SEPTEMBER 2021 EXIT EXAM 8.

A 36 year old man presents with night-time cough and

wheezing for the last 2 months. He has a previous history of
eczema. What finding in his complete blood count would be
1. Answer: D expected?
a. Basophilia
2. Which of the following is part of the treatment regimen for b. Eosinophilia
reactive arthritis but not in other spondyloarthropathy? c. Neutrophilia
a. NSAIDs d. Monocytosis
b. Anti TNF
c. Antibiotics 9. A 38 year old man presents to his dentist with bleeding
d. Methotrexate gums. The dentist refers him for medical evaluation due to
gingival hypertrophy and oral purpura. The CBC is abnormal
3. Which of the following joint vulnerability risk factors is the with numerous immature blasts noted. Which ONE of the
most potent for osteoarthritis? following is the most likely diagnosis?
a. Increased age a. ALL
b. Female gender b. APL
c. Genetic susceptibility c. AML (monoblastic)
d. Nutritional factors d. Therapy-related AML

4. Which of the following statement is true regarding the
diagnosis of osteoarthritis?
a. Blood tests are routinely indicated
b. Radiographic exams are routinely needed for
diagnosis
c. Diagnosis can be based on history and PE
d. ESR and CRP are helpful in the diagnosis
5. Which statement is true about gout diagnosis?
a. Serum uric acid level is always elevated at the
time of an acute attack
b. 24 hour urine collection of uric acid is needed as
part of the work up
c. Confirmatory test is the presence of needle
shaped birefringent crystal in synovial fluid
d. Radiographic exams is required in Gout diagnosis
6. A 35 year old male with scaly rashes having erythematous
base was complaining of asymmetrical oligo-arthritis,
associated with back stiffness triggered by inactivity. He
denies having antecedent infection. Arthritis and hand
deformities were noted during physical examination. What
characteristic radiographic finding is compatible with his
hand condition?
a. Pencil in a cup deformity
b. Trolley track sign
c. Syndesmophytes
d. Dagger sign
10. A 48 year old woman is evaluated for fatigue and intermittent
abdominal discomfort of 2 months’ duration and occasional
dark urine. Medical and family histories are unremarkable.
On PE, vital signs were normal. Abdominal tenderness is
elicited. No jaundice, bruising, or splenomegaly is noted.
CBC showed Hb 7.2 g/dl, WBC - 3 x 109/L, platelet count
125, bilirubin normal, Direct Coombs negative. Bone marrow
is hypocellular. Abdominal ultrasound showed portal vein
thrombosis. Flow cytometry shows CD 55 CD 59 deficiency.
Which of the following is the most likely diagnosis?
a. Aplastic anemia
b. Myelodysplasia
c. Myeloproliferative neoplasm
d. Paroxysmal nocturnal hemoglobinuria
11. A 52 year old man is involved in a vehicular accident in
which his car is struck broadside at an intersection. Though
the airbag inflates, the car rolls over, and the impact against
the door results in a large laceration to his left thigh. After
transport to a local hospital, he is found to have a Hct of
16%. Coagulation studies reveal a PT of 16 seconds and a
PTT of 26 seconds. His platelet count is 70 x 109/L.
Transfusion with which of the following blood products is
most likely to be of benefit to this man?
a. Packed red blood cells (PRBCs)
b. Fresh frozen plasma (FFP)
c. Cryoprecipitate (cryo)
d. Whole blood

7. A 68 year old man is referred to hematology service with
fever, night sweats, and unexplained weight loss.
Immunologic studies of the blood showed mature-looking
lymphocytes that are CD5 and CD23 positive but negative
for cyclin D1. What is the most likely diagnosis?
a. B-cell acute lymphocytic leukemia
b. Chronic lymphocytic leukemia
c. Mantle cell lymphoma
d. Diffuse large B-cell NHL
12. A man was incidentally diagnosed with glucose-6-phosphate
dehydrogenase (G6PD) deficiency after being tested prior to
administration of hydroxychloroquine for COVID infection.
After recovery he has several questions on how this affects
her children. What would you tell the patient assuming his
wife does not have G6PD deficiency?
a. All his children (male and female) will be affected
b. All sons will be unaffected all daughters will be
carriers
c. One of two daughters will be affected
d. All sons will be carriers

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 13. Kristine, 26 years old is 16 weeks pregnant. Two years ago, 19. A 34 year old female was admitted due to increasing
she was diagnosed with SLE and was positive for ANA, peripheral edema, fever, decreasing urine output and
anti-dsDNA, Anti Sm and anti-RO. Her SLE is quiescent at elevated creatinine of 3.5 mg/dl. On further history of 2
the moment. Which of her autoantibodies is most relevant for months prior to admission she was started with anti TB
her current condition? medication isoniazid, rifampin, ethambutol and pyrazinamide
a. Anti-Ro (Myrin P Forte) 3 tablets once a day however she stopped
b. ANA taking the medicine and just resumed taking 3 weeks prior to
c. Anti-dsDNA admission. Urinalysis showed pyuria with white blood cell
d. Anti-Sm casts and hematuria. What is the best approach for this
patient?
14. 65F who is apparently well came in for evaluation of lab a. Initiate hemodialysis
results done after executive check up. Lab results showed b. Do renal biopsy
elevated TSH and normal FT4 and FT3. What is the c. Discontinue Rifampin
diagnosis? d. Give Azathioprine
a. Subclinical hypothyroidism
b. Primary hypothyroidism 20. A 44F was brought to the ER because of difficulty of
c. Subclinical hyperthyroidism breathing and fever. She was noted to be febrile,
d. Primary hyperthyroidism tachycardic, and in distress. She had history of Graves’
disease, but stopped taking medications for 1 year now.
15. A patient presented with fever, purulent rhinorrhea, nasal Thyroid hormone tests are markedly elevated. Chest xray
ulcers, sinus pain, arthritis, microscopic hematuria and 1.0 showed pneumonia. Which of the following is true.
gm/24 hour of proteinuria. Serial chest xray revealed a. Methimazole is the preferred first line of treatment
persistent infiltrates and pulmonary nodules. Renal biopsy b. Once pneumonia is treated, sent patient for
was done showing non-caseating granulomas. What is the thyroidectomy for definitive treatment
most likely diagnosis? c. PTU is preferred
a. Microscopic polyangiitis d. IV levothyroxine should be initiated immediately
b. Goodpasture’s syndrome
c. Churg-Strauss syndrome 21. A 59 year old female was referred to you for further
d. Wegener’s granulomatosis management of diabetes. She is currently managed by her
cardiologist for her heart failure. She is advised to undergo
16. A 24 female presents with palpitations, weight loss and easy coronary angiogram. She is maintained on Metformin for her
fatigability for two months. PE showed BP: 120/70 mmHg, diabetes. Her recent HbA1c is 8.1%. Which of the following
CR: 123/min, (+) lid lag. TSH was suppressed and T4 was drugs with proven cardiovascular benefit should be added to
elevated. She was started on Methimazole 20 mg once a her current treatment regiment?
day and was advised to come back for follow-up after 6 a. Insulin detemir
weeks. What laboratory test should be requested for b. Empagliflozin
adjustment of her medication? c. Saxagliptin
a. TSH d. Pioglitazone
b. FT3
c. FT4 22. Can cause hyperkalemia in chronic kidney disease:
d. TSH, FT4 a. Hemolysis of blood
b. Metabolic acidosis
17. A 30 y/o, male was admitted due to diarrhea of 3 days c. Calcium channel blocker
duration. Initial serum K is 2.9 mM. Repeat serum K the next d. Distal renal tubular acidosis
day is still at 2.9 mM. Despite adequate correction. Last
episode of loose bowel movement was on the day of 23. Criteria for uncomplicated urinary tract infection, EXCEPT:
admission. What other electrolyte imbalance should be a. Bilateral contracted kidneys
corrected to prevent refractory hypokalemia? b. Non pregnant women
a. Hypochloremia c. No anatomical abnormalities
b. Hypomagnesemia d. No instrumentation done
c. Hyponatremia
d. Hypocalcemia 24. In Lupus Nephritis, the most common clinical sign of renal
disease is:
18. A 30 y/o, male with no known comorbidities was admitted a. Hematuria
due to diarrhea and persistent vomiting of 3 days duration. b. Proteinuria
Serum K on admission is 2.9 mM. What is the initial c. Renal insufficiency
treatment of choice? d. Active urine sediment
a. Potassium citrate tablet
b. Potassium chloride tablet 25. In Lupus Nephritis, this correlates best with the presence of
c. 20 mmol KCl in 1L of PNSS renal disease:
d. 20 mmol KCl in 100mL of PNSS a. Anti-dsDNA
b. ANA
c. C3
d. ASO

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 26. Recommendation for detection of microalbuminuria in Type 2 34. Fifteen-year-old male adolescent with previous history of
Diabetes Mellitus: mild to moderate acne since he was fourteen, consulted a
a. At the time of diagnosis Dermatologist due to the appearance of painful papular and
b. When creatinine starts to get abnormal pustular lesions on the back and anterior chest, along with
c. Five years after diagnosis low-grade fever and pain on both knees. Complementary
d. Only when retinopathy is evident exams showed leukocytosis with neutrophilia and elevated
C-reactive protein. In the dermatological exam, exuberant
27. A 60-year-old male suddenly developed multiple elevated and exudative ulcerated and crusted lesions were observed
fluid filled lesions on the extremities measuring 1 to 3 cm. localized on the trunk and with less intensity, on the face and
What primary lesion is being described? neck. What acne treatment will be the most beneficial for this
a. Vesicle patient?
b. Bullae a. Isotretinoin
c. Papule b. Oral prednisone
d. Nodule c. Topical erythromycin
e. Tumor d. Sulfur soap
e. None of the choices
28. A phosphodiesterase inhibitor with vasodilator and
anti-platelet properties. 35. High pitched holosystolic murmur best heard at left lower
a. Cilostazol sternal border which becomes louder during inspiration
b. Ticagrelor a. Mitral regurgitation
c. Pentoxifylline b. Ventricular septal defect
d. Clopidogrel c. Tricuspid regurgitation
d. Aortic regurgitation
29. A systolic click followed with midsystolic murmur which
becomes closer to S1 during standing 36. Answer: A
a. Bicuspid aortic valve
b. Mitral valve prolapse 37. Most common symptom in a patient with peripheral arterial
c. Aortic regurgitation disease.
d. Bicuspid pulmonic valve a. Bipedal edema
b. Decreased pulse on lower extremities
30. Auspitz sign is seen in: c. Pin and needle sensation on lower extremities
a. Herpes zoster d. Claudication
b. Pityriasis rosea
c. Tinea versicolor 38. The most common clinical manifestation ARF
d. Psoriasis a. Carditis
b. Chorea
31. Case: A 30-year-old male complains of itchy rashes of 2 c. Polyarthritis
weeks duration. He noted that the pruritus is more intense at d. Subcutaneous nodules
night when he is about to sleep. On physical examination,
excoriated papules were noted over the finger webs, wrists, 39. Which of the following will benefit from statin therapy
axilla, genital and periumbilical area. Similar lesions were a. A non-diabetic patient with LDL of 200 mg/dL
also noted on another sibling. What is your likely diagnosis b. Patient who had recent myocardial infarction
for this case? c. A diabetic patient with ASCVD risk of 8%
a. Insect bites d. All of the choices
b. Furunculosis
c. Scabies 40. A patient admitted due to critical COVID pneumonia was
d. Pediculosis corporis referred to you due to development of ARDS. What therapy
is the only grade A recommendation in the management of
32. Classic sign of angina pectoris ARDS?
a. Lotad sign a. High frequency ventilation
b. Levine sign b. Low tidal volume
c. Lapras sign c. High positive end expiratory pressure (PEEP)
d. De Musset d. Corticosteroids

33. Drug of Choice for Group A Streptococcal infection 41. A patient was found to have pleural effusion. Thoracentesis
a. Erythromycin was done which revealed a pleural fluid to serum protein
b. Penicillin ratio of 0.6, pleural fluid to serum LDH ratio of 0.5 and LDH
c. Azithromycin of ⅔ the upper limit of normal. Base on the Light’s criteria the
d. Sulfamethoxazole pleural fluid is classified as:
a. Exudative
b. Transudative
c. Uncertain

KBS ☕ & VIT 🍵

 42. Most common ECG abnormality in pulmonary embolism
a. Sinus tachycardia
b. S1Q3T3
c. T wave inversion in leads V1-V4
d. All of the choices mentioned

43. On chest radiograph, it is described as an area of focal

oligemia
a. Palla’s sign
b. Westermark’s sign
c. Hampton’s hump
d. None of the choices

44. Recommendations for surveillance in breast cancer after

primary and adjuvant therapy during follow-up:
a. Annual self breast examination
b. Annual mammography
c. Semi-annual 2D Echocardiography if on
Trastuzumab
d. Pelvic exam every 3 months

45. The most important reason for doing a more invasive

procedure for parapneumonic effusion:
a. Loculated pleural fluid
b. Pleural fluid glucose less than 60 mg/dL
c. Positive gram stain
d. Gross pus

46. The onset of clinical insult as specified in the Berlin Definition

of ARDS
a. One day
b. One week
c. Two weeks
d. One month

47. The overall most common cause of pleural effusion

a. Congestive heart failure
b. Pulmonary tuberculosis
c. Chronic kidney disease
d. Pneumonia

48. Virchow’s triad

a. Venous stasis
b. Endothelial injury
c. Hypercoagulability
d. All of the choices mentioned

49. The most common presenting symptom of Lung CA:

a. Cough
b. Dyspnea
c. Chest pain
d. Hemoptysis

50. PS, 60/F, is diagnosed of Breast Cancer Stage IV (bone

metastasis). Plan is to give systemic chemotherapy. She is a
housewife and was able to do her usual household activities
but with occasional complaint of low back pain 3/10 when
carrying grocery bags. What is the patient’s performance
status?
a. ECOG 0
b. ECOG 1
c. ECOG 2
d. ECOG 3

KBS ☕ & VIT 🍵

 JULY 2020 EXIT EXAM 9. The following is most commonly involved site of
atherosclerotic peripheral artery disease
a. Abdominal aorta and iliac arteries
1. Which among the following are the three principal features of b. Femoral and popliteal arteries
cardiac tamponade? c. Tibial and peroneal arteries
a. Hypotension, bounding pulses, jugular venous d. Dorsalis pedis and posterior tibial arteries
distention
b. Hypertension, soft or absent heart sounds, jugular 10. The primary lesion is more than 1 cm in diameter
venous distention a. Papule
c. Hypotension, soft or absent heart sounds, jugular b. Vesicle
venous distention c. Plaque
d. Hypertension, bounding pulses, jugular venous d. Macule
distention
11. Scraping or scratching a lesion of psoriasis will lead to
2. Assess or re-evaluation of the patient in between high quality pinpoint bleeding. This is known as:
CPR should not be done longer than a. Darier’s sign
a. 10 seconds b. Fitzpatrick’s sign
b. 15 seconds c. Auspitz sign
c. 20 seconds d. Nikolsky sign
d. 25 seconds
12. Major criteria for atopic dermatitis, EXCEPT:
3. Identify the rhythm by selecting the best single answer a. Xerosis
a. Ventricular fibrillation b. Pruritus
b. Complete heart block c. Chronic relapsing course
c. ST elevation myocardial infarction d. Personal or family history of atopy
d. Supraventricular tachycardia e. None of the above

13. Common cause of allergic contact dermatitis, EXCEPT:

a. Rubber
b. Nickel
c. Formaldehyde
d. Neomycin
4. Intermittent claudication is a manifestation of acute occlusive e. None of the above
disease
a. True 14. What laboratory findings would you expect during the critical
b. False phase of Dengue infection?
a. Decreased hemoglobin
5. Clinical criteria for metabolic syndrome b. Detection of virus in the blood
a. Diabetes c. Increased hematocrit
b. Elevated LDL d. Normal white blood cell count
c. Elevated triglyceride
d. Normal HDL 15-16. T.L., a 39 y/o female complains of a 4 days history of fever
accompanied by cough, conjunctivitis and sore throat. She claims that
6. This is determined by stroke volume and heart rate after 2 more days, distinct maculopapular rashes appeared starting
a. Peripheral resistance from her face down to her trunk then extremities.
b. Blood pressure
c. Mean arterial pressure 15. You diagnosed her to have measles because of the following
d. Cardiac output except:
a. Conjunctivitis
7. Most common clinical feature in acute rheumatic fever b. Fever
a. Monoarthritis c. Generalized rashes
b. Oligoarthritis d. Sore throat
c. Polyarthritis
d. Sydenham chorea 16. What is the most common method for the diagnosis of your
patient?
8. Hallmark of rheumatic carditis a. Serology
a. Infective endocarditis b. Skin biopsy of the rash
b. Mitral regurgitation c. Throat swab
c. First degree AV block d. All of the above
d. Pericarditis

KBS ☕ & VIT 🍵

 17. The normal cerebral blood flow is ___ mL/100 grams brain 26. The criteria for reversibility in asthma
tissue/min a. ≥ 10% increase in FEV1
a. 40-45 b. ≥ 12% and 200 ml increase in FEV1 post
b. 50-55 bronchodilator
c. 60-65 c. ≥ 12% and 200 ml increase in FEV1 pre
d. 70-75 bronchodilator
d. ≥ 12% or 200 ml increase in FEV1 post
18. Which of the following are modifiable risk factors for stroke? bronchodilator
a. Hypertension, diabetes, advanced age
b. Diabetes, obesity 27. Which of the following is the first line therapy for persistent
c. Hypertension, smoking, family history asthma?
d. Diabetes, hypertension, snoring a. LABA
b. SABA
19. What mean arterial pressure should be maintained in c. ICS
patients with acute ischemic stroke? ___mmHg d. Prednisone
a. 60 to 80
b. 80 to 100 28. The chest radiographic finding/s of patient with ARDS
c. 90 to 110 a. Increased heart size
d. 110 to 130 b. “Batwing” distribution of edema
c. Patchy peripheral infiltrates extending to the lateral
20. For patients taking warfarin, prothrombin time with lung margins
international normalized ratio (INR) is serially monitored. d. Bilateral homogenous patchy infiltrates
What is the ideal INR level?
a. 1.0 to 1.5 29. Type of Lung cancer most commonly seen in never smokers,
b. 1.5 to 2.0 women, and younger adults:
c. 2.0 to 3.0 a. Small Cell Lung CA
d. 3.0 to 4.0 b. Adenocarcinoma
c. Squamous Cell Lung CA
21. Your patient notes that she can comb her hair, eat alone, d. Large Cell Lung CA
take a bath, and is up and about more than 50% of waking
hours. What is her ECOG status? 30. Most common cause of hypothyroidism worldwide
a. ECOG 1 a. Post surgical Hypothyroidism
b. ECOG 2 b. Iodine Deficiency
c. ECOG 3 c. Hashimoto’s thyroiditis
d. ECOG 4 d. Atrophic thyroiditis

22. The patient eventually finished chemotherapy. Underwent 31. Subclinical Hyperthyroidism
surgery and completed radiation. On evaluation, complete a. Low TSH, high FT4
response was noted. Surveillance was done. How many b. Low TSH, Normal FT4
years of survival without recurrence is tantamount to cure? c. High TSH, high FT4
a. 3 years d. Normal TSH, high FT4
b. 5 years
c. 7 years 32. Most common type of thyroid cancer
d. 10 years a. Papillary thyroid CA
b. Follicular thyroid CA
23. Primary clinical manifestations of bronchiectasis: c. Medullary thyroid CA
a. Recurrent pulmonary infections d. Anaplastic thyroid CA
b. Recurrent hemoptysis
c. Recurrent fever 33. Which of the following is an indication for surgery in patient
d. Recurrent dyspnea with asymptomatic primary hyperthyroidism?
a. Osteoporosis
24. The most common cause of Community Acquired b. Elderly patient more than 60 y/o
Pneumonia c. Calcium level of 1 mg/dL
a. Streptococcus pneumonia d. Creatinine clearance >60 ml/min
b. Staphylococcus aureus
c. Mycoplasma pneumonia
d. Klebsiella pneumonia 34. Which of the following is a blood cellular element that is
responsible for the initiation of the blood clot from a blood
25. Which of the following is the correct treatment for a patient vessel injury?
with moderate risk CAP? a. RBC
a. Extended macrolide b. Eosinophils
b. IV BLIC c. Neutrophils
c. IV 3rd gen Cephalosporin + Oral extended d. Platelets
Macrolide
d. IV BLIC + IV Aminoglycoside

KBS ☕ & VIT 🍵

 35. Which of the following best describes anemia? 43. The most common cutaneous lesion specific for SLE that is
a. Diagnosis of anemia in men is based on the flat or raised rash that spares the nasolabial fold.
hemoglobin level of less than 13 to 14 g/dL and in a. Malar rash
women, less than 12 to 13 g/dL. b. Papulosquamous rash
b. Dietary supplementation with oral iron therapy c. Discoid rash
without determining the specific cause of anemia d. Vasculitis rash
is recommended.
c. A pale palmar crease is an indication of 44. 30-year-old male patient presents with acute monoarthritis of
hemoglobin usually less than 5 g/dL. the knee after acute binge alcohol drinking. What is the likely
d. The mean cell hemoglobin concentration is the diagnosis?
most important index which classifies anemia as a. Osteoarthritis
microcytic, normochromic, and macrocytic b. Pseudogout
c. Gout
36. The primary protein for iron storage. d. Septic arthritis
a. Transferrin
b. TFR1 45. Arthrocentesis is indicated in patients with effusion. A Grade
c. Ferritin 3 synovial fluid suggests what condition?
d. Hepcidin a. Gouty arthritis
b. Osteoarthritis
37. Single most common cause of chronic renal failure is: c. Septic arthritis
a. Atherosclerotic Nephropathy d. Traumatic arthritis
b. Hypertensive Nephrosclerosis
c. Diabetic Nephropathy 46. What is the palpable osteophyte in the DIP joint?
d. HIV-associated Nephropathy a. Heberden’s node
b. Bouchard’s node
38. In patients with diabetes mellitus, risk factor for the c. Swan neck deformity
development of diabetic nephropathy include d. Boutonniere’s deformity
a. Obesity
b. Sedentary lifestyle 47. Provides the most sensitive and specific approach to peptic
c. Hypertension ulcer disease
d. Male gender a. Ultrasound
b. Endoscopy
39. The electrolyte abnormality that will maintain the presence of c. Barium studies
metabolic alkalosis d. All of the above
a. Hypokalemia
b. Hypocalcemia 48. The best diagnostic modality for suspected Gb stones
c. Hyponatremia a. Ultrasound
d. Hypochloremia b. CT scan
c. ERCP
40. The paresthesia, muscle cramping, and tetany which are d. Oral cholecystogram
seen in metabolic alkalosis is also seen in what electrolyte
abnormality? 49. Leading cause of acute pancreatitis:
a. Hypokalemia a. Alcohol
b. Hypocalcemia b. Gallstones
c. Hyponatremia c. Virus
d. Hypochloremia d. Bacterial infection

41. What is estimated total body water of a 50 kg female? 50. This is the threshold for developing alcoholic liver disease in
a. 20 L men
b. 25 L a. 10-20 gm
c. 30 L b. 60-80 gm
d. 35 L c. 40-60 gm
d. 80-100 gm
42. A 65 y/o male known case of prostate cancer was admitted
due to drowsiness. Initial serum Na is 115 mmol/L. What
should be your target serum Na 24 hours after initiating
correction?
a. 125 mmol/L
b. 130 mmol/L
c. 135 mmol/L
d. 140 mmol/L

KBS ☕ & VIT 🍵

 JULY 2020 EXIT EXAM
10. In Lupus Nephritis this correlate best with the presence of
renal disease:
1. 5-Fluorouracil for some time is the cornerstone of a. Anti-dsDNA
chemotherapy in patients with colon cancer. This drug is b. C3
used to enhance its effect. c. ANA
a. Carboplatin d. ASO
b. L – Asparaginase
c. Leucovorin 11. In the most common form of congenital adrenal hyperplasia,
d. Irinotecan which of the following hormones is elevated and is used as
diagnostic marker for this disease?
2. After 5 days of undergoing treatment, E.D., goes back to the a. 11-deoxycortisol
clinic because of jaundice. The doctor is entertaining b. 18-hydroxy-corticosterone
drug-induced hepatotoxicity secondary to anti-TB drugs. c. 17-hydroxy-progesterone
What must be advised to the patient? d. 5-dihydrotestosterone
a. continue the anti-TB medications and do AST/ALT
b. stop the anti-TB medications temporarily and do 12. Increased in preload is seen in
AST/ALT a. Cardiac tamponade
c. continue anti-TB medications and give liver b. Mitral regurgitation
protectant drugs c. Hypertension
d. stop the anti-TB medications permanently d. Aortic stenosis

3. Anti-diabetic medication which is contraindicated in patients 13. Main feature that differentiate cystitis and pyelonephritis:
with CKD (eGFR <30) a. High Grade Fever
a. Gliclazide b. Urinary incontinence
b. Insulin c. Back pain
c. Linagliptin d. Vomiting
d. Metformin
14. Most common cause of hematochezia in elderly patients?
4. Bacteria responsible for conversion of nitrate to nitrite: a. Diverticulosis
a. Candidiasis b. Malignancy
b. Staphylococcus c. Anal Fissure
c. Enterobacteriaceae d. Amoebic Colitis
d. Eischericihia
15. Most common cause of UTI in elderly:
5. Chronic diarrhea is defined as diarrhea lasting for? a. Prostatic hypertrophy
a. &gt; 10 days b. Cystitis
b. &gt; 14 days c. Nephrolithiasis
c. &gt; 7 days d. Nephritis
d. &gt;28 days
16. Multiple endocrine neoplasia 2A
6. Gold standard in the measurement of albuminuria. a. Medullary thyroid carcinoma, pheochromocytoma,
a. Reagent strip urinalysis hyperparathyroidism
b. 24 hour urine collection b. Medullary thyroid carcinoma, pheochromocytoma,
c. Protein- creatinine ratio neurofibromatosis
d. Albumin-creatinine ratio c. Zollinger-Ellison syndrome, acromegaly,
hyperparathyroidism
7. How do you assess long term glycemic control d. Insulinoma, hyperparathyroidism, prolactinoma
a. self blood glucose monitoring
b. FBS 17. Pulsus paradoxus is commonly seen in
c. OGTT a. Cardiac tamponade
d. HgbA1c b. Pulmonary embolism
c. Chronic Obstructive Airway Disease
8. In hypothyroidism, levothyroxine dose adjustment is based d. Constrictive pericarditis
on what level?
a. FT4 18. Relapse in urinary tract infection is within the duration of
b. FT3 a. 4 weeks
c. TSH b. 6 weeks
d. All of the above c. 8 weeks
d. 2 weeks
9. In Lupus Nephritis the most common clinical sign of renal
disease is: 19. S3 occurs during this phase of the cardiac cycle
a. Hematuria a. Atrial contraction
b. active urine sediment b. rapid filling phase
c. Proteinuria c. T wave in the ECG
d. renal insufficiency d. Diastasis

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 28. Which of the following clinical manifestations will distinguish
20. Second most common cause of chronic kidney disease in primary from secondary adrenal insufficiency?
the Philippines. a. Eosinophilia
a. Hypertension b. Alabaster-like paleness
b. Glomerulonephritis c. Hypoandrogenism
c. Pyelonephritis d. Hyperpigmentation
d. Diabetes
29. Which of the following events do NOT occur during the
21. The following condition may increase cerebral blood flow? critical phase of Dengue infection?
a. Arteriovenous malformation a. Viremia
b. All of the choices b. Plasma leakage
c. Polycythemia c. Defervescence
d. Atherosclerosis d. Increasing hematocrit

22. The following is/are true of pituitary adenoma: 30. Which of the following is NOT correct regarding definition of
a. Macroadenoma in a quarter of autopsy cases AKI?
b. Most common cause of pituitary hormone a. at least 50% higher creatinine than baseline within
hypersecretion 1 week
c. A and B only b. reduction in urine output to &lt;0.5 mL/kg per h for
d. Majority are clinically functional longer than 6 h
c. rise from baseline of at least 0.3 mg/dL within 48 h
23. The use of tissue plasminogen activator to restore the d. Rise from a baseline of at least 0.3mg/dl within 72
circulation and arrest the ischemic process can be given up hrs
to how many hours of the first symptom of ischemic stroke?
a. 6 hours 31. Which of the following statements correctly describes
b. 12 hours dexamethasone suppression test?
c. 3 hours a. If cortisol production is autonomous,
d. 4.5 hrs dexamethasone at low doses will suppress ACTH.
b. If cortisol production is driven by an ectopic source
24. This is the most common site of metastasis for colon of ACTH, the tumors are usually resistant to
cancer? dexamethasone suppression.
a. Bone c. If cortisol production is driven by an
b. Adrenal ACTH-producing pituitary adenoma,
c. Liver dexamethasone suppression is effective at low
d. Lungs doses.
d. If plasma cortisol is less than 50 nmol/L at 8-9 AM
25. Typical presentation for patients with left-sided colon cancer? after a 1 mg dexamethasone at 11 PM,
a. Weight loss suppression is demonstrated.
b. Change in caliber of stools 32. Which parameters constitute the warning signs of Dengue?
c. Abdominal pain a. Blurring of vision
d. Anemia b. Mucosal bleed
c. Platelet 80,000 and hematocrit 0.30
26. What is Extensively drug resistant TB? d. Positive tourniquet test
a. Resistance to any fluoroquinolone and to at least
one of the 3 second line injectable drugs 33. Widened pulse pressure is seen in
b. Resistance to both Isoniazid and Rifampicin a. Mitral regurgitation
c. Resistance to one first line drug and one second b. Atrial septal defect
line drug c. Aortic regurgitation
d. Resistance to all first line drugs d. Systemic hypertension

27. Which among the following diseases would cause significant
AKI with azotemia and decrease urine output?
a. Ureteral strictures secondary to genitourinary TB
in a 36 healthy female
b. Unilateral ureteral obstruction of a 35 year old
female without other comorbid condition
c. A 5cm stone in the Left side of kidney in a 69 year
old male
d. Bladder Neck obstruction due to a mass in a 79
year old male
34. A 19 year old girl is being evaluated for absence syndrome.
The physician was able to confirm his impression when the
EEG showed
a. generalized 3Hz spike and wave discharges
b. generalized epileptic polyspikes
c. epileptic discharges from the left temporal lobe
d. random epileptic discharges

KBS ☕ & VIT 🍵

 35. A 23 year old female was referred to endocrine clinic
because of enlarge thyroid, palpitations, weight loss, and
tremors.FT4 was elevated,TSH was low.She is also 12
weeks pregnant. What will be the treatment of choice?
a. Surgery
b. Propylthiouracil
c. Methimazole
d. Radioactive iodine treatment
36. A 23-year-old pregnant woman came to the ER because of
cough, difficulty of breathing and fever of 3 weeks duration.
Diagnosis is Pulmonary TB on chest xray. Which of the
following drug should NOT be given to the patient?
a. Isoniazid
b. Streptomycin
c. Rifampicin
d. Ethambutol
37. A 25 y/o male presented in your clinic with a 5-days history
of fever, myalgia, arthralgia, headache and a generalized
rash. She does not have any history of travel for the past 6
months. She denies any history of wading in flood waters.
However, she reported that there is a creek situated behind
their house. You are considering Dengue infection. What is
the best laboratory test for your patient?
a. Dengue IgG
b. Complete blood count
c. Dengue NS1
d. Dengue IgM
38. A 26 year old female has recurrent focal impaired awareness
seizures and a Cranial MRI was requested to evaluate the
cause. The most common abnormality in this type of seizure
disorder is usually found in the
a. Occipital lobes
b. Parietal lobes
c. Temporal lobe
d. Midline
39. A 27 year old female diagnosed with primary hypothyroidism
was referred to OPD clinic because she is 16 weeks
pregnant. She is currently on Levothyroxine 75 mcg/day.
Which of the following statement is TRUE?
a. Levothyroxine should be stop during the 1st
trimester
b. Levothyroxine dose should be increase during
pregnancy
c. Levothyroxine dose should be maintain throughout
pregnancy
d. Levothyroxine dose should be decrease during
pregnancy
40. A 28-year old male presented with bitemporal hemianopsia.
No polyuria or fatigue. Which of the following is/are present
in prolactinoma?
a. Normal pituitary MRI
b. Elevated prolactin
c. High TSH
d. All of the above
KBS ☕ & VIT 🍵
41. A 35 year old female presents with palpitations, weight loss
and increase in bowel movement. She told you that she
started to experience palpitations about 3 months ago. Past
medical history was unremarkable.Physical Exam showed
BP:120/70 mmHg, CR:116/min, (+) lid lag, (+) hyperreflexia.
Which of the following is true about the case?
a. Treatment of choice is thyroid hormone
replacement
b. Seen predominantly in males, and the very elderly
c. The TSH is suppressed
d. Most common cause worldwide is iodine
deficiency
42. A 35-year-old female sought consult to your clinic due to
amenorrhea with associated weight gain, polyuria, difficulty
climbing the stairs. Pertinent physical findings showed
increased dorsocervical fat pad and violaceous abdominal
striae. You tested for hypercortisolism. Which of the following
laboratory results will increase the likelihood of your clinical
suspicion?
a. Midnight salivary cortisol of 2.5 nmol/L
b. 24-h urinary free cortisol within normal value
c. Plasma cortisol of 130 nmol/L after an overnight
dexamethasone test
d. Midnight plasma cortisol of 75 nmol/L
43. A 35-year-old female with confirmed Conn’s disease came in
to your clinic. You requested for an adrenal CT Scan which
showed a right adrenal mass measuring 1.5 x 2.0 cm. As the
attending physician, what will you advise to this patient?
a. Do a 24-urinary steroid profile
b. Start patient with dexamethasone 0.5 mg/d
c. Refer to a urologist for laparoscopic right
adrenalectomy
d. Refer to an interventional radiologist for an adrenal
vein sampling
44. A 38 year-old female janitress presented at the clinic due to
one month history of intermittent fever and weight loss. She
claims that her mother was previously treated for TB 2 years
ago. On PE, she is febrile at 39C, has clear breath sounds,
with palpable painless masses on the supraclavicular area.
Which is the BEST diagnostic procedure to do at this
moment?
a. chest x ray
b. direct sputum smear microscopy
c. biopsy of the masses
d. tuberculin skin test
45. A 43 y/o male, presented at the ER, with persistent vomiting
on his 6th day of illness. He had a history of fever for 4 days
with generalized body ache. He noted that upon brushing his
teeth, he had minimal gum bleeding. On physical
examination: BP 100/80 mm Hg, HR 90 bpm, 24 cpm and T
37.8 C, in mild respiratory distress. He has epigastric
tenderness and mild hepatomegaly on palpation. How would
you classify the patient?
a. Severe Dengue
b. Dengue with warning signs
c. Dengue without warning signs
d. Mild Dengue
 46. A 45 year old female consulted because of anterior neck
mass noted 4 months ago. She Denies any palpitations,
weight loss nor obstructive symptoms. TSH was normal,
thyroid ultrasound showed a 3 x 2 cm nodule. Which of the
following ultrasonographic finding is suspicious for
malignancy?
a. Wider than tall shape
b. Complex nodule
c. Microcalcification
d. Well-delineated capsule

47. A 65 y/o male known case of prostate cancer was admitted

due to drowsiness. Initial serum Na is 110 mmol/L. What
should be your target serum Na 24 hrs after initiating
correction?
a. 130 mmol/L
b. 135 mmol/L
c. 125 mmol/L
d. 120 mmol/L

48. A 65 year old female diabetic, hypertensive came in to your

clinic due to elevated creatinine of 2.9mg/dl for 4 months
now. Ultrasound showed small size bilateral kidneys with
increased parenchymal echogenicity. What will you advise
the patient?
a. Patient has CKD and treatment with oral
hypoglycemic agent and antihypertensive
medication will prevent progression of CKD
b. Patient has AKI and treatment with
anti-hyperglycemic and antihypertensive agent will
reverse the problem.
c. Patient has an AKI due to elevated creatinine and
will resolve spontaneously
d. Patient has CKD and treatment will reverse
ultrasound findings given strict compliance with
medications

49. A 78 year old male complained of sudden onset of left sided

weakness associated with blurring of vision to the left few
hours he experience slurring of speech. He was immediately
brought to FEU-NRMF Medical Center. Blood pressure was
170/100 cardiac rate 86bpm RR:20cpm. On neuro exam,
patient is dysarthric with 0/5 on the left upper extremities and
4/5 on left lower extremities. What is the computed MAP of
the patient?
a. 125
b. 123
c. 127
d. 120

50. A chronic kidney disease stage 4 patient was admitted due

to a non healing wound. Other than that, he is asymptomatic.
Lab results showed the following: K 5.8 mM, ECG: normal.
What is your initial treatment of choice?
a. Cation exchange resin
b. Intravenous bicarbonate
c. Intravenous regular insulin followed by 50 mL of
50% dextrose
d. Hemodialysis

OCTOBER 2020 EXIT EXAM

KBS ☕ & VIT 🍵

 unremarkable. If the imaging is negative what is the best
scoring system to utilize to predict stroke risk?
a. NIHSS
b. CHADS2
c. ABCD2
d. ICH score
1. ECG diagnosis:
e. None of the above
a. Acute anterior wall myocardial infarction
b. Acute inferior wall myocardial infarction
9. Most common artery affected in spontaneous intracerebral
c. Acute lateral wall myocardial infarction
hemorrhage?
d. Acute right ventricular myocardial infarction
a. Anterior communicating
b. Lenticulo-striate
c. Posterior communicating
d. Middle cerebral (M1 branch)

10. A.F., a 25 y/o male presented in your clinic with a 5-days

history of fever, myalgia, arthralgia, headache and a
2. ECG diagnosis:
generalized rash. She does not have any history of travel for
a. Paroxysmal supraventricular tachycardia
the past 6 months. She denies any history of wading in flood
b. Atrial fibrillation
waters. However, she reported that there is a creek situated
c. Atrial flutter
behind their house. You are considering Dengue infection.
d. Ventricular tachycardia
What is the best laboratory test for your patient?
a. Complete blood count
3. What is the heart rate?
b. Dengue NS1
a. 91/minute
c. Dengue IgM
b. 81/minute
d. Dengue IgG
c. 71/minute
d. 61/minute
11-12 E.D., a 38 years old female janitress presented at the clinic due
to one month history of intermittent fever and weight loss. She claims
4. The greater the heart muscle is stretched during the filling,
that her mother was previously treated for TB 2 years ago. On PE, she
the greater is the force of contraction and the greater the
is febrile at 39C, has clear breath sounds, with palpable painless
quantity of blood pumped into the aorta
masses on the supraclavicular area.
a. Anrep effect
11. Which is the BEST diagnostic procedure to do at this
b. Bowditch phenomenon
moment?
c. Frank Starling mechanism
a. Biopsy of the masses
d. Laplace law
b. Chest x-ray
c. Direct sputum smear microscopy
5. The following are unpaired arteries, except?
d. Tuberculin skin test
a. Superior cerebellar artery
b. Basilar artery
12. What is the treatment for the patient?
c. Anterior communicating artery
a. 2HR/4HRZE
d. Anterior spinal artery
b. 2HR/8HRZE
e. None of the above
c. 4HR/2HRZE
d. 8HR/2HRZE
6. .A 78 year old male complained of sudden onset of left sided
weakness associated with blurring of vision to the left few
13. Which TB patients are most likely to transmit the infection?
hours he experience slurring of speech. He was immediately
a. Smear negative and culture negative pulmonary
brought to FEU-NRMF Medical Center. Blood pressure was
TB
170/100 cardiac rate 86 bpm RR: 20 cpm. On neuro exam,
b. Sputum smear positive positive TB
patient is dysarthric with 0/5 on the left upper extremities and
c. Culture negative extrapulmonary TB
4/5 on left lower extremities. What is the imaging of choice to
d. Culture positive extrapulmonary TB
request?
a. Plain cranial CT scan
14. .Which of the following is the MOST important risk factor for
b. CT scan with contrast
active tuberculosis in patients with TB infection?
c. Cranial MRI with diffusion weighted imaging
a. Age
d. Skull x-ray
b. Chronic renal failure
c. HIV infection
7. What is the computed MAP of the patient?
d. Severely underweight .
a. 120
b. 123
c. 125
d. 127
e. 130
8. A 65 year old came in the emergency room because of
15. Most common clinical presentation of Acute Rheumatic
sudden of slurring of speech however there was resolution of
Fever
symptoms after 2 hours. All the physical examination were
a. Carditis

KBS ☕ & VIT 🍵

 b. Polyarthritis a. Rise from baseline of at least 0.3 mg/dL within
c. Chorea 48H
d. Subcutaneous nodules b. Reduction in urine output to <0.5 mL/kg per h for
longer than 6 h
16. Most common valvular lesion in Acute Rheumatic Fever c. At least 50% higher creatinine than baseline within
a. Mitral stenosis 1 week
b. Aortic stenosis d. Rise from a baseline of at least 0.3mg/dL within 72
c. Mitral regurgitation hrs
d. Aortic regurgitation
25. A 35 year old female sought consult to your clinic due to
17. Duration of secondary prophylaxis for patients with amenorrhea. ROS (+) weight gain, (+) polyuria, (+) difficulty
rheumatic fever with carditis but no residual valvular disease climbing the stairs. Pertinent physical findings showed
a. 5 years after the last attack increased dorsocervical fat pad and violaceous abdominal
b. 10 years after the last attack striae. You tested for hypercortisolism. Which of the following
c. Up to 40 years of age laboratory results will increase the likelihood of your clinical
d. Lifelong suspicion?
a. Midnight plasma cortisol of 75 nmol/L
18. True of abdominal aortic aneurysm b. Plasma cortisol of 130 nmol/L after an overnight
a. More frequent in females than in males dexamethasone test
b. Most are located above the level of the renal c. Midnight salivary cortisol of 2.5 nmol/L
arteries d. 24-h urinary free cortisol within normal value
c. Risk of rupture is 20-40% for aneurysm >5cm in
diameter 26. Which of the following clinical manifestations will distinguish
d. All of the above primary from secondary adrenal insufficiency?
a. Alabaster-like paleness
19. Dissection limited to the ascending aorta b. Hyperpigmentation
a. De Bakey type I c. Hypoandrogenism
b. De Bakey type II d. Eosinophilia
c. De Bakey type III
d. Stanford Type B 27. In the most common form of congenital adrenal hyperplasia,
which of the following hormones is elevated and is used as a
20. Gold standard in the measurement of albuminuria diagnostic marker for this disease?
a. Reagent strip urinalysis a. 11-deoxycortisol
b. 24 hour urine collection b. 18-hydroxy-corticosterone
c. Protein-creatinine ratio c. 17-hydroxy-progesterone
d. Albumin-creatinine ratio d. 5-dihydrotestosterone

21. Antihypertensive drug that have both action on hypertension 28. The most abundant of the anterior pituitary cells:
and proteinuria a. Gonadotropes
a. ACE inhibitor b. Somatotropes
b. Diuretics c. Corticotropes
c. Calcium channel blocker d. Thyrotropes
d. Beta blocker
29. A 38-year-old female was noted to be diabetic and
22. Most common cause of UTI in elderly hypertensive. On examination, her skin is oily with skin tags.
a. Cystitis Which of the following is/are true if acromegaly is
b. Prostatic hypertrophy suspected?
c. Nephrolithiasis a. Elevated IGF-I is confirmatory
d. Urethritis b. Treatment of choice is octreotide
c. Pituitary is the main cause of hormone
23. In Lupus Nephritis the most common clinical sign of renal hypersecretion
disease is: d. None of the above
a. Hematuria
b. Proteinuria 30. Treatment of choice for toxic adenoma:
c. Renal insufficiency a. Surgery
d. Active urine sediment b. Radioactive iodine ablation
c. Medical therapy
d. All of the above

24. Which of the following is NOT correct regarding definition of

AKI? 31. PS, 25 F who underwent total thyroidectomy for multiple
thyroid nodules, complained of numbness around the lips.

KBS ☕ & VIT 🍵

 She also noted spasms of both hands. Tapping her facial bleeding episodes. No follow up done since then. What is the
nerve produced an exaggerated twitching of her orbicularis most likely cause of his anemia?
oris muscle. Treatment of her condition is primarily: a. Iron deficiency
a. Administration of parenteral and oral calcium b. Folate deficiency
b. None, as most conditions resolve within a few c. Vit B 12 deficiency
hours d. Pyridoxine deficiency
c. Administration of loop diuretics
d. Administration of bisphosphonates 40. If the palmar creases are lighter in color than the surrounding
skin when the hand is hyperextended, the hemoglobin level
32. Which of the following is the function of Parathyroid is usually less than
Hormone a. 140 g/L
a. Acts in the bone to facilitate calcium reabsorption b. 120 g/L
b. Acts in the kidney to facilitate calcium excretion c. 100 g/L
c. Acts in the liver to cause calcium resorption d. 80 g/L
d. Enhances synthesis of 1,25 OH Vitamin D in the
intestine 41. A 36-year-old call center agent came in to the clinic due to
cough and difficulty of breathing. Patient is a diagnosed case
33. Anti-diabetic medication which is contraindicated in patients of asthma maintained on Salmeterol + Fluticasone 50/250
with CKD (eGFR <30) mcg, 1 puff 2x a day and was admitted 3 months ago for
a. Insulin exacerbation. Patient claims that she has been coughing
b. Gliclazide with difficulty of breathing for 3 days relieved with daily use
c. Metformin of Salbutamol nebulization and would be sent home by her
d. Linagliptin manager. Based on the GINA guidelines, the patients level of
Asthma control is:
34. How will you treat an in-hospital stress hyperglycemia a. Controlled
a. Metform b. Partly-controlled
b. Sulfonylurea c. Uncontrolled
c. Insulin
d. TZD 42. On physical examination of the patient, vital signs were BP:
120/80 mmHg, CR: 125 beats/min, RR: 30 cycles/min. The
35. How do you assess long term glycemic control patient talks in words with intercostal retractions and
a. Self blood glucose monitoring wheezes. The patient is having
b. FBS a. Mild Asthma Exacerbation
c. OGTT b. Moderate Asthma Exacerbation
d. HgA1c c. Severe Asthma Exacerbation
d. Imminent Respiratory Arrest
36. An indirect measure of the circulating transferrin
a. Iron 43. Which of the following volumes/capacities is/are increased in
b. Ferritin patients with asthma?
c. TIBC a. Residual volume
d. Transferrin receptor protein b. Vital capacity
c. Inspiratory reserve volume
37. WHO defines anemia in women as hemoglobin level d. All of the above
a. <130 g/L
b. <120 g/L 44. Your first strategy in treating an acute asthma attack should
c. <110 g/L be to:
d. <100 g/L a. Block leukotriene receptors
b. Block nicotinic cholinergic receptors
38. The following conditions will present with normal or c. Block muscarinic cholinergic receptors
increased serum ferritin, EXCEPT d. Activated β2-adrenergic receptors
a. Thalassemia e. Activated β1-adrenergic receptors
b. Iron deficiency anemia
c. Myelodysplastic syndrome 45. A 38-year-old male, had several bouts of vomiting and
d. Anemia of Inflammation diarrhea one day after eating shellfish. He noted to be weak
and lethargic when brought to the ER. After initial
assessment, you would expect his laboratories to show
which of the following
a. FeNa > 2%
b. Plasma BUN/Crea ratio > 20
c. Urine specific gravity of 1.010
d. Urine Osmolality of 300 mOsm/KgH2O

39. A 50-year-old male consulted for incidental finding of low 46. A 25-year-old male diagnosed with acute lymphoblastic
hemoglobin on his latest CBC. He underwent a total leukemia had undergone initiation chemotherapy. After two
gastrectomy 5 years ago for BPUD. Patient denied having days, creatinine increased from 1.4 mg/dL to 2.9 mg/dL.

KBS ☕ & VIT 🍵

 Other labs showed K 5.5 mol/L and serum phosphorus of 7
mg/dL. What is the diagnosis?
a. Ischemia associated AKI
b. Interstitial nephritis
c. Rhabdomyolysis
d. Tumor lysis syndrome

47. RBC index that reflects red cell size

a. MCV
b. MCH
c. MCHC
d. RDW

48. A 56 y/o male working in a plastic factory developed anemia,

occasional fever and easy bruising. CBC revealed Hgb 86
g/L, hct 27%, WBC 2.8 with seg 40, lym 60, platelet 67, and
reticulocyte count of 0.3%. Utz of abdomen is unremarkable.
What will be your next step?
a. BMA and Biopsy
b. Hemoglobin electrophoresis
c. Serum iron and serum ferritin
d. Compute for the reticulocyte production index

49. A 20-year-old Filipino female medical student was noted to

have and MCV of 59 fL and anemia of 10 g/dL. Serum ferritin
was 10 ng/mL (NV = 15-100 ng/mL). He has no history of
lead exposure and stool is negative for occult blood. What is
the most likely diagnosis?
a. Iron deficiency anemia
b. Anemia of chronic disease
c. Lead poisoning
d. Thalassemia minor

50. What is the recommended corticosteroid used in COVID 19?

a. Hydrocortisone 200 mg IV OD
b. Hydrocortisone 200 mg LD then 100 mg IV q12
c. Dexamethasone 6 mg IV OD
d. Dexamethasone 6 mg IV q12

USE AT YOUR OWN RISK!

KBS ☕ & VIT 🍵