FIRST SEMESTER PRELIMS

1. A 70-year old Filipina female denies hypertension, diabetes, surgery, and does not take medications. She is a smoker of 50 pack
years, has no environmental exposure, is obese, and is strongly suspected of breast cancer. What is the most significant risk factor?
Ans: Age

2. What is the most reliable diagnosis for cancer?

Ans: Invasive tissue biopsy

3. 55 year old male, diagnosed of colonic cancer presented with a Karnoffsky performance index of 70. What is the functional
capability?
Ans: Cares for self, unable to do active work

4. What is the tumor marker for adenocarcinoma of the breast, pancreas, lung and ovary?
Ans: CEA

5. Non-neoplastic condition related to the elevation of CEA.

Ans: Smoking

6. Pathologic staging includes:

Intraoperative palpation

7. 49-yr old female who is treated with complete chemotherapy one year ago comes to the clinic for follow-up. Chest x-ray shows
solitary lung nodule and CT-scan revealed a probable metastatic lesion of the lung hilum. What is the patient’s level of response to the
treatment?
Ans: Progressive disease

8. First drug of choice for pleural effusion secondary to malignancy.

Ans: Doxycycline

9. The ideal Karnoffsky performance for cancer who underwent the stress of treatment should be at least?
Ans: 70

10. The highest number of cancer cases is in?

Ans: Asia

11. The most common paraneoplastic endocrine syndrome includes?

Ans: Cushing’s Syndrome from ectopic ACTH

12. 45-year old female with history of breast cancer complains of fatigue. Abdominal x-ray revealed nephrolithiasis. What IV fluid
would you recommend?
Ans: PNSS

13. The most common cause of ectopic vasopressin production leading to SIADH?
Ans: Small cell lung carcinoma

14. One of the following is true regarding treatment of hyponatremia in paraneoplastic syndrome:
Ans: Rapid correction of hyponatremia can lead to central pontine myelinosis

15. The foundation of history taking is:

Ans: Rapport

16. When inviting the patient’s history, you may use this type of question initially:
Ans: Open-ended questions

17. OLDCART or PQRST is a guide for:

Ans: The 7 attributes of a symptom

18. The CAGE questionnaire is used for?

Ans: Alcoholism
19. The following comprises the element in history taking, except:
Ans: Uncover problems unrelated to the present illness

20. One of the following is not a component of the past health history:
Ans: Similar symptoms and illnesses in the family

21. The defined database, problem list, and initial plans are all components of:
Ans: Problem-Oriented Medical Record (POMR)

22. The history of patient illness should not include one of the following:
Ans: Uncover illnesses other than the primary problem

23. The defined database, problem list, and initial plans are all components of:
Ans: Problem-Oriented Medical Record (POMR)

24. One of the following is not an attribute of a symptom:

Ans: Reliability

25. Subjective data includes:

Ans: Headache
26. One of the following is not a component of the past health history:
Ans: Similar symptoms and illnesses in the family

27. The physical exam should be all of the following, except:

Ans: Subjective

28. Clinical assessment involves:

Ans: Primary diagnosis

29. Advising complete bed rest in a patient with ischemic heart disease is included in the:
Ans: Plans

30. One of the following is an objective data:

Ans: Blood pressure of 110/70

31. When making the plan of management for the patient, the physician should:
Ans: Consider the patient’s feelings especially his fear of the problem

32. Comprehensive examination:

Ans: Provides baseline for future studies

33. 75 year old man was rushed to the emergency room. After suffering from massive burns, he suffered 3 rd degree burns of the head,
face, anterior and posterior chest, both upper extremities, and right thigh. He is awake, obeys and follows command, BP: 140/100,
HR: 120, RR: 20, T: 37.8C, weight of 50 lbs., height of 150 cms. He was placed on NPO then IV medications and burn treatment were
started. What are the factors that may predispose this man to develop malnutrition?
Ans: Age, weight, presence of burns, and being placed on NPO

34. What physiologic factors are currently occurring at this stage?

Ans: Increased metabolic rate by 110%, increased glucagon, increased protein loss of 175gms/day, and increased cortisol

35. After 3 days in the burn unit, the patient was stabilized. However, due to inhalation injuries, the patient cannot tolerate oral
feeding. Calculate his BEE
Ans: 625.24kcal/day (Factor of 1.4 is used)

36. Laboratory examination revealed the following: serum albumin: 3, TIBC: 198 creatinine: 0.5, with a 24 hour urinary urea nitrogen
of 60. Your interpretation should be:
Ans: Compromised protein status on a severely catabolic patient

37. After having computed for the energy requirement, you start TPN. After 7 days, you noticed pedal edema, hepatomegaly, and
poor wound healing. The decreased nutrient deficiency is:
Ans: Protein
38. A patient presented with heart failure and neurologic manifestations. The most likely nutrient deficiency is:
Ans: Thiamine

39. This patient remained in the hospital for 21 days. He has been shifted to oral meals on the 14 th day and can eat on his own and a
repeat blood test shows serum albumin: 3, TIBC: 250, creatinine: 0.6, with a 24 hour urinary urea nitrogen of 30. Your interpretation
is:
Ans: Same protein status but with improving protein balance

40. You are assigned in the malnutrition ward and your task is to measure patients anthropometrically. There are a lot of malnourished
children. What is your diagnostic for determining a marasmic child?
Ans: TSF of <3mm and mid-arm circumference of <15cm

41. Those who have low albumin can receive the following, except:
Ans: Whole blood transfusion

42. It measures body fat content among people who have problems with weight:
Ans: TSF (Triceps Skin Fold)

43. Sir John Snow was brought to the emergency room and he got his temperature set at 28C. What are the physiologic changes for a
patient with such temperature?
Ans: Hallucination, hyporeflexia, progressive depression, low level of consciousness

44. The following characteristics identifies a superficial frostbite when comparing to deep frostbite:
Ans: Rolling of dermis over bony prominences

45. This disease is common among children 3-12 years old ma nifesting as mild fever, arthritis, and rash usually bright red on the
cheeks followed by a lacy vesicular rash. It fades in 3 weeks:
Ans: Erythema infectiosum

46. This rash presents with fever, nodules, throat infection, and the presence of annular patches or plaques occurring as polycyclic
lesions:
Ans: Erythema marginatum

47. This condition appears as fever, scaly, papular eruptions on the palms and soles:
Ans: Secondary syphilis

48. A primary lesion seen among children marked by vesiculopustular lesions on mucosal surfaces:
Ans: Primary Herpes Simplex Virus Infection

49. The following are treatment options among patients diagnosed with nosocomial FUO, except:
Ans: None of the above

50. Presence of this compound increases directly the hypothalamic set-point causing fever:
Ans: Prostaglandin E2
51. As the hypothalamic set-point is increased in fever, the following physiologic changes occur in the body, except:
Ans: Peripheral vasodilation of the blood vessels

52. BONUS Hyperthermia is different from fever

53. One of the following is not true on the effects of some anti-pyretic agents in the reduction of fever:
Ans: Acetaminophen activates COX-2, thus, decreasing the development of fever

54. Compute for the BMI of a patient weighing 60 kgs. with a height of 5’3”.
Ans: 23.4

55. The BMI of the above patient is:

Ans: Normal

56. The patient was rushed to the ER, noted to be sleepy, yet when called, opens his eyes and answers some question then returns
back to sleep again. The patient is:
Ans: Lethargic

57. A 65 year old hypertensive patient was sitting in the ER with a BP of 140/85. What would you do?
Ans: 2 answers - None (Normal because the cut-off is 140/90); Strictly advise weight loss and BP control.

58. The following procedures are correct in the measurement of the blood pressure, except:
Ans: Position the arm so that the brachial artery is below the heart level

59. The following conditions may be present in a patient whose pulse rate is >120 bpm with a regular rhythm, except:
Ans: 2nd Degree AV Block

60. Shallow breathing is called:

Ans: Hypopnea

61. A friend from States asked about his temperature of 98.6 degrees Fahrenheit. It is:
Ans: Normal

62. A fever with no normal readings with a diurnal variation of more than 1.1C is called:
Ans: Remittent Fever

63. Pain related to tissue damage is called:

Ans: Nociceptive Pain

64. Which of the following is/are primary nociceptors:

Ans: A-beta and A-delta fibers

65. A type of pain that has unusual burning, tingling, or shock-like quality and can be triggered by a very light touch:
Ans: Neuropathic pain

66. The most common emotional disturbance in patients with chronic pain:
Ans: Depression

67. It is a painful response to a non-painful stimuli:

Ans: Allodynia

68. The essential first step in evualuating acute, new onset headache:
Ans: Neurologic Evaluation

69. The following statements are true, except:

Ans: Brain tumor is a cause of headache and only causes severe pain

70. A 21 year old male was brought to the ER complaining of acute, severe headache characterized as pounding, with nausea and
vomiting. Pain is accentuated when he moves his eyes. Upon examination, his BP is 120/90, CR of 150, RR of 20, and the neck was stiff.
The possible cause of the headache is?
Ans: Meningitis

71. In connection to the above question, which of the following is mandatory?

Ans: Lumbar tap

72. A 65 year old female is complaining of bilateral headache which is more severe on the left which was gradual in onset. Peaking
intensely over a few hours, it is described as dull, boring pain with superimposed stabbing pain. The headache was worse during night
time especially when staying in an airconditioned room. She complains of tenderness in the scalp and on examination the patient was
noted to be febrile. What is the most probable diagnosis?
Ans: Giant cell arteritis
73. A 30 year old female came to the clinic due to on and off left-sided headache which was described as throbbing, sometimes with
light-headedness and scalp tenderness. Most of the time, it is associated with nausea and vomiting with visual disturbances. It is
triggered while watching movie and lately the attacks became more frequent due to lack of sleep. The most possible cause of headache
is?
Ans: Migraine

74. 50 year old male came to the clinic due to unilateral headache for the last 4 weeks. The headache usually occurs at night with 1 or
2 attacks lately and one of the attacks usually occur at the same hour each day. It was described as excruciating pain, non-fluctuating,
and during attack, it is accompanied by unilateral lacrimation, rhinorrhea, and nasal congestion. What is the probable diagnosis?
Ans: Cluster Headache

75. Which of the following is/are common characteristics of trigeminal autonomic cephalalgia?
Ans: All of the above

76. It is the anterior slippage of the vertebral body, pedicles, superior and inferior facets. Leaving the posterior elements behind, may
be asymptomatic or may cause low back pain and hamstring tightness.
Ans: Spondylolisthesis

77. Which of the following is/are indications for surgery among patients with lumbar disc disease?
Ans: All of the above

78. Which of the following is/are manifestations of a multiple lumbosacral nerve injury within the spinal canal?
Ans: D - B and C only (Doc did not dictate the statements in those letters)

79. A 35 year old male complained of progressive low back pain accompanied with morning stiffness and unrelieved by rest. Laboratory
work-up showed elevated ESR and imaging studies showed sclerosis of the sacroiliac joint. What is the probable cause of the low back
pain?
Ans: Ankylosing spondylitis

80. This causes neck pain, radiating to the back of the head, shoulder, and arms and the source of headache came from the posterior
occipital region. Pathologic findings include osteophytes, dysprotrusion and hypertrophic facets.
Ans: Cervical spondylosis

81. The following causes abdominal pain due to parietal peritoneal inflammation, except:
Ans: Vascular rupture

82. True regarding obstruction of the hollow viscera, except:

Ans: Pain is usually well-localized

83. Which of the following is/are intrathoracic diseases that often maculates as abdominal emergencies ?
Ans: All of the above

84. A 75 year old male, known hypertensive, suddenly complains of unrelenting chest pain described as a ripping sensation radiating
to the back between the shoulder blades. This is caused by:
Ans: Aortic dissection

85. A 25 year old male complained of retrosternal pressure and 12 lead ECG was done which revealed to be within normal limits. He
was given anti-anginal therapy and was relieved. What is the cause of the chest pain?
Ans: Esophageal spasm

86. A 60 year old female, hypertensive, complained of on-and-off chest pain lasting for 5 - 10 minutes and is described as retrosternal
tightness. Exercise stress test was done showing significant ST segment changes. Coronary arteriography was done and was
unremarkable. These findings are compatible with?
Ans: Cardiac X Syndrome

87. A 45 year old male, recently diagnosed with DVT, suddenly complained of severe, pleuritic chest located substernally. He is also
hypotensive, dyspneic, and tachycardic. The probable cause is:
Ans: Pulmonary embolism

88. Which of the following tests will support the diagnosis regarding the question above?
Ans: D-dimer Test
89. It is the most widely used method to gauge obesity.
Ans: BMI

90. The following statements are true regarding obesity:

Ans: Energy expenditure increases as the individual gets more obese.

91. Obesity in male is associated with a higher mortality from cancer which includes the following:
Ans: Gallbladder

92. Which of the following increases the risk of pulmonary diseases from obese individuals?
Ans: All of the above

93. Which of the following is/are best predictor of cardiovascular diseases?

Ans: BMI of 40

94. Insulin resistance is increased in which of the following?

Ans: E - B and C only (Intraabdominal fat and Acanthosis negrigans)

95. BMI of 30 is considered as:

Ans: Obesity I

96. Which of the following drugs induce weight gain?

Ans: D - A and B only (Sulfonylurea and Lithium)

97. Which of the most commonly preferred and acceptable bypass procedures is used in the treatment of obesity?
Ans: Rouen-Y Gastric Bypass

98. Weight loss in older persons is associated with a variety of deleterious effects which include the following:
Ans: All of the above

99. The following are age-associated physiologic changes that predisposes elderly persons to weight loss:
Ans: D - A and C only ( Reduced efficiency of chewing; Declining chemosensory)

100. A quarter of individuals with involuntary weight loss are caused by:
Ans: Malignant neoplasm

101. Which of the following statements is/are true regarding EPO?

Ans: D - A and B only (EPO is produced in the renal peritubular capillary lining cells; Fundamental stimulus for production is the
availability of O2.)

102. The following statements are true regarding anemia, except:

Ans: E - C and D only (Only present with advanced signs and symptoms; In acute blood loss, hemoglobin and hematocrit levels
reflect the volume of blood loss.)

103. Which of the following reflects the defect in hemoglobin synthesis?

Ans: D - B and C only (MCH; MCHC)

104. What is the absolute reticulocyte count in a patient with a hemoglobin of 9, hematocrit of 27, and reticulocyte of 8?
Ans: 4.8

105. A 50 year old male complains of easy fatigability and on-and-off dizziness. Hemoglobin was recorded at 7.5, hematocrit of 23,
and reticulocyte count of 9. What is the probable cause of anemia?
Ans: D - A and B (Marrow production defect; Red cell maturation defect)

106. If the reticulocyte production index is more than 2.5, which of the following will be considered as the probable cause of anemia?
Ans: Hemoglobinopathy

107. Which of the following indirectly measures the transferrin level:

Ans: TIBC
108. Which of the following is/are manifestations of polycythemia?
Ans: All of the above

109. A 60 year old male with a hemoglobin of 175 is diagnosed of polycythemia. RBC mass was elevated. What will be your next step
to arrive at a diagnosis?
Ans: Measure the EPO level.

110. A 45 year old smoker presented with polycythemia and measurement of EPO was low. He has a palpable spleen on the left costal
margin. What is the probable diagnosis?
Ans: Polycythemia vera

111. In fibrin clot formation, coagulation is externally initiated by:

Ans: Tissue Factor exposure

112. It is the major protease enzyme of the fibrinolytic system acting to digest fibrin to fibrin degradation products.
Ans: Plasmin

113. Hemarthrosis and spontaneous muscle hematoma are characteristics of:

Ans: D - B and C only (Factor VII and IX deficiency; Fibrinogen deficiency)

114. A patient was scheduled to undergo elective major surgery. He is presently taking aspirin 80mg for one year now. To avoid major
bleeding following surgery, aspirin should be stopped for how many days?
Ans: 7 days

115. Which of the following test assesses the Vitamin K dependent clotting factors?
Ans: PT time

116. True regarding imaging studies

Ans: D - A and B only (Doc failed to mention the statements also)

117. True regarding lymphadenopathy.

Ans: All of the above

118. Which of the following is/are indications for splenectomy?

Ans: All of the above

119. Which of the following vaccines should be given in a splenectomized patient?

Ans: All of the above

120. A patient with neutropenia can be given the following:

Ans: All of the above

FIRST SEMESTER MIDTERMS

1. One of the following is not a characteristic of parasympathetic..?
A. Excitatory to the whole GIT

2. 40y/o man, presents diarrhea in the ER <1 day duration, with fever = 38C, no signs of dehydration.
C. Observe the patient
3. Diarrhea due to Caribbean cruise
B. Norovirus

4. 24y/o female, diarrhea with 1 month duration, using laxative to control weight, but BMI is 21kg/m2, and thinks she is overweight.
what is the cause of diarrhea?
D. all of the above (factitial, secretory diarrhea due to laxative, & osmotic diarrhea)

5.21 y/o 2nd year med student, with diarrhea 5 months duration, abdominal pain relieved by defecation, stool is small, and there is
sense of incomplete evacuation, with stress that is due to increased in study load.
A. Irritable bowel syndrome

6. 44y/o, G4P4, presents with constipation. upon rectal exam, there is no fissure or mass but unable to push out examining finger
B. Pelvic floor dysfunction

7. No fever, no abdominal pain

C. Pseudodiarrhea

8.80y/o male veteran, in nursing home, rushed to hospital due to diarrhea. Suspects infectious diarrhea due to:
A. clostridium difficile

9. 60y/o alcoholic with chronic diarrhea that persists even with fasting
A. Enterocyte injury

10. Treatment options for 1 month pregnant patient with diarrhea

Fluids and antifungal medication

11.Rushed to ER due to watery diarrhea, thirst, lack of appetitie, PR=110bpm, BP=80/60, with skin tenting
C. Severe dehydration

12. Daycare center

Giardia Lablia

13. Not a characteristic of oral phase of swallowing

A. Characterized by elevation of larynx

14. BONUS

15. This is characterized by hoarseness…and pharyngeal propulsion..

B. oropharyngeal phase dysphagia

16. This is characteristic by dysphagia.. skin changes and pancirrhosis

A. systemic sclerosis

17. Solid and liquid dysphagia due to an abnormality with the LES
C. achalasia

18. Common radiologic finding with patients being asymptomatic from any dysphagia would be presence of the
C. cricopharyngeal bar

19. In getting a history of a patient complaining of dysphagia, what factors would you consider in leading you to a possible diagnosis
A. localization
B. associated symptoms
C. type of food
D. All of the Above

20. One of the following is not a characteristic of the esophagus

A. the cervical portion is innervated by the vagus nerve
B. the thoracic portion is composed of your smooth muscle and the upper esophagus sphincter is intrinsically closed at rest due to
its inherent and elastic properties

21. The excitatory neurotransmitter of the distal esophagus is your

A. substance P

22. One of the following does not cause dysphagia to solid and liquid food..
A. achalasia
B. caustic injury
C. scleroderma
D. esophageal spasms
23. Which of the following is the most common cause of upper GI bleeding?
B. peptic ulcer

24. True regarding institution of proton pump inhibitor therapy at presentation if all patient of upper GI bleeding
A. to decrease high risk ulcer characteristic

25. Which of the following is/are preventive strategy/ies for rebleeding in a bleeding ulcer
A. eradication of H. pylori

26. -27 Case: A 50-year old male, hypertensive, known alcoholic seen on the ER due to massive hematemesis. he was pale-looking,
BP – 90/60? PR – 120 RR – 24,PE revealed palmar erythema, spider angioma, & gynecomastia. The most probable cause of GI
bleeding
B. esophageal varices

How will you manage this patient with active bleeding?

A. endoscopic therapy
B. octreotide infusion
C. transjugular
D. A and B only

28. The following is/are true regarding stress-related gastric mucosal injury
A. it only occur in extremely sick patients
B. significant bleeding develops when ulceration occurs
C. thermacologic prophylaxis for bleeding may be considered in high risk patients and it may decrease bleeding and lower mortality
rate
D. A and B only

29. Which of the following causes significant lower GI bleeding in patients >50-60 years of age?
A. NSAIDs induced lesions
B. Vascular Ectasias
C. Adenocarcinoma of the small bowel
D. A & B only

30. Which of the following is/are associated with hematochezia due to Upper GI Bleeding (UGIB)?
A. Hemodynamic instability
B. Elevated blood urea nitrogen (BUN)
C. Bloody nasogastric aspirate should always be present (sometimes when you check NGT there isn’t any)
D. A & B only

Case for 31 & 32

45 year old female seen at the ER due to dizziness and body malaise. There is positive fresh blood per rectum… On examination BP
70/60 Pulse 130 RR 24. Hemodynamic stabilization was successful.

31. Which of the following procedures should be done 1st to identify the cause and start treatment.
A. Endoscopy 1st, then colonoscopy (For actively bleeding patients)

32. Assuming bleeding persisted, which of the following procedures can be done.
A. Angiography
B. Enteroscopy
D. A & B only

33. Which of the following is NOT TRUE regarding abdominal enlargement?

A. Abdominal pain and swelling frequently the result of intra-abdominal infection and inflammation.
B. Abdominal pain is more often than abdominal discomfort
C. New onset of inguinal or umbilical hernia
D. Abdominal distension from ascites
34. Which of the following will cause abdominal distention ..?
A. Impaired intestinal transit of gas

35 & 36 Case
A 60 year old German national with poly… Seen at the ER due to abdominal enlargement. There is tensely, distended abdomen with
bulging flanks and everted umbilicus.

35. The possible cause of the abdominal distention is

C. Ascites

36. Assuming a prominent abdominal venous pattern were noted and upon examination the flow is away from the umbilicus. Which
of the following condition(s) is likely to be considered?
C. Portal Hypertension

37. Upon auscultation of the abdomen a harsh bruit was heard over the right upper quadrant. Which of the following can be
present?
A. Hepatocellular CA
B. Alcoholic hepatitis
D. A & B only

38. If a right upper quadrant pulsation was appreciated which of the following should be considered?
C. Right tricuspid insufficiency

39. What would you expect regarding radiologic findings if abdominal Xray was done?
B. Haziness with loss of psoas margin

40. Blood work was done and there was low platelet count, prolongation of prothrombin time, lower serum albumin. Which of the
following should be considered?
C. Cirrhosis

41. 40 year old male underwent paracentesis due to ascites. Which of the following tests is needed to complete the SAAG (serum
ascites albumin gradient)?
A. Ascitic fluid albumin level
B. Serum albumin level
D. A & B only

42. The completed SAAG ratio is 1.1 g/dL. The possible cause of the ascites would be
A. Cirrhosis
B. Cardiac ascites
D. A & B only

43. A patient came for paracentesis complained of fever, nausea, vomiting w/ hepatic encephalitis. Ascitic fluid examination … 250/
mm3, culture of one bacterial pathogen. Which of the following could have caused the symptoms above?
A. Perforation from ruptured viscus and abcess
B. Bowel perforation from paracentesis needle
D. A & B

44. 25 yr old female complains of nausea and vomiting, abdominal enlargement, no bowel movement or flatus for the past two days.
What would be the best diagnostic examination to be done upon arrival to the hospital?
B. Abdominal X-Ray

45. 48 yr old male experienced nausea and vomiting after having radiation therapy. If he were scheduled chemotherapy what would
be the best anti-emetic drug?
A. Glucocorticoids
B. Serotonin antagonist
D. A & B

46. 60 yr old female diabetic for more than 20 years with blood glucose recently uncontrolled (?)… complained of nausea, vomiting,
bloatedness, early satiety. Which of these would be helpful for the patient’s nausea and vomiting?
A. Combined 5HT3-Antagonist & D2 Antagonist
B. 5HT4- Antagonist
D. A & B

47. 56 yr old male was diagnosed with heart burn. Pain in swallowing, weight loss with recurrent vomiting and episodes of
hematemesis what is the best procedure to assess this patient?
B. Endoscopy

48. A neuro transmitter that mediates the production of vomiting at the area postrema
E. All of the above (H1, M1 and D2)

49. The following is/are true regarding antiemetic medication

B. Serotonin by which T3 … are good for prevention of cancer chemotherapy-induced vomiting

50. Regarding heartburn, endoscopy is recommended in what?

D. A & B (Symptoms less than 5 years and patients more than 50 y/o)

51. Regarding …. evaluation is recommeded, the following symptoms are present

E. All of the above
(occult GI bleeding, Pain in swallowing, jaundice)

52. A young requiring nitric (?) therapy with frequent heartburn and regurgitation who are responsive to PPI. The recommended
treatment is?
C. Fundoplication

53. Which of the following is/are antiemetic medication

E. All of the above (she did not mention the choices)

54. Standard position for the history exam of the abdomen

C. Left Side of the patient

55. 23 year old male has recurrent abdominal pain, anoexia, nausea, vomiting. On history of examination, he was febrile with 38C.
What should NOT be done?
B. Don’t percuss/palpate the painful area 1st -> do it last.

56. Screen enlarges (sorry di ko maintindihan)

C. Anterior, medially downward

57. Pain on the right lower quadrant when the patient resists his right knee against the examiner hand is called
B. psoas sign

58. The presence of rebound tenderness is

A. Rovsing’s sign
( press the opposite side which is not painful then remove the hand abruptly. if withdrawn and pain is felt on the area, positive
Rovsing’s sign)

59. Most common symptom of splenomegaly

B. pain and heavy sensation in the left upper quadrant
(other accompanying symptoms: early satiety or fullness)

60. Colicky abdominal pain is secondary to

D. bowel obstruction
(other abdominal conditions causing colicky abd. pain – ureteral stone/ureterolithiasis) – “masterin niyo yun ah” Dra. Cordero

61. Tenderness of the right lower quadrant when doing internal rotation of the hip with a flexed knee is your
C. obturator sign

62. A 49 yr old obese female was rushed to the ER due to fever, vomiting, right upper quadrant pain radiating to the back, positive
murphys sign, the likely diagnosis
A. acute diverticulitis
B. splenomegaly
C. cholecystitis
D. liver abscess
( liver abscess – it would be point tenderness, meaning kaunting pindot lang, it would be painful, anywhere along the right upper
quadrant . If murphys sign, it’s only the gallbladder) “masterin niyo yun kasi kailangan alam niyo ‘yon”

63. Normal bowel sound in an adult

C. 5 – 34/min

64. An auscultatory gap is defined as

B. a silent interval between the systolic and diastolic beats

65. Auscultatory gap is associated with

D. atrial stiffness

66. 69-yr old obese female was seen due to headache, BP – 200/100. What would be the next best option to check for BP?
A. check if the cuff is appropriate for the arm
B. retake the BP using the same cuff
C. ask the patient to rest for another 5 minutes
D. ask the patient for intake of coffee

67. Blood pressure become falsely high if

B. the arm is placed below the heart level
D. if the cuff is placed tightly

68. Orthostatic hypotension is defined as

C. a fall in systolic pressure at around 20 or more mmHg

69. The normal difference of blood pressure taken on both arms would be around
A. 10 – 15 mmHg
B. 5 – 10 mmHg

70. Which of the following is true regarding the techniques of measuring the blood pressure?
A. systolic blood pressure remains unchanged or drops slightly from supine to a standing position
B. systolic blood pressure remains unchanged or drops slightly from supine to a standing position
C. after taking the blood pressure of both arms subsequent reading should be taken on the arm with the lower pressure
D. repeated inflation of the cuff does not alter the blood pressure reading

FIRST SEMESTER FINALS (OLD FILE)

61. A 24-year-old male was seen by a dentist due to right molar toothache. On examination, there were bilateral rounded bony
growths on the inner surfaces of the mandible. What are these benign growths?

A. torus palatines
C. aphthous ulcer
B. torus mandibulares
D. oral thrush

62. Thickened itchy ear canal:

A. purulent otitis media
C. acute otitis externa
B. chronic otitits externa
D. serous effusion

63. Symptoms include earache, fever and hearing loss:

A. acute otitis externa
B. acute otitis media
C. bullous myringitis
D. serous effusion

64. To straighten the ear canal during otoscopic exam examination:

A. pull the auricle downward and backward
B. pull the auricle upward, backward and away form the head
C. pull the auricle away from the head
D. pull the auricle upward and backward

65. Narrowed, moist, pale external ear canal:

A. acute otitis media
B. acute otitis externa
C. serous effusion
D. chronic otitis externa

66. One of the following is NOT TRUE in Cranial Nerves examination:

A. Ptosis (III)
B. Facial Droop or Asymmetry (V)
C. Hoarse Voice (X)
D. Articulation of Words (V, VII, X, XII)

67. One of the following statements regarding Test for Lateralization is TRUE:
A. Start the fork vibrating by tapping it on your opposite hand.
B. Place the base of the tuning fork firmly on top of the patient's head.
C. Ask the patient where the sound appears to be coming from (normally in the midline).
D. When the patient no longer hears the sound, hold the end of the fork near the patient's ear (bone conduction is normally greater
than air conduction).

68. Contraindications for use of mydriatic drops in ophthalmoscopic/fundoscopic exam:

A. error of refraction
B. astigmatism
C. head injury
D. unexplained visual loss

69. Measures the power of a lens to converge or diverge light:

A. diopter
C. disc
B. disc
D. ophthalmoscope light

70. One of the following statements is correct when doing fundoscopy:

A. Start 20 inches away from the patient and at an angle 200 lateral to the patient’s line of vision
B. Start 15 inches away from the patient and at an angle 150 lateral to the patient’s line of vision
C. Start 15 inches away from the patient and at an angle 150 along the patient’s line of vision
D. Start 20 inches away from the patient and at an angle 200 along the

71. Skin is generally warm in the following conditions:

A. hypothyroidism
B. cellulitis
C. decreased blood volume
D. jaundice

72. Reflects excessive intake of yellow vegetables or fruits:

A. icterisia
B. jaundice
C. carotenemia
D. heliotrope

73. This type of skin lesion is usually seen along the flexor surfaces of the body:
A. psoriasis
B. atopic eczema
C. tinea versicolor
D. vitiligo

74. Elevated, superficial skin lesion > 0.5 cm:

A. papule
B. cyst
C. plaque
D. café-au-lait

75. Marble like lesion >0.5 cm:

A. papule
B. cyst
C. wheal
D. nodule

76. It is a machinery responsible for red cell production, made up of a rapidly proliferating pool of marrow erythroid precursor cells
and mature RBC.
A. erythropoiesis
B. EPO
C. hematopoiesis
D. erythron

77. What is the fundamental stimulus for production of the glycoprotein hormone produce within the kidney which is a physiologic
regulator of RBC production?
A. availability of iron
B. oxygen availability
C. decrease TIBC
D. decrease red cell mass

78. True with Acute Hemolytic anemia, EXCEPT:

A. signs and symptoms depends on the mechanism that leads to the
B. RBC destruction
C. acute back pain, urine hemosiderin, and renal failure are symptoms associated with extravascular hemolysis
D. elevated LDH E. none of the above

79. Anemia of maturation defect is secondary to:

A. hypoproliferative
B. ineffective ertyhropoiesis
C. marrow production defect
D. hemolysis

80. In a patient with microcytic anemia and low reticulocyte count what test should be ordered.
A. TIBC
B. Transferrin
C. ferritin
D. creatinine

81. True with Lymphadenopathy EXCEPT:

A. 2/3 of patient have a non specific cause or upper respiratory illness
B. can also cause by endrocrine disease
C. subclavian or scalene adenopathy is always abnormal and should be biopsied
D. tender nodes are always benign.

82. What is the significance of Virchow’s node?

A. metastatic CA primary from the lungs
B. metastatic CA primary from the GI
C. Acute Leukemia
D. Infection in the retroperitoneal space

83. Adaptional function of the spleen includes the following, EXCEPT:

A. generation of immune responses to invading pathogen
B. extramedullary hematopoiesis
C. clearance of bacteria and particulates in the blood
D. maintenance of quality control over erythrocyte

84. Basic mechanism for splenomegaly, EXCEPT:

A. increase in demand for splenic function
B. passive vascular congestion
C. infiltration with malignant cells, lipid or glycoprotein laden macrophage
D. removal of senescent RBC

85. True with Weight loss, EXCEPT:

A. involuntary wt. loss is associated with increase mortality and morbidity
B. at age 60 body weight declines by an average of 0.45% per year
C. adipose tissue increase and lean mass decrease with age
D. weight loss of 5% in six to twelve months warrants further investigation

86. Amount of peritoneal fluid needed for diagnostic paracentesis:

A. 50-100 ml
B. 25-50 ml
C. 5-10 ml
D. 150-500 ml

87. Peritoneal/ascitic fluid with protein>25 g/liter and specific gravity of 1000 and 70% predominance of lymphocytes:
A. bacterial peritonitis
B. ascites
C. pancreatic abscess
D. tuberculous peritonitis

90. Chylous ascites is most often due to:

A. WBC
B. lymphatic obstruction
C. RBC
D. triglycerides

91. Jaundice with scleral sparing is seen in patients with:

A. intake of quinacrine
B. exposure to phenols
C. carotenoderma
D. biliary cirrhosis

92. An elevation of direct bilirubin with renal excretion of conjugated bilirubin is seen in:
A. hyperbilirubinemia
B. bilirubinuria
C. phenol intoxication
D. quinacrine overdose

93. Formation of bilirubin occur in:

A. bile
B. reticuloendothelial cells of the liver and spleen:
C. gallbladder
D. proximal small bowel

94. Using the van den Bergh method, the normal serum bilirubin concentration is:
A. 1 mg/dL
B. 17 mg/dL
C. >1 mg/dL
D. >17 mg/dL

95. The classic presentation of this disease is vomiting, retching or coughing preceding Hematemesis in an alcoholic patient:
A. PUD
B. esophageal varices
C. Malllory-Weiss tears
D. gastritis
66. An elevated fluid-containing lesion
A. Bulla
B. Vesicle
C. Pustule
D. Plaque

67. An elevated skin lesion with purulent fluid:

A. pustule
B. plaque
C. bulla
D. vesicle

68. An elevated skin lesion often formed by confluence of papules

A. pustule
B. bulla
C. plaque
D. vesicle

69. Koplik’s spots are seen in:

A. varicella
B. rubella
C. rubeola
D. 5th disease

70. Slapped cheek appearance in children and manifest as arthritis in adults:

A. rubeola
B. varicella
C. 5th disease
D. rubella

71. Rose spots are seen in:

A. rheumatic fever
B. urticaria
C. typhoid fever
D. still’s disease

72. Erythema marginatum is seen in:

A. SLE
B. rheumatic fever
C. rocky mountain spotted fever
D. urticaria

73. Erythema multiforme is described as:

A. maculopapular
B. plaque
C. vesicular
D. target lesion

74. This characteristic is typical of Kawasaki disease:

A. target-like lesions
B. erythema of palms and feet
C. strawberry tongue
D. macules, papules, vesicles in crops

75. Purpuric lesions secondary to N. meningitidis:

A. Vibrio vulnificus
B. Coxsackievirus A16
C. meningococcemia
D. varicella
1. Bilirubin is a breakdown product of heme wherein:
A. 200-250 mg of bilirubin is produced each day
B. 70-80% is derived from the breakdown of hemoglobin in senescent RBC
C. The majority comes from prematurely destroyed erythroid cells
D. The formation occurs in the liver only 261

2. The normal serum bilirubin concentration is:

A. 15.4 umol/L
B. 17 umol/L
C. 3.4 umol/L
D. 5.1 umol/L 261

3. A genetic condition wherein neonates present with severe jaundice and kernicterus due to complete absence of UDPGT activity:
A. Crigler-Najjar Syndrome I
B. Gilbert’s syndrome
C. Crigler-Najjar Syndrome II
D. Dubin-Johnson Syndrome

4. Gold standard for identifying choledocholithiasis :

A. ultrasound
B. CT scan
C. MRCP
D. ERCP

5. A hepatocellular condition that may produce jaundice:

A. drug-induced hepatocellular injury
B. primary biliary cirrhosis
C. choledocholithiasis
D. benign recurrent cholestasis

6. Greenish hue of the skin as a type of jaundice is due to:

A. renal excretion of unconjugated bilirubin
B. hemolytic disorder
C. presence of elastin (serum bilirubin of 3 mg/dL)
D. oxidation of bilirubin to biliverdin

7. Hemolysis as a cause of jaundice is due to:

A. Impaired conjugation or excretion
B. Decreased bilirubin conjugation
C. overproduction of bilirubin
D. Impaired uptake

8. Conjugated hyperbilirubinemia
A. Impaired clearance of bilirubin
B. Impaired/decreased excretion into the bile ductules OR backward leakage of the pigment
C. Exaggerated increase in serum bilirubin during illness or fasting
D. Impaired uptake, conjugation

9. Rotor syndrome is characterized by:

A. Defect in intracellular binding of organic ions
B. Black liver
C. Defect in the secretion of bilirubin glucuronides into the bile canaliculus
D. Dark brown, iron free, granules in liver and Kupffer cells

10. This may cause acute vitamin K malabsorption:

A. Acute necrosis or injury
B. Cholestasis
C. Acute hepatocellular injury
D. Chronic hepatocellular disease
11. Grading of liver disease is done for:
A. Determining severity of the liver disease
B. Determining progression to cirrhosis
C. A and B
D. Determining the need for liver biopsy

12. Maximum allowable daily alcohol consumption for women:

A. 23-45 g/day
B. 22-30 g/day
C. 33-45 g/day
D. 33-55 g/day

13. Pruritus is commonly noted early in:

A. chronic liver disease
B. primary biliary cirrhosis
C. obstructive jaundice
D. sclerosis cholangitis

14. Specific marker for liver injury

: A. Elevated AST
B. Elevated ALT
C. ALT:AST ratio > 2
D. ALT:AST ratio < 2

15. Alcoholic liver disease is usually reflected by:

A. ALT:AST ratio > 2
B. ALT:AST ratio < 2
C. Elevated AST
D. Elevated ALT

26. In doing ophthalmoscopic examination:

A. you use the right hand and right eye when examining the left eye
B. you can examine the eye at a 3 meters distance
C. approach the patient about 15-200 to the line of gaze
D. you can hold the ophthalmoscope like a pen

27. When holding the ophthalmoscope:

A. Look through the aperture with one eye and close the other
B. Use a mydriatic and use bright lights to dilate the pupils
C. Place your free hand on the cheek of the patient
D. The instrument must be held close to the examiner’s eye nestled against the supraorbital ridge

28. In doing otoscopic examination:

A. you can rest the other hand against the patient’s cheek
B. you use the smallest and narrowest speculum
C. you can hold the otoscope vertically like a pen
D. you hold the otoscope in the same hand as the ear being examined

29. The ideal way to examine the ear is:

A. to hold the otoscope vertically
B. to avoid resting the other hand on the patient’s cheek or forehead
C. to hold the otoscope in the opposite hand as the ear being examined
D. to hold the pinna of the ear to be examined firmly and gently pulled upwards and backwards to straighten the canal using the
hand not holding the otoscope

30. This part of the ear is painful if touched with a speculum inserted too far:
A. cartilaginous external ear
B. bony external ear
C. middle ear
D. inner ear

1. A 15 year old girl complained of a brownish flat colored lesion < 2 cm in diameter mostly on her face. The lesion is called a…
A. patch C. papule
B. nodule D. macule
2. a raised lesion > 0.5 cm in size
A. patch C. papule
B. nodule D. macule
3. People with pimples have a
A. patch C. papule
B. nodule D. macule
4. A three year old child was seen at the ER. Her mother noted the development of fluid filled translucent lesions along the face
and trunk. These lesions are called…
A. vesicle C. wheal
B. pustule D. plaque
5. A 32 year old female sought consult for a lesion on the face caused by a previous burn injury this lesion is called a…
A. plaque C. scar
B. erosion D. ulcer
6. a 70 year old male developed a lesion on the foot due to diabetic neuropathy. It showed a loss of epidermis along with a portion
of the dermis. This lesion is called a
A. Erosion C. ulcer
B. Excoriation D. scar
7. A 45 yearold man sought consult due to a paplpable lesion along the dorsal aspect of his wrist. On examination you noticed a
raised encapsulated lesion filled with fluid. What is the lesion called?
A. vesicle C. cyst
B. pustule D. bulla
8. A 65 year old man complained of a mullticolored lesion on his back. On examination of the skin it showed a lesion with
variegated pigmentation, athrophy and telangiectasia noted. The lesion is described as a…
A. polycyclic C. herpetiform
B. poikiloderma D. lichenoid
9. A 25 year old male patient with chronic atopic dermatitis complained of skin thickening with accentuated skin-fold markings
what is this lesion?
A. lichenoid C. crusting
B. lichenification D. morbiliform
10. A 5 year old child develops measles. How do you describe the lesion?
A. patch C. morbiliform
B. papules D. herpetiform
11. an elderly woman complained of multiple erythematous lelsions on her back. On
further examination it showed coalescing incomplete rings. This lesions are called

A. nummular C. polycyclic
B. annular D. morbiliform
12. Lesions caused by constant scratching of the skin.
A. erosion C. lichenification
B. excoriation D. scars
13. Dried exudates from body fluids is called
A. scales C. crust
B. erosions D. wheal
14. Psoriasis is characterized by numerous
A. scales C. crust
B. erosions D. wheal
15. A grouped vesicular lesion is described as
A. herpetiform C. polycyclic
B. morbiliform D. annular lesions
16. Acute tonsillitis is considered if the duration is:
A. <3 days C. 3 weeks-3 months
B. <3 weeks D. >3 months
17. Quinsy is a term for:
A. Hypertrophy C. Peritonsillar abscess
B. Hyperemic tonsils D. Tonsillolith
18. A bony midline overgrowth along the hard palate:
A. Fordyce C. Torus palatinus
B. Koplik’s D. Torus mandibulares
19. A smooth tongue is due to:
A. Iron or folic acid deficiency C. Malnutrition
B. Radiotherapy D. Aging
20. Presence of a pseudomembrane along the pharyngeal area is usually due to:
 A. Clostridium tetani C. Corynebacterium diphtheria
B. Staphlococcus aureus D. Streptococcus pyogenes
21. Chronic exposure to sunlight with a thick and scaly appearance of the lower lip:
A. Premalignant lesion C. Due to secondary candida infection
B. Due to malnutrition D. Kaposi’s sarcoma
22. Chronic tobacco chewing is seen in:
A. Atrophic glossitis C. Fordyce spots
B. Leukoplakia D. Hairy tongue
23. Measles infection is related to appearance of this lesion/s:
A. Fordyce spots C. Kaposi’s sarcoma
B. Koplik’s spots D. Candidiasis
24. Presence of kaposi’s sarcoma is usually related to this type of infection:
A. Rubeola
B. HIV
C. Syphillis
D. Candidiasis

25. One of the following statements regarding candidiasis is TRUE:

A. Related to HIV
B. Seen in patients with prolonged use of steroids
C. Not related to chronic antibiotic use
Seen as adherent purplish plaque
SECOND SEMESTER PRELIMS (OLD FILE) 7. Example of parenchymal lung disease potentially producing
cough:
- Cough and Hemoptysis
A. lung abscess
- Dyspnea and Pulmonary Edema B. COPD
C. asthma
- Hypoxia and Cyanosis
D. chronic bronchitis

8. Procedure of choice for visualizing an endobronchial tumor

1. The efferent limb of the cough reflex includes receptors and collecting cytologic and histologic specimens:
within:
A. sputum cytology
A. trigeminal nerve B. computed tomography
B. recurrent laryngeal nerve C. fiberoptic bronchoscopy
C. superior laryngeal nerve D. pulmonary function test
D. vagus nerve
9. Associated symptom and setting include dyspnea, orthopnea
and paroxysmal nocturnal dyspnea:

2. Most common site of hemoptysis: A. pulmonary embolism

B. left ventricular failure
A. . parenchyma C. chronic bronchitis
B. . trachea D. right ventricular failure
C. alveoli
D. airways/tracheobronchial tree 10. Cough and sputum production is commonly noticed at night
or early in the morning, often with history of wheezing
episodes especially at night::

3. Two most common causes of hemoptysis: A. lung Ca

B. gastroesophageal reflux
A. tuberculosis and bronchogenic Ca C. tuberculosis
B. bronchitis and bronchiectasis D. lung abscess
C. bronchitis and bronchogenic Ca
D. tuberculosis and bronchiectasis 11. Pulmonary edema secondary to pneumonia is classified as
secondary to the following mechanism:

A. imbalance of Starling forces

4. Treatment of massive hemoptysis: B. lymphatic insufficiency
C. altered alveolar-capillary permeability
A. blood transfusion D. incompletely understood
B. codeine
C. antitussive 12. The mechanism for this type of dyspnea occurs in
D. intubation patients<25 years of age, which makes it as an example of
prearteriolar, high-pressure pulmonaryedema:

A. narcotic overdose
5. Massive hemoptysis is defined as: B. neurogenic pulmonary edema
C. exposure to high-altitude
A. expectoration of >100 mL/24 hrs
D. cardiogenic pulmonary edema
B. expectoration of >100->600mL/24 hrs
C. expectoration of >100-<600mL/24 hrs 13. Pulmonary edema secondary to hypoalbuminemia is due to
D. expectoration of >600mL/24 hrs the following mechanism:
6. Cough secondary to intake of ACE inhibitors is mediated by A. increased pulmonary capillary pressure
the accumulation of this agent: B. increased negativity of interstitial pressure
C. altered alveolar-capillary membrane permeability
A. angiotensin converting enzyme
D. decreased plasma oncotic pressure
B. substance P or bradykinin
C. renin 14. Pulmonary edema secondary to mitral stenosis is due to the
D. aldosterone following mechanism:
 A. increased negativity of interstitial pressure A. midsternal line
B. increased pulmonary capillary pressure B. midclavicular line
C. decreased plasma oncotic pressure C. anterior axillary line
D. altered alveolar-capillary membrane permeability D. posterior axillary line

15. Mechanism involved in pulmonary edema secondary to 22. Mucoid sputum is described as:
aspiration of gastric contents:
A. yellowish
A. unknown B. translucent, white
B. altered-alveolar-capillary membrane permeability C. greenish
C. lymphatic insufficiency D. blood-streaked
D. imbalance of Starling forces
23. Hyper resonance on percussion is seen in patients with:
16. Possible mechanism of dyspnea in asthma:
A. large pleural effusion
A. hypoxia B. emphysema
B. afferent mismatch C. lobar pneumonia
C. stimulation of irritant receptors in airways D. large pneumothorax
D. pulmonary embolism
24. Louder, clearer voice sounds when a patient is instructed to
17. Characterized by mucus hypersecretion, and after a few say “ninety-nine”:
hours of sleep, secretions can accumulate and produce
dyspnea and wheezing which are relieved A. bronchophony
B. whispered petriloquy
by cough and expectoration: C. egophony
D. normal
A. asthma
B. bronchiectasis 25. When “ee” is heard as “ay”, with quality that sounds nasal:
C. chronic bronchitis
D. pulmonary embolism A. normal
B. egophony
18. Dyspnea that occurs only in the upright position: C. whispered petriloquy
D. bronchophony
A. trepopnea
B. orthopnea
C. PND
D. platypnea 26. Breath sounds in a normal air-filled lung:

19. The process includes the leakage of air into the pleural A. bronchial
space, manifesting with sudden onset of dyspnea, pleuritic pain B. bronchovesicular
and cough in a preciously healthy C. predominantly vesicular
D. tracheal
young adult:
27. Unilateral hyperresonance suggests:
A. hyperventilation syndrome
B. spontaneous pneumothorax A. pneumonia
C. pulmonary embolism B. large bulla or pneumothorax
D. asthma C. asthma
D. emphysema
20. This type of dyspnea occurs acutely, separated by
symptom-free perios, characterized by bronchial 28. This thoracic deformity is normal during infancy, and often
hyperresponsiveness involving release of inflammatory accompanies normal aging anf COPD:

mediators: A. pigeon chest

B. funnel chest
A. COPD C. barrel chest
B. Pulmonary embolism D. flail chest
C. asthma
D. chronic bronchitis 29. Disease condition wherein the percussion note is dull over
the airless area, without tracheal deviation, with bronchial
21. This line drops vertically from the midpoint of the clavicle: breath sounds, late inspiratory
crackles and increased tactile fremitus over the involved area: 37. This condition is suspected if the patient’s blood remains
brown after being mixed in a test tube and exposed to air:
A. atelectasis
B. consolidation A. pulmonary arteriovenous fistula
C. chronic bronchitis B. methemoglobinemia
D. left-sided heart failure C. right to left shunt
D. polycythemia
30. Disease condition wherein there is shifting of the trachea
toward the affected side: 38. Impaired oxygen diffusion is secondary to:

A. left-sided heart failure A. decreased atmospheric pressure

B. chronic bronchitis B. anatomic shunts
C. atelectasis C. impaired pulmonary function
D. consolidation D. hemoglobin with low affinity for oxygen

31. Normal PaO2, with reduced absolute quantity of oxygen 39. One of the following statements is TRUE:
transported per unit volume of blood is diminished:
A. peripheral cyanosis results from vasodialtion and
A. carbon monoxide poisoning diminished peripheral blood flow
B. respiratory hypoxia B. the absolute rather than the relative quantity of
C. anemic hypoxia reduced hemoglobin is important in producing
D. circulatory hypoxia cyanosis
C. decreased SaO2 results from marked increase in the
32. Compensatory mechanism for chronic hypoxia with PaO2
increase in the hemoglobin concentration: D. central cyanosis can be detected reliably when the
SaO2 has fallen to 50%
A. thrombocytopenia
B. anemia D. leukemia 40. Effects of hypoxia EXCEPT:
C. polycythemia
A. pulmonary arterial constriction
B. metabolic acidosis
C. myocardial ischemia
33. One of the following statements is TRUE regarding exercise: D. decreased cerebral blood flow
A. decreasing oxygen extraction from the delivered blood
B. increasing the pH of the tissues and capillary blood
C. increasing the cardiac output and ventilation
D. preferentially directing blood the exercising muscles
by changing vascular resistance indirectly

34. Occurs in heart failure: SECOND SEMESTER MIDTERMS

1. Renal disease progression is modified by number of
A. anemic hypoxia
factors except?
B. respiratory hypoxia
C. circulatory hypoxia D. Trauma
D. hypoxia secondary to high altitude
2. The kidney adapts for the loss of volume for the loss
35. Caused by congenital cardiac malformations:
of 1 kidney thru the ffg:
A. carbon monoxide poisoning D. increase in renal mass
B. right to left shunt
C. circulatory hypoxia
D. respiratory hypoxia 3. Effects of impaired calcium and phosphate absorption?
A. Secondary hyperparathyroidism
36. Cause of central cyanosis:

A. cold exposure 4. True statement of acid base regulation in the tubule

B. arterial obstruction Ans :50 meqs non carbonic hydrogen ion is
C. anatomic shunts
normally excreted per day by a 50 kg man
D. venous obstruction
5. Renal failure is best characterized by?
D. increase alpha hydroxylase
6. What stimulates a higher parathyroid hormone
secretion?
B. decrease renal calcitriol production
7. True statement regarding renal progression to end
stage renal disease?
D. AOTA (Angiotensin 2 facilitating into
..,activation of fibroblast, prolonged and uncorrected
proteinuria)
8. One of the ff statement is true of the kidney.
D. AOTA (20% of the cardiac output, stimulated
by different factors and cytokines ,numbers is
influence by medulla?)
9. What causes vasodilatation in afferent arteriole in
patient who presents with hypotension?
A. myogen (?)reflex
10. what is the effect of angiotensin 2?
A. …and enhance by aldosterone
11. ____ for protein?
A. part of the archiring(?) cap
12. __ in the urine will be a first sign of transplant
rejection.
B. WBC
13. reflect interstitial fibrosis and tubular dilatation.
C. coarse granular __?
14. seen among family members with episode gross
hematuria renal failure.
D. hereditary nephritis
15. the urinary protein is 300 mg/day is seen among?
AOTA(DM,fever, HPN)
16. in a patient presenting with acute renal failure which
acute nephrotogram is most useful?
A. fractional excretion of sodium
17. the ff. will cause pre renal azotemia except ?
C. glomerulonephritis
18. if renal vessel were occluded in a patient with acute
tubular necrosis which would present with heavy
proteinuria and hematuria ?
B. renal vein thrombosis
19. at what GFR would you start patient with chronic
renal failure on dialysis?
A. less than 15%
20. A 50 yr old male patient weigh 78kg and a creatinine
of 1.23mg/dl will have a GFR of ?
A. 79
21-22. A patient present with the ff parameters : pH: 7.2,
pCO2:34,pO2:90, bicarb: 18, O2 sat: 95%
21. … blood gas abnormality.?
B. metabolic acidosis
22. what is the common clinical manifestation of patient
presenting with the above problem?
B. respiratory rate
23. the electrolyte responsible for water balance and
malfunction(?)?
B. Sodium
24. Hypoxia refers to?
C. low oxygen pressure in the alveolus
25. a patient was brought to the ER and upon seeing the
patient unconscious she labeled her as stuporous , what
is the basis for labelling the patient stuporous?
B. patient on stimulation woke up while
stimulation was painful, but after that lapses to sleep.
26. a patient ignoring a painful stimuli on the affected
side in spite of an intact sensation presents with?
D. sensory neglect
27. patient was asked to turn hand rapidly over the back,
over and back on the thigh, to test for?
B. coordination
28. which reflex test cord t5 and t6?
A. brachioradialis
29. a 3/5 muscle stretch shows?
A. caN raise the arm but wont be able to raise it
when you put a downward pressure
30. if a patient has lesion in the pharyngeal muscle , what
would be the tear?
Ans: cranial nerve 9 and 10
31. when a patient blinks on a cotton wink on the cornea
it denotes involvement of ?
ans. Both 7 and 5
32. if your patient presents with a considerable lack of
affect that patient is?
B. depressed
33. consensual response ,patient presents with lesion on
the ff. except?
A. ipsilateral optic nerve
34. when you asked the patient to follow a moving object
of a full range of movement, you are testing for?
Ans: smooth pursuit
35. which of the ff is/are used in assessing
comprehension?
A&B only (asking the patient to point to
appropriate object ,statement with embedded process
and … for construction)
36. true of wernicke’s aphasia.
A. ability to follow command in the action
musculature if preserve
37. which type of aphasia has non fluent output and
impaired comprehension of speech language.
B. global aphasia
38. girchman syndrome is a combination of which of the
ff. symptom?
A&B only(right and left confusion, acalculia(?))
39. the patient will be socially disinhibited if shown to
have impairment of judgement, insight and foresight is
suffering from what syndrome?
B. frontal disinhibition
40. what trival base meaning defecit (????) .
ans: the patient cannot read appropriate name
when shown an object, but can point to the
appropriate object when the name is provided
by the examiner
41. which of the ff is used to better assess repetition?
D. A&C only (asking patient to repeat single
word, tongue twister)
42. which of the ff statement is/are true of hemisphasia
neglect?
E. AOTA
43. which of the ff true of prosopagnosia?
A&B only(patient can recognize familiar
faces,patient can tell if two faces are identical or
not
44. damage of the pre frontal part of the brain impairs
which of the ff?
E. AOTA
45. discarded
46. with anoxia carbon monoxide poisoning or complete
water shed zone infarction, will result into which of the ff
aphasia?
C. isolation aphasia
47. most common language disorder?
Anomic aphasia
48. parapheresis is best characterized as?
intraspinal lesion at or below the upper thoracic
cord level
49. Cramps are characterized as ?
A. lower motor neuron in origin
50. One of the ff pertains to acute episodic hemipheresis .
B. vascular bleed
51. one of the following is the most common cause of
parapheresis
D. in the spinal lesion at or below the upper thoracic
spinal cord
52. true of right sided hemipharesis.
A, it results from upper motor neuron lesion
above the midcervical spinal cord
53. one of the ff statement is true in left sided
hemipharesis.
There is a tendency to talk effectively
64. called sinus arrest or AV block.
. C. sinus hypersensitivity
65. involved a cardio inhibitory response .
B. situational syncope
66. increase peripheral sympathetic activity and venous
pulling.
A. neurocargiogenic syncope
67. 8 cranial nerve involvement
vertigo of vestibular nerve origin

54. often produce symmetric weakness of shoulder girdle 68. triggered by amicasin .
muscle . B. labyrinthin dysfunction
B. myopathy 69. prodromal presyncopal symptom.
55. one of the ff is not atypical manifestation of your left B. faintness
hemipharesis . 70. Vestibular dysfunction
C. language and speaking problem pathologic vertigo
56. this neurologic deficit is due to upper motor lesion of 71. one of the ff is not related ___ and tinnitus associated
the mid cervical spinal cord or above the foramen with vertigo.
magnum with language disorder and cortical B. benign paroxysmal vertigo
disturbances.
A. parapheresis 72. one of the ff is not a feature of nystagmus due to
peripheral disorder
57. associated symptom in acute paraphersis. .A. can be horizontal or vertical
C. incontinent and absent VTR
73. one of the ff is not a classification of the dizziness.
58. discarded blink disturbance
59. acute or hepictotic hemipharesis is commonly due to? 74. one of the ff statement about nystagmus of central
origin is not true.
vascular problems A. situated by head movement
60. one of the ff did not present acute hemipharesis. 75. example of physiologic vertigo .
B. meningitis C. car sickness
61. associated symptom in acute parapheresis . 76. vertigo is best describe by which of the ff statement.
incontinent and absenst VTRs B. is usually due to a disturbance in the
62. focal myalgia may be secondary to. vestibular system
D. rupture of macro tendon 77. this is due to lesion in around the fourth ventricle .
B. central positional vertigo
Matching type

63. your autonomic .. 78. one of the ff is the most common cause of pathologic
B.is postural hypotension vertigo .
vestibular dysfunction
79. the most common offending drug for this type of
vertigo isaminoglycoside antibiotic.
B. associated bilateral labyrinthin dysfunction

80. associated with progressive hearing loss or tinnitus .

B. recurrent unilateral labyrinthin dysfunction