UNIVERSITY OF THE PHILIPPINES MANILA

PHILIPPINE GENERAL HOSPITAL

DEPARTMENT OF MEDICINE

RESIDENTS EXAM
Endocrinology and Neurology
July 3, 2009

MULTIPLE TRUE OR FALSE. There are 5 statements after each question. Determine
whether each statement is true or false. On the answer sheet, place an x in the box
corresponding to your answer.

ENDOCRINOLOGY

Diabetes Mellitus:

1. Which of the following is/are TRUE of type 1, type 2 and gestational Diabetes
Mellitus (DM)? (Harrisons 17th ed., p. 2276-2288)
A. Type 1 is purely genetic while Type 2 is multifactorial in origin.
B. A long asymptomatic period of hyperglycemia is rare prior to the diagnosis
of type 1 DM.
C. Features of type 1 DM do not become evident until approximately 80% of
beta cells are destroyed.
D. Hypertension more commonly accompanies overt nephropathy in type 1 DM.
E. Most patients with gestational diabetes mellitus revert to normal glucose
tolerance post-partum but have substantial risk of developing DM later in
life.

2. Which of the following is/are TRUE of type 2 diabetes mellitus (DM)? (Harrisons 17th
ed., p. 2277-2281)
A. The American Diabetes Association recommends screening all individuals > 40
years every year and screening individuals at an earlier age if they are
overweight and have one additional risk factor for diabetes.
B. A random plasma glucose concentration of > or = 11.1 mmo/L accompanied by
classic symptoms of DM (polyuria, polyphagia, weight loss) is sufficient for the
diagnosis of DM
C. Oral glucose tolerance testing using 75 g anhydrous glucose dissolved in
water is not recommended as part of routine care
D. Type 2 DM is characterized by impaired insulin secretion, insulin
resistance, excessive hepatic glucose production, and abnormal fat
metabolism.
E. In type 2 DM, increased hepatic glucose output predominantly accounts for
postprandial hyperglycemia.

3. Which of the following is/are TRUE of the chronic complications of diabetes mellitus?
(Harrisons 17th ed., p. 2285-2294)
A. Blindness in diabetic patients is primarily the result of progressive diabetic
retinopathy and clinically significant macular edema.
 B. The pathophysiologic mechanisms invoked in proliferative retinopathy include
loss of retinal pericytes, increased retinal vascular permeability, and abnormal
retinal vasculature.
C. Microalbuminuria may be less predictive of diabetic nephropathy and
progression to macroalbuminuria in type 2 DM.
D. DM-related autonomic neuropathy can cause bradycardia, orthostatic
hypotension, gastroparesis, bladder-emptying abnormalities, hypoglycemia
unawareness, hyperhidoris and anhidosis.
E. In addition to cardiovascular disease, cerebrovascular disease and
congestive heart failure are increased in individuals with DM.

4. Which of the following oral hypoglycemic agents is/are correctly paired with its
description? (Harrisons 17th ed., p. 2299)
A. Acarbose increases risk of hypoglycemia
B. Biguanides increase insulin secretion
C. Sitagliptin increases insulin, decreases glucagon and slows gastric
emptying
D. Sulfonylureas decreases hepatic glucose production
E. Thiazolidinediones contraindicated in congestive heart failure

5. Which of the following is/are TRUE of diabetic emergencies? (Harrisons 17th ed., p.
2283-2285)
A. Volume depletion and hyperglycemia are prominent features of both DKA
and HHS.
B. In contrast to DKA, acidosis and ketonemia are absent or mild in HHS.
C. Fluid replacement should initially stabilize the hemodynamic status of the
patient.
D. A reasonable regimen for HHS begins with an IV insulin bolus of 0.1
units/kg followed by IV insulin at a constant infusion rate of 0.1 units/kg per
hour.
E. Because bicarbonate deficit is common, bicarbonate replacement is usually
necessary.

6. A 65 year old obese male who is a known diabetic for the past 10 years stopped
taking his insulin shots 10 days ago due to financial constrains. Two days before he
consulted you, he started having lethargy, nausea, vomiting and vague epigastric
pain. You noted him to have Kussmaul respirations and a fruity odor in his breath.
The following statements are TRUE about this case: (Harrisons 17th ed., p. 2283-
2284)
A. The patient most likely has mildly elevated serum potassium despite a total
overall potassium deficit.
B. Elevation of serum amylase would clinch the diagnosis of acute pancreatitis.
C. A normal serum sodium is a good prognostic sign since it indicates the patients
good hydration status.
D. Certain medications such as captopril or penicillamine may cause false-
positive reactions to nitroprusside stick used in detecting urine ketones.
E. The degree of acidosis is usually proportional to the degree of hyperglycemia.

7. Which of the following is/are part of the Whipples triad? (Harrisons 17th ed., p. 2305)
A. Symptoms consistent with hypoglycemia
B. Uncontrolled diabetes
 C. Low plasma glucose concentration
D. Hypoglycemia unawareness
E. Relief of symptoms after the plasma glucose level is raised

Dyslipidemia:

8. What is/are TRUE of dyslipidemia? (Harrisons 17th ed., p. 2425)

A. In obese patients, weight loss is often associated with reduction of plasma apo-B
containing lipoproteins and plasma HDL-C.
B. Estrogen administration is associated with increased VLDL and HDL
synthesis.
C. Elevated plasma LDL-C levels are usually not a feature of DM
D. Hypothyroidism is associated with elevated plasma LDL-C due primarily to
a reduction in hepatic LDL receptor function and delayed clearance of LDL.
E. The hyperlipidemia of nephrotic syndrome appears to be due to a combination of
increased hepatic production and increased clearance of HDLs, with increased
LDL production.

9. Which of the following drugs used in the treatment of hyperlipidemia is/are correctly
paired with its description? (Harrisons 17th ed., p. 2428, Table 350-6)
A. Ezetimibe increases lipoprotein lipase
B. Cholestyramine increases LDL receptors
C. Fenofibrate decreases intestinal cholesterol absorption
D. Nicotinic acid causes cutaneous flushing and GI upset
E. Simvastatin decreases cholesterol synthesis, increases hepatic LDL
receptors

Obesity and Metabolic syndrome:

10. According to the NCEP/ATP III 2001 guideline in the diagnosis of metabolic
syndrome, which of the following is/are included? (Harrisons 17th ed., p. 1510, Table
236-1, p. 2282)
A. Central obesity: >/= 102 cm for men and >/= 88 cm for South Asian cut points
B. Fasting plasma glucose of >/=100 mg/dl or previously diagnosed type 2 DM
C. Hypertension: BP >/= 140/90 mmHg
D. Low HDL cholesterol: < 50 mg/dl for both men and women
E. Triglycerides >/= 150 mg/dl or specific medication

Thyroid Disorders:

11. Which of the following is/are TRUE of hypothyroidism? (Harrisons 17 th ed., p. 2229-
2233)
A. The weight gain is due mainly to fluid retention in myxedematous tissues.
B. Increased peripheral resistance may be accompanied by systolic hypertension.
C. The dose of levothyroxine is adjusted based on free T4 level, with the goal of
treatment preferably in the upper half of the reference range.
D. Emergency surgery is high risk in patients with untreated hypothyroidism.
E. The dose of levothyroxine may need to be increased during pregnancy and
returned to previous levels after delivery.
12. Which of the following is/are TRUE of myxedema coma? (Harrisons 17 th ed., p.
2233)
A. It almost occurs in the elderly and is usually precipitated by factors that
impair respiration, such as drugs, pneumonia, congestive heart failure,
myocardial infarction, gastrointestinal bleeding, or cerebrovascular
accidents.
B. Levothyroxine 500 mcg IV or via nasogastic tube is the initial treatment for
myxedema coma.
C. External warming is indicated if the patients temperature is < 35 degrees
Celsius.
D. Supportive measures in the treatment of myxedema coma include use to
hydrocortisone, hypotonic IV solutions, IV glucose infusion and early antibiotic
use.
E. It has a high mortality rate, despite intensive treatment.

13. Which of the following is/are the histopathologic findings in Hashimotos thyroiditis?
(Harrisons 17th ed., p. 2230)
A. Abundance of colloid
B. Fibrosis
C. Germinal center formation
D. Hypertrophy of thyroid follicles
E. Marked neutrophilic infiltration

14. Which of the following is/are TRUE of hyperthyroidism? (Harrisons 17 th ed., p. 2233-
2237)
A. Thyrotoxicosis is the state of thyroid hormone excess and is synonymous with
hyperthyroidism.
B. Smoking is a major risk factor for Graves disease but is a minor risk factor for
the development of ophthalmopathy
C. Severe ophthalmopathy, with optic nerve involvement and chemosis
resulting in corneal damage, is an emergency requiring joint management
with an ophthalmologist.
D. A form of hypokalemic periodic paralysis is particularly common among Asian
females with thyrotoxicosis.
E. It is useful to monitor blood counts prospectively among patients taking
antithyroid drugs as drug-induced agranulocytosis is dose-related.

15. Which of the following is/are TRUE of thyroid storm? (Harrisons 17th ed., p. 2237)
A. Even with treatment, 30% of mortality is caused by cardiac failure,
arrhythmia, or hyperthermia
B. A drugs inhibitory action on T4 to T3 conversion makes propranolol the
antithyroid of choice.
C. One hour after the first dose of propylthiouracil, stable iodide is given to
block thyroid hormone synthesis via the Wolff Chaikoff effect
D. Large doses of PTU should be given orally or by nasogastric tube or per
rectum.
E. Additional therapeutic measures include glucocorticoids, antibiotics if
infection is present, cooling, oxygen and IV fluid

16. Which of the following exhibit decreased radioiodine uptake? (Harrisons 17 th ed., p.
2237)
 A. Graves disease
B. Toxic adenoma
C. Subacute thyroiditis
D. Thyrotoxicosis factitia
E. Struma ovarii

17. Thyroid carcinoma is the most common malignancy of the endocrine system. Which
of the following is/are TRUE? (Harrisons 17th ed., p. 2243)
A. Age is an important prognostic factorthyroid cancer at a young age (<20) or in
older persons (>60) is associated with a worse prognosis
B. Iodine radioisotopes can be used to diagnose and treat differentiated
thyroid cancers.
C. Thyroglobulin levels can be used to detect residual or recurrent disease for
papillary carcinoma, but not for follicular thyroid carcinoma.
D. Parathormone levels can be used to detect residual or recurrent disease for
medullary carcinoma.
E. Psammoma bodies and orphan Annie appearance of nuclei are histologic
characteristic of medullary carcinoma.

18. Which of the following are risk factors for thyroid carcinoma in patients with thyroid
nodule? (Harrisons 17th ed., p. 2243 Table 335-10)
A. Family history of thyroid cancer or MEN2
B. History of head and neck irradiation
C. Iodine deficiency
D. Male sex
E. Smoking

19. Which of the following patients can be classified as having Stage IV thyroid cancer,
according to the American Joint Committee on Cancer Staging? (Harrisons 17 th ed.,
p. 2243)
A. 37 year old male with papillary carcinoma, 2 cm thyroid nodule, with nodal
involvement, with no distant metastases
B. 40 year old female with medullary carcinoma, with direct invasion of the
thyroid capsule, with nodal involvement, with liver metastasis
C. 55 year old male with anaplastic carcinoma, 1 cm thyroid nodule, with
no lymph node involvement, no distant metastases
D. 62 year old female with follicular carcinoma, 2 cm thyroid nodule, with
no lymph node involvement, with scalp metastasis
E. 38 year old male, with papillary carcinoma, 3 cm nodule, with nodal
involvement, and with bone metastases

Adrenal:

20. The typical features of chronic cortisol excess include: (Harrisons 17th ed., p. 2255)
A. Thin, brittle skin
B. Hypotension unresponsive to vasopressors
C. Osteoporosis
D. Distal muscle weakness
E. Acne
 21. The diagnosis of Cushings syndrome is based on laboratory documentation of
endogenous hypercortisolism. The following statements are TRUE: (Harrisons 17th
ed., p. 2255-2257)
A. Measurement of 24-hour urine free cortisol should not be used as a screening
test for hypercortisolism
B. Failure to suppress plasma cortisol after an overnight 1 mg
dexamethasone suppression test suggests hypercortisolism
C. Elevated midnight samples of cortisol are suggestive of Cushings
syndrome.
D. The definitive diagnosis is established by failure of plasma cortisol to fall after
high-dose dexamethasone suppression test.
E. MRI can accurately distinguish ACTH-secreting pituitary tumors from other types
of adenomas

22. TRUE statements regarding adrenal insufficiency: (Harrisons 17th ed., p. 2265)
A. The causes of adrenal crisis include surgical stress in a patient with chronic
adrenal insufficiency, acute hemorrhagic destruction of bilateral adrenals,
septicemia with Pseudomonas or meningococcemia, and rapid withdrawal of
steroids from a patient with bilateral adrenal hyperplasia.
B. The occurrence of stress necessitates an immediate increase in steroid
intake.
C. In the treatment of adrenal crisis, IV infusion of 5% glucose in normal
saline solution should be started with a bolus IV infusion of 100 mg
hydrocortisone followed by a continuous infusion of hydrocortisone at a
rate of 10 mg/hr.
D. An alternative approach of administering 100-mg bolus of hydrocortisone IV
every 6 hours can maintain the plasma cortisol constantly at stress levels.
E. Treatment of adrenal crisis is directed toward repletion of circulating
glucocorticoids, replacement of water deficit and correction of potassium.

Secondary hypertension:

23. What is/are the criteria for the diagnosis of primary aldosteronism? (Harrisons 17th
ed., p. 2260)
A. Systolic hypertension without edema
B. Potassium depletion that is responsible for muscle weakness and fatigue.
C. Hposecretion of renin that fails to increase appropriately during volume
depletion
D. hypersecretion of aldosterone that does not suppress appropriately in
response to volume expansion
E. sodium retention phenomenon of mineralocorticoids

24. Pheochromocytomas produce, store and secrete catecholamines. Which of the

following are TRUE? (Harrisons 17th ed., p. 2260)
A. Panic attacks are the most common manifestation.
B. Ten percent are bilaterally found in the adrenals.
C. Among the screening tests, urine VMA is the most sensitive.
D. Alpha-adrenergic receptor blocking agents must be given only after beta-
blockade has been induced, since administration of these agents by themselves
may cause a paradoxic increase in blood pressure.
 E. Laparoscopic adrenalectomy is associated with fewer complications and a
faster recovery than laparotomy.

Osteoporosis:
25. Which of the following is/are TRUE of osteoporosis? (Harrisons 17th ed., p. 2397-
2407)
A. It is defined operationally as a bone density that falls 2.5 SD below the mean for
young healthy adults of the same race and gender, also referred to as a Z score
of -2.5
B. Estrogen deficiency states such as menopause preferentially affects cortical
bone rather than trabecular bone.
C. Glucocorticoids are the most common cause of medication-induced
osteoporosis.
D. If calcium supplementation is given to osteoporotic patients, the dose should be
at least 1000mg at a time due to poor calcium absorption fraction.
E. Both alendronate ad risedronate are approved for the treatment and
prevention of postmenopausal osteoporosis.

26. Which of the following is/are TRUE of the management of osteoporosis? (Harrisons
17th ed., p. 2402-2407)
A. Estrogen replacement decreases osteoporotic fractures but increases
cardiovascular events.
B. Raloxifene, a bisphosphonate, reduces bone turnover and bone loss in
postmenopausal women.
C. Patients taking alendronate should remain upright for at least 30 mins after a
meal to avoid gastroesophageal reflux disease.
D. There are no consistent effects of fluoride on vertebral or nonvertebral
fractures.
E. Calcitonin is indicated for prevention of osteoporosis because it sufficiently
prevents bone loss in early postmenopausal women.

Hyperparathyroidism:
27. Which of the following is/are TRUE of primary hyperparathyroidism? (Harrisons 17th
ed., p. 2380-2385)
A. The elevation of circulating parathyroid hormone usually leads to hypercalcemia
and hyperphosphatemia.
B. The distinctive bone manifestation is called osteitis fibrosa cystica.
C. Kidney involvement is usually from deposition of calcium in the renal
parenchyma or nephrolithiasis.
D. Neuromuscular manifestations may include proximal muscle weakness,
easy fatigability, and atrophy of muscles and may be striking as to suggest
a primary neuromuscular disorder
E. With the use of multiple markers of bone turnover, such as formation indices
(hydroxypyridinium collagen cross-links) and bone resorption indices (bone
specific alkaline phosphatase, osteocalcin and type I procollagen peptides),
increased skeletal turnover is detected in essentially all patients.

Hypoparathyroidism:
 28. Which of the following is/are TRUE of hypoparathyroidism? (Harrisons 17th ed., p.
2391-2393)
A. Basal ganglia calcification and extrapyramidal syndrome are more common
and earlier in onset in hereditary hypoparathyroidism
B. Alopecia and candidaisis are characteristic of hereditary
hypoparathyroidism associated with autoimmune polyglandular failure
C. As of the present, the most frequent cause of acquired hypoparathyroidism is
surgery for hyperthyroidism.
D. Hypocalcemia associated with hypomagnesemia is associated with both
deficient PTH release and impaired responsiveness to the hormone.
E. Oral calcium and vitamin D restore the overall calcium-phosphate balance but
not reverse the lowered urinary calcium reabsorption typical of
hypoparathyroidism. Therefore, high doses of Vitamin D (>120,000 U/day)
combined with elemental calcium (>/= 2 g) is satisfactory.

Pituitary:
29. Which of the following is/are TRUE of pituitary disorders? (Harrisons 17th ed., p.
2195-2224)
A. Octreotide and lanreotide are preferred medical treatment for
acromegalic patients.
B. LH stimulates ovarian estrogen secretion in women, while it stimulates
seminiferous tubule development and regulates spermatogenesis in men.
C. In diabetes insipidus, the 24-h urine volume is usually less than 50 mL/kg and
the osmolarity is less than 300 mosm/L.
D. Pregnancy, lactation, chest wall stimulation, sleep and stress are
physiologic causes of hyperprolactinemia
E. Signs and symptoms of TSH and ACTH deficiency are the first to occur in the
course of pituitary failure.

30. Contraindication/s to growth hormone replacement therapy include: (Harrisons 17 th

ed., p. 2209)
A. Active neoplasm
B. Chronic kidney disease
C. Morbid obesity
D. Systemic hypertension
E. Uncontrolled diabetes mellitus and retinopathy

Short Stature:
31. In the evaluation of patients with short stature, the following statements are TRUE:
(Harrisons 17th ed., p. 2208)
A. Bone age is delayed in all forms of true growth hormone deficiency or
growth hormone receptors defects
B. High levels of estrogen lead to early epiphyseal closure
C. Short stature should be comprehensively evaluated if a patients height is > 2 SD
below the mean for age or if the growth rate has decelerated.
D. Final height can be predicted using standardized scales or estimated by
adding 6.5 cms (boys) or subtracting 6.5 cm (girls) from the midparental
height.
E. Adequate adrenal and thyroid hormone replacement should also be given along
with growth hormone.
Hirsutism
32. Which of the following is/are TRUE of hirsutism? (Harrisons 17th ed., p. 301-304)
A. Hirsutism refers to a condition of in which androgen levels are sufficiently high to
cause excessive male-pattern hair growth, deepening of voice, breast atrophy
and cliteromegaly.
B. Sudden development and rapid progression of hirsutism suggest the
possibility of an androgen-secreting neoplasm.
C. DHEAS is the primary mediator of androgen action at the level of pilosebaceous
unit.
D. In nonclassic congenital adrenal hyperplasia, the adrenal glands cannot
secrete glucocorticoids efficiently. This results in the accumulation of
steroid precursors that are subsequently converted to androgen.
E. Vitamin A is usually the first-line endocrine treatment for hirsutism and acne

Gynecomastia
33. Which of the following is/are cause(s) of gynecomastia? (Harrisons 17th ed., p. 2318)
A. Androgen deficiency
B. Androgen insensitivity
C. Excess estrogen production
D. Increased alpha-reductase activity
E. Increased peripheral aromatase activity

NEUROLOGY:

Cerebrovascular disease:

34. Which of the following is/are TRUE of cerebrovascular diseases? (Harrisons 17th ed.,
p. 2513-2517)
A. The definition of stroke is based on laboratory studies like brain imaging
B. The most significant causes of cardioembolic stroke in most of the world are
rheumatic atrial fibrillation.
C. In the setting of prior stroke or brain injury, a patient with fever or sepsis
may manifest hemiparesis, which clears rapidly when the infection is
remedied.
D. There are no reliable clinical findings that conclusively separates ischemia from
hemorrhage, although a more depressed level of consciousness and higher initial
blood pressure favor ischemia, and a deficits that remits suggests hemorrhage.
E. Brain edema peaks on the fifth day but can cause mass effect for ~ 10 days.

35. Which of the following is/are TRUE of the treatment of acute ischemic stroke?
(Harrisons 17th ed., p. 2514-2516)
A. After initial stabilization, an emergency head CT scan with contrast should be
performed to differentiate ischemic from hemorrhagic stroke
B. Heparin given subcutaneously afforded no additional benefit over aspirin
and increased bleeding rates
C. Hemicraniectomy markedly reduces mortality, and the clinical outcomes of
survivors are acceptable.
D. Occlusions in large vessels generally involve a large clot volume and often
fail to open with IV rtPA alone.
E. Aspirin and clopidogrel are the antiplatelet agents that have been proven
effective for the acute treatment of ischemic stroke.
36. Which of the following is/are TRUE of the acute management of intracranial
hemorrhage? (Harrisons 17th ed., p. 2534)
A. In general, supratentorial hematomas with volumes at least 60 ml have a
poor prognosis
B. Evacuation of supratentorial hematomas does not appear to improve
outcome.
C. Patients with cerebellar hematomas > 3 cm in diameter require watchful waiting
for signs of impaired consciousness and precipitous respiratory failure.
D. For patients taking warfarin sodium, more rapid reversal of coagulopathy
can be achieved by infusing prothrombin complex concentrates followed
by fresh frozen plasma and vitamin K.
E. If hematoma causes marked midline shift of structures with consequent
obtundation, coma or hydrocephalus, osmotic agents coupled with induced
hyperventilation can be instituted to lower intracranial pressure.

37. Which of the following is/are TRUE of transient ischemic attacks? (Harrisons 17th
ed., p. 2521)
A. The standard definition of duration is < 24 hours, but most TIAs last <30 mins.
B. TIAs may herald stroke, and are an important risk factor that should be
considered separately
C. The improvement characteristic of TIA is not a contraindication to
thrombolysis since infarcts of the brain may occur even though neurologic
signs and symptoms are absent
D. The risk of stroke after a TIA is 10-15% in the first 3 months, with most
events occurring in the first 2 days.
E. Acute antiplatelet therapy has not been tested specifically after TIA but is
likely to be effective and is recommended.

38. Thrombus formation on atherosclerotic plaques may embolize to intracranial arteries

producing an artery-to-artery embolic stroke. Which of the following is/are TRUE of
artery-to-artery embolic stroke? (Harrisons 17th ed., p. 2517-2518)
A. Carotid bifurcation atherosclerosis is the most common source of artery-
to-artery embolus.
B. There is substantial benefit for carotid endarterectomy in patients with carotid
stenosis >/= 50%.
C. Endarterectomy is most beneficial when performed within 2 days of symptom
onset.
D. At present, carotid endarterectomy in asymptomatic women remains
particularly controversial
E. Balloon angioplasty coupled with stenting is at the very least comparable
to endarterectomy as a treatment option for patients at high risk for
surgery.

39. What is/are the contraindication(s) to administration of intravenous recombinant

tissue plasminogen activator (rTPA) for acute ischemic stroke? (Harrisons 17th ed.,
p. 2515 Table 364-1)
A. Major surgery in preceding 14 days
B. Platelets < 100,000
C. Prior stroke or head injury within 1 year
D. Recent myocardial infarction
E. Sustained BP > 160/100 despite treatment
Dementia:

40. Which of the following is/are the most important risk factor(s) for Alzheimers
disease? (Harrisons 17th ed., p. 2541)
A. Female gender
B. Lower educational attainment
C. Old age
D. Past history of head trauma
E. Positive family history

41. Which of the following is/are TRUE of the clinical differentiation of the major
dementias? (Harrisons 17th ed., p. 2537-2538)
A. A change in personality, disinhibition, and gain of weight or food obsession
suggests dementia of Lewy bodies.
B. The diagnosis of frontotemporal dementia is suggested by the early presence of
visual hallucinations, delirium and REM sleep disorder.
C. A history of sudden stroke with irregular stepwise progression suggests
multi-infract dementia.
D. Rapid progression of the dementia in association with motor rigidity and
myoclonus suggests Creutzfeldt-Jakob disease.
E. BONUS

Benign Positional Vertigo:

42. Which of the following is/are TRUE of benign paroxysmal positional vertigo (BPPV)?
(Harrisons 17th ed., p. 145, Table 22-1)
A. Atlhough the condition may be due to head trauma, usually no precipitating
factors are identified.
B. The pattern of nystagmus in the posterior canal is distinctive. When supine, with
the head turned to the side of the offending ear (bad ear down), the upper eye
displays a large amplitude torsional nystagmus.
C. Mild disequilibrium when upright may also be present.
D. In contrast to central positional vertigo, BPPV demonstrates fatigability and
habituation
E. Vertigo in central position vertigo is more severe than in BPPV.

Epilepsy:
43. Which of the following is/are TRUE of the evaluation of a patient with seizure?
(Harrisons 17th ed., p. 2498-2505)
A. Epilepsy describes a condition in which a person has recurrent seizures that may
be due to correctable or avoidable circumstances.
B. Even in the absence of symptoms and signs suggesting infection, a lumbar
puncture is mandatory in all patients infected with HIV.
C. The EEG has not proved to be useful in predicting which patients with
predisposing conditions will go on to develop epilepsy.
D. Almost all patients with new-onset seizures should have a brain imaging study
especially in children who have an unambiguous history and examination
suggestive of a benign, generalized seizure disorder.
E. Simple seizures are those in which the seizure activity is restricted to discrete
areas of the cerebral cortex.
 44. Which of the following patient profile(s) yield(s) the greatest chance of remaining
seizure-free after drug withdrawal? (Harrisons 17th ed., p. 2510)
A. Absence of childhood history of seizures
B. Complete medical control of seizures for 1-5 years
C. Normal EEG
D. Normal neurologic examination
E. Single seizure type, either partial or generalized

Neuropathies:
45. What is/are the required for the diagnostic criteria for Guillain-Barre syndrome
(GBS)? (Harrisons 17th ed., p. 2670, Table 380-3)
A. Areflexia
B. Disease course > 2 weeks
C. Mild sensory involvement
D. Progressive weakness of 2 or more limbs due to neuropathy
E. Relatively symmetric weakness

46. What is/are used in the treatment of patients with GBS? (Harrisons 17th ed., p. 2670)
A. glucocorticoids
B. methotrexate
C. high dose intravenous immunoglobulin
D. cyclophosphamide
E. plasmapharesis

CNS infections:
47. Which of the following is/are TRUE of meningitis? (Harrisons 17th ed., p. 2621-2635)
A. In the usual case of viral meningitis, treatment is symptomatic and
hospitalization may not be required. An exception is patients with deficient
humoral immunity.
B. Failure to sterilize the CSF after 36 hours of antibiotic therapy in patients
with S. penumoniae meningitis should be considered presumptive
evidence of antibiotic resistance.
C. Due to high prevalence of resistance, Penicillin G no longer has a role in the
treatment of meningococcal meningitis.
D. CSF finding consistent with TB meningitis include elevated opening pressure,
xanthochromic appearance of CSF, lymphocytic pleocytosis and reduced protein
concentration.
E. The most common complication of fungal meningitis is a superimposed bacterial
meningitis.

48. Which of the following is/are TRUE of viral encephalitis? (Harrisons 17th ed., p. 2629-
2631)
A. The most important viruses causing sporadic cases of encephalitis in
immunocompetent adults are herpesviruses.
B. The characteristic CSF profile is indistinguishable from that of viral
meningitis
C. A decreased CSF glucose concentration is distinctly unusual in viral
encephalitis
D. CSF PCR has become the primary diagnostic test for CNS infections
caused by CMV, EBV, VZV, and enteroviruses.
 E. Majority of patients with proven HSV encephalitis have MRI abnormalities
involving the temporal lobes.

49. Which of the following is/are TRUE of brain abscess? (Harrisons 17th ed., p. 2635-
2637)
A. The most common symptom is fever.
B. Meningismus is not present unless the abscess has ruptured into the
ventricle or the infection has spread to the subarachnoid space.
C. Lumbar puncture should be performed in patients with known or suspected focal
intracranial infections such as abscess or empyema.
D. All patients should receive a minimum of 4 weeks of parenteral antibiotics
therapy.
E. Glucocorticoids should not be given routinely to patients with brain
abscesses.

Parkinsons Disease:
50. Which of the following is/are part of the cardinal signs of Parkinsons disease?
(Harrisons 17th ed., p. 2550)
A. Akathisia
B. Bradykinesia
C. Dementia
D. Rest tremor
E. Rigidity

Myasthenia Gravis:
51. Which of the following is/are TRUE of myasthenia gravis? (Harrisons 17th
ed., p. 2672-2677)
A. Women are affected more frequently than men.
B. The fundamental defect is a decrease in the number of available
acetylcholine receptors at the postsynaptic muscle membrane.
C. Despite the muscle weakness, deep tendon reflexes are preserved.
D. The presence of anti-acetylcholinesterase receptor antibodies is virtually
diagnostic and a negative test excludes the disease
E. Long acting pyridostigmine should be used for daytime medication because of
good absorption during this period.

CNS Tumors:
52. Which of the following is/are TRUE of meningiomas? (Harrisons 17th ed., p. 2605-
2606)
A. They invade the skull but only infrequently invade the brain.
B. They are more frequent in men.
C. Peak incidence is in middle age.
D. Chemotherapy is curative for meningiomas.
E. For meningiomas that are not surgically accessible, radiosurgery is the
treatment of choice.

53. What is/are TRUE of the treatment of tumors metastatic to the brain? (Harrisons 17 th
ed., p. 2608-2609)
A. Improvement of symptoms with glucocorticoids is often dramatic,
occurring within 24 hours.
B. Radiation is the primary treatment for brain metastasis.
 C. Stereotaxic radiosurgery is of benefit in patients with four or fewer
metastases demonstrable by MRI.
D. Accessible single metastases may be surgically excised as a palliative
measure.
E. Brain metastases of large cell lung cancer and melanoma are often responsive to
systemic chemotherapy.

Demyelinating Disorder:
54. What is/are included in the triad of multiple sclerosis? (Harrisons 17th ed., p. 2611)
A. Conduction block
B. Demyelination
C. Fibrosis
D. Gliosis
E. Inflammation

55. Which of the following ancillary symptoms of multiple sclerosis is/are correctly
matched? (Harrisons 17th ed., p. 2613-2614)
A. Facial myokymia persistent rapid flickering contractions of facial
musculature
B. Lhermittes symptom electric shock-like sensation evoked by neck
flexion
C. Paroxysmal symptoms prolonged duration with alteration of consciousness
D. Trigeminal neuralgia brief lancinating facial pain triggered by an afferent
input from the face or teeth
E. Uhthoffs symptom transient unilateral visual blurring during a hot
shower

Multiple Choice:

ENDOCRINOLOGY

1. What is the most common site of development of foot ulcer among diabetic individuals?
(Harrisons 17th ed., p. 2292)
A. Calcaneal part
B. Dorsal aspect of the foot
C. Great toe
D. Lateral aspect of the foot

2. Which of the following insulin preparations should be injected just before or just after a
meal? (Harrisons 17th ed., p. 2297)
A. Aspart
B. Lente
C. Regular insulin
D. Ultralente

3. The following laboratory findings are present in diabetic ketoacidosis, EXCEPT:

(Harrisons 17th ed., p. 2283)
A. Hyperlipoproteinemia
B. Hypertriglyceridemia
C. Increased BUN and creatinine levels
D. Leukocytosis
 E. Normal anion gap metabolic acidosis

4. Among pregnant patients with high risk for GDM, screening for glucose intolerance
should be done during _______ of pregnancy:
A. 12th-16th week
B. 16th-20th week
C. 20th-24th week
D. 24th -28th week
E. 28th-32nd week

5. As hypoglycemia ensues, which among the following is the first and the most important
of the counterregulatory hormone responses?
A. Cortisol
B. Epinephrine
C. Glucagon
D. Growth hormone
E. Somatostatin

6. Large retrosternal goiters can cause venous distention over the neck and difficulty
breathing, especially when arms are raised. This phenomenon is called: (Harrisons 17th
ed., p. 2228)
A. Pembertons sign
B. Pendred sign
C. SVC sign
D. Watson Sign

7. What is the most common cause of hypothyroidism worldwide? (Harrisons 17th ed., p.
2229)
A. Autoimmune disease
B. Drug-induced
C. Hashimotos thyroiditis
D. Iatrogenic causes
E. Iodine deficiency

8. If there is no residual thyroid function, what is the daily replacement dose of

levothyroxine? (Harrisons 17th ed., p. 2232)
A. 0.6 ug/kg body weight
B. 1.2 ug/kg body weight
C. 1.6 ug/kg body weight
D. 2.2 ug/kg body weight

9. Which of the following is/are compatible with subclinical hyperthyroidism? (Harrisons

17th ed., p. 2235, Figure 335-8)
A. Normal TSH and normal FT4
B. Low TSH, normal FT3, normal FT4
C. Low TSH, high FT3, normal FT4
D. Low TSH, high FT4
E. High TSH, high FT4

10. Which of the following is an absolute contraindication to RAI therapy? (Harrisons 17th
ed., p. 2236)
 A. Breastfeeding
B. Children
C. Malignancy
D. Pregnancy 6 months after treatment
E. Thyroid ophthalmopathy

11. High levels of this substance in maternal blood during the last trimester of pregnancy
predicts neonatal thyrotoxicosis: (Harrisons 17th ed., p. 2234)
A. Anti-thyroid peroxidase (anti-TPO)
B. Thyroid-stimulating immunoglobulin (TSI)
C. Thyroid stimulating hormone (TSH)
D. Total triiodothyronine (T3)
E. TSH-binding inhibiting immunoglobulin (TBII)

12. What malignancy is associated with a mutated RET protooncogene? (Harrisons 17th ed.,
p. 2246)
A. Follicular carcinoma
B. Medullary carcinoma
C. Parathyroid carcinoma
D. Papillary carcinoma
E. Pituitary adenoma

13. This thyroid cancer tends to be multicentric, invades locally, and is characterized by
psamomma bodies. (Harrisons 17th ed., p. 2245)
A. Anaplastic thyroid cancer
B. Follicular thyroid cancer
C. Medullary thyroid cancer
D. Papillary thyroid cancer

14. What is the most common presenting feature of adult hypopituitarism? (Harrisons 17th
ed., p. 2214)
A. Hypogonadism
B. Hypothyroidism
C. Hypoprolactinemia
D. Short stature
E. SIADH

15. What is the most common pituitary hormone hypersecretion syndrome in both males and
females? (Harrisons 17th ed., p. 2204)
A. Acromegaly
B. Diabetes insipidus
C. Hyperprolactinemia
D. Hyperthyroidism
E. Precocious puberty

16. The initial screening procedure for pituitary-adrenal suppressibility is: (Harrisons 17th
ed., p. 2256)
A. Administration of dexamethasone 0.5 mg every 6 hrs for 2 consecutive days
B. Intravenous infusion of 500mL/h of normal saline for 4 hours
C. Overnight 1mg dexamethasone suppression test
D. Rapid ACTH stimulation test
 E. Sodium restriction

17. Which of the following tests would differentiate between an ACTH-secreting pituitary
tumor and ectopic ACTH secretion? (Harrisons 17th ed., p. 2257)
A. 24- hour urinay free cortisol
B. Basal ACTH secretion
C. High dose dexamethasone suppression test
D. Low dose dexamethasone suppression test
E. Selective petrosal sinus sampling

18. The most common cause of ectopic ACTH is: (Harrisons 17th ed., p. 2255)
A. Brain tumor
B. Breast tumor
C. Lung tumor
D. Parathyroid tumor

19. What is the most common cause of endogenous Cushing syndrome? (Harrisons 17th
ed., p. 2255)
A. Adrenal carcinoma
B. Bilateral adrenal hyperplasia
C. Congenital adrenal hyperplasia
D. Exogenous steroid intake

20. Which of the following is the most common sign of Cushings syndrome?
A. Amenorrhea
B. Hirsutism
C. Obesity
D. Purple skin striae
E. Skin hyperpigmentation

21. The definitive diagnosis of Cushing syndrome is established by: (Harrisons 17th ed., p.
2256)
A. Administration of dexamethasone 0.5 mg every 6 hrs for 2 consecutive days
B. Intraveous infusion of 500mL/h of normal saline for 4 hours
C. Overnight 1mg dexamethasone suppression test
D. Rapid ACTH stimulation test
E. Sodium restriction

22. What is the major androgen secreted by the adrenal gland? (Harrisons 17th ed., p. 2248)
A. Androstenedione
B. Dehydroepiandrosterone
C. Dihydrotestosterone
D. Testosterone

23. What is the cardinal symptom of adrenocortical insuffieciency? (Harrisons 17th ed., p.
2263)
A. Asthenia
B. Hyperpirgmentation
C. Arterial hypotension
D. GI disturbances
E. Excessive irritability
24. What differentiates secondary adrenal insufficiency from primary adrenal insufficiency?
(Harrisons 17th ed., p. 2265)
A. A more pronounced degree of hypotension
B. More severe weakness and fatigue
C. Presence of hypoglycemia
D. Presence of pigmentation changes
E. Protracted vomiting

25. What glucocorticoid preparation has the lowest mineralocorticoid potency? (Harrisons
17th ed., p. 2269)
A. Dexamethasone
B. Hydrocortisone
C. Methylprednisolone
D. Predisone

26. The classic triad of pheochromocytoma includes the following, EXCEPT: (Harrisons 17th
ed., p. 2270)
A. Headache
B. Hypertension
C. Palpitation
D. Profuse sweating

27. Urinary tests are widely available and commonly used for initial testing of
pheochromocytoma. Among these tests, which is the most sensitive? (Harrisons 17th
ed., p. 2271, Table 337-2)
A. Chromogranin A
B. Fractionated metanephrine
C. Total metanephrine
D. VMA

28. A 38 year old male consulted you for hypertension that was noted 8 months ago. On
inspection, you noted that he has coarsened facial features, frontal bossing, and
increased heel pad thickness. How will you confirm the diagnosis in this case?
(Harrisons 17th ed., p. 2210)
A. Do an oral glucose loading test
B. Do insulin-induced hypoglycemia
C. Measure random growth hormone level
D. Measure serum IGF-1 level
E. Measure serum TSH

29. What is the most common manifestation of MEN type 1? (Harrisons 17th ed., p. 2358)
A. Glucagonoma
B. Hyperparathyroidism
C. Insulinoma
D. Neoplasia of the pancreatic islets
E. Pituitary adenoma

30. Nelson syndrome pertains to the rapid pituitary enlargement and increased pigmentation
that results from high ACTH levels in a patient with residual pituitary adenoma. This
usually develops after: (Harrisons 17th ed., p. 2214)
 A. Adrenalectomy
B. Pituitary irradiation
C. Transsphenoidal resection of pituitary adenoma
D. Use of octreotide
E. Use of steroidogenic inhibitors

NEUROLOGY:
31. What is the most common cause of cerebral embolism?
A. Cardiac prosthetic valves
B. Rheumatic heart disease
C. Dilated cardiomyopathy
D. Endocarditis
E. Atrial fibrillation

32. This syndrome consists of contralateral hemisensory loss followed later by an agonizing,
searing or burning pain in the affected areas. (Harrisons 17th ed., p. 2525)
A. Claude syndrome
B. Dejerine-Roussy syndrome
C. P2 syndrome
D. Weber syndrome

33. It is brought by bilateral infarction in the distal posterior cerebral artery producing crotical
blindness (blindness with preserved papillary light reaction) and unawareness or denial
of the blindness: (Harrisons 17th ed., p. 2526)
A. Anton syndrome
B. Balint syndrome
C. Claude syndrome
D. Wallenberg syndrome

34. This is a poorly understood occlusive disease involving large intracranial arteries where
the lenticulostriate arteries develop a rich collateral circulation around the occlusive
lesion, resembling a puff of smoke: (Harrisons 17th ed., p. 2520)
A. Takayasus arteritis
B. Binswangers disease
C. Moyamoyas disease
D. CADASIL
E. Dejerine-Roussy Syndrome

35. What is the most common cause of dementia in western countries? (Harrisons 17th ed.,
p. 2536)
A. Alzheimers disease
B. Vascular dementia
C. Frontotemporal dementia
D. Cortical basal degeneration
E. Dementia with Lewy bodies

36. About 10% of patients with Alzheimers disease develop this syndrome described as a
belief that a caregiver has been replaced by an impostor. What do you call this
syndrome? (Harrisons 17th ed., p. 2537)
A. Capgras syndrome
 B. Geitz syndrome
C. Meige syndrome
D. Loey-Dietz syndrome

37. What is the most important microscopic finding in Alzheimers disease?

A. Lewy bodies
B. Neuritic senile plaques
C. Psammoma bodies
D. Amyloid angiopathy

38. What is the most common type of multiple sclerosis? (Harrisons 17th ed., p. 2614)
A. Primary progressive
B. Progressive/relapsing
C. Relapsing/remitting
D. Secondary progressive

39. What is the most common presenting finding or symptom of multiple sclerosis?
A. Internuclear ophthalmoplegia
B. Transverse myelitis
C. Cerebellar ataxia
D. Optic neuritis
E. Urinary retention

40. What is the most common cause of meningitis in adults > 20 years old? (Harrisons 17th
ed., p. 2621)
A. Enteric gram-negative bacilli
B. Haemophilus influenzae
C. Neiserria meningitides
D. Staphylococcus aureus
E. Streptoccus pneumoniae

41. What is the most common cause of viral meningitis? (Harrisons 17th ed., p. 2628)
A. HIV
B. Adenoviruses
C. Herpes viruses
D. Enteroviruses
E. Influenza viruses

42. What is the most common pathogen causing fungal meningitis? (Harrisons 17th ed., p.
2634)
A. Histoplasma capsulatum
B. Coccidiodes immitis
C. Sporothrix shenkii
D. Cryptococcus neoformans
E. Aspergillus fumigatus

43. A non-encapsulated brain abscess is called? (Harrisons 17th ed., p. 2635)

A. Brain liquefaction
B. Cerebritis
C. Dawsons abscess
D. Pseudoabscess
44. What is the most common seizure type resulting from metabolic derangements?
A. Absence seizures
B. Atonic seizures
C. Complex partial seizures
D. Generalized tonic-clonic seizures
E. Myoclonic siezures

45. What is the most common syndrome associated with complex partial seizures?
(Harrisons 17th ed., p. 2500)
A. Hughlings Jackson syndrome
B. Juvenile myoclonic epilepsy
C. Lennox-Gastaut syndrome
D. Mesial temporal lobe epilepsy
E. Todds syndrome

46. What is currently considered as the best initial choice for the treatment of primarily
generalized tonic-clonic seizures? (Harrisons 17th ed., p. 2509)
A. Carbamazepine
B. Ethosuximide
C. Phenytoin
D. Valproic acid

47. All of the following are side effects of phenytoin EXCEPT:

A. Ataxia
B. Gum hyperplasia
C. Hirsutism
D. Leukopenia
E. Lymphadenopathy

48. The following are metastatic tumors associated with intracranial hemorrhage, EXCEPT:
(Harrisons 17th ed., p. 2534)
A. Breast carcinoma
B. Bronchogenic carcinoma
C. Choriocarcinoma
D. Malignant melanoma
E. Renal cell carcinoma

49. What is a part of the diagnosis of severe migraine?

A. Blurring of vision
B. Severe headache > 5 times per month
C. Significant functional impairment
D. Vertigo > 3 times per month

50. The following are pathologic hallmarks of motor neuron degenerative disorders except
A. Death of anterior horn cells in the spinal cord
B. Death of brainstem homologues involving the bulbar muscles
C. Death of corticospinal, motor neurons
D. Death of lower motor neuron
E. Death of upper motor neuron