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3. The patient was treated with oral steroids with resolution of lesions. The steroid was
discontinued. Three days later, the patient became febrile followed by
appearance of erythematous patches on trunk and extremities with pinpoint
pustules on the patches. What is your diagnosis?
A. Mycosis Fungoides
B. Drug reaction
C. Von Zumbusch
D. Folliculitis
5. Clinical clues to look for in patients with exfoliative dermatitis secondary to stasis
dermatitis:
A. Varicosities, edema,ulcers at the ankle
B. Persistence of islands of normal skin within diffusely involved areas
C. Prominent white dermographism
D. Onycholysis and pterygium of the nails
11. The mechanism of hypoxemia in patients with an increased carbon dioxide and a
normal alveolar to arterial oxygen gradient is:
a. hypoventilation
b. diffusion impairment
c. ventilation perfusion mismatch
d. shunt
12. According to the Philippine Clinical Practice Guidelines on CAP, the basis for the
diagnosis of pneumonia is established by:
a. when cough has been present for two weeks
b. clinical findings alone
c. radiologic diagnosis to confirm the diagnosis
d. by sputum G/S and C/S done routinely
13. In the Gina (Global Initiative Against Asthma) Guidelines the addition of a long
acting beta agonist as controller medication is recommended in which category:
a. mild intermittent
b. mild persistent
c. moderate persistent
d. status asthmaticus
17. Modality which has largely replaced bronchography for the diagnosis of
bronchiectasis:
a. PET (positron emission tomography)
b. fiberoptic bronchoscopy
c. HRCT (high-resolution computed tomography)
d. gallium Scan
20. The most common etiologic agent of pneumonia in HIV-infected patients with
CD4+ counts of <200/µL:
a. Mycobacterium avium-intracellulare
b. Cytomegalovirus
c. Pneumocystis carinii
d. Nocardia
21. The single useful measurement for thyroid function in a suspect hypothyroid
patient is:
A. T3
B. T4
C. TSH
D. Thyroglobulin
24. The first to rise up among the lipoproteins in diabetes mellitus is:
a. Total cholesterol
b. LDL
c. HDL
d. Triglycerides
26. The single-thyroid drug which can be safely use in pregnant women:
a. Neomercazole
b. Thiamazole
c. Propylthiouracil
d. Tapazole
30. The other term for Subacute thyroiditis are the following, EXCEPT:
a. Painless thyroiditis
b. Granulomatous thyroiditis
c. Giant cell thyroiditis
d. De Quervan’s thyroiditis
31. One of these cardiac anti-arrythmic drugs contains 37% iodine and can induce
thyrotoxicosis:
a. Flecainide
b. Verapamil
c. Amiodarone
d. Propranolol
32. Conns’ syndrome commonly present with the following signs and symptoms,
EXCEPT:
a. Hyperkalemia
b. Hypernatremia
c. Alkalosis
d. hypertension
33. The effort less appearance of gastric or esophageal contents in the mouth is
called:
a. Heartburn
b. Pyrosis
c. Vomiting
d. Regurgitation
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1356 Chap 251
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1358 Chap 251
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1371 Chap 252
36. A 40-year-old patient with a history of peptic ulcer surgery due to massive upper
GI bleeding came in because of lightheadedness, diaphoresis confusion 90 min
after eating. Your diagnosis is:
a. Dumping syndrome
b. Bile reflux gastritis
c. Afferent loop syndrome
d. Postvagomtomy diarrhea
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1374 Chap 252
37. A 39-year-old seaman showed you the following hepatitis serologic profile:
HbsAg (+), IgM anti-HAV (+), IgM anti-HBc (+), anti-HCV (-). Your diagnostic
interpretations are:
a. Acute Hep A superimposed on Chronic Hep B
b. Acute Hep A and B
c. Acute Hep A
d. Acute Hep B
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1470 Chap 266
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1494 Chap 269
39. A collection of tissue, fluid, debris, pancreatic enzymes and blood which develop
over a period of 1-4 weeks after the onset of acute pancreatitis is:
a. Phlegmon
b. Pseudocyst
c. Abscess
d. Pseudoaneurysm
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1525 Chap 274
40. A sudden and severe loss of vision in patient with acute pancreatitis is:
a. Diabetic retinopathy
b. Glaucoma
c. Purstcher’s retinopathy
d. Retinal detachment
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1356 Chap 274
41. The most consistently observed risk factor for development of pancreatic cancer
is:
a. Chronic alcoholism
b. Diabetes mellitus
c. Cigarette smoking
d. Acute pancreatitis
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1352 Chap 275
42. The following frequent signs and symptoms of pancreatic cancer, EXCEPT:
a. Abdominal pain
b. Weight loss
c. Jaundice
d. Splenomegaly
Harrison’s Principle of Internal Medicine Vol. 2 13 th Edition page 1532 Chap 275
43. A serum creatinine level starts to increase when the glomerular filtration rate is:
a. 75ml/min
b. 50ml/min
c. 25ml/min
d. 10mml/min
45. A source of endogenous toxin which can cause acute renal failure is:
a. Rhabdomyolysis
b. Sepsis
c. Radiocontrast agents
d. Antibiotics
46. The most common complication of end stage renal disease is:
a. Congestive health failure
b. Hypertension
c. Recurrent infections
d. Gastrointestinal bleeding
48. The major cause of death in end stage disease patients receiving dialysis is:
a. Bleeding
b. Infection
c. Uremia
d. Cardiovascular disease
For nos. 49 – 52: A 68-year-old female was admitted because of LBM. Her condition
started 3 days PTA as abdominal pain, followed by LBM characterized as watery, non-
bloody, and occurring 4-5 times per day. LBM became more persistent and profuse,
hence, the admission.
Her past history included mild hypertension of 2 years, which was treated
irregularly, and joint pains of 10 years.
On admission, vital signs were the following: BP = 90/60; HR = 100/min; RR =
24/min; T = 38.5 C. She was weak looking but conscious. He r skin and tongue were
dry. The heart had a gr 2/6 systolic aortic murmur. The abdomen was soft, tympanitic,
and slightly tender all over, with hyperactive bowel sounds.
Lab result revealed the following: CBC: Hb = 132g/l, WBC ct = 10.2, Seq. = 0.85,
Ly = 0.15. Urinalysis: pH = 5.0, SG = 1.030, protein = +, sugar = trace, pus cells = 1-
3/hpf, rbc = 5-10/hpf, hyaline cast = 5-10/hpf. FBS = 6.4 m mol/I; serum creatinine = 330
mmol/l; serum Na+ = 136 mmol/l; serum K+ = 3.4 mmol/l. Stool exam: pus cell = 5-
10/hpf; rbc = 3-5/hpf. ECG = sinus tachycardia.
51. If this is an uncomplicated acute renal failure, when would you expect the
kidneys to recover?
a. 1-2 weeks
b. 2-3 weeks
c. 3-4 weeks
d. 2-3 months
52. If this patient had chronic renal failure secondary to diabetic nephropathy when
would you expect end stage renal disease to set in?
a. 3-5 years
b. 5-10 years
c. 10-15 years
d. 15-20 years
56. The like hood that a daughter of a patient with severe hemophilia A will be a
carried of hemophilia is:
a. 0%
b. 25%
c. 50%
d. 100%
58. Which of the following hematopoietic growth factors is non-lineage specific and
would induce formation of progenitor cells.
a. Granulocyte colony stimulating factors
b. Macrophage colony stimulating factor
c. Granulocyte-macrophage colony stimulating factor
d. Erythropoietin
59. One of the following is true in patients with New York Heart Association functional
class IV:
a. Symptoms occur with ordinary activity
b. Asymptomatic at rest
c. Symptoms occur even at rest
d. None of the above
61. One or some of the following is/are true regarding jugular venous pulse (JVP),
EXCEPT:
a. The left internal jugular vein is the best to use in JVP measurement
b. Cannon a wave may be seen in complete heart block
c. It reflects phasic pressure changes in the left atrium
d. A and C
62. Prominent waves of the JVP waves are seen in the following, EXCEPT:
a. Severe mitral stenosis with atrial fibrillation
b. Severe tricuspid stenosis in sinus rhythm
c. Ventricular tachycardia
d. A and B only
65. The following are true regarding digitalis in heart failure, EXCEPT:
a. It is now obsolete since the discovery of ACE inhibitors which block
the RAA axis
b. It is particularly effective in patient with systolic heart failure by stimulating
myocardial contraction
c. It improves ventricular emptying by improving myocardial contractility
d. It has little or no value in heart failure patients in sinus rhythm and diastolic
dysfunction
67. The following are true regarding contractile process of the cardiac muscle,
EXCEPT:
a. During activation, the A band remains constant in length, whereas the I
band shortens and the Z lines move towards one another
b. The interactions between the actin and myosin is inhibited by the
tropomyosin during relaxed stage
c. Troponic I, accelerates cardiac contraction
d. A and B
69. Which of the following exposures is most likely to result in transmission of HIV to
an uninfected person?
a. One use of injected drugs with a needle previously used by an HIV
infected person
b. Once instance unprotected sexual intercourse with an HIV infected partner
c. being born to a woman with symptomatic HIV disease
d. sustaining a needle stick injury with a needle used to draw blood from a
patient with AIDS
70. An HIV man presents with Pneumocystic pneumonia, oral hairy leukoplakia, oral
candidiasis. Select the stage of HIV disease.
a. Acute retroviral syndrome
b. Early disease (CD4 count greater than 500/ul)
c. Intermediate disease (CD4 count 200 to 500/ul)
d. Late disease (CD4 count 50 to 200/ul)
Harrison’s Textbook of Internal Medicine, 15 th edition
71. A 26 year old female prostitute with recently diagnosed HIV infection has
odynophagia and vaginal discharge without fever. Select the most likely
pathogen.
a. Candida
b. Cytomegalovirus
c. Hepatitis C
d. Microsporidia
73. Which of the following statements is true about the bactericidal activity of
antibiotics?
a. B lactam antibiotics are bactericidal in vivo at all concentrations
b. Only bactericidal antibiotics are effective in sterilizing abscesses
c. Relapse rates of endocarditis are higher when bacteriostatic
antibiotics are used in place of bactericidal drugs
d. The MIC of the antibiotic predicts its bactericidal activity
76. All of the following statements are true about human papilloma virus, EXCEPT:
a. An abnormal Pap test requires consideration of human papilloma virus
b. Women with some serotypes of human papilloma virus should be routinely
screened for cervical neoplasia
c. Cervical neoplasia in a 23 year old woman suggest HIV disease
d. Interferon alfa eliminates human papilloma infection
78. Rheumatic heart disease. Select the organism most likely to cause endocarditis.
a. A. aureus
b. S. bovis
c. E.faecalis
d. Viridans streptococci
79. A 63 year old man with diabetes and peripheral vascular disease. Select the
most appropriate prophylaxis.
a. Rabies vaccine
b. Pneumococcal vaccine
c. Hepatitis B vaccine
d. Meningococcal vaccine
80. Approximately one third of patient infected with this virus may respond to
treatment with interferon alfa.
a. Norwalk virus
b. Rotavirus
c. Human herpesvirus 6
d. Hepatitis C virus
81. The following are risk factor for the increasing prevalence of drug resistant TB,
EXCEPT:
a. HIV-1 infection
b. Addition of a single new drug to a failing anti-TB regimen
c. Failure to complete treatment of active TB
d. Increased age
92. Which component of the neurologic exam would be most important in the diagnosis
of this case
A. mental status exam
B. cranial nerve exam
C. motor exam
D. sensory exam
93. On further exam the patient was noted to be rigid with tremors and bradykinesia.
What is your consideration?
A. Cortical dementia
B. Subcortical dementia
C. Binswanger’s disease
D. Normal pressure hydrocephalus
95. A 54 year old alcoholic was brought to the ER confused and disoriented with
fluctuating consciousness and perception. What is your diagnosis?
A. Alzheimer’s disease
B. Alcohol intoxication
C. Alcohol delirium
D. none of the above
96. A few months later the patient mentioned above came back because of memory
impairment and confabulation. What is your diagnosis?
A. Alzheimer’s disease
B. Korsakoff’s syndrome
C. Wernicke’s encephalopathy
D. None of the above
99. A 50 year old man was brought to the ER because of worsening confusion and
distractibility. The wife can’t pinpoint the exact onset of symptoms but remembers her
husband to be acting different some 2 months ago. Lately the patient has been
complaining of headache.What’s the least likely possibility?
A. Dementia
B. Delirium
C. Mood disorder
D. Primary psychotic disorder
100. On further exam the patient has lapses in memory and mild right facial weakness.
What diagnostic tool will you employ?
A. lumbar puncture
B. electroencephalograph
C. Ct scan of the head with contrast
D. None of the above
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