INTERNAL MEDICINE 13.

Which event occurs in Cardiogenic Shock in the

Preliminary Examinations Systolic Dysfunction Pathway?
AY 2015 – 2016, First Semester - COMPENSATORY VASOCONSTRICTION
- PAGE 1759

The pages indicated for the answers or rationale in some

items are from Harrison’s Principles of Internal
Medicine, 19th Edition.

7. Which of the following is true of septic shock?

- BOTH
- For severe or prolonged hypovolemia: inotropes after
restoring the blood volume (use of PNSS, give 2-3 L in
the next 20-30 minutes)
- Blood Transfusion: given at hemoglobin of less than
10mg/dL; the blood bag should be less than 2 weeks
- Transfusion of Blood Components: pRBC, FFP
- If the patient is stable not transfuse when hemoglobin
is less than 7mg/dL

8. A hypertensive smoker of 7 pack years was seen at the

ER due to sudden chest pain, difficulty of breathing, was
diaphoretic, BP-90/palpatory; pale looking, tracheal 14. In what percentage of cases does left ventricular failure
deviation to the right, decreased breath sounds accounts for in cardiogenic shock that complicates acute
appreciated on the left and heart sound hardly appreciated MI:
on the left chest wall. What is the diagnostic procedure of - 80%
choice to determine the pathology? - PAGE 1759
- CHEST X-RAY
15. The first line of treatment for acute cardiogenic
9. This is a classic case of: pulmonary edema.
- TRAUMATIC SHOCK - NITROGLYCERIN SUBLINGUAL
- given at 0.4 mg x 3 every 5 minutes
10. Management of the above case: - stable at more than 100mg/dL: given nitroglycerin
- VOLUME EXPANDERS, CHEST DECOMPRESSION intravenously
USING A CHEST TUBE - PAGE 1763

11. Component of cardiogenic shock due to severe 16. Global ischemia due to severe left main stenosis is
depression of cardiac index when it is: usually seen in the electrocardiography as:
- <2.2L/MIN/M2 - MORE THAN 3 MM ST DEPRESSION IN MULTIPOINT
- Take the systolic BP at rest, then during inspiration. LEADS
Note if the difference is >10mmHg: PULSUS - PAGE 1760
PARADOXUS
17. Pulmonary edema due to cardiogenic shock is caused
12. Which event occurs in Cardiogenic Shock in the by:
Diastolic Dysfunction Pathway? - INCREASED SVR
- INCREASED LEFT VENTRICULAR END DIASTOLIC
PRESSURE
- PAGE 1759
18. LV failure in cardiogenic shock is characterized by the 29. Effective retroviral therapy is marked by:
following EXCEPT: - <50 COPIES PER ML
- SYSTEMIC VASCULAR RESISTANCE WITH
PULMONARY VASCULAR RESISTANCE IS 30. An American tourist had a recent history of unprotected
INCREASED sexual intercourse. What is the best indicator if he has
contracted the disease?
19. Intraaortic Ballon Pump operates during what phase of - VIRAL LOAD
the cardiac cycle:
- DURING EARLY DIASTOLE 31. Male, HIV screening using ELISA revealed him to be
- sausage shaped balloon reactive, but the Western blot was indeterminate. What
- inflates during EARLY DIASTOLE to augment should be advised to the patient?
coronary blood flow (it is during diastole that the - REPEAT WESTERN BLOT IN 4-6 WEEKS
coronary arteries receive blood) - PAGE 1246

20. This can help differentiate cardiogenic and non 32. What is the average rate of decline per year of CD4+ T
cardiogenic cause of pulmonary edema: cells when no symptoms are observed in a patient?
- SWAN GANZ CATHETER - 50 uL/YEAR
- PAGE 1763 - PAGE 1250

21. A 24-year old primigravid went to your clinic. She had 33. Prophylaxis against Cryptococcus neoformans may be
HIV for a year but did not consult. What is the best discontinued if the CD4+ T cell count of the patient is:
diagnostic tool for the infant to determine infection with - >100/uL for 3 MONTHS
HIV? - PAGE 1252
- POLYMERASE CHAIN REACTION (PCR)
34. The most common finding on a chest X-ray film of
22. Primary determinant of the risk of HIV transmission: patients with Pneumocystis carinii pneumonia:
- VIRAL LOAD - NORMAL CHEST X-RAY
- PAGE 1253
23. HIV transmission is characterized by:
- MALE CIRCUMCISION CONFERS LOWER RISK 35. Which of the following is true of TB infection in patients
with HIV-AIDS?
24. Body fluid that is least infectious in patients with HIV: - TB IS PRIMARY CAUSE OF DEATH
- URINE - PAGE 1254
- To date, there is no evidence that HIV transmission
can occur as a result of exposure to tears, sweat, or 36. Most common form of syphilis:
urine. - CONDYLOMA LATA
- PAGE 1223
37. What is the hallmark of HIV nephropathy?
25. It is very unlikely that mother-to-child transmission will - PROTEINURIA
occur if the mother’s level of plasma viremia is: - PAGE 1259
- 1000 COPIES PER ML
- It is extremely unlikely if the level is undetectable (<50 38. Which of the following is TRUE about the Immune
copies/mL). Reconstitution Inflammatory Syndrome (IRIS)?
- PAGE 1223 - CAN BE FATAL
- PAGE 1261
26. Which of the following blood products will least likely
transmit HIV? 39. Fever, generalized seizure, headache, (+) Indian ink.
- HYPERIMMUNE GAMMA GLOBULIN These are signs of what disease associated with
- It has been found out that hyperimmune gamma HIV/AIDS?
globulin, hepatitis B immune globulin, plasma-derived - CRYPTOCOCCAL MENINGITIS
hepatitis B vaccine, and Rho immune globulin have - PAGE 1264
NOT been associated with transmission of HIV
infection. 40. [Question is NOT audible.]
- PAGE 1222 - AMPHOTERICIN B + FLUCYTOSINE

27. Viral disease characterized by pharyngitis, 40. EBV can cause which of the following malignancies?
splenomegaly, and lymphadenopathy: - LYMPHOMA
- EBV
41. Risk for osteomyelitis is highest in which of the
28. [Question in the recording is not clear.] Complication of following:
EBV that leads to upper airway obstruction: - HISTORY OF DM
- LYMPHOID TISSUE HYPERPLASIA
42. Common pathogen of osteomyelitis: 59. Not transmitted from person to person:
- STAPHYLOCOCCUS AUREUS - DENGUE

43. Drug of choice for methicillin-resistant Staphylococcus 60. Most viral fevers EXCEPT:
aureus (MRSA): - DENGUE
- VANCOMYCIN
61. No fever:
44. Osteomyelitis caused by Pseudomonas aeruginosa - USE OF GLUCOCORTICOIDS
responds to what class of antibacterial drugs?
- FLUOROQUINOLONE 62. Male, collapse, bystander, not breathing, no pulse.
What is the sequence of the Basic Life Support?
45. Epidural abscesses may be best viewed through the - CAB (Compressions, Airway, Breathing)
use of what diagnostic modality:
- MRI 63. Depth of the compressions must be:
- AT LEAST 2 INCHES DEEP
46. Chest X-ray revealed bowel perforation with peritonitis.
What is the possible diagnosis? 64. The patient above was revived after three cycles, with
- PNEUMOPERITONEUM stable pulse and with spontaneous breathing. He was
- The hallmark of this condition is the presence of brought to nearest hospital. This step in the life support
radiolucency under the diaphragm. cycle pertains to:
- EARLY ADVANCED CARE
47. A chronic alcoholic male had an abdomen with
generalized tenderness. What is the most likely condition 65. This refers to one hour or less following acute changes
present? to cardiovascular status:
- PRIMARY BACTERIAL PERITONITIS - ONSET OF THE TERMINAL EVENT
- PAGE 846 - should be PRODROME

49. Splenic abscesses are best viewed using what 66. The rhythm most commonly associated with cardiac
diagnostic modality? arrest:
- CT SCAN - VENTRICULAR FIBRILLATION
- PAGE 851
67. Lost consciousness, no pulse, no spontaneous
51. A tourist went to visit the Cordillera Mountains. Two (2) breathing:
weeks later: high grade fever with headache and body - 1 BREATH EVERY 5-6 SECONDS
weakness. What is the most likely diagnosis?
- MALARIA 68. The defibrillator attached to the patient above indicates
that a shock is needed. What is the next step?
52. What is the most prominent risk factor in the case - DO A DEFIBRILLATION
above?
- HISTORY OF TRAVEL 69. Changes in sensorium – AML with severe headache
and obtundation. Management include EXCEPT:
53. What diagnostic test will best confirm the diagnosis? - TRANSFUSION (MAY LEAD TO A BLAST CRISIS)
- BLOOD SMEAR
70. Breast CA, admitted due to cough and fever,
54. Howell-Jolly bodies are found in what condition? pneumonia, Gram positive cocci. Management include
- ASPLENIA EXCEPT:
- CEFTAZIDIME
55. Treatment for Septic Shock include:
- VANCOMYCIN + GENTAMYCIN + PIPERACILLIN- 71. Irritant reproductive cough, infiltrates on the basal lung
TAZOBACTAM field, ground glass appearance, PFT:
- INTERSTITIAL LUNG DISEASE
56. This disease caused by Staphylococcus aureus, - This is due to imatinib.
associated with retained nasal packings, is due to
liberation of TSST-1: 72. Hodgkin’s lymphoma, rituximab, hypersensitivity
- TOXIC SHOCK SYNDROME reaction:
- GIVE HYDROCORTISONE
57. Which of the following is the most common causes of
community-acquired pneumonia? 73. Treatment for SCC, severe pain of both knees:
- STREP PNEUMONIA - TUMOR LYSIS SYNDROME: HYPERURICEMIA

58. Hantavirus: 74. Back pain and severe paresthesia, cauda equina
- BUNYAVIRUS syndrome. Manifestations include EXCEPT:
- SPASTIC REFLEXES
 92. The definition of Elimination of a disease in vaccination:
75. Pericardial effusion, SCC of the lungs, gold standard - REDUCE INDIGENOUS TRANSMISSION OF AN
for determining malignant pericardial effusion: INFECTION IN A GEOGRAPHIC AREA
- BIOPSY
93. Increase in vaccine preventable diseases
76. Superior VC Syndrome. The most common cause of - ALL OF THE ABOVE
SVC Syndrome is:
- LUNG CANCER 94. Which of the following is true?
- next: lymphoma - PARENTERAL VACCINES ARE NOT EFFECTIVE BY
MUCOSAL ADMINISTRATION
77. SC Compression:
- THORACIC MOST COMMON 95. DISCARDED
- CERVICAL LEAST COMMON
96. A patient was bitten by a rabid dog. Which of the
78. SC Compression: following should be given as part of post-exposure
- UNKNOWN ETIOLOGY prophylaxis?
- TREATMENT FAILURE - RABIES IMMUNOGLOBULIN, RABIES VACCINE,
- PROGRESSIVE WORSENING TETANUS TOXOID

79. HSV mode of infection: 97. Adult less than 18 years

- DIRECT INOCULATION TO THE SKIN - ALL OF THE ABOVE

80. Herpes Simplex infection in health care workers, 98. Which of the following is true regarding adult
usually manifests at the fingertips: vaccination:
- HERPETIC WHITLOW - FOR VARICELLA VACCINE, THOSE WITH NO
EVIDENCE OF IMMUNITY, GIVE TWO DOSES
81. Central eschar and proximal adenopathy:
- RIKETTSIA AKARI 99.
- ALL OF THE ABOVE
82. Presence of gummas:
- TERTIARY SYPHILIS 100. True of vaccination:
- PREMATURE INFANTS MAY BE VACCINATED
83. Gas gangrene, failed abortion:
- CLOSTRIDIUM SEPTICUM 101. Immunocompromised individual
- ALL OF THE ABOVE
84. Gas is seen on X-ray. What antibiotics are the best
choice for the management of the patient? 102. Given to travelers:
- AMPICILLIN, CLINDAMYCIN, CIPROFLOXACIN - INFLUENZA AND PNEUMOCOCCAL

85. Variola, varicella are similar in that the rashes are: 103. Pregnancy
- VESICLES AND OTHERS OCCUR AT ROUGHLY THE - DISCARDED
SAME TIME
104. Open Cholecystectomy. The most common causative
86. Bartonella causes what disease condition? agent of intra-abdominal abscess:
- VERRUCA PERUANA - STREPTOCOCCUS

87. Erythematous reaction with well defined margin 105. Best intervention to prevent healthcare-associated
- ERYSIPELAS infections (HAI):
- 70% ALCOHOL HAND RUB
88. The following are Gram-negative bacilli EXCEPT:
- ERYSIPELOTHRIX RHUSOPATHIAE 106.
- This is a Gram-positive bacilli. - STAPH

89. 107. When is the best time to administer antimicrobial

- TOXINS, IMMUNOSUPPRESANT prophylaxis in surgery:
- 1 HOUR PRIOR TO SKIN INCISION
90. Target population includes
- 108. A patient with an in-dwelling Foley catheter has
septicemia. The catheter was identified as the source of
91. infection. Management will include:
- BEST IS TO REMOVE THE CATHETER
109.
- STREPTOCOCCUS

110. Vascular device associated:

- CONS (Coagulase-Negative Staphylococcus aureus)

111. BKA, high grade fever, increased tenderness

- GAS

112. Infected vascular catheter. Best management:

- REMOVE

113. HSCT 7months prior to consultation, maculopapular

rash:
- VARICELLA

114. Stem cell transplant, was on BS antibiotics:

- CANDIDA

115. Infections in transplant patients:

- SOLID ORGANS > HSCT; LONGER TIME DURATION