This document appears to be an exam answer sheet for a final exam in internal medicine for third-year dental students. It contains questions about topics related to internal medicine that are relevant for dentistry, such as infectious diseases that can be transmitted in dental settings, the roles and responsibilities of dental professionals, diabetes, endocrinology, hepatitis, and more. The answer sheet includes spaces for students to write their answers to 60 multiple choice questions.

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Al Azhar University-Gaza
Faculty of Dr. H .Abdulshafi Of Dentistry
Name:………………………… Date : 24 June, 2012
Time : 2 Hours
Student No : ………………...
Final Exam
Internal Medicine (I) - 3rd
year
Second Semester 2011-2012
Answer Sheet
Question Answer Question Answer Question Answer
1 21 41
2 22 42
3 23 43
4 24 44
5 25 45
6 26 46
7 27 47
8 28 48
9 29 49
10 30 50
11 31 51
12 32 52
13 33 53
14 34 54
15 35 55
16 36 56
17 37 57
18 38 58
19 39 59
20 40 60

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Part(I) Examination (MCQ’s)
Answer)ONE(OnlySelect the best answer
1) Diseases transmitted in dental settings by which one of the following :
a) From the patient to the dental worker
b) From the dental worker to the patient
c) From one patient to another
d) From the dental office to the community
e) All of the above
2) The objectives of linking internal medicine to dentistry . all of the following is true Except
a) Dentists don’t treat only healthy people
b) Dental treatments can affect the patient health
c) Give a full details of internal medicine topics to the dentist
d) Dentists can discover some signs of special diseases
e) Emergency treatments of medical emergiencies encountred in dental practice
3) A 45 year old female presents with a 6 months history of recurrent meal time swelling in her right
submandibular region. Clinical examination doesnot reveal any dental abnormality. What is the most
likely cause of her symptoms?
a) Lymphadenitis
b) Sialolithiasis
c) Sialadenitis
d) Goiter
e) Xerostomia
4) Roles and responsiblilitis for dental professionalism , all of the followig is true Except :
a) Early detection of systemic diseases and recognition of oral manifestations of common diseases
b) Often first to identify a systemic health problem based on what they see in the patient’s mouth
c) Oral evaluation and diagnosis
d) Make approprite referral to physician when needed
e) Manage and treat all medical diseases encountred in dental practice
5) High plasma insulin levels has the following effects
a) It stimulates breakdown of adipose tissue
b) It stimulates the storage of glycogen in the liver
c) It enhances protein catabolism
d) It increases the absorption of glucose from the intestine
e) Causes glycogenolysis
6) Oral glucose tolerance test (OGTT)
a) A 75 gm glucose load is usually used
b) Can be very dangerous and must be avoided in the elderly
c) If fasting blood glucose is 100 mg/dl, OGGT is needed to establish the diagnosis of diabetes
d) OGGT can differentiate between Type 1 and Type 2 diabetes
e) Is the method of choice in the diagnosis of diabetes
7) Gestational diabetes
a) Occurs when a pregnant eats too much sugar
b) Occurs when a diabetic becomes pregnant
c) Occurs when a pregnant woman becomes diabetic

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d) Occurs when the fetus becomes diabetic
e) Occurs when insulin is deficient
8) When there is severe lack of insulin, blood glucose increases and
a) Polyuria and dehydration develops
b) Edema develops
c) Tachycardia develops
d) Exophthalmus develops
e) Obesity develops
9) Type 1 diabetes mellitus, all of the followings are true Except :
a) Autoimmune disease
b) 5 – 10 % of diabetes mellitus
c) Result from peripheral tissues resistance to insulin
d) Mainly disease of children and young adults
e) Treated with insulin
10) The beta cells of pancreatic islets secret:
a) Insulin.
b) Glucagon
c) Epinephrine
d) Amylase
e) Amylin
11) All of the followings are systemic complication of diabetes mellitus Except
a) Retinopathy
b) Arthritis
c) Skin lesions
d) Delayed wound healing
e) Increased susceptibility to infection
12) The most common cause of diabetic ketoacidosis i
a) Increased insulin dose
b) Presence of infection
c) Inadequate food intake
d) Emotional stress
e) Increased physical exercise
13) Why glucosuria is consequence of hyperglycemia
a) Because the kidneys are damaged
b) Because the kidneys have congenital tubular defect
c) Because the amount of blood filtered by the kidneys is incorrect
d) Because the amount of filtered blood by the kidneys is decreased
e) Because the kidneys are unable to reabsorb all the filtered glucose in the filtered blood
14) All of the followings are necessary precautions when treating T1DM patient Except :
a) Brief morning appointments (Decrease stress)
b) Patient should not take normal insulin dosage and eat normal breakfast. Confirm this with patient.
c) Consult physician if procedure will affect the patient’s ability to eat. Physician may alter the
insulin therapy/diet for patient.
d) Minimize risk of infection: consider antibiotic coverage after surgery and treatment
in presence of suppuration.
e) Have a source of sugar available

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15) A 45 year old male with a history of T1DM loses consciousness during the course of dental treatment.
What do you think is the most likely cause?
a) Addosonian crisis(acute adrenal insufficiency)
b) anaphylaxis
c) hyperglycemia
d) hypoglycemia
e) ketoacidosis
16) The classical endocrine action
a) Hormone may be secreted by a neighboring cell.
b) Hormone may be secreted by the same cell.
c) Hormone carried via blood from a secreting gland.
d) Hormone may be manufactured in situ.
e) Hormones may be secreted by exocrine glands
17) Hormone membrane receptors respond to the following hormone
a) Steroid.
b) Catecholamine.
c) Thyroid hormones.
d) Insulin.
e) Adrenalin
18) Homeostasis means
a) Arrest of bleeding.
b) Keeping external environment stable.
c) Maintaining stable internal environment of the body.
d) Maximizing reaction towards internal environment.
e) Keeping internal environment unstable
19) Hormones are
a) Chemical messengers which are secreted by glands via ducts.
b) Secreted by the exocrine glands.
c) Non-specialized chemical messenger.
d) Chemical messenger produced by specialized cells of the endocrine system.
e) Are related to vitamins in structure
20) Diabetes Insipidus ,all of the followings are true Except
a) The only cause of diabetes insipidus is posterior pituitary destruction
b) Polyuria
c) Polydepsia
d) Excessive thirst
e) Pale urine in immense amounts (2-24L/day)
21) Hyperprolactinemia in femalescauses ‫النت‬ ‫من‬
a) Galactorrhea amenorrhea syndrome.
b) Obesity.
c) Hypertension.
d) Hyperglycemia.
e) Cushing’s syndrome
22) Excess growth hormone secretion leadsto
a) Gigantism if it occurs after puberty.
b) Acromegaly if it occurs before puberty.
c) Gigantism if it occurs before puberty.

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d) Diabetes insipidus if it occurs after puberty.
e) Short stature
23) The hormone vasopressin (AVP)
a) Is synthesized in the posterior pituitary.
b) Its secretion is defective in diabetes insipidus.
c) Is important for lactation.
d) Is released by a trophic hormone from hypothalamus.
e) Is synthesized in the anterior pituitary
24) The anterior lobe of the pituitary secrets
a) Thyroid stimulating hormone (TSH).
b) Anti diuretic hormone (ADH).
c) Corticotrophin releasing hormone (CRH).
d) Thyroid releasing hormone (TRH).
e) Oxytocin
25) All the following are typical clinical features of Cushing's syndrome except
a) Generalized osteoporosis
b) Systemic hypotension
c) Hirsutism and amenorrhea
d) Proximal myopathy
e) Hyperglycemia
26) The most common cause of Cushing's syndrome is:
a) Insufficient ACTH production.
b) Hyperplasia of the adrenal cortex.
c) Pituitary hypofunction.
d) Deficient adrenocortical hormones.
e) Increased levels of catecholamines
27) Which of the following diseases is characterized by arrhythmias, tremors, diarrhea and weight loss:
a) Cushing's syndrome.
b) Hypothyroidism.
c) Addison's disease.
d) Hyperthyroidism.
e) Diabetes mellitus
28) Clinical picture of hypothyroidism include all of the followings Except :
a) Hypothermia
b) Bradycardia
c) Diarrhea
d) Hypoventilation
e) Poor mental function
29) Thyroid hormone is stored in the lumen of follicles in the form of
a) free T3
b) free T4
c) attached to thyroglobulin in the gland
d) attached to thyroid binding globulin (TBG)
e) attached to albumin
30) Clinical picture of hyperthyroidism include all of the followings Except :
a) Nervousness
b) Tremors
c) Excessive sweating
d) Weight loss and increased appetite
e) Cold intolerance

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31) The level of total thyroxin (T4)
a) Will be increased during pregnancy.
b) Is usually normal in thyrotoxicosis.
c) Is usually elevated in hypothyroidism.
d) May be increased due to TBG deficiency.
e) Usually increased in hyperparathyroidism
32) The element most essential for the biosynthesis of thyroid hormones is:
a) Sodium.
b) Phosphorus.
c) Calcium.
d) Iodine.
e) magnesium
33) In Graves' disease
a) TSH is usually elevated.
b) T4 elevated and T3 is low.
c) Both FT4 and FT3 are elevated.
d) ACTH is elevated.
e) FSH level is usually elevated
34) High risk population for HAV ( Hepatitis A Virus)
a) Hemophiliacs
b) Dialysis patients
c) Individuals living in poor hygiene and sanitation areas
d) IV drug abusers
e) Health care personnel
35) A patient tells you that he had hepatitis. All of the following may be of concern when providing dental
treatment for him Except
a) The patient will need antibiotic cover for invasive procedure
b) Increased bleeding following invasive procedure due to impaired synthesis of clotting factors
c) Possible cross-infection risk
d) Impaired drug metabolism
36) A 30 year old patient comes in with symptoms of hepatitis. The following serological results are
obtained: Hepatitis A IgM antibody negative, Hepatitis A IgG antibody positive, Hepatitis B surface
antigen positive, Hepatitis B surface antibody negative, Hepatitis C antibody negative. This set of
results suggests that the patient has acute:
a) Hepatitis A
b) Hepatitis B
c) Hepatitis C
d) Hepatitis A and B
37) Route of Transmission of HBV include all of the followings except
a) Sexual
b) Perinatal
c) Percutaneous
d) Oral
e) Intra venous drug users ( IVUD )

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38) Definition of chronicity of viral liver disease ( To diffirentiate between acute
and chronic viral disease )
a) Persistent viral Infection for 1-2 months
b) Persistent viral Infection for 3-4 months
c) Persistent viral Infection for 5-6 months
d) Persistent viral Infection for more than 6 month
e) Persistent viral Infection for less than 6 months
39) Which Hepatitis Virus leads to very high chronicity rate ?
a) HAV ( Hepatitis A Virus )
b) HBV ( Hepatitis B Virus )
c) HCV ( Hepatitis C Virus )
d) HDV ( Hepatitis D Virus )
e) HEV ( Hepatitis E Virus )
40) High risk population for HAV ( Hepatitis A Virus )
a) Hemophiliacs
b) Dialysis patients
c) Individuals living in poor hygiene and sanitation areas
d) IV drug abusers
41) Common symptoms of hepatitis include:
a) Fever, nausea, diarrhea
b) Malaise, anorexia, jaundice
c) Nausea, vomiting, right upper quadrant abdominal pain
d) Clear urine, dark colored stools, anorexia
42) All of the followings are blood borne pathogens except
a) HIV ( Human Immunodeficiency Virus )
b) HBV ( Hepatitis B Virus )
c) HCV ( Hepatitis C Virus )
d) HDV( Hepatitis D Virus )
e) HEV( Hepatitis E Virus )
43) All of the followings are non modifiable risk factors for coronary artery disease Except :
a) Male sex
b) Age
c) Family history
d) Dyslipidemia
e) All of the above
44) The goals of treating Hypertension ,all of the following is true except :
a) To decrease cerebrovascular accidents
b) To decrease progression of kidney disease
c) To decrease acute coronary events
d) To decrease urinary tract infections
e) To decrease the progression of diabetic complications
45) All of the followings are indication for infective endocaditis prophylaxis Except :
a) Cardiac catheterization and stent insertion
b) Prosthetic cardiac valve
c) Previous infective endocarditis
d) Cardiac transplants with valvulopathy
e) Congenital Heart Disease

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46) Definitive diagnosis of acute rheumatic fever need :
a) Two major criteria without evidence of recent streptococcal infection
b) One major criteria plus two minor criteria without evidence of recent streptococcal infection
c) Three minor criteria plus evidence of recent streptococcal infevtion
d) One major criteria and two minor criteria plus evidence of recent streptococcal infection
e) Four major criteria
47) Rheumatic fever , all of the followings are true Except :
a) Rare below three years age
b) Common age between 5 – 18 years
c) Common in developed countries
d) Common in developing countries
e) Overcrowding and poor hygiene and sanitation
48) Right sided heart failure is associated with the following except
a) pulmonary stenosis
b) COPD
c) Peripheral Edema
d) Jugular Venous Distension
e) Arterial hypertension
49) Which one of the following is the least likely indication for antibiotic prophylaxis to prevent infective
endocarditis
a) Congenital heart disease
b) Diabetes mellitus
c) Previous hisrory of endocarditis
d) Rheumatic fever
e) Valvular heart disease
50) Siogren’s syndrome includes all of the following Except:
a) Xerostomia
b) Keratoconjunctivitis
c) Arthritis
d) Lymphoma
51) The major clinical diagnostic criteria for the diagnosis of Behcet’s disease include all of the
followings Except :
a) Recurrent oral ulcerations (aphthae)
b) Recurrent genital ulcerations
c) Ocular lesions (conjunctivitis, reduced visual acuity
d) Skin lesions (papules, pustules, ulcers)
e) It is more common in females
52) Medical & Dental Management of systemic lupus erythematosis , include all
of the followings except :
a) Avoid excessive exposure to sunlight
b) NSAIDS for mild active disease with antimalarial drugs
c) Systemic corticosteroids for mucocutaneos lesions
d) Assess adrenal function for possible suppression
e) Consult with physician regarding systemic manifestation
53) The followings are common causes of polyarthritis except
a) Septic arthritis
b) Rheumatoid Arthritis
c) Systemic lupus Erythrematosus

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d) Reiter’s disease
e) Reactive arthritis
54) Joint involvement in rheumatoid arthritis , all of the followings are correct except
a) Sparing distal interphalengeal joints of the hands
b) Tempromandibular joint involvement in > 80 % of cases
c) Knee joint involvement in 80% of cases
d) Cervical spines involvement in 40% of cases
e) Shoulder joint involvement in 60% of cases
55) Which one of the followings is extra articular manifestation of rheumatoid arthritis
a) Rheumatoid nodule
b) Cardiovascula
c) Pulmonary
d) Hematological
e) All of the above
56) Behcet’s Disease , all of the followings are correct except
a) Vasculitis with triad of oral and genital ulcers and uveitis or iritis
b) Aphthous like ulcers, covered in pale pseudomembrane
c) Painless ulcers on lips, gingiva, buccal mucosa, tongue and palate
d) Genital ulcers similar in appearance
e) Heal in days to weeks with scarring
57) Pernicious anemia occurs due to the deficiency of:
a) Intrinsic factor
b) Vitamin B12 (extrinsic factor)
c) Folic acid
d) Iron
58) In microcytic hypochromic anemia, there is:
a) Reduced MCV,reduced MCH, normal MCH concentration
b) Reduced MCV, reduced MCH, reduced MCH concentration
c) Normal MCV, normal MCH, reduced MCH concentration
d) Increased MCV, decreased MCH, normal MCH concertration
59) Type of anemia seen in thalassemia is:
a) Simple microcytic
b) Microcytic hypochromic
c) Macrocytic
d) Nromocytic normochromic
60) Which one is correct regarding the cause of Iron deficiency anemia.
a) Malabsorption
b) Pregnancy
c) Chronic blood loss
d) Inadequate dietary intake of iron
e) All of the above

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Part (II) Examination
(Short Answer Questions)
Question (1)
What are the criteria used for Diagnosis of Diabetes Mellitus?
A1C ≥6.5%
The test should be performed in a laboratory using an NGSP-
certified method standardized to the DCCT assay
or
Fasting plasma glucose (FPG)
mg/dl (7.0 mmol/l)≥126
ic intake forFasting: no calor
at least 8 h
or
Two-hour plasma glucose ≥200 mg/dl (11.1 mmol/l) during an
OGTT
The test should be performed as using a glucose load
containing the equivalent of 75 g anhydrous glucose dissolved
in water
or
mmol/l)mg/dl (11.1≥200A random plasma glucose
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis,
Question (2)
What are the criteria used for Diagnosis of Acute Rheumatic Fever?

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Major criteria :
 Migratory polyarthritis
 Carditis,
 Subcutaneous nodules,
 Erythema marginatum, and
 Sydenham chorea.
Minor criteria:
 Fever, arthralgias, increased blood levels of acute phase reactants ( ESR/C-reactive) , leukocytosis and
prolonged PR interval on ECG.
Plus evidence of antecedent streptococcal infection, e.g. positive throat cultures for group A streptococci, elevated
antistreptolysin O titre (> 250 U) or a history of recent scarlet fever
Question (3)
Discuss the classification of anemia and give an example for each.
1- Normochromic normocytic anemia:
anemiaof ChronicDisease
hemolyticAnemia
‫كتابتها‬ ‫عارفة‬ ‫مش‬ ‫ريهام‬ ‫اياها‬ ‫بتقلك‬ ‫بكرة‬ ‫وحدة‬ ‫كمان‬ ‫في‬
2- hypochromic microcytic anemia:
thalassemia
iron deficiency
3- normochromic macrocytic anemia:
vit.B12 deficiency
folate deficiency
Question (4)
Discuss the main functions of the liver and mention some liver abnormalities related to dental practice.
• Temporarynutrientstorage (glucose-glycogen)
• Remove toxinsfromblood
• Remove old/damaged RBC’s
• Regulate nutrientormetabolite levelsinblood—keepconstantsupplyof sugars,fats,aminoacids,
nucleotides(includingcholesterol)
• Secrete bile viabile ductsandgall bladderintosmall intestines.
related to dental practice :Hepatitis- liver cirrhosis
Question(5)
Explain the importance of rheumatology in dental practice.

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Question(6)
Mention few examples of oral manifestation of systemic diseases
1. Hyperpigmentation…………………………… Hyperbilirubinaemia ……………………………………….
2. Oral ulcers…………………… Lupus erythematosus …………………………………………………………
3. Oral bleeding………………… Chronic liver diseases …………………………………………………………
4. Gum hypertrophy………… Leukemia ……………………………………………………………
5. Xerostomia…… Sjögren syndrome ……… Lupus erythematosus .
6. Periodontitis………………diabetes……………………………………………………………….
GoodLuck
Dr.Suhail Kishawi