Answer A)
32. Zenker diverticulum called the formation of the gastrointestinal tract
is the most common in the region? (April 91)
A) In the esophagogastric distinction
B) Faringoesophageal region
C) On the anticolic surface of Jejunum
D)
Part 2 of the duodenum
TO)
On the sigmoid column
139
GENERAL SURGERY
ZENKER DIVERTICULA (FARINGGOESEFAGEAL DIVERTICULA):

• Diverticulae are pocket-like protrusions of the esophageal wall. In the three
main regions of the esophagus
They are seen. The Zenker diverticulum is most commonly seen in the upper
esophagus.
•
Akkizdir, usually seen in men over 50 years.
Inferior pharyngeal constructor with transverse fibers just above cricopharyngeal

muscle
Between the oblique fibers of the muscles, the back usually extends to the left.
The most common symptom is the sensation of food in the upper esophagus.
It is a pulse diverticulum containing only the mucosal layer.
•
It has been suggested to occur as a result of motility disorder in the upper
esophagus.
There are premature contractions in the cricopharyngeus muscle.
It can cause symptoms such as dysphagia, obstruction, aspiration, bad breath.
Diagnosis is made by barium graphy.
Coexistence with hiatal hernias is common.
Treatment is surgery. Diverticulectomy + cricopharyngeal myotomy is performed.

(Answer B)
33.
What is the cause of Zenker diverticulum? (September 90)

A) Functional impairment of gastroesophageal junction
B) Negative intrathoracic pressure
C) Upper sphincter dysfunction
D)
Lymphadenopathy in the neck
TO)
Irritation of solid and liquid foods

(Answer C)
34.
Used to stop bleeding in severe esophageal bleeding
What is a special bubble tube? (September 90)

A) Levine
B) Foley
C) Sengstaken-Blakemore
D)
Müller-Abbott
TO)
Swan-Ganz
A three-lumen Sengstaken Blakemore tube is used to stop severe esophageal bleeding.

Müller abbott tube for intestinal obstruction, foley (a probe type), swan ganz
central
used to measure venous pressure.
(Answer C)
140
35.
Vasopressin is contraindicated in esophageal variceal bleeding
What is the situation? (September 89)

A) Systemic hypotension
B) Hypovolemia
C) Renal hypertension
D)
dehydration
TO)
Coronary ischemia
Vasopressin has an efficacy of 70% when used in esophageal variceal bleeding.

Angina pectoris and myocardial infarction may occur as it reduces the blood flow to
the myocardium.
is contraindicated in coronary ischemia. The place of bleeding with selective
arteriography
located. This method is not useful if the amount is below 0.5 ml / min. Vasopressin
on the bleeding ground
pressure is tried to reduce.
(Answer E)
36.
Upper GIS endoscopy is contraindicated in which of the following? (September 88)

A) Systemic disease
B) GIS bleeding
C) Myocardial infarction
D)
Diabetes mellitus
TO)
Pyloric stenosis
Indications of Upper GIS Endoscopy:

• Dyspepsia
• Abdominal pain
• Atypical chest pain
• Dysphagia
• Vomiting
• Weight loss
• Acute or chronic GI bleeding
• Suspicious barium stomach radiography
Contraindications for upper GIS endoscopy:
• Severe shock
• New myocardial infarction, unstable angina, cardiac arrhythmia
• Severe respiratory disease
• Atlantoaxial subluxation
• Possible organ perforation
* These are relative contraindications. Endoscopy can be performed safely by
experienced persons.
(Answer C)
141
GENERAL SURGERY
37.
The most common cause of upper gastrointestinal bleeding is:

A) Stomach cancer
B) Esophageal cancer
C) Heir of the esophagus
D)
Duodenal ulcer
TO)
Stomach ulcer
UPPER GIS BLEEDING

• The most common gastrointestinal emergency
• The most common cause is duodenal ulcer
• The most common cause of massive upper GIS bleeding is esophageal varices.
• The most common cause of upper GIS bleeding in children is esophageal varices.
•
If the bleeding is excessive, hematemesis is red and clotted. If less violent

black colored and can be seen in the form of coffee grounds.
• Bright red blood may come from the bottom if the amount of bleeding is too high
and the passage is fast.
(Answer D)
142
STOMACH DUEDONUM DISEASES AND SURGERY
STOMACH DUEDONUM DISEASES

AND SURGERY
one. Which of the following statements is true about gastric emptying?
(September 2011)
a)
Cholecystokinin fi stimulates gastric emptying in ziological dose

B)
Truncal vagotomy in patients with gastric resection of liquid foods from the
stomach
slows the discharge
C.)
The half-time of water drainage is about 30 minutes
D)
The half-time of gastric emptying of solid foods is about 4 hours
E) Leptin inhibits gastric emptying

the innervation
• Parasympathetic efferent and afferent innervation occurs through the vagus nerves
and motility
It increases. (B mistake)
• Each vagus is spread to the antrum and pylorus under the name of Laterjet nerves
in the anterior and posterior of the stomach.
branches (6 - 7 cm before the pylora).
• Acid-producing cells in the proximal stomach that are separated from the anterior
and posterior vagus nerves.
innervates
• The Criminal Grassi nerve is one such branch that originates from the posterior
vagus; plays a role in ulcer recurrences.
• Sympathetic nerves reach the stomach from the celiac plexus.
PHYSIOLOGY
• The stomach traditionally has two functions:
• Reservoir proximal stomach
• Muscular distal segment that crushes and mixes food
• Pacemaker in the middle of the large curvature
• Controls the discharge of proximal gastric fluids, antrum solid particles.
• Relaxation of the proximal stomach due to eating occurs with vagal stimulation.
• Neural and hormonal feedback inhibiting gastric emptying
alerts.
• Cholecystokinin secreted from the duodenum in the presence of digested food in
the duodenum
Inhibits gastric emptying in doses. (The error of option A). The discharge of
liquid foods is effected immediately by gravity and the discharge of solid foods
takes place in 6 hours. (C and D
wrongness)
• Basal acid release 2–5 mEq / h
• Stimulation of gastric acid secretion consists of 3 phases
• Cephalic
Gastric (acetyl choline, gastrin and histamine)
• Intestinal
143
GENERAL SURGERY
• The same phases apply to the inhibition of acid secretion.

• Most important is the gastric phase.
• Gastrin secretion decreases when the antrum mucosa meets acid; When the pH of the
antral drops to 2
gastrin secretion completely stops.
• The intestinal phase of inhibition begins when semi-digested foods enter the
duodenum. Acidation of the duodenum inhibits acid secretion.
• Pepsin is secreted by the chief cells in the form of proenzyme pepsinogen.
• The conversion of pepsinogen to pepsin begins when the acid is at pH 4 or below;
pH 2
speed. Pepsinogen is reversibly inactivated when pH is 5; When 7
is irreversibly denatured.
• The most important stimulus that increases pepsin secretion is vagal stimulation.
• Vagal stimulation triggers bicarbonate secretion.
• Stomach distension and prostoglandins increase gel thickness; pepsin, N – acetyl
cysteine, NSAID
drugs thin.
• Intrinsic factor required for absorption of vitamin B12 from parietal cells in
stomach mucosa
(IF) is also secreted.
• Vit B12 supplementation is required only in patients with total gastrectomy.
(Answer E)
2nd. Upper gastrointestinal endoscopy performed in a patient who had previously
undergone gastric ulcer surgery, if ulcer was detected in the 2nd and 3rd part of
the duodenum
Which of the following should be considered first? (September 2011)
a)
insulinomas
B)
gastrinoma
C.)
Helicobacter pylori
D)
Somatostatinomas to
E) Stomach cancer
gastrinoma
(Zollinger-Ellison Syndrome)
• Gastric acid hypersecretion due to excessive gastrin-producing tumor.
• 60% is non-beta islet cell tumor, 25% is solitary adenoma, 10% is microadenoma or
hyperplasia.
• Most are associated with MEN olup 1, most of which are multiple and benign.
• Symptoms such as peptic ulcer and diarrhea are seen.
• Ulcers, multiple or unusual ulcers that do not heal with known anti-ulcer
treatments, or
Recurrent ulcer after surgery that is expected to heal ulcer should bring to mind
gastrinoma.
• Diagnoses fasting hypergastrinemia (200pg / ml)
• Treatment is medical and surgical.
(Answer B)
144
3. Used in targeted therapy of metastatic gastrointestinal stromal tumors

What is the c-kit inhibitor drug?
a)
5-fluoro uorourasil
B)
irinotecan
C.)
Oxal iplatin
D)
Endoxan
E) imatinib
GISTs are slowly progressing submucosal tumors. Small lesions are usually
incidental. Sometimes they cause ulcers and cause bleeding. Large lesions are
usually weight loss, abdominal
pain, fullness and bleeding. Propagation by hematogenous route
happens to the liver and lungs. Rarely positive lymphoma in pathological
examination after surgery
The diagnosis is made by endoscopic and biopsy. However, symptomatic and 2 cm
large tumors should be removed. Most gastric GISTs occur in the trunk of the
stomach and wedge resection is appropriate for treatment. Prognosis depends on the
presence, number, and tumor size of mitotic activity. Invasion to neighboring
organs is indicative of malignancy. Most GISTs
protooncogen and c-kit. imatinip blocks the activation of c-kit trosicnase and
It can be used in the treatment of metastatic, nonresectable GIST patients.
(Answer E)
4. Which of the following methods has the highest malabsorptive effect in bariatric
surgery? (May 2011)
a)
Sleeve gastrectomy
B)
Laparoscopic gastric banding (LAGB)
C.)
Biliopancreatic diversion (BPD)
D)
Vertical gastroplasty (VBG)
E) Roux-en Y gastric by-pass (RYGB)

Long-term sustained weight loss in obese patients with bariatric surgery
to improve the health status. Reducing this calorie intake or from food
reduced calorie absorption, less food intake, less food intake
In this way, it is tried to be achieved by changing eating habits. Operations used
in the treatment of morbid obesity surgery are associated with intestinal
malabsorption.
gastric resection together or alone. Stomach-restrictive operations
laparascopic vertical band gastroplasty is laparoscopic adjustable gastric band.
Pancreatic interventions with bili-yopancreatic deflection and duodenal replacement
And diversion. Roux-en-Y gastric bypass provides both restrictive and absorption
disorder
has features.
(Answer C)
145
GENERAL SURGERY
5. H. pylori on chronic gastritis caused by Helicobacter pylori

the possibility of complete disappearance in cases where gastritis can be treated
by eradication
Which of the following is a gastric tumor? (May 2011)
a)
Stony ring cell carcinoma
B)
malton to
C.)
Linitis plastika
D)
Carcinoid tumor
E) Gastrointestinal stromal tumor

STOMACH LYMPHOMA
-
1-5% of gastric neoplasms; It is the second most common malignant tumor of the
stomach.
More than 50% of all primary GI lymphomas are of gastric origin.
It mostly settles in the small curvature and antrum.
-
The M / E ratio is 2/1.
Patients are usually over 50 years of age.
It develops from the MALT (mucosa associated lymphoid tissue) in the stomach.
Majority of B cell origin; diffuse large cell or immunoblastic lymphoma type.
Predisposing chromosomal diseases:

Klinefelter syndrome
Wiscott-Aldrich syndrome
Ataxia-telangiectasia
Various immunodeficiency syndromes (X-linked recessive)
Immunosuppressive therapy is also predisposing.
H. pylori infection is positive in 64-100% of patients with gastric lymphoma and

benefit.
Macroscopically advanced gastric lymphoma is similar to common gastric cancer
According to Gross morphological characteristics, gastric lymphomas are divided

into 5 groups;
in fi ltratif
ulcerative
nodular
polypoid
combined
Most tumors are large; 50% over 10 cm.
Unlike other lymphomas, primary gastric lymphomas may involve bone marrow or
peripheral LN uptake.
does not lead.
It is not diagnosed until the mass reaches large dimensions.

-
Abdominal pain is the most common complaint (80%), which is largely resolved by H2
blockers and proton pump inhibitors. Nausea, vomiting, loss of appetite and
weakness fl
are the symptoms.
Occult bleeding occurs in more than half of the patients.
Diagnosis is made by endoscopy and endoscopic biopsy, but biopsies should be taken
deeply.
146
Unless systemic involvement, surgical exploration, liver biopsy, paraaortic and

Celiac LN biopsy is routinely performed. Splenectomy indicated for direct
involvement
Subtotal gastrectomy for distal gastric lesions and total gastrectomy for proximal
tumors
appropriate operations.
If there is no residual disease after surgery, radiotherapy is unnecessary.
Radiotherapy is used to treat residual disease, positive surgical margins, or

recurrence.
In some studies, chemotherapy and radiotherapy can be treated individually or

together with surgical treatment.
provides the survival.
Prognosis is better than adenocarcinoma.
(Answer B)
6. A 42-year-old male patient was admitted to the emergency department with acute
abdominal symptoms.
The patient's right lower abdominal region, especially in all abdominal regions
Sensitivity and defenses are detected. Abdominal X-ray with free air
diarrhea after a trip 3 weeks before the patient's history
Learned.
Which of the following is the most likely diagnosis for this patient? (December
2010)
A) Acute appendicitis perforation
B) Meckel's diverticulitis perforation
C) Typhoid enteritis perforation
D) Tuberculous enteritis perforation
E) Perforation of Campylobacter infection
TIFO ENTERITY
Salmonella typhi is the most common agent.
Bleeding occurs in 10–20% of patients.
Perforation from Peyer's Plaques is 1–2%, usually at the last 30 cm of the ileum
and primary
need repair.
Fluoroquinolones are used in TMP-SMX.
Carrier is seen in 3% of bile. Ampicillin, probenecid and amoxicillin in carrier
used. Cholecystectomy can be performed. The story of the problem is acute and only
3 weeks.
tbc should be differentiated from enteritis perforation with this aspect.
Meckel diverticulum perforation is seen in diarrhea constipation. Diarrhea also
associated with travel
not suitable. The history is not appropriate for acute appendicitis perforation.
(Answer C)
147
GENERAL SURGERY
7.
Which of the following is not early stomach cancer? (April 2009)

A) Tis
B) T1N0
C) T1N1
D)
T1N2
TO)
T2N0
STOMACH CANCER STAGING:

TNM
TX Primary tumor cannot be evaluated
T0 No evidence of primary tumor
TIS Carcinoma in situ; no invasion of lamina propria
T1 Lamina invaded propria or submucosa
T2 Muscularis propria or invasion of subserosa
T3 Serosa invaded
T4 Neighboring organs afflicted
NX Regional lymph nodes cannot be evaluated
N0 No regional LN metastasis
N1 1-6 metastatic LN
N2 Metastasis in 7-15 regional LNs
N3 Metastasis in more than 15 regional LNs
MX Metastasis cannot be evaluated
M0 No distant metastasis
M1 Has distant metastasis
Early gastric cancer refers to cancer involving the mucosa and submucosa. However,
lymph node metastasis may be present in every stage of early gastric cancer. It is
most commonly seen in the early stomach ca corpus. Type 2 C
is the most common macroscopic type.
(Answer E)
148
8.
Muscularis propria invasion, serosa and 12

TNM classification of gastric cancer with metastasis detected in regional lymph
node
stage according to the system? (April 2008)
A) T1N1
B)
T2N1
C) T2N2
D)
T3N2
TO)
T3N3
T2 tumor and 12 lymph node metastasis not reaching serosa according to TNM staging
system
presence of N2 tumors. See also a description of question 1.
(Answer C)
9.
Complaints in patients with Dumping syndrome

I start? (September 2007)
A) As the volume of circulating blood decreases
B) Decreased arterial pressure
C) With increased blood flow
D)
With the rise of hematocrit
TO)
With hyperosmolar food coming into the small intestine
DUMPING SYNDROME;
• Late dumping occurs 2-4 hours after a meal; vasomotor symptoms in early dumping
as is, but no gastrointestinal symptoms
• Patients with dumping usually eat food to avoid the discomfort of eating.
reduce intake very much; as a result they lose weight.
Primary mechanisms leading to Dumping syndrome
disappearance occurs when hyperosmolar fluids drain into the small intestine.
• There are 4 surgical causes that impair reservoir function and accelerate gastric
emptying.
o Proximal gastric accommodation and relaxation disturbance as a result of
vagotomy,
o Reduction of stomach capacity as a result of gastric resection,
o By-pass or removal of the pylor,
o Loss of duodenal feedback inhibition by bypassing the duodenum with
gastrojejunostomy.
• When hypertonic gastric contents suddenly switch to jejunum
lumen, plasma volume decreases, vasomotor symptoms occur
• Some enteric hormones such as serotonin, GIP, VAP, neurotensin from the stretched
jejunum wall
they are responsible for at least some of the vasomotor symptoms.
• Enteroglucagon is held responsible for late Dumping. Enteroglucagon beta cells
sensitive to stimuli and develops reactive hypoglycemia with excessive insulin
release
Dumping is most commonly seen after Billroth II gastrojejunostomy; early incidence
50%.
(Answer E)
149
GENERAL SURGERY
10.
Which of the following types of gastric epithelial polyps develop into malignancy
is the highest risk? (April 2007)

A) Inflammatory
B) Hamartomatous
C) Adenomatous
D)
heterotopic
TO)
hyperplastic
polyps
• Most common benign tumors.
• They are more common in the age group 50-60. They usually settle in the antrum of
the stomach.
• They cause nausea, vomiting in 30% of patients and bleeding in 15-20% of
patients.
HYPERPLASTIC POLYPS
• Inflammatory, regenerative, hamartomatous, or Japanese type I and II polyps.
• The most common type of stomach polyp (50-60% of all stomach polyps)
• They are usually smaller than 2 cm.
• Potentially malignant, although very small (1-2%)
• Patients with multiple polyps have a higher risk of malignancy.
• Patients are often asymptomatic.
• Endoscopic polypectomy is performed for treatment.
ADENOMATOUS POLYPS
• Neoplastic polyps or Type III and IV polyps according to Japanese classification.
• They develop in the gastric mucosa, which has undergone intestinal metaplasia.
• Less common polyp type.
• They usually settle in the antrum.
• The risk of malignancy increases as it grows (<2 cm. ==> risk 4%;> 2 cm. ==> risk
24%).
• In general, the risk of conversion to malignancy is as high as 25-80%.
• The presence of adenomatous polyps indicates a high risk of developing
adenocarcinoma anywhere in the stomach.
• Patients are usually asymptomatic.
• Polyps with single and stalk less than two centimeters can be endoscopically
excised and for treatment
It is sufficient.
• Larger polyps should be surgically excised.
HAMARTOMATOUS POLYPS:
• It is seen in Peutz-Jeghers syndrome.
• Diagnosis is made by barium graphy.
• Endoscopic and histological examination is required. Because of a small amount of
malignancy
potential.
(Answer C)
150
11th.
Distal subtotal gastric resection due to gastric cancer and Billroth II anas-
A patient who underwent tomosis could not remove gas-stool after 12 months of
surgery
complaints to the emergency room.
Which of the following is not likely to cause this? (September 2006)
A) Bezoars
B)
Intraabdominal adhesion
C) Tumor recurrence
D)
Efferent ans syndrome
TO)
Alkaline reflux gastritis
ALKALEN REFLUX GASTRIT

• It is seen in 5-15% of patients who have undergone stomach surgery.
• Burning epigastric pain, nausea and biliary vomiting may occur. Bile vomiting
does not relieve pain.
• The cause is the removal, by-pass or destruction of the pylon.
• It is most commonly seen after Billroth II gastrojejunuostomy operations.
• Diagnosis is made by endoscopy and mucosal biopsies.
• Afferent Ans, another postgastrectomy syndrome with biliary vomiting
It must be distinguished from the syndrome. Bile vomiting in Afferent Ans Syndrome
relieves pain.
EFFERENT ANS SYNDROME:
• Secondary or partial obstruction of the aneurysm near the anastomosis
It occurs.
Symptoms may occur months, years after surgery.
• Common abdominal pain, nausea and biliary vomiting are among the symptoms.
• Diagnosis is made by contrast-enhanced gastric emptying radiographs.
• The most common cause is obstruction secondary to adhesions near the anastomosis.
Bezoar:
• Foods that are not well digested as a result of changes in motility after gastric
resection.
petrification.
(Answer E)
12.
Fasting blood gastrin level in a patient with the diagnosis of marginal ulcer 350
pg / ml.
What is the most appropriate method for diagnosing gastrinoma in this patient?
(September 2005)
A) Tc99 scintigraphy
B) Gastroduodenoscopy
C) Secretin provocation test
D)
Glucose stimulation test
TO)
Magnetic resonance imaging
Secretin test: 2U / kg secretin iv within 30 seconds; 5 min. before, just before,

and half
The serum gastrin level is measured every 5 minutes for hours. In Zollinger-Ellison
syndrome
The level of gastrin increases dramatically.
(Answer C)
151
GENERAL SURGERY
13.
Which of the following causes massive upper gastrointestinal bleeding
is the least likely? (September 2005)

A) Esophageal varices
B) Erosive Gastritis
C) Gastric Ulcer
D)
Reflux esophagitis
TO)
Postbulber duodenal ulcer
UPPER GIS BLEEDING:

• The most common gastrointestinal emergency
• The most common cause is peptic ulcer
• The most common cause of massive upper GIS bleeding is esophageal varices.
• The most common cause of upper GIS bleeding in children is esophageal varices.
•
If the bleeding is excessive, hematemesis is red and clotted. If less violent

black colored and like coffee grounds.
• Bright red blood may come from the bottom if the amount of bleeding is too high
and the passage is fast.
The most common pathologies causing massive upper gastrointestinal bleeding are
gastroduodenal ulcers, esophageal varices and erosive gastritis (gastric erosion).
Given in options
reflux esophagitis is the least likely cause of massive upper gastrointestinal
bleeding. reflux
bleeding in esophagitis is occult and occult bleeding.
(Answer D)
14.
Which of the following is surgical intervention in a patient with peptic ulcer

bleeding?
is not one of the factors that increase the probability of davi? (September 2005)
A) Hypotension
B) Age of Patient
C) Transfusion
D)
Ulcer Size and Place
TO)
Presence of “visible vessel ide in endoscopy
Presence of hypertension, hematemesis, transfusion, presence of arterial structure

seen on endoscopy, active bleeding, size of ulcer and
localization are factors that increase the necessity of surgical treatment.
(Answer B)
152
15.
Acute erosive development in a patient in intensive care unit due to severe burn
Which of the following plays the most important role in the pathogenesis of
gastritis?
(April 2005)
A) Ingested toxic substances
B) Mucosal ischemia
C) Hyperacidity
D)
Prostaglandin synthesis disorder
TO)
Bile reflux
CURLING ULSERS.
•
Ulcers due to stress erosions in burns.
Mucosal ischemia is the most important factor disrupting mucosal defense.
Severe physiological stress, such as severe burns, trauma, hemorrhagic shock,

respiratory failure, or sepsis
due to the development of lesions.
It develops in every patient under severe stress, but in a small part of the lesion
large submucosal
veins; may cause life-threatening bleeding.
(Answer B)
16.
Which of the following statements about early gastric cancer is wrong?

(April 2005)
A) Muscularis does not exceed propria.
B) Recurrence is high after surgery.
C) Lymph node metastasis
D)
Exophytic may grow into the lumen.
TO)
They are usually well differentiated cancers.
EARLY STOMACH CANCER:

•
It is used only for gastric cancer limited to mucosa and submucosa, with or without
lymph node metastasis.
Muscularis did not exceed propria.
•
Approximately 10% of patients may have lymph node metastasis.
There is a vast majority of well differentiated pathology.
Recurrence is usually not seen after surgical treatment.
Intraluminal exophytic growth may be seen.

(Answer B)
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GENERAL SURGERY
17. Which is not an intestinal type of gastric CA compared with diffuse type?
(April 2004)
A) Being epidemic
B) Helicobacter associated with pylori
C) Better prognosis
D)
More common
TO)
To be seen at a younger age
STOMACH CA 'LAUREN CLASSIFICATION

one. Intestinal type: glandular structure similar to colon cancer, diffuse
inflammatory cell infiltration
and intestinal metaplasia. In countries with a high incidence of stomach cancer
It is seen. It is also called epidemic type. Prognosis is better. Over 50 years,
mostly in men
Monitored.
2nd. Diffuse type: More common in mucosa, less inflammatory reaction Well
differentiated
and the prognosis is worse. It is less common than the intestinal type. Bad
differentiated, infiltrative growth feature. It has a worse prognosis. At a young
age
It is seen. It is not associated with chronic gastritis and H. pylori.
(Answer E)
18.
Which of the following is not an inoperability criterion for gastric cancer?
(Eylül2004)
A) Detection of Virchow nodule
B) Detection of rectal shelf in rectal touch
C) Abdominal acid
D)
Palpation of the tumor

TO)
Multiple metastases in liver
Stomach Cancer Spread:

• Directly metastasizes to omentum, liver, pancreas and colon.
• Most commonly metastasizes to liver by hematogenous route.
• Supraclavicular lymph node metastases by lymphogen route, Virchow nodule,
Axillary lymph node
metastasis is called Irish nodule.
• Spread to the peritoneum by implantation. Ovarian implantations are called
Krukenberg tumor and rectouterin implantations are called Blummer shelf. Metastatic
nodules around the umbilicus Sister
It is called the Mary Joseph nodule.
• Above is considered to be inoperable because it means distant metastasis to
gastric Ca
It is.
Palpation of the tumor is not an inoperability criterion.
(Answer D)
154
19.
Burning, pain, feeling fullness behind sternum after meals, often
with complaints of cough observed at night and recent coarseness of voice

What is the most likely diagnosis in a patient presenting? (April 2003)
A) Cancer of the lower end of the esophagus
B) Gastroesophageal reflux
C) Achalasia
D)
Duodenal ulcer
TO)
CHOLELITHIASIS
GASTROOESOPHAGEAL REFLUX DISEASE

•
Burning, sensation of fullness, cough, and posterior sternum in gastroesophageal

reflux disease
Roughening of the voice may occur with reflux causing edema in the vocal cords.
It is the most common disease of the esophagus. (75%)
Reflux esophagitis is associated with an abnormal prolongation of the esophageal

mucosa with normal gastric content.
is a chemical inflammation of the distal esophagus.
The difference between a healthy person and a patient with reflux esophagitis is
the frequency of reflux attacks and the
the length of time the material remains in the esophagus.
The most important reason is thought to be insufficiency in LES. The gold standard
for diagnosis 24
hour PH monitoring.
(Answer B)
20. In a patient with a history of stomach ulcers, sudden, severe abdominal pain
begins.
Wide rectangle in the middle of abdomen on a standing abdominal X-ray
seen in the form of a shadow of gas. What is the most likely diagnosis in this
patient? (September 2001)
A) Acute gastric dilatation
B) Hiatal hernia
C) Stomach volvulus
D)
Gastric outlet obstruction
TO)
Perforation of stomach to bursa omentalis
The described patient has luminal organ perforation. Normally, the expected finding
is the detection of free air under the diaphragm on the right. Direct abdomen
standing
rectangular gas shadow on the x-ray of the perforation bursa omentalise
indicates that.
In free perforation, the patient suddenly feels a severe epigastrium pain, the pain
rapidly spreading to the entire abdomen.
It spreads. Diagnosis of free air under diaphragm by direct abdominal radiography
but the weather may sometimes not be seen.
(Answer E)
155
GENERAL SURGERY
21.
What is the most accurate definition of early gastric cancer? (April 2001)
A) Tumor confined to mucosa and submucosa without metastasis to lymph nodes
B) Tumor of mucosa and submucosa regardless of metastasis to lymph nodes
C) Finding distant metastasis
D)
Muscularis propria invasion
TO)
Serosa invasion

(Answer B)
22.
Which is the least likely to have a precursor in stomach cancer? (September 99)
A) Adenomatous polyp
B) Villous polyp
C) Hyperplastic polyp
D)
Juvenile polyposis
TO)
Tubular polyp

(Answer C)
23.
The least seen complication after truncal vagatomy and antrectomy

A) Alkaline reflux syndrome
B) Iron deficiency
C) Diare
D)
Vitamin B12 deficiency
TO)
Dumping syndrome
EARLY COMPLICATIONS OF GASTRECTOMY SECONDARY:

Bleeding, pancreatitis, duodenal stump leak, diarrhea, stomal obstruction, gastric
remnant
It is necrosis.
SECONDARY LATE COMPLICATIONS TO GASTRECTOMY:
•
Dumping syndrome, afferent loop syndrome, alkaline gastritis, marginal ulcer,

malnutrition,
malabsorption, iron deficiency anemia, bezoar and carcinoma.
Vitamin B12 deficiency anemia may occur after many years. However, this occurs in
very few cases and
usually subclinical course.
(Answer D)
156

24.
Which helicobacter pylori may cause
information not available? (September 98)

A) Gastric cancer
B)
Chronic gastric ulcer
C) Chronic duodenal ulcer
D)
Gastric lymphoma
TO)
Hyperplastic polyp
HELICOBACTER PYLORI
↔ Gram (-) bar
Üret Produces urease / urease is positive and under the mucus layer
It settles.
Associated Pathologies
Gast Chronic Gastritis
↔ Peptic Ulcer
Kars Gastric carcinoma
↔ Gastric Lymphoma
(Answer E)
25. Metabolic findings of a patient with pyloric stenosis and frequent vomiting
is a table? (September 96)
A) Hyperkalemic hypochloremic alkalosis
B) Hypokalemic hypochloremic alkalosis
C) Hypokalemic hyperchloremic acidosis
D)
Hyperkalemic hyperchloremic acidosis
TO)
Hyperkalemic normochloremic alkalosis
Stomach fluid is a liquid rich in K + and Cl-. In pyloric stenosis, vomiting and
loss of gastric fluid due to nasogastric decompression leads to hypochloremic and
hypokalemic metabolic alkalosis.
(Answer B)
26.
Gastric perforation is suspected and the first radiological examination should be

performed.
What is kik? (September 97)

A) USG
B)
X-Ray with mast lying down

C) PA AC radiography
D)
ÖMD with Bary
TO)
IT
First consideration should be given to patients with suspected gastric duodenum and
other lumen organ perforation
the examination is direct radiography. Free air under the diaphragm on the right
radiograph is pathagonomic for intraperitoneal lumen perforation.
(Answer C)
157
GENERAL SURGERY
27.
Which artery is causing massive bleeding in duodenal ulcers? (September 97)

AA. Pancreaticoduodenale inferior
B) A. Right gastric
C) A. Left gastric
D)
A. gastroepiploic
TO)
A. gastroduodenal
Duodenal ulcers are generally located on the second continent of dueonum and the
ulcer is penetrated forward.
perforation occurs, bleeding occurs when the ulcer is penetrated to the back. Back
during penetration, the ulcer erodes the wall of the arteria gastoduodenal and
causes
bleeding. Duodenal ulcer bleeding is the most common cause of upper
gastrointestinal bleeding.
(Answer E)
28.
Which of the following does not increase gastric basal acid secretion? (April 96)
A) Release of the antrum after Bilroth II surgery
B) Anthral G cell hyperplasia
C) Zollinger-Ellison syndrome
D)
Atrophic gastritis
TO)
Gastric ulcer
Somatostatin generally inhibits both motility and secretion of the gastrointestinal
tract,
therefore, it reduces gastric basal acid secretion.
Basal acid secretion artery because it is gastrin secreting tumor in Zollinger-
Ellison syndrome.
In anthral G cell hyperplasia, acid secretion increases as G cells secrete acid.
Bilroth II is left as an antrum stump after gastojejunostomies. Bilroth II surgery
on the release of gastric acid and released from the duodenum, after which the
duodenum will be disabled.
acid secretion increases because there will be no duodenal secretion with
inhibitory effect.
In atrophic gastritis, the loss of function of the cells, shrink in shape and
atrophy
Housing.
Therefore, the secretion of acid from the gastric glands is reduced.
(Answer D)
29.
Late Dumping syndrome occurs due to which of the following?
(September 95)
A) Hyperglycemia
B)
Seratonin release
C) Hypovolemia
D)
Reactive hypoglycemia
TO)
Noradrenaline release
158
as is, but there are no gastrointestinal symptoms.
• Patients with dumping usually eat food to avoid the discomfort of eating.
• Enteroglucagon is held responsible for late Dumping. Enteroglucagon beta cells
sensitizes to stimuli and develops reactive hypoglycemia with excessive insulin
release.
(Answer D)
30.
Which is not in pyloric stenosis? (April 96)

A) Hypochloremic alkalosis
B) Weight loss without diarrhea
C) Biliary vomiting after each meal
D)
Visualization of peristalsis after meal
TO)
Mass palpation on the right umbilicus
Hypochloremic loss of gastric fluid due to vomiting and nasogastric decompression

in pyloric stenosis
hypokalemic metabolic alkalosis. Excessive stomach content loss and continuous
vomiting leads to weight loss of the patient. Pylor stenosis is not seen in the
vomit bile. Because bile
duodenum is poured to the second part. Bile cannot enter the stomach because the
pyloric sphincter is closed.
(Answer C)
31.
Which of the following factors is not included in the etiology of gastric cancer?
(April 96)
A) Gastric banding
B)
Pernicious anemia
C) Helicobacter pylori
D)
Blood group
TO)
Gastric resection for duodenal ulcer
ETHOLOGY OF STOMACH CANCER:

• Excessive use of Na Cl (excessive use of salt).
• Consumption of smoked, smoked, canned foods.
• Nitrates and nitrites can be converted to carcinogenic N-nitrosamines.
• Salt improves the mutagenicity of foods with nitrous content, ie acts as
cocarcinogen.
• Low fat, low protein and low vitamin A and C consumption increase the risk of
stomach Ca.
• High vitamin A and C consumption reduces the risk.
• Drinking water with a high rate of H. pylori increases the risk.
• Cancer develops in the stomach stump after gastrectomy due to benign disease
risk increases.
• Pernicious anemia, atrophic gastritis and achlorhydria are also predisposing to
gastric Ca (10% gastric Ca
Develops)
• Other situations where risk increases; Menetrier disease, radiation exposure,
aflatoxin intake,
family history, blood group A, Ebstein-Barr virus infections.
(Answer A)
159
GENERAL SURGERY
32.
Which does not indicate that the duodenal ulcer is penetrating the pancreas?
(April-93)
A) Onset of back pain
B) Changing daily rhythm of pain
C) Bleeding
D)
Nausea and vomiting
TO)
Loss of periodicity
When the peptic ulcer is penetrated to the surrounding organs and tissues, all
qualities of ulcer pain change.
Besides localization change, rhythm, periodicity disappears (Periodicity
disappears) alkali, milk and
The answer to the dishes disappears. Especially at night the pain is exacerbated
and spread towards the back. duodenal
Contrary to popular belief, bleeding is not expected in the penetration of the
ulcer to the pancreas.
(Answer C)
33.
Which of the following organs does not have a peptic ulcer? (April 92)
A) Esophagus
B)
Stomach
C) Duodenum
D)
ileum
TO)
Gastrojejunostomy junction
Peptic ulcer may occur anywhere the gastrointestinal mucosa is in contact with
acid. by Dola
where there is no acid, there will be no peptic ulcer. Esophageal acid is due to
reflux, stomach own acid
secretion, duodenum acid is the first place where the stomach content is emptied of
peptic ulcer
can be seen. Ileum, pancreas and bile fluids due to acid pH not alkaline
It has pH. Therefore, ulcers are not seen.
(Answer D)
34.
Which is seen after subtotal gastrectomy? (September-90)

A) Fe deficiency anemia
B) Malabsorption
C) Megaloblastic anemia
D)
Hypochrome anemia
TO)
Sideroblastic anemia
Continuity of gastrointestinal system after subtotal gastrectomy gastrojejunostomy

The duodenum is left in the form of a stump. Therefore, the duodenum loses its
functionality. Iron is largely absorbed from the duodenum. Because of that
iron deficiency anemia is common in these patients.
(Answer A)
160
35.
Which plays the most important role in the pathophysiology of prepyloric gastric
ulcer?
(April 90)
A) Atrophic gastritis
B) Hyperacidity
C) Breaking of mucosal barrier of drug
D)
Back diffusion of H + ion
TO)
Mucosal circulation disorder
Factors that increase the damage in the etiology of preploric gastric ulcer include
hyperacidity, alcohol, aspirin, smoking, stress, Helicobacter pylori infection,
non-stereoid anti-inflammatory drugs
countable. Mucus secretion, bicarbonate secretion,
mucosal blood flow, epithelium regeneration ability and prostoglandin secretion.
(Answer E)
36.
Which situation does Dumping syndrome not occur? (April 89)

A) Parsiel gastrectomy
B) Subtotal gastrectomy
C) Truncal vagotomy
D)
Truncal vagotomy + pyloroplasty
TO)
Proximal gastric vagotomy
Dumping syndrome is most common after Billroth II gastrojejunostomies. Because the

normal function of the pylorus is disrupted in these surgeries and the stomach
content is very fast
Pass. In proximal gastric vagotomy, pyloric function did not change and
gastrointestinal passage did not accelerate. Therefore, dumping syndrome is not
seen in PGV.
(Answer E)
37.
Where is the most common perforation in peptic ulcer? (April 89)
A) Stomach front
B) Back side of stomach
C) Small curvature
D)
Duodenum front side
TO)
Back side of duodenum
Peptic ulcer is most commonly located on the second continent of the duodenum and
causes perforation by penetrating the anterior surface of the duodenum, while the
gastroduodenal artery penetrating the posterior side of the duodenum.
Erodes the wall and causes bleeding.
(Answer D)
161
GENERAL SURGERY
38.
Disease causing loss of liver mature by percussion

A) Ulcer perforation in the stomach and duodenum
B) Left heart failure
C) Excessive weakness
D)
Chronic pulmonary emphysema
TO)
Uncomplicated hydatid cyst in liver right lobe
Air passage to the intraperitoneal area as a result of perforation of lumen organs

such as the stomach and duodenum
It will be. Liver percussion may not be obtained in percussion due to passing air.
(Answer A)
39.
Which is the most common cause of gastrojejunocholic and gastrocolic fistula?

(April 89)
B)
Granulomatous colitis
C) Gastric cancer
D)
Colon cancer
TO)
Marginal ulcer
Gastrojejunocholic fistulas are often associated with posterior gastroenterostomies

for duodenal ulcer.
is seen later. This problem develops in 10-15% of marginal ulcers.
(Answer E)
40.
Late Dumping syndrome occurs due to which of the following?
(September 88)
A) Hyperglycemia
B) Seratonin release
C) Hypovolemia
D)
Reactive hypoglycemia
TO)
Noradrenaline release
as is, but there are no gastrointestinal symptoms.
•
Patients with dumping usually eat food to avoid the discomfort of eating.
Enteroglucagon is held responsible for late Dumping. Enteroglucagon beta cells

sensitizes to stimuli and develops reactive hypoglycemia with excessive insulin
release.
(Answer D)
162
41.
After one of the following operations, iron deficiency
Is it most common? (September 88)

A) Billroth II surgery
B) Billroth I surgery
C) Vagotomy pyloroplasty
D)
Vagotomy gastroduodenostomy
TO)
Proximal gastric vagotomy
Bilroth II is left as an antrum stump after gastojejunostomies. Bilroth II surgery

then the duodenum will be disabled and it loses its functionality. Iron large
rate is absorbed from the duodonum. Therefore, iron deficiency anemia in these
patients
It is not unusual.
(Answer A)
42. Which of the following peptic ulcer surgical treatment early postoperative
is not one of the complications of the term? (September 88)
A) Duodenum stump leakage
B) Stomach atony
C) Marginal ulcer formation
D)
Bleeding
TO)
Organic clogging
SECONDARY EARLY COMPLICATIONS OF GASTRECTOMY:

Bleeding, pancreatitis, duodenal stump leak, diarrhea, stomal obstruction, gastric
remnant
It is necrosis.
SECONDARY LATE COMPLICATIONS TO GASTRECTOMY:
•
Dumping syndrome, afferent loop syndrome, alkaline gastritis, marginal ulcer,

malnutrition,
malabsorption, iron deficiency anemia, bezoar and carcinoma.
(Answer C)
43.
What is the name of a diffuse spreading carcinoma involving the entire wall of the
stomach?
(April 88)
A) Polypoid type carcinoma
B)
Ulcerated type carcinoma
C) Linitis plastica
D)
Papillary adenocarcinoma
TO)
Superficial spreading carcinoma
In diffuse gastric cancer, all layers of the gastric wall are involved and the
tumor spreads to all sides.
This appearance is called itis Linitis plastica, flasks stomach..
(Answer C)
163
GENERAL SURGERY
44.
Which is the most common sign of stomach cancer?April 88)

A) Bleeding
B) Abdominal pain
C) Weight loss
D)
Vomiting
TO)
circle
STOMACH CANCER SYMPTOMS:

It is an insidious disease that is difficult to detect early.
↔ Complaints
↔ Weight loss (most often)
↔ Indigestion
↔ Early saturation
↔ Non-specific gastrointestinal complaints
Ign In terms of symptomatology between benign disease, early gastric cancer and
advanced gastric cancer
There is a serious difference.
Weight loss is the most common finding in gastric cancer. This is caused by loss of
appetite and bleeding.
(Answer C)
45.
Total gastrectomy is best suited for the treatment of
surgery method? (September 87)

A) Zollinger-Ellison syndrome
B) Duodenal ulcer missed medical treatment
C) Gastric ulcer missed medical treatment
D)
Acute hemorrhagic pancreatitis
TO)
Diverticulum of duodenum
The lesions in Zollinger-Ellison syndrome are multifocal. Therefore, the most

appropriate surgical procedure
total gastrectomy.
(Answer A)
164
SMALL BOWEL - APPENDIX DISEASES AND SURGERY
THIN BOWEL - APPENDIX

DISEASES AND SURGERY
one. The most common congenital anomaly in the gastrointestinal tract is:
A) Meckel's diverticulum
B) Imperforate anus
C) Tracheoesophageal ülstule
D) Esophageal diverticulum
E) Omphalocele
Meckel's diverticulum
It often contains ectopic gastric epithelium.
Therefore, ulceration and arterial erosion may occur.
Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal
tract.
Note: The same question is available in the Keep in Mind of Infotus General Surgery
(Answer A)
2nd. Which is one of the extra-intestinal symptoms of Crohn's disease
It is not? (May 2011)
a)
Erythema nodosum
B)
conjunctivitis
C.)
thrombocytopenia
D)
E) Amyloidosis
Complications of Crohn's Disease
Obstruction-perforation is the most common complication. Fistula
Toxic megacolon Cancer
Extraintestinal manifestations of Crohn's disease are present in 30% of patients.
Extra intestinal findings of Crohn's disease:
Skin
Erythema multiforme
Erythema nodosum
Pyoderma gangrenosum
Eye
Iritis Uveitis
Conjunctivitis
165
GENERAL SURGERY
Joint
Peripheral arthritis
Blood
Anemia
*** Thrombocytosis Phlebotrombosis
Arterial thrombosis
Liver
Non-specific triadite
Sclerosing cholangitis
Kidney
Nephrotic syndrome
Amyloidosis
Pancreas
pancreatitis
General
Amyloidosis
(Answer C)
3. Lymph node that exits the visceral peritoneum and invades adjacent organs
colorectal cancer without TNF involvement and distant metastasis according to TNM
system
at which stage? (December 2010)
A) TisN0M0
B) T2N0M0
C) T3N0M0
D) T4N0M0
E) T3N1M0
STAGING
Modified Dukes (Astler– Coller) Classification
Stage A: Tumor localized to the mucosa
Stage B1: Tumor muscularis did not exceed propria, no lymph node involvement
Stage B2: Tumor muscularis exceeds propria, no lymph node involvement
Stage C1: B1 + lymph node involvement
Stage D: Metastasis
TNM Staging
Tis: Carcinoma in situ
T1: Tumor involved submucosa
T2: Tumor involved muscularis propria
166
T3: Tumor spread to serosa

T4: Tumor exceeding visceral peritoneum, spread to adjacent organs
N1: 1–3 pericholic and perirectal lymph node involvement
N2: ≥4 pericholic and perirectal lymph node involvement
N3: Vascular pedicle lymph node involvement
M0: No metastasis
M1: Metastasis present
T1
T2
N0
N0
M0
M0
Stage 2
T3
T4
N0
N0
M0
Stage 3
Any T
N1,2,3
M0
Stage 4
Any T
Any N
M1
Stage 1
M0
(Answer D)
4.
Which of the following is the most common cause of acute abdomen during pregnancy?
(April 2010)
A) Small bowel obstruction
B) Peptic ulcer perforation
C) Acute appendicitis
D) Cholangite
E) Volvulus
The main symptom of acute appendicitis is abdominal pain. Classically pain
initially down the epigastrium
or diffuse, moderate and continuous in the umbilical region, sometimes intermittent
on this pain.
cramps. Differences in the anatomical location of the appendix
where the phase occurs mainly causes variations. In this case, the visceral
component of the pain appears in the normal site, where the cecum during somatic
component rotation
If it stops, it will appear in that part of the abdomen. The most common cause of
acute abdomen in both sexes is acute
And appendicitis. Acute appendicitis is the most common cause of acute abdomen in
pregnant women.
(Answer C)
167
GENERAL SURGERY
5.
Which of the following statements about appendicitis in pregnancy is wrong?

(Eylül2008)
A) It is more common in the first two trimesters.
B) Diagnosis becomes difficult in the late stages of pregnancy.
C) Abdominal ultrasonography is useful in the diagnosis.
D)
Performing surgery carries the risk of premature birth.
TO)
Perforation of the appendix does not affect fetal and maternal mortality.
Although appendicitis can be seen in every period of pregnancy, it is mostly seen

in the first two trimesters.
tend. Most useful imaging in the diagnosis of acute appendicitis
method is ultrasonography. Any appendectomy or pregnancy
surgery carries a 10-15% risk of premature birth. The most important determinant of
fetal and maternal mortality
factor is the perforation of the appendix. Fetal mortality in early appendicitis is
3 -5% while perforation
With this ratio increases to 20%.
(Answer E)
6. Which of the following is the main factor that initiates acute appendicitis?
September 2007)
A) Bacterial proliferation and mucus secretion in lumens
B) Clogging of the appendix lumen
C) Intra-lumen pressure drop
D)
Lymphatic and venous obstruction
TO)
Decrease in arterial blood flow
ETIOLOGY OF ACUTE APPENDICITIS:

one-
obstruction
a) Fecalcites (most often)
b) Lymphoid hypertrophy (most common in children)
c) Foreign body
d) Parasites (askaris; most common)
2nd-
Other reasons
a) Generalized infections
b) Fibrosis
(Answer B)
168
7. Diffuse redness, diarrhea and venous

fullness was detected in a 60-year-old patient in the liver
covering the mass and right heart valves were pathological thickening.
For this patient with high levels of 5-hydroxyindoleacetic acid in urine
which is the most likely diagnosis? (September 2007)
A) Carcinoid syndrome
B)
Hepatocellular carcinoma
C) Pheochromocytoma
D)
Atrial myxoma
TO)
Cushing's syndrome
CARCINOID TUMOR:
• Low endometrial cancer originating from the entire endocrine cell system except
the pancreas and thyroid C cells.
grade tumors.
• It is most commonly seen in the duodenum, terminal ileum and appendix. Not in the
esophagus.
• It is most commonly located in the appendix and ileum (60-70%).
• Potentially malignant tumors.
• Serotonin, cytokeratin, S-100 protein, prealbumin can be used as marker.
CARCINOID SYNDROME:
• Episodic flushing, bronchospasm, diarrhea in 5-10% of patients with malignant
carcinoid
and vasomotor collapse attacks.
• Carcinoid Syndrome caused by metastasis of carcinoid tumor to liver
It called.
• Carcinoid tumor most commonly metastas to the liver
tumors.
• The most common carcinoid tumors with carcinoid syndrome are carcinoid tumors
located in the ileum.
Symptoms of carcinoid syndrome include hepatomegaly, diarrhea and flushing 80%,
right heart
valve diseases 50%, asthma 25%, malabsorption and pellegra (dementia, dermatitis,
diarrhea)
countable.
Diagnosis: The most reliable method is the determination of 5-HIAA levels in urine.
(Answer A)
8.
A 45-year-old male patient has a cramp-like abdomen for two days.

He was admitted to the emergency department with pain, nausea and vomiting. Story 3
She had undergone appendectomy for perforated appendicitis years ago. made
On physical examination, the patient was dehydrated and the abdomen was distended.
Gas-fluid levels are observed on the abdominal X-ray.
A) Acute cholecystitis
B)
Intestinal obstruction secondary to adhesion
C) Colorectal cancer
D)
Acute mesenteric ischemia
TO)
Sigmoid volvulus
169
GENERAL SURGERY
FINE BOWEL OBSTRUCTIONS:

MOST FREQUENT REASONS:
• Postoperative adhesions (65-80%)
• Hernia (15-25%)
• Malignant tumors (10-15%)
CLINICAL IN INTESTINAL OBSTRUCTION
• Colic abdominal pain
• Vomiting
• Inability to remove gas-stool
• Abdominal distention
• Air fluid levels on standing post-abdominal radiography.
In intestinal obstructions, gas accumulates in the lumen and causes distention.
Before intestines
peristalsis increases, then decreases, then disappears. Edema in the intestines
that lost motility
develops and progresses to circulatory disorders, causing necrosis.
(Answer B)
9.
Occasionally cramp-like abdominal pain, febrile fever nausea and vomiting

35-year-old female with complaints of abdominal pain in the physical examination
sensitivity and malnutrition findings were observed. Small intestine passage taken
X - ray showed stenosis and enteroenteral fistula in three different segments.
2006)
A) Typhoid enteritis
B)
C) Entero-Behcet's disease
D)
Crohn's disease
TO)
Gastro-intestinal lymphoma
CROHN'S DISEASE:
• It is the most common primary surgical disease of the small intestine.
• Can be seen at any age (more often at age 30-40).
• Pain is the most common symptom. Malabsorption secondary to diarrhea and weight
loss are seen.
• Obstruction, perforation, internal fistula (the abscess adhering to the
surrounding tissues,
fistula, sinus), abscess.
• Perianal disease: 25% in Crohn's disease with small bowel involvement and 50% in
colonic involvement
It is seen.
SURGICAL TREATMENT INDICATIONS: (also refers to complications).
• Obstruction (most common) Because inflammation is full-thickness, healing in
muscularis occurs with structure
and this leads to obstruction.
• Fistula formation (non-fistulas)
• Abscess
• Perforation
• Severe perianal involvement
• Non-response to medical treatment
• The presence of Ca
• Bleeding
(Answer D)
170
10.
A 24-year-old female patient with acute appendicitis underwent surgery.
1 cm carcinoid tumor is detected at the end of the dice.

Which of the following operations is performed for this patient? (April 2006)
A) Right hemicolectomy
B) Appendectomy + cecum resection
C) Appendectomy only
D)
Appendectomy + regional lymph node dissection

TO)
Subtotal colectomy
TREATMENT OF APPENDIX CARCINOID:

•
Carcinoid tumor is the most common site of appendix

metastasis and invasion if there is no mesoapendice in carcinoid tumors smaller
than 1 cm.
only appendectomy is sufficient.
For lesions larger than 2 cm, right hemicolectomy is performed.

(Answer C)
11th.
Gastrointestinal adenocarcinomas should be

A) Stomach
B)
Small intestines
C) Cecum
D)
sigmoid
TO)
Rectum
In the gastrointestinal tract, adenocarcinomas are the least common in the small
intestine, most commonly in the colon and
especially in the rectosigmoid region. The reasons for the rare occurrence of
adenocarcinoma in the small intestine are the IgA synthesis of the small intestine,
the small intestine motility to the colon motility.
the regeneration time of the small intestine epithelium
short and short time into the lumen.
(Answer B)
12.
Which is not indicated for the treatment of emergency appendectomy? (April 2004)
A) Acute appendicitis
B) Perforated appendicitis with local peritonitis
C) Acute appendicitis in pregnant women
D)
Perforated appendicitis with diffuse peritonitis
TO)
Plastrone appendicitis
171
GENERAL SURGERY
The treatment of acute appendicitis is surgery. Plastrone appendicitis: perforated

appendiceal omentum
It is the name given to the situation where the abdominal organs are surrounded by
outside. Plastrone appendicitis has a very close relationship between the abdominal
organs and the appendix.
perforated appendiceal organs are very likely to be injured. For this reason,
plastrone appendicitis medical treatment with antibiotherapy is applied first, then
surgical treatment
makes. Physical examination of the plastrone appendiceus
The mass is detectable.
Painful mass in the right lower quadrant with the infusion or perforated appendix
surrounded by the omentum
If plastrone appendicitis is defined as appendicitis, firstly antibiotic and fluid
resuscitation followed by elective appendectomy is performed.
(Answer E)
13.
Which of the following small bowel benign tumors is most common and
causes symptoms in the clinic? (September 2003)

A) Lipoma
B) Fibrom
C) Hamartoma
D)
hemangioma
TO)
leiomyoma
SMALL BOWEL BENIGN NEOPLASIS:

• Adenoma (the most common benign tumor of the small intestine).
• Leiomyoma (the most common symptomatic benign tumor of the small intestine).
• Polyp
• Lipoma
Leiomyomas are benign tumors of the smooth muscle. Intramural spread to obstruction
or by spreading intramural and extramural. Bleeding is most common
is the symptom seen.
(Answer E)
14. The most important factor in the etiology of acute appendicitis
A) Bacterial infection
B) Luminal obstruction
C) Vascular insufficiency
D)
Chemical factors
TO)
Lymphoid tissue hyperplasia
172
ETIOLOGY OF ACUTE APPENDICITIS:

1- Obstruction
a) Fecalcites (most often)
b) Lymphoid hypertrophy (most common in children)
c) Foreign body
d) Parasites (askaris; most common)
2- Other reasons
a) Generalized infections
b) Fibrosis
(Answer B)
15. Areas where carcinoid tumor is frequently localized in the gastrointestinal
tract
Which of the following is given in the correct order? (April 2003)
A) Appendix, stomach, duodenum
B) Appendix, ileum, rectum
C) Appendix, duodenum, ileum
D)
Stomach, ileum, rectum
TO)
Duodenum, ileum, rectum
CARCINOID TUMOR:
• Low grade originating from the entire endocrine cell system except the pancreas
and thyroid C cells
tumors.
• It is most commonly located in the rectum, appendix and ileum (60-70%).
• Potentially malignant tumors.
(Answer B)
16.
The most common complication of Meckel's diverticulum in adults

A) Intestinal obstruction
B) Bleeding
C) Diverticulitis
D)
Development of malignancy
TO)
perforation
173
GENERAL SURGERY
MECKEL DIVERTICAL
•
Meckel's diverticulum is the most common true diverticulum of the small intestine.
Meckel's diverticulum develops as a result of the closure of the omphalomesenteric

(or vitelline) duct that provides the relationship between the middle intestine and
yolk sac during the intrauterine period.
Rectal hemorrhage due to Meckel's diverticulum (especially in children), intestinal

obstruction
(especially in adults).
Meckel diverticulum in the hernia sac is called littre hernia. Due to Meckel's
diverticulum
perforation and acute abdomen.
(Answer A)
17.
Which of the following colonic lesions has the lowest risk of malignancy?
(Nisan2003)
A) Villous adenoma
B) Familial polyposis
C) Hyperplastic polyp
D)
Ulcerative colitis
TO)
Adenomatous polyp
Hyperplastic polyps are the most common polyps of the gastrointestinal tract.
Hyperplastic polyps
malignancy potential is very low. Not even acceptable. The potential of malignancy
increases as villous, tubulovillosis and tubular polyps seen in the colon discard
the villous component. Familial polyposis
Polyps are common adenomatous polyps associated with high risk of malignancy.
Shows.
(Answer C)
18.
A 30-year-old woman with other aspects of perforated appendicitis
Because of this, appendectomy was performed and the wound was closed primarily. The
patient did not receive antibiotics and intraabdominal abscess developed.
What is the most likely cause of abscess in this patient? (April 2002)
A) Pseudomonas aeruginosa
B) Bacteroides fragilis
C) Streptococcus faecalis
D)
Proteus mirabilis
TO)
Serratia marcescens
E. coli and Bakterioides fragilis in the gastrointestinal lumen due to appendix

perforation are translocated into the abdomen. In the gastrointestinal flora,
aerobes include gram (-) bacilli and
especially E. coli is the most common. The most common anaerobes are Bakterioides
fragilis.
(Answer B)
174
19.
Which is not seen in a patient with terminal ileum resection? (April 2001)
A) Gallstones
B) Oxalate stones
C) Vitamin B12 deficiency
D)
Iron deficiency anemia
TO)
Degradation of fatty acid absorption
Ileum resection is secondary to complications such as obstruction - perforation due

to Crohn 's disease. Ileum Vitamin B12 and bile salts to absorb the intestine
is the segment. Unabsorbable bile salts proceed to the colon causing water and salt
secretion
prepare the ground as land. Iron is mostly absorbed from the duodenum. Therefore
ileum
resections are not affected. In other words, iron deficiency anemia is not seen in
ileum resections. In addition, new bile production in the liver to replace bile
acids lost in faeces
Due to gallstones develop.
Vitamin B12 is a vitamin absorbed from the terminal ileum by intrinsic factor.
(Answer D)
20. A 40-year-old male patient was operated with a preliminary diagnosis of
appendicitis.
(September 2000)
A) Carcinoid tumor
B)
lymphoma
C) Adeno carcinoma
D)
mucosel
TO)
leiomyoma

Tumor.
(Answer A)
21.
What is the most appropriate treatment option in this patient? (September 2000)
A) Right hemicolectomy
B) Appendectomy
C) Laparotomy only
D)
Removing the mass only
TO)
biopsy

metastasis and invasion if there is no mesoapendice in carcinoid tumors smaller
than 1 cm.
only appendectomy is sufficient.

(Answer?)
175
GENERAL SURGERY
22.
Which diverticulum is real and most common? (April 2000)

A) Column diverticulum
B) Duodenal diverticulum
C) Meckel's diverticulum
D)
Zenker diverticulum
TO)
Diverticulum of small intestine
See description of question 14.

(Answer C)
23.
Treatment of secondary peritonitis after perforated appendicitis
Which of the following is the most appropriate antibiotic that can be used per se?
(April 2000)
A) Ceftriaxone
B) Crystallized penicillin
C) Cefoxide
D)
amikacin
TO)
cefazolin
Abscess due to discharge of intestinal content of perforated acute appendicitis to

intraperitoneal area
It develops. Agents that are effective in the development of abscess are intestinal
flora bacteria, Aerob (E.
Coli), anaerobe (bactterioides) microorganisms. Antibiotics to be used for
therapeutic purposes
spectrum should cover these two factors. Perforated appendicitis or non-perforated
appendicitis
the most prominent drug is cefoxitin. Cephoxide has the strongest antianaerobe
effect of cephalosporin.
(Answer C)
24.
What type of kidney stones are most common after ileal resection? (September 99)
A) Calcium
B) Magnesium
C) Uric acid
D)
cysteine
TO)
oxalate

is the segment. Increased excretion of oxalic acid in urine leads to the formation
of Ca-oxalate stones
It happens. Primary hyperoxaluria, an inherited disease characterized by excessive
production of oxalate
Diffuse oxalate crystal accumulations in the body.
(Answer E)
176

25.
Pathological specimen of the patient who underwent appendectomy with the diagnosis
of acute appendicitis
1 cm diameter carcinoid tumor that does not exceed the wall

which approach is appropriate? (September 99)
A) Radiotherapy
B) Operation is sufficient
C) Re-open the abdomen and make exploration
D)
Lymph node dissection
TO)
Radiotherapy + Lymph node dissection
CARCINOID TUMOR:
•
Potentially malignant tumors.
Metastasis and mesoapendice in carcinoid tumors less than 1 cm

appendectomy is sufficient.
See also a description of question 5

(Answer B)
26.
Which of the following occurs after terminal ileum resection
is not one of the complications that may arise? (April 99)

A) Kidney stone formation
B) Decreased serum iron level
C) Steatore
D)
Vitamin B12 deficiency
TO)
Malabsorption of bile salts

is the segment. Unabsorbable bile salts proceed to the colon causing water and salt
secretion
prepares the ground as land. In addition, liver loss of feces in the liver
gallstones develop due to the construction of new bile instead. Malabsorption of
bile salts diarrhea
causes steatorrhea if resection is more than 100 cm.
Increased excretion of oxalic acid in urine causes Ca-oxalate stones to form.
oxalate
Primary hyperoxaluria, an inherited disease characterized by overproduction, is
common in the whole body.
oxalate leads to crystal deposits.
(Answer B)
177
GENERAL SURGERY
27. What disease do you consider with segmental involvement and non-cascading
granulomatous lesion involving all layers? (September 98)
A) Crohn
C) Radiation colitis
D)
Tuberculosis
TO)
Sarcoidosis
CROHN'S DISEASE:
• Spontaneous improvements and acute exacerbations and
is a chronic inflammatory disease that can be seen in all.
• The terminal ileum is most commonly involved.
• Although the etiology is unknown, people with a family history are at high risk.
• Severe edema of the mucosa and submucosa, aphthous ulcers, linear ulcers and
intestinal wall
Full coat involvement is available.
• Structure and stenosis may develop due to submucosal involvement and submucosal
fibrosis.
• There is transmural involvement due to involvement of all layers.
• Full-thickness inflammation, hopping involvement and healthy intestines between
Crohn's disease
The presence of segments is characteristic.
(Answer A)
28.
What causes acute appendicitis more often? (September 98)

A) Fecalite
B)
mucosel
C) Lymphoma
D)
adenocarcinoma
TO)
Parasitic

(Answer A)
29.
Around sixty years of age with the least chance of causing GIS bleeding

A) AV malformation
B)
Polyp
C) Carcinoma
D)
diverticulosis
TO)
• Rectal hemorrhage due to Meckel's diverticulum (most commonly especially in

children), intestinal obstruction
(especially in adults). The most common cause of massive lower GIS bleeding is
diverticulosis.
(Answer E)
178
30.
The patient was diagnosed with acute appendicitis and fever with tremors,
intermittant
What do you think if you have abdominal pain and hyperbilirubinemia? (April 98)
A) Plastron
B) Perforated appendicitis
C) Pilephilebite
D)
Gangrenous appendicitis
TO)
Phlegmanous appendicitis
ACUTE APPENDICIT COMPLICATIONS:

- Perforation (most common); frequent in children and the elderly. Prevents
plastron perforation in adults.
- Generalized peritonitis
- Abscess (periapendicular abscess)
- Pieloflebit; Septic thrombophlebitis of the portal vein. Million abscess foci may
be seen in the liver.
liver causes a millier abscess). Findings of pieloflebolitis include high fever,
chills,
right upper quadrant pain, hepatomegaly, sensitivity, jaundice and other signs of
sepsis.
(Answer C)
31.
What is the most common symptom of meckel diverticulum in children? (September 97)
A) Nausea and vomiting
B)
hematemesis
C) Rectal bleeding
D)
Diarrhea
TO)
Constipation
MECKEL DIVERTICAL
• Meckel's diverticulum is the most common true diverticulum of the small
intestine.
• Meckel's diverticulum provides the relationship between the middle intestine and
yolk sac during intrauterine period.
Omphalomesenteric (or vitelline) occurs as a result of the closure of the duct.
• Rectal bleeding due to Meckel's diverticulum (especially in children) and
intestinal obstruction (especially in adults). Typical finding, painless massive
rectal in the child
It is bleeding.
(Answer C)
32.
What is the most common complication of adult Meckel's diverticulum? (April 97)
A) Bleeding
B)
diverticulitis
C) Obstruction
D)
malignancy
TO)
Peritonitis

(Answer C)
179
GENERAL SURGERY
33.
Which is not seen in a blind moment? (April 97)

A) Vomiting
B)
Diarrhea
C) Weight loss
D)
Anemia
TO)
Neurological disorder
Blind loop (Blind loop) syndrome is the name given to the intestinal reproduction
of bacteria in the small intestine secondary to any bowel anomaly and intestinal
stasis syndrome. So suffered the staze
diarrhea and malabsorption due to lack of absorption in the segment, weight loss,
anemia and neurological
disorders occur. Vomiting is not observed in blind ans syndrome.
(Answer A)
34. What is the disease in which barium graphy is useful in both diagnosis and
treatment? (April 97)
A) Strangulated invagination
B) Sigmoid colon volvulus
C) Adhesion
D)
diverticulitis
TO)
the Intusception
Intussusception occurs when the proximal bowel segment enters the distal segment.
Barium graphy is useful both in diagnosis and treatment. Intertwined intestinal
segments
separation. In diverticulitis, barium column radiography is only useful for
diagnosis. In the acute stage of diverticulitis, barium column radiography is
contraindicated.
(Answer E)
35. A 35-year-old male patient presented with right lower quadrant pain, diarrhea,
What is the most likely diagnosis if there are fistulas opening to the skin?
(September 96)
B)
Cystic fibrosis
D)
Crohn's disease
TO)
Tuberculosis
The patient mentioned in the question describes fistulas secondary to granulomatous

inflammation.
These include Crohn's and tuberculosis, which can lead to granulomatous fistula.
intestinal
Tuberculosis is very rare.
Tbc enteritis is most commonly seen in the ileum and ileocecal valve region, then
in the cecum and colon.
• It is most commonly seen between 30-50 years of age and is more common in women.
• The most common symptoms; abdominal pain, weight loss, loss of appetite,
intermittent fever, night sweats, diarrhea and
Constipation.
In Crohn's disease, involvement is full-thickness and transmural, with intact
tissue in between. Full floor
Enteroenteral and enterocutaneous fistulas may be seen due to involvement.
(Answer D)
180
36.
Pellegra-like findings, facial flushing, hypotension attacks and
Which examination is performed in cases with increased bowel sounds? (September 92)
A) 5 HLFS in urine
B) Gastrin
C) Insulin
D)
cortisol
TO)
glucagon
CARCINOID SYNDROME:
•
In 5-10% of patients with malignant carcinoid, episodic flushing, bronchospasm,

diarrhea and
is a syndrome characterized by attacks of vasomotor collapse.
•
Carcinoid syndrome is a condition that occurs when a carcinoid tumor metastasizes
to the liver.
The most common carcinoid tumor metastatic to the liver is carcinoid tumors located
in the rectum.
The most common carcinoid tumors with carcinoid syndrome are carcinoid tumors
located in the ileum.
Symptoms of carcinoid syndrome include hepatomegaly, diarrhea and flushing 80%,

right heart valve
diseases 50%, asthma 25%, malabsorption and pellegra (dementia, dermatitis,
diarrhea) can be counted.
The most reliable diagnostic method is the determination of 5-HIAA levels in urine.
Serotonin metabolite 5HIAA increases in urine.
(Answer A)
37.
1/3 distal of the appendectomy material in the patient opened for acute
appendicitis
1 cm diameter carcinoid tumor and no involvement in the meso procedure

A) Antiserotonin drugs
B) Emergency chemotherapy
C) Appendectomy is sufficient
D)
Right hemicolectomy
TO)
Re-exploration for the evaluation of metastases
CARCINOID TUMOR:
•
Metastasis and mesoapendice in carcinoid tumors less than 1 cm

appendectomy is sufficient.
3% of malignant carcinoids metastasize to regional lymph nodes, in which cases the

right
hemicolectomy is required.

(Answer C)
181
GENERAL SURGERY
38.
Which of the following is the Obturator test positive? (September 89)

A) Acute pancreatitis
B) Acute cholecystitis
D)
Mechanical ileus
TO)
Peptic ulcer perforation
SPECIAL NAME TESTS IN ACUTE APPENDICITIS:

OBTURATOR TEST:
positive for acute appendicitis. In the right lower quadrant of the thigh with
rotation of the thigh in flexion
hears severe pain.
Psoas sign: Pain in femoral flexion,
Blumberg Sign: Pain in the appendix localization,
Roussing Finding: Pain in the right lower quadrant when we stroke up the descending
colon
(Answer C)
39. Which kidney pathology is seen in a patient with large ileum resection?
(September 89)
A) Oliguria
B)
hematuria
C) Proteinuria
D)
glomerulonephritis
TO)
Ca-urate stones
19. See the explanation of the problem.

(Answer E)
40.
Death in untreated simple mechanical intestinal obstruction is usually
depending on which of the following factors? (September 88)

A) Intestinal bleeding
B)
Loss of fluid and electrolyte
C) Septicemia
D)
Toxemia
TO)
Aspiration of digestive system coverage
182
Mechanical obstructions that do not cause a direct disturbance in the intestinal

blood flow
It is blocked.
The most common cause of death is electrolyte imbalance due to fluid-electrolyte
loss. Vomiting and
fluid sequestration in the occluded part.
(Answer B)
41.
Diarrhea-causing vasoactive amine in Dumping syndrome

A) Bradikinin
B) Histamine
C) Serotonin
D)
secretin
TO)
Gastric inhibitory polypeptide
Some of the strained jejunum wall in Dumping syndrome, such as serotonin, GIP, VIP,
neurotensin
released enteric hormones; they are responsible for vasomotor symptoms. Diarrhea
serotonin
it causes.
(Answer C)
42.
The most important event in the etiology of acute appendicitis

A) Invagination
B) Ischemia
C) Obstruction
D)
infection
TO)
Edema
Obstruction of the lumen is the most accused mechanism in the etiology of acute
appendicitis.
(Answer C)
183
GENERAL SURGERY
184
COLON - RECTUM DISEASES AND SURGERY
COLUMN - RECTUM
one. A 55-year-old male patient who has been followed and treated for 30 years with
the diagnosis of ulcerative colitis
is admitted to the hospital. The colonoscopy showed that the entire colon was
involved,
In situ carcinoma is detected in biopsy specimens.
What is the most appropriate approach for this patient? (September 2011)
A) Total procto colectomy

B) Total colectomy
C) Follow-up without treatment
D) Repeat biopsy with chromoendoscopy
E) Medical treatment with ileostomy
ULSERATIVE COLLITE
one. It is an inflammatory disease involving the colon mucosa.
2nd. Immunological hyperactivation The IL-1 receptor antagonist / IL-1 ratio
decreases.
-
Appendectomy and smoking are protective against ulcerative colitis.
4. There is familial predisposition (HLA DR2). DR 1501 is more benign, DR 1502 is

more severe clinical.
5. While Crohn can hold every part of the GTC, UC is only column-specific.
6. UC begins as a proctitis; progresses proximally without leaving any intact
mucosa arada Pancolite oza
Ile back – wash ileitis ”
7. Hemotesia is the most common symptom.
8. The most common extra-bowel finding is peripheral arthritis and ankylosing
spondylitis (reversible)
9. Sclerosing cholangitis is irreversible. The risk of colon carcinoma is
increased.
10. Perianal involvement is rare.
11th. Mucosal edema, ulcerated and hemorrhagic pseudopolyps are seen.
12. Ulcerative colitis and Crohn should be differentiated.
13. ANCA: p – ANCA (p = perinuclear) is specific for ulcerative colitis.
14. ASCA: ASCA is positive for crohn's disease.
15. 5 – ASA derivatives and immunomodulators are used in the treatment.
16. Active disease not responding to medical treatment, cancer risk, severe
bleeding, perforation and
In case of obstruction surgical treatment is applied.
17. Total proctocolectomy treats UC. Total colectomy, mucosal proctectomy
(rectal mucosectomy), ileal pouch anal anastomosis is the first choice.
(Answer A)
185
GENERAL SURGERY
2nd. Which of the following statements about colon diverticulum is incorrect?

(September 2011)
A) Hypertro fi may be seen in the muscle layer before the formation of diverticulum
B) They are located on the mesenteric side of antimesenteric tapeworm
C) In some cases, the arteriole may displace towards the dome of the diverticulum
D) Usually seen when the muscle layer in the colon wall is weak
E) Usually seen in sigmoid colon
DIVERTICULAR DISEASE OF COLUMN
• It is the disease of developed countries.
• An abnormal sac or pouch protruding out of a hollow organ wall.
• It may be a real / false diverticulum.
• The stool volume decreases and the column contracts more.
Diverticulum is more common (95%) in the left colon (especially in the sigmoid).
• Diverticular disease is asymptomatic unless complications develop.
• The most common complications are diverticulitis (10–25%) and bleeding (15%).
• Barium colon graph is contraindicated in diverticulitis. The best imaging
modality is CT.
• Clinic of diverticulitis, left lower quadrant pain, fever and chills; colonic
obstruction.
• Internal fi stulae (50% of the most common cholesthesia) may develop.
Diverticulitis is the most common
Is a plus.
• Diverticulitis treatment, liquid diet and outpatient antibiotics, oral intake if
severe
cut. IV fluids and IV antibiotics should be given and hospitalization is required.
• Surgical treatment: excision of the segment with diverticulitis.
ETIOLOGY OF COLON DIVERTICULES
Mucosa-feeding vessels (vaza recte) penetrating into the muscle layer of the weak
Colon diverticulum is more common in these areas. 90% is seen in the sigmoid colon.
The most accepted factors for the etiology of diverticular disease of the colon
are; column
changes in wall resistance, colon motility disorders and dietary
deficiency. Low-fiber diet low volume and less water-stool
formation and slowdown of the gastrointestinal tract. All these factors cause
increased intra-column pressure, making it difficult to expel the contents of the
colon.
Increased intraluminal pressure in the colon has been demonstrated in patients with
diverticulosis.
Physical inactivity, constipation, obesity, smoking and nonsteroidal antiin fl
ambulatory drug
use is also associated with the risk of developing diverticular disease.
Another factor that plays a role in the pathogenesis of diverticular disease is the
tensile strength decreases with increasing age. In recent years, both in utero and
divertilosis
It is suggested that it may be among the etiological factors.
(Answer D)
186
3. Which of the following negative effects on healing of enterocutaneous stules

has? (May 2011)
A) Presence of lateral ül stule

B) Presence of non-epithelized tractus
C) Single tract
D) Tractus shorter than 2 cm
E) Jejunal origin
Factors that adversely affect the spontaneous closure of the fistula:
Proximal fistules are less likely to close than distal ül stulae.
Factors that adversely affect:
Very short (<2cm) fistula tract
Epithelialization of the fistula tract
Active granulomatous bowel disease
Abscess, presence of foreign body
Obstruction of the distal bowel segment
Presence of radiation enteritis
Nutritional disorder
The presence of tumors in the fistula tract can be considered.
(Answer D)
4.
Abdominal pain, fever and physical examination revealed tenderness in the left
lower quadrant.
Which of the following should be considered first in a 65-year-old female patient
who was previously diagnosed with similar complaints?
(April 2010)
A) Colon cancer
B) Ogilvie syndrome
C) Crohn's disease
D) Ischemic colitis
E) Diverticulite
This question typically describes diverticulitis. Left lower quadrant in elderly

male and female patients
pain defender, presence of rebaund and detection of leukocytosis in laboratory
tests diverticulitis
should think. In addition, diverticulitis attack due to the patient's previous
complaints.
however it means that it is mild.
(Answer E)

187
GENERAL SURGERY
5.
Which of the following is the lowest risk of developing colon cancer?

(April 2009)
A) Gardner syndrome
C) Villous adenoma
D)
Ulcerative colitis
TO)
Hamartomatous polyp
Hyperplastic Polyp
- The most common type of polyp.
- They are seen 10 times more than adenomatous polyps.
- They do not have malignancy potential.
- Colonoscopic polypectomy is applied for treatment.
Inflammatory Polyp
- It is mostly seen as nodular lymphoid hyperplasia.
- They do not have malignancy potential.
- There is a possibility that they will disappear with advancing age.
Juvenile Polip
- They may cause GIS bleeding and intestinal obstruction.
- In case of multiple malignancy potential exists. The malignancy potential of
single juvenile polyp is low.
- Diagnosis and treatment colonoscopic polypectomy is sufficient.
Adenomatous Polyp
- Silent / Semisil
- Tubular
(65-80%)
* Malignancy potential increases and
prognosis worsens.
- Tubulovillous
(10-25%)
- Villous (5-10%)
Malignant potential increases as villous component increases in adenomatous polyps.
Arrow increase in malignancy
direction, while the opposite arrow indicates the incidence.
Hamartomatous polyps have the lowest risk of malignancy.
(Answer E)
188
6. A 65-year-old male patient with abdominal pain and constipation for 4 days
emergency department. Body temperature 38, 5 ° C, lower left abdomen in palpation
more pronounced sensitivity and fullness in the dial. Laboratory
The number of leukocytes was 12500 / mm3. Standing direct
abdominal x-ray shows gas in the colon and several air-fluid levels in the small
intestine.
A) Volecular cecum
B)
Sigmoid diverticulitis
C) Ulcerative colitis
D)
Gastroenteritis
TO)
Mesenteric vascular event
The patient expressed in the question was left lower quadrant pain, leukocytosis
and fever, direct X-ray
The presence of air - fluid levels in the colon and gas and small intestine should
suggest diverticulitis and diverticulitis, the most common complication of
diverticulosis.
DIVERTICULAR DISEASES
Diverticular disease (Diverticulosis) = Colonic diverticulum is called.
It is common in elderly and especially in men.
The sigmoid colon is most commonly involved (50%).
40% descending colon, 5-10% whole colon involvement can be seen.
diverticulitis
It is the most common complication of diverticulosis.
In narrow diverticulums, a small faecalitis obstructs the diverticulum mouth and
the diverticulum
as a result of the accumulation of secretions, pressure increase and bacterial
proliferation occur and inflammation begins.
If this infection is not limited, abscess and generalized peritonitis may develop.
For diverticulosis, the expression of left-sided appendicitis in elderly male
patients is used. Lower left quadrant pain,
Fever, chills, diarrhea / constipation symptoms may occur.
Colonoscopy or rectosigmoidoscopy is contraindicated in acute diverticulitis.
Diagnosis of acute diverticulitis
it is best put with CT.
(Answer B)
7. Hereditary nonpoliposis following colorectal cancer (Lynch syndrome)
which statement is incorrect? (September 2009)
A) Most cancers are located in the rectosigmoid region.
B) Cancer usually occurs at a younger age.
C) The incidence of synchronous and metachronous cancer is higher than normal.
D)
It accounts for 5-10% of colorectal cancers on average.
TO)
The incidence of endometrial cancer is high.

189
GENERAL SURGERY
HEREDITARY NONPOLIPOSIS COLORECTAL CANCER (LYNCH SYNDROME):

LYNCH I:
Autosomal dominant inheritance.
A tumor in the right colon is usually present without a large number of colon
polyps
There is no extracolonic manifestation (malignancy outside the colon is rare).
LYNCH II:
Colorectal, endometrial, ovarian, gastric, hepatobiliary, upper urinary tract
cancers are accompanied.
Lynch syndromes constitute 3% of all colorectal cancers. It is autosomal dominant.
Mutations in the DNA repair genes (DCC mutation, mutation in miss-match repair
genes) are detected in the affected individuals. Around 80 years of age, 80% of
patients develop colorectal CA. More
holds the right column. (70%)
Prognosis is better than sporadic colon Ca. Mucinous adenocarcinomas are more
common. Synchronous - metachronous lesions were seen in 40% of the patients.
In addition, all colorectal cancer and adenomas developed before the age of 40
Lynch syndrome
It is considered.
(Answer A)
8.
How to screen individuals without risk factors for colon cancer

a)
Annual colonoscopy after 50 years
B)
Tumor markers after 40 years of age
C.)
The detection of occult blood in the annual stool after the age of 50
D) Annual flexible sigmoidoscopy after the age of 50

E) Barium colon radiography every 2 years after the age of 40
COLORECTAL CA Screening:
- Fecal occult blood and / or rectosigmoidoscopy should be performed every year
over 50 years.
PATIENTS IN HIGH RISK GROUP IN TERMS OF COLON CANCER:
Patients over 50
Premalignant lesions
Patients with ulcerative colitis for more than 10 years
Crohn's disease with stricture formation
Familial adenomatous polyposis syndromes
Hereditary nonpoliposis colon cancer syndrome
Colon polyp history
Family history of colorectal cancer or polyp
(Answer C)
190
9.
In adults over 50 years of age, most of the massive gastrointestinal bleeding

Which is the common cause? (April 2008)
A) Polyp
B) Granulomatous colitis
C) Diverticulosis
D)
carcinoma
TO)
Ulcerative colitis
BOTH Bleeding:
Bleeding is the distal from the Treitz ligament.
They constitute 15% of major gastrointestinal bleeding
95% column welded
Lower GIS bleeding spontaneously stops at 75%.
The most common causes of lower gastrointestinal bleeding:
Meckel's diverticulum in infants and children (most common), Polyps, Ulcerative
colitis, Duplication.
Young Adult Meckel's diverticulum (most common), Inflammatory bowel disease, Polyps
Diverticulosis (most common), Inflammatory bowel disease, Polyps, Malignancy,
Arterio-venous malformations in adults up to 60 years
Vascular ectasia over 60 years (most common), Diverticulosis, Malignancy, Polyps
(massive over 60 years)
lower gastrointestinal bleeding is the most common cause of diverticulosis.
More rarely at any age:
Infectious diarrhea (Shigella, amoeba), ischemic colitis, varices, coagulopathies
cause lower GIS bleeding
can.
(Answer C)
10.
A 40-year-old with occasional colic-type abdominal pain
A small intestinal x-ray showed intussusception secondary to polyps. Rectoscopic

examination of the rectum
In the physical examination of the patient with polyp in the face pigmentation,
a tumor in the genital area and tenderness in the abdomen.
A) Classic type familial polyposis
B) Juvenile polyposis syndrome
C) Gardner syndrome
D)
Turcot syndrome
TO)
Peutz-Jeghers syndrome
191
GENERAL SURGERY
PEUTZ-JEGHER SYNDROME:
Mucocutaneal hyperpigmentation + GIS shows hamartomatous polyps.
It is inherited as autosomal dominant.
Breast, cervix, ovary, thyroid, lung, skin, gallbladder, pancreas, testicular Ca
risk increases with extraintestinal manifestation.
Stomach, colon, small intestine Ca risk is increased.
It may cause complications such as bleeding and invagination.
Polypectomy should be performed even if the treatment is asymptomatic. Because
there is a possibility of developing malignancy even at very low risk. In these
patients, both the small intestine and colon
Since it is a polyp, complications related to the polyp, invagination, perforation,
obstruction
There is a high probability.
Follow-up of the patients is performed by annual colonoscopy. If malignancy
develops, most likely adeno CA
It develops.
(Answer E)
11th.
Dysplastic normal epithelium, the first stage of development of colorectal cancer
tumor suppressor gene that plays a role in epithelial transformation? (Eylül2008)

A) K-ras
B)
DCC
C) APC
D)
p53
TO)
DPC4
Return from normal epithelium to dysplastic epithelium begins with the APC gene
mutation.
K-ras mutation plays a role in the transition from early adenoma to intermediate
adenoma.
The mutation responsible for the transition from late adenoma to intermediate
adenoma is DCC and DPC4.
Adenoma carcinoma transformation is associated with p53 mutation.
Normal epithelium → 5q APC loss → Hyperproliferative epithelium (dysplasia) → → DNA
methylation
changes → (early adenoma) (12p activation K-ras) → Intermediate adenoma → (18q
DCC loss) → Passadenoma → 17p p53 loss → Cancer → Metastasis.
(Answer C)
12.
Which of the indications for surgical treatment of ulcerative colitis

A) Inability to respond to long-term medical treatment
B) Intermittent gastrointestinal bleeding
C) Development of dysplasia
D)
Toxic megacolon
TO)
Growth and developmental delay in children
192
INDICATIONS OF SURGICAL TREATMENT IN ULCERATIVE COLITIS:

Emergency surgery
- Toxic megacolon
- Column perforation
- Serious bleeding
Elective surgery
- Non-response to medical treatment
- Inability to tolerate medication
- Development of side effects (eg growth retardation or side effects secondary to
the drugs used)
effects.
- Presence of dysplasia
(Answer B)
13.
Colic-type abdominal pain, biliary vomiting and bloody mucus defecation
What is the most likely diagnosis for an 8-month-old baby with complaints? (April
2007)
A) Meckel's diverticulitis
B) Appendicitis
C) Hirschsprung's disease
D)
intussusception
TO)
Mid-gut volvulus
Intussusception:
It is generally common in infants under 1 year of age.
It is the most common disease requiring emergency surgical treatment in children
under 2 years of age.
Often invagination proceeds from the terminal ileum to the colon.
As pain increases with GIS motility, pain symptoms in intermittent episodes are
important.
Bloody, mucus defecation in the consistency of strawberry jelly from the rectum is
pathagnomonic.
In the physical examination of the patient, the segment which is invaginated can be
palpated in the abdomen.
In the treatment of barium radiography with the first diagnosis and treatment
Studied. If successful, surgical intervention is required.
(Answer D)
14. Prostate abscess spontaneously ruptures most frequently to:
(April 2007)
A) Perineum
B) Suprapubic region
C) Rectum
D)
Subtrigonal advance to the bladder
TO)
urethra
193
GENERAL SURGERY
The most common cause of prostate abscesses is E.coli in GIS flora.
They usually occur as a complication of bacterial prostatitis.
Prostate edema due to inflammation is detected as edematous, sensitive and

enlarged.
During the treatment, the condition did not improve and both physical examination
and laboratory
If it goes, it can be thought that prostatitis picture progresses to abscess.
Abscess usually drains into the urethra.
Like all abscesses in the body, the treatment of prostate abscess is drainage and
then antibiotherapy.
(Answer E)
15.
In the follow-up of a patient who has undergone colon cancer surgery,
which should be done every 3 months in the first 2 years? (April 2007)
A) Carcinoembryogenic antigen determination
B) Colonoscopy
C) Abdominal computed tomography
D)
Complete blood count
TO)
Lung X-ray
Preoperative high levels of CEA in patients operated for colon cancer

is expected to fall. If not falling or increased during follow-up, metastasis or
local
relapse.
CEA
Increased level means recurrence or metastatic disease.
Lung, breast, stomach, pancreas tumors can also be found high in CEA.
In addition, smokers, cirrhosis, pancreatitis, renal failure and ulcerative colitis
in high CEA
It can be found.
Its height is not important in diagnosis, it is used in the follow-up of treatment.
(Answer A)
16.
Which of the following does not lead to solitary rectal ulcers? (April 2007)
A) Rectal bleeding
B) Pain
C) Internal intussusception
D)
Development of perianal fistula
TO)
Mucus defecation
Solitary rectal ulcers are usually associated with internal invagination. Among the
complications
pain, bleeding, rectal discharge with mucus, obstruction.
(Answer D)
194
17.
Which is consistent with the macroscopic appearance of Crohn's colitis
is not a finding? (April 2007)

A) Wall thickening
B) Thickening in the mesentery
C) Segmental involvement
D)
Mesenteric lymphadenopathy
TO)
Serosal telangiectasias
CROHN COLLIT:
Spontaneous improvements and acute exacerbations in any or all of the
gastrointestinal tract
is a chronic inflammatory disease.
The terminal ileum is most commonly involved.
Although the etiology is unknown, the risk is very high in people with a family
history. This means that immunological mechanisms dominate the event.
Severe edema of the mucosa and submucosa, aphthous ulcers, linear ulcers and
complete bowel wall
involvement is seen.
Submucosal involvement and stenosis due to submucosal fibrosis may be seen.
Involvement of all layers (transmural involvement) is pathagonomic for Crohn.
Full-thickness inflammation, hopping involvement, and the presence of healthy bowel
segments are diagnostic.
It can be seen at any age (more often at age 30-40).
Pain is the most common symptom. Malabsorption secondary to diarrhea and weight
loss can be seen.
Obstruction, perforation, internal fistula (inflamed area adhering to surrounding
tissues, abscess,
(Answer E)
18.
Massive lower gas in patients over 70 years of age who had never undergone surgery
before
The most common lesion causing bleeding of the gastrointestinal tract is:
A) Aortoenteric fistula
C) Diverticulosis
D)
Colon cancer
TO)
Peptic ulcer

Massive, severe, from the subscriber, the words are only associated with
Diverticulosis for bleeding.
(Answer C)
195
GENERAL SURGERY
19.
Adeno-, which causes complete intestinal obstruction in the rectosigmoid junction.
A patient with carcinoma was found to have signs of intestinal perforation.

Which of the following is most likely to be a perforation site?
(Eylül2007)
A) Rectum
B) Sigmoid colon
C) Splenic flexura
D)
cecum
TO)
Terminal ileum
The narrowest part of the column is the sigmoid colon and the widest part is the
cecum. Laplace during obstruction
According to the law, the highest pressure will occur in the widest place, because
the column is usually from the cecum.
perforated.
(Answer D)
20.
Presenting with sudden onset of massive lower gastrointestinal bleeding
A 35-year-old patient had a history of aphthous mouth and genital ulceration in

recurrent episodes for the last 10 years.
Angiography showed bleeding in the terminal ileum.
2007)
A) Gastrointestinal lymphoma
B) Angiodysplasia
C) Drug-related ulceration
D)
Crohn's disease
TO)
Entero-Behcet's disease
ENTERO BEHÇET DISEASE:

Aphthae and genital ulcers are typical for Behçet's involvement with
gastrointestinal involvement.
In Behçet's disease with GIS involvement, vasculitis involving the venules is
typical.
The disease occurs in attacks.
It comes with nausea, vomiting, abdominal pain, fever, diarrhea, mass and melena.
Steroids can be used for treatment. If no response is obtained, surgery may be
necessary.
(Answer E)
21. Which of the following is typical of ulcerative colitis
A) Rectal bleeding
B)
Perianal disease
C) Diare
D)
Weight Loss
196
TO)
Anemia
TYPICAL FINDINGS IN ULCERATIVE COLITIS:

It is often localized to the left colon.
If it holds the entire colon, it may be in the form of pancolitis.
Hematocesia is the most common symptom.
As inflammation progresses, mucus stools, severe tenesmus, anemia, abdominal pain,
fever and weight loss
It is seen.
Peripheral arthritis and ankylosing spondylitis are the most common extra-bowel
findings.
It may be degraded.
(Answer B)
22.
In general, colorectal tumor metastases from regional lymph nodes
Which organ is most frequently seen after? (April 2005)

A) Lung
B) Bone
C) Liver
D)
Adrenal
TO)
Brain
Colorectal cancers most commonly metastasize to regional lymph nodes. Metastasis

away from lymph node
Metastasis. Colorectal cancers distant metastasis to the first liver
tend to metastasize.
(Answer C)
23.
A 75-year-old male patient with iron deficiency anemia
kg slimming and abdominal pain. Fecal occult blood positive

is detected.
A) Gastric ulcer
B) Duodenal ulcer
C) Arteriovenous malformation in small intestine
D)
Right colon cancer

TO)
Sigmoid cancer
COLORECTAL CANCER SYMPTOMS:

The most common symptom is abdominal pain, the first symptom is change in
defecation pattern, rectal bleeding, obstruction,
perforation, delayed weight loss, abdominal mass.
Detection of Streptococus bovis bacteriemia while investigating the etiology of
fever
It might suggest.
While right colon cancers generally go with bleeding, left colon cancers are
generally obstructed.
(Answer D)
197
GENERAL SURGERY
24.
Which of the following is a diagnosis of hereditary nonpolyposis colorectal cancer?
is not one of the necessary criteria? (September 2005)

A) At least 3 relatives of the patient have colon cancer
B) At least one of the affected relatives has first degree affinity
C) Presence of the disease for two generations
D)
More than one tumor focus
TO)
At least one of the relatives of the disease before the age of 50

LYNCH I:
polyps
There is no extracolonic manifestation (malignancy outside the colon is rare.
LYNCH II:
Colorectal, endometrial, ovarian, gastric, hepatobiliary, upper urinary tract
cancers are accompanied. So
extracolonic manifestation is available.
Mutations in DNA repair genes in affected individuals (DCC mutation, miss-match
repair
gene mutation). Around 80 years of colorectal CA develops in 80% of patients.
It mostly holds the right column (70%).
common. Synchronous - metachronous lesions were seen in 40% of the patients.
Lynch syndrome
It is considered.
Amsterdam Criteria
Presence of colorectal Ca in at least one first degree relative and at least 3
relatives
Presence of colorectal Ca in at least two consecutive generations
At least one of them is under 50.
(Answer D)
25.
An elderly patient presenting with massive lower gastrointestinal bleeding

A) Colon tumor
B)
Hemorrhoids
C) Polyp
D)
diverticulosis
TO)
Inflammatory bowel disease

(Answer D)
198
26. Which is one of the radiological findings of Crohn's disease

A) Long segmentary stenosis in the terminal ileum
B) Fistulization with neighboring organs
C) Common loss of australia in colon involvement
D)
Segmentary and asymmetric bowel involvement
TO)
Mucosal linear ulcers and cobblestone findings
RADIOLOGICAL FINDINGS IN CROHN'S DISEASE:

Nodular contour
Linear and deep ulcers
Fistulas and abscesses
View of paving stone (due to Serosa involvement)
Thickening and asymmetry in the intestinal wall (since the involvement is
irregular)
Pushing of intestinal loops
Diffuse narrowing of lumen (Rope Mark of Kantor> Depending on mucosal and muscular
involvement)
Presence of disease-free intact areas (skip pad)
Sinuses, fistulas (internal and external)
(Answer C)
27.
Metastasectomy is most useful in metastatic liver cancer
cancer is one of the following? (September 2003)

A) Pancreatic cancer
B)
Colorectal cancer
C) Gallbladder cancer
D)
Lung cancer
TO)
Malignant melanoma
The most common tumors of the liver are metastatic tumors. 1/3 of all tumors in the
body
metastasis to liver by hematogenous way. Isolated hepatic metastases mostly come
from colonic metastases and neuroendocrine tumors. Metastases are most commonly
transmitted to the liver via the portal vein.
Among the small intestine tumors, the most common metastasis to the liver is
carcinoid tumor.
If there is peritoneal spread, it causes acid. Metastasectomy is most useful in
metastatic liver cancers. Colorectal cancers and Wilms tumors.
(Answer B)
28.
Which of the following is the most common cause of colesical fistula formation?
(September 2003)
A) Diverticulitis
B)
Intraabdominal abscess
C) Trauma
D)
Colon cancer
TO)
Radiation enteritis
199
GENERAL SURGERY
GASTROINTESTINAL FISTULES:
Fistula: Apart from the normal anatomical course and endings of the lumen of the
hollow organs,
opening of an organ or skin surface at an abnormal location. Reasons:
Diverticulitis (the most common cause of cholesical fistulas)
Previous operations
traumas
Intraabdominal infections
Granulomatous bowel diseases
- Fistulas are divided into two according to flow rate. Low flow fistula with flow
rate below 500 ml / day
fistulas, high flow fistula has a flow rate of over 500 ml / day.
FACTORS AFFECTING THE SPONTANEOUS HEALING OF THE FISTULA
Very short (<2cm) fistula tract
Epithelialization of the fistula tract
Active granulomatous bowel disease
Abscess, foreign body in fistula tract
Obstruction of the distal bowel segment
Presence of radiation enteritis
Nutritional disorder
Presence of tumor in fistula tract
(Answer A)
29.
A 40-year-old male patient had pain in the anal area during defecation.
and then he is admitted with the complaint of bleeding in the form of dripping. For
this patient
Which of the following is the most likely diagnosis? (September 2002)
A) Rectal cancer
B)
Perianal fistula
C) Perianal abscess
D)
Condyloma acuminata
TO)
Anal fissure
ANAL FISSURE:
It is the name given to the anoderm cleft in the posterior or anterior midline,
just distal to the dentate line.
90% is located in the rear midline, 10% is in the front midline.
Pain in the defecation can be among the symptoms of drip bleeding.
In the etiology, high sphincter pressure and mucosal ischemia are accused.
Skin tag + hypertrophic anal papilla + anal ulcer ır It is called chronic anal
fissure.
The presence of multiple fissures with atypical localization in the anal area
should suggest Crohn's disease.
(Answer E)
200
30.
A 64-year-old man with complaints of fatigue and fatigue.
There were no pathological findings on physical examination. Low serum iron level,
high transferrin level, stool secretion
blood was found to be positive.
2002)
A) Crohn's disease
B) Diverticulosis
C) Right colon tumor
D)
Left colon tumor
TO)
Inflammatory bowel disease

(Answer C)
31.
An anal canal epidermoid carcinoma located below the dentate line is the most
common
Which lymph nodes metastasize? (April 2002)

A) Superior rectal
B) Internal pudental
C) Obturator
D)
hypogastric
TO)
inguinal
Anal canal squamous carcinomas are usually of the nonkeratinized type. It is more
common in women. Other
It is detected incidentally during the examination of benign anal canal diseases.
Dentate line
cancers metastasize to inguinal nodes. If the dentate is above the line
it spreads to the superior rectal, internal, pudental, hypogastric, or obturator
lymph nodes. colorectal
most common distant metastases to the liver.
(Answer E)
32.
Which of the following should be done primarily in the diagnosis of colon cancer
is not one of the examinations required? (April 2002)

B) Abdominal ultrasonography
C) Rectosigmoidoscopy
D)
Barium column radiography
TO)
colonoscopy
201
GENERAL SURGERY
60-70% of colorectal carcinomas are located at the rectosigmoid junction and are
usually at the distance of rectal touch.
In colorectal cancers, colonoscopy allows the examination of the entire arm. Biopsy
and identification of synchronous tumors. Barium column radiograph colorectal
is a frequently used technique in the diagnosis of carcinomas and has better
results with double contrast technique.
obtainable. Appearance of apples is typical in scirous and annular lesions.
Rigid sigmoidoscope 25 cm, flexible sigmoidoscope 60 cm intestine segment
examination
It provides.
Computed tomography is an effective method for staging the tumor and determining
the metastases.
imaging method.
Transrectal USG for the detection of wall invasion and lymph nodes of rectal
cancers
available.
(Answer B)
33. Which is one of the high risk factors involved in the development of colon
cancer
a)
Adenocarcinoma in another organ
B)
C.)
Presence of familial adenomatous polyposis
D) The presence of ulcerative colitis for more than 10 years

E) Being over 50
PATIENTS IN HIGH RISK GROUP IN TERMS OF COLON CANCER:
Patients over 50
Premalignant lesions
Patients with ulcerative colitis for more than 10 years
Crohn's disease with stricture formation
Familial adenomatous polyposis syndromes
Hereditary nonpoliposis colon cancer syndrome
Colon polyp history
Peuts - Jeghers syndrome
(Answer A)
34. A 40-year-old female patient was taking antibiotics with perianal abscess
drainage.
What do you think first of all if the perianal discharge starts a month later?
(September 2001)
A) Pilonidal sinus
B)
Anal fissure
C) Rectovaginal fistula
D)
Perianal fistula
TO)
Hemorrhoids
202
PERIANAL FISTULA:
Perianal abscess drainage, fissure, tuberculosis, Crohn's disease, presence of Ca,
radiation colitis, and history of radiotherapy, actinomycosis and chlamydia
infections play a role in the etiology.
Localization
70% intersphincteric fistula (most common)
25% transsphincteric fistula
4% suprasphincteric fistula
1% extrasfinkteric fistula Clinically progresses to purulent discharge.
The main purpose of treatment; preservation of anorectal function and eradication
of sepsis.
For this, fistulotomy and fistulectomy can be performed.
(Answer D)
35.
The malignant potential of colorectal polyps is
bounce? (April 2001)

A) Inflammatory polyp
B) Juvenile polyp
C) Metaplastic polyp
D)
Villous adenoma
TO)
Tubular adenoma

(Answer D)
36. A 50-year-old patient who had fecal urine in his colonoscopy
fistula was detected. What is the most likely diagnosis in this patient? (April
2001)
A) Crohn
B) Diverticulitis
C) Angiodysplasia
D)
Column Ca
TO)
Ulcerative colitis
In this patient enteresical fistula is present and the most common cause is
diverticulitis. also
The age of the patient and the table described are typical for diverticulitis.
(Answer B)
203
GENERAL SURGERY
37.
Which of the following matches is incorrect? (April 2001)

A) Peutz jeghers - mucosal hyperpigmentation
B) Gardner syndrome - osteoma
C) Carcinoid tumor - glossitis
D)
Turcot syndrome - CNS tumors
TO)
Behçet - Oral and genital ulcers
GARDNER SYNDROME
- Epidermoid cyst, osteoma, desmoid tumor, upper GIS neoplasms, multiple
adenomatous polyps
TURCOT SYNDROME
Adenomatous polyp + CNS tumors
PEUTZ-JEGHERS SYNDROME:
- Hamartomatous polyps are seen in mucocuteneal hyperpigmentation + GIS.
- It is inherited as an autosomal dominant.
- Breast, cervix, ovary, thyroid, lung, skin, gallbladder, pancreas, testicular Ca
increased risk of extraintestinal manifestation.
- Stomach, colon, small intestine Ca risk is increased.
- It may cause complications such as bleeding, invagination.
- Polypectomy should be performed even if the treatment is asymptomatic. Because at
a very low risk
There is a possibility of developing malignancy. In these patients, both the small
intestine and colon
complications, invagination, perforation, obstruction
are likely to be seen.
- The follow-up of the patients is performed by annual colonoscopy.
ENTERO BEHÇET DISEASE:
- Behçet's involvement with gastrointestinal involvement is typical of aphthous and
genital ulcers in the mouth.
- Vasculitis involving venules is typical in Behcet's disease with GIS involvement.
- The disease occurs in attacks.
- Comes with nausea, vomiting, abdominal pain, fever, diarrhea, mass and melena.
- Steroids can be used for treatment. If no response is obtained, surgery may be
necessary.
CARCINOID TUMOR:
- (the most common neuroendocrine tumor of GIS); they originate from neuroendocrine
cells such as enterochromaffin and argentaffin cells. Tumor secretion products
(serotonin and other
carcinoid syndrome occurs when vasoactiveamines are introduced into the systemic
circulation. This is
It shows a picture characterized by episotic flushing, wheezing, diarrhea and
cardiac symptoms.
Glossite is not observed.
(Answer C)
38.
Which is the absolute operation indication for Crohn's disease?
(Eylül2001)
A) Asymptomatic recurrence
B)
Gastrointestinal fistula
C) Intestinal obstruction
D)
Free perforation
TO)
Intraabdominal abscess
204
INDICATIONS OF SURGICAL TREATMENT IN CORHN'S DISEASE:

• Obstruction (Most common). Since inflammation is full-thickness, healing in
muscularis occurs with stricture.
This causes obstruction.
• Fistula formation (non-fistulas)
• Abscess
• Perforation
• Severe perianal involvement
• Non-response to medical treatment
• The presence of Ca
• Bleeding
(Answer A)
39. What is not a feature of Peutz-Jeghers syndrome? (September 2001)
A) Mucocutaneous pigmentation
B)
Multiple polyps
C) Osteoma
D)
Colic Pain
TO)
the intussusception
PEUTZ-JEGHERS SYNDROME:
Mucocutaneal hyperpigmentation + GIS shows hamartomatous polyps.
It is inherited as autosomal dominant.
Breast, cervix, ovary, thyroid, lung, skin, gallbladder, pancreas, testis Ca
increased risk of extraintestinal
manifestation.
Stomach, colon, small intestine Ca risk is increased.
It may cause complications such as bleeding and invagination.
Polypectomy should be performed even if the treatment is asymptomatic. Because
there is a possibility of developing malignancy even at very low risk. In these
patients, both the small intestine and colon
Since it is a polyp, complications related to the polyp, invagination, perforation,
obstruction
There is a high probability.
Follow-up of the patients is performed by annual colonoscopy.
GARDNER SYNDROME:
Epidermoid cyst, osteoma, desmoid tumor, upper GIS neoplasms, multiple adenomatous
polyps
accompanies.
(Answer C)
40.
If the ileocecal valve is normal, if sigmoid obstruction is present,
Where does perforation occur most frequently? (April 2000)

A) Immediate distal obstruction
B)
Immediate proximal obstruction
C) Terminal ileum
D)
cecum
TO)
Transverse column
According to the law, the highest pressure will occur in the widest place, because
the column is usually from the cecum.
perforated.
(Answer D)
205
GENERAL SURGERY
41. Which is the absolute operation indication for ulcerative colitis?

(Nisan2000)
A) Bleeding
B)
Toxic megacolon
C) Perforation
D)
obstruction
TO)
Colectomy for cancer prevention
INDICATIONS OF SURGICAL TREATMENT IN ULCERATIVE COLITIS:

Emergency surgery
- Toxic megacolon
- Column perforation
- Serious bleeding
Elective surgery
- Non-response to medical treatment
- Inability to tolerate medication
- Development of side effects
- Presence of dysplasia
(Answer E)
42.
Which is the first to be done in a patient with massive hematocesia?
(September 2000)
A) Nasogastric probe
B)
rectoscopy
C) Angiography
D)
scintigraphy
TO)
Tomography
The most common causes of lower gastrointestinal bleeding:
Meckel's diverticulum in infants and children (most common), Polyps, Ulcerative
colitis, Duplication.
- Young Adult Meckel's diverticulum (most common), Inflammatory bowel disease,
Polyps
- Diverticulosis (most common), Inflammatory bowel disease, Polyps in adults up to
60 years
Malignancy, Arterio-venous malformations
- Angiodysplasia is the most common cause of lower GIS bleeding over 60 years of
age.
- Vascular ectasia (most common), Diverticulosis, Malignancy, Polyps (over 60
years)
The most common cause of massive lower gastrointestinal bleeding is diverticulosis.
- Rarely at any age: Infectious diarrhea (shigella, amoeba), ischemic colitis,
varicose veins, coagulopathy, may cause GIS bleeding.
Diagnosis for lower gastrointestinal bleeding:
- Nasogastric catheter; eliminate the possibility of bleeding from the upper
gastrointestinal tract origin
must be done (to be done first)
- Rectoscopy
- Colonoscopy
- Angiography
- Technetium marked erythrocyte scintigraphy.
(Answer A)
206
43.
Recurrent lower gastrointestinal bleeding and tenesm 70
What should be considered first in the patient? (April 99)

B) Chron's disease
C) Column diverticulum
D)
Rectal cancer
TO)
Internal hemorrhoids

(Answer D)
44. In which localized colon cancer is Fe deficiency anemia most common?
(April 98)
A) Ascending column
B) Transverse column
C) Descending column
D)
sigmoid
TO)
Rectum
The right column is wider than the left column. Right colon cancers (ascending
colon) are ulcerated. This
therefore, deficiency anemia occurs due to chronic blood loss without changing the
color of the stool. Left
Colonic cancers are usually annular, so colic-type abdominal pain and obstruction
are common symptoms.
(Answer A)
45.
Around sixty years of age with the least chance of causing GIS bleeding

A) AV malformation
B) Polyp
C) Carcinoma
D)
diverticulosis
TO)

(Answer E)
207
GENERAL SURGERY
46.
Seventy-year-old patient with sudden onset of gas stool failure, generalized
abdominal tenderness, distension, fever, and leukocytosis, and if an inverse U view

is detected on a direct abdominal X-ray, which is the most likely diagnosis?
(September 98)
A) Toxic megacolon
B) Sigmoid volvulus
C) Ulcerative colitis
D)
Sigmoid colon cancer
TO)
Rectal cancer
volvulus:
SIGMOID VOLVULUS
- Cramp-like abdominal pain, distension, obstacle symptoms.
- The presence of leukocytosis, fever, and peritoneal irritation
He really is.
- Reverse U, omega mark / coffee bean image is dominant in ADBG.
- An x-ray with barium enema may show “Bird beak deformity..
- First rigid sigmoidopexy is tried. If unsuccessful, the volvulated sigmoid
segment is surgically removed. Anastamosis or Hartman procedure can be performed in
surgical treatment.
In intestinal obstructions:
one. Replacement of fluid-electrolyte loss
2nd. Decompression (NG)
3. Antibiotic in appropriate dose with broad spectrum
4. Appropriate surgical treatment
(Answer B)
208
47.
What is the most common anal fistula? (September 98)

A) Intersphincteric
B)
Transsfinkterik
C) Suprasphincteric
D)
Ekstrasfinkterik
TO)
İnfrasfinkterik
PERIANAL FISTULA:
- Perianal abscess drainage, fissure, tuberculosis, Crohn's disease, presence of
Ca, radiation colitis, and history of radiotherapy, actinomycosis and chlamydia
infections play a role in the etiology.
- Localization
• 70% intersphincteric fistula (most common)
• 25% transsphincteric fistula
• 4% suprasphincteric fistula
• 1% extrasphincteric fistula
- The clinical course is continuous purulent discharge.
- The main purpose of treatment; Preservation of anorectal function is eradication
of sepsis.
- Fistulotomy and fistulectomy can be performed for this.
(Answer A)
48.
Segmental involvement in non-cascading granulomatous lesion involving all layers
Which disease does it suggest? (September 98)

A) Crohn's disease
B)
Ulcerative colitis
C) Radiation colitis
D)
Tuberculosis
TO)
Sarcoidosis
CROHN'S DISEASE:
- Spontaneous improvements and acute exacerbations in any or all parts of GIS
is a chronic inflammatory disease.
- The terminal ileum is most commonly involved.
- The etiology is unknown, but the risk is very high in people with a family
history. This means that immunological mechanisms dominate the event.
• Severe edema of the mucosa and submucosa, aphthous ulcers, linear ulcers and
intestinal wall
complete involvement is seen.
• Stenosis due to submucosal involvement and submucosal fibrosis may occur.
• Involvement of all layers (transmural involvement) is pathagonomic for Crohn.
• Full-thickness inflammation, hopping involvement and coexistence of healthy bowel
segments
It is pathognomonic.
• Granulomas are non-caseified and 50% are present.
• Can be seen at any age (more often at age 30-40).
• Pain is the most common symptom. Malabsorption secondary to diarrhea and weight
loss can be seen.
• Obstruction, perforation, internal fistula (the abscess adhering to the
surrounding tissues,
(Answer A)
209
GENERAL SURGERY
49.
Which is the most common cause of colesical fistula?September 98)

A) Radiation fistula
B) Crohn's disease
C) Diverticulitis
D)
Tuberculosis
TO)
Ulcerative colitis
See explanation of question 36.

(Answer C)
50.
Which of the following is the least likely to become cancerous? (April 97)
A) Colitis ulcerosis
B) Gardner syndrome
C) Familial polyposis
D)
Juvenile polyp
TO)
Villous adenoma

(Answer D)
51. It is known that the consumption of excess fat plays a role in the etiology of
some cancers.
Which of the following is common in populations with high fat consumption?
(April 97)
A) Breast Ca, Colon Ca
B) Lung Ca, Larynx Ca
C) Oral Cavity Ca, Stomach Ca
D)
Brain Ca, Bone Ca
TO)
Liver cancer, bile duct cancer
Colon cancer tends to be more common in socioeconomic societies. that

meaning that environmental and dietary factors play a role in the etiology of colon
cancer. in diet
high animal protein intake and fatty foods play a role in the etiology of colon
cancer.
Aspirin can be said to prevent or reduce the risk of colon cancer.
It is thought that the consumption of excess fat has a role in the etiology of
breast cancer.
Colon malignancies also increase with consumption of red meat.
(Answer A)
210
52.
If GIS bleeding is present in the colon diverticulum
It can not be done? (September 97)

A) Upper GIS endoscopy
B) Colonoscopy
C) Barium graphy
D)
Angiography
TO)
rectosigmoidoscopy
CT is the best diagnostic method for colon diverticulitis during acute attacks.
During acute attack
Since perforation and barium used may leak into the intraperitoneal area
X-ray is contraindicated in acute diverticulitis. Water-soluble contrast if
absolutely necessary
radiographs. X-ray and colonoscopy during the episode of diverticulitis
Contraindicated.
(Answer C)
53.
Where do the adenomatous polyps of the colon most commonly reside? (September 97)
A) Ascending column
B) Transverse column
C) Cecum) Descending colon
TO)
rectosigmoidal
The distribution of colorectal Ca and colon polyps are similar. In 2 cases, the
most common rectosigmoid junction is located in the ascending column, descending
column and transver column respectively.
The malignancy potential of adenomatous polyps is directly proportional to the size
of the polyp.
Adenomatous Polyp
- Silent / Semisil
- Tubular
(65-80%)
* Malignancy potential increases and
prognosis worsens.
- Tubulovillous
(10-25%)
- Villous
(5-10%)
Malignant potential increases as villous component increases in adenomatous polyps.

Arrow increase in malignancy
direction, while the opposite arrow indicates the incidence.
(Answer E)
211
GENERAL SURGERY
54.
What is the most common symptom in rectal cancer? (September 97)

A) Hematocesia
B)
Diarrhea
C) Weight loss
D)
tenesmus
TO)
Colic Pain
RECTUM CANCER SYMPTOMS:

- The most common symptom is hematocesia,
- The first symptom is a change in defecation pattern,
- Abdominal pain, obstruction, perforation,
- Late finding is seen as weight loss, abdominal mass.
- Detection of streptococus bovis bacteriemia when investigating the etiology of
fever.
.
- Rectal cancer has a feeling of tenesmus and complete emptying. Until the anal
canal is invaded
Much pain is not evident.
(Answer A)
55.
According to TNM classification in colon Ca, the wall was completely invaded and
paraco-
is the distant metastasis stage with lymph node involvement? (September 97)
A) Stage0
B) Stage 1
C) Stage2
D)
Evre3
TO)
Evre4
STAGING
Modified Dukes (Astler– Coller) Classification
Stage A: Tumor localized to the mucosa
Stage B1: Tumor muscularis did not exceed propria, no lymph node involvement
Stage B2: Tumor muscularis exceeds propria, no lymph node involvement
Stage D: Metastasis
TNM Staging
Tis: Carcinoma in situ
T1: Tumor involved submucosa
T2: Tumor involved muscularis propria
212
(Answer D)
56.
Which of the following findings is not seen in Crohn's disease? (September 97)
a)
Recurrent abdominal pain
B)
Diarrhea
C.)
Fire
D) Arthritis
E) Pancreatitis
CROHN DISEASE FINDINGS:
- Pain is the most common symptom. Malabsorption secondary to diarrhea and weight
loss can be seen.
- Obstruction, perforation, internal fistula (inflamed area adhering to surrounding
tissues, abscess,
fistula, fissure, sinus), abscess, fatigue, fever, arthritis, abdominal mass can be
seen.
(Answer E)
57.
Which of the following is the main cause of anal abscesses and fistulas? (April 96)
A) Crohn's disease
B) Trauma
C) Surgical operation
D)
Hemorrhoids
TO)
Anal gland and crypt inflammation
Perianal fistulas with mixed bacterial invasion of anal crypts of anorectal

abscesses
It develops. Anorectal fistula is usually a spontaneous or surgical procedure of a
pyogenic abscess.
occurs due to discharge. Most fistulas are caused by anorectal crypts. Abscess and
Tuberculosis and Crohn 's are among the causes of fistula, but these are not the
most common causes.
(Answer E)
213
GENERAL SURGERY
58.
A 35-year-old male patient presented with right lower quadrant pain, diarrhea,
What is the most likely diagnosis if there are fistulas opening to the skin?
(September 96)
B)
Cystic fibrosis
D)
Crohn's disease
TO)
Tuberculosis
Pain, diarrhea and fistula coexistence should bring CROHN to mind.

(Answer D)
59.
Lateral Partial Sphincterotomy for the treatment of which disease?

(September 96)
A) Anal fistula
B)
Anal fissure
C) Anal abscess
D)
Hemorrhoids
TO)
Ulcerative colitis
ANAL FISSURE:
- It is the name given to the anoderm cleft in the posterior or anterior midline,
just distal to the dentate line.
- 90% in the rear center line, 10% in the front center line.
- In defecation, pain and drop-bleeding may be among the symptoms.
- High sphincter pressure and mucosal ischemia have been implicated in the
etiology.
- Skin tag + hypertrophic anal papilla + anal ulcer ır It is called chronic anal
fissure.
- The presence of multiple fissures with atypical localization in the anal region
may cause Crohn's disease.
should think.
- Lateral partial internal sphincterotomy is applied for treatment.
(Answer B)
60.
What is the most common cause of cholesical fistula? (September 96)

A) Diverticulitis
B)
Crohn's disease
C) Bladder carcinoma
D)
Colon corsinoma
TO)
Ulcerative colitis

(Answer A)
61.
What is the first step in the treatment of sigmoid volvulus? (September 96)
A) Nasogastric decompression
B) Emergency surgical resection
C) Decompression with rigid sigmoidoscope
D)
Elective surgical resection
TO)
Open with barium enema
214
SIGMOID VOLVULUS
- Cramp-like abdominal pain, distension, obstacle symptoms.
- The presence of leukocytosis, fever, and peritoneal irritation
indicates that.
- Reverse U, omega mark / coffee bean image is dominant in ADBG.
- An x-ray with barium enema may show “Bird beak deformity..
- First rigid sigmoidopexy is tried. If unsuccessful, the volvulated sigmoid
segment is surgically removed. Anastamosis or Hartman procedure can be performed in
surgical treatment.
(Answer C)
62.
The strongest finding supporting a malignant colon polyp

A) Multiple mucosal ulcers
B)
Ulcer diameter greater than 1 cm
C) Tumor reaching Lamina Propria

D)
Presence of multiple polyps
TO)
Muscularis mucosal invasion
Invasion is the strongest finding indicating that the stem polyps are malignant.
muscularis
mucosal involvement is a stage II tumor.
(Answer E)
63. A patient with active ulcerative colitis has abdominal diarrhea for the last 12
hours,
on a distilled table. Transverse abdominal X-ray
The column is overfilled with gas and monitored at a diameter of 9 cm.
Which of the following is not done to this patient? (April 95)
A) Cutting of oral food to nasogastric decompression
B) Anticholinergic administration
C) Steroid administration
D)
Broad spectrum antibiotic and IV fluid
TO)
Rest cure
Toxic megacolon due to transverse colon diameter above 8 cm

It was developed.
Toxic megacolon is a complication of ulcerative colitis with a high risk of
perforation. Intraluminal pressure
Increasing anticholinergics and barium colon radiography are contraindicated in
toxic megacolon.
(Answer B)
64.
First choice for determining upper gastrointestinal bleeding localization
which method is the following? (September 95)

A) Nasogastric probe
B)
Tomography
C) Endoscopy
D)
Selective angiography
TO)
Esophageal-stomach-duodenum radiography
215
GENERAL SURGERY
UPPER GIANT HEMORRHAGE

- Bleeding from the upper part of the Treitz ligament.
- Hematemesis: Bloody vomiting in fresh bright red color or coffee grounds. This
appearance occurs as a result of digestion of blood with gastric acid
- Melena: It is a stool-like bleeding that looks like a bright, black, smelly tar.
In order to form Melena at least 50 ml. There should be blood loss.
- Hematocesia: Bleeding manifested as a bright red stool. hematochezia
can also be seen in patients with upper GI bleeding when the passage is accelerated
(amount of bleeding> 1 liter).
•
Hematemesis and blood in the stool in the period following melee may remain
positive for 21 days.
Endoscopy is the first diagnostic procedure for the diagnosis of upper GIS
bleeding.
(Answer C)
65.
Where is the most common occlusion caused by colorectal carcinomas? (September 95)
A) Ascending column
B)
Transverse column
C) Sigmoid colon
D)
cecum
TO)
Hepatic flexura
The largest part of the cecum column is the narrowest part of the sigmoid column.
Therefore, right colon tumors usually present with iron deficiency anemia secondary
to bleeding, while left colon tumors
because the left colon is narrower, it presents with obstruction. Sigmoid colon
most of the colon
It is the colon segment where the obstruction is most common in the tumors because
it has a narrow space.
(Answer C)
66. What causes cecum perforation due to rectosigmoid obstruction?
(April 94)
A) Free posterior part of cecum
B) Circular muscle of cecum
C) Large cecum
D)
Retroperitoneal
TO)
Low blood flow
According to the law, the highest pressure will occur in the widest place Column is
usually from the cecum
perforated.
(Answer C)
67.
Which rarely causes tumor-like formation in the intestinal wall?
It is si? (April-94)
A) Giardia
B)
rotavirus
C) Askaris
D)
Amoeba
216
TO)
Schistozomiazis
AMEBIC COLLITE:
- The agent is E. histolytica.
- Invasive amebiasis is a finding with small ulcers in the colon and most commonly
seen in the cecum, which is detected as a palpable mass in the right lower quadrant
during physical examination.
- Person with amebic colitis may be an asymptomatic carrier or may present with
bloody diarrhea.
- Amebic colitis should be differentiated from Crohn's and Ulcerative colitis.
- Diagnosis is made by the presence of trophozoites on stool microscopy.
- Metronidazole + iodoquinol is used for treatment.
- Antibiotherapy if ameboma (inflammatory mass) has occurred in the cecum due to
invasive amibiasis
Applied,
If no response is obtained, it is surgically excised.
(Answer D)
68.
What is the most common complication of Crohn's disease? (April 93)

a)
Cancer development
B)
stricture
C.)
Fistula
D) Perforation
E) Obstruction
See explanation of problem 48.
(Answer E)
69.
Which ulcerative colitis is not seen? (April 93)

A) Uveitis
B) Arthritis
C) Necrotizing fasciitis
D)
TO)
Erythema nodosum
EXTRAINTESTINAL FINDINGS IN ULCERATIVE COLITIS:

•
Musculoskeletal system:
- Ankylosing spondylitis
- Peripheral arthritis
The most common extraintestinal finding is reversible. For this reason, it is used
in the follow-up of treatment.
•
Leather and mouth

- Erythema nodosum
- Pyoderma gangrenosum
- Aphthous stomatitis
Pelvic osteomyelitis
Eye
- Uveitis
- Episcleritis
217
GENERAL SURGERY
Blood and vascular system

- Anemia (Fe deficiency, Vit B12 or folate deficiency)
- Thrombocytosis
- Leukocytosis
- Hypercoagulability
Kidney and genitourinary system

- Nephrolithiasis
- Obstructive uropathy
- Genitourinary system fistulas
Other
- Bronchopulmonary vasculitis
- Pleurocarditis
(Answer C)
70.
Which is unexpected in anorectal abscess and fistula? (April 93)

A) Tuberculosis
B)
Ulcerative colitis
C) Granulomatous colitis
D)
diverticulosis
TO)
Actinomycosis
Anorectal abscess, perianal abscess drainage, fissure, tuberculosis, Crohn's

disease, Ca
presence, radiation colitis, ulcerative colitis, granulomatous colitis, history of
radiotherapy, actinomycosis
and chlamydia infections are blamed in the etiology. Generally anorectal abscess in
diverticulosis
and fistula is not expected.
(Answer D)
71.
What is the most common symptom of regional enteritis? (September 93)

A) Fire
B)
Bleeding
C) Diarrhea
D)
obstruction
TO)
Fistula
The most common symptom in Crohn's Disease is pain. However, the most common among
the items mentioned in the question
the finding is diarrhea.
(Answer C)
72.
Which part of the large intestine most commonly involves idiopathic colitis
ulcerosis?
(April 91)
A) Cecum
B) Outgoing column
C) Rectum
D)
Transverse column
TO)
Descending colon
218
CHARACTERISTICS OF INFLAMMATORY BOWEL DISEASES:

Ulcerative colitis
Crohn's
Localization
Rectum, left colon
Anywhere
Rectal involvement
Almost always
About 50%
Fistula
Rare
Stylish
Ulcer
Irregular, widespread involvement
Paving stone view, full floor

involvement due to serosal involvement
Shortness
Rare (suspected carcinoma)
Frequent (Mucosa, submusical involvement)
carcinoma
Incidence increases
Incidence increases
Toxic colon dilatation
More often (due to diffuse involvement)
More rare
diarrhea
Stylish
Stylish
Rectal bleeding
Frequent, Continuous
Rare, Intermittent
tenesmus
Stylish
No
Abdominal pain
Rare
Stylish
Fire
Rare
More often
Vomiting
No
Stylish
Weight Loss
Rare
Stylish
Perianal disease
No
Stylish
Abdominal mass
No
Stylish
Malnutrition
Rare
Rare
Ulcerative colitis
Crohn's
Endoscopic discrimination
Edema, erythema, rectal involvement
Aphthous ulcers, perianal disease,

rectum intact
Interim findings
Granular appearance with contact

bleeding
Linear ulcers, flagstone

appearance, solid areas in between
Individual ulcers, pu
Contact bleeding, combined ulcers, strictures (Muscular layer

stricture and stenosis
Is seen)
Symptoms and signs
Late Findings
Ulcerative colitis usually involves the rectum in all cases.

(Answer C)
73.
Perforation is most common if there is complete obstruction by tumor formation in

the sigmoid colon
where is it seen? (April 91)

A) Cecum
B)
Sigmoid colon
C) Transverse column
D)
Hepatic flexura
TO)
ileum
Due to the large diameter of the cecum, it is subjected to more pressure. According
to Laplace Law
perforation often occurs here.
(Answer A)
219
GENERAL SURGERY
74. A fifty-five-year-old patient had polyp in the transverse colon. If biopsy

comes as adenomatous polyp and there is no malignancy
It is? (September 91)
A) Colostomy
B) Segmentary colostomy
C) Total colostomy
D)
Local excision
TO)
Chemotherapy
Treatment of adenomatous polyps is polypectomy and the decision of wide excision is

absence, surgical margin positively and negatively. Surgical margin is negative and
no Ca
local polypectomy is sufficient treatment.
(Answer D)
75.
Which of the following most frequently requires surgical intervention in Crohn?

(September 91)
A) External fistula
B) Perforation
C) Bleeding
D)
Internal fistula
TO)
Obstruction + stricture
Crohn's disease has segmental and complete involvement. Due to the full involvement
of the structure, obstruction may develop. Patients with signs of bowel
obstruction, abdominal mass and abscess, internal
and external fistula, perirectal fistula unresponsive to local treatment,
perforation of abdominal cavity, severe
bleeding and blind ans syndrome. However, recurrence is common after surgery.
If this question is perceived as the most common indication for surgery in Crohn's
disease, the answer is obstruction.
(Answer E)
76.
Which of the following does not exist in Gardner syndrome? (September 91)
A) Polyposis carton
B) Osteoma
C) Desmoid tumors
D)
Epidermoid cyst
TO)
Mucosal pigmentation
GARDNER SYNDROME:
Epidermoid cyst, osteoma of the mandible, epidermal inclusion cyst, tooth
anomalies, desmoid tumor,
upper GIS neoplasms, multiple adenomatous polyps. Mucocutaneous pigmentation
Peutz is seen in Jeghers syndrome.
(Answer E)
220
77.
Secondary cancer in which organ of someone with familial colorectal carcinoma
Is the risk of becoming more? (September 91)

A) Stomach
B)
Liver
C) Bronchus
D)
Bladder
TO)
endometrium

LYNCH I:
- Autosomal dominant inheritance.
-
polyps
- There is no extracolonic manifestation (malignancy outside the colon is rare).

LYNCH II:
- Autosomal dominant inheritance.
- Colorectal, endometrial, ovarian, gastric, hepatobiliary, upper urinary tract
cancers are accompanied.
-
In Lynch II syndrome, endometrial cancer is the most common concomitant of colon

carcinoma.

Mutations in DNA repair genes in affected individuals (DCC mutation, miss-match
repair
gene mutation). Around 80 years of colorectal CA develops in 80% of patients.
It mostly holds the right column. (70%)
common. Synchronous metachronous lesions are seen in 40% of the patients.
Lynch syndrome
It is considered.
(Answer E)
78. Only the closest lymph nodes are involved in colon cancer in the Dukes
classification
is the stage? (April 90)
A) Stage A
B) Stage B1
C) Stage B2
D)
Stage C
TO)
Stage D
DUKES STAGING
-
Dukes A: Tumor inside the colon wall
Dukes B: Tumor that crossed the colon wall but did not have lymph node metastasis
-
Dukes C: Tumor with lymph node metastasis
Dukes D: Distant metastasis

(Answer D)
221
GENERAL SURGERY
79.
Which of the following has no role in the etiology of rectal prolapse?
(April 90)
A) Chronic constipation
B)
Congenital causes
C) Connective tissue laxity
D)
Hemorrhoids
TO)
Long sigmoid colon
RECTAL PROLAPSUS
- It is the case where all the layers of the rectum come out of the anus.
Risk factors
- Elderly female patients
- Constipation-causing patients using psychiatric drugs
- Hysterectomies
- Patients with spinal cord trauma requiring routine laxatives
- Nulliparity
- Long rectosigmoid
- Douglas pouch is deep.
- Poor internal sphincter mechanism
- Pelvic floor defect (diastasis of levator sudden muscle)
- Anorectal operations such as hemorrhoidectomy, fistulectomy
- Internal rectal invagination
(Answer D)
80.
Where is colon cancer most common? (September 90)

B)
Rectosigmoid region
C.)
D)
Descending colon
Ileocecal region
TO)
Ascending column
98% of colon cancers are adenocarcinomas and usually develop from the background of
adenomatous polyps.
25% of colon cancers are located in the cecum or colon, 25% in the rectum and
distal sigmoid and 25% from the pattern in the colon and proximal sigmoid. In
general, 75% rectosigmoid region is located.
An important part can be detected at the touch.
(Answer D)
222
81.
What is the most common cause of perianal fistula? (September 90)

A) Perianal abscess
C) Tuberculosis
D)
Intersphincteric abscess
E) Crohn's disease
Mixed bacterial invasion of anorectal abscess pararectal distances usually caused
by anal crypts
develops with. Anorectal fistula is usually a spontaneous or surgical procedure of
a pyogenic abscess.
occurs due to discharge. Most fistulas are caused by anorectal crypts. Abscess and
Tuberculosis and Crohn 's are among the causes of fistula, but these are not the
most common causes.
The most common cause of perional fistula is perianal abscess.
(Answer A)
82.
What is the most common cause of anemia by occult bleeding? (April 89)
A) Left column Ca
B) Right colon Ca
C) Rectum Ca
D)
TO)
intussusception
because the left colon is narrower, it presents with obstruction.
(Answer B)
83.
If the rectosigmoid region is completely infiltrated by cancer and the lumen is

clogged the colon
from which region? (April 88)

A) Descending column
B) Lienal flexura
C) Outgoing column
D)
ileum
TO)
cecum
Because the cecum diameter is large, it is subjected to more pressure (Laplace's

law), where perforation often occurs.
(Answer E)
223
GENERAL SURGERY
84.
Malignant neoplasms with more obstructive symptoms
Which part of the intestines develop? (September 88)

B) Sigmoid colon
C) Hepatic flexure
D)
Ascending column
TO)
cecum
because the left colon is narrower, it presents with obstruction. Sigmoid colon
most of the colon
It is the colon segment where the obstruction is most common in the tumors because
it has a narrow space.
(Answer B)
85.
Which drug is not used to treat colitis ulcerosis?
(September 87)
A) Flurouracil
B) Corticosteroids
C) Azothiopurine
D)
immunosuppressives
TO)
Amino salicylic acid
In the treatment of ulcerative colitis diet is applied. The drug is sulfasalazine,

adrenocorticosteroids, immunosuppressives, 5-amino salicylic acid or antimicrobial
therapy. Surgery has a place in the treatment.
Opioids, anticholinergics are not given. 5-Florouracil has no place in the
treatment.
(Answer A)
224
Pancreas and Spleen Diseases and Surgery
Pancreas and Spleen

one. Which of the following is the most common indication for splenectomy?
(September 2011)
a)
Immune thrombocytopenic purpura
B) Cyst in the spleen

C.)
Hereditary spherocytosis
D)
Trauma
TO)
Portal hypertension
Indications for splenectomy:

A ile For the purpose of disease control and staging;
Trauma (most often)
•
Hereditary Spherocytosis, elliptocytosis (exact indication)
Sickle cell anemia, autoimmune anemia
ITP, TTP
Splenic cysts and tumors
Hodgkin's lymphoma
Primary spleen tm (definite indication)> most common malignant tm angiosarcoma
In the presence of splenic artery aneurysm, splenectomy is performed to control the

disease.
B amacıyla For the purpose of hypersplenism;
Hairy cell leukemia
Lymphoproliferative diseases (CML, NHL)
Felty syndrome
Myeloid metaplasia
Thalassemia major
Gaucher's disease
Splenic vein thrombosis
•
Sarcoidosis
SLA
Por fi ria erythropoietica
Sickle cell anemia
AIDS
Thrombocytopenia associated with drug use
(Answer D)
TUSTIME ALL TASS QUESTIONS
225
GENERAL SURGERY
2nd.
Which one of the pancreatic pseudocysts, pancreatic serous cystic

is not useful in differentiating from neoplasms? (April 2010)
a)
Patient's history
B)
Amylase level of cyst content
C.)
Endoscopic retrograde cholangiopancreatography
D) Computed tomography
E) CA 19-9 level of cyst content
PSEUDOCYSTS
•
Serum in addition to continuous pain, fever and ileus during or after a

pancreatitis attack
If the level of amylase remains high, the pseudocyst should be considered.
CT is the most valuable diagnostic method.

•
Ultrasonography (which may also be useful as a preliminary examination prior to CT)

other pathologies.
ERCP, congestion in the Wirsung canal, or from the pancreatic duct of the dye into
the pseudocyst
extravasation. Thus, both pseudocyst and serous cyst filling can be seen.
It doesn't help. The most valuable diagnostic method for pseudocyst is CT.
Endoscopic retrograde
The presence of lymphocyte infiltration and fibrosis in the biobside of
cholangiopancreatography is pathophonomic for chronic pancreatitis.
The patient's history is more typical for the pseudocyst. Because after the attack
of pancreatitis does not fall fever
or development of the ileus should be considered as pseudocyst.
The amylase level of the cyst content increases in both pseudocysts and serous
cystic neoplasms, but it is higher in serous cystic neoplasms than pseudocyst.
available.
(Answer C)
3.
Indication of surgical treatment of chronic pancreatitis

a)
Pain unresponsive to treatment
B)
Suspected of pancreatic cancer
C.)
Duodenal obstruction
D) Exploration of common bile duct

E) Infected necrosis panreatitis
226
CHRONIC PANCREATITIS:
• Recurrent or persistent abdominal pain, pancreatic inflammation, endocrine or
exocrine pancreatic insufficiency is a condition.
• Pathologically, there is irreversible destruction of pancreatic tissue.
Etiology:
• Alcoholism
• Hyperlipoproteinemia
• Hypercalcemia
• Congenital anomalies of pancreatic duct (such as pancreatic divisum)
• Pancreatic trauma
• Hereditary pancreatitis.
Clinic
• Most patients (60-85%) are alcoholic.
• It is 2 times more common in men.
• Back pain is specific to pancreatitis.
Mechanisms that cause pain:
• Pressure increase in the pancreas parenchyma or duct
• Increased intrapancreatic nerve count
• Inflammatory events
• Peripancreatic edema
• Anorexia and weight loss
• Insulin-dependent DM develops in 1/3 of patients
• Steatore
Indications for surgical treatment:
• Pain: Continuous or unresponsive to medical treatment is the most common
indication for surgery.
Choledochus, duodenum and colon obstruction due to pancreatitis
• Pancreatic cancer suspicion
• Splenic or portal vein obstruction due to pancreatitis, splenic or portal
hypertension,
pseudocyts
Infected necrotizing pancreatitis; Acute pancreatitis is a complication and an
(Answer E)
4.
Determining the severity of acute pancreatitis

I.
C-reactive protein
II.
Serum amylase
III.
IL-6
IV.
procalcitonin
Which factors are useful in determining the level? (April 2009)

a)
Alone I
B)
I and III
C.)
II and III
D) II and IV
E) I, II, III, IV

227
GENERAL SURGERY
Acute pancreatitis is 80% edematous pancreatitis with supportive treatment.

heals without complications. The risk of complications is high in patients with
severe pancreatitis.
Distinguishing severe pancreatitis-edematous pancreatitis:
a- A decrease in alpha II macroglobulin level and an increase in complement levels
are in favor of necrotizing pancreatitis.
b- C-reactive protein: It is useful in determining the severity and prognosis of
acute pancreatitis. 48 hours
then it starts to rise.
c- IL-6: Complications secondary to pancreatitis and multiorgan insufficiency if
high
syndrome will develop.
d- Elevation of hemotocrit refers to excessive hemoconcentration and is indicative
of poor prognosis.
e- Detection of necrotizing pancreatitis on abdominal tomography means that
prognosis will be poor.
revenue.
(Answer B)
5.
To determine the prognosis of acute pancreatitis, the following Ranson criteria

which is not included in the initial application? (April 2008)
A) Age above 55
B) Arterial oxygen (pO2) level less than 60 mmHg
C) Glucose level above 200 mg / dL
D)
Leukocyte count above 16 000 / mm3
TO)
Lactate dehydrogenase level higher than 350 IU / lt
RANSON CRITERIA:
At the time of application:
- Age> 50
- White ball> 16. 000
- Glucose> 200 mg / dl
- LDH> 350 IU / L
- SGOT (AST)> 250 IU / dl
In the first 48 hours;
- Hematocrit drop> 10%
- Blood urea nitrogen increase> 8 mg / dl
- Serum Ca ++ <8 mg / dl
- Arterial Po2 <60 mmHg
- Base gap> 4 mEq / L
- Approximate fluid loss> 6 L
(Answer B)
6.
Which of the following diseases is Gray Turner? (September 2007)

a)
Acute hemorrhagic pancreatitis

B)
Portal hypertension
C.)
Acute appendicitis
D)
Ulcerative colitis
E) Acute duodenal ulcer
228
ACUTE PANCREATITIS
-
Non-activation of the gland's own enzymes and interstitial release
The typical finding is epigastric pain in the back.
Physical examination shows epigastric tenderness and bowel sounds.
Complications of pancreatitis such as phlegmon, pseudocyst and abscess should be

considered if there is an abdominal mass.
There is severe fluid loss.
Bluish color changes around the navel (Cullen) or lower back (Gray-Turner) (approx.
1%)
bacterial inflammation.
visible.
It is seen in hemorrhagic pancreatitis due to the dissection of tissues from the
periphery of the pancreas through the retroperitoneum.
(Answer A)
7.
Which is the most common islet cell tumor of the pancreas?

(Eylül2006)
A) Adenocarcinoma
B)
gastrinoma
C) Somatostatinoma
D)
insulinoma
TO)
glucagonomas
Insulinomas:
-
It is the most common islet cell tumor.
It originates from beta cells.
80% are single and benign and 15% are malignant.
Less than 5% are a part of MEN-1 syndrome and generally tend to be multiple.
Symptoms are due to cerebral glucose deficiency.
Behavioral disorder, memory loss, blurred consciousness, palpitations due to

sympathetic discharge
nervousness and sweating can be seen.
In general, the classical diagnosis is made with the Whipple triad.

- Symptoms of fasting hypoglycemia,
- Blood glucose levels below 50mg / dl during symptomatic periods
- Relieve symptoms with intravenous glucose.
- A insulin / glucose ratio above 0.3 is diagnostic for insulinoma.
- Proinsulin levels of more than 50% suggest malignant insulinoma.
Medical treatment
- Streptozocin (antibiotic and alkylating agent); Selective by Langerhans islet
cells
taken as; selectively and irreversibly destroying beta cells; S phase cells
more effective on; is also used in islet cell tumors that do not secrete insulin;
hepatotoxic, nephrotoxic effect.
- Diazoxide: Opens ATP-sensitive K + channels in beta cells; secretion of insulin
decreases
- Surgical excision is performed in cases that do not respond to medical treatment.
(Answer D)
229
GENERAL SURGERY
8.
Splenectomy due to splenic injury as a result of traffic accident 42

To protect an old patient against infection from the following approaches
Which one is the most suitable? (September 2006)
A) Long-term penicillin injection once a month starting on the day of discharge
B)
Immediately after splenectomy H. influenzae type B, meningococcal serogroup C,

polyvalent
pneumococcal triple vaccine
C) Polyvalent pneumococcal vaccine at two weeks postoperatively

D)
Immunostimulant drug administration to increase the patient's immune response and

polyvalent pneumococcal vaccine repeated once a month
TO)
Repeated IgG injection every month with penicillin prophylaxis
POST-SPLENECTOMY SEPSIS:
- Most often with pneumococcus. Meningococcus and H. influenza.
- If splenectomy is performed for hematologic or malignancy, the risk is greater.
- Most commonly seen in the first two years.
- Annual mortality is 1/300 in children and 1/1000 in adults.
- Fast course, hours of septic shock, DIC and death is seen.
- Vaccination should be performed 2 weeks before elective splenectomy to prevent
post-splenectomy sepsis,
vaccination should be performed immediately after traumatic splenectomy,
prophylactic penicillin in children
It should be used.
(Answer B)
9.
Which of the following is indicative of poor prognosis in acute pancreatitis?

(Nisan2006)
A) High serum amylase level
B) Hyperbilirubinemia
C) High urine amylase level
D)
Prolonged prothrombin time
TO)
Low serum calcium level
The low level of calcium is one of the 48th hour Ranson criteria and has a negative
effect on prognosis.
See also 4. Description of the problem
(Answer E)
10.
Which of the following is not one of the signs of gastrinoma? (April
2006)
A) Treatment-resistant ulcers
B) Constipation
C) MEN 1 syndrome
D)
Gastroesophageal reflux
TO)
Atypical ulcer
230
GASTRINOMA (ZOLLINGER-ELLISON SYNDROME):

- Gastric acid hypersecretion due to excessive gastrin-producing tumor.
- 60% non-beta islet cell tumor, 25% solitary adenoma, 10% microadenoma or
hyperplasia
can be seen in the form.
- Most are with MEN-1, most of which tend to be multiple and benign.
- Symptoms include peptic ulcer, gastroesophageal reflux, diarrhea.
- Ulcer, multiple or unusual ulcer or ulcer that does not heal with known antiulcer
treatments
Recurrent ulcer after surgery that is expected to heal should bring to mind
gastrinoma.
- Fasting hypergastrinemia (> 200pg / ml) is diagnostic.
- The treatment is medical first, and surgery can be performed in patients who do
not respond.
(Answer B)
11th.
Surgical treatment alone in chronic pancreatitis
is not one of the indications? (September 2005)

A) Pain causing narcotic habit
B) Portal vein obstruction leading to portal hypertension
C) Pseudocyst
D)
Pancreatic calcification
TO)
Choledochal obstruction
INDICATIONS FOR SURGICAL TREATMENT OF CHRONIC PANCREATITIS;

•
Pain: Continuous or unresponsive to medical treatment is the most common indication

for surgery.
•
Suspected of pancreatic cancer
Splenic or portal vein obstruction due to pancreatitis, splenic or portal

hypertension,
pseudocyts
Pancreatic calcification alone is not an indication for surgery.

(Answer D)
12. A 42-year-old female patient lost consciousness following behavioral changes

due to the hospital. Blood pressure and pulse rate are normal
The patient's blood sugar level is measured as 40 mg / dl.
Which of the following tests is most useful for diagnosis in this patient? (April
2005)
A) Insulin / Glucose ratio
B) Determination of gastrin level
C) Tolbutamide test
D)
Glucose tolerance test
TO)
Glucagon level determination
231
GENERAL SURGERY
INSULINOMA: In general, the classic diagnosis is made with the Whipple triad.
- Symptoms of fasting hypoglycemia,
- Blood glucose levels below 50mg / dl during symptomatic periods
- Relieve symptoms with intravenous glucose.
- A insulin / glucose ratio above 0.3 is diagnostic for insulinoma.
- Proinsulin levels of more than 50% suggest malignant insulinoma.
- See also 6. Description of the problem
(Answer A)
13.
Which of the following is not indicated for splenectomy? (September 2003)

A) Immune thrombocytopenic purpura
B) Primary hypersplenism
C) Thalassemia major
D)
Splenic vein thrombosis leading to gastric varices

TO)
Chronic lymphocytic leukemia
INDICATIONS FOR SPLENECTOMY:

For the purpose of disease control and staging
• Hereditary spherocytosis, elliptocytosis (exact indication)
• Sickle cell anemia, autoimmune anemia
• ITP, TTP
• Spleen cysts and tumors
• Hodgkin's lymphoma
Primary splenic tumors (definite indication) is the most common malignant splenic
tumor angiosarcoma
• Splenic artery aneurysm
For hypersplenism;
• Hair cell leukemia
• Lymphoproliferative diseases (CML, NHL)
• Felty syndrome
• Myeloid metaplasia
• Thalassemia major
• Gaucher's disease
• Splenic vein thrombosis
• Sarcoidosis
• SLE
(Answer E)
14.
Which of the indications for surgery in chronic pancreatitis

A) Insulin-requiring diabetes
B)
Suspected pancreatic carcinoma
C) Portal hypertension
D)
Bile duct obstruction
TO)
Presence of pseudocyst
232
INDICATIONS FOR SURGICAL TREATMENT IN CHRONIC PANCREATE:

• Pain: Continuous or unresponsive to medical treatment is the most common
• Pancreatic cancer suspicion
•
Splenic or portal vein obstruction due to pancreatitis, splenic or portal
hypertension,
pseudocyts
(Answer A)
15. The following laboratory findings of a patient diagnosed with acute

pancreatitis
Which is a sign of poor prognosis? (April 2003)
A) Serum calcium level 7 mg / dl
B) Serum amylase level of 1000 U
C) Arterial PO2 70 mmHg
D)
Urine amylase level 3000 U
TO)
Coagulation time 10 minutes
The low level of calcium is one of the 48th hour Ranson criteria and has a negative
effect on prognosis.
(Answer A)
16.
A 66-year-old female patient had a history of jaundice
Low back pain. Physical examination of the gallbladder painless

as it comes. In rectal examination, acolic stool is detected. For this patient
which is the most likely diagnosis? (April 2003)
A) Acute cholecystitis
B) Pancreatic head carcinoma
C) Pancreatic pseudocyst
D)
Gallbladder carcinoma
TO)
Klatskin tumor
CARCINOMA OF THE PANCREAS:

• Obstructive jaundice, weight loss and deep localization in approximately 75% of
pancreatic head carcinomas
abdominal pain. Back pain (25%) indicates a worse prognosis. Because it is due to
retroperitoneal invasion of the tumor.
• Distal biliary gallbladder (Courvoisier's sign) in periampullary neoplasms should
suggest distal biliary obstruction due to pancreatic neoplasm.
•
Obstructive jaundice occurs early, but occasionally decreases. Because necrosis

tumor fragments are poured into the duodenum and bile drains (collapsing jaundice).
jaundice
Itching may be accompanied.
• Acolic stool due to obstructive jaundice is detected.

• Occasionally there is occult blood in the stool.
• Diagnosis is made by endoscopy, ERCP and CT
(Answer B)
233
GENERAL SURGERY
17.
In which of the following diseases is spontaneous rupture of the spleen most

common?
(Eylül2002)
A) Hereditary spherocytosis
B)
Sarcoidosis
C) Polycythemia vera
D)
Acute leukemia
TO)
Infectious mononucleosis
Causes of Spontaneous Spleen Rupture:

• Malaria (Most often)
• Infectious mononucleosis (2nd frequency)
• Leukemia
• Sarcoidosis
• Polycythemia vera
• Hemolytic anemia
• Congestive splenomegaly
• Abscess
(Answer E)
18.
Which of the following does not play a role in the etiology of acute pancreatitis?
(April 2002)
A) Alcoholism
B)
hypercalcemia
C.)
D)
Hyperuricemia
hyperlipidemia
TO)
Trauma
ACUTE
-
ETHOLOGY OF PANCREATITIS:
Gallstone (45%) is the most common cause in our country.
Use of alcohol (35%)
Abdominal trauma
Hypercalcemia. Hyperparathyroidism (may cause acute and chronic pancreatitis).
Hyperlipidemia (especially pancreatitis in patients with high chylomicron and VLDL)
is common).
Medicines
- Anticonvulsants (valproic acid)
- Antibiotics (sulfonamides, tetracyclines)
- Antimetabolites (6-mercaptopurine)
- Diuretics (hydrochlorothiazide, furosemide)
Viral infections (mumps, coxaki, hepatitis, others)
- Pancreatic cancer
- Peptic ulcer penetrates the pancreas
- ERCP
- Pancreatitis due to ischemia and hypoperfusion
- Scorpion venom
- Hereditary pancreatitis is rare and dominant. Family history. trypsinogen
gene defect was detected. Pancreatitis in these patients begins at the age of 12-14
- Postoperative pancreatitis (iatrogenic).
- Long T-tube arms
- Oddi sphincter 5 mm. more than strong dilatation
- After Billroth II gastrojejunostomy, pancreatitis may develop due to obstruction
of the generating loop.
(Answer D)
234
19.
Very fat, 55-year-old male patient
sweating, palpitations, confusion, headaches occur and eating

is the most likely diagnosis if these complaints are going through later?
(September 2001)
A) Diabetes Mellitus
B) Zollinger - Ellison syndrome
C) Hyperinsulinemia
D)
Carcinoid tumor
TO)
The symptoms that were secondary to hyperunsilunemia were counted in the patient.
Symptoms secondary to hyperunsilunemia were described in the patient described.

See also 7. Description of the problem
(Answer C)
20.
Splenectomy, the highest clinical improvement in which hematological diseases
Provide? (September 2001)

A) Idiopathic thrombocytopenia
B)
Hereditary spherocytosis
C) Immune thrombocytopenic purpura
D)
Thalassemia major
TO)
hypersplenism
Hereditary spherocytosis is the most common gallbladder hemolytic anemia.

It is the only type of anemia that can be cured by splenectomy. Jaundice, anemia
and reticulocytosis with splenectomy
but the osmotic fragility test remains abnormal.
(Answer B)
21.
Necrolytic migratory thrombophlebitis,
hair thinning and diarrhea. What is the most likely diagnosis? (April 2001)
A) Diabetes
B)
glucagonomas
C) Cushing's syndrome
D)
Somatostatinomas to
TO)
insulinoma
GLUKOGOMO to:
-
Pancreas originate from a2 cells
70% are at risk of malignancy.
They are usually larger than 5 cm.

-
They often settle in the corpus and tail of the pancreas.
- Symptoms include migratory necrolytic dermatitis, weight loss, stomatitis,

anemia, hyperglycemia, thrombophlebitis.
-
Zinc can be used to treat dermatitis.
Somatostatin, streptozocin and dacarbazine are used for medical treatment.
Surgical excision is applied in cases that do not respond.

(Answer B)
235
GENERAL SURGERY
22.
The following periampules have the worst prognosis for cancers of the region.
It is si? (April 2001)

A) Pancreas
B)
Vateri light bulb
C) Duodenum
D)
Lower end of common bile duct
TO)
Hepatic ductus
TUMORS OF PANCREAS:
Pancreatic head tumors (83%); most common periampullary region with the worst
prognosis
tumor is
• Obstructive jaundice, weight loss and deep localization in approximately 75% of
pancreatic head carcinomas
abdominal pain. Back pain (25%) indicates a worse prognosis. Because it is due to
retroperitoneal invasion of the tumor.
• Distal biliary gallbladder (Courvoisier's sign) in periampullary neoplasms should
suggest distal biliary obstruction due to pancreatic neoplasm.
•
Obstructive jaundice occurs early, but occasionally decreases. Because necrosis
tumor fragments are poured into the duodenum and bile drains (collapsing jaundice).
jaundice
Itching may be accompanied.

• Diagnosis is made by endoscopy, ERCP, and CT
Tumors of the periampullary region;
• Ampulla vater own tumors (10%)
• Duodenal mucosa tumors (4%)
• Distal tumors of the common bile duct (5%)
(Answer A)
23.
Which is not the cause of pain in chronic pancreatitis? (September 2000)

A) Pancreatic ductal pressure increase
B) Inflammation of intrapancreatic nerve
C) Pancreatic ischemia
D)
pseudocyst
TO)
Peripancreatic edema
MECHANISMS THAT CAUSE PAIN IN CHRONIC PANCREATITIS:

- Pressure increase in the pancreas parenchyma or duct
- Increased intrapancreatic nerve count
- Inflammatory events
- Peripancreatic edema – Pancreatic ischemia – Pseudocyst formation is the most
reliable in relieving pain
distal pancreatectomy.
(Answer E)
236
24.
Where is the accessory spleen most common? (September 2000)

A) Omentum majus
B) Pancreas head
C) Spleen hilum
D)
Liver
TO)
Pelvis
Accessory Spleen (14-30%):

1- Spleen hilum (most common)
2- Gastrosplenic-Splenocholic league
3- Gastrocolic league
4- Splenorenal league
5- Omantum majus
(Answer C)
25. A 60-year-old female patient presented with complaints of jaundice and
abdominal pain. made
On physical examination, the right upper quadrant is stretched and painless.
In blood biochemistry, total bilirubin level is 6 g / dl, direct bilirubin level is
4 g / dl
dl. What is the first test you want? (September 2000)
A) MRI
B)
Tomography
C.)
D)
PTK
USG
TO)
ERCP
The patient described has a clinic suitable for periampullary tumors.

•
Pancreatic head tumors (83%) are the most common periampullary tumors with the
worst prognosis.
• Ampulla vaterine's own tumor

• Duodenal mucosa tumors
• Choledochal distal tumors (least observed)
Clinical findings;
• Obstructive jaundice
• Itching
• Weight loss (most common symptom)
• Pain, slow developing, blunt, increasing character after meals
•
Thrombophlebitis, phlebotrombosis
• Palpable gallbladder may result in distension of the gallbladder. Buna

Courvoisier-Terrier
called the finding.
Pancreas and duodenum are located in the retroperitoneal region.
(Answer B)
237
GENERAL SURGERY
26. The above patient had a smooth surface localized in the epigastrium after 4
weeks.
cm diameter mass is detected. What is the most likely diagnosis? (April 2000)
A) Pancreatic abscess
B) Pancreatic pseudocyst
C) Cystadenoma
D)
Chronic pancreatitis
TO)
Infected pancreatic necrosis
ACUTE PANCREATITIS COMPLICATIONS:

Systemic complications
- ARDS
- Kidney failure
- Myocardial dysfunction
Local complications
- Pseudocyst (Most common complication)
- Pancreatic necrosis
- Pancreatic abscess
Pancreatic abscess:
• Pü collection. Usually later than infected pancreatic necrosis, 3-4
weeks later.
• Percutaneous or open abscess drainage should be performed.
• If the abscess develops in acute pancreatitis, the mortality rate is 10%.
• Mortality rate in infected necrotizing pancreatitis is 35%.
PSEUDOCYSTS
• More than 1/3 of the cystic lesions of the pancreas are pseudocysts.
• Most are located in the omentum minus.
• 75% are caused by pancreatitis and 25% by traumatic cause.
• In patients with pseudocysts caused by pancreatitis, alcoholism is more common
than cholelithiasis as a cause of pancreatitis.
• It tends to be seen mostly in the 4th and 5th decades and in men.
• Tends to occur 3-4 weeks after the attack of pancreatitis.
• Pseudocyst is considered if amylase decreases after approximately 3 weeks after
the episode of pancreatitis.
(Answer B)
238
27. A sixty-year-old male patient suddenly started after a heavy meal and spread to
the back
complains of stomach epigastric pain. Physical examination of the patient with
nausea and vomiting revealed mild fever, epigastric tenderness and decreased bowel
sounds. Abdominal radiography showed dilatation of the upper duodenum and small
amount in the left pleural cavity.
liquid is seen.
USG revealed multiple stones in the gallbladder.
Which diagnosis and prognosis should be considered first? (April
2000)
A) Leukocytes, glucose, AST, hematocrit
B) Hematocrit, calcium, glucose, LDH
C) LDH, glucose, leukocyte, AST, amylase
D)
LDH, leukocyte, amylase, lipase
TO)
LDH, amylase, biluribine, glucose, AST
The patient's presentation is consistent with acute biliary pancreatitis. For the
prognosis of acute biliary pancreatitis
Ranson criteria should be observed.
(Answer C)
28.
What is the most important indication for pancreatic transplantation?

(April 2000)
A) Type I diabetes
B)
Pancreatic trauma
D)
Chronic pancreatitis
TO)
Exocrine pancreatic insufficiency
The most important indication for pancreatic transplantation is Type I diabetes

mellitus. Prevention of nephropathy by pancreatic transplantation in type I
diabetes mellitus
and to improve the quality of life.
(Answer A)
29.
Which is the lowest indication for splenectomy?

(April 2000)
B)
Hairy-cell leukemia
C) Glucose-6-phosphate dehydrogenase deficiency
D)
Staging of Hodgkin's disease
TO)
Splenic trauma
Splenectomy is not indicated for intravascular hemolysis. Splenectomy is not

indicated for GGPDH deficiency.
(Answer C)
239
GENERAL SURGERY
30.
Which is one of the systemic complications of acute pancreatitis

B)
Acute renal failure
C) Sepsis
D)
hypoglycemia
TO)
Hypovolemic shock
ACUTE PANCREATITIS COMPLICATIONS:

Systemic complications
- ARDS
- Kidney failure
- Myocardial dysfunction
- Sepsis
Local complications
- Pseudocyst (Most common complication)
- Pancreatic necrosis
- Pancreatic abscess
In acute pancreatitis, hyperglycemia occurs, not hypoglycemia.
(Answer D)
31.
Which does not adversely affect prognosis in acute pancreatitis? (April 99)
A) 3% reduction in hematocrit
B) Blood sugar at the time of first arrival is 250
C) Ca ++ less than 7 mg
D)
PO2 partial pressure below 55 mmHg
E) Over 20,000 leukocytosis

Poor prognosis in acute pancreatitis is determined according to Ranson criteria. 5.
Description of the problem
See.
(Answer A)
32.
In which of the following diseases splenectomy, treatment of the disease
is done with the indication of hypersplenism, too? (April 99)

B) Autoimmune anemia
C) Thrombotic thrombocytic purpura
D)
ITP
TO)
Agnogenic myeloid metaplasia
Except for E, examples of splenectomies for disease control and staging

It is given.
See explanation of question 12.
(Answer E)
240
33.
Which of the Ranson criteria is examined at the time of first application?

(September 98)
A) PO2 <60 mmHg
B) Base gap> 4 mEq / L
C) Glucose> 200 mg / dl
D)
Htc> 10%
TO)
Ca + 2 <8 mg / dl
RANSON CRITERIA:
At the time of application:
• Age> 50
• White cell> 16. 000
• Glucose> 200 mg / dl
• LDH> 350 IU / L
SGOT (AST)> 250 IU / dl
In the first 48 hours;
• Hematocrit drop> 10%
• Blood urea nitrogen increase> 8 mg / dl
Serum Ca ++ <8 mg / dl
• Arterial Po2 <60 mmHg
• Base gap> 4 mEq / L
• Approximate fluid loss> 6 L
(Answer C)
34.
Which is the cause of acute pancreatitis? (April 98)

A) Alcohol
B)
Gallstone
C) Hyperlipidemia
D)
hyperthyroidism
TO)
Trauma
ACUTE
-
ETHOLOGY OF PANCREATITIS:
Gallstone (45%) is the most common cause in our country.
Use of alcohol (35%)
Abdominal trauma
Hypercalcemia. Hyperparathyroidism (may cause acute and chronic pancreatitis).
Hyperlipidemia (especially pancreatitis in patients with high chylomicron and VLDL)
is common).
Medicines
- Diuretics (hydrochlorothiazide, furozemide)
241
GENERAL SURGERY
viral
-
infections (mumps, koksaki, hepatitis, others)

Pancreatic cancer
Peptic ulcer penetrates the pancreas
ERCP
Pancreatitis due to ischemia and hypoperfusion
Venom
Hereditary pancreatitis is rare and dominant. Family history. trypsinogen
gene defect was detected. Pancreatitis in these patients begins at the age of 12-14
Postoperative pancreatitis (iatrogenic).
Long T-tube arms
Oddi sphincter 5 mm. more than strong dilatation
After Billroth II gastrojejunostomy, pancreatitis may develop due to obstruction of
the generating loop.
(Answer D)
35.
What causes the frequent and serious infection in a splenectomy patient?

d? (April 98)
A) S. pneumonia
B) Group A hemolytic streptococcus
C) Pseudomonas aeruginosa
D)
Candida albicans
TO)
S. aureus
POST-SPLENECTOMY SEPSIS:
- Most often with pneumococcus. Meningococcus and H. intluenza.
- If splenectomy is performed for hematologic or malignancy, the risk is greater.
- Most commonly seen in the first two years.
- Annual mortality is 1/300 in children and 1/1000 in adults.
- Fast course, hours of septic shock, DIC and death is seen.
- Vaccination should be performed 2 weeks before elective splenectomy to prevent
post-splenectomy sepsis,
vaccination should be performed immediately after traumatic splenectomy,
prophylactic penicillin in children
It should be used.
(Answer A)
36.
Sixty-year-old male weight loss, jaundice, stool color and right hypo-
What is your diagnosis in a patient who described pain in the chondriac region?
(April 97)
A) Pancreatic head cancer
B)
Acute cholecystitis
C) Cholangite
D)
choledocholithiasis
TO)
CHOLELITHIASIS
242
PANCREAS CANCER
-
60-80 years are common. It is common in men.
-
Adenocancer is common
2/3 of the pancreas is at the head
Weight loss is the most common symptom. 2. Pain often happens
Jaundice may be present in tumors with pancreatic head localization
Gallbladder may be palpable (Couruasier-terrier finding)
20% mobile thrombophlebitis (Trousseau sign)
CA can be increased to 19-9
USG, CT, ERCP and PTK can be used for diagnosis.
Periampullary tumors tumors of the pancreas> ampulla vateri> duodenum and distal
common bile duct
Eradication of the duodenum may be seen in periampullary tumors in PMD
Whipple surgery is recommended for pancreatic head and periampullary tumors.
The most common symptom in periampullary tumors is jaundice.
(Answer A)
37.
Fasting hypoglycemia (Glucose 40mg / dl), hypoglycemia symptoms and
What is the most likely diagnosis in a patient whose symptoms have passed after
eating? (September 96)
A) Islet cell adenoma
B) Insulinoma
C) Nesidioblastosis
D)
Pancreatic pseudocyst
TO)
Pancreatic adenocarcinoma
The described table is a whiple triad and is pathogonomic for insulinoma.

(Answer B)
38.
Which of the following does the Courvoisier-Terrier symptom occur? (April 96)
A) Acute cholangitis
B) Liver abscess
C) Pancreatic carcinoma
D)
Acute cholecystitis
TO)
choledocholithiasis
Courvoisier Terrier is the most common sign of pancreatic head carcinoma. Less
choledocholithiasis. Palpable gallbladder, gallbladder handling as a result of
distension
It may come. This is called the Courvoisier-Terrier finding.
(Answer C)
243
GENERAL SURGERY
39.
Spontaneous splenic rupture is common in which of the following? (April 96)

A) Cytomegalovirus
B)
Sickle cell anemia
C) Typhoid
D)
Malaria
TO)
Acute leukemia

• Leukemia
• Sarcoidosis
• Abscess
(Answer D)
40.
What is the most common cause of acute pancreatitis? (September 95)

A) Stone of gall bladder
B)
Alcohol
C) Hypercalcemia
D)
Trauma
TO)
Infection
ETIOLOGY OF ACUTE PANCREATITIS:

- Gallstone (45%) is the most common cause in our country
- Use of alcohol (35%)
- Abdominal trauma
- Hypercalcemia. Hyperparathyroidism (may cause acute and chronic pancreatitis).
- Hyperlipidemia (especially in patients with high chylomicron and VLDL)
Is seen).
Medicines
- Diuretics (hydrochlorothiazide, furozemide)
Viral infections (mumps, coxaki, hepatitis, others)
- Pancreatic cancer
- Peptic ulcer penetrates the pancreas
- ERCP
- Pancreatitis due to ischemia and hypoperfusion
- Scorpion venom
- Hereditary pancreatitis is rare and dominant. Family history. In the trypsinogen
gene
defect. Pancreatitis in these patients begins at the age of 12-14
- Postoperative pancreatitis (iatrogenic).
- Long T-tube arms
- Oddi sphincter 5 mm. more than strong dilatation
- After Billroth II gastrojejunostomy, pancreatitis may develop due to obstruction
of the generating loop.
(Answer A)
244
41.
Factors that do not adversely affect prognosis in acute pancreatitis include:

a)
Over 55 years
B)
Leukocytes over 16. 000 / mm3
C.)
Blood sugar levels above 200 mg / dl
D)
Low serum calcium
TO)
Height of serum amylase
High amylase in the diagnosis of pancreatitis is not diagnostic. However, it can be

considered.
However, there was a correlation between the prognosis of pancreatitis and the high
level of amylase.
It could be.
(Answer E)
42.
Which of the following has the highest loss of HCO-3 in the fistula? (April 95)
A) Stomach
B) Bile ducts
C) Jejenum
D)
Distal ileum and cecum
TO)
Pancreas
CONTENTS OF GASTROINTESTINAL FLUIDS

Daily amount
NA
Cl
HCO 3
Saliva
500-2000
10
20-30
10
30
Stomach
1000-2000
60-90
30-10
100-130
Small intestines
2000-9000
120-140
5-10
90-120
30-40
Column
60
30
40
Pancreas
600-2000
140
55-10
70-90
95-115
Bile
50-800
140
5-10
90-110
30-40
The amount of HCO3 in GIS fluids is mostly found in the pancreas with 115mEq / L.
So the pancreas
HCO3 loss is higher in fistulas than in other fistulas. HCO3 by stimulation of the
sectarian
Up to 145mEq / L.
(Answer E)
245
GENERAL SURGERY
43.
Which of the following enzymes is important in the diagnosis of acute pancreatitis?
d? (April 95)
A) SGOT
B) SGPT
C) ALP
D)
LDH
TO)
lipase
Lipase used in the diagnosis of acute pancreatitis rises late compared to amylase
remains high and is a more valuable finding in the diagnosis of acute pancreatitis
than amylase.
(Answer E)
44.
Which is not one of the Ranson criteria in acute pancreatitis in the early period?
d? (April 94)
a)
Over 55 years
B) Leukocyte above 16000 / mm3

C) Amylase height in blood
D)
Over SGOT 250 IU / dl
TO)
LDH above 350 IU / dl

(Answer C)
45.
Which benefit from splenectomy but does not produce gallstones?
(September 93)
A) ITP
B) Hereditary spherocytosis
D)
Thalassemia
TO)
Autoimmune hemolytic anemia
Hereditary spherocytosis is the most common type of gallstone-producing hemolytic

anemia. Curing with splenectomy
is the only type of anemia provided. With splenectomy, jaundice, anemia and
reticulocytosis in hereditary spherocytosis rapidly improve.
However, the osmotic fragility test does not improve. In case of non-response to
medical treatment, ITP is indicated for splenectomy. Gallstone due to
thrombocytopenia in ITP
It is not visible.
(Answer A)
246
46.
Which influences prognosis in acute pancreatitis? (September 93)

A) Hyponatremia
B)
hypernatremia
C) Hypocalcemia
D)
hypercalcemia
TO)
hypokalemia
(Answer C)
47.
Slimming, opening and closing jaundice and fecal occult blood (+) in the patient
Is hangisidüşünül? (April 93)

A) Gallstone
B) Pancreatic tumor
C) Hepatoma
D)
I Kolanjiosarko
TO)
Vascular tumor of ampulla
Tumors of the periampullary region;

• Pancreatic head tumors (83%)
• Ampulla vater own tumors (10%)
• Duodenal mucosa tumors (4%)
• Distal tumors of the common bile duct (5%)
AMPULLA WATERI TUMORS:
• Symptoms are similar to pancreatic cancer; weight loss. Pain is less pronounced.
• Obstructive jaundice occurs early, but occasionally decreases because necrosis
tumor fragments are poured into the duodenum and drained to the bile (collapsible
jaundice).
• Diagnosis is made by endoscopy, ERCP and CT
• Because it develops slowly and locally, many are resectable.
• The five-year survival rate is 35-40%.
(Answer E)
48.
Amylase elevation seen in the patient with acute pancreatitis after two weeks
which makes you think? (April 93)

A) Pancreatic abscess
B) Pseudocyst
D)
Pancreatic acid
TO)
Pancreatic necrosis infection
247
GENERAL SURGERY
PSEUDOCYSTS
• More than 1/3 of the cystic lesions of the pancreas are pseudocysts.
• Most are located in the omentum minus.
• 75% are caused by pancreatitis and 25% by traumatic cause.
• In patients with pseudocysts caused by pancreatitis, alcoholism is more common
than cholelithiasis as a cause of pancreatitis.
• It tends to be seen mostly in the 4th and 5th decades and in men.
• Tends to occur 3-4 weeks after the attack of pancreatitis.
• Pseudocyst is considered if amylase decreases after approximately 3 weeks after
the episode of pancreatitis.
(Answer B)
49.
Which of the following is the cause of spontaneous splenic rupture? (September 92)
A) Polycythemia vera
B) Spherocytosis
D)
Aplastic anemia
TO)
SAFETY

• Leukemia
• Sarcoidosis
• Abscess
(Answer E)
50.
Which is not used in acute pancreatitis? (April 92)

A) Dolantin
(Answer A)
15. Which of the following conditions increases the risk of developing testicular
torsion? (September 2004)
A) Acute epididymoorchitis
B) Undescended testis
C) Hydrocele
D) Testicular tumor
E) Epididymal cysts
The rotation of the testis around the spermatic cord is called torsion. Trauma and
etiology of torsion
undescended testis.
(Answer B)
221
SMALL INTERNSHIP
16. Tuberculosis bacilli are the most common place in the genitourinary system in
men.
A) Bladder
B) Prostate
C) Kidney
D) Epididymis
E) Ductus deferens
In the genitourinary system, the most common organ of tuberculosis is the kidneys.
In the male genital tract, epididymis is the most common site of tuberculosis and
fallopian tubes are the most common in the female genital system.
Tuberculosis comes to the kidney by hematogenous route. Then ureter, bladder,
epididymis, prostate
It can hold. In women, TBc can come to the genital organs (fallopian tubes) by
hemotogenous route.
(Answer C)
17. What is the most useful diagnostic method in the differential diagnosis of
acute testicular torsion and acute epididymoorchitis? (April 2003)
A) Doppler USG
B) Tomography
C) MR
D) Angiography
E) Scintigraphy
(Answer A)
18. Which of the following is the most common cause of lower vesicoureteral reflux?
(April 2003)
A) Ectopic urethral orifice
B) Dual ureteral system
C) Prune-Belly syndrome
D) Trigonal muscle weakness
E) Contracted bladder
The most common cause of vesicouretaral reflux is insufficiency at the entrance of
the ureters to the bladder (trigon). Other
reflux in the options. However, the most common cause is the trigon weakness is the
correct answer.
ETHOLOGY OF SHOOT
Congenital causes:
Trigonal weakness: The most common cause. It's more common in girls.
Urethral anomalies:
•
Complete ureteral duplications
Ectopic ureter orifice
ureterocele
222
UROLOGY
Prune Belly syndrome (Eagle Barret):

•
Bilateral inguinal hernia,
Pes ekinovarus,
Agenesis and atresia of the anterior abdominal muscles.

Trigon Distorting Causes
•
Decreased bladder compliance
Neurogenic bladder
Secondary edema of bladder cystitis
prostatectomy
(Answer D)
19. Which is one of the complications of genitourinary tuberculosis

A) Renal calcification
B) Hypertension
C) Male infertility
D) Contracted bladder
E) Bladder diverticulum
Complications of Tuberculosis:
•
Renal-perinephritic abscess, renal failure, renal calcification
Ureteral stricture, scar, progressive hydronephrosis
Contracted bladder, reflux
Obstruction of the epididymal duct (obstructive azoospermia), infertility

(Answer E)
20. The most common infection with renal tumors in the differential diagnosis of
renal infections
A) Acute pyelonephritis
B) Pyonephrosis
C) Xanthogranulomatous pyelonephritis
D) Chronic pyelonephritis
E) Emphysematous pyelonephritis
Xanthogranulomatous Pyelonephritis
•
It is a chronic bacterial infection with widespread renal destruction.
DM, obstruction and stone (staghorn) are risk factors.

•
It is mixed with renal tumors in imaging methods and histopathological

examinations.
Clinical: Side pain

Treatment: Nephrectomy
(Answer C)
223
SMALL INTERNSHIP
21. A 36-year-old man had painless testicular enlargement. Most likely diagnosis
A) Embryonal carcinoma
B) Lymphoma
C) Mixed tumor
D) Seminom
E) Yolk sac tumor
TESTICULAR TUMORS
They are the most common solid tumors of 15-35 years.
Etiology:
•
The most important factor is cryptorchidism.
Gonadal dysgenesis,
chemicals and trauma are also held responsible.
Features: 95% germ cell. 5% non-germ cell.

Pathology:
Germ Cell
•
Seminoma (35%): The most common bilateral testicular tumor. Sometimes in the
scintiotrophoblastic component
Hosts.
Embryonic cell cancer (20%)
Teratoma (5%)
Choriocarcinoma (1%)
•
Mixed cell (teratocarcinoma) (40%): Teratoma + embryonal cancer
Yolk sak (Endodermal sinus Tm): The most common testicular tumor in children
Non-Germ Cells
•
Leyding cell (containing Reinke crystal) Asymptomatic, gynecomastia
Sertoli cell tumor
Gonadoblastoma: It is associated with gonodal dysgenesis.
Clinic:
•
Typical clinical painless scrotal swelling for testicular tumors.
20% of the cases present with acute pain due to tumor orchitis and bleeding into
the tumor.
The most common testicular tumor is lymphoma in patients over 50 years of age.
Complication: The most common metastasis is in the lungs. It spreads to the

paraaortic lymph nodes by lymphatic route.
Diagnosis: Biopsy is not taken from testicular tumor and may cause scrotal and
lymphatic contamination.
Treatment:
•
orchiectomy
Paraaortic lymph node dissection
BEP
Radiotherapy
(Answer D)
224
UROLOGY
22. What is the latest manifestation of lower urinary tract obstruction? (September
2000)
A) Dilatation of the upper urinary tract
B) Trabeculation
C) Cellul formation
D) Bladder wall hypertrophy
E) Diverticulum formation
Changes due to obstruction of the bladder:
one-
Epithelial hyperplasia, Smooth muscle hypertrophy,
2nd-
Trabeculation (folds in the bladder)
3-
Cellular formation (advanced trabeculation)
4-
Diverticulum formation
(Answer A)
23. Which of the urinary tract infections in childhood is a common cause of stone
formation?
it causes? (September 2000)
A) Proteus mirabilis
B) E.coli
C) Staphylococcus saprophyticus
D) Streptococcal agalactia
E) Neisseria gonorrea
Struvite stones (Magnesium ammonium phosphate): Stones formed in alkaline
environment. Urease secreting
bacterial (Proteus) infection occurs, makes the urine alkaline.
Struvite stone in the left kidney
(Answer A)
24. Alpha fetoprotein in a 24-year-old patient presented with painless swelling of
the testis
and human chorionic gonadotropin levels are determined.
Which is the most likely diagnosis? (September 2000)
A) Seminom
B) Embryonic carcinoma
C) Tekoma
D) Granulosa cell tumor

E) Dysgerminoma
225
SMALL INTERNSHIP
AFP and HCG are both positive, suggesting embryonal carcinoma. There may be
alkaline phosphatase or HCG positivity in seminomas.
(Answer B)
25. In an infertile man, 1 ml volume, 15 million / ml number 30% motility, 2%
relative to Krugere
fertilization program worst if normal sperm morphology has 2 million / ml leukocyte
Which affects? (April 2000)
A) Hypovolemia
B) Oligospermia
B) Leukospermia
D) Teratospermia
E) Astenospermia
Evaluation of male factor
In a normal sperm analysis (sperm sample given after 3 days of abstinence)
•
volume> 2 ml.
pH 7.2 - 7.8
Number of sperm> 20 million / ml
Sperm motility> 50% of active progression
Normal sperm morphology should be> 50%. Teratospermia (worst prognosis)
Causes of male infertility

Unknown reason
47.2%
Idiopathic
26.4%
varicocele
12.3%
infections
6.6%
Immunological factors
3.1%
Congenital causes
2.1%
Sexual dysfunction
1.7%
Endocrine causes
0.6%
(Answer D)
26. What is radiotherapy-sensitive testicular tumor? (April 2000)
A) Seminom
B) Teratoma
C) Embryonic carcinoma
D) Teratocarcinoma
E) Choriocarcinoma
The most sensitive testicular tumor to radiotherapy and chemotherapy is seminoma.
(Answer A)
226
UROLOGY
27. Which is not a risk factor for bladder cancer? (April 2000)
A) UV light
B) Smoking
C) Industrial exposure to aryl amine
D) Phenacetin
E) Hematobium infestation of schistosoma
BLADDER CANCER
Etiology:
•
Aniline dyes containing benzidine, beta-naphthylamine
Abnormalities of tryptophan metabolism
Cigaret
cyclophosphamide
•
Analgesic nephropathy
Schizosomiasis (actually makes squamous cell CA more often)
It may also occur in the pelvicalyceal system in the kidney, most often in the
bladder.
(Answer A)
28. A young girl presented with complaints of cystitis. Her sterile urine
examination revealed hematuria and pyuria.
What is the most likely diagnosis? (September 99)
A) Hurnhem ulcer
B) Tuberculosis of the urinary system
C) Bladder cancer
D) Vaginite
E) Pyelonephritis
If the patient has recurrent hematuria, if there is abundant leucocytes in the
urine and the agent cannot be isolated
should come from tuberculosis. Tuberculosis does not grow on conventional media but
only Lowenstein broth. This
therefore, special media must be cultivated for such patients.
(Answer B)
29. A child falling from the wall is brought with the complaint of inability to
urinate. Patient made
examination of the suprapubic smooth contoured mass and urethral outlet hematoma
clot is detected.
What is the next best step for diagnosis? (September 99)
A) Pelvic USG
B) IVP
C) Retrograde urograms
D) Voiding cystography
E) Renogram with diuretic

Ruptures with pelvic fracture, perineal injuries with legs open and traumatic
Urethral catheterization is a common cause of urethral injury. Suprapubic, scrotal
with anuria
or perineal fluid extravasation may be manifest symptoms. Diagnosis with retrograde
urography
Placed.
(Answer C)
227
SMALL INTERNSHIP
30. Which urinary stone is made of alkaline urine for treatment? (September 99)
A) Oxalate
B) Calcium
C) Citruvite
D) Uric acid
E) Magnesium ammonium
Uric acid and cystine stones are formed in acidic urine environment. Magnesium-
ammonium-phosphate
Stones occur in patients with continuous alkaline urine due to infection of the
urinary tract. Acid
stones formed in the environment by making urine alkaline, stones formed in the
environment by making urine acidic
crystallization is prevented.
(Answer D)
31. A 20-year-old male patient was operated for testicular tumor. Alveolar formed
by anaplastic epithelial cells with prominent nucleoli in the pathology of the
tumor,
tubular and papillary structures.
What's your diagnosis? (April 99)
A) Cystic seminoma
B) Spermatocytic seminoma
C) Embryonic carcinoma
D) Choriocarcinoma
E) Teratoma
Embryonal carcinoma is described in terms of age group and histological appearance.
Embryonic carcinomas account for about 40% of testicular germ cell tumors. 90% in
blood
hCG and / or AFP are measured high.
(Answer C)
32. Which is a non-germinal testicular tumor? (April 99)
A) Seminom
B) Teratoma
C) Choriocarcinoma
D) Leydig cell tumor
E) Embryonic carcinoma
Non-Germ Cell Tumors
•
Leyding cell (containing Reinke crystal): Asymptomatic or gynecomastia
Sertoli cell tumor
Gonadoblastoma: It is associated with gonodal dysgenesis.

(Answer D)
228
UROLOGY
33. What is the cardinal finding of bladder tumors? (September 98)

A) Nocturia
B) Polyuria
C) Hematuria
D) Suprapubic pain
E) Suprapubic mass
The most common symptom of bladder cancer (85%) is painless, gross or microscopic
hematuria.
There is no correlation between the number, size and stage of the lesions and the
amount of hematuria.
(Answer C)
34. Which of the following tumors in a 30-year-old man with gynecomastia
A) Seminoma
B) Yolk sheet tumor
C) Teratoma
D) Leydig cell tumor
E) Embryonic carcinoma
Leydig cell tumor is a stromal benign tumor. 2-6. decadence. Androgen, estrogen
or both.
Pre-puberty androgen-induced puberty is precocious. In adult, high estrogen-related
bilateral gynecomastia and feminization symptoms are seen in 30% of patients.
(Answer D)
35. Which of the following is the kidney stone seen as a result of urinary tract
infection?
(April 98)
A) Calcium Oxalate Stones
B) Urate stones
C) Magnesium ammonium phosphate stones
D) Cystine stones
E) Xanthine stones
(Answer C)
36. Which cancer has the most lymphatic spread? (April 98)
A) Prostate Ca
B) Basal cell Ca
C) Synovial sarcoma
D) Ewing's sarcoma
E) Astrocytoma
The most common lymphatic spread is prostate cancer. It spreads especially to
obturator lymph nodes.
Prostate cancer has spread to the lumbar vertebra and pelvic bones by hematogenous
route.
(Answer A)
229
SMALL INTERNSHIP
37. What is the most common predisposing factor in renal pelvis squamous cell
cancer?
(September 97)
A) Aniline dyes
B) Bilhariozis
C) Stones
D) Polycystic kidney
E) Chronic analgesic use
More than 90% of renal collecting system tumors urothelial transitional
cell carcinomas. Less than 5% are squamous cell carcinomas and are often associated
with chronic inflammation and stone formation. Chronic irritation water (stone)
modifier (transitional)
epithelium suffers squamous metaplasia. Squamous cancer may develop on this ground.
A similar event occurs between schizosomiasis and squamous bladder cancer.
(Answer C)
38. Which is not used in the paralytic bladder? (April 97)
A) Anticholinergic
B) Cholinergic
C) Carbachol
D) Betanecol
E) Bladder exercise
Anticholinergic drugs in the paralytic bladder may adversely affect the contraction
of the bladder smooth muscle. Therefore, they are not used.
(Answer A)
39. Which prostate lobe most commonly develops from prostate carcinoma? (September
96)
A) Peripheral lobe
B) Anterior lobe
C) Lateral lobe
D) Middle lobe
E) Periurethral lobe
Prostate anatomy
230
UROLOGY
PROSTATE CANCER
Prostate Zones:
1- Peripheral zone → 60-70% of prostate CA develop from here
2- Central zone → prostate CA may develop.
3- Transitional zone → BPH develops
(Answer A)
40. Which tumor responds well to chemotherapy? (September 96)
A) Endometrial cancer
B) Astrocytoma
C) Stomach cancer
D) Retinoblastoma
E) Germ cell testicular tumor
Germ cell tumors are susceptible to chemo and radiotherapy. The most typical
examples are testicular seminomas.
(Answer E)
41. What is the most common cause of acute urethritis? (April 96)
A) Staphylococcus aureus
B) Staphylococcus epidermidis
C) Herpes simplex virus
D) Neisseria gonorrhea
E) Haemophilus ducrei
The most common cause of acute urethritis is Neisseria gonorrhea. Gonorrhea, 30%
Clamydia trachomatis accompanied
would.
N. GONORRHOEA (GONOKOK)
•
Gonococci are diplococci without Gram (-) capsules. They contain

lipooligosaccharides.
Gonococci do not have a vaccine available and cannot ferment maltose.
The organism is transmitted via the viral route.
The incidence of N. gonorrhea is highest in the sexually active age group (15-25).
Newborns can become infected during labor.
While gonorrhea is generally symptomatic in men, it is often asymptomatic in women.
Antigens found in gonococci:

•
Pilus: Pilus of these antigens is absolutely necessary for virulence of gonococcus.

Gonococcal piles
clings to the mucosa.
protein I (por); is the most important surface antigen. Protects the gonococcus
from killing in a notrofil. It prevents phagolysosome formation.
protein II (opa): Provides attachment to the host cell. Gonokok CD66 (CEA) exprese
clings to the cells.
protein III
Lipopolysaccharide type
Fe binding protein
IgA1 protease (other IgA protease-producing bacteria H.influenza, S.pnomoni)

231
SMALL INTERNSHIP
Gonococcal antigens
Gonococci are intracellular microorganisms.

Gonococci can synthesize Beta lactamase by acquiring plasmids from conjugation of
Heamophilus genera.
Meningococci cannot synthesize beta-lactamase.
The IgA protease secreted by the gonococci allows the host to settle and maintain
infection.
In people with C6-C9 deficiency, gonococci cause widespread infections.
Clinic
Gonorode2-4 has a daily incubation period.
Abundant leukocytes and gram (-) diplococci in yellow discharge after incubation
period
Monitored.
The most common clinical presentation in men is urethritis.
Gonococcal urethritis and

cervicitis
If untreated, urethritis can lead to epididymitis and orchitis-related sterility.

Although infection in women is generally asymptomatic, it is more serious if
infection occurs.
Watch. (Endometritis, PID)
Common infections of gonococci, bacteremia as a result of skin rash and pain in
small joints
Arthritis-Dermatitis syndrome occurs.
Findings showing dissemination of N. gonere infection; suppurative arthritis (most
common), skin
lesions and gonococcal meningitis.
In the newborn, contamination through the birth canal enters the conjunctiva,
resulting in a condition called Ophthalmia Neonatarum.
Treatment: Ceftriaxone
(Answer D)
232
UROLOGY
42. Which of the urinary system stones is not radiopaque? (April 96)
A) Urate
B) Oxalate
C) Cystine
D) Struvite
E) Mix
Non-opaque stones → Uric acid, xanthine
Opaque stones → Calcium oxalate, calcium phosphate
Semiopac stones → Cystine, Magnesium ammonium phosphate
(Answer A)
43. PAS (+) Michealis Guttman body lesion with yellow, granular plaque appearance
in the bladder mucosa Which of the following? (September 95)
A) Chronic cystitis
B) Malacoplaki
C) Bladder diverticulum
D) Bladder papilloma
E) Bladder cancer
malakoplakia
•
Usually in immunosuppressed people
It develops as a result of chronic infection of E. coli.
Hematuria is the cause.
Pathology:
•
Submucosal large histiocytes (Von-Henseman cells)
PAS (+) inclusion (Michalis Gutman) bodies in histiocytes
Inflammatory-granulomatous involvement of bladder, GIS, lung, bone and mesenteric

lymph nodes
changes to
Diagnosis: Cystoscopy; yellow mucosal granular plaque and nodules are seen in the
bladder.
(Answer B)
44. Which of the following is not characteristic of Wilms' tumor?
(September 95)
A) Aniridi
B) Hemihypertrophy
C) Exophthalmus
D) Hypertension
E) Genitourinary system anomaly
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SMALL INTERNSHIP
WILMS TUMOR
The most common anomalies were;
•
Genitourinary anomalies (4.4%)
Hemihypertrophy (2.9%)
•
Sporadic aniridia (1.1%)
Wilms tumor is more common in children with familial hemihypertrophy.

There is deletion on chromosome 11 in patients with Aniridi and Wilms tumor.
Familial Wilms tumor is more bilateral than sporadic as in retinoblastoma
It is a feature.
The incidence of congenital anomalies is higher in bilateral and familial Wilms
tumors.
The WT gene inhibits p21 protein-mediated cell cycle. WT gene mutation
Therefore, tumorogenesis occurs.
Syndromes accompanying Wilms Tumor
WAGER
Wilms tumor, aniridia (most common concomitant anomaly), genital anomalies, mental
retardation
Denys-Drash syndrome
Gonodal dysgenesis (male pseudohermaphroditism), nephropathy, renal

failure and development of Wilms tumor are monitored. WT-1 gene has a dominant
negative mutation.
Beckwith-Wiedeman syndrome:
Growth in body organs (tongue, liver), even hemihypertro renal, renal medullary
for the development of cysts, adrenal cytomegaly and Wilms tumor (and other
primitive tumors)
predisposition
Nefroblastomatozis
It is a premalign lesion for Wilms tumor in the kidney.
(Answer C)
45. Suitable for tumor marker markers to detect germ cell tumors of the testis
choose? (April 95)
A) Carcino embryogenic antigen + keratin
B) Alpha fetoprotein + beta hCG
C) CEA + alpha-fetoprotein
D) Beta hCG + acid phosphatase
E) Alpha fetoprotein + keratin

The germ cell tumors are AFP AND HCG.
(Answer B)
46. If bilateral hydronephrosis, dilated bladder, oligohydramnios are detected in
maternal ultrasonography, which is the most likely diagnosis? (April 95)
B) Bilateral ureteropelvic stenosis
D) Posterior urethral valve
E) Wilms tumor
234

UROLOGY
The most common cause of hydronephrosis in the fetus is uretoropelvic junction

stenosis. 80% of amniotic fluid originated from urine
oligohydramniosis occurs in cases that obstruct the urinary tract.
Posterio urethral valve is the presence of mucosal valve in the urethra, especially
observed in boys.
Valvin's wings allow the bladder to pass easily. However, the child is forced to
mix.
Diagnosis can be made by MSUG or cystoscopy. Bladder and bilateral kidney in
children with PUV
collector systems are dilated.
(Answer D)
47. Urinary tract infection is detected in the newborn. For diagnosis, the
following
Which of the examination methods is not done? (April 95)
B) Ultrasonography
C) Cystourethrography
E) Kidney scintigraphy
IVP has no place in the detection of urinary tract infection in the newborn.
(Answer A)
48. Bilateral calyxial irregularity, thrust spring, renal contours in IVP
What do you think of the diagnosis if there is lobulation? (September 94)
A) Tuberculosis pyelonephritis
B) Chronic Renal Failure
C) Chronic pyelonephritis
E) Polycystic kidney disease
Autosomal Dominant (Adult) Polycystic Kidney Adult polycystic kidney (APKD)
•
It is characterized by multiple cysts in both kidneys, the largest of which can be

3-4 cm.
is an autosomal dominant disease.
The most important complications are hypertension and urinary infection.
Berry aneurysms (Willis polygon) are present in 10-30% of cases.
1/3 of them have asymptomatic liver cysts (the most common concomitant lesion).
Colonic diverticulum, ovarian cysts, aortic aneurysm, mitral valve prolapse may
also be present.
Autosomal Recessive (Childhood) Polycystic Kidney

•
It is autosomal recessive.
•
The findings are seen at birth and renal failure develops during infancy.
There are numerous bilateral small cysts in the kidneys.
In almost all cases, there are cysts in the liver and proliferation of portal bile
ducts (congenital hepatic fibrous).
Living babies develop cirrhosis.
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SMALL INTERNSHIP
Polycystic kidney IVP findings;

•
Expansion and flattening, pushing and elongation of calyxes
Lobulation in kidney contour
Growth in kidney contour

(Answer E)
236
UROLOGY
49. Urinary culture of E. coli growth, antibiotic use, but not reproductive use
After discontinuation of antibiotics, E. coli was re-grown in culture.
A) Foreign body in urinary system
B) Vesicoureteral reflux
C) Chronic bacterial prostatitis
D) Urinary stone
E) Pyelonephritis
(Answer C)
50. Which testicular tumor is most sensitive to radiotherapy? (September 93)
A) Embryonic carcinoma
B) Choriocarcinoma
C) Teratocarcinoma
D) Fibrosarcoma
E) Seminom
(Answer E)
51. When osteoblastic activity was seen in bone radiographs in an elderly male
patient,
makes? (September 92)
A) Rectal touch
B) IVP
C) Radiological examination
D) Urine examination
E) Blood biochemistry
Osteoblastic activity in the elderly patient revealed bone metastasis of prostate
cancer.
and rectal touch should be done.
The size and limits of the consistency of the prostate are important for rectal
examination. Bone or board
hardening rectal touch is a pathognomonic finding for prostate cancer.
(Answer A)
52. Which of the following is the most appropriate treatment for absorption type
hyperoxaluria? (September 92)
A) Magnesium oxide
B) Allopurinol
C) Chlorothiazide diuretic
D) Calcium-rich, oxalate-poor diet
E) Sodium cellulose phosphate
In the treatment of hyperoxaluria; and oxalate binders such as antacids containing
high doses of calcium-aluminum.
(Answer D)
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SMALL INTERNSHIP
53. What is the predisposing factor for the emergence of nasocomial urinary tract
infection in women? (April 92)
A) Short ureter
B) Malnutrition
C) Gynecological operation
D) Catheter
E) Antibiotic use
(Answer D)
54. Which of the following makes phosphate stones? (September 91)
A) Proteus vulgaris
B) P. aeroginosa
C) E. coli
D) Klebsiella
E) Mycoplasma
In the presence of infection with urea-degrading bacteria (such as Proteus
vulgaris), the medium contains abundant ammonium (NH4) and bicarbonate (HCO3) by
the degradation of urea. Thus, urine
It happens. Phosphates show easily crystallization and aggregation in alkaline
medium.
(Answer A)
55. If the kidney has stage III tumor, which of the following is expected?
(September 91)
A) Infiltration into adipose tissue
B) Renal vein infiltration
C) Distant metastasis
D) Capsule-limited tumor
E) Infiltration to surrounding organs
RENAL CELL CARCINOMA (HYPERNEFROM)
It is an adenocarcinoma originating from tubular epithelial cells (proximal
tubule). Most cases
sporadic but familial forms have also been reported.
Familial Renal Cell Carcinoma forms:
1) Autosomal dominant RCC
2) Von Hippel-Lindau patients
3) Hereditary Papiller CA
In addition, the tendency to develop RCC in analgesic nephropathy has been reported
in smokers.
Clinical stage
I Kidney limited
II Perinephric adipose tissue invasion
III Regional LN metastasis or renal vein invasion
IV Invasion or distant metastasis to surrounding tissues
238
UROLOGY
types
•
The most common histological type is Clear cell.
Granular cell and papillary cell have the best prognosis among all types.
Sarcomatoid type has the worst prognosis.
Histological grading is performed according to the Fuhrman system based on core

anaplasia.
Parathormone-like substance secreting hyperparathyroid, erirtopoetin secreting

polycythemia,
secretion of renin may cause hypertension, non-metastatic hepatic dysfunction.
Symptoms:
•
hematuria
Side pain
Diagnosis: CT-MR
Treatment:
•
Surgical
Radiotherapy
IL-2, INF-alpha
RCC in IT
(Answer B)
56. The most likely diagnosis in a patient with painless, total, gross and clotted
hematuria is:
A) Renal tuberculosis
B) Kidney tumor
D) Bladder tumor
E) Urinary stone disease
(Answer D)
57. Which of the following treatments is preferred in patients with prostatic
hypertrophy? (April 91)
A) Urethral dilatation
C) Operation
D) Androgen therapy
E) Orchiectomy and antiandrogen treatment
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SMALL INTERNSHIP
Indications for surgery in BPH:

•
Presence of dilatation in upper urinary tract
If residual urine volume exceeds 100 cc or causes chronic infection
To be seen with bladder stone
Macroscopic hematuria with very uncomfortable symptoms
•
Drug non-responsiveness
(Answer C)
58. Which causes hypertrophy and hematuria in the bladder? (September 90)
A) Trichomoniasis
B) Schistosomiasis
C) Filariasis
D) Ditrotelium dentriticum
E) Diphyllobotrium latum
Schistosoma hematobium passes through water through the larvae penetrating the skin
and entering the lymphatics. It settles in the bladder veins as retrograde. They
multiply here, the parasite eggs are small
clogs the veins. This leads to necrosis and ulceration of the bladder wall. Ulcers
cause fibrosis.
Hypertrophy in the bladder, bladder capacity is reduced. Terminal or total
hematuria is seen.
(Answer B)
59. What is the first sign of benign prostatic hypertrophy? (September 90)
A) Incontinence
B) Bladder hypertrophy
C) Hematuria
D) Hydroureteronephrosis
E) Bladder diverticulum
Due to the increase in urethral resistance, first bladder muscle to overcome the
anterior resistance
Hypertrophy and intra-bladder pressure increases.
(Answer B)
60. What is the non-hematuria disease? (September 90)
A) Stenosis of renal artery
B) Polycystic kidney
C) Trauma
D) Stone
240
UROLOGY
Causes of Hematuria:
•
Infection,
Inlamation (Glomerulonephritis)
Trauma,
Rock,
•
Congenital (Polycystic kidney, Hemangioma, Sickle cell anemia),
neoplasms
(Answer A)
61. What is considered if renal calyxes are small and small in the kidney section?
(April 90)
A) Chronic pyelonephritis
B) Glomerulonephritis
C) Hypoplastic kidney
D) Acute renal failure
E) Kidney tumor
In the hypoplastic kidney, the kidney size is small (Normal 12 x 6 x 3 cm) and
histological examination of the nephrons
structure is normal. Renal calyxes are small and small in renal section.
(Answer C)
62. Which does not change the risk of developing hydronephrosis in obstructive
uropathy?
(April 90)
A) Infection with obstruction
B) Intrinsic or extrinsic obstruction
C) Location of obstruction
D) Duration of obstruction
E) Severity of obstruction
Obstruction associated with infection is important. Because infection parenchymal
atrophy
accelerates and increases fibrosis. The location of the obstruction is also
important.
The higher the obstruction, the greater the effects on the kidney. obstruction
time is also important. It is divided into two groups as acute and chronic. None in
chronic obstruction
The event lasts until there is no parenchyma.
(Answer B)
63. Which should be done first in diagnosis of benign prostatic hypertrophy?
(September 89)
A) Cystoscopy
B) Rectoscopy
C) Ultrasound
D) IVP
E) Rectal touch
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SMALL INTERNSHIP
BENIGN PROSTATE HYPERPLASIA

It is the most common urological disease seen in men after 50 years of age,
glandular due to age and androgen release
and / or hyperplasia of fibromuscular elements. BPH develops from the transitional
zone
most common peripheral zone).
Symptoms (prostatism):
one-
Irritative symptoms: It occurs in 50-80% of patients in the later stages of BPH;
of-pollakiuria and nocturia.
2nd-
Infravesical obstructive symptoms: Reduction in urine caliber and flow-projection

(Uroflowmeter is also detected and is the most common obstructive symptom), Urine
onset and end
difficulty, Residual urine (determined by post-voiding catheterization and USG),
Sudden stopping of urine
weakness, terminal drip
3- Late stage-decompensated stage symptoms: glob vesical, overflow incontinence,

advanced stage
VUR (bilateral hydroureteronephrosis and renal failure develop)
Diagnosis:
•
The touch is elastic (enlarged first) and has enlarged prostate
TRUSG
Treatment:
•
α1 blockers (prazosin, doxosocin, terazosin-tamsulosin) reduce obstruction.
finasteride
(Answer E)
64. What is the most common finding in polycystic kidney disease? (April 89)
A) Albuminuria
B) Hematuria
C) Phosphatics
D) Pain
E) Uremia
(Answer B)
65. Which of the following is released from the fructose in the sperm structure?
(April 89)
A) Vesiculo seminalis
B) Ductus deferens
C) Prostate
D) Epididymis
E) Plexus pampiniformis
epididymis
Spermatoids gain tail, sperm provides conversion. In addition, by resorbing the
testicular fluid,
concentrates sperm.
Duktus Deferens
The main task is to store sperm.
Vedicula Seminalis
In men, 70% of the ejaculate consists of vesicular seminalis. The vesicular
seminalis fluid contains fructose and
is rich in prostoglandin.
(Answer A)
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UROLOGY
66. What is the microorganism that causes the formation of magnesium-ammonium-

phosphate stones? (April 89)
A) Klebsiella
B) Proteus
C) E. coli
D) Salmonella
E) Shigella
(Answer B)
67. The cause of azoospermia occurs when androgen is used for a long time
A) Virilizing effect
B) Cholestatic hepatitis
C) Gonadotropin inhibition
D) Hepatoma
E) Anemia
Prolonged androgen use suppresses GnRH. Spermatogenesis slows down because FSH is
suppressed.
(Answer C)
68. Which of the following does not have vesicoureteral reflux? (September 88)
A) Ureterocele
B) Ureteral stone
C) Edema in the bladder wall due to cystitis
D) Congenital trigon weakness
E) Complete ureter duplication
The most common cause of VUR is trigone failure. Other factors are involved in the
etiology of VUR. ureterocele,
is the name of the hernia that sags into the bladder of the ureter mucosa. Double
collector again
system (double ureter) increases the risk of reflux in people. Reflux of bladder
mucosa edema caused by cystitis
increases the risk. Therefore, cystitis causes reflux and recurrent urinary tract
infection.
(Answer B)
69. Which of the following often causes renal damage in renal tuberculosis?
(September 88)
A) Pyelonephritis
B) Vesicoureteral reflux
C) Scar formation in the ureteropelvic junction
D) Calyxal stone
E) Destruction of calyx infundibulum
Renal tuberculosis especially involves the ureteropelvic junction. As the ureteral
lumen is closed with scatric and necrotic material, renal drainage is completely
prevented. This condition is called otonephrectomy.
(Answer C)
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SMALL INTERNSHIP
70. In a forty-year-old female patient, which of the following is the most common
cause of uncomplicated first-time urinary infection? (April 88)
A) E.coli
B) Staphylococcus
C) Streptococcus
D) Chlamydia
E) Proteus
(Answer A)
71. What is the chromosomal abnormality that may be the cause of sterility in men?
(September 87)
A) Turner syndrome
B) Kleinfelter syndrome
C) Testicular feminization
D) Adrenogenital syndrome
E) Achondroplasia
Gynecomastia, azospermia, atrophic testis, increased gonadotropins

there are multiple X chromosomes (XXY structure). As the number of X chromosomes
increases, mental retardation increases.
(Answer B)
72. Which of the following is the enzyme present in the blood in prostate cancer?
(September 87)
A) Alkaline phosphatase
B) 5 'Nucleotidase
C) SGOT
D) SGPT
E) Acid phosphatase
In prostate cancer; PSA, PAP (prostatic acid phosphatase) increases. PSA is

secreted from the prostate acid epithelium,
height is sensitive to prostate diseases, but not specific to prostate cancer. the
PSAs
protease property. BPH and prostatitis are also slightly increased.
(Answer E)
73. Which of the following symptoms does not occur in acute pyelonephritis?
(September 87)
A) High fever
B) Lumbar pain
C) Miction disorders
D) Pyuria
E) Renovascular hypertension
Acute pyelonephritis
• It is generally one-sided.
• The kidney is edematous and large.
Clinic:
• Fire (over 40)
• Shivering, sweating
• Tachycardia
• Side pain
• Nausea, vomiting
• Symptoms of cystism (polysacuria, nocturia, dysuria, urgency)
• KVAH (+)
Laboratory:
• The presence of leukocytes and bacteria in urine analysis (leukocyte silene)
• It is characterized by reproduction in culture.
• Leukocytosis is detected in the blood.
(Answer C)
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DERMATOLOGY
DERMATOLOGY
one. Lesion, which may be a leading symptom of squamous cell carcinoma of the skin,
A) Seborrheic keratosis
B) Pem fi gus foliaceus
C) Lentigo
D) Actinic keratosis
E) Verruca vulgaris
Actinic (solar) keratosis; is the most common premalignant skin lesion. Skin in
elderly places
firmly adherent brown keratotic papules. Squamoz cell can become CA (20%). Fast
if it grows or ulcers, it is considered a return to malignancy. The treatment is
surgery and chemotherapy.
(Answer D)
2nd. Which is one of the factors involved in the pathogenesis of acne
It is not? (May 2011)
A) Ination
B) Follicular hyperproliferation
C) Bacterial proliferation
D) Excess sebum production
E) Use of retinoic acid derivatives
The pathogenesis of acne involves four important processes: hyperkeratinization in
the pilosebaceous unit, excessive sebum secretion, proliferation of
Propionibacterium acnes (P. acnes) bacteria and inactivation. Oil
A plug is formed in the duct of the glands and the head of this plug becomes black
and hard. Sometimes, the channel is clogged
Although, the gland continues to secrete fat, thus forming a cyst filled with fat.
Black
points are called comedones. After the formation of comedones, the bacteria in our
skin called propionibacterium acnes settles here and contributes to acne formation.
Retinoic acid derivatives are used in the treatment of acne.
(Answer E)
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SMALL INTERNSHIP
3. Direct immu-no-orescent in a patient with oral mucosal ulceration and blisters

on the body
IgG antibodies were detected on the epidermal cell surface. Nikolsky sign positive
Features.
In this case, which of the following should be considered first?
A) Pem fi gus vulgaris
B) Dermatitis herpetiformis
C) Bullous pem fi goid
D) Scatricial pem fi goid
E) Epidermolysis bullosa
PEMPHIGUS
It is more than 50-60 years old.
The incidence of men and women is equal.
In the epidermis, there are autoantibodies of IgG structure against desmosomes.
Other autoimmune
coexistence with diseases is common.
S fl but:
P. vulgaris:
It is the most common form. Nikolsky (+).
The underlying skin is normal and there is no erythema-in amation. No itching.
Mucosal involvement is present in almost every patient.
It causes erosion in mucous membranes. Does not leave scar.
P. foliaceus:
It shows subcorneal bulla formation.
The vesicles cover more than 90% of the body surface.
Mouth lesion is very rare.
The Nikolski phenomenon is (+).
Diagnosis:
Immune-orescent: honeycomb-like staining in tissue.
Tzanck test shows acantholysis. Herpes and zonada are (+).
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DERMATOLOGY
Treatment:
Systemic steroids and immunosuppressive drugs. Lesions of the oral mucosa at the
latest
answers.
(Answer A)
4. Which of the following skin diseases does not involve joint involvement? (April
2010)
A) Psoriasis
B) Reiter syndrome
C) Lichen planus
D) Behcet's disease
E) Skin sarcoidosis
Lichen planus is a skin disease. It does not cause joint involvement.

LIKEN PLANUS
It is an acute or chronic itchy inflammatory disease of the skin and mucous
membranes.
Etiology:
Emotional stresses precipitate drugs (thiazide, ACE inhibitors, penicillamine,
antimalarials).
HIV, Hepatitis (C) infections and autoimmune diseases (ulcerative colitis, diabetus
mellitus, myastinea gravis, primary biliary cirrhosis) are common.
Clinic:
It holds the skin, nails and mucous membranes.
Skin:
The elementary lesion is a smooth, polygonal, purple colored, bright, extremely
itchy papule.
It is usually bilateral symmetrical, flexor faces.
It is most commonly seen on the wrists and ankles. Koebner (+).
There are Wickman stria on.
Hypertrophic (most common), atrophic, actinic, erosive, can be bullous types.
Scalpel makes cicatricial alopecia.
Mucosa:
2/3 cases are kept.
Makes painful gray reticular plaque in the buccal mucosa in the mouth.
This lesion is premalignant. On SCC may develop.
Glans penis, vulva vagina can also be involved.
Nail:
It is kept in 10% of cases.
Subungual hyperkeratosis, pterygium, may be onycholysis.
Histology:
hyperkeratosis
Vakuolar degeneration in basal cells
Colloid degeneration in keratinocytes (bolt bodies). They occur as a result of
apoptosis.
Band-shaped infiltration in dermo-epidermal bishop
Treatment:
corticosteroid, retinoid, PUVA, dapsone, cyclosporine.
(Answer C)
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SMALL INTERNSHIP
5. Which of the following skin diseases does not involve joint involvement?
(April 2010)
A) Psoriasis
B) Reiter syndrome
C) Lichen planus
D) Behcet's disease
E) Skin sarcoidosis
Lichen planus is a skin disease. It does not cause joint involvement.

LIKEN PLANUS
membranes.
Etiology:
Emotional stresses precipitate drugs (thiazide, ACE inhibitors, penicillamine,
antimalarials).
mellitus, myastinea
gravis, primary biliary cirrhosis).
Clinic:
Skin:
itchy papule.
Mucosa:
2/3 cases are kept.
Nail:
Histology:
hyperkeratosis
Colloid degeneration in keratinocytes (bolt bodies). They occur as a result of
apoptosis.
Treatment:
corticosteroid, retinoid, PUVA, dapsone, cyclosporine.
(Answer C)
248
DERMATOLOGY
6. A 50-year-old male patient presented with painful erosions in his mouth for
about 3 months and Nikolsky positive diffuse bullae in the body for 15 days.
which of the following should be considered? (September 2009)
A) Pemphigus foliageus
C) Pemphigus vulgaris
D) Impetigo herpetiformis
E) Pemphigus erythematosus
PEMPHIGUS
•
It is more than 50-60 years old.
The incidence of men and women is equal.
In the epidermis, there are autoantibodies of IgG structure against desmosomes.

Coexistence with other autoimmune diseases is common.
Classification:
•
P. vulgaris:
It is the most common form. Nikolsky (+).
The underlying skin is normal, without erythema-inflammation.
No itching.
Mucosal involvement is present in almost every patient.
It causes erosion in mucous membranes.
Does not leave scar.
P. foliaceus:
•
It shows subcorneal bulla formation.
The vesicles cover more than 90% of the body surface.
Mouth lesion is very rare.
The Nikolski phenomenon is (+).
Diagnosis:
•
Immune fluorescence: honeycomb-like staining in the tissue.
Tzanck test shows acantholysis. Herpes and zonada are (+).
Treatment:
•
Systemic steroids and immunosuppressive drugs.
Lesions in the oral mucosa respond to treatment at the latest.
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SMALL INTERNSHIP
Pem fi gus vulgaris
(Answer C)
7. Which of the following is not the priority settlement of lichen planus? (April
2009)
A) Nipple
B) Glans penis
C) Inner faces of wrists
D) Oral mucosa
E) Ankles
Lichen planus is a blue-colored, itchy, papulosqamous skin disease involving flexor
faces. Nipple
This is not the place of expected involvement.
LIKEN PLANUS
membranes.
Etiology:
•
Emotional stresses, drugs (thiazide, ACE inhibitors, penicillamine, antimalarials)

precipitation
would.
mellitus, myastinea gravis, primary biliary cirrhosis) are common.
CLINIC
250
DERMATOLOGY
Skin:
•

itchy papule.
Mucosa:
•
2/3 cases are kept.
Nail:
•

Lichen planus
Histology:
•
hyperkeratosis
•
Colloid degeneration in keratinocytes (bolt bodies). These are the result of

apoptosis
It occurs.
Treatment: Corticosteroid, retinoid, PUVA, dapsone, cyclosporine.

(Answer A)
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SMALL INTERNSHIP
8. Which of the following pyodermas is not caused by Staphylococcus aureus?

(April 2008)
A) Fronculus
B) Carbonyl
C) Bullous impetigo
D) Bockhart impetigos
E) Ectyma gangrenosum
Ectyma gangrenosum is caused by Pseudomonas.
staphylococci
•
Toxic shock syndrome,
Gr (+) pneumonia in hospitals,
Abscess, pneumotocele, empyema and pneumothorax seen after pneumonia,
Pyodermia infectious
Scalded skin syndrome,
Acute mastitis in pregnant women and lactation women,
Nail pulp infection (felon),

•
Boil the,
The folliculitis,
Carbuncles's,
Food poisoning,
Meningitis in open head injuries
The most common cause of acute bacterial endocarditis
S. aureus is the most common lung infection in early stages in patients with cystic
fibrosis
Is a plus.
Staph. aureus is still the most important cause of osteomyelitis.

(Answer E)
9. Which of the following is not one of the non-muscular findings of

dermatomyositis?
(September 2007)
A) Carpal tunnel syndrome
B) Leukopenia
C) Photosensitivity
D) Cardiomyopathy
E) Atelectasis
Dermatomyositis and polymyositis are subgroups of the same rheumatologic disease.
Interstitial in dermatomyosis
pulmonary disease, muscle weakness (myopathy), cardic involvement. Lokopenia
(pancytopenia) SLE
The findings.
252
DERMATOLOGY
Polimyositis
Properties:
•
Proximal muscle weakness is observed
Increased muscle enzymes
Characteristic electromyographic (EMG) examples
Inflammatory infiltrates in muscle biopsy
When typical rash is added to this complex, it is called dermatomyositis
Polymyositis peaks in childhood and advanced adulthood
May accompany malignancy in adult onset
Etiology and pathogenesis:

•
The main sites of inflammation are skeletal muscle and less frequently heart
muscle.
Skin involvement is a minor pathological feature
CLINIC
Skin:
•
Rashes-erythematous areas, exfoliation, atrophy, face, neck, upper body in

dermatomyositis
and extensor scattered on faces
Pathognomonic findings
Heliotrop eyelids (purple and swollen)
Gottron symptom (erythematous papules in MKF and PIF joints)

Dermatomyositis and Gottron papules on hand
Other
•
Mechanical hands (hypertrophic changes in hard erythematous skin, palms and

fingers)
Sign of erythematous shawl (neck and back)
Lungs:
•
chronic interstitial lung disease, especially in combination with T-RNA synthetase

antibodies
Anti-Jo-1 syndrome (Synthetase antibody)

•
Mechanic's hand
Interstitial lung disease
Symmetrical polyarthritis
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SMALL INTERNSHIP
Joint
•
Mild, symmetrical inflammatory arthritis (rarely dextructive)
Most cases with synthetase antibodies
Eyebrow:
•
•
Regular progressive muscle weakness

Skeletal muscle weakness is the primary symptom of polymyositis (
difficulty sitting in bed, combing hair)
Pharyngeal muscle involvement: difficulty swallowing; aspiration
Laboratory:
Increase in muscle enzymes
•
CK, aldolase high
Elevated serum myoglobin levels
Specific autoantibodies
•
Synthetase antibodies (anti-aminoacyl-tRNA synthetase) (most commonly jo-1

antibody)
Particle antibodies that recognize signal (SRP antibodies)
Mi-2 antibodies
Diagnosis
one. Characteristic proximal muscle weakness
2nd. Inflammatory cell infiltrates in muscle biopsy
3. Elevation in muscle enzymes
4. Myopathic EMG changes
Treatment: immunosuppressive agents
(Answer B)
10. In a 35-year-old female patient with subcutaneous nodules with elevated serum
rheumatoid factor levels, which of the following should be considered first?
(September 2007)
A) Chronic hepatitis B infection
C) Polymyalgia rheumatica
D) Sarcoidosis
E) Primary Sjogren's syndrome
Sjogren's syndrome usually develops secondary to RA. Patients with RA have RF
positivity. also
Dry eye and mouth of Sjögren syndrome are seen. Primary Sjogren is not associated
with RA. RF is negative. Primary Sjogren only has dry eyes and mouth. Ant-Ro, Anti-
La positive.
sarcoidosis
Sarcoidosis is the most common lung disease of unknown etiology:
The main lesion is noncaseating granulomas
254
DERMATOLOGY
Multisystem disease
•
Lungs are most commonly involved (90%)
Mediastinal, hilar lymphadenopathy

•
Pulmonary infiltrations
Skin or eye lesions
• Rare symptoms: peripheral adenopathy, erythema nodosum, arthritis, splenomegaly,

hypercalcemia, diffuse or local nervous system involvement
Commonly involved organs in sarcoidosis:
•
lungs
Lymph nodes
Skin
Liver, spleen
joints
Eye
FAQ
Muscles.
It is most commonly observed between the ages of 30-50.
The incidence of blacks in the US is 10-18 times higher than whites.
Results:
•
Circulating T lymphocyte count decreased
CD8 / CD4 ratio> 2

•
T lymphocytes were increased in bronchoalveolar lavage fluid.
Humoral immunity is normal and susceptibility to infections is increased
Lung involvement:
•
Fatigue, exercise dyspnea
Non-productive cough,
Hemoptysis (rarely)
Chest pain, Pleurisy
Pulmonary function tests

•
Findings of restrictive disease
Deterioration of small airway functions
Lung radiogram:
Early enlarged intrathoracic lymph nodes are the rule.
Stage 0: Normal lung
Stage 1: Bilateral hilar adenopathy
Stage 2: Bilateral hilar adenopathy and parenchymal involvement
Stage 3: Fibrosis, (honeycomb lung)
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SMALL INTERNSHIP
Sarcoidosis lung involvement (ground glass and interstitial thickening)
Systemic involvement
Uveitis (frequent) (most common systemic involvement)
Skin lesions
Nervous system involvement (most commonly the 7th cranial nerve)
Cardiomyopathy (arrhythmias, conduction disorders, sudden death)
Abnormalities of liver function
Disorders of calcium metabolism
In sarcoidosis, active vitamin D secreted from granuloma tissue causes
hypercalcemia.
Skin lesions are usually indicative of chronic progressive sarcoidosis. Only
erythema nodosum occurs early in the disease and is associated with good prognosis.
Diagnosis: Transbronchial biopsy provides an appropriate clinical diagnosis. (best
diagnostic method)
treatment
•
Corticosteroid is the basic drug. Stage 0 and I do not require treatment.
Lupus is a skin finding in pernio sarcoidosis and an indication for steroid use
Monitoring disease activity

•
ACE enzyme measurement,
Ga 67 lung scintigraphy
Bronchoalveolar lavage are indicators.

(Answer D)
11th. In the second stage of syphilis, what is the finding observed in the oral
mucosa? (April 2007)
A) Leukoplasia
B) Aft
C) Erosion
D) Bull
E) Mucous plaque
Cylindrical shank on lower lip
256
DERMATOLOGY
PERIODS OF SPRILIS
one. Shankr period:
•
Papule-vesicle-ulcer occurs 2 weeks later at the site where the bacterium enters.
The edge of the shank is hard and collapsed.
•
Spontaneously passes within 2 weeks.
The lymph nodes may swell. Hard and mobile
2nd. Roseol period:

•
It is seen after an average of 6 weeks. (3 weeks - 6 months)
Maculopapular rashes occur. (Roseola). Forms mucous plaque in mouth.
Condylomata lata in the genital area (raised skin lesion)
I. II. In this period, the patient is contagious.
Blood can cause meningitis, periostitis and chorioretinitis.
2 - 3 months will disappear.
Secondary dialysis findings
3. GOM period:
•
It may involve mucosa, bone, skin, liver and other internal organs.
Gom does not have microorganisms.
III. Patients are not contagious during the period.
Cardiovascular syphilis (10%) is the most common aortitis, ascending aortic

aneurysm and aortic valve
failure is seen.
The main pathologic lesion is endarteritis obliterans.

(Answer E)

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SMALL INTERNSHIP
12. Which of the following skin diseases causes poxvirus? (September 2006)
A) Verruca vulgaris
B) Molloscum contagiosum
C) Epidermodysplasia verruciformis
D) Condyloma accuminatum
E) Keratoacanthosis
MOLLUSCUM CONTAGIOSUM
•
It belongs to the Poks virus family, but is quite different from variola and
vaccinia viruses.
It is transmitted directly or indirectly. (Visible during sexual transmission)
The virus remains localized in the basal layer of the epidermis. It doesn't mix.
The lesions are seen on the face, arms, back and hips.
The pustular belly lesion resolves spontaneously in 6-8 weeks.
Molluscum contagiosum
COWPOX-ORF- BUFFALOPOX
The butcher is a pox lesion in the hand area in veterinarians. (Papopox virus)
Orf on the Finger
(Answer B)
13. Which of the following dermatophyte infections is most common in children?
(April 2006)
A) Tinea capitis
B) Tinea manuum
C) Tinea favosa
D) Tinea pedis
E) Tinea cruris
258
DERMATOLOGY
Epidemic tinea capitis

•
It occurs in children and is anthropophilic.
The agent is M. audouinii.
It is mostly non-inflammatory and causes gray areas in the hair.
It can be transmitted by clothing that comes in contact with hair, such as hats.
Therefore, it may cause epidemics in schools and nurseries.
It may heal spontaneously in puberty.
Treatment: In addition to oral griseofulvine, a topical agent such as boric acid is

used to reduce infectivity.
treated with a fungistatic agent.
Favus (tinea favosa)
•
It occurs in children and adults.
Created by T.schoenleinii.
It is a severe form of tinea capitis. Permanent hair with scutula formation and
scarring
loss.
Treatment: Griseofulvine as well as debridement is required.
a - Tinea capitis, b - Favus, c - inflammatory knitwear fi tone verrukosum
(Answer A)
14. Interstitial keratitis, inner deafness, scabbard tibia and Hutchinson teeth,
syphilis
Which clinical findings? (April 2006)
A) Early congenital syphilis
B) Primary syphilis
C) Secondary syphilis
D) Late congenital syphilis
E) Neurosyphilis
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SMALL INTERNSHIP
Congenital Sphilis
•
An infected woman can pass T. pallidum to her fetus after 3 months of pregnancy.
(Congenital
syphilis)
The best test for the diagnosis of congenital syphilis is FTA-ABS test.
If a fetus with syphilis is born, early and late findings are observed.
Early findings:
•
Bullous lesions (hand and foot)
Macular lesions (body)
Septal defect in the nose
hepatosplenomegaly
Late findings:
•
It occurs after the age of 4 years.
Hutchinson teeth (saw tooth)
Interstitial keratitis
8. nerve involvement
Saddle nose
Scabbard tibia
•
Small maxilla
Congenital dialysis
(Answer D)
15. Which of the following is wrong for bullous pemphigoid? (September 2005)
A) Lesions appear as bulla on erythematous surface
B) IgE elevation in 50% of cases
C) Lesions are absolutely not malignant
D) Steroids have no place in treatment
E) Subepidermal blistering
Bullous Pemphigoid
Clinic
•
Over 50 years old, on flexor faces of extremites; big, tense

is a disease characterized.
Buller shows subepidermal settlement.
There is linear IgG deposition along the basement membrane. Antibodies against
hemidesmosomes
It develops.
Mouth mucosa involvement is very rare.
260
DERMATOLOGY
Bullous pem fi goid
Treatment: Steroid, methotrexate and cyclophosphamide

(Answer D)
16. Nikolsky's symptom may help diagnose which of the following diseases:
Is the evidence? (September 2005)
C) Chronic bullous dermatosis of childhood
D) Acquired epidermolysis bullosa
E) Stevens-Johnson syndrome
Nikolsky phenomenon has been described for bullous diseases of the skin. When
pressure is applied on the blister,
bale Nikolsky is negative in subepidermal bullae.
Subcorneal bullae: Nikolsky (+) is.
•
Bullous impetigo
•
SSSS (Ritter's disease)
Miliaria crystalina
impetigo herpetiformis
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SMALL INTERNSHIP
Intraepidermal bullae: Nikolsky (+).

•
HSV
Shingles zoster
Pemphigus vulgaris
Acute eczema
Subepidermal blisters are Nikolsky (-).

•
Bullous pemphigoid
Stevens - Johnson syndrome
Dermatitis herpetiformis
Herpes gestationis
Placement of epidermal bullae
(Answer A)
17. Which of the following is not one of the criteria for diagnosing atopic
dermatitis?
(April 2005)
A) Itching
B) Exacerbation and remission
C) Clinical course lasting more than 2 weeks
D) Family history of atopy
E) Presence of eczematous dermatitis lesions
Atopic Eczema
•
It is the eczema of genetically transmitted atopic individuals.
Allergen specific IgE structure.
In these people with eczema; may develop asthma, allergic rhinitis and allergic
conjunctivitis.
Diagnostic criteria:
•
Severe itching
Atopy history (familial and personal)
Chronic course (recurrence and remission)
Typical localization and morphology
If 3 of them are diagnosed.

Treatment
•
Dissociation with irritant substance
Cortisone Pomade
(Answer C)
262
DERMATOLOGY
18. Which of the following is one of the subepidermal vesiculobullous diseases?

(April 2005)
A) Miliaria pustulosa
C) Erythema repens
D) Reiter syndrome
E) Stevens-Johnson syndrome
(Answer E)
19. Acantholysis plays a role in the pathogenesis of which of the following
diseases?
(September 2004)
A) Pemphigus
C) Bullous pemphigoid
D) Erythema multiforme
E) Scatricial pemphigoid
(Answer A)
20. Forty-five-year-old female patient hand long-term on the middle finger tip
complaining of excessive pain. He states that especially in cold weather the pain
increases. Physical examination revealed that the fingertip region was normal.
Pressing on the nail detects excessive sensitivity.
A) Felon
B) Panaris
C) Glomus tumor
D) Distal phalanx fracture
E) Subungal abscess
Glomus tumor is a very painful, benign vascular lesion located mostly in the nail
bed.
Lesion. Surgical treatment leading to a rapid recovery of patients' complaints
is the most effective method.
(Answer C)
21. Stafa. aureus colonization role in the etiology of which of the following
diseases:
play? (April 2004)
A) Stasis dermatitis
B) Neurodermatitis
C) Contact dermatitis
D) Seborrhoic dermatitis
E) Numular eczematous dermatitis
Numular eczema is characterized by well-delineated para-shaped lesions. Abundant
staphylococci and micrococci were found in the lesions.
(Answer E)
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SMALL INTERNSHIP
22. Which of the following bullous diseases can be seen with celiac disease?
(April 2004)
B) Scatricial pemphigoid
C) Dermatitis herpetiformis
D) Pemphigus vegetans
E) Chronic bullous dermatosis in childhood
DERMATITIS HERPETIFORMIS
It occurs in men aged 30 years.
Knee and elbow extensor faces, sacral region, back and scalp, symmetrical itchy,
papulovicular
lesions are seen.
Dermatis herpetiformis
The Nikolski sign is (-).

It is seen with gluten enteropathy.
IgA and neutrophils, eosinophils in dermal papilla and dermo-epidermal junction in
biopsy
storage.
Treatment: Dopsan, sulfapyridine, gluten-free diet.
(Answer C)
23. Red-violet nodules and plaques on skin and mucous membranes in HIV patients
What is the cancer observed in the form of? (September 2003)
A) Kaposi's Sarcoma
B) Basal cell carcinoma
C) Squamous cell carcinoma
D) Malignant melanoma
E) Bowen's disease
CAPACITY Sarcoma (KS)
Firstly in 1872 by Moritz Kaposi, an Austrian-Hungarian dermatologist.
It has been identified. (Multiple Idiopathic Hemorrhagic Sarcoma)
It was a very rare tumor until the HIV epidemic. The causative agent is HHV-8.
264
DERMATOLOGY
Clinical Forms:
one. Classic (European) KS
2nd. Africa (Endemic) KS
3. Iatrogenic (Associated with Immune Depressive Drugs) KS
4. HIV Related (Epidemic) KS
5. Non-epidemic Gay Related KS
Kaposi's sarcoma in the hand
HISTOPATOLOGY:
1) Patch Stage: Dilated, irregular and angular blood vessels are observed in the
reticular dermis.
Macrophages containing varying proportions of lymphocytes, plasma cells and
occasional hemosiderin
inflammatory infiltrate occurs.
2) Plaque Stage: Dilated, irregular dermal vascular channels in the plaque, more
spindle spindle cells form perivascular communities. Red spheres scattered between
vascular channels, hemosiderin
charged macrophages, lymphocytes and plasma cells. Spindle cells and macrophages
The structure can be found in pink hyaline droplets that are not clear. Mitotic
figures can be found in places.
3) Nodular Stage: In lesions, diffuse proliferation of the spindle spindle cells of
the dermis and subcutaneous adipose tissue is involved. This is particularly
characteristic on cellular ground,
scattered small vessel structures, often containing tek wagon-like ”typical single-
row erythrocyte sequences, and
slit-like spaces. A more pronounced hemosiderin pigment, lymphocytes and some
macrophages may be present in this cellular substrate. Round, pink cytoplasmic
mitotic figures with droplets are also common
(Answer A)
24. Which of the following is not one of the diseases that are aggravated by
ultraviolet?
(September 2003)
A) Pemphigus foliaceus
B) SLE
C) Acne rosacea
D) Herpes zoster
E) Herpes simplex
(Answer D)
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SMALL INTERNSHIP
25. Skin lesions occurred in a subject exposed to hexochlorobenzene. What is your

diagnosis in this patient? (September 2003)
A) Pemphigus
B) Porphyry cutena tarda
C) Contact dermatitis
D) Bone marrow suppression
E) Drug-induced lupus
(Answer B)
26. What is the skin sign for Lyme disease? (April 2003)
A) Erythema nodosum
B) Erythema migrans
C) Erythema annulare
D) Erythema multiforme
E) Erythema marginatum
The causative agent of Lyme disease is a spirochete called Borrelia burgdorferi. It
is a microaerophilic bacterium. It is a disease with ticks. The incubation period
ranges from 3 to 32 days.
It is associated with minimal immune response. The name ema erythema chronicum
migrans inde in 25% of patients
given characteristic skin lesion.
Erythema chronicum migrans 3-30 days after tick bite around the tick bite site
It is a typical lesion of stage I of the disease with a pale hyperemic middle.
Erythamo chronicum migrans
Stages of the disease

Stage I
•
Weakness
Headache
Fire
•
Shake
Erythema chronicum migrans
Joint and muscle pain may also occur.
II. stage (Neurological - Cardiological)

•
Heart Blocks
myocarditis and
pericarditis
Aseptic meningitis
266
DERMATOLOGY
Facial nerve paralysis (Bell's paralysis)

•
Peripheral neuropathies
III. phase
•
Arthritis involving large joints (knee, elbow, etc.)
Acrodermatitis chronica atrophicans

(Answer B)
27. Which of the following is not one of the diseases with photosensitivity?
(April 2003)
A) Psoriasis
B) Pellegra
C) Pemphigus
D) Dermatomyositis
E) Scleroderma
Erythema chronica atro ans kans
(Answer E)
28. Which of the non-essential diagnostic criteria of atopic dermatitis? (September
2002)
A) Pruritus
B) Typical morphological distribution
C) Chronic recurrent dermatitis
D) Atopic family history
E) Ig A height
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SMALL INTERNSHIP
Diagnostic Criteria of Atopic Dermatitis

Major criteria
•
Atopic family history
Severe and persistent itching, prurigo, (infection and eczema formation)
Reactivity to common inhalants
Findings of atopic disease in the respiratory system, ichthyosis and cataract
Continuous or repetitive nature of the findings
Increased itch with skin dryness and sweating
Disorder in pharmacological or vascular tests
Minor criteria
•
Early onset
Food intolerance, increased reactivity to the drug
•
Gastrointestinal symptoms
The course of the disease changes with heat, infections and excitement
Intolerance to lipid solutions, wool and closed clothing
Blood eosinophilia
(Answer E)
29. Which of the following elementary lesions is not seen in Dermatitis

Herpetiformis?
(April 2002)
A) Erythema
B) Bull
C) Vesicle
D) Purpura
E) Papule
Dermatitis herpetiformis (Duhring's disease); itchy symptomatic or asymptomatic
gluten enteropathy with primary lesion of papules, papulovesicles or urticarial
plaque
is a chronic disease.
(Answer D)
30. Which of the following diseases are observed on the outside of the eyebrows?
(April 2002)
A) Lupus Vulgaris
B) Erythema multiforme
C) Actinomycosis
D) Rozasea
E) Leprosy
268
DERMATOLOGY
M. leprae
M. leprae causes leprosy (leprosy).
It cannot be produced in cultures.
It can be produced in the mouse soles and armadilla.
People are natural hosts.
Since the optimum temperature for reproduction (30 ° C) is below body temperature,
it
reproduces better.
Infection occurs as a result of prolonged contact with patients with lepromatous
leprosy having M. leprae. (skin lesion
and nasal secretions)
M. leprosy scrapings of the nasal mucosa were stained by Zielh - Helsen method
shown.
Most often N.auricularisi.
Bacteria multiply mainly in 3 places:
one. Skin histiocytes
2nd. Endothelial cells
3. Schwann cells (nerve)
There are three main clinical forms of leprosy:
one. Tuberculoid leprosy:
•
It is seen in people with high resistance.
Skin looks like tbc.
Cellular immunity to bacteria limits the growth of bacillus.
The lepromin test is (+).
Hypopigmented macular skin lesions are seen.
There are thickened skin lesions and sensory loss.
Lepramatous leprosy and tuberculoid leprosy
2nd. Lepramatous leprosy:

•
It is seen in people with low resistance. The cellular response is impaired.
Makes symmetrical and nodular lesions.
In the leprosy, facial hair loss develops. At the beginning of the eyebrow shedding
begins in the form of more
then it ends with all eyebrows and eyelashes.
Facies leonides (lion face) are seen.
Foam histiocytes are found instead of granulomas.
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SMALL INTERNSHIP
•
Lepromin skin test is negative.
•
High fever attacks.
Nose and palate falls.
3. Dimorphic shape:
•
It consists of a mixture of two tables.
Diagnosis
•
Staining of bacilli skin lesions in lepromatous leprosy

shown.
• Very few bacilli are seen in tuberculoid form and typical granuloma appearance
for diagnosis
It is sufficient.
•
No serological test is useful in leprosy.
treatment
•
Dapsone (acts as sulfonamides)
rifampicin
Clophasimine (acts by binding to DNA and blocking potassium input)
Minocycline,
Clarithromycin,
Fluoroquinolones
(Answer E)
31. Which of the following diseases is seen in the mouth lesion? (September 2001)
A) Lichen planus
B) Psoriasis
D) Seborrheic dermatitis
E) Pitriasis rosea
Causes of oral ulcer
Aphthous infection
•
Fungal (Candidiasis, etc.)
Bacterial (Vincent's angina, syphilis)
Viral (Herpes simplex)
GIS diseases
•
Crohn's disease
Celiac disease
Dermatological diseases
•
Lichen planus
pemphigoid
Pemphigus
Medicines
•
Hypersensitivity (Steven-Johnson syndrome)
Cytotoxic drugs
270
DERMATOLOGY
Systemic diseases
•
Systemic lupus erythematosus
•
Behcet 's disease
malignancies
•
carcinoma
Leukemia
Kaposi's sarcoma
(Answer A)
32. Which of the following is not a major symptom of atopic dermatitis?

(April 2001)
A) IgE height
B) Continuous or repetitive nature of the findings
C) Percentage is typical
D) Itching
E) Self and family history of atopy
(Answer A)
33. What is the most common cause of id reaction in children? (April 2001)
A) Tinea pedis
B) T. corporis
C) T. inguinalis
D) Corion celci
E) Favus
Id reaction in children usually occurs during tinea pedis infection or treatment
Hypersensitivity reaction caused by immune mechanisms. The second most common cause
is T. capitis. Acute vesicular eczema occurs. Small follicular papules or mostly on
hands and feet
vesicles develop. The treatment of the fungus also improves the id reaction.
(Answer A)
34. Which is the etiology of Kaposi's sarcoma? (September 2000)
A) CMV
B) EBV
C) VZV
D) HHV-8
E) HSV-1
(Answer D)
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SMALL INTERNSHIP
35. Which is the most important diagnostic criterion in Behçet's disease?

(September 2000)
A) Pathergy test
B) Inguinal ulcers
C) More than three oral aphthous ulcers per year
D) Retinitis
E) Skin lesions
Behcet 's disease; mucocutaneous, ocular, genital, articular, vascular, CNS and GIS
involvement is a multisystemic, inflammatory, recurrent and chronic disease
Painful oral ulcers are the first symptoms of the disease. The most important eye
involvement is iridocyclitis. Recurrent superficial and deep mobile
thrombophlebitis can be seen.
Major findings in Behcet's disease;
•
More than 3 oral aphthous ulcers per year (the most important criteria)
Genital ulceration
iridocyclitis
thrombophlebitis
Erythema nodosum
Aspiric pustule formation is 80% (+) when sterile needle is inserted into the
forearm skin. the deep
nonspecific reaction)
Acneiform eruptions
Minor findings;
•
Arthritis, arthralgia
Vascular involvement
GIS involvement
Diagnosis of Behçet's disease is the most important diagnostic criterion compared

to clinical manifestations.
aphthous ulcers. Colchicine is the first choice of treatment.
(Answer C)
36. Which of the following is a secondary syphilis lesion? (September 2000)
A) Aortite
B) Condyloma lata
C) Gom
D) Shanky
E) Tabes dorsalis
(Answer B)
37. Pathergy test is used in the diagnosis of which of the following diseases?
(April 2000)
A) Aphthous stomatitis
B) Pemphigus vulgaris
C) Behcet's disease
D) Scabies
E) Leishmaniasis cutis
(Answer C)
272
DERMATOLOGY
38. Which acantholysis occurs? (September 99)

A) Pemphigus
B) Pemphigoid
D) Lyell syndrome
E) Verruka vulgaris
(Answer A)
39. What is the onset and pathognomonic lesion of acne? (September 99)
A) Reasonable
B) Vesicle
C) Comedon
D) Pustule
E) Bull
Acne is an inflammation of the pilosebaceous glands. Comedones are observed from
outside as a result of the oxidation and accumulation of fatty material in
pilosabase glands.
(Answer C)
40. Which of the following is a protozoon that only infects the skin? (April 99)
A) Trypanosoma gambiense
B) Trypanosoma rhodensiene
C) Trypanosoma cruzi
D) L. donovani
E) L. Tropica
L. Tropica
•
It is a factor in orient boils.
•
Dogs are natural reservoirs.
L. tropica remains localized in the skin. It does not spread systemically.
L. tropica resides in RES cells and lymphoid tissues of the skin.
It comes from the bite of the midge.
Clinic
• First, a red papule at the bite point. This papule gradually makes numerous
satellite nodules and they come together and ulcerate.
•
If secondary bacterial infection develops, it multiplies and spreads to the

environment. Trail after recovery
It leaves.
Leaves lasting immunity.
L. tropica has two forms, dry and wet:
Dry type is usually seen on the face at any time.
Age type is usually in arms and legs in summer and autumn.
Treatment
•
The boil is kept clean with antiseptic solutions to prevent secondary infections.
Cryotherapy or systemic sodium stibogluconate (5-valent antimony compounds)
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SMALL INTERNSHIP
Oriental boils
(Answer E)
41. What is used in the systemic treatment of oriental boils? (April 98)
A) Antimony compounds
B) Sulfonamides
C) Mebendazole
D) Chloramphenicol
E) TMP-SX
(Answer A)
42. Which one does not comply with the 9s rule used in the calculation of the burn
percentage? (September 97)
A) Right upper extremity
B) Left upper extremity
C) Front body
D) Head
E) Genital area
Calculation of burned surface area:
Head and neck: 9%
Body front: 18%
Body rear: 18%
Upper left extremity: 9%
Upper right extremity: 9%
Lower right extremity: 18%
Left lower extremity: 18%
Genital area: 1%
(Answer E)
43. Which of the epidermal cell regeneration times is shorter? (September 97)
A) Psoriasis
B) Rozasea
C) Acne vulgaris
D) Parapsoriasis
E) Pitriasis rozae
274
DERMATOLOGY
psoriasis
Etiology:
•
It is associated with HLA; The strongest relationship is HLA Cw6.
The most prominent of the trigger factors is trauma.
The occurrence of lesions in trauma areas is called the KOEBNER phenomenon.
Infections may be triggering factors. Beta-hemolytic streptococci and viral

infections play a role.
•
Other important factors are drugs, lithium, NSAIDs, antimalarials, systemic

steroids
Sudden discontinuation of treatment.
psoriasis
Pathophysiology:
•
Epidermal hyperproliferation, increase in turnover level (normally decreases from

28 days to 3-4 days)
There is inflammation in the dermis; this inflammation proceeds into the epidermis
to form Munro microabscesses.
Dermal papillae are edematous. They extend up to the epidermis. (Papilomatosis)
Candle stain phenomenon caused by scratching a transparent object with a hard

object
(pathognomonic for psoriasis). It occurs due to papillomatosis.
(Answer A)
44. Which of the following is more likely to cause skin cancer than the normal
population?
is an autosomal recessive disease in which it develops? (Eylül97)
A) Oranosis
B) Cystic fibrosis
C) Phenylketonuria
D) Hemochromatosis
E) Albinism
(Answer E)
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SMALL INTERNSHIP
45. Which of the following is the most common elementary element of lichen planus
in the clinic?
Lesion? (April 97)
A) Pustule
B) Papule
C) Nodule
D) Vesicle
E) Bull
(Answer B)
46. Which is the fastest and most reliable diagnostic method in the diagnosis of
herpes virus infection? (September 96)
A) Vesicular lesions on erythematous floor
B) Tzanck test
C) Serological tests
D) Tissue cultures
E) ELISA
Tzanck test, the scratch of the lesion from the bottom of the smear with wright or
giemsa
staining of multinuclear giant cells and intranuclear inclusions.
Herpes virus is diagnosed as soon as a test.
(Answer B)
47. Discoid lupus in which part of the body is observed most? (April 96)
A) Face
B) Inguinal
C) Femoral
D) Thoracic
E) Abdominal
DLE lesions are most commonly located on the cheeks, forehead, nose and ears. Scalp
irreversible alopecia occurs due to destruction of hair follicles. Antimalarial
drugs are used in the treatment.
Discoid lupus erythomatosus
(Answer A)
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DERMATOLOGY
48. A 32-year-old woman with a hyperpigmented lesion on her right thigh was
diagnosed with malignant melanoma. In the epidermis of the lesion, papillary dermis
It was observed to extend to the limit.
What is the stage according to Clark classification? (September 95)
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
E) Stage V
Clark used histological levels in staging:

Clark Level I: Tumors on the basement membrane
Clark Level II: Papillary dermis
Clark Level III: Papillary / reticulardermal junction
Clark Level IV: Reticular dermis
Clark Level V: Subcutaneous adipose tissue
Clark staging in malignant melanoma
(Answer A)
49. What do you think of a patient with plaque-like cicatricial alopecia?
(September 95)
A) Alopesia areate
B) Tinea effulium
C) Use of cyclophosphamide
D) Hypothyroidism
E) Discoid lupus erythematosus
(Answer E)
50. What is the skin lesion of the herpes simplex? (April 95)
A) Erythema annulare centrifigum
B) Erythema chronicum migrans
C) Erythema arthritis
D) Erythema induratum
E) Erythema multiforme
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ERYTHEMA MULTIFORME (Stewens-Johnson Syndrome)

Itchy mucous membranes, symmetrically located on the inner sides of the hands,
soles of the feet, arms and legs
It is characterized by papulovesicular, sharp-edged erythematous plaques (iris
lesion).
Drug rash (sulfonamide), HSV, mycoplasma is involved in the etiology.
Melting multiforme de iris lesion
It is a disease characterized by gray-white pseudomembrane-covered lesions in the

mucosa of the mouth, genitalia and rectum.
Pulmonary, cardiac and GIS involvement may be observed.
Treatment:
Etiological factors are eliminated, fluid-electrolyte therapy, steroids.
(Answer E)
51. Which is the cause of Tinea pedis infection? (April 95)
A) Candida albicans
B) Histoplasma capsulatum
C) Aspergillus fumigatus
D) Trichofiton rubrum
E) Blastomyces dermatidis
(Answer D)
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DERMATOLOGY
52. Which type of malignant melanoma has the best prognosis? (September 94)
A) Nodular malignant melanoma
B) Superfisia malignant melanoma
C) Lentigo malignant melanoma
D) Acral lentiginosis melanoma
E) Amelanotic malignant melanoma
Malignant Melanoma Prognostic Factors:
Clark or Breslow stage of the tumor:
According to Clark, the most important prognostic criterion in malignant melanoma
is the degree of vertical invasion.
The location of the lesion is the worst in the trunk and good in the middle
extremity in the head and neck.
Gender: worse than men.
Lentigo malignant melanoma:
•
Previously, lentigo originates from malignant (in situ melanoma).
It usually settles on the face.
Irregular, brown-black colored macular lesion with dot-shaped pigmentation

starts in the form.
The type with the best prognosis
Lentigo malignant melanoma
(Answer C)
53. Which causes the Papova virus? (April 94)
A) Lichen planus
B) Duhring
C) Psoriasis
D) Verruka vulgaris
E) Molluscum contagiosum
papovaviruses
Isozahedral nucleocapsid, naked, fence-chain circular DNA viruses
Replicates in the kernel
Causes latent and chronic infection
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SMALL INTERNSHIP
Verrü on the finger
Human papilloma virus (HPV)

•
Replicates in epithelial cells of skin
Generates coilocytic cells during replication (Balloon cells)
Transmission from person to person
Causes Condiloma accuminata
•
Causes warts and laryngeal papillomas
Cervical tumors have been associated with vulvar and penile cancers.
(Answer D)
54. Which is the most common Pyoderma gangrenosum? (April 94)

A) Chronic ulcerative colitis
B) Regional enteritis
C) Colon cancer
D) Scleroderma
E) Dermatomyositis
Pyoderma gangrenosum is a rare, chronic liquefaction skin gangrene. 50%
in conjunction with another disease. Ulcerative colitis is typical.
(Answer A)
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DERMATOLOGY
55. Which is the classic triad of Behçet's disease? (April 94)

A) Uveitis, retinitis, genital ulcers
B) Conjunctivitis, stomatitis, enteritis
C) Glossite, uveitis, oral aphthae
D) Dermatitis, oral aphthae
E) Recurrent uveitis, oral aphthae, genital ulcers
(Answer E)
56. What is the disease causing oral lesions? (September 94)
A) Lichen planus
C) Psoriasis
D) Pitriasis rosea
E) Seborrheic dermatitis
(Answer A)
57. Skin in mouth, elbow, flexor faces, lumbar region, polygonal bright,
Which of the violet papular rash occurs? (April 94)
A) Psoriasis
B) Lichen planus
C) Pitriasis rosea
D) Pitriasis versicolor
E) Erythema multiforme
(Answer B)
58.Which of the nails and onycholysis occurs? (September 93)
A) Onychomycosis
B) Psoriasis
C) Fe deficiency
D) Trauma
E) None
(Answer B)
59. Which is not expected in Xeroderma pigmentosum? (April 93)
A) Pustule
B) Cancer development
C) Atrophy
D) Ectropion
E) Hyperpigmentosis
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Xeroderma pigmentosum DNA is an autosomal recessive inherited DNA repair defect. UV

radiation crosses the thymine in DNA to form thymine dimers. Endonucleases before
DNA repair,
perform nucleotide excision. DNA polymerase then re-synthesizes this region.
Finally
does the ligase assembly process. Endonuclease activity is defective in XP
patients.
Main lesions are erythema, vesicle, bullae, pigmentation, atrophy, telangiectasias,
verrucous and papillomatous
lesions. Ectropion can be seen on the lower eyelid. Cancer development can be
observed. Pustule sign
It is not.
Xeroderma pigmentosum
(Answer A)
60. Which of the following diseases is the least likely to occur in the mouth?
(September 92)
A) Lichen planus
B) Bullous pemphigoid
C) Herpes
D) Pemphigus vulgaris
E) Pemphigus foliaceus
Bulloous pemphigoid lesions are mainly in the arms and femoral regions; legs,
localized in the chest and abdomen. Rare mucosal lesions in the form of intact
bullae
found and heal quickly. Since the immune response against hemidesmosomes develops,
there is accumulation of immune complex in the dermo-epidermal junction.
Oral lesions frequently occur in lichen planus and pemphigus vulgaris. Herpes may
cause lesions in the mouth.
Pemphigus foliaceus has subcorneal bullae and oral involvement is rare, but bullous
pemphigoid
involvement is less frequent.
(Answer B)
61. If you have hyperpigmentation and hypertrichosis, which of the following would
you consider?
(April 92)
A) Ocronosis
B) Hemochromatosis
C) Acne vulgaris
D) Porphyry
E) Lead intoxication
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DERMATOLOGY
Porphyry kutanea tarda

UPG decarboxylase is missing. It is the most common porphyria. It is autosomal
dominant. Acquired hexochlorobenzene and polychloro hydrocarbons cause porphyria
kutanea tarda
can.
Uroporphyrin excretion increases in urine.
Symptoms;
•
Photosensitivity The skin is sensitive to minor traumas.
Hypo or hyperpigmentation
hypertrichosis
Cutaneous por fi ri
(Answer D)
62. Which of the medallion symptoms occurs? (April 92)
A) Atopic dermatitis
B) Nummuler eczema
C) Psoriasis
D) Leprosy
E) Pitriasis rosacea
Pitriasis rosea makes a madolian lesion. Sometimes epidemics can do it. Responsible
for viral etiology (HHV-6)
It was maintained. It causes rash lesions especially in the distribution of pine
trees on the back and trunk. Itching
No way. Topical corticosteroids are used for treatment.
Pitriasis rosacea
(Answer E)
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63. Which of the following is a papulovicular rash? (September 91)

A) Chickenpox
B) Measles
C) Red
D) Mumps
E) Rubella
Varicella (chickenpox), very contagious with acute course, itchy characterized by
vesicles in the skin and mucous membranes
is a child disease. The causative agent is the Varicella zoster virus from the
Herpes virus family.
(Answer A)
64. Tunnel (sillon, burrow) is a specific skin lesion of which of the following
diseases?
(September 91)
A) Pediculosis
B) Larva migrans
C) Leishmaniasis cutis
D) Giardiasis
E) Scabies
Tunnel (Sillon), up to 1 cm in length, slightly fluffy, whitish gray broken line
or S-shaped. Scabies (scabies) are his lesions. Erosions due to itching
visible.
(Answer E)
65. Which of the following is typical in psoriasis? (September 91)
A) Chip land
B) Koebner phenomenon
C) Nikolski
D) Omnibus
E) Dermatography
(Answer B)
66. What is Tinea (pitriasis) versicolor? (September 91)
A) E. floccosum
B) T. pedis
C) T. corporis
D) M. canis
E) M. furfur
The agent of T. versicolor is Malassezia furfur.
(Answer E)
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DERMATOLOGY
67. What is the typical lesion of acne vulgaris? (September 90)

A) Vesicle
B) Reasonable
C) Papule
D) Comedones
E) Erythema
(Answer D)
68. Which elementary lesion causes the herpes simplex virus? (September 90)
A) Papule
B) Reasonable
C) Vesicle
D) Erythema
E) Pustule
The elementary lesion of the herpes simplex virus is the vesicle. The elementary
lesion of the Pox virus is pustule.
(Answer C)
69. Which of the following causes permanent baldness? (April 90)
A) Pelate
B) Follicle cyst
C) Favus
D) 2nd circuit syphilis
E) Tinea capitis superficialis
Favus mostly occurs with T. schoenleinii and sometimes with T. violaceum.
Clinically;
1- A finon-shaped yellow-green crout with a broken hair in the middle (scutulum,
godet)
2- Atrophic scatris
3- It is characterized by thin, gray-white hair.
(Answer C)
70. Which of the following is an intraepidermal blister? (September 89)
A) Pemphigus
B) Epidermolysis bullosa
C) Bullous pemphigoid
D) Ichtiosis
E) Dermatitis herpetiformis
(Answer A)
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71. Which is used in the treatment of pediculosis? (September 89)

A) Ketofen
B) Parathion
C) Malathion
D) Saurine
E) Amphotericin
Pediculosis (lice) treatment; benzene hexochloride, benzyl benzoate, Malathion,
carbazine,
pyrethrine, permethrin, xylol and crotamitone are the main drugs used.
(Answer C)
72. What is stratum corneum thickening? (April 89)
A) Acanthosis
B) Hyperkeratosis
C) Papule
D) Parakeratosis
E) Acantholysis
Thickening of the stratum corneum layer is called hyperkeratosis.
Parakeratosis is the loss of stratum granulosum layer and the emergence of
nucleated cells in the stratum corneum.
Acanthosis is an increase in the number of stratum spinosum cells.
In acantholysis, stratum spinosum cells are independent of cells by breaking off
the desmosomes.
become.
(Answer B)
73. Which is not seen in the leprosy? (April 89)
A) Neurofibromatosis
B) Blindness
C) Autoamputation
D) Peripheral neuropathy
E) Claw hand
Autoeputation, palate drop, claw
deformity may occur.
Neurofibromatosis ie neurofibromin is a disease caused by tumors called
neurofibroma originating from peripheral nerve sheaths due to gene deficiency.
(Answer A)
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DERMATOLOGY
74. What is the most common cause of skin cancer? (April 89)
A) Ultraviolet
B) X-ray
C) Oncogenic RNA virus
D) Trauma
E) Radium
Squamous Cell Carcinoma:
•
It is a malignant epithelial tumor originating from the keratinized epidermis.
UV-B suppresses p53 and activates RAS.
It may originate from normal skin exposed to sunlight or may develop from
premalignant lesions.
It is most commonly seen in the lower lip (vermillion line).
Especially makes lymph node metastasis.
In histology, dense mitosis keratin, dyskeratosis (single cell keratosis) can be

seen.
Treatment: Surgery + Radiotherapy

Squamous cell carcinoma
Basal Cell Carcinoma:

•
Epidermis develops from basal cells or hair follicles.
In Gorlin syndrome, PTCH tumor suppressor gene mutation is classic.
Frequent p53 gene mutation in sporadic cases
In areas exposed to sunlight; It is common in areas with dense pilosebaseous

follicles.
•
It does not metastasize, it causes local invasion and destruction.
Treatment: Surgery, radiotherapy, electrodestruction

Basal cell carcinoma
(Answer A)
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75. The first lesions of pemphigus vulgaris are often

A) Scalp
B) Underarms
C) Oral mucosa
D) Body
E) Anogenital region
(Answer C)
76. Alopecia, mucocutaneous junction lesions, steatorrhea, growth retardation and
serum
What is the disease with low zinc levels? (September 88)
A) Coeliac disease
B) Acrodermatitis enteropatica
C) Thallium poisoning
D) Tropical sprue
E) Short bowel syndrome
Acrodematitis Enteropathica:
Zn is the absorption disorder. Rash and diarrhea with fingertips and perioral
eczamematorm
Watch.
Acrodermatitis enteropathica in zinc deficiency
(Answer B)
77. Recurrent mucosal aphthae often occur in the following diseases?
(April 88)
A) Psoriasis
B) Lichen planus
C) Candidiasis
D) Behcet's disease
E) Herpes simplex
The major diagnostic criterion of Behçet's disease is recurrent aphthosis at least
three times a year.
(Answer D)
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DERMATOLOGY
78. What does chickenpox and flower have in common? (April 88)
A) Pleomorphism
B) Maculopapular rash
C) Rush
D) Papulovicular rash
E) Brown pustule
(Answer D)
79. Which of the following diseases is not considered in the differential diagnosis
of psoriasis? (April 88)
A) II. Circuit syphilis
B) Parapsoriasis plaque
C) Lichen planus
D) Impetigo
E) Seborrheic dermatitis
Psoriasis is a papulosquamosis (rash) disease. Impetigo is a vesicular disease
it does not make a differential diagnosis.
(Answer D)
80. Which of the following pathological findings is seen in Pemphigus group
diseases?
(September 87)
A) Spongiosis
B) Acantholysis
C) Cytolysis
D) Dyskeratosis
E) Hyperkeratosis
(Answer B)
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ORTHOPEDICS
ORTHOPEDICS
one. Neonatal period, demonstrating the reducibility of congenital hip dislocation
Which of the following is the test? (September 2011)
A) Trendelenburg
B) Shenton
C) Thomas
D) Ortolani
E) Galeazzi
DKÇ
Etiology;
one. Heredite: Presence of DKC in parents
2nd. Ligament laxity
3. intrauterine malposition
4. Environmental factors: carriage application
Clinic;
Newborn period
• Acetebulum is dysplasic, USG shows femoral head lateral and superior of
acetebulum, femur
The anteversion angle of the head is high. The joint capsule looks like an
hourglass.
• Hyperlakity is present in the joints and soft ducts.
• Abduction limitation is called “Hert sign,, this limitation gradually increases.
• Barlow sign; It is an indicator of unstability – ascending tendency ça. Buttocks
da
adduction is the provocation of dislocation.
• The sign of Ortolani is indicative of subluxation. Unlike Barlow test,
corrective, dislocation
This is the test where the hip is reduced.
(Answer D)
2nd. Which of the following is not a symptom of fat embolism? (May 2011)
B) Petechia
C) Fire
D) Blur of consciousness
E) Bradycardia
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OIL EMBOLISM SYNDROME

The presence of fat emboli in the circulation after long bone fractures or major
trauma
embolism, although it gives clinical symptoms is called fat embolism syndrome.
It forms an ARDS-like picture in the lung.
Because it produces DIC, there are petechiae and purpura related to consumption
coagulopathy in the skin.
(Answer E)
3. Affected tendons in DeQuervain tenosynovitis
It has been awarded? (December 2010)
A) M. abductor pollicis longus + extensor pollicis brevis
B) M. adductor pollicis longus + extensor pollicis brevis
C) M. abductor pollicis brevis + flexor pollicis longus
D) M. adductor pollicis brevis + flexor pollicis longus
E) M. abductor pollicis longus + extensor pollicis longus
SOFT TISSUE INJURIES
1– Lateral Epicondylitis: Stretching of the extensor forearm muscles adhering to
the lateral epicondyle
consists of.
2– Trigger Finger: Annular surrounding of flexor tendons at metacarpophalangiel
joint level
under the ligament, due to contraction due to contraction.
3– Hygroma: Local soft tissue swelling of the hand accounts for 70%. Just below the
tendon, tendon sheath
and mucinous cyst adhering to the capsule.
4– De Quervain Disease: Radial through the abductor pollicis longus and extensor
pollicis brevis
tenosynovitis of tendons on the styloid is called De Quervain's disease.
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ORTHOPEDICS
(Answer A)
4. A 32-year-old female patient learned to have pain in her right knee after
skiing. Pain Increased With Flexion
patient had no signs of inflammation and mild crepitation in flexion
It is palpable.
2010)
A) Tibiofemoral osteoarthritis
B) Externalmeniscusesion
C) Internal meniscus lesion
D) Chondromalacia patella
E) Anterior cruciate ligament lesion
Chondromalacia patella refers to cartilage tissue degeneration of the patella bone.
Anterior knee pain
It is characterized by.
Anterior knee pain is a simple definition of pain caused by the patelofemoral joint
and pain is patellofemoral.
may also be caused by soft tissues surrounding the joint and pathologies around the
knee.
It occurs with knee pain during daily life and makes it difficult to participate in
sports activities. disease
It is thought that it often develops due to excessive stretching of the
peripatellar retinaculum.
Condomalasia patella has the following:
1) Pain: Anterior knee pain can be painful, blunt or throbbing. Pain characteristic
staircase descent – climbing and knee bent at 90 degrees, especially when
traveling, in cinema
emerges.
2) Crepitation: The ear can be heard by the ear usually caused by patellofemoral
arthritis or only the patient
is the sound of friction.
3) Giving Way: It is an important finding of the patellofemoral joint. Weakness of
the quadriceps muscle
This finding occurs during knee flexion yük extension under load (stairs
stroke, downhill descent). It may also occur in knee instabilities and meniscus
tears.
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4) Crash: Knee weight caused by trochlear and patellar problems during extension
under
This condition, which is usually temporary, should not be confused with meniscus
tears.
5) Swelling: It is a transient condition that is not very common in physical
examination. Serious patellofemoral axis
swelling can also be detected in chondral pathologies, synovial diseases, bleeding
and trauma where free proteoglycan-cartilage fragments are present in the joint.
(Answer D)
5. Which of the following does not occur in patients with pure “blow – out
fractures?
(December 2010)
A) Limitation of eye movements
B) Inward and deep displacement of the eyeball
C) Double vision
D) Facial hypoesthesia on the same side as fracture
E) Limitation of jaw opening
BLOW – OUT FRACTURES
Intra-orbital pressure as a result of a blunt striking a larger object than the
orbital bone frame
abruptly increases and a burst-like fracture occurs at the base of the orbit, the
weakest part of the orbit. Broken line
the inferior rectus muscle and orbital fat tissue of the eye herniate into the
maxillary sinus located below the orbital cavity
they become stuck in the fracture line and as a result some symptoms appear. These
symptoms include enophthalmos (posterior displacement of the eyeball), diplopia
(double vision), limitation of vertical eye movements
movements are normal) to control it; up and down the patient in the vertical
direction of the doctor's finger
can not do this movement. As a result of compression or cut of the infraalveolar
nerve in the fracture line
hypoesthesia in the cheek. Radiological diagnosis is made by anterior – posterior
head radiography and Water's radiography.
(Answer E)
6. Radiolucent, benign appearance in the proximal phalanx of the second finger,
What is the preliminary diagnosis of a patient with central lesion?
(December 2010)
A) Enchondroma
B) Chondroblastoma
C) Benign osteoblastoma
D) Fibrous cortical defect
E) Osteoid osteoma
enchondroma
It occurs in the medullary canal of long bones, phalanges and metacarpals.
It originates from the pineal gland. 1–2% malignant transformation may occur.
Having a large number of single extremities Ollier's Disease. (Enchondromatosis).
It is generally asymptomatic and swelling because it is located in the phalanx and
metacarpals.
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ORTHOPEDICS
(Answer A)
7. In the treatment of developmental hip dislocation cases under one year,
If the abduction and internal rotation position is given, which artery is under
compression?
(April 2010)
a)
Internal iliac artery
B)
Arteria profunda femoris
C.)
Obturator artery
D)
Retinacular artery
TO)
Medial circumflex femoral artery
Internal rotation and excessive abduction position given the congenital hip
dislocation of the femoral neck
Medial circumflex compression of the medial artery may occur.
(Answer E)
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8. Structure with the highest risk of injury after displaced humeral shaft
fractures
A) Nervus medianus
B) Nervus radialis
C) Nervus ulnaris
D) Arteria axillaris
E) Arteria brachialis
A.profunda brachii and N.radialis coexist in the humerus diaphysis. Humerus shaft
Fractures N. Radialis injury may occur.
(Answer B)
9. A 68-year-old female patient complained of right hip pain for a week.
history of pain on the right side of the night increased, walking lateral thigh
it is learned that the pain is spreading downwards. What is the most likely
diagnosis for this patient whose pain is increased when the leg is rotated and
abducted?
(April 2009)
A) Septic arthritis of the hip joint
C) Trochanteric bursitis
D) Porthole disc hernia
E) Obstructive artery disease

Trochanteric Bursitis
It is the most common cause of pain in the hip and side of the thigh. Usually in
the 40-60 age group
and especially in women. Three big bursa trochanter, two of them big and one small
in this region. One of the big bursales is under the gluteus maximus muscle and
the other is located on the outer side of the large trochanter, the other under the
tendon of the gluteus medius muscle and
large anterior-upper part of the outer edge of the trochanter. The smaller bursa is
the gluteus minimus muscle
under the tendon and on the inside of the anterior part of the large trochanter.
Inflammation of these scholarships
or irritation causes symptoms related to trochanteric burbit.
Patients usually complain of pain in the trochanteric region and on the side of the
thigh. Acute cases
It is a common pain in stinging and intense chronic conditions. Pain occasionally
by the side of the thigh
can spread to the bottom of the directory. Characteristically, the pain is severe
at night and when standing up and taking the first steps after prolonged sitting or
bedtime. Long-term walks, kneeling
and climbing stairs are activities that increase pain.
Trochanteric scholarships
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ORTHOPEDICS
Physical examination is the emergence of pain and tenderness by palpation around

the large trochanter. hip
resistance to abduction and external rotation can increase pain.
(Answer C)
10. Which of the reasons for splinting in emergency relief for fracture
A) Preventing closed fracture from turning into open fracture
B) Elimination of deformity
C) Prevention of neurovascular complications
D) Pain relief
E) Facilitating patient transport
By splinting, sharp fracture ends are prevented from damaging neurovascular
structures. It also reduces pain.
This facilitates transport of the patient.
(Answer B)
11th. Tuberositas in front of the tibia swelling, tenderness and movements such as
collapse, jumping
In an adolescent boy with pain, which
It should be considered? (April 2009)
A) Freiberg disease
B) Gonalgia
C) Perthes disease
D) Osgood-Schlatter disease
E) Sever disease
OSGOOD-SCHLATTER DISEASE
Tuberculosis is an avascular necrosis of the tibia and is common in men aged 11-13
years.
There is pain but restriction in knee movement.
Radiologically, there is elongation, fragmentation and bone formation in the
patellar ligament.
(Answer D)
12. Which of the following is the typical radiological diagnosis of degenerative
joint disease?
is not one of the findings? (September 2008)
A) Extension of joint spacing
B) Sclerosis in load bearing areas
C) Subchondral cysts
D) Osteophytes
E) Joint deformation
(Answer A)
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13. In a patient with traumatic posterior hip dislocation, the most likely injury
What is the anatomical structure? (April 2008)
A) Obturator nerve
B) Femoral nerve
C) Sciatic nerve
D) Femoral artery
E) Superior gluteal artery
Posterior dislocations: This is the most common type. It is mostly caused by trauma
from the knee. Hip and knee to 90 °
In flexion, traction is performed while femur is abducted, skin is tractioned for
3-6 weeks. patients
the sciatic nerve may be injured.
Posterior dislocation of the hip
(Answer C)
14. What is the most important finding of Volkmann ischemic contracture?
(September 2007)
A) Absence of radial pulse
B) Muscle edema
C) Pain
D) Erythema
E) Scar tissue
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ORTHOPEDICS
VOLKMAN ISCHEMIC CONTRACT

It is a deformity caused by compartment syndrome of the volar side of the forearm.
It is usually seen in children under 10 years.
Etiology: Arterial injury in fractures and dislocations: especially the
supracondylar humerus
Plasters and bandages that prevent blood flow in the forearm, arterial embolism,
drug extravasation
Clinic:
•
It starts with a severe pain in the forearm a few hours after the trauma.
Volar face has heat pulse, swelling, redness. Pain increases with the extension of
the fingers. Pulse
Taken.
After a few days, the flexor muscles and the intrinsic muscles of the hand
paralyzed, radial and ulnar nerve
dermatome sensation decreases.
•
The volar side of the forearm hardens and a 5P sign appears.
Pain, Pulselesness, Pallor, Paresthesia, Paralysis.
•
During the contracture period occurs claw hand.
Treatment:
•
In the acute period, urgent surgical decompression is performed.
Late contracture is tried to be corrected.

(Answer A)
15. Type of fracture usually observed in a 40-year-old woman with her hand open to
the ground
A) Metacarpal fracture
B) Supracondylar humerus fracture
C) Radius lower end extension fracture
D) Olecranon fracture
E) Ulna distal metaphyseal fracture
COLLES FRACTURE:
The distal part can be up to 3 cm upwards due to the radial lower joint.
and the top of the volar angled fractures.
It is most commonly seen as a result of falling into the palm.
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Colles fracture
(Answer C)
16. A physical examination of an obese and enukoid type boy during hip abduction
and internal rotation
movement is limited, the leg is found to be in external rotation. White sphere in
blood
The number and rate of sedimentation is normal.
What is the most likely diagnosis for this child? (September 2006)
A) Epiphysis of femoral head
B) Tuberculosis arthritis
C) Septic arthritis
D) Rheumatoid arthritis
E) Villonodular synovitis
Unlike adults, the hip joint has a growth cartilage that grows from there. Femoral
head epiphyseal shift, femoral growing tip (epiphysis) on the body of the bone
occurs with shift. It can be on one or two hips. It starts with complaints of hip
pain and limping especially in boys aged 11-16 years.
Epi-slip
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ORTHOPEDICS
Types:
If the child can walk without help or with help, the pineal shift is fixed.
means. More than 90% of cases are fixed.
The pineal shift is not stable in patients who cannot even walk with help. This
type of gliding is usually sports
trauma such as injury or fall. Constant slip due to fall
can also become unstable shift.
Symptoms:
In fixed shift, the child develops stiffness in the hip joint, which can be
improved with rest. After a while
this stiffness may cause disruption while walking and may come and start passing
pains. Pain in the buttocks
need not be; can be felt in the groin, thigh or knee. Later, the child moves her
hip
partially lose the ability to do so. The leg usually rotates outwards. This leg is
may appear shorter. Children cannot play games or leaning on their shoes
cannot perform simple tasks.
Symptoms may progress slowly or rapidly. In unstable slipping, the child has severe
pain.
Pain is severe as if it were broken. The child can't move this leg. If it is not
fixed
If the slip is suspected, the leg should not be forced to move. Forcing slipping
further
Can improve.
Treatment: Treatment is usually possible by surgery. The results of this treatment
are very good, untreated
hip joint nutrition may be impaired, or cartilage structure degenerates
(chondrolysis)
(Answer A)
17. Which of the following findings is early in reflex sympathetic dystrophy
A) Severe pain
B) Swelling
C) Excessive sweating
D) Erythema
E) Limitation of joint movement
Sudeck Artophysia (Reflex Sympathetic Dystrophy)

Following trauma, surgery, local or systemic diseases, pain in the hand or foot,
swelling, discoloration and
is a vasomotor dysfunction characterized by stiffness in the joint.
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Trauma causes continuous vasospasm in the terminal arteries without reflex changes
in the large arteries.
There are swelling, tenderness, coldness, sweating, cyanosis and limitation of
movement in the hands and feet. in Radiology
Ost spotted osteoporosis appearance..
Treatment: Sympathetic block, sympatholytic drugs.
(Answer E)
18. Which of the following is achieved dorsally at the level of the distal
interphalangeal joints
define the monitored exostoses?
A) Heberden nodules
B) Bouchard nodules
C) Tofus
D) Bunion
E) Baker's cyst
Deformity:
•
Heber nodules (DIF joint)
Bouchard nodules (PIP joint)
Genu varus
Hallux valgus
News and Bouchard nodules
(Answer A)
19. An eighteen-month-old baby has irritability, weakness, fever and movement of
his left arm
fetched due to failure. Physical examination of the left shoulder region, slightly
swollen,
movements appear to be extremely painful. Laboratory examinations
leukocyte count was 18 000 / mm3 and sedimentation rate was 55 mm / h. Radiographic
examination shows that the shoulder joint is subluxated.
What is the most likely diagnosis for a child? (April 2006)
A) Juvenile rheumatoid arthritis
B) Acute rheumatic fever
C) Traumatic shoulder dislocation
D) Septic arthritis
E) Tuberculosis arthritis
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ORTHOPEDICS
Acute Septic Arthritis

It is most commonly seen in infants and children 1-2 years. It is most commonly
seen in the knee joint.
Pathology
•
The bacterium settles in the synovial membrane and forms acute synovitis. Synovial
membrane swells, edematous,
it becomes hyperemic and produces more synovia.
•
Synovial fluid is cloudy, gray and greenish. Polymorph core more than 50.000 / mm3
leukocytes.
Lysosomal enzymes released from both bacteria and leukocytes break down the
amorphous substrate of the cartilage enzymatically.
Clinic:
•
There are severe pain, limitation of movement, fever, chills, sweating, redness and
loss of appetite.
The joint is swollen, red and hot. The joint is kept flexed due to spasm.
Radiology: No initial findings. The earliest symptom is the shadow of soft tissue
around the joint, resulting in swelling and stretching of the synovial membrane. If
untreated, narrowing of the joint space
and degenerative changes occur.
Laboratory: Leukocyte increase, sedimentation height, CRP height.
Definitive diagnosis: It is made by culture from joint fluid.
Treatment: Requires immediate treatment. If the diagnosis is definitive surgical
drainage and washing + IV antibiotherapy.
(Answer D)
20. Which of the following best describes the Dupuytren contracture? (September
2005)
A) Digital stenosing tenovaginitis
B) Hyperextension in metacarpophalangeal joints, flexion deformity in PIP and DIP
joints
C) Contracture in metacarpophalengeal joints
D) Hyperextension contracture in proximal interphalangeal joints
E) Digital flexion contracture due to fibrosis of palmar fascia
Dupuytren's contracture
(Answer E)
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21. The following physical examination of a 2-month-old baby who is thought to have
congenital hip dislocation
Which findings are not expected? (April 2005)
A) Uneven skin folds in the thigh
B) Trandelenburg finding
C) Barlow test
D) Ortalonia test
E) Limited abduction of the hip
(Answer B)
22. What is the main function of pelvic rotation in normal gait? (April 2005)
A) Shifting the trunk laterally
B) Increasing the step length
C) Increasing knee and ankle flexion
D) Providing shock absorption in the heel striking
E) Lowering the vertical position of the center of gravity during the double
support period
MOVEMENT OF BODY WEIGHT CENTER
The center of gravity of a moving object moves in the direction of movement. Weight
when rolling a wheel
the most effective movement in terms of energy consumption, since it moves in a
straight line parallel to the central ground
shape of the human body is also observed.
hellezoni tries to keep up and down at least on a curve. Center of gravity while
walking
a total of 5 cm plays up and down 5 cm each side. Pelvis rotation in normal gait
Its main function is to ensure the continuity of the body center of gravity.
(Answer E)
23. In acute ischemia due to peripheral arterial occlusion, which
A) Pain
B) Coldness
C) Cyanosis
D) Paresthesia
E) Pulse loss
5P finding of acute arterial occlusion:
one. Pain
2nd. Pulseness
3. Pallor
4. paresthesia
5. paralysis
(Answer C)
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ORTHOPEDICS
24. The most important cause of hip avascular necrosis in people under 45 years of
age
A) Hip fracture due to osteoporosis
B) Corticosteroid use
C) Lumbar nerve root irritation
D) Thoracanteric bursitis
E) Osteoarthritis
Causes of Avascular Necrosis:
•
Primary or idiopathic
Secondary causes
Trauma
Corticosteroid use or Cushing's syndrome

•
Alcohol
SLE or other rheumatologic diseases
Hematological diseases (sickle cell anemia)
Metabolic diseases such as hyperlipidemia, gout
Infection (Septic arthritis, HIV)
Kidney transplantation
Radiotherapy
Gaucher's disease
Malignant diseases infecting bone marrow
Caisson's disease
Pregnancy
Bisphosphonate use
Avascular necrosis of the femoral head
(Answer B)
25. Which of the following tumors have clinical and radiological findings similar
to osteomyelitis? (September 2003)
A) Chondrosarcoma
B) Ewing tumor
C) Multiple myeloma
D) Breast cancer metastasis
E) Malignant lymphoma
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SMALL INTERNSHIP
Ewing Sarkom
•
It is a PNET tumor of bone. It is one of the small round cell tumors. Since it
contains glycogen
PAS is stained positive.
5-25 years of age.
It is most commonly located in the diaphysis of long bones.
There are complaints of pain, swelling, redness.
It is most commonly mixed with osteomyelitis. It is radiosensitive.
There is glycogen storage in the cells.
Makes osteolytic lesion.
Radiologically, lamellar periosteal reaction, such as onion skin, is seen.
It most commonly metastasizes to the lung. The prognosis is poor.
The most common translocation is t (11-22). 22 chromosomes EWS, 11 chromosomes FL1

fused with the gene.
(Answer B)
26. Leg elevated at night and said to be crossed with aspirin in a 12-year-old boy
pain. Sclerosis around the tibia diaphysis
a radiolucent focal 1.5 cm in diameter was found.
What is the most likely lesion in this patient? (April 2003)
A) Osteosarcoma
B) Osteochondroma
C) Chondrosarcoma
D) Osteoid osteoma
E) Aneurysmal bone cyst
Osteoid Osteoma
•
Painful in the metaphysis and diaphysis of the femur and tibia (responds to
aspirin)
lesions.
It is lytic, but reactive sclerosis is present around the lesion.
The middle of the lesion is called nidus.
Nidus should be removed in treatment.
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ORTHOPEDICS
(Answer D)
27. Device and treatment of congenital hip dislocation in 0-6 months old infants
Which of the following positions are required?
(September 2002)
A) Addition and extension
B) Addition and flexion
C) Abduction and extension
D) Abduction and flexion
E) External rotation and extension
Neonatal HCW Treatment:
Keeping the hips in the abduction position to guide the femoral head to the
acetabulum
Abundant spacer is provided, Von Rosen device, pelvic bandage, plaster is given.
(Answer D)
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28. Retroperitoneal hematomas were the most common causes of blunt trauma in
patients.
is one of the following reasons? (April 2002)
A) Kidney parenchyma injury
B) Inferior injuries of the vena cava
C) Pelvis fractures
D) Mesenteric vascular injuries
E) Pancreatic injury
The most common cause of retroperitoneal hematoma is pelvic fractures. Diagnosis is
difficult in blunt traumas and should be suspected in patients with signs and
symptoms of hemorrhagic shock without significant source of bleeding. Bleeding to
the retroperitoneal region may be massive and may exceed 2000 ml.
Abdominal pain (60%), back pain (25%), local or diffuse sensitivity (in 2/3) and
shock (40%)
has. There may be color changes in the flank areas due to bleeding. Hemoglobin and
hematocrit
there is a continuous fall and 80% of patients have hematuria. Hematuria
retroperitoneal
may be the first sign of bleeding.
Diagnosis: CT
(Answer C)
29. Avascular necrosis as a complication of the following fracture types
development is likely? (April 2002)
A) Fibula head fracture
B) Tibia plateau fracture
C) Tibial medial malleolar fracture
D) Femoral neck fracture
E) Femoral supracondylar fracture
As a result of the fracture, circulation in the vessels feeding the bone is
impaired due to trauma. Bone is not nourished and
bone necrosis. Mostly femoral neck, scaphoid, talus and lunatum fractures
is seen later.
(Answer D)
30. If pain, swelling, paleness, stiffness of the joints and radiographs are taken
in a patient who has an operation after forearm fracture, which is the most likely
diagnosis?
(September 2001)
A) Vollkman ischemic contracture
B) Sympathetic dystrophy
C) Non-use atrophy
D) Cosalgia
E) Osteomyelitis
(Answer B)
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ORTHOPEDICS
31. How is bone fracture seen at the junction of the femoral diaphysis and
metaphysis? (April 2001)
A) Intertrochanter fracture
B) Supracondylar fracture
C) Subcondylar fracture
D) Epiphysial fracture
E) Femoral shaft fracture
The fracture region is the supracondylar region of the femur over the condyles
where the diaphysis of the femur and the metaphysis meet. Therefore, the fracture
shown in the figure is called the supracondylar fracture of the femur.
(Answer B)
32. Which of the following is not one of the local factors that adversely affect
fracture healing? (September 2000)
A) To have dislocation together
B) Segment loss between bone fragments
C) Malnutrition of bone
D) Fracture type and location
E) Soft tissue interposition
Factors affecting fracture healing;
General
•
Age
Vitamins A, B, C, D and minerals such as phosphorus, zinc
Hormones
Anticoagulants; adversely affects fracture healing
Local
•
Bleeding character of soft tissues surrounding fracture
Presence of infection
Immobilization increases fracture healing.
Type of bone; Spongyosis bone heals more easily, cortical bone more strength.
Degree of bone loss
Avascular necrosis
(Answer A)
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33. A 20-year-old man presented with a 2-month history of swelling and pain in his
right knee.
References. Filling the medullary cavity in the lower metaphysis of the femur,
The lesion, which destroys the cortex, contains solid cystic areas.
A) Solitary bone cyst
B) Osteosarcoma
C) Osteochondroma
D) Aneurysmal bone cyst
E) Giant cell tumor of bone

I oSTEOSARCOMA
•
It is the most common malignant tumor.
Distal femur, proximal tibia, metaphyseal are the most common sites.
It is common in 10-30 year old men. The most important finding is pain.
Radiological:
•
It is seen as a triangle where the tumor tissue breaks the cortex (Codman's
triangle).
It most commonly metastasizes to the lung.
Treatment:
•
Amputation, chemotherapy, radiotherapy.
(Answer B)
34. Plaster of child falling onto elbow and fracture of arm from distal humerus
pain, paleness and pulse in this child
A) Brachial artery incision
B) Volkman's ischemia
C) Raynoud's disease
D) Vasculitis
E) Nerve compression
Volkman ischemic contracture; fibrosis due to ischemia in the forearm and hand
muscles, wrist
and the resulting flexion deformity.
Etiology, arterial injury, tight dressings and gypsum, blunt crush, injuries are.
It is usually seen in children after fracture and dislocation of the elbow.
In the clinic, severe pain, swelling, numbness, tingling and anesthesia develop in
the forearm and hand. Muscle
Ischemia and paralysis cannot result in finger movements. Flexion of wrist and
fingers over time
develop contractures.
(Answer B)
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ORTHOPEDICS
35. Used in the treatment of torticollis and showing effect by making muscle
paralysis for 5-6 months
Which agent is it? (April 99)
A) Tubocuranine
B) Succinylcholine
C) Botulinum toxin
D) Aflatoxin
E) Bombsin
Botulinum toxin, a very powerful poison, completely blocks the release of Ach from
cholinergic tips, even in very small doses, and its effect lasts for 4-6 months.
Diseases Botox is used in the treatment of:
•
Strabismus
Ocular myopathy due to hyperthyroidism
Essential blepharospasm
Hemifacial spasm
torticollis
(Answer C)
36. Why is circular plaster checked within the first 24 hours? (September 98)
A) To prevent Sudeck atrophy
B) To prevent circulatory disorders
C) For the operation of broken ends
D) To prevent joint stiffness
E) To prevent contracture
It is checked for circulatory disorder. Volkman for ischemic contracture,
especially in forearm casts
attention should be paid.
(Answer B)
37. Radiopaque ring around the radiolucent center in the femur with knee pain with
aspirin
What is the possible diagnosis in a child with visual appearance? (September 97)
A) Ewing's sarcoma
B) Osteoma
C) Osteoid osteoma
D) Osteoblastoma
E) Chondroblastoma
Bone tumor responding to aspirin pain is osteoid osteoma.
(Answer C)

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38. Which artery is injured in a supracondylar humerus fracture? (April 98)

AA. ulnaris
B) A. brachial
C) A. radialis
D) A. Axillaris
E) A. the subclavian
A. Brrachialis injury is common in supracondylar humerus fractures. Therefore,
ischemic contracture may occur in flexor muscles.
(Answer B)
39. Which is not a radiological image of joint tuberculosis? (April 97)
A) Osteoporosis in the adjacent joint
B) Osteophyte
C) Subluxation
D) Contraction of joint space
E) Sequestrum
TUBERCULOSIS ARTHRITIS
The disease typically involves large, load-bearing joints such as the knee and hip,
but the elbow, wrist,
The disease may also occur in the joints of the sacroiliac joint, shoulder, hand
and foot. Patient with a hitch
and there is a decrease in temperature, swelling and range of motion in the joint.
Late cases
A drained sinus may be seen. Even if tuberculosis settling in a joint is treated
appropriately
it causes a decrease in the movement of the joint.
Triple radiological findings are classic in tuberculous arthritis: Juxta-articular
osteoporosis, peripheral bone
erosions and progressive narrowing of the joint space. Initially in other
infectious diseases
and rheumatoid arthritis, as well as soft tissue swelling and osteoporosis are the
most striking findings.
(Answer B)
40. Seventy-year-old female patient with total hip due to degenerative arthritis 6
months ago
prosthesis. Fever rising in the evening for the last 2 months, pain in the hip
while walking
Head with complaints. 11,000 / mm3 multiple
If leukocytes and bacteria are detected, which of the following is the most likely
factor?
(April 96)
A) Streptococcus
B) Staphylococcus epidermidis
C) E. coli
D) Hemophilus influenza
E) Pseudomonas
The most common cause of septic arthritis in patients who have undergone prosthetic
surgery is staphylococcus epidermid.
(Answer B)
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ORTHOPEDICS
41. A 68-year-old patient was hospitalized with a diagnosis of femoral neck
fracture for 13 days.
or it is. The patient had sudden chest pain and inability to breathe.
What is the most likely diagnosis? (April 96)
A) Pulmonary thromboembolism
B) Myocardial infarction
C) Pneumothorax
D) Hydropneumothorax
E) Sepsis
PULMONARY THROMBOEMBOLISM
The most common cause of pulmonary thromboembolism is the separation of a vascular
thrombus in the leg (70-80%, most commonly from deep femoral veins) or in the
pelvis (10-15%).
one.
Hip surgery is the most common cause of orthopedic surgery.
2nd.
Abdominal surgery and other surgical procedures
3.
Long-term immobilization
4.
Oral contraceptive use
5.
obesity
6. Congenital factor deficiencies (APC resistance (most common), protein C, S,

antithromobin III deficiency,
prothrombin anomaly, hyperhomocysteinemia)
7.
Air and fat embolism: Femoral diaphyseal fractures oily bone marrow is mixed with
blood. Lungs
embolism occurs. Fat makes ARDS by creating lung toxicity. In addition, DIC result,
the body
petechiae and purpura.
8.
Tumor: Wilms tumor is the most common tumor in children and pancreas ca
9.
Parasites such as shistosma
10. Septic embolism: originates from the endocarditis affecting the tricuspid
valves.
11th. Amniotic fluid embolism
12. Collagen tissue diseases; SLE and Behcet's disease
(Answer A)
42. Especially around the middle translucent, which settles in the femur and tibia
diaphyseal region
Which bone tumor has sclerotic halos and has a tendency to subcortical
localization? (April 96)
A) Osteoma
B) Osteoid osteoma
C) Osteochondroma
D) Ewing's sarcoma
E) Osteosarcoma
(Answer B)
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43. Vertebra osteomyelitis occurs in a person with intravenous drug habit.

Gr (-), non-fermentative microorganism
It is. Which of the following is the agent? (September 95)
A) E. coli
B) Pseudomonas auroginosa
C) Klebsiella pneumonia
D) Acinetobacter
E) Proteus vulgaris
(Answer B)
44. Serum calcium and phosphorus content is normal and decrease in trabeculation,
coarseness
and a decrease in bone mass, which is the disease?
(September 95)
A) Osteoporosis
B) Osteomalacia
C) Rickets
D) Osteopetrosis
E) Hyperparathyroidism
OSTEOPOROSIS:
It is a systemic disorder characterized by a decrease in bone mass and an increase
in bone fragility as a result of deterioration in the microstructure of bone tissue
and a tendency to fracture of the hip, spine and wrist.
Bone regeneration is a constant bone resorption (osteoclastic activity) and bone
formation (osteoblastic)
activity).
Although the mineral / matrix ratio is normal in osteoporosis, there is a decrease
in bone mass. Osteopenia is called radiographically reduced bone mineral content.
(Answer A)
45. Felting, pain occurs in the hands of someone carrying heavy loads. Press the
shoulder and back
the radial pulse disappears and the pain exacerbates.
A) Carpal tunnel syndrome
B) Costoclavicular syndrome
C) Trap neuropathy
D) Axillary artery occlusion
E) Medulla spinalis lesion
One of the causes of thoracic outlet syndrome is costaclavicular syndrome.
Costoclavicular syndrome: compression of the vessel and nerve bundle between 1 rib
and clavicle
It is a disease caused by.
In cases of fatigue caused by excessive use of arms, some traumas and postural
disorders may cause this condition. Pulling shoulders backwards and downwards hard
(exaggerated)
military posture position). Performing this in the examination may also trigger
pain. Reasonable treatment and exercise, physical therapy applications are
recommended
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ORTHOPEDICS
Brachial plexus anatomy
(Answer B)
46. In young people, which is the most common cause of Volkmann ischemic
contracture
would you? (April 95)
A) Open fractures of the wrist
B) Shoulder dislocation
C) Double forearm fractures
D) Palm injuries
E) Humeral supracondylar extension type fractures
(Answer E)
47. An elderly person, elbow extension, forearm pronation, hand extension, while
falls on his hand and wrist deformity occurs on the wrist What is the diagnosis?
(September 94)
A) Dislocation of the wrist
B) Colles fracture
C) Montegio fracture
D) Bennet fracture
E) Cystic hygroma
The fracture in this position is a Colles fracture.
Monteggia fracture dislocation: Ulna fracture + radius head dislocation
Galeazzi fracture dislocation: Radius lower 1/3 fracture + lower radioulnar
dislocation
Bennet fracture: 1. The fracture dislocation of the metacarpal base.
Cystic hygroma are serous vesicles filled with synovial fluid. It is most commonly
seen on the back of the hand.
(Answer B)
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48. Pain in the vertebral, knee and hip joints bearing over 70 years of age,
What is the diagnosis in a patient without systemic symptoms? (April 94)
B) Osteoarthritis
C) Rheumatic fever
D) Gout
E) Paget's disease
(Answer B)
49. Bone becomes brittle and brittle by deterioration of osteoblastic activity
What is the outgoing bone disease? (April 94)
A) Osteopetrosis
B) Enchondromatosis
C) Osteogenesis imperfecta
D) Ollier's disease
E) Rickets
Osteogenesis imperfecta occurs in type 1 collagen defect. Multiple bone fractures,
blue
Sclera, scoliosis, mitral insufficiency are the symptoms of the disease.
enchondroma
•
It occurs in the medullary canal of long bones, phalanges and metacarpals.
It originates from the pineal gland. Malignant transformation may occur in 1-2%.
Multiple in one limb

Ollier's Disease. (Enchondromatosis).
Multiple hemangiomas to enchondromatosis

if it is accompanied by this is called Mafucci.
Ollier to be more than Mafuccide
chondrosarcoma transformation in disease
risk.
It is generally asymptomatic and has phalanx and

swelling
It makes.
(Answer C)
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ORTHOPEDICS
50. Typical bone disease compressing the medulla spinalis by narrowing the foramen
magnum
A) Fibrous dysplasia
B) Ewing's sarcoma
C) Paget's disease
D) Osteid osteoma
E) Chondrosarcoma
Paget's disease
A metabolic characterized by progressive deformity and expansion as a result of
abnormal bone destruction and construction
bone disease.
There are two phases:
osteolytic:
Bone destruction was accelerated. The bone expands, becomes weak, sponges and spun.
Curved bones
incomplete pathological fractures are seen on the concave side.
osteosclerotic:
Bone construction is accelerated. The expanding bones harden and become sclerosed.
Sclerotic bones easy
broken. Both periostal and endosteal narrow the medulla as it is new bone
formation.
Clinic:
•
It is common in men over 10 years of age. It is generally polyostatic. Insidious

pain in the affected bone
starts then increases and becomes continuous. Most commonly, tibia, femur, pelvis,
vertebrae and
settles on the skull. When vertebrae, it causes kyphosis, deformities in femur and
tibia
causes. Those who settle in the head expand the head, the face remains small. The
hat number increases.
It rarely involves the cervical region and causes neurological symptoms with
compression of the medulla spinalis.
It happens.
It narrows the foramen magnum and causes compression of the medulla spinalis.
Pathological fractures and hearing
malfunctions
Secondary osteosarcoma develops in 1% of cases.
Radiology: Osteolytic stage enlargement, osteoporosis, honeycomb appearance. There

is a view of thrown cotton on the head bones. Bone density increased in
osteosclerotic stage,
cortical translucent lines (incomplete fracture). The medulla is narrowed.
Laboratory: Serum alkaline phosphatase is considerably increased.
Treatment: Calcitonin, diphosphonates and vitamin D are used.
(Answer C)
51. Where does osteomyelitis most often begin? (April 93)
A) Diaphysis
B) Pineal
C) Metaphysis
D) Kortex
E) Under Periost
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Acute Osteomyelitis
Hematogenous pathogenesis of bone and bone marrow is called inflammation of
bacteria. More
children and boys are seen 3-4 times more than girls. It usually settles in the
metaphysis of the growing long bones. Staf is the most common etiology. aureus.
Less streptococci, pneumococci,
salmonella and E.coli. Salmonella infection specific in patients with sickle cell
anemia
as seen.
Clinical Findings
•
It occurs mostly in the lower end of the femur and the upper end of the tibia
metaphysis. The first and most important symptom is continuous and
severe pain. Pain increases with movement. There are systemic findings related to
septicemia in the first 24 hours.
As you progress, fever, chills, nausea and vomiting occur. Antalgic limping of the
lower extremities
It is seen.
Then soft tissue swelling, redness and local heat increase occur. Adding neighbor
There is protective spasm in the muscles and the joint is kept in the most
comfortable position. So the joint
usually flexed.
Laboratory Findings: Increased polymorphonuclear leukocytes, high sedimentation

rate, positive blood culture
and aspiration is the detection of bacteria in the mine.
Radiology: There is no radiological change in bone in the first 10 days. Periostal
reaction after 2 weeks
It is seen. Diagnosis can be made by Ga-67 labeled leukocyte scintigraphy in the
first 10 days.
Definitive diagnosis: Aspiration is made by culture from the fluid.
(Answer C)
52. Abductor pollicis longus-extensor pollicis brevis tendon formation of
tenosynovitis
What disease is it? (September 92)
A) De-Quervain disease
B) Dupuytren's contracture
C) Carpal tunnel syndrome
D) Charcot joint
E) Epicondylitis
De Quervain Disease:
Abductor pollicis longus and extensor pollicis brevis
tenosynovitis of tendons is called De Quervain disease.
De Quervain disease
(Answer A)
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ORTHOPEDICS
53. Which of the following is not a feature of benign bone tumors? (September 92)
A) Wide transition zone
B) Periost-cortex continuity
C) Specific marginal appearance of the lesion
D) Lack of periosteum reaction
E) Absence of soft tissue extension
Benign bone tumors are sharply limited. The wide transition zone is a feature of
malignant tumors.
(Answer A)
54. Anterior-posterior and lateral radiographs of thoracic vertebrae in
osteoporosis
which of the following is not seen? (April 92)
A) Height loss (collapse) in the entire vertebral corpus
B) Concave on the upper and lower surfaces of the vertebral corpus
C) Localized herniation in vertebral corpus (Schmorl nodules)
D) Loss of trabeculation in vertebral corpus
E) Glare due to loss of height in the posterior part of the vertebral corpus
In osteoporosis, collapse of the vertebrae and related height loss occurs. Nucleus
pulposos,
hernie into the vertebra corpus. This is called the Schmorl nodule. Deposits due to
collapse
glare happens.
Osteoprotic vertebral collapse fracture
(Answer E)
55. What is the leg position in the posterior hip dislocation? (April 92)
A) Flex on the hip, add., Outward rotation of the leg
B) Extension of the hip, abd., Outward rotation of the leg
C) Ext. Of hip, add., Outward rotation of leg
D) Flex on the hip, abd., Rotation in the leg
E) Flex in the hip, add., Rotation in the leg
Posterior hip dislocation; the hip is in flexion, adduction, and the leg is in
internal rotation.
(Answer E)
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56. The most important complication of cast in hyperabduction in congenital hip

dislocation
A) Aseptic necrosis of the femoral head
B) Pressure sores
C) Abduction contracture
D) Re-dislocation
E) Acetabular dysplasia
One of the most important complications of hyperabduction in congenital hip
dislocation
Avascular necrosis of the femoral head.
(Answer A)
57. What is the most common cause of Wolkman's ischemia? (September 91)
A) Olecranon fracture
B) Femoral neck fracture

C) Colles fracture
D) Radius head fracture
E) Supracondylar humerus fracture

(Answer E)
58. A 25-year-old multiparous woman had bone pain when walking and
laboratory examination shows hypocalcemia.
Which of the following would you consider in this patient? (September 91)
A) Osteomalacia
B) Osteoporosis
C) Osteosclerosis
D) Rheumatoid Arthritis
E) Ankylosing spondylitis
Osteomalacia is a mineralization defect in the bone matrix. Form before the closing
of the pineal plaques
rickets, osteomalacia is the form after epiphyseal closure. Vitamin D intake
failure,
Renal failure, renal phosphate absorption defects are among the causes.
Osteomalacia presents symptoms with proximal muscle weakness and bone pain. Looser
radiologically
pseudo-fracture lines called fracture (Milkman) are typical.
Scapulada looser fracture
(Answer A)
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ORTHOPEDICS
59. Which of the two-month congenital hip dislocation patients? (April 91)
A) Surgery
B) Non-arson
C) Sheep tilting
D) Thick cloth
E) Keeping the feet flexed
(Answer A)
60. Which is best suited to relieve pain in a costa fracture?
(April 91)
A) Stabilization of patch
B) Surgical costectomy
C) Intercostal nerve blockade
D) Thoracotomy
E) Sewn with wire
Intercostal nerve blockage is best for the treatment of pain in rib fractures
(Answer C)
61. Which of the following diagnoses is present in a patient with acute arthritis
of a large joint?
should be considered before? (September 90)
A) Septic arthritis
C) Behcet's disease
D) Reiter syndrome
Septic arthritis; usually holds a single joint. The joint is swollen, red, hot and
hypersensitive.
(Answer A)
62. Which of the following pathologies has an indication for open amputation?
(September 90)
A) Gas gangrene
B) Ewing's sarcoma
C) Diabetic gangrene
D) Elephantiasis
E) Thromboembolic gangrene
Infected and dirty injuries should be performed emergency amputation
(Answer A)
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63. Which of the following complications are frequently seen in adult patients with
pelvic fractures?
A) Vaginal rupture
B) Bladder rupture
C) Descending colon perforation
D) Ureteral laceration
E) Rectum perforation
Pelvic fractures; bladder and urethral tears are most common due to its
neighborhood
(Answer B)
64. The best way to prevent fat embolism syndrome, which is one of the early
fracture complications, is handicap of the following? (April 90)
A) Prophylactic anticoagulation
B) Immediate immobilization of the fracture
C) Prevention of fracture-induced shock
D) Emergency open reduction of the fracture
E) Administration of prophylactic steroids
The best way to avoid fat embolism syndrome is fixation of the fracture as soon as
possible.
(Answer B)
65. Which of the following fractures heals most easily? (April 90)
A) Humeral fracture
B) Talus neck fracture
C) Femoral neck fracture
D) Tibial spiral fracture
E) Open segment femoral corpus fracture
In segmented fractures, only the periosteal veins die, circulate with feeder and
metaphyseal vessels.
boiling is difficult because it is interrupted. Vein passing through the tibial
body in talus neck fractures
boiling is difficult because it is damaged. Spiral and oblique fractures of both
fragments
vascularization on the curved and wide fractured faces helps to heal.
In open fractures; Osteoblastic activity is discharged out of the fractured
hematoma. From the other side
The door to infection has been opened, so recovery becomes late and difficult.
(Answer D)
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ORTHOPEDICS
66. During the initial examination of any fracture, which

should not be done? (September 89)
A) Investigation of pain and tenderness with palpation
B) Monitoring of deformity in the suspected fracture area
C) Investigation of loss of function
D) Radiological examination
E) Investigation of abnormal movement
It is very painful to look for abnormal movement during the initial examination of
the fracture, and this movement will
it should not be done unless it is necessary because it may damage the nerve pack
and other tissues.
(Answer E)
67. In Pott's disease, where does the vertebra first begin? (September 89)
A) Spinose process
B) Transverse process
C) Arcus vertebrae
D) Intervertebral disc
E) Corpus vertebrae
Tuberculosis Osteomyelitis
It always occurs due to TB infection found elsewhere in the body.
Comes in hematogenous way.
Usually, vertebral bodies (Pott's disease) are located in the metaphysis and
epiphysis of long bones. Here
The resulting caseification necrosis proceeds along the psoas. It may be fistulized
from the inguinal region.
Tuberculous osteomyelitis in vertebrae
(Answer E)
68. If a small child has pain in the tuberositas tibia by running or jumping
What is your diagnosis? (September 89)
A) Chondrom
B) Patella alata
C) Sarcoma
D) Osgood-Schlatter
E) Perthes
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OSGOOD-SCHLATTER DISEASE
•
Tuberculosis is an avascular necrosis of the tibia and is common in men aged 11-13
years.
There is pain, but there is a restriction in knee movement.
Radiological elongation, fragmentation and patellar ligament bone

formation.
(Answer D)
69. What is the radiological finding in acute hematogenous osteomyelitis at 1 week?

(April 89)
A) Periost thickening
C) Narrowing between joints
D) Metaphysis destruction
E) Destruction of cortex
In osteomyelitis, lytic findings in bone metaphysis do not appear in the first 10
days. In the first week however
soft tissue swelling.
(Answer B)
70. Which of the following hip movements is most limited in a 2-year-old child with
congenital hip dislocation? (April 89)
A) Flexion
B) Addition
C) Extension
D) Abduction
E) External rotation
Abduction limitation due to the contracture of the adductor muscles is prominent in
DCF. This is called the Hert sign.
(Answer D)
71. What is the most likely tumor in the distal metaphysis of the femur in a young
patient? (September 88)
A) Osteosarcoma
B) Chondrosarcoma
C) Ewing's sarcoma
D) Multiple myeloma
E) Chondroblastoma
Osteosarcoma is mostly in the 10-20 years of age and most commonly in the distal
end of the femur, proximal end of the tibia and humerus
It settles.
Ewing originates from sarcomochemic marrow. It settles in the diaphysis of long
bones. 5- Between 25 years
Fuck. Makes a periosteum reaction. Mixed with osteomyelitis.
Chondrosarcoma is a malignant tumor originating from cartilage cells in adults.
Long
bones, ribs and pelvis. Contains popcorn-style calcification.
The chondroblastoma is located in the proximal humerus distal femur and lower end
of the tibia epiphysis. Radiology
frequently mixed with tuberculosis.
(Answer A)
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ORTHOPEDICS
72. Where does the degenerative joint disease start? (April 89)
A) Joint cartilage
B) Synovial membrane
C) Periost
D) Joint capsule
E) Joint spacing
(Answer A)
73. Among the traumatic lesions of the child's upper extremities, the most common
cause of Volkman's ischemia
which is the following? (September 88)
A) Humerus diaphysis fracture
B) Ulna radius diaphyseal fracture
C) Elbow dislocation
D) Monteggia fracture dislocation
E) Humeral supracondylar fracture
(Answer E)
74. Volkman ischemic contracture is most common in which of the following? (April
88)
A) Radial head fracture
B) Colles fracture
C) Femoral shaft fracture
D) Supracondylar humerus fracture
E) Olecranon fracture
Volkman ischemic contracture; The first hours following the fracture and the first
day
is a severe complication. Broken ends, edema, hematoma, excessive elbow flexion,
trauma causing hemorrhage in the fracture site;
even ischemic necrosis caused by inhibition of arterial flow. Most (35%)
supracondylar
humerus fractures.
(Answer D)
75. Which of the following is the most common cause of osteomyelitis? (April 88)
A) Salmonella
B) S. aureus
C) Beta hemolytic streptococcus
D) E. coli
E) Pseudomonas
(Answer B)
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76. A patient presented with pain, redness and swelling in one of the large joints.
which is the most likely diagnosis? (September 87)
A) Rheumatic fever
C) Septic arthritis
D) Tuberculosis arthritis
E) Dermatopolymyositis
(Answer C)
77. Which disease does not cause Dupuytren's contracture?
(September 87)
A) Diabetes mellitus
B) Alcohol
C) Chronic liver disease
D) Old age
E) Diabetes insipidus
Duputren contracture is the flexion of the fingers due to fibrosis of the plamar
fascia. DM, alcohol,
liver disease, aging are among the etiological factors.
(Answer E)
78. The most important thing to be done to prevent fat embolism as a result of
fracture
What is the process? (September 87)
A) Open repositioning
B) Emergency stabilization of the fracture
C) Heparin application
D) Wound edges cleaning
E) Oral anticoagulant administration
Fat embolism; Posttraumatic occurrence in the first 72 hours following skeletal
trauma
respiratory syndrome. Oil droplets released from the fracture line go to the lung
Form ARDS. Fat particles also cause DIC to cause widespread petechiae in the body.
cause. Maintaining fracture stability is an important factor in prophylaxis.
(Answer B)
79. Where does osteogenic sarcoma most commonly reside? (September 87)
A) Humerus upper tip
B) Humerus lower end-Ulna upper end
C) Vertebrae
D) Femur lower end-Tibia upper end
E) Flat bones in the head
(Answer D)
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ORTHOPEDICS
80. What is the most common joint for osteochondritis dissecans?

(September 87)
A) Hip
B) Elbow
C) Knee
D) Ankle
E) Shoulder
OSTEOCHONDRITIS DISSECENCE
•
It is the separation of the cartilage from the normal location with the bone under
the joint and falling into the joint.
It is most commonly seen in the knee (medial condyle of the femur most commonly).
•
Knee pain, swelling and lockup (joint mouse) occurs.
Arthroscopically removed.
Knee osteochondritis dissecans
(Answer C)
81. Fever after 48 hours in a hospitalized patient with a fracture of the pelvis,
femur and tibia
elevation, pulse acceleration and dyspnea. Conjunctival and
petechiae in the axillary region, diffuse consolidation areas on chest radiograph,
decrease in hematocrit value and arterial pO2 level was observed as 50mm Hg.
Which of the following is the most likely diagnosis in this patient? (September 87)
A) Disseminated intravascular coagulation
B) Pneumonia
C) Lung bronchiectasis
D) Atelectasis
E) Fat embolism syndrome
OIL EMBOLISM SYNDROME
The presence of fat emboli in the circulation after long bone fractures or major
trauma
embolism, although it gives clinical symptoms is called fat embolism syndrome.
Forms ARDS in lung. Because it produces DIC, there are petechiae and purpura
related to consumption coagulopathy in the skin.
(Answer E)
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Fat embolism
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CHILD SURGERY
CHILD SURGERY
one. Pneumatosis intestinalis and air in portal vein
appearance of radiological findings of which of the following diseases?
(December 2010)
A) Jejunal atresia
B) Infantile hypertrophic pyloric stenosis
C) Bile duct cysts
D) Meconium ileus
NEC is the most common GIS emergency in neonates. It has mucosal or transmural
involvement. Most terminals
ileum and proximal colon. In advanced cases, the stomach and distal colon are also
involved. Right
palpable mass occurs in the lower quadrant. Coagulation necrosis develops in
affected areas. Life's first 2
week is most common. Can be seen up to three months.
Prematurity is the major risk factor.
Clinical Findings: Perforation of fecal occult blood positivity (recognized by
guaiac test),
peritonitis and shock.
X-ray Findings: Pneumatosis intestinalis (air in the intestinal wall, visualized by
direct radiography) is diagnostic. The presence of air in the portal system (USG
shows better) advanced disease
Shows. If perforated, pneumoperitoneum may be detected.
Treatment: Nutrition is stopped, nasogastric drainage is done. Infection therapy
and parenteral nutrition
Applied. Patients should be consulted with pediatric surgery.
Absolute surgical indications: Perforation, positive paracentesis (feces or
microrganism)
Indications for relative surgery: Non-response to treatment, single and fixed bowel
loops, intestinal wall
erythema, palpable mass.
Stricture and short bowel syndrome are late complications.
(Answer E)
2nd. Which of the following extrophytic anomalies is most common with additional
anomalies? (December 2010)
A) Extrophia vesicalis
B) Isolated epispadias
C) Superior vesical fissure
D) Duplex extrofi
E) Extrophia cloaca
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ABDOMINAL WALL DEFECTS

The two most common anomalies are omphalocele and gastrochisis. In the omphalocele,
the defect in the abdominal wall
in the middle of the abdomen, the defect includes all the layers of the abdominal
wall paraumblikal
Localization is. Abdominal wall defects are components of amniotic band syndrome
and extremity – abdominal wall complex.
In the omphalocele, the abdominal organs outside the abdomen are in a sac
consisting of amniotic and peritoneum.
In addition to the small intestine, the liver and other organs may eviscerate.
Gastroschisis te
There is no pouch.
In the omphalocele, the umbilical cord enters the herniated mass or the surrounding
sac; cord insertion is normal in gastrochisis. Defect in the midline of the
omphalocele, usually right
as it is. Omphalocelle may be acid. Concomitant heart, urogenital, neural, GIS,
chromosomal
anomalies can also be seen. Fetal karyotype should be examined. Gastroschisis in
the form of isolated anomalies, sometimes GIS
lesions. Ischemic complications in intestines not protected by sac
visible.
Bladder Extrrophy is a defect of the caudal fold of the anterior abdominal wall.
Epispadias in small defect
posterior bladder wall is seen in the large defect. 1 is seen in 30 000 births.
Urinary and gastrointestinal systems are involved. OEIS complex, omphalocele,
bladder
extrophisia, imperofre anus, meningomyelocele. Both events
is also sporadic. The diagnosis of bladder extrophysis is made when the bladder
cannot be seen while the amniotic fluid is normal. An echogenic mass emerges from
the lower abdominal wall. There are similar findings in cloacal extrophitis.
(Answer E)
3.
Which of the following is the most common cause of acute abdomen during pregnancy?
(April 2010)
A) Small bowel obstruction
B) Peptic ulcer perforation
D) Cholangite
E) Volvulus
The main symptom of acute appendicitis is abdominal pain. Classically pain

initially down the epigastrium
or in the umlical region is diffuse, moderate, and continuous, sometimes
intermittent upon this pain.
cramps. Differences in the anatomical location of the appendix
it causes variations where it is seen mainly. In this case, the visceral component
of the pain is normal.
in place, where the cecum stops during somatic component rotation
it will appear in the area. Acute appendicitis is the most common cause of acute
abdomen in both sexes. pregnant Woman
The most common cause of acute abdomen is acute appendicitis.
(Answer C)
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CHILD SURGERY
4.
Which of the following is the most common site of ectopic testis?

(April 2010)
A) Pelvis
B) Superficial inguinal
C) Femoral
D) Perineal
E) Suprapubic
(Answer B)
5. Which of the following testicular tumors causes early hematogenous spread?
(September 2009)
A) Choriocarcinoma
B) Embryonal carcinoma
C) Seminom
D) Teratoma
E) Yolk sheet tumor
Although cancers are usually transmitted through lymph, some tumors can
They like to metastasize with. Kidney cell cancer, Liver Cancer (HCC) and
Choriocarcinoma
these are the most typical examples.
(Answer A)
6. Which of the following is common in the upper gastrointestinal tract in newborn
infants
system is not one of the causes of bleeding? (September 2009)
A) Stress gastritis
B) Coagulopathy
C) Septicemia
D) Vascular malformation
E) Mallory-Weiss tear
(Answer E)
7. Which of the following is the most common type of bladder cancer in extrofia
vesica?
(April 2009)
A) Changing epithelial cell carcinoma
B) Squamous cell carcinoma
C) Adenocarcinoma
D) Botrioid sarcoma
E) Basal cell carcinoma
Anterior wall of the bladder is absent congenitally in extrofi vesicle. Untreated
flat for a long time
(squamous) metaplasia develops. Squamous cell carcinoma may develop on this ground.
(Answer B)
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8. Gastrointestinal tract duplication is most common

A) Esophageal
B) Stomach
C) Duodenum
D) Ileocecal region
E) Sigmoid colon
Duplications can be found anywhere in the digestive system from the mouth to the
anus.
Duplications are usually paramenterenteric. With these properties diverticulum (eg
Meckel). Diverticula is antimesenteric. Epithelial cover of duplication
usually resembles the epithelium of the intestine to which it is adjacent. But in a
cystic duplication of the language, colonic
gastric heterotopy has been reported in mucosal or rectal duplication.
Tubular duplications can be very long. They may resemble small or large intestines.
Technically
Duplications are the most difficult to treat.
Incidence: Duplications occur every 4500 autopsies. They are more common in white
males. Familial
incidence is not in question.
The most common are jejunoileal duplications. Most rarely duodenal
duplications are seen.
(Answer D)
9. Mallory eWeiss syndrome lower esophagus due to intensive retching in pregnant
and alcoholics
mucosa rupture occurs as a result. It is very rare in the newborn.
Pneumatosis intestinalis observed on the plain abdominal radiograph
Which of the diseases is a finding? (September 2008)
A) Volvulus
B) Duplication
C) Meconium ileus
D) Meconium peritonite
Necrotizing Enterocolitis (NEC)
Necrotizing enterocolitis (NEC) is the most common acquired GIS disease in the NE
period. It is most commonly seen in premature and as a complication of diseases
such as PDA and HIE.
Etiology:
-
Prematurity (Most common)
Asphyxia and hypoxic ischemic damage due to disruption of GIS blood supply
Umbilical vein or artery catheterization
PDA
polycythemia
Hypotensive conditions
important factors
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CHILD SURGERY
Enteral nutrition (excessive and rapid volume increase), early feeding with
hyperosmolar formula
-
Bacterial colonization: GIS is sterile at birth. one. At the end of the week
aerobic and
anaerobic bacteria begin to multiply. The most commonly isolated microorganisms in
NEK are; E.coli, K. pneumonia, S.epidermitis, C.botilunum and some viruses
(enterovirus,
coronavirus, rotavirus).
Pathological Anatomy
Also, if any intestinal section can be involved, it is usually the terminal ileum,
ileocecal region.
and right column.
Clinical findings
•
The onset of symptoms is usually between 3 and 10 days. NEK's earliest clinical
sign of gastric residual volume during feeding.
• Early to mild to moderate distension, bowel sounds are normal. Later

bloody defecation, vomiting begins and ileus develops. Late gas in the intestinal
wall
Crepitation can be seen, enlarged bowel loops can be seen or palpation is felt.
Sometimes the mass is palpable, the abdomen is delicate, acid can be edema on the
abdominal wall.
Radiological findings
•
Enlarged bowel loops and distension are the earliest findings. Little
air-fluid level is also detected in a large number of cases. The presence of
intramural gas (pneumatosis intestinalis) is typical. Gas bubbles can also be seen
in the liver.
Gas in the portal vein (pyopneumo phlebitis) shows a poor prognosis. In advanced
cases
ascites are detected. Perforation develops in 1/3 of the cases. If perforation
developed, persistent acidosis,
There are coagulation disorders, collapse, edema of the anterior abdominal wall,
stiffness and redness.
Laboratory: The most common laboratory findings are; metabolic acidosis, anemia,
thrombocytopenia, leukopenia, electrolyte disorders, fecal occult blood and
reductant positivity, severe
DIC is the case.
Diagnosis: Abdominal distention, ileus
Radiological:
•
Pnomatosis intestinalis
ileus
Portal vende weather
Aerial view of intestinal wall in pneumatosis intestinalis (arrows)
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SMALL INTERNSHIP
Treatment
•
Interruption of oral nutrition
Surgery (Removal of the necrotic segment)
Antibiotics for sepsis (Ampicillin + Gentamicin)

(Answer E)
10. Abdominal swelling and biliary vomiting complaints brought to a 3-day baby
taken
abdominal radiography, dilatation of intestinal segments, soap bubbles in the lower
right
or frosted glass.
What is the most likely diagnosis for this baby? (April 2008)
A) Hirschsprung's disease
B) Ileal atresia
C) Meconium ileus
D) Midgut volvulus
MECONIUM IleUS
Hardening of meconium in the newborn may cause intestinal obstruction and
frequently
cystic fibrosis. Meconium most often accumulates in the lower part of the ileum.
Abdominal
distension is prominent and vomiting develops in a short time. Maximum x-ray of
meconium
gas infiltration at the point where it is concentrated can create a foamy granular
appearance.
Unlike the generalized, straight-line, distended bowel loops over atresia in
atresia
The width of the looplan can vary and the gas build-up will not line properly.
Gastrography enema can be tried in the treatment, if it is not successful or if
perforation is suspected, laparotomy is performed. Trapped meconium is extracted
with isotonic NaCl or acetyl cysteine.
(Answer C)
11th. In any of the following conditions that cause intestinal obstruction
emergency surgery without losing weight? (September 2007)
A) Ileal atresia
B) Midgut volvulus
C) Infantile hypertrophic pyloric stenosis
D) Jejunal atresia
E) Duodenal stenosis
ACUTE MIDDLE VOLVULUS
If normal rotation is complete, the mesentery is spread over a wide base and is in
a fixed state.
However, in the case of malrotation, the mesentery emerges from a narrow base.
The length of the mesentery is long or one of the bowel loops is attached to any
point.
It may be possible to create a factor for rotation around itself.
Acute midgut volvulus in all cases, especially in the first month, under 1 year of
age
symptoms. Suddenly the first sign
biliary vomiting.
As the circulatory disorder increases, intraluminal hemorrhage may occur and may
cause serious rectal
bleeding may occur. Cramp-style abdominal pain is added to the table. Fast-moving
In cases of ischemia hypovolemia shock is also added to the table.
(Answer B)
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CHILD SURGERY
12. Colic-like abdominal pain, biliary and bloody mucus defecation complaints
What is the most likely diagnosis for an 8-month-old baby? (April 2007)
A) Meckel's diverticulitis
B) Appendicitis
C) Hirschsprung's disease
D) Invagination
E) Mid-gout volvulus
intussusception
•
It is the most common cause of ileus in children under 18 months.
Most commonly occurs in the ileocecal region.
Predisposing factors;
•
Idiopathic in 85% cases
polyps
Henoch Schönlein purpura
Lymphomas: Over 6 years, the most common cause is lymphoma.
lipomas
•
parasites
Foreign bodies
Symptoms:
•
Colic pain, strawberry jelly rectal bleeding and right lower quadrant sausage
shaped mass occurs.
Diagnosis; USG and Barium graphy.

In therapy; Barium reduction is surgery if necessary.
intussusception
(Answer D)
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13. For surgical treatment of a baby born with congenital cleft lip
which of the following does not have to be expected? (September 2006)
A) Compliance with post-natal general anesthesia
B) If the body weight reaches 5 kg
C) The introduction of additional formula
D) Hemoglobin level above 10 mg / dl
E) 10 weeks
(Answer C)
14. Invagination in children, which part of the gastrointestinal tract is usually
I start? (September 2006)
A) Duedenum
B) Jejenum
C) Ileum
D) Outgoing column
E) Transverse column
(Answer C)
15. Which of the following requires surgical treatment in the newborn? (April 2005)
A) Hydrocele
B) Undescended testis
C) Cord cyst
D) Inguinal hernia
E) Umbilical hernia
Hydrocele, undescended testes are common in newborn premature infants. But inguinal
hernia is always
It is pathological. Surgical treatment is required.
(Answer D)
16. Which of the following imaging methods does not use contrast agents?
(September 2003)
A) Mammography
B) IVP
C) Phlebography
D) Cholangiography
E) Hysterosalpingography
Contrast is not used in mammography.
IVP: Displays the anotomic structure and renal function of the urinary system.
Opaque substance with iodine IV
used.
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CHILD SURGERY
IVP
Phlebography: To visualize the venous system, opaque administration to the venous

system from the hand or foot
makes.
Lower extremity phlebogra fi
Cholangiography: PTK (percutaneous transhepatic cholangiography) Especially

intrahepatic biliary tract
When it is large, it is given opaque into the bile duct via the transhepatic route.
PTK
Hysterosalpingography: To examine the uterine cavity and the opening of the tubes.
Free peritona
The opaque material is continued until the opaque transition is monitored.
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HSG
(Answer A)
17. The most appropriate approach in a newborn baby with hydrocele is
A) Early surgical treatment
B) Follow-up without treatment until 1 year of age
C) Using groin ligaments
D) Needle aspiration
E) Scrotal elimination
The testis that occurs in the abdomen of the infants developing in the womb play a
role in the descent of the scrotum.
The peritoneal extension called prosessus vaginalis closes and disappears in the
weeks of birth.
It is eliminated.
If this peritoneal protrusion does not completely disappear, the peritoneal fluid
flows into the poresessus vaginalis.
and hydrocele.
In girls, prosessus vaginalis develops and closes towards birth. However, such a
testis formation
Since it does not go down the groin, a similar picture is seen as a cystic
it is similar to the situation mentioned, and is specifically referred to as kız
Nuck Cyst ında in girls.
Hydrocele patients are waited until the age of 1 for procesus vaginalis closure. If
you still continue
surgical operation is performed.
hydrocele
(Answer B)
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CHILD SURGERY
18. Which of the following is not a feature of omphalocele? (April 2003)

A) The defect is covered with a pouch
B) Solid organs in the pouch
C) Umbilical cord in normal position
D) Frequent rotation anomaly
E) Frequent anomalies other than digestive system
In the fetus, herniation into the umbilical cord occurs as the intestines do not
fit into the abdomen at 6 weeks. 10
The intestines return to the abdomen once a week. If this rotation is not
performed, omphalocele is formed.
The omphalocele is covered with peritoneum of solid organs such as intestines and
liver
that is outside. The umbilical cord continues from the omphalocele pouch. Normal is
not in place.
prematurity, chromosomal abnormalities, congenital diaphragmatic hernia, GIS and
cardiovascular
system (CVS) anomalies.
Omphalocele
(Answer C)
19. A 3-week course of severe vomiting involving one-week food
What is the most likely diagnosis in a baby boy? (September 2002)
A) Tracheoesophageal fistula
B) Prepyloric veb
C) Meconium ileus
D) Infantile hypertrophic pyloric stenosis
E) Aganglionic megacolon
HYPERTROPHIC PILOR STENOSIS (HPS)
It is developmental in the newborn. Especially YD also seen in 2-3 weeks after
birth
manifested by bile-free vomiting. EGF in milk in children receiving cow's milk
pyloric muscle hypertrophy. Boys (especially the first child) 4 times more than
girls
Affected.
External PGE is administered to keep the ductus arteriosus open. Eosinophilic
gastroenteritis, epidermolysis bullosa, trisomy 18, and Turner, Smith-Lemli-Opitz
and Cornelia de Lange
syndromes may also be accompanied by HPS.
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Clinic: Provocative and bile-free vomiting after meal

Diagnosis: Diagnosis with barium radiography
USG: Pyloric muscle thickness is greater than 4 mm or total pyloric length is more
than 14 mm.
Treatment: Surgery (Ramstedt pyloromyotomy)
(Answer D)
20. What is the most common additional anomaly with gastrointestinal duplication?
(September 2001)
A) Renal agenesis
B) Radial agenesis
C) Syndactyly
D) Hemivertebra
E) Patent - Urachus
Duplications can be found anywhere in the digestive system from the mouth to the
anus.
Duplications are usually paramenterenteric. With these properties diverticulum (eg
Meckel). Diverticula is antimesenteric. Epithelial cover of duplication
usually resembles the epithelium of the intestine to which it is adjacent. But in a
cystic duplication of the language, colonic
gastric heterotopy has been reported in mucosal or rectal duplication.
Tubular duplications can be very long. They may resemble small or large intestines.
Technically
Duplications are the most difficult to treat.
Incidence: Duplications occur every 4500 autopsies. They are more common in white
males. Familial
incidence is not in question.
The most common are jejunoileal duplications. Most rarely duodenal
duplications are seen.
Accompanying anomalies are common:
one)
Many investigators have vertebral anomalies (Bifid or fused spine) and thoracic and
tracheoabdominal
found a relationship between duplications. This is consistent with the “Split
Notochord birisi, one of the mechanisms proposed in the embryogenesis of
duplications.
2nd)
Enteric cystic duplication is associated with intestinal atresia or malrotations

documented.
3) Tubular end-bowel duplications are often associated with genitourinary and

genital malformations.
They are seen.
(Answer D)
21. Where is the most common teratoma in infants? (April 2001)
A) Mediastinal
B) Cervical
C) Retroperitoneal
D) Intraabdominal
E) Sacrococcygeal
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CHILD SURGERY
Dermoid cyst or mature teratoma is most common in the sacrococcygeal region

(sacrococcygeal teratoma).
57% of the cases are in this area. 27% of the gonads in the ovary in women, in men
is testicular.
Sacrococcygeal teratoma occurs every 20,000-40,000 live births.
Mature cystic teratoma, ie dermoid cyst, constitutes 10-20% of all ovarian tumors.
Most common
germ cell ovarian tumor, as well as the most common ovarian
The tumors.
Although it can be seen at any age, it is most commonly seen in women of
reproductive age.
Although usually unilateral, dermoid cysts are present in both ovaries in 8-15% of
cases
The dermoid cyst can carry fragments from all germ cells, but is usually the
predominant ectoderm
It is layer. For this reason, the parts of the skin and leather attachments are
seen more. Since the sebaceous glands in the skin are also present in the dermoid
cyst, the cyst fluid is dark-viscous, yellow-brown.
color, oily, dense liquid. Most of the time in the cyst hair, hair, teeth, bone,
cartilage, such as nerve
tissues.
Terotomas are tumors that originate from multiple germ layers and also contain more
than one cell type. Rarely, there may be tumors developed from only one germ layer.
Benign mature teratoma
Immature teratomas show a malignant course.
(Answer E)
22. Which of the following is an indicator of good prognosis in neuroblastoma?
(April 2001)
A) NSE activity
B) be less than 1 year
C) Retroperitoneal adrenal location
D) Differentiation of cells
E) High ferritin
neuroblastoma
Neuroblastoma is the most common solid tumor of childhood and infancy
It constitutes approximately 50% of malignancies seen during the period.
Cytogenetic disorders were detected in the analysis of neuroblastoma cells in 80%
of the cases.
The most common disorder is rupture of the short arm of chromosome 1. 2. The most
common anamoli
is seen on chromosome 17.
Neuroblastoma can develop from anywhere the sympathetic chain is present. Primary
in abdominal
adrenal gland (40% of neuroblastomas) and paraspinal ganglion.
a. Good prognostic indicators
-
Stage IVS
Phases I and II
<1 year
Girl Gender
-
Mediastinal, cervical placement
Presence of opsomyoclonus
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SMALL INTERNSHIP
b. Indicators of poor prognosis

-
Stage III and IV
> 2 years
Abdominal placement
Metastasis findings
High serum ferritin level
N-myc gene amplification

neuroblastoma
(Answer B)
23. Abdominal distention, biliary vomiting, meconium inability to remove the 48-
hour baby's foot was taken on the direct abdominal X-ray calcifications are
detected.
A) Annular pancreas
B) Malrotation
C) Meconium ileus
D) Meconium peritonite
Meconium peritonitis
Intestinal perforation may occur in utero or immediately after birth and meconium
peritoneum
It empties. The most common cause of this type of perforation is meconium ileus due
to cystic fibrosis,
sometimes it may also be due to intestinal obstructions due to meconium plugs or
other causes.
If the perforation is spontaneously healed and a small amount of meconium escaping
to the peritoneum can be missed,
calcified meconium can then be detected on an x-ray taken incidentally.
(Answer D)
24. 4-year-old girl who had omphalitis in the newborn period
which one do you think first? (April 2000)
A) Caroli
B) Extrahepatic portal hypertension
C) Peptic ulcer
D) Budd chiari
E) Post-necrotic cirrhosis
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CHILD SURGERY
The most common cause of upper GIS bleeding in pediatric age is variceal bleeding
due to portal hypertension.
(Answer B)
25. Childhood neuroblastoma, which does not have a poor prognosis criterion? (April
2000)
A) N myc copy number increase
B) be older than 1 year
C) Stage IV (D)
D) Close to diploid or tetraploid karyotype
E) Stage IV S (Ds)
(Answer E)
26. What is the best view of diaphragmatic movements? (April 98)
A) PA chest radiography
B) CT
C) Lateral decubitus chest radiography
D) Fluoroscopy
E) Apicolordotic chest radiography
Diaphragmatic movements are best observed on fluoroscopy. Real-time movements in
fluoroscopy X ray
can be observed under.
Lateral decubitis x-ray: This is the best finding for pleural effusion.
Apicolordotic lung radiography: Oblique angle lung to show the apical parts of the
lung
X-ray is.
(Answer D)
27. Which is the most common form of cleft palate? (April 98)
A) Bifid uvula
B) Unilateral incomplete cleft lip and palate
C) Unilateral complete cleft lip and palate
D) Bilateral cleft palate
E) Bilateral cleft palate and lip
Cleft palate is either isolated or seen with cleft lip. Form seen with cleft lip
more common. Isolated cleft palate is the most common form of bifid uvula.
most common form of cleft palate unilateral complete cleft
lip and palate.
(Answer C)

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28. The first diagnosis of congenital hypertrophic pyloric stenosis in a child

What is treatment? (September 97)
A) Pyloroplasty
B) Emptying enema
C) Balloon dilation
D) Fluid-electrolyte imbalance corrected
E) CO narcosis
The newborn with congenital pylor stenosis has metabolic alcoholosis and
hypovolemia because of continuous vomiting.
It also loses intense potassium and chlorine from the stomach. Hypokalemia,
hypochloremia
Added. Increased aldesterone as a result of hypovolemia, trying to keep salt and
water from the kidney, potassium
and tries to increase the hydrogen. Vomiting in the urine in the child to be kept
acid, because of aldesterone
hydrogen is discarded. This is called paradoxical aciduria. This definition results
from metabolic alkalosis and hypovolemia.
occurs.
(Answer D)
29. Metabolic picture of a patient with pyloric stenosis and frequent vomiting
How? (September 96)
A) Hyperkalemic hypochloremic alkalosis
B) Hypokalemic hypochloremic alkalosis
C) Hypokalemic hyperchloremic acidosis
D) Hyperkalemic hyperchloremic acidosis
E) Hyperkalemic normochloremic alkalosis
(Answer B)
30. Polyhydramnios in the pregnancy of his mother; bruising, dyspnea
and what do you think of the distended newborn? (September 96)
C) Tracheo-esophageal fistula
D) Invagination
E) Meckel's diverticulum
Tracheo-esophageal fistula
one. Proximal atresia-distal atresia (A)
2nd. Proximal fistula-distal atresia (B)
3.
Proximal atresia-distal fistula (C-87%)
4. Proximal fistula-distal fistula (D)

5.
H type fistula (E)
Diagnosis:
•
The most important data suggesting tracheoesophageal anomaly in the clinic are as
follows.
•
The mother has polyhydroamnios and has high α-Fetoprotein (AFP)
The catheter cannot be molded into the stomach at 10-11 cm
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CHILD SURGERY
There is excessive secretion in the baby's mouth.

•
•
Cyanosis, cough, regurgitation and breathing difficulties during feeding

Gastric distention and aspiration pneumonia are also common in these patients. Gas
in the gastrointestinal tract
in favor of atresia.
• 50% of patients with tracheo-esophageal fistula have additional anomalies.

Congenital heart diseases (PDA, vascular ring, aortic coarctation are the most
common), imperforate anus,
malrotation and duodenal anomalies.
(Answer C)
31. In a child, when the sternocleidomastoid muscle is immediately medial
What is the most likely diagnosis for the mass when fistulized out? (September 96)
A) Dermoid cyst
B) Branchial cyst
C) Cystic hygroma
D) Thyroglossal cyst
E) Hemangioma
Branchial cyst:
•
It develops as a result of failure to close the branchial cleft.
It contains mesodermal, endodermal and echododerm tissues.
They are painless, mobile, generally soft and flat masses.
Fistulae (pharynx), fistula mouth squeezed smelly liquid is squeezed.

Branchial arch cyst
(Answer B)
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32. A rapidly growing abdominal mass, diffuse bone metastasis and

What is the most likely diagnosis of the disease with increased catecholamine
metabolites in urine?
(April 96)
A) Wilms tumor
B) Ewing's sarcoma
C) Neuroblastoma
D) Hodgkin's disease
E) Lymphocytic lymphoma
Neuroblastoma is caused by embryonic neural crest. Mainly sympathetic nervous
system
and the adrenal medulla. It is the most common solid tumor in childhood. generally
Leukemia is the most common intraabdominal malignancy in the newborn. (All
childhood Wilms'
tumor).
It is most commonly seen in retroperitoneum (adrenal and paraspinal ganglia) and in
25% of the posterior mediastinum.
It metastasizes to the bone marrow and causes Homer Wright rosette formation. These
tumors
As it secretes adrenaline and noradrenaline, VMA, metanephrine and normetanephrine
in urine
increased.
(Answer C)
33. Which of the following is not a sign of gastro-schizia? (April 96)
A) Usually located on the right
B) Small intestines are edematous and adherent
C) The hub is in place
D) Not covered with membrane
E) Other congenital anomalies are also common
gastroschisis:
In the anterior abdominal wall, but without the lateral incision of the umbilicus,
liver herniation. The abdominal cord is intact and comes out of its normal
position. Gastrokizis to
accompanying additional anomalies is not common.
Emergency surgical intervention is applied.
Gastrokizis
(Answer E)
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CHILD SURGERY
34. The newborn, 6-hour baby with Down syndrome has a small amount of biliary
vomiting. Standing abdominal radiography shows double bubble.
What is the most likely diagnosis in this patient? (September 95)
B) Duodenal atresia
C) Hirschprung's disease
D) Meconium ileus
E) Intestinal duplication
DUEDENAL ATHESIA
Duodenal obstruction is a congenital malformation of 2.5-10 per 100,000 births.
is the most common cause of small bowel obstruction in the fetus.
Most cases with duodenal atresia can be diagnosed by prenatal ultrasonography. The
double-bubble appearance in the stomach and duodenum due to dilatation forms the
basis of the diagnosis.
Duodenal stenosis or atresia is usually limited to the first or second part of the
duodenum.
the most common place is the immediate neighborhood of the bulb.
The duodenal lumen becomes obliterated by proliferation of epithelial cells at 5
and 6 weeks. 8-10 weeks
Recanalization occurs by vacuolization and degeneration of the cells in the cord.
In this case
deficiency with duodenal lumen stenosis, atresia or duodenal web formation
It may result.
Clinic
• About 50% of the cases had polyhydramnios in their mothers. bilious
vomiting usually occurs a few hours after birth and occurs as early as possible.
is the finding.
•
Epigastric distention is present. Most cases do not remove meconium. For diagnosis,
direct
abdominal graf double bubble ”finding is sufficient.
Double bubble on standing abdominal radiography

view
Treatment: duodeno-duodenostomy or after an adequate preoperative preparation

duodenojejunostomy.
(Answer B)
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35. What is the most common cause of acute abdomen in a child over one year old?
(September 95)
A) Invagination
B) Acute appendicitis
D) Volvulus
E) Meconium ileus
Invagination is the most common cause of acute abdomen in children under one year
of age.
The most common cause of acute abdomen in children over one year is acute
appendicitis.
(Answer B)
36. Restlessness, nausea, vomiting, bloody diarrhea after 10 days in a newborn
child
abdominal distention occurs. Pneumatosis intestinalis on X-ray
is detected.
What do you think of this patient? (April 95)
B) Hirschsprung's disease
C) Anal atresia
D) Necrotizing enterocolitis
E) Invagination
Ileus in premature newborn, distention in the abdomen, necrotizing enteocholitis to
the mind of pneumomatosis intestinalis
It brings. Oral nutrition is discontinued in the treatment. Surgery removes
gangrene intestinal segments.
(Answer D)
37. What is the finding of double air-fluid level directly in the abdomen?
(September 94)
A) Meconium ileus
B) Hirscprung disease
C) Congenital duodenal atresia
D) Ileal atresia
E) Jejunal atresia
(Answer C)
38. In the anamnesis, what is the most characteristic symptom that distinguishes
Hirschsprung's disease from functional constipation? (April 94)
A) Defecation number once or less per week
B) Fecal incontinence
C) Constipation since the first week of life
D) Rectal prolapse
E) Fecal plug
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CHILD SURGERY
HIRSCHSPRUNG DISEASE
Definition
•
Congenital megacolon is the cause. It is most commonly seen in the recto-sigmoid

region.
It occurs in 1 in 5000 live births.
It is more common in men.
It is caused by incomplete caudal migration of neural crest cells.
Obstruction of the segment of the large intestine without nerve cells; dilatation
occurs in the upper parts.
Neighborhood: Constipation since neonatal period

Physical examination: There are no stools in the rectum.
Diagnosis: There is no ganglion cells in rectum biopsy.
Complication: Enterocolitis (Most Mortal)
Treatment: Surgery.
(Answer C)
39. Respiratory stress, mediastinal shift, increase in anterior-posterior diameter
of scaphoid abdomen and chest
What would you think of a child with? (September 93)
A) Bochdalek hernia
B) Emphysema
C) Chronic bronchitis
D) Cystic fibrosis
E) Pneumonia
CONGENITAL DISEASES OF DIAPHRAGMATIC
CONGENITAL DIAPHRAGMATIC HERNIA (KDH)
These defects are seen in fetal life 8-10. It occurs as a result of the inability
to separate the thoracic and abdominal cavities in the first week.
one. Bochdalek hernia:
It is the most common type and is located in the posterolateral region of the
diaphragm.
80% of the posterolateral defects are on the left. Herniation of the lung during
intrauterine (IU)
causes hypoplasia.
2nd. Morgagni hernia:
The defect is in front of the diaphragm and in the retrosternal region. Morgagni
hernia from Larrey range
diaphragmatic crus due to the development of sternal and costal elements and the
incidence of 5%
In the newborn, it is mostly asymptomatic and may not be diagnosed until later
years.
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SMALL INTERNSHIP
Diagnosis:
•
From birth it causes significant respiratory distress, hypoxemia, acidosis,

pulmonary hypertension and persistent fetal circulation in the baby.
In addition to these clinical findings, collapse of the abdomen (scaphoid abdomen)

brings the diagnosis closer.
Respiratory sounds were decreased on the affected side by listening and on the
chest X-ray, the thorax of the intestines
and mediastinal structures shift to the opposite side.
Mechanical ventilation and intracorporeal membrane oxygenation (ECMO)

including intense respiratory support has increased survival.
•
Despite aggressive treatment, mortality may be as high as 50%. The definitive

treatment is surgery.
Morgagni hernia left

bowel in the hemithorax
(Answer A)
40. A three-week-old baby develops nausea, vomiting and hypochloremic alkalosis.
What
You think? (April 93)
A) Imperforated anus
D) Morgagni hernia
E) Congenital pyloric stenosis

(Answer E)
41. What is the best surgical age for undescended testes? (April 92)
A) Between 1-2 years
B) 5
C) 7
D) 10
E) 13
CONGENITAL TESTIC ANOMALIES
Cryptorchidism (true undescended testicle)
•
The testis is located on the normal descent path between the kidney and scrotum.
Germ cell losses persist until the age of 2 and after 6 years of infertility is the
rule.
Leydig cells are not affected by body temperature and their numbers remain normal.
The risk of malignancy increased 20-40 times compared to normal testis.
Testicular agenesis should be considered in the differential diagnosis and MRI is

the most useful test. But first done
the required test is USG.
•
If there is an accompanying hernia, a previous lowering operation has been
attempted and the ectopic testis
undescended testis) is surgical treatment.
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CHILD SURGERY
Treatment
•
Can be expected up to 1 year.
Medical treatment can be tried until the age of 2 and HCG or GnRH (LH-RH) analogues
in treatment
used
The aim of surgical treatment (orchiopexy) is to lower the testis to the scrotum.
The most common malignancy (60%) was seminoma.

(Answer A)
42. What do you think about vomiting as soon as the baby is born? (April 91)
B) Esophageal diverticulum
C) Duodenal atresia
D) Pyloric stenosis
E) Infection
Esophageal atresia is usually associated with tracheo-esophageal fistula. First
symptom on the first day
excessive salivation, vomiting when fed, coughing and choking, such as choking.
Since the baby cannot swallow the amniotic fluid, the mother has polyhydramnios
when she is pregnant. Born
The first and easiest way to diagnose an infant is to insert the nasogastric
catheter into the esophagus.
It is to look at. Heart and vertebral anomalies are common in these patients. Most
common cardiac anomalies
It is seen. The risk of aspiration is very high.
(Answer A)
43. What treatment do you use if the child has unilateral cryptorchidism?
(September 90)
A) Laparotomy
B) Laparoscopy
C) hCG
D) Excisional biopsy
E) Orchiectomy
Cryptorchidism is the absence of testis in the scrotum. Most commonly mixed with
retractile testis. Premature
and immature. Most go down to 1 year. Anterior abdominal wall anomalies are common.
Complications such as cancer, infertility and torsion may develop. It is most
commonly associated with inguinal hernia. In the treatment, hCG is applied first. A
small number of cases resolve with this treatment. Those who do not recover should
undergo surgical treatment before the age of 2 years. Because it's up to 2 years
old.
Infertility develops in the majority of cases, the benefit of surgery is reduced.
(Answer C)
44. Which of the following is present in Pierre-Robin syndrome? (April 90)
A) Cleft palate, glossoptosis, micrognottia
B) Cleft lip, glossoptosis, micrognottia
C) Half palate, glossoptosis, macrognottia
D) Macroglossi, glossoptosis, makrognottia
E) Cleft palate, macroglossi
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Pierre-Robin syndrome, high-arched or cleft palate, glossoptosis and micrognathia

It is characterized by. Airway obstruction and feeding problems may be seen in the
newborn.
Pierre-Robin Syndrome
(Answer A)
45. What is the most common cause of acute abdomen in a child over one year old?
(April 90)
A) Invagination
B) Acute appendicitis
D) Volvulus
E) Meconium ileus
(Answer B)
46. What is the radiological finding in a baby with meconium ileus? (September 89)
A) Enlargement of the heart contours
B) Innovation in costumes
C) Air shadow under aperture
D) Psoas shadow becoming clear
E) Foam appearance in the lower right quadrant
Meconium ileus is a cause of intestinal obstruction in the newborn and causes
cystic fibrosis.
may be a symptom. The terminal ileum is thin in the meconium ileus. Darkened,
sticky clogged with meconium. Biliary vomiting, common abdominal distention and
meconium
inability is seen. A small number of air fluid levels, such as granular, bread
(foam)
image.
(Answer E)
47. Fever, cough, weakness, liver size and lung sounds are normal
In the child, posterior mediastinal mass was detected on the lateral radiograph.
What is the diagnosis in this patient? (September 89)
A) Neuroblastoma
B) Lung fibrosis
C) Cystic fibrosis
D) Bronchogenic cyst
E) Angiofibroma
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CHILD SURGERY
In the posterior mediatenal mass, the tumor of neurogenic origin should be

considered first. Noroblastoma, ganglionorinoma are examples.
Neurogenic tumor of posterior mediastinum
(Answer A)
48. Which is the most common cause of acute appendicitis? (April 89)
A) Volvulus
B) Ovarian torsion
C) Gastroenteritis
D) PID
E) Acute mesenteric lymphadenitis

Acute mesenteric induced by yersinia enterocolitis if the most common complication
of acute appendicitis is not perforated
And lymphadenitis.
(Answer E)
49. What is the possible diagnosis in a four-month-old baby with projectile
vomiting alkalosis? (April 89)
A) Meconium ileus
B) Meconium peritonite
C) Congenital hypertrophic pyloric stenosis
D) Ileal atresia
E) Invagination
(Answer C)
50. What increases mortality in congenital diaphragmatic hernia? (April 89)
A) PDA
B) Hypoplasic lung
C) VSD
D) Mediastinal shift
E) Intra-abdominal pressure increase
Lung is the organ that determines prognosis in congenital diaphragmatic hernia.
Diaphragmatic hernia result
The abdominal organs passing through the thorax cavity cause lung hypoplasia by
compressing the lung in fetal life.
(Answer B)
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51. Abdominal pain, nausea and vomiting, stool gel stool in rectal touch
what is your possible diagnosis? (September 88)
A) Stress ulcer
B) Meckel's diverticulum
C) Invagination
D) Duplication
(Answer C)
52. What do you think if the newborn has vomiting in the first 24 hours, foamy
secretion in the mouth and polyhydramniosis in the mother? (Eylül88)
A) Aganglionic megacolon
B) Invagination
D) Meckel's diverticulum
E) Congenital pyloric stenosis
(Answer C)
53. Where does invagination occur most frequently? (April 88)
A) Colocolic
B) Ileocecal
C) Ileoileal
D) Jejunoileal
E) Duodenojejunal
(Answer B)
54. What is the most common anomaly with tracheo-esophageal fistula? (September 87)
B) Tracheal atresia
C) Broncho-esophageal fistula
D) Gastroschisis
E) Diverticulum of esophagus
(Answer A)
55. Where is Meckel's diverticulum most common? (September 87)
A) Ileum
B) Jejunum
C) Duodenum
D) Transverse column
E) Rectum
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CHILD SURGERY
Definition
•
Vitelline canal residue (Omphalomesenteric canal)
60 cm from the iliocecal valve
Pathology: The most common mucosa is the ileal mucosa. However, the most common
ectopic
the mucosa is the parietal cell. Ulceration and bleeding due to parietal cell acid
It happens.
Symptoms: Meckel's diverticulum is the most common cause of hemorrhage in children,
while adult presentation is most common with gastrointertinal obstruction.
Diagnosis: Can be demonstrated by parietal cell scintigraphy (Technetium-99m-
pertechnnatate).
Treatment: Surgery
(Answer A)
56. When should a 3-month-old baby diagnosed with inguinal hernia be operated?
(September 87)
A) As soon as diagnosis is made
B) Since the processus vaginalis may close spontaneously, after waiting 2-3 years.
C) Before starting primary school
D) Providing appropriate surgical conditions as soon as possible
E) If the result of hernia bond application is not achieved
Children with inguinal hernitis have a high risk of incarceration and
strangulation.
The newborn should be operated as soon as possible, even if appropriate surgical
conditions are met.
(Answer D)
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CHEST AND CARDIOVASCULAR SURGERY, RADIOLOGY
CHEST AND CARDIOVASCULAR

SURGERY, RADIOLOGY
one. Thrombocytopenia and congestive heart failure with vascular anomaly following
Which of these diseases? (September 2011)
A) Sturge-Weber syndrome
B) Klippel-Trenaunay syndrome
C) von Hippel-Lindau syndrome
D) Kasabach-Merritt syndrome
E) Ataxia-telangiectasia
Kasabach-Merritt syndrome; is a combination of a rapidly growing hemangioma,
thrombocytopenia and acute or chronic consumption coagulopathy. Clinical findings
are usually in early infancy
period, but may also be seen later. Hemangioma is often at birth
available, characteristic single and large. The vascular lesion is usually
cutaneous.
rarely shows organ localization. Coexisting thrombocytopenia; bleeding, ecchymosis,
pete fl i
formation and rapid growth of the hemangioma. Severe anemia may occur due to
bleeding or microangiopathic hemolysis.
Thrombocytopenia is caused by sequestration or increased destruction of platelets
within the hemangioma.
(Answer D)
2nd. A 25-year-old female patient with a mass in her breast
imaging method is: (May 2011)
A) Ultrasonogram
B) Mamogra fi
D) Lymphatic scintigraphy fi
E) Duktogra fi
The first examination to be performed in this patient is USG and solitary cystic
distinction should be made.
Although Solit mass is important in USG results, the fact that the patient's age is
younger increases the likelihood of broadenoma. However, pathological diagnosis
should be made. So biopsy
It should be done.
(Answer A)
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3. The condition where surgical treatment is contraindicated in lung cancer is as

follows:
Which is? (May 2011)
A) Cost involvement
B) Visceral pleural involvement
C) Parietal pleural involvement
D) Contralateral hilar lymph node metastasis
E) Peribronchial lymph node metastasis
The criteria for inoperability in lung cancer are as follows. Inoperability
Criteria:
1- Metastasis to extra-thoracic lymph nodes (cervical, supraclavicular)
2- Mediastinal bilateral LAP
3- Liver, brain, bone, skin metastasis (distant organs and tissue metastases)
4- Chest wall invasion
5- Vocal cord paralysis
6- Presence of malignant fluid in pleura
7- Vena Cava Superior Syndrome
8- Counter lung and bronchial metastasis
9- Pericardial tamponade with pericardial involvement
10- Tumor less than 2cm from carina in the main bronchus or bifurcation
11- Horner Syndrome
12- Acute myocardial infarction, heart, liver and kidney failure
13- Advanced dementia
14- COPD, Cor pulmonale
15- Stage Ill-B and stage IV are inoperable. These are only RT and KT. (Small cell
only
stage IA is operable)
(Answer D)
4. A 30-year-old male patient was brought to the emergency department after a
traffic accident.
Severe respiratory distress, neck vein fullness, hypotension detected
no breathing sounds are heard on the right side of the patient's chest.
2010)
A) Lung contusion
B) Hemothorax
C) Blood pressure pneumothorax
D) Lung hematoma
E) Chylothorax
Young male shortness of breath after traffic accident, neck venous fullness due to
acute right heart failure
and pneumothorax with decreased breathing sounds…
(Answer C)
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5. Sudden development in a 20-year-old male patient with no previous complaints

chest pain, progressive dyspnea, cold sweating, hypotension, tachycardia
Breathing sounds are not detected in the hemithorax. What is the first thing that
should be done to the patient who has hypersonarity in percussion?
(April 2010)
A) Observation
B)
Tube thoracostomy
C.)
Emergency thoracotomy
D) Mediastinoscopy
TO)
Tomography-guided elective thoracentesis
The first thing to do in pneumothorax is to perform thoracostomy and leave closed

drainage.
(Answer B)
6. After surgical treatment of which of the following congenital heart diseases
Paraplegia may occur? (April 2009)
B) Ventricular septal defect
C) Epstein anomaly
D) Transposition of large vessels
E) Patent ductus arteriosus
The largest of the anterior radicular arteries, a. radicularis magna (Adamkiewicz
artery). Medulla
spinalis is the most important artery feeding the lumbar region. Lower thorocal,
upper lumbar aorta
therefore, paraplegia may develop in the affected events (aortic dissection,
aneurysm, operation).
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SMALL INTERNSHIP
Medulla spinalis nutrition
(Answer A)
8.
In which localization do abdominal aortic aneurysms most frequently develop?

(September 2008)
A) Infrarenal aorta
B) Aortic iliac region
C) Suprarenal aorta
D) Thoraco-abdominal aorta
E) Iliac artery
ABDOMINAL AORTIC ANEURYSM

•
•
It usually comes with an asymptomatic pulsatile mass. Aortic diameter> 3 cm.

In some cases, abdominal and side pain due to blood leaking weeks before open tear
can
The cause is atherosclerosis. It is most commonly in the infrarenal aortic segment.
Indication of symptoms> 5.5 cm, rapid growth is the operation indication.
Tearing into the duodenum or abdomen can be lethal
Diagnosis: USG, CT, angio

Treatment: Surgery is a synthetic patch
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Abdominal aortic aneurysm
(Answer A)
9.
There is no cyanosis in infancy; however, cyanosis and arrhythmias develop before

adulthood. In Doppler ECO, the septal and posterior liflets of the tricuspid valve
adhere to the inner wall of the right ventricle below the normal annulus and
some of them are atrialized.
What is the congenital heart disease described above?
(September 2005)
A) Pulmonary atresia
B) Trunkus arteriosus
C) Univentricular heart
D) Transposition of the great arteries
E) Ebstein anomaly
ABSTRACT ABNORMALITY OF TRICUSPID VALVE

Pathophysiology
The tricuspid valve is located below the right ventricle.
The part above the tricuspid valve of the right ventricle was atrialized. Right
ventricle shrinks
For intrauterine survival right heart failure may occur. (Hidrops Fetalis)
Although the right atrium is enlarged, it is afunctional. For this reason, patent
foramen ovaleden shunt
the latter can be seen in cyanosis and polysystem. 75% have ASD. Tricuspid valve
failure
accompanies.
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SMALL INTERNSHIP
Ebstein's anomaly
symptoms
•
Exercise dyspnea, peripheral edema, right ventricular failure symptoms, cyanosis

are seen.
• Palpitations (10% are associated with Wolf - Parkinson - White syndrome.

tachyarrhythmias
Fuck)
Physical findings
•
Tricuspid insufficiency: Large v waves and pulsatile liver are seen in the neck
veins.
Pansystolic murmur accompanied by systolic thriller is heard along the edge of the
sternum
Pulmonary graph in Ebstein's anomaly
Diagnosis: Echocardiography
Treatment
•
Tricuspid valve replacement and ASD in patients with early right ventricular
failure
Shutdown
Lithium salt treatment can cause Ebstein's anomaly

(Answer E)
10. Which of the following exerts significant pressure on the esophagus? (September
2005)
A) Aorta ascendens
B) Pulmonary artery
C) Vertebral lesions
D) Left atrium
E) Right ventricle
When the left atrium grows, it moves to the posterior side of the left side of the
heart. Therefore behind it
can press the esophagus.
(Answer D)
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11th. Which of the following diseases lead to acute arterial obstruction in the
lower extremity
not hungry? (April 2005)
A) Thrombus in left ventricular aneurysm
B) Mitral stenosis
C) Atrial fibrillation
D) Tricuspid regurgitation
E) Previous aortic valve replacement
Embolism in the right heart affects the lung. Emboli in the left heart are
transferred to the systemic circulation
they cause arterial blockages.
(Answer D)
12. In a patient with posteroanterior lung radiography, the right hemithorax was
completely covered with homogeneous shading and the heart, trachea and mediastinum
were shifted to the left.
It is seen.
A) Total massive lung collapse (atelectasis)
B) Diffuse lung damage
C) Hydrothorax
D) Hydropneumothorax
E) Lobar pneumonia
In hydrothorax, the affected side undergoes lung compression atelectasis. The
mediastinum is pushed to the opposite side.
Pleural excision in the right hemithorax
(Answer C)
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SMALL INTERNSHIP
13.
Which is one of the natural changes caused by aging

A) Left ventricular hypertrophy
B) Osteopenia
C) Decrease in muscle mass
D) Low hemoglobin
E) Decrease in T cell functions
The function of all endocrine organs decreases in the elderly. Decrease in muscle
mass and bone mass
It occurs. In particular, cellular immunity decreases. However, any dysfunction in
the bone marrow
No way.
(Answer D)
14.
In acute ischemia due to peripheral arterial occlusion, which

A) Pain
B) Coldness
C) Cyanosis
D) Paresthesia
E) Pulse loss
Cyanosis is a finding of chronic arterial insufficiency.

5P finding of acute arterial occlusion:
one. Pain
2nd. Pulseness
3. Pallor
4. paresthesia
5. paralysis
(Answer C)
15.
The patient presented with fever, cough, severe side pain, intermittent cough.
What is the first radiological examination? (April 2004)
A) Two-way chest radiography
B) Apicolordotic radiography
C) Right lateral decubitus radiograph
D) Lung tomography
E) Fluoroscopy
Fever, cough, sputum, side pain bring to mind the first pneumonia. The diagnosis of
pneumonia
radiographs should be taken. Chest X-ray shows air bronchogram of lobar
pneumonitis.
364
Right upper lobar pneumonia
(Answer A)
16. A 75-year-old female patient who had no previous complaints had lasted for two
months.
with weight loss, weakness, jaundice and right upper quadrant pain in the back
References. In the physical examination, the gall bladder is painless. This
The most useful examination to diagnose in a patient is:
A) Endoscopic retrograde pancreatography
B) Computerized abdominal tomography
C) Pertükan transhepatic cholangiography
E) Selective angiography
Jaundice, pruritus and palpable gallbladder should be considered first in
pancreatic cancer. The first diagnosis is CT.
(Answer B)
17. Benign following liver in a 28-year-old woman planning pregnancy
surgical excision of the tumor
A) Hemangioma
B) Hemartoma
C) Adenoma
D) Focal nodular hyperplasia
E) Lipoma
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SMALL INTERNSHIP
LIVER BENIGN TUMORS

Liver adenomas
•
Frequent use of oral contraceptives
It is seen in fertile women
Can be asymptomatic
Right upper quadrant pain
Hemorrhage can cause death if ruptured into the abdomen (in hepatic adenomas)
artery with central location)
Diagnosis: CT-MRI
Hepatic adenoma in liver
Treatment:
•
Discontinuation of oral contraceptives
Surgical
Radiofrequency ablation if there is surgical risk
Prognosis:
•
Good
Malignant transformation is very rare

(Answer C)
18. The most common finding in a person with foreign body located in the trachea
A) Wheezing
B) Decreased lung sounds by listening in the right lung
C) Atelectasis in the right lung
D) Hoarseness
E) Hemoptysis
Wheezing is the most common finding in a person with a foreign body in the treche.
(Answer A)
366
19. Seventy years old having a calf pain from just walking the long distance road
is a
The patient's physical examination did not reveal any ischemic wounds on the feet.
Which of the following arteries is most likely to occlude in this patient?
(September 2002)
A) Popliteal artery
B) Main femoral artery
C) Deep femoral artery
D) Superficial femoral artery
E) Anterior tibial artery
The absence of an ischemic wound in the feet of the patient revealed that the main
vascular structures (deep femoral, popliteal, tibial)
artery) intact. The presence of only calf pain indicates superficial femoral artery
occlusion.
Superficial and deep femoral artery in angiography
(Answer D)
20. Physical examination of a person injured with a stab
expansile mass is palpated. A murmur is heard on the mass and the heart rate slows
down when pressure is applied.
A) Hematoma
B) Pseudoaneurysm
C) Arteriovenous fistula
D) Real aneurysm
E) Venoma
Arteriovenous fistulas may develop after puncture injury or after femoral angio.
arterial
High flow jet flow is available. A covered stent is inserted into the artery to
close the fistula.
(Answer C)
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SMALL INTERNSHIP
21. The most probable diagnosis in a 50-year-old male patient with leg pain during
walking and resting for the past three months who smoked two packs a day for
fifteen years
A) Behcet's disease
B) Buerger's disease
C) Acute arterial embolism
D) Venous gangrene development
E) Deep vein thrombosis,

THROMBOANJEITIS OBLITERANCE
•
The middle and small arteries are segmental inflammatory (neutrophilic) and
proliferative diseases of the veins and nerves.
It is thought to be an immune related event.
Man's favorites.
Increased pain at night, raynaud, digital ulceration, spherical thrombophlebitis

and claudication
Symptoms of the disease.
Pulse decreased in the distal. Proximally normal.

Burger disease
Diagnosis
•
biopsy
Coronary veins in angiorrhaphy
Treatment
•
Smoking cessation
amputation
Lower extremity angiography
Burger disease
(Answer B)
368
22. Which is one of the radiological findings of pulmonary tuberculosis

A) Cavitation
B) Calcification
C) Hilar lymphadenopathy
D) Pulmonary venous congestion
E) Pleural effusion
Primary tuberculosis is most commonly located in the upper lobe lower segment and
lower lobe superior segment
lymphadenopathy (Ghon complex) is observed in the lung hilum.
Ghon complex in primary tuberculosis
Secondary tuberculosis is most commonly located in the apex. It may cause

cavitation, calcification, pleural effusion, empyema, pneumonia.
Apical brozis in secondary tuberculosis
(Answer D)
23. In obstructive sleep apnea syndrome, obstruction is characteristic
in which anatomical region? (April 2002)
A) Vocal cord
B) Oropharynx
C) Hypopharynx
D) Larynx
E) Trachea
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SMALL INTERNSHIP
Central sleep apnea: It occurs due to insufficient and incompatible functioning of

the respiratory center in the brain. Increased carbon dioxide and oxygen in the
blood following respiratory arrest and stopping
Waking up after reduction is typical. People suffering from central sleep apnea,
peripheral apnea
He remembers the periods of waking up more easily than the living.
Peripheral (Obstructive) sleep apnea: Relaxation of muscles that hold the airway
open in the throat
with oropharynx closure, narrowing occurs. Airways
As a result of narrowing the breathing stops and the amount of oxygen in the blood
decreases. Snoring,
after a night of fluttering, both serious exertion and necessary sleep
could not be taken.
Risk factors
•
Increased fat tissue around the neck and throat due to excess weight.
The presence of tonic or adenoid, especially grown with children.
Sleep apnea occurs 2 times more in men than in women, so men

Being a risk factor.
• Sleep apnea is 2-3 times more common in middle aged adults than in young people.
age is also considered a risk factor.
• The use of alcohol and sleep medication because it causes the throat muscles to
relax during sleep.
also creates a risk factor.
Treatment
•
In order to diagnose and measure the severity of sleep apnea, “polysomnography uyku
should be performed in sleep laboratories.
The CPAP device is usually used after the patient's problem is detected. The goal
of using CPAP (Continious Positive Airway Pressure) is to provide continuous air
pressure to the patient.
The application is to keep the upper airways open during sleep.
(Answer B)
24. Which of the following is the most common cause of acute respiratory distress
syndrome?
(April 2002)
A) Fat embolism
B) Severe sepsis
C) Pancreatitis
D) Toxic gas inhalation
E) Wide burns
ADULT RESPIRATORY DISORDERS SYNDROME - ARDS
•
It is characterized by severe dyspnea, hypoxia, decreased pulmonary compliance,

pulmonary edema.
Acute hypoxic, hypocapneic respiratory failure.
Age is defined as lung
Bilateral pulmonary infiltration in less than seven days

•
Pulmonary artery end pressure is 18 mmHg or less. (Left heart failure

separation from pulmonary edema)
There is a defect in the lung capillary endothelium. Extravasated from plasma

endothelium to alveoli
(intrapulmonary alveolocapillary shunt)
370
Etiology:
•
Shock fluid aspiration,
DIC
Bacterial septicemia (the most common cause of ARDS),
Trauma,
Blood transfusion,
pancreatitis,
Smoke inhalation,
Overdose of heroin
Clinic:
•
The most common symptom is dyspnea
The first symptom is an increasingly tachypnea followed by dyspnea.

•
Rales may be heard in physical finding
Ventilation, lung volumes and acute respiratory alkalosis
ARDS Diagnosis
one. Appropriate clinical setting (sepsis, gastric content aspiration, multiple
transfusion, DIC, multiple
bone fractures, burns, pulmonary confusion, pancreatitis, burning gas inhalation,
intensive
chronic lung disease with left heart failure).
absence.
2nd. Diffuse pulmonary infiltrates on chest x-ray
3. PaO2 <50 mmHg when FiO2> 0.60.
Lung X-ray:
•
Patchy or diffuse, bilateral cotton waste infiltration
The lung is grossly edematous and hemorrhagic; microscopically, intraalveolar

proteinous fluid collection is available.
treatment
•
The goal is to achieve tissue oxygenation.
Most patients require mechanical ventilation (PEEP).

(Answer B)
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SMALL INTERNSHIP
25. Ultrasonography is not suitable for determining the pathologies in which organ?
(September 2001)
A) Pancreas
B) Liver
C) Pleura
D) Lung
E) Prostate
USG is an examination based on the transmission of sound waves to the tissue and
retrieving them again. It is very good for evaluation of solid organs (liver,
spleen, kidney). Full of liquid
evaluates organs (gall bladder, bladder) well. Also bladder; prostate, uterus, etc.
help to pass the sound. (Acoustic window). Thus, urogenital structures with good
USG
Evaluated.
Because the lung is full of air, it doesn't sound good. Therefore, lungs,
intestines, such as air
USG evaluation of tissues is not appropriate.
(Answer D)
26. Which symptom is most advanced in acute arterial occlusion
Shows? (September 2001)
A) Paleness
B) Coldness
C) Paralysis
D) Pulse failure
E) Pain
Paralysis in acute arterial occlusion indicates that the nerves are beginning to be
damaged. Therefore, it is an indication that ischemia has reached advanced
dimensions.
(Answer C)
27. Which of the following causes lower extremity embolism most frequently? (April
2001)
B) Mural thrombus of aortic aneurysm
C) Atrial fibrillation secondary to mitral stenosis
D) Bacterial endocarditis
E) Atrial myxoma
The most common cause of lower extremity embolism is atrial fibrillation.
(Answer C)
28. Which is the mediastinal flatter? (September 99)
A) Open pneumothorax
B) Hemothorax
C) Bronchial rupture
D) Clavicle fracture
E) Scoliosis
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Open Pneumothorax:
If the hole in the chest wall is smaller than the opening of the glottis, air
enters the injured lateral lung.
can continue to exit. Because until the outside air enters through the small hole
in the chest wall
collapse in the injured lateral lung is partial because plenty of air will flow
from the glottis to the lungs.
A thoracic wound that extends beyond the laryngeal cross-sectional area will result
in complete collapse of the lung and the prominent proxismal shift of the
mediastinum in each respiratory effort. Because, with inspiration, the chest
When the cage is swollen and the volume increases, the air easily penetrates
through the hole in the thorax wall, mediastinal
and is pushed into the contralateral lung, which is normally enlarged. So against
the operation of the normal lung next door is disrupted. If it's in the expiration,
the situation is completely the opposite.
Mediastinal structures are pushed to the ipsilateral side (patient side) (ast
mediastinal flutter ”). mediastinal
swinging makes IVC and SVC bend, making it difficult for the heart to fill with
blood. The resulting hypoventilation and reduced cardiac output are increasingly
life-threatening
(Answer A)
29. The patient complained of cough and fluid coming from the mouth.
lotus flower-like image.
What is the most likely diagnosis? (September 99)
A) Tuberculosis
B) Hydatid cyst
C) Pulmonary embolism
D) Hodgkin's disease
E) Metastatic cancer
Echinococcus, a cestode, has four subgroups: E. granulosus, E. multilocularis (E.
alveolaris), E vogelli, and E. oligarthus (pseudomultilocular hydatidosis).
Pulmonary hydatid cysts are mostly formed by E. granulosus. E.alveolaris,
especially in the liver
It was found.
Lung hydatid cysts are usually seen in males and adults. Chest pain and dyspnea
often asymptomatic. Sometimes they can open the airways and give symptoms.
Cysts are 70% solitary and 30% multiples. Solitary ones right lung and lower lobes
they prefer. Cysts grow faster in children than adults. The clinical course of the
cyst should be between 5-20 years. Air contrasts in the lung with cyst fluid
Because of this, hydatid cyst is clearly seen in convective lung roentgenograms.
(Answer B)
30. Which of the Adson tests is positive? (April 99)
A) Scalenus anticus syndrome
B) Muscular torticollis
C) Congenital high scapula
D) Congenital vertebral fusion
E) Congenital hemivertebra
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SMALL INTERNSHIP
Thoracic outlet syndrome (TÇS)

Anatomy:
The anterior and medius scalene muscle adheres to the 1st rib. Subclavian artery
and brachial plexus from this triangle
It passes. The subclavian vein passes in front of the anterior scalen muscle.
Nonspecific symptoms due to neurovascular compression in the scalene triangle (pain

in the upper extremity,
atrophy, sensory impairment and circulatory disorder). Cervical in most patients
ribs or C7 transverse process. Some patients have abnormal bone
There is a thick fibrous band extending from the tip to the 1st rib.
Neurological examination is usually normal. In some patients, a decrease in pulse
rate in the Adson maneuver or
loss can be detected (can be in normal individuals, with little significance).
Adson maneuver
(Answer A)
31. Hypertension and intermittent claudication
Considered? (April 99)
A) PDA
B) Burger disease
C) Aortic aneurysm
D) Aortic coarctation
E) Constructive pericarditis
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AORTIC COARCTATION
Aortic coarctation
Pathophysiology
•
95% distal to left subclavian artery
Often leads to hypertension
Perfusion with increased collateral artery circulation distal to coarctation
Kidneys are perfused with low blood pressure renin level and renin angiotensin
system activation is increased. If it did not cause heart failure in childhood,
It is difficult to detect before adult hypertension develops.
Common in Turner syndrome (bicuspid aorta and pulmonary stenosis may accompany)
More common in men
Especially in the 3rd. Increased risk of aortic rupture in trimester
Willis polygon with aneurysm
Often associated with bicuspid aortic valve
symptoms
•
headache
•
claudication
leg fatigue
CHF
epistaxis
Physical findings
•
Increased measured blood pressure
Leg pulses decreased or absent
The upper part of the body is well developed but the legs are sometimes not well
developed
Diagnosis:
ECG
•
Left ventricular hypertrophy
Chest film
•
cardiomegaly
'3' shape appearance in the aorta
Notches in collaterals and costumes
Bicuspid aorta is the most common cardiologic
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SMALL INTERNSHIP
Notching of ribs in aortic coarctation
MR-CT angiography
Angioma and CT angioma in aortic coarctation
Treatment
•
Surgical treatment is the standard treatment
Percutaneous balloon aortoplasty

(Answer D)
32. Which lower extremity atherosclerosis is most common? (September 98)

A) Aortic bifurcation
B) A. femoralis superficialis
C) Popliteal artery
D) A. femoralis profunda
E) A. iliaca interna
Settlement sites of atherosclerotic plaques in order of frequency
•
Abdominal aorta
Coronary arteries
Popliteal arteries
Descending thoracic aorta
Internal carotid arteries
Willis polygon
(Answer C)
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33. Which test is positive for thoracic outlet syndrome? (April 98)
A) Adson test
B) Watson test
C) Trendelenburg test
D) Homans test
E) Obturator testing
(Answer A)
34. Which of the following does not cause peripheral embolism? (September 97)
B) Transmural myocardial infarction
C) Pulmonary stenosis
D) Mitral stenosis
E) Atherosclerotic plaque
(Answer C)
35. What is the first affected structure in peripheral arterial occlusion?
(September 96)
A) Muscle cell
B) Epithelial cell
C) Endothelial cell
D) Nerve cell
E) Connective tissue
Fatty streaks in the endothelium are the first lesions of atherosclerosis.
(Answer C)
36. What is the first step in the treatment of Buerger's disease? (September 96)
A) Lean salt-free diet
B) Use of β blockers
C) Vasoconstrictor use
D) Smoking cessation
E) Sympathectomy
(Answer D)
37. An elderly patient; severe pain, abdominal pain, suddenly hit the back while
working
If fainting and convulsions occur, what is the most likely diagnosis? (September
96)
A) Peptic ulcer perforation
B) Lumbar disc herniation
C) Abdominal aortic aneurysm
D) Intestinal obstruction
E) Pancreatic pseudocyst
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SMALL INTERNSHIP
Aortic aneurysm rupture was reported.

(Answer C)
38. Which is the most common accompanying dissecting aortic aneurysm? (April 95)
A) Medial cystic necrosis
B) Atherosclerosis
C) Syphilis
D) PAN
E) Thromboangitis obliterans
(Answer A)
39. Which is not a sign of aortic dissection? (September 93)
A) Peripheral pulse loss
B) Paraplegia
C) A murmur of stenosis in the aortic focus
D) Vocal cord paralysis
E) Horner syndrome
Hypertension is the most common cause of dissecting aortic aneurysm. But more
common in Marfan syndrome
It is seen. This is due to the presence of fibrillin-deficient vessels in
connective tissue in Marfan syndrome.
degeneration of the media layer.
(Answer C)
40. What should be done for diagnostic purposes in patients with necrosis of the
toes? (September 93)
A) Plethysmography
B) Lymphangiography
C) Venography
D) SPECT
E) Aorta-peripheral angiography
(Answer E)
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41. Which Adson test is performed? (April 93)

A) Lung pancoast tumor
B) Thoracic outlet syndrome
C) Intrathoracic goiter
D) Thyroid cancer
E) Parathyroid adenoma
(Answer B)
42. Which peripheral artery is the most common atherosclerotic aneurysm? (April 92)
A) Poplitea
B) Carotis
C) Subclavia
D) Femoral
E) Axillary
Atherosclerotic aneurysm is most commonly seen in the abdominal aorta.
Atherosclerotic aneurysm in the popliteal artery is the most common peripheral
artery.
(Answer A)
43. What is the most common cause of superior mesenteric artery occlusion?
(September 91)
B) Acute thrombosis
C) Atherosclerosis
D) Mycotic embolism
E) Aortic aneurysm
Artery occlusion is the most common cause of arteriosclerosis.
(Answer C)
44. What is the most common site of arterial embolism? (April 91)
A) Femoral bifurcation
B) Iliac bifurcation
C) Popiteal artery
D) Aortic bifurcation
E) Coronary artery
Emboli are the most common femoral bifurcation.
(Answer A)
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SMALL INTERNSHIP
45. What is the symptom of abdominal aortic aneurysm rupture? (April 91)
A) Severe abdominal pain that hits the waist
B) Pulse loss in the lower extremity
C) Coldness of lower extremity
D) Hair loss
E) Color changes in the lower extremity
The aorta is a retroperitoneal organ. Waist and abdomen when abdominal aortic
aneurysm begins to leak
may cause pain. Examination revealed a pulsatile mass. Patients with this type are
at risk of rupture.
care should be taken when examining.
(Answer A)
46. Middle-aged woman in the cold, bruising, whitening, hand fingers
What is considered if there is tingling? (April 90)
A) Raynaud's disease
B) Buerger's disease
C) Arteriosclerosis
D) Thrombophlebitis
E) Diabetus mellitus
Raynoud's disease is a triphasic discoloration of the fingers (blood
current is reduced to white; bruising followed by red after reactive hyperemia).
Raynold Phenomenon is a triphasic discoloration that accompanies rheumatologic
disease. Raynould's phenomenon typically accompanies scleroderma.
(Answer A)
47. What is the most common cause of fat embolism? (September 89)
A) Burns
B) Long bone fractures
C) Immobilization
D) Dehydration
E) Soft tissue trauma
Femoral diaphyseal fractures are the most common cause of fat embolism.
(Answer B)
48. Which is not present in acute arterial obstruction? (April 89)
A) Paralysis
B) Edema
C) Paleness
D) Pulse free
E) Pain
(Answer B)
380

49. In which case is surgery contraindicated in lung cancer? (September 88)
A) Local chest wall invasion
B) Extra-thoracic metastasis
C) Pleural fluid
D) Age over 70
E) Having a systemic disease
In all cancers, distant metastasis is usually a contraindication for surgery.
Other contraindications:
•
Lymph node involvement on the other side
Malignant pleural effusion
Superior vena cava syndrome
N. Laryngeal recurrent involvement
N. phrenicus paralysis
Pulmonary dysfunction
(Answer B)
50. What do you do if an air embolism occurs when inserting a venous catheter
through a large vessel?
(September 88)
A) Right shoulder up, upside down
B) Left shoulder up, upside down
C) Tilted prone
D) Lay down on your back
E) Feet raised
(Answer A)
51. Which of the following is not a cause of pulmonary embolism? (April 88)
A) Lower extremity trauma
B) Congestive heart failure
C) Left atrial myxoma
D) Pelvis fracture
E) Deep vein thrombosis
The most common cause of pulmonary embolism is thrombus in the lower extremity calf
veins. (Deep vein thrombosis)
Myxoma is the most common benign tumor of the heart. Systemic arterial emboli in
left atrial myxoma
It occurs. In addition, myxoma fever, thrombocytopenia and mitral stenosis
decreasing with sitting
murmur.
(Answer C)

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SMALL INTERNSHIP
52. What is the most common source of thrombus? (April 88)

A) Iliac veins
B) Popliteal veins
C) Inferior vena cava
D) Femoral veins
E) Deep calf veins
(Answer E)
53. A middle-aged male patient with a gangrene on his toe
What is considered? (April 88)
A) Buerger
B) PAN

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PEDIATRICS

Exophthalmos - wide open eyes

Goitre (most often)

Microcephaly - Craniostosis - ventricular expansion

HSM and jaundice

Severe hypertension - heart failure

Death if not treated

2nd. To prevent bleeding due to vitamin K deficiency in newborn infants

B) The mother is given a high dose of vitamin K before birth.

ALL TYPES OF TISTIME QUESTIONS

ALL TYPES OF TISTIME QUESTIONS

Intrauterine infections RDS

Asphyxia / birth trauma

Severe congenital anomaly

Umbilical cord trauma

ALL TYPES OF TISTIME QUESTIONS

6. In twin-to-twin transfusion syndrome developed in intrauterine period, donor

Cardiac hypertrophy, Myocardial dysfunction, Right ventricular outflow tract

Polyhydroamnios preterm labor, abruptio placenta, fetal neuromuscular dysfunction

AC: Cystic adenomatoid malformation, diaphragmatic hernia, chylothorax

Achondroplasia, Spina bifida, Werding Hoffman, trisomy 18, 21, Klippel-Feil

Twin-twin transfusion (donor)

Diabetic mother baby, Backwith-Wiedemann syndrome

Amniotic fluid leakage

Fetal anemia, fetal heart failure, twin-twin transfusion (recipient), hydrops

Renal agenesis / urethral atresia

Polyuric renal disease

ALL TYPES OF TISTIME QUESTIONS

Open neural tube defects

Gastroschisis-omphalocele, intestinal atresia

Cyanotic heart disease

Intrauterine growth retardation (IUGR)

Hypoglycemia, LGA, Severe Diabetes: SGA

Graves disease / myasthenia gravis

Neonatal transient thyrotoxicosis / transient myasthenia

ITP / isoimmunthrombocytopenia or neutropenia

Neonatal myotonic dystrophy, congenital contractures, respiratory

CHD, Microcephaly, Mental retardation

IUBG, Neutropenia, thrombocytopenia, fetal death

Fetal anemia, hypoalbuminemia, hydrops, jaundice in the newborn.

Konjac. Heart block, rash, anemia, thrombocytopenia, neutropenia

ALL TYPES OF TISTIME QUESTIONS

10. Which is the cause of oligohydroamniosis? (April 94)

ALL TYPES OF TISTIME QUESTIONS

EXAMINATION AND RESUSCITATION

ALL TYPES OF TISTIME QUESTIONS

Pathological Skin Findings of Newborn:

ALL TYPES OF TISTIME QUESTIONS

Family (OR, OD)

Fetal alcohol / hydantoin

Cornelli de Lange syndrome

Aquaduct. Stenosis (X-linked, infectious)

Chiari / DandyWalker malformation

Beningn subarachnoid space expansion

Mass lesion: abscess, hematoma, tumor, neurocutaneous

Wormian bone anomaly

Any ongoing shape or size anomaly requires CT removal.

ALL TYPES OF TISTIME QUESTIONS

Wide front fontanel

Intrauterine growth retardation

Congenital rubella syndrome

Rickets due to vitamin D deficiency

D) Traces of amniotic tape