Professional Documents
Culture Documents
Internal Medicine Board Questions
Internal Medicine Board Questions
Answer: C P. 1658
Answer: C P. 262
Answer: D P. 1680
Answer: B p. 256
1
6. The a wave of the jugular venous pulse (JVP) represents:
a. right ventricular contraction
b. right atrial contraction
c. ventricular septal defect
d. atrial septal defect
11. A 16-year-old male patient presenting with hepatitis syndrome has the
following serologic exam findings:
2
13. True of Ascaris infestation:
a. may cause ground itch
b. Loeffler’s pneumonitis results from allergy to ascaris eggs
c. adult worms reside mostly in the small intestines
d. the drug of choice in biliary ascariasis is Mebendazole because
it paralyzes the worms and prevents their further migration
14. Which of the following risk factors has been directly associated with
Bronchogenic Carcinoma?
a. Asbestos exposure
b. Aflatoxin ingestion
c. Cigarette smoking
d. Chronic Bronchitis
17. A patient with CAP requires hospitalization when one of the following is
present:
a. age < 65 years old
b. COPD in exacerbation
c. temperature of 38.5C
d. unilobar CXR infiltrate
18. One of the following is NOT a useful clue to the microbial etiology of
CAP (Community Acquired Pneumonia)
a. edentulous persons likely to develop pneumonia due to
anaerobes
b. susceptible people exposed to an infectious aerosol in
Legionellosis
c. patients with severe hypogammaglobulinemia at risk of infection
with S. pneumoniae
d. anaerobic lung abscess occuring in patients prone to aspiration
3
20. Gold standard in the diagnosis of PTE:
a. ventilation-perfusion scan
b. pulmonary angiography
c. Helical/Spiral CT Scan
d. transesophageal echocardiography
21. One of the disorders below does NOT have vesicles or bulla as
presenting lesions:
a. Impetigo
b. Chicken pox
c. Herpes Simplex
d. Psoriasis
22. Annular lesions with raised erythematous border and clear centers,
distributed over the trunk area:
a. Tinea unglum
b. Psoriasis
c. Tinea versicolor
d. Tinea corporis
23. Grouped vesicles arranged in a segmental pattern over the right side
of the trunk, T7-8 level:
a. Herpes Simplex
b. Chicken pox
c. Verruca vulgaris
d. Herpes Zoster
26. In typhoid fever, which of the following specimen will have the best
sensitivity for culture if a patient has been given antibiotics?
a. blood
b. bone marrow
c. stool
d. urine
4
28. The fungus which is a normal inhabitant of the human mucocutaneous
body surfaces and is a frequent cause of fungemia is:
a. Aspergillus
b. Candida
c. Cryptococcus
d. Histoplasma
29. An 18-year-old boy had sex with an HIV+ prostitute a week ago. He is
frightened and wants assurance he has not been infected. You should:
a. tell him you regret that there is no way at this time to tell if
he has been infected or not
b. ask for an immediate AIDS ELISA test
c. ask for an immediate Western Blot test
d. assure him that if it was a one night affair he probably did not
get infected
32. A patient with Bell’s Palsy has a pathology involving which cranial
nerve?
a. III
b. V
c. VII
d. III and VII
34. The first drug of choice in a patient presenting with frank seizures is:
a. Diphenylhydantoin IV
b. Phenobarbital IV
c. Carbamazepine p.o.
d. Diazepam IV
5
36. A Cavernous sinus lesion could involve several cranial nerves. Which
of the following is least likely to be affected?
a. oculomotor nerve
b. Trochlear nerve
c. Abducens nerve
d. facial nerve
38. Elevated urea in patients with chronic renal disease occurs because of
a. an increased reabsorption of urea by the proximal tubules
b. decreased secretion of urea by the distal tubules
c. decreased urea excretion
d. an increased renal blood flow
40. What is the most conservative management for chronic renal failure?
a. dietary proteins of 0.6 g/kg/day
b. allopurinol 300 mg OD
c. dialysis
d. kidney transplant
6
44. A 50-year-old male with ESRD 20 diabetic nephropathy was brought to
the emergency room because of weakness and light headedness. He
has just completed his first dialysis, and was observed to be somewhat
confused. BP = 90/40, CR = 80/min., RR = 20/min. The most likely
explanation for his condition is:
a. Dialysis disequilibrium syndrome
b. Dialysis dementia
c. Poor dietary intake during dialysis
d. Reduced dialysate temperature
47. All of the following anemias except one are chronic developing over
weeks. Which anemia may develop acutely?
a. aplastic
b. pernicious
c. hemolytic
d. iron deficiency
48. In the tumor cell cycle, the cells refractory to chemotherapy are the:
a. Cells in the G2 phase
b. Cells in the M phase
c. Cells in the G0 phase
d. Cells in the active S phase
7
52. Lung cancer that is associated with significant progressive dyspnea
and increasing hypoxemia
a. Squamous cell carcinoma
b. Oat cell CA
c. Adenocarcinoma
d. Bronchoalveolar CA
8
60. The diagnosis of diabetes mellitus is certain in which of the following
situations?
a. persistently elevated nonfasting serum glucose levels
b. successive fasting plasma glucose of 147, 165, 152 mg/dL
in an otherwise healthy 40-year-old female
c. A serum glucose level of 140 mg/dL in a pregnant woman in her
26th week AOG
d. glycosuria in a 30/F
9
a. polymorphonuclear cells
b. monocytes
c. lymphocytes
d. lymphoma cells
69. A 30-year-old female has severe perennial allergic rhinitis. Her house
is frequently flooded. She has a dog and sleeps on kepok pillow. As
part of management of her allergy, you should advice her to
a. get a new kapok pillow and launder it frequently
b. try to scoop out the flooded water as soon as the rain pours
c. keep the dog out or get a cat instead
d. replace the kapok pillow with foam rubber, cover the pillow
and mattress with allergen proof encasings
73. If only one person is present to provide basic life support, chest
compressions should be performed at a rate of ______ per minute,
and breaths twice in succession every 15 seconds
a. 50
b. 80
c. 60
d. 40
10
a. kidneys
b. brain
c. heart
d. liver
a. Isoniazid
b. Pyrazinamide
c. Rifampicin
d. Streptomycin
MPL: 0.25 p:964
80. The most common form of Lung cancer arising in lifetime of a non
smoker young women
a. Small cell carcinoma
b. Adenocarcinoma
c. Squamous cell carcinoma
d. Large cell carcinoma
MPL: 0.50 p: 507
11
83. DNA synthesis phase
a. G1
b. G2
c. G0
d. S
MPL: 0.333 p: 469
86. In typoid fever this diagnostic exam is not affected by prior antibiotic
use:
a. Bone marrow culture
b. Blood culture
c. Urine culture
d. Stool culture
MPL: 0.25 p: 899
12
a. Pseudomonas aeruginosa
b. Staphylococcus aureus
c. Escherichia coli
d. Proteus vulgaris
MPL: 0.50 p: 1715
13
A. elderly
B. female sex
C. smoking
D. pregnancy
MPL: 0.25 p: 1466
14
105. The most common cause of partial or generalized epilepsy in the
elderly is :
A. stroke
B. brain tumor
C. infection
D. trauma
MPL: 0.50 p: 2537
15
A. normochromic normocytic
B. hypochromic normocytic
C. hypochromic microcytic
D. normochromic microcytic
MPL: 0.333 p: 1226
16
A. pancreatic abscess
B. pleural effusion
C. pericardial effusion
D. peptic ulcer disease
MPL: 0.50 p.1898
17
A. membranoproliferative
B. membranous
C. focal segmental glomerulosclerosis
D. minimal change disease
MPL: 0.5 p: 1687
136. The diagnostic laboratory method of choice for typhoid fever in the first
week
of illness:
A. bone marrow culture
B. blood culture
C. urine culture
D. stool culture
MPL: 0.25 p: 991
18
137. The most important predictor of multi-drug resistant M. tuberculosis
organism
in all studies is:
A. history of treatment tuberculosis
B. HIV
C. noncompliance
D. diabetes mellitus
MPL: 0.5 p: 958
19
A. contaminated water supply
B. food exposed to flies and cockroaches
C. food utensils not properly disinfected
D. ingestion of live oral cholera vaccine
MPL: 0.25 p: 909
147. The single most useful clinical sign of the severity of pneumonia:
A. BP of 120/80
B. Respiratory rate of > 30/min
C. Cardiac rate of 76
D. Temperature of 37C
MPL: 0.333 p: 1532
20
A. hypertension
B. alcoholism
C. cigarette smoking
D. obesity
MPL: 0.5 p: 537
156. A deficiency of this protease inhibitor is a proven genetic risk factor for
COPD
A. alpha 1 anti trypsin
B. alpha 2 anti trypsin
C. M protein
D. piZZ alpha 2 anti trypsin
MPL: 0.5 p: 1548
159. Heart failure with warm and flushed extremities and with widened pulse
pressure
A. Low output
B. High output
C. Diastolic heart failure
D. Systolic heart failure
21
MPL: 0.5 p: 1369
22
167. The most common presenting complaint in patients with ST elevation
MI:
A. Dysnea
B. Weakness
C. Pain
D. Vomiting
MPL: 0.5 1449
170. This form of respiratory failure occurs when alveolar flooding and
subsequent
intrapulmonary shunt physiology occur:
A. Type 1 respiratory failure
B. Type 2 respiratory failure
C. Type 3 respiratory failure
D. Type 4 respiratory failure
MPL: 0.25 p: 1583
171. Heavy drinkers (i.e., those consuming 100 g of ethanol per day for the
preceding 2 years) have a higher incidence of acquiring what type of
organism in Community acquired Pneumonia?
A. gram positive organism
B. gram negative organisms
C. anaerobes
D. enterococci
MPL: 0.5 p: 1530
23
B. cats
C. mosquito
D. rodents
MPL: 0.25 p: 1042
3. Currently considered the best initial treatment for primarily generalized tonic
clonic seizures is:
A. Phenytoin
B. Valproic acid
C. Carbamazepine
D. Phenobarbital
Page 2367
24
C. Listeria monocytogenes
D. Group B streptococci
Page 2471
25
B. Swelling of bony and soft tissue
C. Periarticular muscle atrophy
D. Bony Crepitus
Page – 2039
14. Which of the following is considered as the most common form of idiopathic
osteoarthritis
A. Bouchard’s nodes
B. Heberden’s nodes
C. Gelatinous dorsal cyst
D. Osler nodes
Page 2040
15. A 30 y/o female with SLE is noted to have a prolonged partial thromboplastin
time. This abnormality is associated with:
A. Leukopenia
B. Central nervous system vasculitis
C. Central nervous system hemorrhage
D. Deep venous thrombosis
Page 1964
16. The best screening test for the detection of SLE is:
A. Anti-Sm
B. Anti- dsDNA
C. Antinuclear antibodies
D. Anti-Ro
Page 1961
17. Diagnosis of gouty arthritis is base on the finding of crystals in the synovial fluid
and which of the following crystals is diagnostic of gout?
A. Apatite crystals
B. Birefringent needle-shaped crystals
C. Rod-shaped weakly birefringent crystals
D. Rhomboid strongly birefrintent crystals
Page 2046-2049
18. The preferred treatment of acute gouty attack in elderly patient is:
A. Colchicine
B. NSAID
C. Intraarticular steroid infection
D. Oral steroid
Page 2046
19. Joint pain among patient with Rheumatoid arthritis is cause mainly by which of
the following mechanism?
A. Muscle spasm
B. Stretching of periostal nerve endings
C. Stretching of the joint’s ligaments
D. Distention of joint capsule
Page 1971
26
20. Axial (vertebra) joints involvement in Rheumatoid arthritis is usually limited to
the:
A. Cervical vertebrae
B. Thoracic vertebrae
C. Lumbar vertebra
D. Sacral vertebrae
Page 1971
21. Evidence suggests that early aggressive treatment of rheumatoid arthritic patient
with Disease-Modifying Antirheumatic Drugs (DMARD) maybe effective at
slowing the appearance of bone erosions. Which of the DMARD is currently
considered the best initial choice?
A. D-penicillamine
B. Gold compound
C. Methotrexate
D. Sulfasalazine
Page 1975
22. Which of the following Vitamins is capable of eliciting systemic anaphylactic
reaction?
A. Cobalamine
B. Pyridoxine
C. Riboflavin
D. Thiamine
Page 1949
23. Which of the following medicine or drug is NOT effective in the treatment of the
acute event of systemic anaphylactic reaction?
A. SC Epinephrine
B. IV Dopamine
C. IV Diphenlydramine
D. IV Glucocorticoids
Page 1950
26. Majority (>50%) of all esophageal cancers are of which cell type?
A. adenocarcinoma
B. squamous cell carcinoma
C. lymphoma
D. sarcoma
27
Page 542
27. Not considered as risk factor for the development of Pancreatic cancer?
A. smoking
B. cholelithiasis
C. long standing DM
D. obesity
Page 537
31. Secretion of water and bicarbonate rich solution from the pancreas is stimulated
by:
A. secretin
B. cholecystokinin
C. gastrin
D. somatostatin
Page 1895
28
34. Who among the following is considered to be diabetic?
A. a 34 y/o male who complained of excessive thirst, weight loss and casual
blood sugar of
120mg%
B. asymptomatic 40y/o female with Fasting Blood sugar of 120mg%
C. a 45 y/o female with polyuria and +4 sugar in the urine
D. a 40 y/o male executive with HbAiC of 8%
Page 2153
35. The best way to assess blood sugar control is to monitor the:
A. Fasting blood sugar
B. Post prandial blood sugar
C. Glycosalated Hemoglobin
D. Urine sugar
Page 2172
36. A patient who is Hypertensive and Hypokalemic, should make one consider
which of the ff. as the most likely cause of the hypertension?
A. Pheochromocytoma
B. Conn’s Syndrome
C. Cushing’s disease
D. Addison’s disease
Page 2138
38. Which of the following physiologic condition can stimulate prolactin secretion by
the pituitary gland?
A. Phenothiazines
B. Menstruation
C. Stress
D. Post meal
Page 2085
29
D. elevated TSH with low thyroid hormones
Page 2115
42. Which of the following test is recommended as the initial screening for
Cushing’s Sydrome?
A. overnight dexamethasone test
B. low dose dexamethasone test
C. high dose dexamethasone test
D. plasma ACTH determination
Page 2135
43. Which of the following have the most potent glucocorticoid effect?
A. Triamcinolone
B. Betamethasone
C. Dexamethasone
D. Paramethasone
Page 2147
44. The most potent risk factor for development of active TB disease is:
A. Malnutrition
B. Old age
C. Late adolescence
D. HIV co-infection
Page 955
Case: A 58 years old male presented with 4 days fever and lately weakness and
dizziness whenever he sits or stands up; disorientation. Upon PE:
BP=90/60mmHg, PR=112/min., RR=28/min., T=39.8ºC. The only remarkable
30
finding is an ulcerated skin lesions in the lower leg with black discoloration. Lab
tests: WBC=2,500cells/m3; gram negative bacilli from smears of the skin lesion.
47. This patient has
A. SIRS
B. severe sepsis
C. septic shock
D. sepsis
Page 1606
48. The most probable organism that has causes severe febrile illness with changes
in sensorium and associated with ulceration and black discoloration of the skin
is:
A. S. aureus
B. B. anthrasis
C. Cl. Perfringens
D. P. aeruginosa
Page 310
49. The following anti microbial agent is effective for the treatment of Pseudomonas
infection:
A. Nafcillin
B. Tetracycline
C. Ceftazidime
D. Any of the above
Page 708
50. The major anatomic site for the establishment and propagation of HIV infection
is:
A. Genital organs
B. Lymphoid organs
C. Vascular system
D. Lymphocytes
Page 1080
53. Hypoglycemia in severe malaria is associated with poor prognosis and it may
result from
31
A. failure of hepatic gluconeogenesis
B. increased glucose consumption by host and parasite
C. increased insulin secretion in treatment with Quinine
D. all of the above
Page 1222
54. The diagnostic test of malaria that is also used to monitor response to treatment
is:
A. Serology
B. Stained blood film
C. either
D. neither
Page 1224
59. The following laboratory findings are suggestive of Iron Deficiency Anemia
EXCEPT
A. koilonychias
B. decreased serum ferritin
C. decreased total iron binding capacity
D. low reticulocyte response
Page 589
32
60. Which of the following statement regarding Polycythemia Vera is correct?
A. anemia is common
B. transformation to acute leukemia is common
C. an elevated plasma erythropoietin level excludes the diagnosis
D. phlebotomy is used only after hydroxyurea and interferon have been tired
E. thrombotic risk is mainly attributed to Thrombocytosis
Page 627-628
61. Diagnosis of Acute Myeloid Leukemia is established by the presence of:
A. ≥ 10% myeloblasts in the bone marrow
B. ≥ 20% myeloblasts in the bone marrow
C. ≥ 5% myeloblasts in the bone marrow
D. < 5% myeloblasts in the bone marrow
Page 632
62. Which of the following syndrome have autoimmune hemolytic anemia with
immune thrombocytopenia?
A. Raynaud’s syndrome
B. Evans syndrome
C. Hemolytic uremic syndrome
D. Thrombotic thrombocytopenic purpura
Page 612
63. Which of the following is the cytogenetic hallmark of Chronic Myelogenous
Leukemia?
A. t(15:17)
B. t(9;22)
C. inv 16
D. t(8;21)
Page 638
64. What is the most common symptom of patient with Myeloma?
A. Fever
B. Bleeding
C. Bone pain
D. Numbness
Page 657
65. Cryoprecipitate is produced by centrifugation after thawing of this particular
blood component
A. Packed RBC
B. Single donor apheresis platelet
C. Fresh frozen plasma
D. Cryosupernate
Page 664
66. Asthma is a disorder characterized by:
A. Acute airway inflammation followed by bronchoconstriction
B. Persistent subacute airway inflammation
C. Sensitivity to metacholine and histamine
D. Hypertrophy and hyperplasia of bronchial mucus glands
Page 1508
67. Major infectious cause of asthma exacerbation in adults is:
A. Respiratory syncitial virus
B. Influenza virus
C. Streptococcus
D. Mycoplasma
33
Page 1510
68. The hallmark of COPD is airflow obstruction as evidenced by
A. Increased FEV1/FVC
B. Increased FEV1
C. Decreased FEV1/FVC
D. Decreased residual volume (RV)
Page 1551
69. Paradoxical inspiratory inward movement of the rib cage seen in patients with
severe COPD is called the:
A. Palla’s sign
B. Tripod posture
C. Hamman’s sign
D. Hoover’s sign
Page 1551
70. The single most useful clinical sign of severe pneumonia among patient without
underlying lung disease is:
A. RR>30/min
B. T>38ºC
C. BP<110 systolic
D. CR>100
Page 1532
71. Recurrent pneumonia in the same location is most likely due to the presence of:
A. Immunodeficiency
B. Bronchial obstruction
C. Lung hypoplasia
D. Interstitial lung disease
Page 1537
73. Sudden severe dyspnea, and P.E. finding of unilateral absent breath sounds and
hypertesonance in a COPD patient without antecedent injury should make one
suspect:
A. Primary spontaneous pneumothorax
B. Secondary spontaneous pneumothorax
C. Traumatic pneumothorax
D. Tension pneumothorax
Page 1568
34
75. Hospital acquired pneumonia (HAP) is consider if pneumonia occur:
A. Occurs 24 hours after being placed on a respirator
B. Occurs 48 hours after hospital admission
C. Occurs 72 hours after ICU admission
D. Occurs rarely in large, variegated-patient medical centers
Page 1538
76. A 56 y/o female admitted for Acute Pyelonephritis was started on Amikacin 500
mg IV every 6 hours. After 7 days repeat serum creatinine=5.7 mg/dL (Initial
was 1.3 mg/dL). Urinalysis at this time will reveal:
A. RBC casts
B. Pus cell casts
C. fine granular casts
D. muddy brown granular casts
Page 1649
77. A 65 y/o male with poorly controlled diabetes had renal colic and underwent an
IVP. He develop oliguria 1 day after the procedure. Repeat serum
creatinine=6.9 mg/dL (Initial=2.9 mg/dL). The risks factors on this patient that
predispose him to develop contrast dye nephropathy are the following, EXCEPT:
A. Diabetes
B. Renal Insufficiency
C. Infection
D. Elderly
Page 1647
78. The findings of eosinophiluria in patient with acute Renal Failure is suggestive
of:
A. Acute Allergic Insterstitial Nepritis
B. Acute Glomerulonephritis
C. Acute Tubular Necrosis
D. Acute Uric Acid Nephropathy
Page 1649
79. Which of the following statement is true regarding the measurement of GFR?
A. BUN overestimates GFR because urea is reabsorbed by the tubules
B. Serum creatinine is ⇑ after ingestion of cooked meat
C. Cockcroft-Gault equation is similar for both male and female
D. Insulin clearance is affected by both tubular absorption and secretion
Page 246-247
80. A patient with Chronic Renal Disease and GFR of 40 ml/min has serum K of 6.2
meq/L. the elevated K is due to the following, EXCEPT:
A. ⇓ urinary K+ excretion
B. constipation
C. ⇑ dietary K+ intake
D. drugs that ⇓ K+ secretion in tubules
Page 1655
35
81. A 36 y/o female with Chronic Renal Disease complains of restless leg syndrome.
Screatinine=5.2 mg/dL. You should advice the patient to:
A. consult neurologist
B. therapeutic trial of high dose B6 & B12
C. therapeutic trial of phenytoin
D. initiation of Dialysis
Page 1659
82. A 46 y/o hypertensive patient serum creatinine=9.8 mg/dL and with marked
pallor. The anemia is primarily due to:
A. hemolysis
B. ⇓ EPO synthesis
C. bone marrow suppression
D. Iron deficiency
Page 1658
83. The most prominent findings in patient with nephritic syndrome is:
A. hypoalbuminemia
B. edema
C. proteinuria > 3.5 gm/1.73m 2
D. hyperlipidemia
Page 1684
84. A 20 y/o male, smoker was admitted because of oliguria and hemoptysis. Initial
lab: revel serum creatinine=8.6mg/dL. Urinalysis shows rbc casts and
dysmorphic rbc. (+) anti GBM Ab’s. The expected histopathologic findings is
A. thickened glomerular basement membrane
B. prominent mesangial deposits of IgA
C. crescents formation
D. glomerulosclerosis
Page 1683
85. Duration of treatment of acute uncomplicated cystitis in non pregnant woman is:
A. single dose
B. 3 days
C. 7 days
D. 14 days
Page 1718-1719
36
D. Abundance of smooth muscle cells
Page 1429
88. Which of the following risk factors is a coronary heart disease risk equivalent?
A. Hypertension
B. Diabetes Mellitus
C. Dyslipidemia
D. Obesity
Page 1431
89. The abnormal lipoprotein profile associated with insulin resistance known as
Diabetic dyslipidemia?
A. High LDL low HDL
B. High Triglyceride, High LDL
C. High Triglyceride, Low HDL
D. Low HDL, Low LDL
Page 1431
90. Microvascular angina is a condition caused by:
A. Abnormal constriction or failure of normal dilatation of the coronary
conductance
vessels
B. Normal constriction the coronary resistance vessels
C. Abnormal constriction or failure of normal dilatation of the coronary
resistance vessels
D. Abnormal dilatation of the coronary resistance vessels
Page 1434
91. The major sites of atherosclerotic disease are the:
A. Conductance vessels
B. Resistance vessels
C. Epicardial arteries
D. Endocardial arteries
Page 1434
93. The typical physical examination findings of patients with Stable Angina Pectoris
is:
A. (+) atrial gallop
B. (+) ventricular gallop
C. Mitral systolic murmur
D. Normal
Page 1436
37
C. Iron deficiency anemia
D. Grade I fundus
Page 1480
95. Class I drug used in the treatment of symptoms of patients with Chronic stable
Angina pectoris include which of the following?
A. Dipyridamole and chelation therapy
B. Clopidogrel and long acting dihydropiridine CCB
C. ASA, beta blockers and NTG
D. Long acting nitrates and beta blockers
Page1439
96. Stenosis of the left main coronary artery on three vessel disease in patients with
Diabetes Mellitus or severe LV dysfunction are best treated with:
A. Traditional medical management
B. PCI
C. CABGS
D. Thrombolysis
Page 1442
98. The most common presenting symptom of patients with STERMI is:
A. Dyspnea
B. Chocking
C. Deep and visceral pain
D. Nape pain
Page 1449
100. In which of the following pattern of MI will the use of morphine be restricted
because of its
vagotonic effect?
A. anterior MI
B. antero lateral MI
C. Postero inferior MI
D. Massive MI
Page 1452
38