PHILIPPINE COLLEGE OF PHYSICIANS

COMMITTEE ON RESIDENCY TRAINING PROGRAM

RESIDENCY IN-SERVICE TRAINING EXAMINATION (RITE)

YEAR LEVEL I | FEBRUARY 06, 2019
QUESTIONNAIRE

Instructions: Choose the best answer. There are 50 items for this set of examination.
Write your answers in the sheet provided for. You are given 1 ½ hours to answer this
set. Submit your answer sheet together with the test questions to your proctor. A
feedback will be conducted by your proctor after everybody has finished with the exam.
The MPL will be announced as well. Do not attempt to copy the exam. Any form of
cheating is NOT allowed. Please answer the feedback form after the examination.

PLEASE MAINTAIN HONESTY AND INTEGRITY DURING THE EXAMINATION.

1. Which treatment is appropriate in order to avoid overuse of topical corticosteroids

and minimize likelihood of flares in atopic dermatitis?

A. Emollients
B. Sedating antihistamines
C. Topical antiseptics
D. Wet dressings

2. A 31/M, known to have asthma and allergic rhinitis, complains of difficulty sleeping
due to pruritus of eczema. Which drug can benefit the patient?

A. Diphenhydramine
B. Loratadine
C. Cetirizine
D. Prednisone

3. What are the most common causes of irritant contact dermatitis?

A. Rubbing alcohol solutions

B. Bleach solutions
C. Water
D. Soaps and detergents

4. A 24/F, known asthmatic, presents with pruritus and scaling over both hands. She
handwashed her laundry with a new brand of detergent a week ago and also tried on a
new hand cream recently. What test/procedure will you recommend to identify the
culprit ?

A. Eosinophil percentage on CBC

B. Patch testing
C. Skin biopsy
D. Prick testing

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5. After 4 days of therapy with amoxicillin 500 mg PO TD, a patient with a non-purulent
cellulitis on the left foot reports progression of swelling and episodes of low-grade
fever. The patient has allergy to Cotrimoxazole. Which treatment is appropriate?

A. Increase dose of Amoxicillin to 1 gram PO TID

B. Amoxicillin-clavulanic acid 1 gram PO BID
C. Empirical treatment with Clindamycin
D. Reassure patient and continue current therapy

6. A 30/F, with no known co-morbid condition, complains of pain and swelling on the
dorsum of the right hand a day after sustaining a scratch wound. You note erythema,
non-fluctuant swelling and tenderness on the area with some scanty purulent discharge.
What antibiotic would you prescribe?

A. Cephalexin 500 mg PO QID

B. Amoxicillin 500 mg PO TID
C. Topical Mupirocin BID
D. Clindamycin 450 mg PO TID

7. Which antihistamine is a standard treatment of acute spontaneous urticaria?

A. Loratadine
B. Hydroxyzine
C. Prednisone
D. Ciclosporin

8. A patient with chronic spontaneous urticaria reports persistent symptoms despite

treatment with Cetirizine 10 mg tablet OD for the last 2 weeks. What should you do
next?

A. Add leukotriene antagonist to current medication

B. Add Prednisolone 50 mg per day for 3 days
C. Increase Cetirizine 10mg tablet to 3 times a day
D. Continue Cetirizine 10 mg tablet OD for another 2 weeks

9. What is the recommended timing of sputum collection for direct Ziehl-Nielsen

microscopy according to the 2016 CPG on TB?

A. Spot-spot, 1-hour apart

B. Spot-early morning
C. Spot-after 48 hours
D. Spot-after 72 hours

10. Which drug inhibits transcription by interfering with DNA-dependent RNA

polymerase?

A. Isoniazid
B. Rifampicin
C. Pyrazinamide
D. Ethambutol

11. What are the effective treatment regimen and duration for patients with TB
meningitis?

A. 2HRZE/4HR
B. 2HRZE/10HR
C. 2HRZES/1HRZE/5HRE
D. 2HRZES/1HRZE/9HRE

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12. A 34/M, was diagnosed and treated for Pott’s Disease and was declared cured 3
years ago. He presents with recurrence of low back pain. Further work up shows the
need for “re-treatment”. How will you treat him?

A. 2HRZE/4HR
B. 2HRZE/10HR
C. 2HRZES/1HRZE/5HRE
D. 2HRZES/1HRZE/9HRE

13. A 22/F, is a clinically diagnosed case of PTB. Her baseline and end of 2nd month direct
sputum smear microscopy (DSSM) results are negative. When should you request for
another sputum examination as part of monitoring treatment response?

A. No further sputum examination

B. End of 3rd month
C. End of 5th month
D. End of 6th month

14. Based on the Philippine Clinical Practice Guidelines on Community Acquired

Pneumonia in Immunocompetent Adults 2016 Updates, what is the drug of choice for
low risk pneumonia without comorbid illness?

A. Amoxicillin
B. Azithromycin
C. Cefuroxime
D. Sultamicillin

15. A 67/M, diabetic, presents with a 4-day history of cough productive of greenish
phlegm, fever, and back pain. PE: BP of 100/70, RR of 27/min, HR of 126/min, Temp of
38.5 C, CBG of 267 mg/dl, and crackles from mid-to-base at the right posterior
hemithorax. What is the patient’s pneumonia risk stratification?

A. Low risk
B. Moderate risk
C. High risk
D. Severe risk

16. Which drug is helpful for severe cases of amphetamine abuse?

A. Lidocaine
B. Cyproheptadine
C. Barbiturates
D. Pyridoxine

17. What is the most reliable prognosticator of poor outcome in poisoning or drug
withdrawal?

A. Core temperature
B. CNS manifestation
C. Cyanosis
D. Respiratory rate

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18. Which disease condition causes low level of Blood Urea Nitrogen?

A. Anabolic state
B. Gastro intestinal hemorrhage
C. Severe liver disease
D. Syndrome of Inappropriate Anti-Diuretic Hormone

19. What is the triceps skinfold in marasmus?

A. 8mm
B. 6-7mm
C. 4-5mm
D. <3mm

20. In specific nutrition support (SNS), what is the recommended percentage of

carbohydrate intake for protein energy malnutrition?

A. 40-50%
B. 30-39%
C. 21–29%
D. 10- 20%

21. A 48/F, known hypertensive, presents with 2-month history of productive cough
with scanty sputum. She intermittently took over-the counter decongestants to no avail.
Except for 5 lbs. weight loss during this period, chest x-ray and basic lab tests are all
normal. Which test will you request next?

A. Pulmonary function test

B. Sputum cytology
C. Chest ultrasound
D. Sputum AFB
22. Which condition will most likely present as diffuse alveolar lesions on chest x-ray?

A. Pulmonary infarction
B. Radiation pneumonitis
C. Hypersensitivity pneumonitis
D. Acute respiratory distress syndrome
23. A 62/F, presents with a 4-day history of fever, cough and right-sided pleuritic chest
pain. Chest x-ray shows right lower and middle lobe infiltrates with effusion. Which
pleural fluid result would indicate a complicated effusion that may require chest tube
thoracostomy?

A. pH >7.20
B. Glucose >60 mg/dL
C. (+) gram stain / culture
D. Protein 1 gm
24. Which procedure has replaced the lateral decubitus x-ray in the evaluation of
suspected pleural effusions and as a guide to thoracentesis?

A. Chest CT-scan
B. Chest ultrasound
C. Chest MRI
D. Thoracoscopy

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25. What size of the space between the lungs and chest wall is therapeutic thoracentesis
indicated?

A. 1-3 mm
B. 4 – 5 mm
C. 7- 9 mm
D. >10 mm
26. What is the standard test to detect and confirm diagnosis of bronchiectasis?

A. Chest MRI
B. Chest CT-scan
C. Chest x-ray
D. Chest ultrasound
27. How often should periodic contrasted chest CT-scan be done in patients with
resected non-small cell lung carcinoma?

A. Every 3 months
B. Every 6 months
C. Every 9 months
D. Once a year
28. A 45/M comes to ER because of an acute exacerbation of severe asthma attack. He
becomes agitated, confused and develop progressive respiratory distress and cyanosis.
What would be his expected ABG?

A. pH 7.45, pCO2 30mmHg, pO2 88mmHg

B. pH 7.28, pCO2 55mmHg, pO2 60mmHg
C. pH 7.40, pCO2 33mmHg, pO2 80mmHg
D. pH 7.35, pCO2 40mmHg, pO2 75mmHg
29. 62/M, diabetic, presents with voluminous watery diarrhea occurring for > 10
episodes accompanied by vomiting. He is clinically dry with brownish urine on foley
catheter. What is the expected urinary sediments?

A. RBC casts
B. WBC casts
C. Granular casts
D. Crystalluria

30. What is the most compatible Gram stain finding for gonococcal urethritis?

A. Gram +, extracellular, coccobacilli

B. Gram +, intracellular, diplococci
C. Gram -, extracellular, coccobacilli
D. Gram -, intracellular, diplococci

31. A 25/M consulted due to morning stiffness and pain from the neck down to the
lumbar area. An xray of the lumbo-sacral spine showed “body fusions”. What is the
most likely diagnosis?

A. Osteoarthritis
B. Ankylosing spondylitis
C. Rheumatoid Arthritis
D. Gouty Arthritis

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32. A patient who has been coughing for 3 weeks underwent work up for pulmonary
tuberculosis. The chest x-ray revealed an apical scar, the sputum AFB smear was
negative, and the sputum GenXpert showed MTB positve, Rif negative. Which TB
regimen should be given for this patient?

A. 9HR
B. 6HRZE
C. 2HR/4HRZE
D. No treatment is necessary

33. Which condition commonly occurs in women described as tickle or sensitivity in the
throat and is typically “dry” or at most productive of scanty amount of mucoid sputum?

A. Cough-variant asthma
B. Cough hypersensitivity syndrome
C. Chronic eosinophilic bronchitis
D. Gastroesophageal reflux disease
34. What is the consequence of alveolar hypoventilation syndrome regardless of cause?

A. Respiratory alkalosis
B. Compensatory decrease in serum bicarbonate
C. Hypoxemia
D. Primary erythrocytosis
35. A 28/M with a 3-day history of productive cough and fever is brought to ER due to
difficulty of breathing. PE: BP 100/70 mmHg; HR 108/min; RR 25/min. Chest: decreased
breath sound and dullness over the right mid-base lung fields. Chest x-ray: blunted right
costophrenic angle with shifting of radiodensity on right decubitus film. What is your
next appropriate diagnostic procedure?

A. Chest CT-scan
B. Bronchoscopy
C. Pleural tap
D. Fluoroscopy
36. What is the most common sign/symptom accompanying severe migraine attacks?

A. Photophobia
B. Lightheadedness
C. Vomiting
D. Nausea
37. Which feature readily distinguishes syncope from seizure?

A. Variable posture
B. Cyanosis and frothing of mouth
C. Immediate transition to unconsciousness
D. Facial pallor
38. A 25/M, person living with HIV, who was recently diagnosed with Kaposi’s Sarcoma
presents with numbness over the hands and feet. What is the most likely diagnosis?

A. Multiple mononeuropathy
B. Distal Symmetric Polyneuropathy
C. Progessive Polyradiculopathy
D. Demyelinating Polyradiculopathy

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39. A 52/F, presents with a unilateral, throbbing frontal headache of moderate in
intensity and aggravated by movement, associated with nausea and vomiting. The
headache is being felt repeatedly and lasting for almost the entire day. PE: normal.
What is the most likely diagnosis?

A. Tension Headache
B. Migraine Headache
C. Hypnic Headache
D. Cluster Headache

40. What is the leading cause of cancer-related death worldwide?

A. Prostate cancer
B. Breast cancer
C. Colon caner
D. Lung cancer

41. What would a chest x-ray finding of a 6-cm solitary nodule with spiculations at the
right upper lobe in a chronic smoker mean?

A. Pulmonary tuberculosis
B. Lung cancer
C. Pneumonia
D. Sarcoidosis

42. A 65/M presents with pallor, 20% weight loss in 6 months and hypochromic,
microcytic anemia. Which malignancy would you consider in this patient?

A. Lung CA
B. Colon CA
C. Gastric CA
D. Pancreatic CA

43. 50/M, known case of CKD secondary to hypertensive nephrosclerosis not on dialysis,
complains of dyspnea and body weakness maintained on ACEI and Spironolactone for
his CHF. 12L ECG shows loss of P wave and widened QRS complex. Serum K is 8.5mmol/l
;Na is 138mEq/L; creatinine is 2.5mg/dl. What is your immediate intervention?

A. Insulin
B. 50% Dextrose
C. Calcium gluconate
D. Bicarbonate

44. What condition causes metabolic alkalosis with concomitant extracellular fluid
volume expansion, hypertension, hypokalemia and high renin?

A. Estrogen therapy
B. Primary aldosteronism
C. Cushing’s syndrome
D. Liddle’s syndrome

45. What diagnostic test would differentiate Syndrome of Inappropriate Antidiuretic

hormone secretion from other causes of euvolemic hyponatremia?

A. UNa >20
B. UNa <20
C. Serum uric acid >4mg/dl
D. Serum uric acid <4mg/dl

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46. Which antibiotic can be used for the treatment of patients with aspiration
pneumonia?

A. Azithromycin
B. Cefuroxime
C. Gentamycin
D. Moxifloxacin

47. Which can cause tendon rupture and prolongation of QT interval?

A. Azalides
B. B-lactams
C. Cephalosporins
D. Fluoroquinolones

48. A 75/F, with severe CAP is admitted at the ICU with pleural effusion on the right
lung. CTT insertion is done revealing empyema. Which organism needs to be covered in
our empirical therapy pending sputum and/or blood culture results?

A. Hemophilus
B. Legionella
C. MRSA
D. Pseudomonas

49. A 50/M, with history of intermittent attacks of arthritis relieved by NSAIDs, consults
ER because of severe right knee pain and swelling for 2 days. PE shows swollen, effused
and erythematous right knee. CBC reveals mild anemia and decreased creatinine
clearance. What is the most appropriate drug to give for this patient?

A. Colchicine 0.5 mg/tab BID

B. Prednisone 30 mg single dose then taper on subsequent days
C. Celecoxib 400 mg as initial dose followed by 200 mg BID
D. Indomethacin 50mg QID

50. Lifestyle modification to control gout includes low purine diet and limit the intake of
meat to how much?

A. 2 - 4 ounces/day
B. 4 - 6 ounces/day
C. 6 - 8 ounces/day
D. 8 - 10 ounces/day

END OF EXAMINATION

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