IM

I. CT scan
II. bone scan
1. Secondary hypertension maybe due to: III. PET scan
I. Renal artery stenosis Answer: all of the above
II. Cushing syndrome
III.Pheochromocytoma 7. A 62 yr old diabetic was admitted because of fever with
A. I, II, III - ANS right flank pain and chills. She also experienced dysuria and
B. I & II loss of appetite...(+) right CVA tenderness. CBC Hgb 140 Hct
C. I & III 0.40 WBC 20000 with neutrophilia. UA Pus cells 40-50 hpf
D. II& III bacteria +4. Urine gram stain showed negative rods. Serum
Crea 0.8. In the ward, IV Ciprofloxacin was administered. 3
** Secondary hypertension is high blood pressure caused by days later, she is still febrile and has persistent R flank pain.
another condition or disease. Conditions that may include Urine CS was still unavailable. Which ancillart procedure is
kidney disease, adrenal disease, thyroid problems and best to this time?
obstructive sleep apnea.
A. CT scan with contrast of the abdomen
2. Environmental toxins that may cause hepatitis is B. Repeat urine cs
A. Alcohol ** C. Repeat serum crea
B. Isoniazid D. Ultrasound of KUB
C. Cytomegalovirus
D. Vinyl chloride* Answer: A

* Vinyl chloride monomer is a known cause of angiosarcoma CT scan of the abdomen is the investigation of choice for the
of the liver. It also has other toxic effects on the liver, and it diagnosis, treatment options, and prognostication of EPN. A
has recently been suggested that exposure to vinyl chloride diabetic patient with fever, renal angle pain, and pyuria
also causes hepatocellular CA. * Heavy drinking over many attending emergency should be subjected to immediate CT
years can lead to alcoholic hepatitis — inflammation in the scan to rule out EPN.
liver due to alcohol, which can lead to liver failure.
8. Opportunistic pathogen causing infectious diarrhea among
3. Patients with treatment- resistant depression are treated AIDS pt. are the ff except:
with which of the following?
I. Electroconvulsive therapy A. Blastocystis hominis - answer
II. Transcranial magnetic stimulation B. G. Lamblia
III.Vagus nerve stimulation C. CMV
A. II, III D. Mycobacterium aerium
B. I,II
C. I,III Ratio: lives in person’s digestive tract w/o causing harm
D. I,II,III- ANS
** also includes talk therapy and experimental techniques. 9 .Benzodiazepines are useful drugs because of the following
properties
4. In the examination of the abdomen the order of procedure 1. Sedative
is 2. Skeletal muscle relaxant
A. auscultation, palpation, inspection, percussion 3. Anti epileptic
B. percussion, palpation, inspection, auscultation Answer : ALL
C. inspection, auscultation, palpation, percussion - ANS Uses of Benzodiazepines (AC-DIAZEPAM)mnemonic
D. inspection, palpation, auscultation, percussion Alcohol withdrawal
Concious sedation
Diagnostics
5. acute myeloid leukemia patients are prone to -except Insomia
a. hypernatremia and hypokalemia- (answer) hyponatremia Anti convulsabt
b. stroke due to thrombosis -50 fold increased risk Pre anesthetic
c. bleeding due to lack of platelets Anxiolytic
d. early satiety die to splenomegaly Muscle relaxant

6. The most useful tests uncover tumors not detected by
other screening modalities are 10. Asterixis when present in a patient is suggestive of:


I.Encephalopathy B. Transurethral resection of prostate
II.Drug Intoxication C. Alpha adrenergic blocker
III.CNS Infection D. Radiation therapy

A.I,II,III Answer: B. Transurethral resection of prostate
B.I,II Treatment of benign prostate
C.II,III Surgical management is indicated for recurrent UTI, bladder
D.I stones, hydronephrosus, urinary retention/severe symptoms,
renal insufficiency secondary to BPH, medical therapy failure.
Answer: B 1. Transurethral Resection of the Prostate (TURP) - possible
Ratio: Asterixis is an uncommon but significant sign in central short term complication: TURP syndrome (absorption of
nervous system (CNS) disorders. Bilateral asterixis is usually hypotonic irrigation fluid leading to hyponatremia), blood
due to metabolic encephalopathies. several drugs can cause loss, urinary retention, infection.
bilateral asterixis and include phenytoin, valproate, Source: Surgery Topnotch handout - Urology
carbamazepine, metoclopramide, and barbiturates. Some
antipsychotics such as lithium and clozapine and antibiotics 14. Hepatitis A is mostly transmitted via _______
such as ceftazidime have been rarely implicated. Lithium can A. sexual
cause asterixis at both the therapeutic and toxic plasma B. percutaneous
levels. C. fecal-oral
D. perinatal
Reference: NCBI journal
Ratio: Hepatitis A- this agent is transmitted almost exclusively
11. In a previously healthy young male adult, in which of the by the fecal-oral route. Person-to-person spread of HAV is
following conditions will azotemia result? enhanced by poor personal hygiene and overcrowding.
th
A. Non obstructing nephrolithiasis on both kidneys Source: Harrison’s 20 edition page 2353
B. Unilateral renal staghorn calculus
C. Urolithiasis at the distal right ureter 15. In acute pulmonary edema which of the following do you
D. Unilateral ureterolithiasis with a solitary kidney admister?
I. Oxygen inhalation
Answer: D. II. IV furosemide
Obstruction of urine flow in both ureters, the bladder, or III. IV morphine
urethra or obstruction of a solitary kidney may cause post-
renal AKI/Azotemia. Answer: I, II, III
A. Non-obstructing - no azotemia is expected. Ratio: treatments of Pulmonary Edema: Support of
B and C: Unilateral obstruction rarely cause azotemia since oxygenayion and ventilation, reduction of overload (Diuretics
the other kidney is functioning. and Morphine).
th
D. Obstruction in patients with solitary kidney (Single Kidney) Source: Harrison’s 20 edition page 2057
is possible kasi walang other kidney to compensate for the
excretion of nitrogen containing compounds.
16. ST elevation on ECG maybe associated with which of the
12. The major cause of lung cancer is ___. following disease?
A. Contraceptive pill use I. Acute myocardial infarction
B. TB scars II. Pericardtis
C. Tobacco/cigarette use III. LV aneurysm
D. Genetic mutations
Answer: I, II, III
Answer: C. Tobacco/cigarette use Ratio: ST elevation on ECG may be seen on the following:
Smoking is the number one cause of lung cancer. It causes Myocardial infarction , Prinzmetal's angina, Acute
about 90 percent of lung cancer cases. Tobacco smoke pericarditis, Left ventricular aneurysm, Blunt trauma to the
contains many chemicals that are known to cause lung cancer chest resulting in a cardiac contusion, Hyperkalemia, Acute
(American Lung Association) myocarditis, Pulmonary embolism, Brugada syndrome,
Hypothermia and Subarachnoid Hemorrhage.
13. Symptomatic patients like those who have difficulty to
urinate or recurrent urinary tract infection, diagnosed to have
benign prostate hyperplasia are best treated with ___. 17. A 25v year old tricycle driver was given co-amoxiclav after
A. Transurethral microwave therapy undergoing incision and drainage of a right foot abscess


secondary to staphylococcus aureus complicating a th
(Harrison’s principles of internal medicine 16 ed p1383)
punctured wound. He took the medicines for one week
however two days later, he developed fever and lower 20. Bleeding/thrombosed haemorrhoids are treated with
extremities and trunk; right wound was dry without which of the following?
erythema. CBC showed Hgb 12.5, HCt 0.35 WBC 120000, I. Rubber band ligation
segmenters 0.06, lymphocytes 0.03 and eosinophils 0.20, II. Injected sclerotherapy
platelet count 120000. Urinalysis: pH of 6.5, protein (+), III. Hemorrhoidectomy
glucose (-); RBC 1-5/hpf, WBC: 30-40/hpf, (+) WBC cast, few
epithelial cells; bacteria: few; creatinine: 2.5 mg/dL; urine A. I, II
culture was negative. Which is most likely the diagnosis? B. I, II, III
A. Sepsis induced acute kidney injury C. I, III
B. Acute pyelonephritis D. II, III
C. Drug Induced interstitial nephritis
th
D. Post infectious glomerulonephritis **Harrison’s Principles of Internal Medicine 19 ed p 1977

Ratio: Drug-induced acute interstitial nephritis (DI-AIN) is a 21. An 88 year old male was brought to the ER due to inability
common cause of AKI, affecting about 20% of patients with to pass out urine for 24hours. PE: hypogastric mass, firm,
unexplained AKI, and leads to CKD and ESRD (1)any drug can slightly tender and dullness to percussion. Which of the
potentially cause DI-AIN, antibiotics, non-steroidal anti- following management should be performed first?
inflammatory drugs, and proton pump inhibitors, are the A. Emergency dialysis
most frequent offenders B. IV fluid administration
(2) Diagnosis of DI-AIN is obvious when the classic triad of C. Administration of IV diuretic
rash, fever, and eosinophilia occur within a few days of the D. Insertion of urinary catheter
initiation of a culprit drug. However, these findings occur in
<10% of patients. 22. A newly married woman came from honeymoon
Urinary abnormalities such as eosinophiluria, pyuria, and developed urinary frequency, urgency and dysuria. Urine was
white blood cell (WBC) casts, considered typical of DI-AIN. It grossly bloody. There was no abdominal pain nor vaginal
often presents with an unexplained rise in serum creatinine discharge. Urinalysis: pH 6; sugar (-); protein trace; RBC 10-
level. 20/hpf, all isomorphic; WBC 50-70/hpf; squamous cells few;
bacteria many. Which first line empirical therapy will you
prescribe?
18. Defect in hemoglobin synthesis usually result from: A. Cotrimoxazole forte, 1 tab every 12 hours for 3 days
I. insufficient iron supply B. Cefuroxime 500mg, 1 tab every 12 hours for 7 days
II. decreased globin production C. Nitrofurantoin 100mg, 1 tab every 6 hours for 3
III. Idiopathic days
D. Amoxicillin 500mg, 1 tab every 8 hours for 7 days
Answer: I, II
th
Ratio: Defect in hemoglobin synthesis: reduced iron **Harrison’s Principles of Internal Medicine 19 ed p 866
availability, lead poisoning, reduced heme synthesis, or
reduced globin production. 23. Mar, 45, complains of creeping dysesthesias on his calves
and feet with an irresistible urge to move his limbs especially
19. In condition like asymptomatic bacteriuria, which urologic at night. What do you think is he suffering from?
procedure warrants antimicrobial prophylaxis? A. Iron deficiency anemia
A. Changing long term urethral catheter B. Restless leg syndrome
B. Urodynamic studies C. Parkinson’s disease
C. Transurethral resection of prostate-for BPH D. Periodic limb movement of sleep
D. Cystoscopy
→ Patients with restless leg syndrome (RLS) report an
Routine antimicrobial prophylaxis is recommended for most irresistible urge to move the legs. Many patients report a
patients with congenital heart disease whether operated on creepy-crawly or unpleasant deep ache within the thighs or
or not. Antibiotic prophylaxis is not uniformly effective. calves, and those with more severe RLS may have discomfort
in the arms as well. For most patients with RLS, these
Nonetheless, it is recommended for all dental procedures,
dysesthesias and restlessness are much worse in the evening
gastrointestinal and genitourinary surgery, and diagnostic and first half of the night.
procedures such as proctosigmoidoscopy and cystoscopy.
th
**Harrison’s Principles of Internal Medicine 19 ed p 192


24. gallstone lodged in the common bile duct is known as__ 28.Medical management of subarachnoid hemorrhage:

a. choledocholithiasis - answer Choledocholithiasis (also
I. Monitor serum electrolytes and osmolarity
called bile duct stones or gallstones in the bile duct) is the II. Administration of anti convulsants
presence of a gallstone in the common bile duct. III. Control of blood pressure

B cholangitis a. I, II, III
b. I, III
C cholecystolithiasis c. I, II
D. cholecystitis d. II, III

Cholangitis is an inflammation of the bile duct system. 29.Treatment for patients with advanced aggressive
lymphoma includes:
Cholecystolithiasis refers to the presence of stones in the

gallbladder. I. CHOP combination chemotherapy
Cholecystitis (ko-luh-sis-TIE-tis) is inflammation of the II. CHOP + radiation therapy
gallbladder. III. CHOP + rituximab therapy

25.In a normal sized heart apex is palpated at________ a. III
b. I, II
a. 6th L ics MCL c. I
b. 4th LCIS anterior axillary line d. I, II, III
c. 5th Left ICS MCL
d. 5th LCIS anterior axillary line
30. Chest x-ray is a very useful and informative procedure in
diagnosis of diseases like:
26.Patsy believes in herself too much and boasts of her I. alveolar or interstitial
achievements all the time. She thinks she is only qualified II. hilar and mediastinal
member of the society who can do work well and often time III. pneumothorax or effusion
insults and demean her colleagues. She presents herself as A. II, III
the most capable to do a job. Which personality disorder C. I, II
does she have? Β. Ι, ΙΙ, ΙΙΙ
D. I, III
a. Borderline (wide mood swings and can feel a great
sense of instability and insecurity) Answer: D
b. Narcissism (inflated sense of their own importance,
a deep need for excessive attention and Rationale:
admiration, troubled relationships, and a lack of II. On a chest x-ray, the hilar region reveals a shadow which
empathy for others) - Ans consists of the combination of lymph nodes, the pulmonary
Histrionic (self-esteem depends on the approval of others and arteries, and the pulmonary veins. Due to the overlap of these
does not arise from a true feeling of self-worth.) structures, it can sometimes be difficult to detect enlargement
Anti-social (long-term pattern of manipulating, exploiting, or of these lymph nodes or the presence of a mass in this region.
violating the rights of others without any remorse) This is one of the reasons why ordinary chest xray can miss a
lung cancer.

27.Splenomegaly is associated with the following 31. Earl, 38, hypertensive 30, hypertensive and
hyperlipidemic on medications was recently
I. Myeloproliferative syndrome observed by friends to be depressed. He used to be a jolly,
II. Hogkin’s lymphoma gregarious of party" guy. His depression may have been due
III. Metastatic tumor like melanoma to which medicine?
A. indapamide
a. II, III C. irbesartan
b. I, II B. propranolol
c. I, II, III D. ramipril
d. I, III
Answer: D


Side effects: signs of depression (e.g., poor concentration,
changes in weight, changes in sleep, decreased interest in
activities, thoughts of suicide)

32. When used for a longtime, which analgesic has been
shown to cause
urologic malignancy?
A. Mefenamic acid
C. Colecoxib
B. Paracetamol
D. Phenacetin

Answer: D
Adverse effects:
Methaemoglobinaemia, sulfhaemoglobinaemia and
haemolytic anaemia.
Potentially Fatal: Renal papillary necrosis and transitional-cell
cancer of the renal pelvis (prolonged use).

33. Which do you prescribe a 90 year old patient with CKD
stage 3
complaining of knee joint pains?
A. Tramadol-may cause dizziness and reduce seizure
threshold
B. Ibuprofen *
C. Mefenamic acid

-Mefenamic acid can further deteriorate renal function in
patients with underlying renal disease
D. Diclofenac sodium 35. Characteristics of rheumatoid arthritis:
-can result in progressive kidney damage
I. Prevalence increases with age
Answer:B II. Women are affected three times more than
Ibuprofen is metabolized in the liver to inactive compounds. It men
does not accumulate in renal insufficiency, and two of the III. Joint deformities develop after persistent
inactive compounds are dialyzable. It is considered a safe inflammation
option for the treatment of pain in patients with renal
insufficiency or dialysis. a. I & II c. I, II, III
b. I d. II & III
34. Predisposing Factors of developing cholelithiasis is/are
________________? th
(Harrison’s 19 p. 2218-2220)
• The incidence of rheumatic diseases rises with age,
I. Genetic such that 58% of those >65 years will have joint
II. Type IV hyperlipidemia complaints
III. Obesity • Diagnostic clustering is also evident when sex and
race are considered.
a. II, III c. III o Gout, spondyloarthritis, and ankylosing
b. I, II d. I, II, III spondylitis are more common
o RA, fibromyalgia, and lupus are more
frequent in women.
• RA and OA Joint deformity usually indicates a long-
standing or aggressive pathologic process.

36. Which of the following may prevent anal condylomas?

a. Application of liquid nitrogen
b. Intralesional interferon alpha


c. Vaccination with HPV vaccines
d. Application of podophyllotoxin

• Vaccines effective in preventing HPV infection and
HPV-associated disease represent a major
th
development in the last decade (Harrison’s 19 p.
1199)
o Vaccine Types
§ Gardasil (HPV types 6, 11, 16, 18)
§ Cervarix (HPV types 16, 18)
o Development of anal CA is associated with • it should be appreciated that the vast majority of
human papillomavirus (HPV), sexually such patients with early stages of CKD will succumb
transmitted, may lead to anal warts to the cardiovascular and cerebrovascular
(condyloma acuminata) (Harrison’s 19 p.
th consequences of the vascular disease before they
1198) can progress to the most advanced stages of CKD
th
o HPV infects the female vulva, vagina, and (Harrison’s 19 p. 1813)
cervix and the male urethra, penis, and • eGFR is 25mL/min based from the table she is CKD
scrotum. Perianal, anal, and oropharyngeal Stage IV which has poor outcome
infections occur in both genders. Genital
warts are caused primarily by HPV-6 or
th
HPV-11 (Harrison’s 19 p. 1198) 38. Acute precipitating factors in heart failure include:
• For anal or perianal lesions, cryotherapy or surgical
removal is safest and most effective. (Harrison’s 19
th I. Coronary artery disease
p. 1201) II. Non compliance to medications
• Recombinant IFN-α is used for intralesional III. Excessive sodium intake
treatment of genital warts, including perianal lesions
as it causes clearance of infected cells by immune- a. I & II c. I & III
boosting effects. IFN should not be used to treat b. I d. I, II, III
th
vaginal, cervical, or anal lesions. (Harrison’s 19 p.
1201) • All are precipitating factors in Heart failure
• Podophyllotoxin (0.05% solution or gel and 0.15% • Congestive Heart Failure (CHF) and new-onset
cream) induces necrosis of genital wart tissue that cardiomyopathy of uncertain cause are suspected to
th
heals within a few days (Harrison’s 19 p. 1201) be primarily due to coronary artery disease
th
(Harrison’s 19 p. 1460)
• Non compliance to any medications will surely make
37. An 87 year old patient was recently diagnosed with CKD disease progress even faster
secondary to hypertensive nephrosclerosis. Estimated GFR • If the cardiac disorder is more severe, sodium and
was 25mL/min. Which is TRUE for this patient? water retention continue, and the increment in blood
volume accumulates in the venous circulation, raising
th
a. The risk of having end stage renal disease is greater venous pressure and causing edema (Harrison’s 19
than her risk of dying p. 252) as one of the symptoms of heart failure. In
b. If she starts hemodialysis, median life expectancy is symptomatic patients, some improvement usually
5 years occurs with restriction of sodium intake and small
th
c. She is more likely to die than progress to end stage doses of oral diuretics (Harrison’s 19 p. 1541)
renal disease
d. Her eGFR level is associated with good outcome
39. Treatment for patients with prostate hyperplasia but
asymptomatic will need ___________.

A. Surgical extirpation of prostate

B. Administration of alpha 1 adrenergic blocker
C. No treatment but watchful waiting
D. Transurethral microwave thermotherapy


D. Lumbar puncture

* MRI is usually the preferred test to diagnose
tumors of the spinal cord and surrounding
tissues. A contrast agent that helps highlight
certain tissues and structures may be injected
into a vein in your hand or forearm during the
test

42. If the result tells you there is a mass lesion present on the
cervical spine area, which test do you request for?

A. Excision of the mass with biopsy

B. CSF analysis
C. CT guided biopsy of the mass
D. PET scan

40. Which of the following can cause post-renal *Today, biopsy of spinal lesions is best
azotemia? performed under computed tomography (CT)
fluoroscopic guidance. Indications for imaging-
A. Leptospirosis
guided biopsy include confirming metastasis in a
B. Anaphylactic shock
patient with a known primary tumour,
C. Urethral stenosis determining the nature of a solitary bone lesion,
D. Aminoglycoside exposure excluding malignancy in vertebral body
compression, and investigating for infection.
* A. Leptospirosis - renal azotemia
Among the various issues to be considered are
B. Anaphylactic shock -prerenal azotemia
site of lesion, location of adjacent vital
D. Aminoglycoside - renal azotemia
structures, approach, and type and size of
(intrinsic) needle.

43. Final results of all work-ups show Potts disease. What will
you prescribe?
A. Quadruple anti-tb therapy
B. Streptomycin and fluoroquinolone
C. Radiation therapy
D.Surgical removal of the mass

Situation: Bee boy a 20 year old was absent from class due to
exudative tonsillitis and fever. Six months later, he
Situation 1- JV consulted your clinic because of severe nuchal complained of migratory polyarthritis, choreic movements.
pain. PE was normal. You requested for a cervical spine x-ray 44. Which of the following test will you request to support
which showed muscle spasm. You prescribed him medicines impression?
and advise to return after a week. A. CBC
B. ESR
41. Two weeks later, JV tells you he has not achieved C. RA factor
symptom relief. The pain has even spread to his shoulder and D. Anti streptolysin O
chest. Physical exam findings are normal except for shoulder An attempt should be made to recover the organism from a
limitation of movement due to pain. Which procedure will throat culture, although group A streptococci can be
you next request for? recovered from the upper res- piratory tract of only 25 to 40%
of patients at the time the diagnosis is made. If a rapid
A. EMG-NCV antigen detection test is used but is negative, a confirmatory
B. Cranial CT Scan throat culture must be performed. It is helpful to obtain two
C. MRI of the spines or three cultures from the throat at the time the diagnosis is


sus- pected, but before initiating antibiotic therapy, in order B. Serum amylase and lipase (used as markers for
to confirm the presence of the organism. inflammation)
At least 80% of patients with ARF have an elevated anti- C. CT scan of the abdomen (CT is less sensitive than Utz for
strepto- lysin O titer at presentation. If one employs two diagnosis of Acute cholecystitis)
additional strepto- coccal antibody tests such as the anti- p. Gastroscopy (EGD is standard treatment for acute
DNAse B or anti-hyaluronidase test, the percentage of cholecystitis)
patients who show evidence of a preceding group A
streptococcal infection will rise to 95%. 49. While waiting to be admitted which treatment will you
th
(Harrisons principle of IM 16 ed) initiate at the ER?
A. Anticholinergic (predisposes to gallbladder CA due to
45. Examining your patient your findings are; normal vital reduced gallbladder motility)
signs and JVP; 5 cm , 45” angle ,right ventricular heave, B. Proton pump inhibitor (increases risk of biliary tract
opening snap and accentuated S1 on auscultation, diastolic infection)
murmur. Your most likely diagnosis is- C. Oral antibiotic (nothing oral is given)
A. tricuspid stenosis D. Parenteral antibiotic (initiated to treat possible infection)
B.Pulmonary regurgitation (ANSWER)
C. Mitral stenosis
D. Aortic insufficiency Situation 4- A 25 year old mason was rushed to the
Emergency room due to crush injury from a fallen cemented
46. Chemoprophylactic treatment of RHD in Bee Boy’s case wall. There were hematomas on his trunk, buttocks and
includes- extremities. Serum creatinine was 9 (0.6-1.1) mg/dL
A. Ciprofloxacin
B. Doxycycline 50. If the fractional excretion of sodium (FENa) is more than
C. Benzathine Penicillin 1% the diagnosis is most likely
D.CLoxacillin A. post renal acute kidney injury ( >4%)
B. Intrinsic acute kidney injury (>1%) (ANSWER)
Recommendations of the American Heart Association and of C. pre-renal acute kidney injury (<1%)
the World Health Organization are for intramuscular injection D. chronic kidney disease (Not used in CKD patients)
of 1.2 million units of benzathine penicillin G every 4 weeks or
for oral penicillin V (250 mg twice daily) or oral sulfadiazine 51. An ECG done showed tall peaked T waves. Which of the
(1.0 g daily). following do you need to deternine?
th
(Harrisons principle of IM 16 ed) A. Calcium (hypercalcemia corresponds to diminished Twave
Situation: amplitude)
Teddy Ver, 33 yrs old BMI of 30, consults you due to B. Sodium (inc/dec does not have an effect on ECG)
epigastric painradiation to the back following a meal of C. Phosphorus (rarely considered for arrhythmia)
lechon and kare-kare. He has been experiencing abdominal D. Potassium (Hyperkalemia is a common cause of tall T
fullness sand discomfort with burping more often lately. PE : waves) (ANSWER)
normal VS, anicteric sclerae, +murphys sign, CBC: leukocytosis
with neutrophilia. UA normal. 52. He required dialysis but eventually his urine output and
creatinine go back to normal. He went home well without
47. Which diagnosis do you consider Teddy Ver has? being subjected to hemodialysis. What do you advice the
A. Calculous cholecystitis patient before discharge?
B. PUD a. he should regularly consult to the nephro because he has
C. Acute appendicitis already CKD
D. Gastroesophageal Reflux.
Severe right upper quadrant tenderness with respiratory b. he does not need follow up because he has fully recovered
arrest on in- spiration (Murphy’s sign) suggests cholecystitis
c. he has the need to have creation of permanent vascular
or, occasionally, ascending cholangitis. Ascites in the presence
of jaundice suggests either cirrhosis or malignancy with access for dialysis now
peritoneal spread. d. he would need renal folllow up since he is at risk of

progressive CKD in the future
(Harrison principle of IM pg 241)
situation 5: mr. D. Lim, 60, chief executive officer consults
48. To make a definitive diagnosis which procedure will you you because of nuchal pain and generalized headache. Bp for
do first? 3 consecutive dauys is 170/100.
A. Ultrasound of liver, gall bladder, pancreas (ANSWER)


th
53. on PE of CVS: dynamic precordium, apex 6 LICS 1 cm D. Bone densitometry
from MCL, gr 1/6 sytolic blow murmur at aortic area
58. Management of miss jarilyn osteoporosis includes the
a. LVH
following except
b. RVH A. Risk factor reduction
B. Fall prevention strategies
c. right atrial enlargement C. Institution of oral calcium and vitamin D
D. Administration of contraceptive pill –
d. left atrial enlargement
Progestin only pills and injections have
54. diagnostics for cardiomegaly mixed results in the research
In terms of BMD and fracture risk,
I. chest X ray and the World Health
II. ECG Organization states the progestin only
birth control options are safe
III. 2D echo for long term use when it comes to
BMD and fracture risk in women.
a. I, II, III

Situation 7 – In a patient; diagnosed with systemic lupus
erythematosus with albuminuria and bipedal edema, you
55. to prevent end organ damage what medicine would you discussed the possibility of renal biopsy
prescribe?
a. anti-arrythmic 59. Renal biopsy is important because ___
I. it determines activity index -Renal biopsy allows specimens
b. anti platelet aggregation to be classified according to the current International Society
of Nephrology/Renal Pathology Society (ISN/RPS)
c. anti- anginal
classification and to define activity and chronicity indexes for
d. anti hypertensive tubular and vascular changes
II. it determine prognosis - renal biopsy in determining
--hypertensive emergencies encompass a spectrum of clinical patients’ prognosis is unknown.
presentations in which uncontrolled blood pressures lead to III. It is useful in staging the disease
progressive or impending end organ damage. A. I, II, III
B. II , III
C. I, II
situation 6 – janilyn, 30 asthmatic uncontrolled by LABA and D. I, III
SABA, has been tajing corticosteroids for nearly a year. She
started experiencing low back pains which attributed to her 60. As the attending physician, what procedure will you
weight gain and abdominal pain. request the pathologist to do to confirm the presence of
lupus erythematosus?
56. You wanted to rule out spinal fracture based on the given
I. Light microscopy
history which test will you require for?
II. Immunofluorescence
a. ct scan of cervicothoracic spine II. Electron Microscopy

b. x ray of thoracolumbar spine – lower back pain A. I, II, III
B. I
c. PET SCAN
C. I, II
d. bone densinometry D. II, III
biopsy should be examined by light microscopy,
immunofluorescence and, if possible, electron
57. to support your impression of osteoporosis, which test
microscopy. Furthermore, vascular and interstitial lesions
will you order to be done?
should be described and data on activity and chronicity
A. Total bone scan
should be quantified (but activity and chronicity indices
B. Serum Vitamin D
are not obligatory).
C. Serum Calcium




61. goals of therapy in an SLE patient include the following:
I to control acute, severe flares
II to develop maintenance strategies
III to suppress symptoms to an acceptable level
A. I,II,III ß answer
B. II & III
C. I
D. I & II

63. which is now considered the primary diagnostic imaging
test for pulmonary embolism?
rd
A. transesophageal echocardiography – 3 if Contraindicated
Situation 8 - a patient, 35 years old, multigravid presents to sa CT with IV contrast
you with tachypnea, sudden onset of chest pain, dyspnea and B. chest xray with air bronchiogram ?
st
cough. PE showed 30/min, low grade fever, neck vein C. chest CT with IV contrast – 1 line
nd
distention and loud P2; multiple prominent varicose veins on D. ventilation perfusion lung scan – 2 line
both LE
Chest CT ~ CT of the chest with intravenous contrast is the
62. which laboratory procedure will you request for to clinch principal imaging test for the diagnosis of PE
your diagnosis of pulmonary embolism? Lung scanning ~ Lung scanning has become a secondline
A. serum Troponin diagnostic test for PE, used mostly for patients who cannot
B. D dimer - answer tolerate intravenous contrast. The diagnosis of PE is very
C 12-Lead ECG unlikely in patients with normal and nearly normal scans and
D. Brain Natriuretic Peptide is about 90% certain in patients with high-probability scans
Echocardiography ~ Echocardiography is not a reliable
diagnostic imaging tool for acute PE because most patients
with PE have normal echocardiograms. However,
echocardiography is a very useful diagnostic tool for
detecting conditions that may mimic PE, such as acute
myocardial infarction, pericardial tamponade, and aortic
dissection. Transthoracic echocardiography rarely images
thrombus directly. The best-known indirect sign of PE on
transthoracic echocardiography is McConnell’s sign:
hypokinesis of the RV free wall with normal or hyperkinetic
motion of the RV apex. One should consider transesophageal
echocardiography when CT scanning facilities are not
available or when a patient has renal failure or severe
contrast allergy that precludes administration of contrast
despite premedication with
high-dose steroids. This imaging modality can identify saddle,
right main, or left main PE.


64. With the diagnosis of pulmonary embolism from deep
vein thrombosis, managment include the following:
I. heparin with transition to warfarin
II.heparin with transition to oral anticoagulant
III. oral anticoagulation with RIVAROXABAN without heparin


A. I, II, III ß answer inhibitors (ACE inhibitors) and angiotensin receptor blockers
B. I, II (ARBs).
C. I, III
D. II, III 67. Which renal diagnostic procedure would MOST likely
provide a definitive diagnosis?
ANTICOAGULATION
Effective anticoagulation is the foundation for successful a) Duplex scan
treatment b) Renal ultrasound
of DVT and PE. There are three options: c) Biopsy
(1) the conventional strategy of parenteral therapy “bridged” d) CT scan
to warfarin,
(2) parenteral therapy “bridged” to a novel oral anticoagulant Kidney biopsy is usually needed to diagnose the specific
such as dabigatran (a direct thrombin inhibitor) or edoxaban underlying disease causing the nephrotic syndrome and to
(an anti-Xa agent), or determine the best treatment.
(3) oral anticoagulation with rivaroxaban or apixaban (both
are anti-Xa agents) with a loading dose followed by a Situation 10 – Blanche, 30 years old, complains of body
maintenance dose as monotherapy without parenteral weakness, drowsiness, failure to focus in her work and
anticoagulation. increased and 7-day menstrual flow, utilizing 6-7 sanitary
napkins/day.
Situation 9 – A 21 year old nursing student consulted due to 68. In your interview, she tells you that she does not eat meat
periorbital and bipedal edema of one week. She denies and has become a vegetarian. However, she does not take
oliguria, change in the color of urine, dysuria and CVA vitamin supplements either. Vital signs are normal, pale
tenderness. She has no other illness. Family history is likewise palpebral conjunctiva and lips, clear breath sounds, regular
unremarkable. rhythm, gr 1/6 systolic murmur at the base, abdomen is
normal, pale nailbeds. You diagnose her to have _______.
65. A random urine protein and creatinine ratio was
requested which revealed proteinuria 4 gms in 24 hours. This a) Aplastic anemia
is consistent with proteinuria that is ______. b) Thalassemia
a) Selective - occurs when permeability to albumin is c) Iron deficiency anemia
increased, but without a marked increase in the d) Leukemia
filtration of other higher-molecular-weight proteins
Situation 10 - Blanche, 30 years old, complains of body
b) Nephrotic weakness, drowsiness, failure to focus in her work and
c) Sustained increased and 7-day menstrual flow, utilizing 6-7 sanitary
d) Functional - transient increase in urinary protein napkins/day .
excretion caused by changes in glomerular
hemodynamics, such as can occur with vigorous 69. You requested for serum ferritin and result was less than
15; total iron Binding capacity was more than 360. You
exercise or fever
interpret these to be the result of
Nephrotic-range proteinuria is the loss of 3 grams or more A. Iron deficiency anemia (*ANSWER)
B. Renal disease
per day of protein into the urine or, on a single spot urine
C. Inflammation
collection, the presence of 2 g of protein per gram of urine
D. Thalassemia
creatinine.
66. Which medicine do you start for this patient to address (*Iron deficiency is the most common cause of anemia and
usually results from blood loss. Iron stores are low, as shown
the proteinuria
by low serum ferritin and low serum iron levels with high
a) Nebivolol serum total iron-binding capacity.Such symptoms include
b) Ramipril fatigue, loss of stamina, shortness of breath, weakness,
dizziness, and pallor.)
c) Hydralazine

d) Amlodipine 70. Which medicine will you prescribe Blanche whose
hemoglobin is 9.5 and hematocrit of 0.33?
The types of medicine that can help with blood pressure and
A. Plasma expander
proteinuria are called angiotensin-converting enzyme B. Blood transfusion


C. Erythropoietin injection and T wave abnormalities. Which of the following do you
D. Ferrous sulfate (*ANSWER) consider as the most likely cause of orthopnea?
A. Congestive heart failure (*ANSWER)
(*Ferrous sulfate- commonly used for IDA. Iron tablets B. Acute coronary syndrome
contributed a higher improvement to haemoglobin C. Fluid overload
concentration, during menstruation. D. Valvular heart disease
Plasma expanders- used to treat patients who have suffered
hemorrhage or shock. (*Pericarditis can lead to fluid build-up around the heart
Blood transfusion- Reasonable in almost all patients it (pericardial effusion). Orthopnea (3 pillow orthopnea) and
Hgb/Hct < 7/21. ECG abnormalities are considered to be an important sign and
Erythropoietin injection-indicated for the treatment of symptom mainly because it is often a sign of worsening heart
anemia due to chronic kidney disease (CKD), including failure.)
patients on dialysis.)

71. Ken Koy, 20 years old developed flu like symptoms. After
3 days, he complained of chest pain, shortness of breath and AB, 57, asmathic, smoker, hypertensive consults you due to
dizziness. palpitations and chest pain.
' Physical examination showed BP of 90/60, PR 40/min,
pericardial friction rub. Your primary working diagnosis is 74. Symptoms presented on consult include dyspnea, cough,
A. Pericarditis (*ANSWER) fatigue, and sputum production accompanying the
B. Costochondritis aforementioned complaints. Pertinent PE showed: RR 30, RV
C. Complete heart block Impulse along left sternal border, loud P2 and clubbing. What
D. Rheumatic fever is your working diagnosis
A. Acute coronary syndrome
(*Acute pericarditis is most often associated with viral B. Bronchial asthma in exacerbation
infection. Patients with acute pericarditis commonly report a C. COPD
prodrome of fever, malaise, and myalgias. The cardinal D. Cor Pulmonale - ANSWER
features of acute pericarditis are chest pain, pericardial
friction rub, and gradual repolarization changes on Symptoms
electrocardiography (ECG).) * Fainting spells during activity.
* Chest discomfort, usually in the front of the chest.
* Chest pain.
72. Upon discharge he was prescribed aspirin, a month later * Swelling of the feet or ankles.
he consulted you. Because of melena of four times and * Symptoms of lung disorders, such as wheezing or coughing
dizziness. The most cost effective laboratory exam you will or phlegm production.
request is: * Bluish lips and fingers (cyanosis)
A. complete blood count (*ANSWER)
B. erythrocyte sedimentation rate
C. electrocardiogram 75. After a chest xray, you also requested for an ECG. Which
D. fecal occult blood test of the following do you expect his ECG to show given the PE
findings of RV impluse, increased P2 and clubbing
(CBC- Presence of melena (+bleeding). Patient is experiencing A. T wave inversion in V5-V6
dizziness which can be a symptom of anemia. Check for Hgb B. Right ventricular hypertrophy -ANSWER
level and hct. C. Normal sinus rhythm
ESR- not diagnostic; it is a non-specific test that may be D. Left ventricular hypertrophy
elevated in a presence or absence of an inflammatory
condition. Electrocardiographic (ECG) abnormalities in cor pulmonale
Fecal occult blood test- test for presence of microscopic or reflect the presence of right ventricular hypertrophy (RVH), RV
invisible blood in stool. Patient already has melena (blood is strain, or underlying pulmonary disease (see the image
already visible) below). Such ECG changes may include the following: ... P-
pulmonale pattern (an increase in P wave amplitude in leads
2, 3, and aVF
73. He developed orthopnea of 3 pillows but he tells you he
has no passage Of black colored stools anymore. His 76. On admission, he changed to wear hospital gown. You
electrocardiogram showed ST segment observed that he had varicose veins on his lower extremities.


Which possible disease entity will you now consider as C. Clonidine
another possible cause of his present problem D. Carvedilol
A. Pulmonary emboli, recurrent
B. Bronchictasis
C. Sleep apnea -ANSWER Rationale: Telmisartan provides renal benefit at all stages of
D. Neuromuscular disorder the renal continuum in patients with type 2 diabetes. It
improves endothelial function in patients with
Lung conditions that cause a low blood oxygen level in the normoalbuminuria, delays the progression to overt
blood over a long time can also lead to cor pulmonale. ... nephropathy in patients with microalbuminuria and reduces
Scarring of the lung tissue (interstitial lung disease) Severe proteinuria in patients with macroalbuminuria
curving of the upper part of the spine (kyphoscoliosis)
Obstructive sleep apnea, which causes stops in breathing
because of airway inflammation 79. What is the BEST daily protein allowance to maximize
When the right heart fails because of chronic lung disease, renal protection
pulmonary artery hypertension, or pulmonic valve stenosis, it ????? dko alam sorry walang 0.8 sa choices
hypertrophies and results in chronic diastolic failure of the
right ventricle. This is chronic cor pulmonale. A. 0.6 g of protein/kg BW
B. 1.2 g of protein/kg bW
A 60 yo banker, diabetic, hypertensive for 30 years came for C. 1.5 g of protein/kg bw
follow up. You did a thorough PE and noted abnormal D. 0.9 g of protein /kg bw
fundoscopy Rationale: Guidelines for dietary protein intake have
traditionally advised similar intake for all adults, regardless of
77. Which lab request will you order to determine the highest age or sex: 0.8 grams of protein per kilogram of body weight
risk of progression for CKD, when you see the result each day (g/kg BW/d).
A. GFR of 40 ml/min, urine albumin of 250 mg/g
B. GFR of 20 ml/min, urine albumin of 350 mg/g -ANSWER Situatlon 14 - Gigi, 37 years old was admitted under your
C. GFR of 80 ml/min, urine albumin of 30 mg/g service due to low
D. GFR of 60 ml/min, urine albumin of 150 mg/g serum sodium manifested as weakness and drowsiness.
Correction
with appropriate fluid has been initiated but serum sodium
remains low. Further interview made you discover that
during her
fast delivery to her youngest son, she had massive bleeding.
Since then, she became amenorrheic.

80. Your PE showed normal vital signs, absent axillary hair.
What is your
MOST likely diagnosis??

A. Diabetes insipidus
B. Syndrome of inappropriate anti-diuretic hormone
C. Hyperprolactinemia
D. Sheehan's syndrome

Rationale: Sheehan's syndrome (SS) is postpartum

hypopituitarism caused by necrosis of the pituitary gland. It is
usually the result of severe hypotension or shock caused by
massive hemorrhage during or after delivery. Patients with SS
have varying degrees of anterior pituitary hormone
deficiency. Its frequency is decreasing worldwide and it is a

rare cause of hypopituitarism in developed countries owing to
78. Which medicine will you prescribe to delay the
advances in obstetric care. However, it is still frequent in
progression of diabetic
nephropathy? underdeveloped and developing countries.
A. Amlodipine
B. Telmisartan- answer


83. Which of the following disease do you have in mind?

a. Acute appendicitis
b. Acute pancreatitis
c. Acute coronary syndrome
d. Calculous cholecystitis
Calculous cholecystitis is characterized by biliary colic.
The pain develops when a stone obstructs the cystic duct,
resulting in progressive increase of tension in gallbladder wall.
Chief symptoms is associated with pain that is constant and
increases in severity and typically last hours. Located in the
epigastrium or RUQ and radiated to the upper back. Pain
typically appears during the night or after a fatty meal.

84. To clinch your diagnosis since blood count showed

leukocytosis what test will you request?

a. Serum amylase and lipase
b. 12L ECG
81. Due to her history of postpartum bleeding, you now c. UTZ of the liver, gb and pancreas
consider that Gigi is d. Abdominal CT scan with contrast
suffering from Abdominal UTZ is the standard diagnostic test for all
A. Acromegaly gallstones with the presence of typical symptoms
B..TSH secreting adenoma Mild to moderate leukocytosis
C. Hypopituitarism Mild elevation of serum bilirubin
D. Diabetes insipidus Mild elevation of serum alkhaline phosphatase, transaminase
and amylase
RATIONALE : Sheehan's syndrome (SS) is postpartum
hypopituitarism caused by necrosis of the pituitary gland. It is
85. 2 days later you observed that his eyes were slightly
usually the result of severe hypotension or shock caused by
icteric and urine is tea colored. Your consider presence of
massive hemorrhage during or after delivery.
obstruction in the common bile duct. Which procedure is
most appropriate?
82. Which ancillary procedure do you request for to support
your impression a. ERCP
as the possible cause of persistently low sodium? b. Endoscopic UTZ
c. Scout film of the abdomen
A. SeruM cortisol determination d. MRCP
B. Skull x-ray ERCP- diagnostic and therapeutic
C. Ultrasound of kidney & adrenals
Situation 16: Joey is 65 year old, Diabetic, underwent below
D. Cranial CT scan
Rationale:T he gold standard imaging for the diagnosis of knee amputation of his left leg. He consults you because he is
Sheehan’s Syndrome is MRI. The pituitary gland is housed in bothered by progressive shortness of breath, easy fatigue and
the sella turcica, which is a groove in the sphenoid bone. vague chest pain. You consider coronary artery dse but his
Pituitary gland necrosis empties the sella turcica. Imaging can 12L ECG in normal
reveal partial or full loss of the gland. Approximately 70% of
all Sheehan’s cases evidence a completely empty sella turcica 86. Having a high index of suspicion for coronary artery
[8, 11]. CT scans can also help in diagnosis (Figure 1). disease. Which of the following test will you request for?

a. 2d echo
Situation 15: Norbert suddenly experienced colicky b. Thallium dipyridamole test
abdominal pain after eating lunch of crispy pata, drinking c. Stress echocardiogram
wisky, vodka and beer. Pain later localized to the epigastrium d. Treadmill exercise test
with radiation posteriorly. Findings show tenderness at the 2D Echo is the most employed cardiovascular imaging
epigastrium area and umbilical region. modality for assessment of cardiovascular disease and is


often performed in patients without history of Coronary Case: Jonathan had a Friday night out with his drinking
artery disease buddies when he arrived home he experienced severe
epigastric pain radiating to the back accompanied by nausea,
Situation 16. vomiting and abdominal distention
87. The ancillary test done confirmed obstruction in 3 vessels 92. while at the ER, which blood exam will you request for to
including left main artery. You will proceed to do rule out diagnosis of acute pancreatitis
a. MRI a. CBC
b. Cardiac CT Scan b. Serum amylase/ lipase
c. Coronary Angiogram – gold standard for LMCD Diagnosis of acute pancreatitis is established by 2 of
d. Repeat ECG with Trop I the following 3 criteria:
Typical abdominal pain in the epigastrium that may radiate to
88. Treatment of choice for Joey’s condition involving 3 the back
vessels including the left main coronary artery is Threefold or greater elevation of serum lipase and/or amylase
a. Angioplasty Confirmatory findings of acute pancreatitis on cross sectional
b. Coronary Artery Bypass Graft - CABG offers a survival abdominal imaging
advantage over medical therapy for significant LMCA disease C. Serum creatinine
since medical therapy alone has been associated with poor D. Serum electrolytes
outcomes. CABG surgery has been accepted as the standard
revascularization method for LMCA disease for several 93. The pain became severely boring. His BP went down from
decades. 120/80 to 70/40, HR 110/min. Management includes
c. Sclerotherapy I. ICU admission
d. Medical Management II. IV fluid resuscitation
III. no oral alimentation
Situation 17. Missy, 75yo, hypertensive lately was frequently I, II, III
grappling for words and would occasionally forget her II, III à Supportive: NPO, IV Fluids (HYPOVOLEMIA is the
favorite son’s address. A month later, she began losing track most common cause of death), Pain medication
of appointments. (Meperidine)
I, III
89. On consultation, VS were normal, PE findings are likewise I, II
normal. However, you observed that she kept asking you the 94. While explaining to his family the pathology of his illness,
same questions about 7x. as you advised her son to subject you mention the more common cause of his illness namely
her to some work-ups including memory test, you tell him a. hyperlipidemia à Hypertriglyceridemia (>1000mg/dL) can
that you highly consider his mother to be suffering from what cause acute pancreatitis
disease? b. alcohol intake à GALLSTONE is the leading cause of acute
a. Parkinson’s disease – movement disorder pancreatitis followed by alcohol
b. Alzheimer’s disease c. blunt trauma
c. Frontotemporal dementia – more on judgment and social d. drug intake
situations
d. Multiple sclerosis – attention impairment, incidental CASE: Mr. Donal Dock, a tourist went surfing in Siargao for
memory and psychomotor function th
one week. On his 8 day, he experienced chills, fever, cough
and dyspnea
90. Her standard memory test showed a result that is 1.5 SD BP 120/80, RR: 28/min T: 39.5 PR:90. Flaring of ala nasi, right
below normal. You identify her to have basal crackles, regular rhythm, no cyanosis
a. Normal
b. Moderate Cognitive Impairment 95. With the above symptoms and PE findings, what is your
c. Mild Cognitive Impairment most likely diagnosis
d. Severe Cognitive Impairment a. acute viral illness
b. pneumonia à Stay in hotel or on cruise ship in previous 2
91. You want a drug with few side effects and given only once weeks à Legionella (Atypical pneumonia)
daily for better compliance. Drug of choice? c. tuberculosis à cough of atleast 2 weeks
a. Gingko biloba d. infectious mononucleosis à Triad: Pharyngitis (most
b. Tacrine severe symptom), fever, adenopathy
c. Donepezil – approved drug in all stages and taken once
daily 96. Which ancillary procedure do you request for to support
d. Rivastigmine your diagnosis?
A. Sputum gram's stain


B. Chest x-ray D. Varicella zoster
Chest radiography (posteroanterior and lateral views) has Primary varicella typically presents with fever, constitutional
been shown to be a critical component in diagnosing symptoms and a vesicular, pruritic, widely disseminated rash
pneumonia.8 According to the latest American Thoracic that primarily involves the trunk and face.(5) The symptoms
Society (ATS) guidelines for the diagnosis and treatment of usually resolve within 7 to 10 days, but in rare cases primary
adults with CAP, “all patients with suspected CAP should have varicella leads to more severe disease and visceral invasion.
a chest radiograph to establish the diagnosis and identify
complications (pleural effusion, multilobar disease).”8 Chest 99. What do you advise her since she tells you she has a
radiography may reveal a lobar consolidation, which is scheduled Biochem Exam?
common in typical pneumonia; or it could show bilateral, A. Take a cold bath daily and apply mupirocin ointment
more diffuse infiltrates than those commonly seen in atypical B. Take paracetamol and take the Biochem exam
pneumonia. However, chest radiography performed early in C. Rest and isolate herself from relatives and classmates
the course of the disease could be negative. Implement Varicella Control Measures
C. CBC Implementing outbreak control measures requires various
D. Blood C&S activities, including notification of the outbreak, exclusion or
isolation of varicella case-patients and, if appropriate, HZ
97. On history, he tells you he has not taken any antibiotic in case-patients, and management of persons without evidence
the last 3 months. Which antibiotic will you prescribe? of immunity
A. Amoxicillin 1 gm every 12 hours Exclusion or Isolation of Case-patients
B. Cefuroxime 500mg every 12 hours Depending on the setting, isolation of persons with active
C. Clarithromycin 500mg every 12 hours disease consists of excluding, furloughing, or grouping
Clinical studies have provided evidence that erythromycin is together (cohorting) persons who are ill and are likely to
the first-line treatment. An intravenous dosage of 1g every 6 transmit varicella until their rash has crusted over. Vaccinated
hours as initial therapy will be effective in most cases. persons with varicella may develop lesions that do not crust
Parenteral treatment may be switched to oral administration (macules and papules only). Isolation guidance for these
only after clinical response is observed. In vitro susceptibilities persons is to exclude until no new lesions appear within a 24-
and preliminary experimental and clinical results suggest that hour period
clarithromycin will most likely become the preferred D. Paracetamol + acyclovir will have to be taken
treatment once an intravenous preparation is available
worldwide. However, orally administered clarithromycin at 100. She asks your advice since her sister in law who stays
the dosage of 500 mg every 12 hours may be recommended in with her is pregnant. What do you advise her?
those developing countries in which health systems cannot She can tell her to leave for one month before resuming
afford the costs of intravenous therapy. In the case of office work
clinically severe illness or in seriously immunosuppressed She will need post exposure prophylaxis with varicella
hosts with confirmed legionellosis, a combined therapeutic Immune globulin
approach is warranted. Rifampicin 600 mg every 12 hours Management of persons with contraindications to the
intravenously or orally has to be added to the usual dosage of varicella vaccine
erythromycin. Other alternative therapies, but with less Persons without evidence of immunity who have
distinct clinical efficacy, that can be combined with contraindications to vaccination (e.g., immunocompromised
erythromycin are doxycycline 100 mg every 12 hours persons, pregnant women) should be excluded from an
intravenously or orally, and intravenous ciprofloxacin 200 mg outbreak setting through 21 days after rash onset of the last
every 6 hours. identified case-patient because of the risk of severe disease in
D. Levofloxacin 750mg once daily these groups. If these persons are exposed to a case of
varicella or HZ, VZIG should be administered as soon as
Situation 20 -Gigi a first year medical student developed flu possible and within 96 hours of exposure
like symptoms. While putting on her makeup she saw a C. Preemptive administration of acyclovir
vesicle on the anterior portion of her right ear. This was D. She will need varicella vaccine only.
followed by 3 or 4 more lesions. She noted erythema on the
base of the vesicle. The next morning the vesicles were on
her face body, thumb and extremities. On consultation, you
noted a T: 38°C, congested tonsillopharyngeal walls, vesicular
lesions all over.
98. What did gigi have?
A. Herpes zoster
B. Stevens Johnson syndrome
C. Hypersensitivity Reaction