Removal Examinations 2016

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Neurology

1. In which seizure type is the behavioral arrest usually accompanied by automatisms?

a. Complex partial seizure
b. Focal Seizure without dyscognitive feature
c. Generalized tonic clo nic seizure
d. Atonic seizure
e. Myo clonic seizure
2. What seizure type is typically seen in patients suffering from metabolic derangements?
a. Generalized tonic clo nic
b. Atonic
c. Myo clonic
d. Both A and C
e. All of the above
3. Which of the following anticonvulsants increase the availability of GABA?
a. Phenytoin
b. Carbazepine
c. Diazepam
d. Valproic acid
e. Levetiracetam
4. Which of the following is/are the pathognomic sign/s of meningeal irritation?
a. Fever
b. Headache
c. Focal neurologic deficits
d. Nuchal rigidity
e. All of the above
5. Which of the following bacteria causing meningitis is acquired though in gestion of
contaminated cheese and milk?
a. S. pneumonia
b. L. monocytogenes
c. N. meningitides
d. H. influenzae
e. Both A and C
6. Which is the most commo n cause of viral meningitis?
a. Enterovirus
b. Arbovirus
c. Herpes viru s
d. EBV
e. CMV
7. Which of the following CSF parameters will be significantly altered if antibiotic therapy was
in itiated a few hours prior to LP?
a. WBC count
b. Glucose concentration
c. Gra m stain

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 d. PCR assay
e. None of the above
8. Which of the following la bel/s also connote/s cluster headache?
a. Paroxysmal nocturnal cephalgia
b. Migrainous neuralgia
c. Erythromelalgia of the head
d. Red migraine
e. All of the above
9. Which of the following statement/s is/are TRUE of tension headache?
a. Unilateral occipitonuchal, frontal or temporal predominance
b. Accompanied by aura symptoms such as rhinorrhea, injected conjunctiva and flushing
of the cheeks
c. Present throughout the day
d. Usu ally begins in childhood and adolescence
e. Both A and C
10. In a young male patient presenting with acute “thunderclap ” headache that is occipitonuchal in
lo cation, which of the following causes of headache would you likely attribute this?
a. Migraine headache
b. Tension headache
c. Cluster headache
d. Subarachnoid hemorrhage
e. Headache due to brain tumor

CASE
A 55-ye ar-old female sought consult due to headache and progressive weakness of the le ft upper and
lo wer extremities for the past few months. Her past medical history revealed history of hypertension. Her
physical examination findings were essentially normal. However, her neurologic examination should a
MMT grade of 4/5 on the le ft upper and 3/5 on the lo wer extremity, which her right upper and lower
extremity had a grade of 5/5. Also noted was an extensor plantar re sponse on the le ft. The in itial
impression at the ER was brain tumor.

11. Which of the data gathered from the history and PE/NE support/s the diagnosis of brain tumor
as opposed to stro ke?
a. Age and Gender
b. Temporal profile
c. Past medical history
d. Presence of focal neurologic deficits
e. All of the above
12. What diagnostic work up will be most useful in confirming your in itial impression
a. Skull x-ray
b. Plain MRI scan
c. Contrast enhanced CT scan
d. EEG
e. Lumbar puncture

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CASE
…..chromatin with some showing central …….….. whorls and psammoma bodies found

13. Based on the ima ging results, what is the most likely tumor this patient has?
a. Lymphoma
b. Multiple myeloma
c. Meningioma
d. Glio blastoma multiforme
e. Olig odendroglioma
14. Based on the biopsy, what is the most likely WHO grade of this tumor?
a. I
b. II
c. III
d. IV
e. V
15. The headache of this patient is secondary to in crease ICP, what would be the most likely
mechanism?
a. Localized pathology that deform the adjacent brain tissue
b. Generalized brain swelling
c. Obstruction to the flow and absorption of the CSF
d. Increase in venous pressure
e. Idiopathic
16. Which of the following medical management for increased ICP would be id eal for this case?
a. Mannitol
b. Furosemide
c. Hyp ertonic saline
d. Prednisone
e. Dexamethasone
17. What would be the id eal management of the tumor for this case?
a. Surgical re moval only – if la rge and symptomatic
b. Surgical re moval followed by chemotherapy
c. Surgical re moval followed by ra diotherapy – if grade II (a typical)
d. Surgical re moval followed by both chemotherapy and ra diotherapy
e. Observation only – if small and asymptomatic
18. …..eration, patient was referred due to twitching of the left upper extremities followed by
stiffening, of a….. followed by lo ss of consciousness. How would you characterize this patient’s
seizure?
a. Complex partial seizure
b. Focal becoming generalized
c. Tonic seizure
d. Clonic seizure
e. Generalized tonic clo nic seizure
19. Should it be appropriate to start this patient on anticonvulsant?

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 a. No, because it is an unprovoked seizure
b. No, because it is only the patient’s first attack
c. No because there is no EEG yet,
d. Yes, because it is symptomatic and provoked - ? not sure
e. Yes, because all seizures needs to be on AED

20. Which anticonvulsant/s would not induce the hepatic microsomal enzyme system?
a. Levetiracetam
b. Valproic acid
c. Topiramate
d. Both A and C
e. All of the above
= = = = = ======================================

21. “Shadow Plaques” are

a. Disru pted blood-brain-barrier
b. Periventular cuffing by T-cells
c. Partial re mye lination of naked axons
d. Astrocytic proliferation
22. Which of the following statement/s is/are true of MS
a. MS is approximately threefold more common in women than men
b. The age of onset os typically between 40 and 60 years
c. MS prevalence is ten to twenty folds higher in the tropics than in temperate zones
d. All are true
23. Which of the following in creases the risk of MS
a. Higher socioeconomic status
b. Higher antibody titers to EBV
c. Dizygotic twin s of MS
d. All are correct
24. …Clinically definite MS diagnostic criteria
a. Two or more symptoms and two or more signs
b. Reflect pathology in anatomically non-contiguous white matter tracts
c. Symptoms must la st for more than 24 hours separated by a month or more
d. All should be fulfilled
25. Most common cognitive ability lost in dementia
a. Language
b. Judgment
c. Memo ry
d. Problem solving
26. The stro ngest risk factor for dementia
a. Menopausal age
b. Advancing age
c. Ethnicity
d. Socio-economic status
27. A Personality change, disinhibition, and compulsive eating would point more to.

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 a. AD
b. FTD
c. DLB
d. Vascular dementia
28. A history of stroke with irreg ular stepwise progression would suggest
a. AD
b. FTD
c. DLB
d. Vascular dementia
29. Dementia with vertical gaze deficit would suggest
a. Heavy metal intoxication
b. Hyp othyroidism
c. Progressive supranuclear palsy
d. Norma l pressure hydrocephalus
30. The more common cause of dementia in Asia
a. Alzheimer’s disease
b. Cerebrovascular disease
c. Parkinson’s disease
d. Cerebral amyloid angiopathy
31. Infection that may be associated with dementia
a. Chronic meningitis
b. Acute bacterial meningitis
c. Partially tre ated bacterial meningitis
d. Limbic encephalitis
32. The cardinal features of Parkinson’s disease
a. Resting tremors
b. Rigidity
c. Gait impairment
d. All are correct
33. The non motor features of Parkinson’s disease
a. Freezing
b. Anosmia
c. Microg raphia
d. All are correct
34. Atypical Parkinsonism
a. Early speech and gait impairment
b. Prominent resting tremors
c. Good response to le vodopa
d. All are correct
35. Multiple-system atrophy is suspected when a patient presents with
a. Atypical parkinsonism
b. Cerebellar signs
c. Autonomic dysfunction
d. All of the above

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36. Most commonest cause of secondary parkinsonism
a. Carbon monoxide poisoning
b. Stroke
c. Neuroleptics
d. Infection
37. Complaints of diplopia and impairment of downward gaze on examination
a. MSA-p
b. MSA-C
c. Dementia with Lewy bodies (DLB)
d. PSP
38. Endocrine disease that can cause myopathic symptoms
a. …osternism (hyperaldosteronism?)
b. Hyp erthyroidism
c. Hyp erparathyroidism
d. Hyp othyroidism
e. All of the above
39. Hyp erkalemic periodic paralysis is re lated to abnormality of ___ channel
a. Sodium
b. Potassium
c. Calcium
d. Chloride
e. A and C
40. Mya sthenia gravis, as a neuromuscular ju nction disease has a defect in the ____ area
a. Presynaptic
b. Synaptic
c. Postsynaptic
d. All
e. B and C only
41. …altered sensation with out la teralizing sign
a. Ischemic encephalopathy
b. Arachnoid hemorrhage
c. Meningitis (viral)
d. All - ??
e. B and C only
42. …..ation, is a patient with a GCS of 3; (-) brainstem reflexes (-) spontaneous
re spire………..mo st helpful is the
a. Cranial MRI
b. …..
c. Cranial CT scan with contrast
d. Lumbar puncture
e. ABG
43. ….evaluating brainstem function
a. …… if this answer tests any of the cranial nerves, answer is A and B
b. Corneals, gag

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 c. Primitive re flexes
d. All
e. A and B only
44. …..Basilar artery occlusion would manifest ___ breathing pattern
a. Cheyne-strokes
b. Neurogenic HPVN
c. Apneustic breathing
d. Cluster breathing
e. A and D
45. ….patient with depressed le vel of consciousness you are examining in the ER; which of the
following patients would need your immed iate attention and management
a. …/90
b. ….O.S 3-4 O.D 6.7 mm sluggishly re active to lig ht
c. ….ent movement of the RUE and RLE
d. With (+) Babinski – most likely answer: sign of brain or nervous system disorder
e. With (-) D…..
46. …….Reflexes evaluates the
a. Edinger-Westphal nucleus - accessory oculomotor nucleus
b. …..cleus
c. Medulla
d. Vestibular nucleus
e. B and D
47. Clinical Symptoms of MG
a. Chewing Difficulty
b. Nasality
c. Diplopia
d. All
e. A and B
48. Neuronal activity is in itially lost at a cerebral blood flow of
a. 30-40 mL/100 g of cerebral tissue
b. <10 mL/100 g of cerebral tissue
c. 40-50 mL/100 g of cerebral tissue
d. 20-30 mL/100 g of cerebral tissue
49. First line tre atment of painful polyneuropathy
a. Carbamazepine
b. Trama dol
c. Pregabalin
d. A and C
e. All
50. Anti-platelet for acute tre atment of acute ischemia
a. Clopidogrel – only for secondary prevention
b. Heparin
c. Aspirin
d. All of the above

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 e. A and C
51. (similar to this question but with motor changed by 1 point, so in stead of 8, it ’ll be 9?) A 73 year
old male was brought to ER d/t altered LOC. on neuro PE, he responds only to moaning and
minima lly opening his eyes upon doing sternal rub, and tries to reach your hand as you perform
the sternal rub. He has a good respond on his le g when you pressed. BP 130/80, RR 36, T36.2.
Deep supple neck in re lation to re spiration. What is the GCS score:
a. 7,
b. 8,
c. 9,
d. 10
e. 11

Nephrology

1. A 48 y/o male with staghorn calculi on P.E. developed fever and chills, with PPE of (+) KPT on
rig ht and pyuria of TNTC, what is/are the most probable uropathogens?
a. E. coli
b. Proteus
c. Klebsiella
d. All
e. Only B and C
2. In a 36 y/o female with recurrent headache with incidental findings of pyuria and no growth on
urine culture, what are your considerations?
a. Renal tuberculosis
b. Fungal UTI
c. Analgesic nephropathy
d. All
e. Only A and B
3. What is the duration of tre atment of acute bacterial prostatitis
a. 3 days
b. 7 days
c. 14 days
d. 30 days
4. True statement with regards to catheter-associated UTI
a. Most common source of gram (-) bacteremia in hospitalized patients
b. Can be prevented by frequent irrigation of bladder with antimicrobial agent
c. Risk of UTI is 8-10 per days of catheterization
d. There is a decrease in cidence if catheter is changed regularly
5. What is the stage of CKD in a 40 y/o male diabetic weighing 55 kg with serum creatinine of 2.7
mg/dL?
a. 1
b. 2
c. 3

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 d. 4
e. 5
6. Absolute indication of re nal replacement treatment in patient with CKD, EXCEPT:
a. Pericarditis
b. Sere anemia
c. Uremic bleeding
d. Restless le g syndrome
e. Intractable pulmonary edema
7. In a 28 y/o female with recurrent edema for 2 years, what are the findings suggestive of chronic
kidney disease?
a. Anemia
b. Hyp erphosphatemia and hypocalcemia
c. Elevated BP
d. All
e. Only A and B
8. What is the target BP control in a CKD stage 4 2” to CGN patient?
a. 130/80-85
b. 125/75
c. MAP of 92
d. All
e. Only A and B

9. Urinalysis findings suggestive of chronic kidney disease

a. Muddy brown granular cast
b. Broad granular cast
c. Proteinuria
d. Hematuria
10. Beta-lactams cause acute tubulo in terstitial nephritis through this mechanism
a. Blockage of cyclo oxygenase re sulting in afferent arteriolar vasoconstriction
b. Haptenization
c. Concentration of the drug metabolites in the medulla
d. Drug crysta llization in the tubules and in terstitium
11. The following are measures done that will prevent acute urate nephropathy, EXCEPT
a. Hyd ration
b. Allopurinol
c. Rashburi case
d. Hemodialysis
e. NAC
12. What is the cause of tubulo in terstitial nephritis presenting with “Sicca” syndrome, distal RTA
and moderate re nal failure?
a. Sarcoidosis
b. Calcium oxalate crystal deposition
c. Light chain cast nephropathy
d. Sjogren’s syndrome

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13. The usual presentation of lithium nephropathy causing chronic tubulo in terstitial nephritis
a. RTA
b. Nephrogenic diabetes in sipidus
c. Fanconi syndrome phosphatemia
14. In a 56 y/o female with CKD stage 4 secondary to hypertensive nephrosclerosis have serum K
of 6.5 meg/L and ECG findings of PVC’s have what kind of hyperkalemia
a. Mild
b. Moderate
c. Severe
d. Intractable
15. In hypokalemia, urgent treatment is necessary on the following, EXCEPT
a. Serum K = < 2
b. Patient with acute myocardial infarct
c. Presence of paralysis
d. Patient with hepatic encephalopathy
e. With ECG findings of multifocal PVC’s
16. A 20 y/o female diagnosed case of medullary cystic disease of the kidney was admitted
because of DOB few hours PTA. PPE: BP= 90/60, CR= 106/min, RR=28/min. Vesicular breath
sounds, (-) edema. Urinalysis = pH = 5.5. ABG: pH-7.26, pCO2=20,HCO3-10. IF this is re nal
tubular acidosis, what is the type?
a. I
b. II
c. III
d. IV
17. On the above patient, the cardiovascular effect is/are
a. Hyp otension
b. Pulmonary edema
c. Arrh ythmia
d. Done
18. What are the causes of clinical finding of metabolic alkalosis and hypokalemia?
a. Furosemide
b. Vomiting
c. Diarrhea
d. All of the above
e. Only A and B
19. A 26 y/o female developed lb m and vomiting with oliguria. BP=palpatory. CR = 120/min,
RR=22/min, BUN = 30 mg/dL, Serum creatinine= 6.8 mg/dL. Urinalysis Na=50. What is the type
of AKI?
a. Pre-re nal
b. Ischemic ATN
c. Nephrotoxic ATN
d. Post-renal
20. A 78 y/o hypertensive is seen at the ER for edema and progressive weakness. Serum
creatinine=1/2 mg/dL which of the following statement/s is/are correction

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 a. The patient can be re assured that his symptoms are not due to renal disease
b. A normal Screatinine in elderly doesn’t mean a normal GFR
c. She needs further evaluation to assess GFR
d. All are correct
e. B and C only
21. The following statement/s is/are true with regards to serum creatinine as a marke r of GFR
a. Its le vel is in versely proportional to muscle mass
b. It is readily observed in the tubules
c. Large changes in GFR corresponds to only sma ll change in serum creatinine
d. All of the above
e. Only A and B
22. The best time to collect urine for examination in patient suspected to have UTI
a. First void morning specimen
b. After taking a bath
c. Anytime when patient is able to promote adequate sample
d. After drinking increase amount hf fluid
23. In a 60 y/o male, obese, smoker complaining of gross hematuria, with palpable (L) flank mass
which is firm and non tender and moves downward with inspiration have CT scan findings of
homogenous mass on the (L ) kidney enhanced by contrast that extend beyond the capsule but
still with in the Gerota’s Fascia. No in volvement of renal vein and inferior venal cava
a. Stage I
b. Stage II
c. Stage IIIa
d. Stage IIIb
e. Stage IV
24. Renal Cell CA is re sistant to chemotherapy because
a. Multiple chromosomal alterations and deletions
b. Proximal tubule cells contain elevated le vels messenger RNA for multidrug resistant
P-170
c. Multidrug resistance gene are over expressed
d. All of the above
e. B and C only
25. A patient with ADPKD, prone to develop nephrolithiasis and nephrocalcinosis because of:
a. Increase uric acid formation
b. Low urine pH and citra te
c. Urinary stasis from distorted collecting duct by the cysts formation
d. All of the above
e. B and C only
26. A 19 y/o male who had sore throat 1 week ago developed periorbital edema and oliguria.
Urinalysis revealed dysmorphic re d cells and rbc cast. The expected lig ht microsco py finding
on renal biopsy is:
a. Diffuse proliferation of mesangial, endothelial, and epithelial cells
b. Extensive epithelial cells proliferation with crescents formation
c. Predominant mesangial cell proliferation

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 d. Focal sclerosis and hyalinosis of <50% of glomerulus
e. Thickened glomerular basement memb rane
27. A 23 y/o male, smo ker was admitted because of oliguria and hemoptysis; initial laboratory
re sults Screatinine= 8.6 mg/dL urinalysis – rbc casts and hematuria. (+) antiGBM antibodies.
The most likely diagnosis:
a. Alport’s syndrome
b. Typ e III RPGN
c. Good Pasteur ’s syndrome
d. Nail Patellar syndrome
28. A 23 y/o female has re current episodes of gross hematuria over the past years. Each of these
episodes was preceded by re spiratory tract in fection. No PPE. Urinalysis re vealed dysmorphic
re d cells Screatinine=1.1 mg/dL. Definitive diagnosis is by:
a. Determination of serum IgA
b. Determination of ANA titer
c. Renal biopsy with histopathologic findings on immunofluorescence
d. ASO titer determination
e. All of the above
29. A 40 y/o male who is apparently well, developed generalized edema. Urine albumin: creatinine
ra tio is 4. The following statement is true for re nal biopsy on this patient
a. Not indicated
b. May start on treatment sin ce it ’s not a priority
c. Should be done prior to start of treatment
d. Will do it when tre atment failed
30. Predominant mesangial IgA deposit is a finding on the following, EXCEPT:
a. IgA nephropathy
b. Lupus nephritis
c. Henoch-Schonlein purpura
d. DM nephropathy

Oncology

31. Most significant risk factor for cancer

a. Age
b. Alcohol
c. Smoking
d. Vira l infection
32. Primary site of cancer for males 20-39 years old dying of cancer
a. Bone sarcoma
b. CNS tumor
c. Lung cancer
d. Leukemia
33. Guardian of the Genome
a. RAS
b. Rb

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 c. Myc
d. P53
34. Most common paraneoplastic syndrome
a. Hyp ercalcemia,
b. Hyp ernatremia
c. Hyp ermagnesemia
d. Hyp onatremia
35. Maximum growth ra te occurs when the tumor is at this of it ’s maximum size
a. 17%
b. 27%
c. 37%
d. 47%
36. A decrease of the tumor size by 20% from baseline:
a. Complete re sponse
b. Partial re sponse
c. Progressive disease
d. Stable disease - ?
37. Doxorubicin acts on which stage of the cell cycle
a. G1
b. G2
c. S
d. M
38. Standard treatment for stage I lu ng cancer
a. Lobectomy
b. Lobectomy + adjuvant chemotherapy
c. Chemotherapy + ra diotherapy
d. Chemotherapy
39. Characteristic of luminal A subtype breast cancer
a. High grade
b. More re sponsive to chemotherapy
c. Respond to endocrine therapy
d. Poor prognosis
40. High probability of being colon carcinoma
a. Polyp of 1.3 cm size
b. Pedunculated polyp
c. Tubular polyp
d. Villous adenoma
41. True of esophageal cancer
a. >50% of patients survive 5 years after diagnosis
b. Most common in itial symptoms is weight lo ss – progressive dysphagia and weight
lo ss are 2 most common
c. Prognosis is good
d. It is more commo n in whites than blacks
42. Risk factor for pancreatic cancer

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 a. Alcohol
b. Acute pancreatitis
c. Cigarette smo king
d. Schistosoma ja ponicum
43. In gastric cancer, metastatic nodule to ovary is known as
a. Blumer’s shelf
b. Krukenberg’s tumor
c. Sister Mary Joseph node
d. Virchow’s node
44. Standard treatment for muscle invading bladder cancer
a. Chemotherapy
b. Intravesical BCG
c. Radial cystectomy
d. Transurethal surgery
45. Standard imaging for estimating uterine and paracervical extension of disease into the soft
tissues
a. CT scan
b. MRI
c. Pet scan
d. Lymphangiogram
46. Recommended screening for a 55 year old nulliparous married woman with no family history of
malignancy, EXCEPT
a. Self-breast examination every month
b. Pap smear every year until age 65
c. Colonoscopy every 3-5 years
d. Mammography every 2 years
47. The desired tumor response if treatment goal is to control the disease
a. Complete re sponse
b. Partial re sponse
c. Stable disease - ?
d. Progressive disease
48. Recommended adjuvant treatment for early breast cancer in premenopausal woman with ER
and PR positive, HER2neu-negative tumor:
a. Chemotherapy only
b. Hormo nal therapy only
c. Chemotherapy then hormonal therapy - ?
d. Hormo nal therapy and radiation
49. Recommended adjuvant therapy for stage 2 re ctal cancer
a. Chemotherapy
b. Chemotherapy + RT
c. RT
d. No need for adjuvant therapy
50. Recommended first line treatment for SVC syndrome due to sma ll cell lung cancer
a. Endovascular stent - ?

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 b. RT
c. Chemotherapy
d. Concurrent chemo-RT
51. Which is NOT a characteristic of Tumor Lysis Syndrome?
a. Hyp ercalcemia
b. Hyp eruricemia
c. Hyp erkalemia
d. Hyp erphosphatemia
52. Cardiomyopathy is a toxicity of which chemotherapy drug?
a. 5FU
b. Cisp latin
c. Doxorubicin
d. Vincristine
53. Surgery and radiation are equivalent treatment options of which stage of cervical cancer?
a. Non-invasive disease
b. Early in vasive disease
c. Locally advanced disease
d. Metastatic disease
54. The standard of care in the treatment of metastatic prostate cancer
a. Chemotherapy
b. Complete androgen blockade
c. Radical prostatectomy
d. RT
55. The standard tre atment for superficial bladder cancer:
a. Transurethral re section of bladder (TURB) - ?
b. TURB then adjuvant chemotherapy
c. TURB then in travesical BCG
d. TURB then RT
56. A patient with longstanding GERD who underwent endoscopy showed Barrett’s esophagus
with low grade dysplasia
a. Medical tre atment of GERD
b. Endoscopic surveillance
c. Endoscopic re section - ?
d. Surgical re section
57. In which type of cancer will you recommend treatment with chemotherapy with or with out RT in
patients with good performance status because of the significant extension in survival?
a. Stage 4 lu ng adenocarcinoma - ?
b. Stage 3 unresectable liver cancer
c. Extensive stage sma ll cell lung cancer
d. Locally advanced pancreatic cancer
58. A patient with a big solitary liver mass cannot undergo percutaneous liver biopsy due to
severely deranged bleeding parameters What else can you request to confirm the diagnosis of
liver cancer?
a. Endoscopic ultrasound and serum AFP

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 b. Convectional CT Scan and serum AFP
c. Multi-p hasic CT scan and serum AFP - ?
d. MRI and serum AFP
59. Lobectomy offers the best chance of cure for which lu ng cancer?
a. Limited stage sma ll cell
b. Stage 2 non-small cell
c. Stage 3B non-small cell
d. Extensive stage sma ll cell
60. Recommended tre atment for early stage pancreatic cancer
a. Surgery then adjuvant chemotherapy
b. Surgery then adjuvant chemo-RT
c. Definitive chemo-RT
d. Surgery Only

Comm unicable Disease

Set A: A. Tetanus B. Rabies C. Malaria D. Schistosomiasis

61. From the portal circulation the parasites migrate to the mesenteric vessels and shed ova in the
in testine or the urinary bladder. The ova can be carried by the circu lation to other areas like the
liver, lungs and the CNS
Answer: D

62. There is prevention in the re lease of in hibitory neurotransmitters in the ventral horns of the
spinal cord or motor nuclei.
Answer: A

Set B: A. Leptospirosis B. Hepatitis B C. Hepatitis C D. Hepatitis A

63. A construction worker developed fever, headache, generalized myalgia, difficulty in walking
with conjunctival suffusion and tenderness of the thigh and leg muscle. After a few days tea
color urine and icteric scle ra were noted
Answer: A

64. A 35-ye ar-old male has an upper abdominal pain. Ultrasound reveals a solid mass on the rig ht
lo be. Alpha feto protein is elevated. His mother is known to have positive surface antigen since
adolescence. The patient was delivered at home.
Answer: B

65. Abrupt onset of high-grade fever and abdominal discomfort followed by jaundice, tea color
urine, ALT > 1000 about a month after eating raw oysters.
Answer: D

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 66. A street vendor has fever. After about one week, it is accompanied by cough, blood streak
sputum, difficulty of breathing, ja undice and anuria
Answer: A

67. A young adult had casual sexual contact about 3 months ago. He has icteric sclera now with
positive surface antigen, IgM to core antigen and with elevated ALT
Answer: B

Set C: A. Gonorrhea B. Syphilis C. Herpes Simplex D. Granuloma

in guinale

68. Intracellular Gra m (-) diplococcic on gram stain, PCR, culture and sensitivity using Thayer-
martin media
Answer: A

69. PCR is preferred test for CSF. Culture is the gold standard. Antigen detection may be better
than culture for detecting the pathogen in healing lesions. Cytology such as in Tza nck or Pap
sme ar are unreliable.
Answer: C

70. Series of antibody titer testing (q uantitative) is used to monitor re sponse to treatment
Answer: B

71. Azithromycin 1 g orally once per week or 500 mg daily for at le ast 3 weeks and until all lesions
have completely healed
Answer: D

72. Acyclovir 400 mg orally three times a day for 7-10 day or Valacyclovir 1 g orally twice a day for
7-10 days OR famciclovir 250 mg orally three times a day for 7-10 days
Answer: C

Set D: WHO HIV clin ical staging A. 1 B. 2 C. 3 D. 4

73. Active PTB Answer: C

74. Thrombocytopenia Answer: C
75. Central nervous system toxoplasmosis Answer: D
76. Unexplained persistent fever for >1 month Answer: C

CASE (77-78) A 75 year old farmer sustains deep wounds on his left foot after stepping on a rusty nail.
His immun ization history is unknown. Vital signs show that his HR – 150 beats per minute, sBP – 170
mmHg and T – 40 C
77. As the physician assigned to this patient, the following should be done:
a. Give ampicillin as the preferred antibiotic since the organism involved is a G+ bacteria
b. Start metronidazole 500 mg IV q 6 hours for seven days

18
 c. Start penicillin 50,000 – 100,000 IU per kg/day
d. Start cla rithromycin 500 mg IV q12 if the patient is allergic to penicillin
78. Since the patient cannot afford TIG, the alternative would be
a. Equine derived antitoxin 10,000 – 20,000 U IM
b. Equine derived antitoxin 10,000 – 20,000 U SQ
c. Rabbit derived antitoxin 10,000 – 20,000 U IM
d. Rabbit derived antitoxin 10,000 – 20,000 U SQ
79. A 76-ye ar-old female presents with fever and productive blood tinged cough of three weeks
duration. She consults a physician who re quests for a chest x-ray with findings suggestive of
PTB. Her sputum AFB smears are all negative. The physician still thinks that this is a case of
TB. The cla ssification of this patient is:
a. Latent TB infection
b. TB disease
c. Presumptive TB
d. TB exposure
80. A 51-ye ar-old male hospital ja nitor presents with productive cough of four weeks duration,
yellowish, mucoid and blood tinged. He is also cachectic and anorexic. His sputum AFB result
is positive. Macrophages and T cells provide partial protection through this kind of immun ity:
a. Cell mediated immunity
b. Humoral immunity
c. Innate immunity
d. Non specific immunity
81. Which diagnostic test will reveal positive result for salmonella typhi in fection on the 3rd week of
illn ess
a. Blood culture
b. Stoll culture
c. Urine culture
d. CSF analysis
82. Drugs of choice for multidrug resistant Typ hoid fever EXCEPT:
a. Azithromycin
b. Ciprofloxacin
c. Cotrimoxazole
d. Ceftriaxone
83. Which of the following statements is true regarding proctocolitis?
a. Tenesmus
b. Diarrhea
c. Infection is limited to the re ctal mucosa (distal 10-12 cm)
d. Results fro m direct rectal in oculation of typical STD pathogens only
84. Major pathologic lesions in chronic schistosomiasis
a. Antibodies, eosinophils and macro phages directed against schistosomula
b. Large granulomas and fibrosis
c. Forma tion of soluble immun e complexes
d. Immediate effect of egg deposition on liver tissues
85. Diagnostic modality which uses schistosome eggs to detect antibodies in the patient’s sera

19
 a. KatoKatz
b. ELISA
c. FECT
d. COPT
86. Most common site of Nosocomial in fection
a. Lungs
b. GIT
c. GUT
d. Skin and subcutaneous tissues
87. Droplet precautionary measures should be observed in caring for a patient with :
a. Typ hoid fever
b. Diphtheria
c. Varicella in fection
d. Tuberculosis
88. Which specimen is best to yield positive re sults for le ptospirosis during the 2nd week of illness
a. Blood
b. Urine
c. CSF
d. Dialysate
89. Histopathologic findings explaining calf pain in le ptospirosis
a. Centrilobular necrosis with proliferation of Kupffer cells
b. Cell surface adhesions and cellular toxicity
c. Hemorrhage and in flammation
d. Swelling and vacuolation of myofibrils
90. The following microorganisms may be spread thru person to person contact EXCEPT
a. Salmonella
b. Entamoeba
c. Shigella
d. Giardia

Hematology

1. Which of the blood cells has the shortest half-life?

a. Red blood cells
b. Monocytes
c. Platelets
d. Gra nulocytes
e. Lymphocytes
2. The kidney synthesizes which of the following Hematopoietic growth factor?
a. Gra nulocyte colony-stimulating factor
b. Erythropoietin
c. Thrombopoietin
d. Interleukin-3
e. All of the above

20
3. Which metabolic pathway protects the re d cells from oxidizing agents?
a. Methemoglobin re ductase pathway
b. Hexose-monophosphate shunt
c. Embden-Meyerhof pathway
d. Leubering-Rapaport shunt
e. None of the above
4. A 70-ye ar-old woman with rheumatoid arthritis presents with a normocytic normochromic
anemia: Hb 10 g/dl and Hematocrit 33. The rest of the blood counts are normal and direct
Coombs’ test is negative.
a. Vitamin B12 deficiency anemia
b. Aplastic anemia
c. Iron deficiency anemia
d. Anemia of chronic disease
e. Hyp ersplenism
5. What is the parameter that determines the marrow re sponse to anemia?
a. Hemoglobin level - ?
b. Hematocrit
c. RBC count
d. Reticulocyte count
e. MCV
6. The main mechanism of anemia in folate and B12 deficiency
a. Hemolysis
b. Blood loss
c. Ineffective erythropoiesis
d. Splenic sequestration
e. Aplasia
7. What is the appearance of the bone marrow in aplastic anemia
a. Hyp ercellular
b. Normo cellular
c. Hyp ocellular
d. Fibrotic
e. Paucity of erythroid precursors
8. The in gestion of favor beans can cause severe hemolytic anemia in patients with
a. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
b. Paroxysmal nocturna hemoglobinuria (P NH)
c. Pyruvate kinase (PK) deficiency)
d. Autoimmune hemolytic anemia (AIHA)
e. Hereditary spherocytosis
9. Intravascular hemolysis is established in the presence of
a. Low serum haptoglobin
b. Elevated indirect bilirubin
c. Hemosiderinuria
d. Increased serum lactin dehydrogenase (LDH)
e. Low hemoglobin

21
10. A decrease in bone marrow iron stores is seen in
a. Anemia of chronic disease
b. Iron deficiency anemia
c. Lead intoxication
d. MDS
e. Thalassemia
11. Which of the following tests indicates a hypoproliferative anemia
a. Norma l MCV
b. Increased RDW
c. Low hemoglobin
d. Low re ticulocyte count
e. Elevated hematocrit
12. A hemolytic disorder caused by an acquired somatic mutation in a hematopoietic stem cell
a. Warm type AIHA
b. Paroxysmal cold hemoglobinuria (PCD)
c. G6PD deficiency
d. Drug-induced hemolytic anemia
e. PNH
13. A 33-ye ar old woman presented with fatigue and pallor. Gynecologic history revealed heavy
menstrual bleeding of several years. Complete blood count showed HB 10.8 g/dL, Hct 31.3,
MCV 78 fL. Peripheral blood smear showed Anisocytosis. What is the most likely explanation of
this patient’s anemia
a. Thalassemia syndrome
b. Lead poisoning
c. Iron deficiency anemia
d. Anemia of chronic disease
e. vWD
14. A 44-ye ar-old woman with chronic liver disease developed anemia and splenomegaly CBC
showed pancytopenia. Bone marrow is aspiration is normal
a. Vitamin B12 deficiency anemia
b. Aplastic anemia
c. Iron deficiency anemia
d. Anemia of chronic disease
e. Hyp ersplenism
15. Which ONE of these statements is TRUE regarding hereditary spherocytosis?
a. It is caused by a defect in hemoglobin
b. More common in males
c. Splenectomy can halt hemolysis
d. A predominantly Caucasian disease
e. Majority of cases are acquired
16. True of polycythemia vera EXCEPT
a. A clo nal disorder involving a multipotent hematopoietic progenitor cell in which
phenotypically normal red cells, granulocytes, and platelets accumulate in the
presence of a re cognizable physiologic stimulus

22
 b. Clinical features may in clude splenomegaly, plethora and aquagenic pruritus
c. Elevated plasma EPO level with isolated erythrocytosis excludes PV
d. Phlebotomy is the standard treatment of choice
e. Majority of patients will show mutation in Jak 2
17. True of hypocalcemia in transfusion medicine, EXCEPT
a. Citra te chelates calcium and thereby in hibits the coagulation cascade
b. Patient may manifest with circu moral numbness and/or tingling sensation of the
fingers and toes
c. May result from multiple ra pid tra nsfusions
d. Prevented by using fre sh or washed RBCs
e. If calcium is necessary, it must be given through a separate lin e
18. Most common symptom in myeloma
a. Anemia
b. Susceptibility to bacterial infection
c. Renal failure
d. Bone pain
e. Neurologic symp toms
19. Most popular tre atment re gimen for Hodgkin Lymphoma
a. R-CHOP
b. ABVD
c. Thal Dex
d. Melphalan prednisone
e. VAD
20. True of Henoch-Schönlein purpura, EXCEPT
a. Acute inflammatory reaction with IgA and complement components in capillaries,
mesangial tissue, and small, Aaterioles, leading to in creased vascular permeability
and localized hemorrhage
b. Manifest as purpuric rash on the extensor surface of the arms and le gs, usually
accompanied by jo int pains, abdominal pain, and hematuria
c. Coagulation tests are abnormal
d. Glucocorticoids may provide symp tomatic relief but will not alter the course of the
illn ess
e. Renal impairment may occur
21. The deficiency or antibodies to this metalloprotease that cleaves vWF will re sult to persistence
of ultra-large vWF molecules in the circulation
a. GpIb-IX complex
b. GpIIb-IIIa complex
c. ADAMTS13
d. Medium-molecular-weight forms of vWF multime r
e. Collagenase
22. True of von Willebrand Dise ase, EXCEPT
a. Rarest in herited bleeding disorder
b. Classified into three major types: type 1, 2, and 3
c. Mainstay of tre atment for mild type is desmopressin

23
 d. Patients have predominantly mucosal bleeding symptoms
e. Typ e 3 vWD are usually with no detectable vWF
23. True of ITP , EXCEPT
a. Characterized by mucocutaneous bleeding and a lo w, often very low, platelet count,
with otherwise normal peripheral blood cells and smear
b. Splenectomy has been used for treatment of patients who relapse after
glucocorticoids
c. Serologic testing for SLE is performed to evaluate for secondary causes if ITP
d. In adult, it is usually an acute disease, most commonly following an infection, and with
a self-limited course
e. Eltrombopag may be recommended for those who are refractory to
immun osuppressive and are not amendable for splenectomy
24. True of heparin induced thrombocytopenia, EXCEPT
a. Associated with in creased risk of thrombosis and not with bleeding
b. Results fro m antibody formation to a complex of the platelet-specific protein platelet
factor 4 (P F4) and heparin
c. Can occur after exposure to UFH but not with LMWH
d. Diagnosis is mainly clin ical
e. Prompt discontinuation of heparin and use of alternative anticoagulants like DTI
25. True of Glanzmann’s disease EXCEPT
a. Deficient or defective in the glycoprotein IIb-IIIa complex
b. Platelets do not bind fibrinogen hence cannon aggregates
c. Platelets re act normally to all stimu li except ristocetin
d. Effective therapy for hemorrhagic episodes including transfusion with normal platelets
e. Platelets are of normal size
26. True of hemophilia, EXCEPT
a. Autosomal dominant disease due to mutations in the F8 or F9 gene
b. Hemophilia A and Hemophilia B are clinically in distinguishable
c. May typically show iso lated prolongation of the aPTT assay
d. Inhibitor formation to FVIII or FIX is one of the major complications of hemophilia
treatment
e. Affected females are carriers
27. Most common presenting sig n of myeloproliferative disorders
a. Splenomegaly
b. Nystagmus
c. Digital gangrene
d. Bone mass
e. Gum hyperplasia
28. B cell ALL marke r
a. CD 13 and 33
b. CD 3 and 4
c. CD 19 and 20
d. CD 41 and 61
e. CD 7

24
 29. Laboratory features of CML, EXCEPT
a. LAP score is zero
b. Norma l platelet count
c. Decreased WBC count
d. Positive for BCR, ABL by FISH
e. Ph Chromosome positive
30. Blast cutoff for the diagnosis of AML by the WHO classification
a. 5%
b. 10%
c. 20%
d. 30%
e. 40%

Gastroenterology

31. True re garding bilirubin

a. Unconjugated bilirubin is water soluble
b. Biliru bin existing in the serum is predominantly unconjugated
c. Predominantly unconjugated bilirubin is seen in viral hepatitis
d. Conjugated bilirubin in plasma is tightly bound with albumin
32. True re garding Gilbert ’s syndrome
a. Due to decrease in bile conjugation
b. Predominantly conjugated hyperbilirubinemia
c. There is excessive transcription of bilirubin UGT-1 gene
d. May be le thal in occasional cases
33. Most common cause of biliary tra ct obstruction
a. Tumor
b. Ascaris
c. Surgical trauma to the biliary tree
d. CBD stones
34. Advantage of ultrasound over CT scan in the imaging of the hepatobiliary tree
a. Ima ges are cle arer even among obese patients
b. Portability
c. Utilizes radiation therefore is much accurate
d. Contrast media are ro utinely used therefore the images are sharper
35. Helps in confirming the diagnosis of primary biliary cirrhosis
a. Ceruloplasmin
b. Alpha-1 anti-trypsin
c. Transferring
d. Anti mito chondrial antibody
36. Histologic lesion indicating more severe course in chronic hepatitis
a. Councilman bodies
b. Brid ging necrosis
c. Hyp erplasia of Kupffer cells

25
 d. Hya line body formation
37. With chronic state EXCEPT
a. HAV
b. HBV
c. HCV
d. HDV
38. Seen in fulminant hepatitis EXCEPT
a. Rapidly enlarging liver size
b. Prolonged prothrombin time
c. Rapidly increasing bilirubin levels
d. Encephalopathy
39. Mechanism of gallstone formation
a. Increase in 7 alpha hydroxylase activity
b. Increased bile acid concentration in bile
c. Increased gallbladder motility
d. Obesity
40. Serum amylase may be normal among patients with abdominal pain in the following conditions
a. Hyp erglycemia
b. Hyp eruricemia
c. Chronic pancreatitis
d. Diabetic
41. True re garding the upper esophageal sphincter
a. Function is supplemented by the diaphragmatic crura
b. With inhibitory in nervation
c. Made of smo oth muscle
d. Crico pharyngeus muscle
42. Evaluates both motor and stru ctural disorders of the esophagus
a. Esophagoscopy
b. Esophageal manometry
c. Barium swa llow with fluoroscopy
d. Esophageal pH monitoring
43. True re garding prima ry achalasia
a. Lower esophageal sphincter re laxes unnecessarily
b. With loss of in tramural inhibitory neurons
c. Characterized by rapid course of dysphagia and weight lo ss
d. Nitro glycerine aggravates the symptoms of this disease
44. Increased gastric volume predisposes to gastroesophageal reflux in
a. Pyloric obstruction
b. Bending
c. Obesity
d. Ascites
45. True re garding gastroesophageal reflux/GER disease
a. H. pylori is an etiologic agent
b. Gastroesophageal re flux is a normal phenomenon

26
 c. Gastroesophageal re flux disease is solely due to re flux of acid in the esophagus
d. Wearing tight belts can alleviate the symptoms of GERD
46. Non-pharmacological tre atment of GERD includes the following EXCEPT
a. Weight reduction
b. High back rest
c. Avoid smo king
d. Drinking plenty of fluids during dinner
47. True re garding Barrett esophagus
a. May give rise to squamous cell carcinoma of the esophagus
b. Intestinal metaplasia of the esophagus
c. A risk factor for gastric cancer
d. May be seen among patients who suffer from caustic in jury to the esophagus
48. Cells found in the body of the stomach EXCEPT
a. Mucous neck cell
b. G-cells
c. Chief cells
d. Enterochromaffin cells
49. Among the factors protecting the gastric mucosal from damage EXCEPT
a. Bile salts
b. Mucous
c. Microvascular system
d. Epidermal growth factor
50. H. pylori eradication is ro utinely recommended for
a. Gastritis of any etiology
b. Prevention of gastric cancer
c. Treatment of low grade MALT tumor
d. GERD tre atment
51. True re garding Whip ple Disease
a. Due to re section of pancreatic head, duodenum and distal CBD
b. Patient is allergic to gliadin
c. Patients have liver cirrhosis
d. Histology reveals PAS (+) cytoplasmic granules within the macro phages
52. Acute inflammatory diarrhea
a. Shigella
b. Cholera
c. Inflammatory bowel disease
d. Lactose in tolerance
53. Features more commonly seen in Crohn’s disease
a. Toxic megacolon
b. Colo-rectal CA
c. Rectal bleeding
d. Fistula
54. High malignant potential is seen in polyps in the following syndromes except
a. Familia l colonic polyposis syndrome

27
 b. Turcot’s syndrome
c. Peutz-Jegher’s syndrome
d. Gardner’s syndrome
55. Similarities between GI TB and Crohn’s disease EXCEPT
a. Caseating granuloma
b. Fistula
c. Stricture
d. Palpable RLQ mass
56. Painful stra ining at stool with sensation of incomplete emptying after defecation is a symptom
pointing to pathology involving
a. Appendix
b. Rectum
c. Stomach
d. Descending colon
57. True re . bleeding diverticulosis
a. More common in the cecum
b. Preceded by severe abdominal pain
c. Antibiotics is the main mode of treatment
d. Commonly manifests as melena
58. Compatible with adynamic ileus EXCEPT
a. Abdominal distention
b. Colicky abdominal pain
c. Distended in testinal lo ops
d. Abdominal discomfort
59. Medication for diarrhea predominant irritable bowel syndrome
a. Loperamide
b. Tegaserod
c. Metoclopramide
d. Benzodiazepines
60. Associated with pseudomembranous enterocolitis
a. Metronidazole
b. Clindamycin
c. Quinolone
d. Erythromycin

Cardiology

61. VM 60 year old male, businessman, hypertensive, diabetic, obese, 40 pack years smoker
complained of pain in the right buttocks while walking for > 200 meters and is re lieved by
re sting. BP=150/100, HR = 70/min , RR= 18/min. The right femoral, popliteal, posterior Tibial and
dorsalis are all +1 while the left femoral, popliteal posterior tibial and dorsalis pedis artery is + 2.
Your initial imp re ssion is peripheral arterial disease. Ankle brachial in dex was done. Which of
the following ankle brachial indices is compatible with PAD in the patient?
a. Left ABI = 0.92; Right ABI = 0.97

1.0- 1.4 N
0.91- 0.99 borderline
0.70- 0.90 mildly abnormal
0.40- 0.69 moderately abnormal 28
<0.40 severly abn
>1.4 incompressible vessels
 b. Left ABI = 1.0; Right ABI = 1.6
c. Left ABI = 1.4; Right ABI = 1.0
d. Left ABI = 1.2; Right ABI = 0.8
e. Left ABI = 0.7; Right ABI = 1.1
62. What is the sig nificance of a positive Allen ’s test?
The need for this test arises in
a. Stenosed or obstructed brachial artery
cases in which a procedure that
b. Stenosed or obstructed radial artery may compromise radial artery
patency is being considered.
c. Stenosed or obstructed ulnar artery -StatPearls
d. Stenosed or obstructed palmar arteries
e. Stenosed or obstructed axillary artery
63. SS 30 year old male seaman complained of recurrent severe pain with movement with
presence of dry gangrene over the big toe and 2nd toe of the le ft foot. He’s none hypertensive
and non-diabetic but is 40 pack years smoker. Pulses are still +2 in the dorsalis and posterior
tibial arteries. What is your prima ry diagnosis?
a. Fibromuscular dysplasia
b. Primary Raynaud’s disease
c. Buerger’s disease
d. Atheroembolism or blue toe syndrome
e. Lymphedema
64. The la teral wall of the le ft ventricle is represented on the 12 le ad ECG by what le ads?
a. Lead VI Lateral wall – Lead I, AVL, V5, V6
Inferior wall – Lead II, Lead III, AVF
b. Lead I Anterior wall – V3, V4
c. Lead AVF Anterior septal wall – V1, V2
No specific view – AVR
d. Lead AVR
65. Correct placement of ECG le ads is essential. The unipolar chest le ad V5 should be placed in
a. 4th ICS le ft sternal margin V1 – 4th ICS right sternal margin
V2 – 4th ICS left sternal margin
b. 5 ICS midclavicular line
th
V3 – midway between V2 & V4
c. 5th ICS anterior axillary line V4 – 5th ICS MCL
V5 – 5th ICS AAL
d. 6th ICS midclavicular line V6 – 5th ICS midaxillary line (MAL)
66. The cell memb rane is imp ermeable to entry of sodium io ns during which phase of the action
potential? His phase is also called the re sting or polarized state.
a. Phase 1 Phase 0 – Rapid depolarization
-Na channels opens; Ca moves slowly into the cell
b. Phase 3 Phase 1 – Early repolarization
-Na channels closes; Transient K efflux
c. Phase 4 Phase 2 – Plateau phase
-Ca cont. to flow in; K cont. to flow out; myocytes contraction
d. Phase 0 Phase 3 – Rapid repolarization
-Large amt. of K diffuse out as the K channels open
67. The QT in terval on the ECG -Ca channels close
Phase 4- Resting potential
a. Represents electrical systole -High K permeability

b. Varies with age, sex and heart rate

c. Norma l value in adults is 0.35-0.44s
d. All of the above
68. Which is pathognomic of dilated cardiomyopathy
a. S3
b. Distended ju gular veins CHF
c. Pulsus alternans CHF

29
 d. None of the above
69. Which is the LEAST commo n of the following cardiomyopathies
a. Dilated cardiomyopathy
b. Restrictive cardiomyopathy
c. Peripartum cardiomyopathy
d. Hyp ertrophic cardiomyopathy
70. Blood pressure is stro ngly and directly related to vascular mortality, without any evidence of
threshold down to at least which fothe following BP
a. 115/75 mm Hg
b. 135/85 mm Hg
c. 155/95 mm Hg
d. 175/105 mm Hg
71. The prevalence of hypertension in adults > 18 years of age is now (2015)
a. 21%
b. 26%
c. 28%
d. 32%
e. 35%
72. Dive rse pathogenesis and etiology of uncontrolled BP is which of the following
a. Poor therapeutic effects
b. Presence of interfering substance such as in take of NSAIDS
c. Sleep apnea syndrome
d. Adverse drug re action
e. Increase sodium intake
73. Chronic coronary artery disease is manifested as
a. Unstable angina pectoris
b. Non ST elevation MI
c. ST elevation MI
d. Stable angina pectoris
74. The most common etiology of systolic heart failure is
a. Valvular heart disease
b. Congenital heart disease
c. CAD + hypertension
d. Dilated cardiomyopathy
75. If the cause of heart failure is isch emic heart disease. The best treatment is
a. Mechanical re vascularization
b. Ivabradine
c. Isosorbide
d. Dinitrate
e. Spironolactone
76. The ECG evidence that thrombolytic therapy can still be administered is which of the following?
a. Q wave with ST elevation
b. ST depression
c. ST elevation

30
 d. Symmetrical T wave inversion
77. Which of the following is a moderate risk factor for the development of venous
thromboembolism
a. Immobility due to sitting
b. Bed rest > 3 days
c. Myo cardial in farction
d. Thrombophilia
e. Major trauma
78. Which of the following type of hypertension is associated with CV risk factors and has
in creased risk of CV events?
a. White coat hypertension
b. Masked hypertension
c. Non dipper/reversed
d. Morning surge hypertension
79. Home BP monitoring is an example of out of office blood pressure level. Which of the following
is considered hypertension in HBPM?
a. > 140/90 mm Hg
b. > 135/80 mm Hg
c. > 100/80 mm Hg
d. > 135/85 mm Hg
80. A patient with SVT-heart ra te ra nging from 180-200 BPM secondary to acute coronary
syndrome. Which of the following will be the best drug to administer?
a. Digitalis IV
b. Amiodarone IV and drip
c. Ivabradine oral preparation
d. Verapamil IV push
81. The gold standard in the diagnosis of heart failure is
a. NT PRO BNP
b. 2-D echo doppler
c. Coronary angiography
d. Nuclear ima ging
82. A 34 y/o male came to the emergency due to dyspnea. On PE, patient was noted to be
cachectic, have neck engorgement, which does not collapse on inspiration, tachycardic,
protruberant abdomen and bipedal edema. ECG – low voltage ECG with diffuse flattening of
the T waves, CXR – normal heart size with calcification. The most likely diagnosis is:
a. Right ventricular infarction
b. Tricuspid stenosis
c. Constructive pericarditis
d. Cor pulmonale
83. Which of the following is NOT a major Jones criteria
a. Arthralgia
b. Carditis
c. Erythema marginatum
d. Chorea

31
 e. None
84. Which of the following acute conditions is potentially life threatening condition that warrants
immed iate hospitalization and aggressive evaluation
a. Acute ischemic heart disease
b. Aortic dissection
c. Acute pneumothorax
d. Acute pericarditis
85. Which of the following is TRUE
a. The cardiac auscultatory for the tricuspid valve is at the 4th intercostals space, right
b. To appreciate the diastolic murmur of mitral stenosis is best to use to bell
c. LV heave is present in mitral stenosis
d. A murmur with a thrill is grade at least 2/5
86. A 32 y/o male has brachial artery of 210/130 mmHg with a weak pulse on the lo wer extremities.
Which is the most like ly diagnosis?
a. Renovascular hypertension
b. Essential hypertension
c. Coarctation of aorta
d. Pheochromocytoma
87. A 35 y/o male is evaluated for progressive dyspnea. Past medical history re vealed he was told
he had a murmur during childhood. His cardiac examination re vealed murmu r that starts from
S1 and ends up after S2 associated with a thrill the upper sternal border of the chest. What is
the most likely cause of patients murmu r?
a. Atrial septal defect
b. Ventricular septal defect
c. Coarctation of aorta
d. Patient ductus arteriosus
88. NN 65 year od male, hypertensive with poor compliance to treatment with 50 pack smoking
history complained of progressive chest pain, shortness of breath and cough for 3 months. Due
to the progression of the chest pain, consul t was done. PE: BP= 220/130 mmHg, HR = 114 bpm,
RR=28/min, (-) neck vein engorgement nor hepatojugular re flex. Bronchovesicular breath
sounds, AB 7th ICSLAAL, (+) heave, (-) S3 S4, no murmur, ECG: sinus tachycardia le ft, le ft
atrial enlargement, Left ventricular hypertrophy. One of your differential diagnoses is an aortic
aneurysm. What non-invasive diagnostic test is a stand alone test that will confirm your
diagnosis?
a. Chest x-ray
b. Contrast enhanced CT scan
c. Aortography
d. Transesophageal echocardiography
e. MRA
89. LL 53 year old male hypertensive, diabetic, (-) asthma nor COPD, (-) CKD, 35 pack year
smo ker, has been complaining of recurrent wall chest pain (10/10) for the past 1 week.
BP=230/120, HR=120, RR=23; conscious, coherent, 3/6 diastolic murmur at the base. Your
admitting impression is Aortic aneurysm R/O aortic dissection. While waiting for the imaging
examination to be performed, what medications can you start to temporize your patient’s status

32
 a. Captopril 25 mg tab sublingual stat
b. Na Nitro prusside 4 mcg/kg/min IV
c. Enoxaparin 0.4 cc SC stat then OD
d. Hyd ralazine 10 mg IV stat dose
e. Carvedilol 25 mg tab per orem stat dose
90. Where is the most common lo cation of an acute aortic dissection?
a. Ascending aorta
b. Descending aorta
c. Aortic arch
d. Supra abdominal aorta
e. Infra abdominal aorta

Pulmonology

1. Alveolar edema occurring in ARDS can result to the following changes

a. Marke d decreased in lung compliance
b. Atelectasis
c. Decreased aeration
d. All of the above
e. B and C only
2. The hypercapnia in early ARDS is secondary to
a. Increase in pulmonary dead space
b. Decrease in pulmonary dead space
c. Decrease in lung compliance
d. Increase in lung compliance
e. Fibrocellular proliferation
3. Diagnostic criteria for moderate ARDS
a. Acute onset of bilateral lu ng infiltrates
b. Pulmonary capillary wedge pressure < 18 mmHg
c. PaO2/FiO2 100 mmHg > 200 mmHg
d. All of the above
e. A and C only
4. The mechanism of hypoxemia in ARDS is:
a. Ventilation perfusion mismatch
b. Hyp oventilation
c. Intrapulmonary shunting
d. Diffusion abnormality
e. Low in spired oxygen concentration
5. The type of leukocytic infiltrations in the lung in terstitium of patients with ARDS
a. Eosinophils
b. Lymphocyte
c. Neutrophils
d. Basophils
e. Monocytes

33
6. These chest x-ray findings can differentiate cardiogenic from non-cardiogenic pulmonary
edema
a. Pulmonary vascular redistribution
b. Cardiomegaly
c. Bilateral pleural effusions
d. All of the above
e. A and B only
7. Marke d reduction in lung compliance in ARDS is due to:
a. Alveolar and interstitial fluid
b. Loss of surfactant
c. Microvascular occlusion
d. A and C only
e. A and B only
8. The central feature of ARDS
a. Increased pulmonary vascular permeability
b. Decreased pulmonary vascularity
c. Alveolar and interstitial fibrosis
d. Neutrophil infiltrated interstitium
e. Increased le ft atrial fillin g
9. Mechanical ventilation is a device that can support ventilator function and improve oxygenation
through application of
a. Positive pressure
b. High lu ng volume
c. High oxygen-content gas
d. A and B only
e. A and C only
10. Contraindications for the use of noninvasive ventilation
a. Severe gastrointestinal bleeding
b. Hyp otension
c. Upper airway obstruction
d. All of the above
e. A and C only
11. This type of re spiratory failure re sults from alveolar hypoventilation
a. Typ e I
b. Typ e II
c. Typ e III
d. Typ e IV
e. All of the above
12. A 45-ye ar-old female came in at the ER with difficulty of breathing, pleuritic chest pain on the
lo wer rig ht and low grade fever. There was dullness and absent breath sounds on the rig ht
lo wer lu ng. Chest x-ray showed homogenous haziness on the rig ht lo wer lu ng suggestive of
pleural effusion. TO determine if this is a free flowing fluid, one must re quest for:
a. Lateral upright view
b. Thoracentesis

34
 c. Lateral decubitus view
d. Apicolordotic view
e. Fluoroscopy
13. All of the following procedures can be utilized to diagnose pulmonary embolism, EXCEPT
a. Ventilation-perfusion scanning
b. CT angiogram
c. Pulmonary angiography
d. Magnetic re sonance ima ging (MRI)
e. Pet scan
14. A 60 year old male smoker complained of chronic cough with blood streak sputum with weight
lo ss for the past 3 months and noted to have a pulmonary mass at the right upper lo be by chest
x-ray and CT scan. An impression of bronchogenic carcinoma was given. What will be your
next step?
a. Do a needle lu ng biopsy - ?
b. Request for thoracoscopic examination
c. Do thoracentesis
d. Request for MRI to further confirm the diagnosis
e. Request for spirometric test and lu ng volume studies
15. A 50 year old male smoker was diagnosed to have community acquired pneumonia. He is a
known diabetic with present HBa1C=6%. Chest x-ray revealed infiltrates with minimal pleural
effusion on the right. What is the risk classification of this patient
a. Minima l risk
b. Low risk
c. Moderate risk
d. High risk
16. The drug of choice for community acquired pneumonia caused by atypical bacteria
a. Macro lides
b. Cephalosporins
c. Cloxacillin
d. Beta la ctams

Matching
Match the different patient with the auxiliary procedure that is of most helpful in arriving at the diagnosis
A. Sleep study B. Spirometry C. Chest CT Scan D. Chest MRI E. Chest Ultra sound

17. A 60 y/o male, smo ker with cough and difficulty of breathing for more than 6 years already was
ru shed to the ER because of very severe difficulty of breathing while watching his favorite TV
show at home
Answer: D

18. A 26 y/o female was noted to be gaining weight for the past 2 months and complaining of
sleepiness
Answer: A

35
 19. A 70 y/o male sough consult because of cough for more than 3 months and about 15% weight
lo ss in 2 months
Answer: C

20. A 54 y/o female, obese, sought consultation because of difficulty of breathing for almost 2
weeks now and nonproductive cough for more than a month. On PE there is la gging on the (L )
side of the chest with decrease fremitus and in tensity of breath sounds also on the (L) side of
the chest
Answer: ??

21. A 60 y/o female sought consultation because of cough for one week and difficulty of breathing
for the past 2 days. She denies any history of chronic respiratory symptoms nor allergy. On
re view of systems, she have fre quent sneezing for the past 2 weeks
Answer: C

22. A 48 y/o male, non-smoker sough consultation because of chest tightness on exertion. He
denies any cough or other respiratory symptoms
Answer: B

23. A 65 y/o female, non-smoker, with history of DM type and hypertension for more than 10 years
sough consultation because of chest pain felt at the sternal area and it is said to be very painful
and tearing. ER BP is 120/70
Answer: C

24. A 43 y/o female, obese, sought consultation because of the mediastinum on routine chest x-ray.
She denies having any symptoms in ROS
Answer: C

25. A 17 y/o student, obese, sought consultation because of CBC results of Hbg 20 mg% and hct
65
Answer: A

26. A 57 y/o male patient sought consultation because his pleural fluid cytology study is (+) for
malignant cells and chest x-ray re veal pneumonia (R) base
Answer: C

Match the following patients with asthmas with the different severity of asthma exacerbation
A. Mild B. Moderate C. Severe D. Resp. Arrest Imminent

27. A 18 y/o female ru shed to the ER because of difficulty of breathing. PE: she has a respiratory
ra te of 30/min . PR=125 diaphoretic. She can hardly talk when she is being in terviewed
Answer: C

36
 28. A 15 y/o male was ru shed to the ER because of difficulty of breathing in the ER. He was noted
to be cyanotic and confused
Answer: D

29. A 23 y/o female, sought consultation because of difficulty of breathing. On PE. Her RR is
25/min and on auscultation there is expiratory wheezes
Answer: B

30. A 21 y/o male was ru shed to the ER because of severe difficulty of breathing. On examination,
patient is (+) pulsus paradoxus of 20 mmHg
Answer: B

Rhe umatology:

31. An inflammatory joint is characterized by

a. Join pain in the evening
b. Morning stiffness of more than one hour
c. Bony hypertrophy of the distal interphalangeal joint
d. Limitation of motion of joint
32. Inflammation of the site of attachment of a lig ament or tendon to the bone is known as
a. Tendonitis
b. Bursitis
c. Enthesitis
d. Synovitis
33. Which of the following conditions is now (mayb e a typo “not”) inflammatory joint problem?
a. Osteoarthritis – generally considered NOT inflammatory
b. Gouty arthritis – in flammatory
c. Ankylosing spondylitis – in flammatory
d. Systemic lu pus erythematosus arthritis – in flammatory
34. The most common ro ute by which bacteria enters the joint
a. Lymphatic spread
b. Contiguous spread
c. Hematogenous spread
d. Direct in oculation
35. M.S . 70 y/o female consulted because of (R) knee pain of 2 years. P.E. of the (R) knee showed
bony hypertrophy, valgus, (+) coarse crepitation, what is your diagnosis?
a. Rheumatoid arthritis
b. Gouty arthritis
c. Septic arthritis
d. Osteoarthritis
36. Which of the following statements characterize fibromyalgia
a. Highly inflammatory condition
b. Presence of tender joint site
c. Easily diagnose using common laboratory tests

37
 d. Commonly seen in women of reproductive age
37. Which statement best characterized TB arthritis?
a. Acute monoarticular highly inflammatory, la rge joint
b. Chronic monoarticular, la rge joint, lo w in flammation
c. Chronic polyarticular, sma ll joint, in flammatory
d. Acute, polyarticular, large jo ints, in flammatory
38. One of the following is NOT related to an in fectious agent as a cause of arthritis
a. Rheumatic fever arthritis
b. Potts disease
c. Chondrocalcinosis
d. Lyme disease
39. The crysta l of calcium pyrophosphate dehydrate disease is characterized as
a. A needle shape negatively birefringent
b. Ovoid, maltase cro ss
c. Rhomboid shape, positively birefringent
d. Rectangular, negatively birefringent
40. JJ 35 y/o male, 5’6 200 lbs. previously well consulted because of (R) ankle arthritis. He had a
history of eating binge 2 days ago. PE showed a highly inflamed (R) ankle [(+) warmth,
tenderness, limitation of motion and redness)]. What is your diagnosis?
a. Septic arthritis
b. Fracture
c. TB arthritis
d. Gouty arthritis
41. Which of the following non pharmacologic interventions is le ast helpful in patients with gouty
arthritis due to hyperuricemia
a. Cold compress
b. Warm compress
c. Increase water intake
d. Increase in take of low fat dairy product
42. What joint structure is primarily affected in osteoarthritis
a. Intraarticular ligament
b. Meniscus
c. Hya line cartilage
d. Synovium
43. Pain in osteoarthritis arises fro m the following EXCEPT
a. Capsular stretching
b. Synovial inflammation
c. Cartilage fibrillation
d. Bone marro w edema
44. The diagnosis of osteoarthritis is most likely if
a. Sugar level of the synovial fluid is low
b. Protein le vel is high - ?
c. Lactate dehydrogenase level is low
d. White cell count of synovial fluid is 900/ui

38
45. Drug of choice to relieve pain in osteoarthritis
a. Glucosamine sulfate
b. Acetaminophen
c. Hya luronic acid
d. Glucocorticoid
46. Which of the following confer greater specificity for the diagnosis of early rheumatoid arthritis?
a. Elevated CRP
b. (+) Rheumatoid factor
c. (+) anticyclic citrullinated peptide
d. Elevated ESR
47. One of the following is true re garding the epidemiology of rh eumatoid arthritis
a. Prevalence in male and female is equal
b. Prevalence increases with age
c. No genetic predisposition
d. Prevalence is high in those living in tropical countries
48. The most common complaint of patients with ankylosing spondylitis
a. Morning stiffness
b. Chronic low back pain
c. Arthritis of the ankle jo int
d. Fever
49. One of the following is NOT characteristic of psoriatic arthritis
a. Dactylitis
b. Presence of psoriasis
c. (+) Rheumatoid factor
d. Asymme tric inflammatory arthritis
50. The goal of therapy in Rheumatoid arthritis
a. Control systemic in volvement
b. Pain relief
c. Reduce inflammation
d. All of these
51. One of the following is NOT considered a member of the seronegative spondyloarthropathies
a. Psoriatic arthritis
b. Rheumatoid arthritis
c. Reactive arthritis
d. Ankylosing spondylitis
52. MT 35 y/o female consulted because of arthritis of the wrist joint, ankle and knee joint,
photosensitivity and malar rash. What test would you request to stre ngthen your diagnosis?
a. ANA
b. CRP
c. X-ra y of both wrist, ankles
d. Rheumatoid factor
53. The jo ints prima rily affected in ankylosing spondylitis
a. Wrist
b. Axial skeleton

39
 c. Knee
d. Proximal interphalangeal joint
54. The le ading cause of death in patients with SLE in the Philippines
a. Anemia
b. Infection
c. Acute myocardial infarction
d. Renal in sufficiency
55. S.T. 45 y/o female consulted because of 3 months history of itchiness of both eyes and dryness
of the mouth, such that she has difficulty in chewing food P.E. revealed bilaterally enlarged ___
tender parotid. What is your diagnosis
a. Parotitis, vira l
b. Sjögren’s syndrome
c. Systemic lu pus erythematosus
d. SLE
56. Polymyositis is characterized clinically by
a. Symmetric proximal muscle weakness
b. Intense in flammation of proximal muscle
c. Presence of heliotrope rash over proximal muscle
d. Asymme tric inflammation of distal muscle
57. A systemic vasculitis that affects small and medium size arteries that is associated with Hep
B/C, in fection, Hypertension, testicular pain and weight loss of > 4 kg in the la st 3 months
a. Takayasu’s arteritis
b. Polyarteritis nodosa
c. Temporal arteritis
d. Behcet’s arteritis
58. C.T. 28 y/o male, consulted because of blurring of visio n for 4 months, re current aphthous ulcer
and arthritis of both knees. Pathergy test (+). What is your diagnosis?
a. Rheumatoid arthritis
b. Gonococcal arthritis
c. Septic arthritis
d. Behcet’s syndrome
59. Which of the following statements regarding temporal arteritis is true?
a. Affects sma ll size arteries
b. May cause blindness due to isch emic optic neuropathy
c. Commonly seen in female of reproductive age
d. Prevalence in the Philippines is high
60. The most common pulmonary manifestation of SLE is
a. Interstitial in flammation
b. Pleuritis
c. Shrinking lu ng syndrome
d. Intraalvelor hemorrhage

Endocrinology

40
61. Which of the following tests is most helpful in differentiating high versus lo w form of
thyrotoxicosis?
a. 24-h r RAIU
b. FT4
c. TSH
d. Thyroid ultrasound
62. Which of the following drugs will block thyroid hormone synthesis via Wolff-Ch aikoff effect
a. Carvedilol
b. Lugol’s solution
c. Methimazole
d. Prednisone
63. Which of the following cardiac manifestations is seen in hypothyroidism
a. Augmented myocardial contractility
b. Decreased diastolic pressure
c. Enhanced dromotropic effect
d. Increased peripheral resistance
64. What is the most commo n cause of painful thyroiditis
a. Gra nulomatous
b. Hashimoto’s
c. Postpartum
d. Riedel’s
65. A 35-ye ar-old male complained of cold in tolerance, constipation and progressive weight gain
despite of anorexia. He had previous history of total thyroidectomy for a multinodular goiter 10
years ago with no maintenance meds. He was seen somnolent with sluggish movement and a
very deep voice. BP noted to be 130/90 mm Hg and heart rate is 52/min. The thyroid gland is
not palpable. What will be the treatment of choice in this setting?
a. Iodine
b. Levothyroxine
c. Liothyronine
d. Thyroglobulin
66. A 40 year old male presented with a thyroid nodule of 1.5 cm in size that moves on deglution.
What makes him a high risk to develop thyroid CA?
a. Age
b. Gender
c. Movable nodule
d. Nodule size
67. What is the most abundant form of vitamin D in our body?
a. 7-hydrocholesterol
b. 1alpha-hydoxyvitamin D
c. 25-h ydroxyvitamin D
d. 1,25-d ihyroxyvitamin D
68. Which of the following biological actions is an indirect effect of PTH
a. Enhance re nal excretion of phosphate
b. Inhibit renal re absorption of calcium

41
 c. Promote bone formation
d. Stimulate in testinal re absorption of calcium
69. Which endocrine gland produces vasopressin
a. Adenohypophysis
b. Hyp othalamus
c. Neurohypophysis
d. Pineal
70. What is the most commo n cause of an intrasellar mass?
a. Acromegaly
b. Cushing’s disease
c. GnH-producing pituitary adenomas
d. Prolactinoma
71. A 38 year old female was referred for endocrine evaluation. She noticed to have gained weight
for the past few months. Recently she was diagnosed having hypertension and diabetes. Few
days ago, she developed violaceous striae over her abdomen. What will be the best initial
la boratory examination?
a. Plasma metanephrine
b. ACTH stimulation test
c. Overnight dexamethasone test - ?
d. Plasma aldosterone and renin activity
72. In patient with chronic adrenal in sufficiency, the best way of giving prednisone is
a. 2 equal doses
b. 3 equal doses
c. Once a day
d. 2/3 in the morn ing and 1/3 in the afternoon
73. Patient with congenital adrenal hyperplasia should be given
a. Prednisone
b. Spironolactone
c. Alpha blocker
d. Fludrocortisone
74. Which of the following is a pheochromocytoma associated syndrome
a. Waterhouse-Friderichsen syndrome
b. Down syndrome
c. Neurofibromatosis type 1
d. Cushing’s syndrome
75. In Conn’s disease, you should expect which of the following laboratory findings
a. Low potassium, lo w re nin and lo w aldosterone
b. Low potassium, lo w re nin and high aldosterone
c. Low potassium, high renin and high aldosterone
d. High potassium, high renin and high aldosterone
76. Which of the following organ contains beta 1 receptor
a. Vascular smooth muscles
b. Cardiac muscle
c. Bronchial smo oth muscle

42
 d. Uterus
77. Treatment of pheochromocytoma
a. Beta blocker before alpha blocker
b. Alpha blocker before beta blocker
c. Diuretic before beta blocker
d. Diuretic before alpha blocker
78. Which among the following conditions may lead to secondary hyperaldosteronism
a. Hyp okalemic acidosis
b. Congestive heart failure
c. Hyp orenin hypoaldosteronism
d. Renal tubular acidosis
79. Most common cause of secondary adrenal in sufficiency
a. Sudden withdrawal fro m prolonged steroid use
b. Sheehan’s syndrome
c. Adrenal TB
d. Waterhouse-Friderichsen syndrome
80. Electrocardiographic sig n of hypokalemia
a. Deep T wave
b. ST segment depression
c. Prominent U wave
d. Atrial fibrillation
81. A 46 year old male patient is ru shed to the ER complaining of nausea, vomiting and severe
abdominal pain of (8?) hours duration. He is diabetic for 2 years on unrecalled medication. (+)
Polydipsia and polyuria for 1 week. PE: dry mucosa, tachycardia, BP – 90/60 mmHg, RR –
28/min , systemic PE unremarkable. What is your differential diagnosis
a. Acute pancreatitis
b. Acute abdomen
c. Diabetic emergency
d. All of the above
82. Capillary blood glucose revealed 500 mg/dl. At this point, you are stro ngly considering diabetic
emergency. What essential la b/s will you request?
a. Serum/urine ketones
b. ABG
c. Serum electrolytes, BUN crea
d. All of the above

Further Lab tests showed

Na – 150 mEq/L K–4 Cl 110 Crea 135 umol/L urine ketones ++
ABG pH 7.3 pCO2 25 pO2 90 HCO3 25 Hb 145 wbc 12.5 w/ segmenter
predominance
83. Compute for the serum osmolality and anion gap
a. 308 MOsm and AG of 15
b. 336 MOsm and Ag of 15
c. 310 MOsm and AG of 14

43
 d. 320 mOsm and AG of 14
84. Management for diabetic emergencies includes
a. Potassium replacement only when lab shows hypokalemia
b. Fluid re placement at 2-3 L in the first 1-3 hours
c. Any type of insulin at 0.15 u/kg given as initial bolus only
d. Immediate corre ction of acidosis w/ IV sodium bicarbonate
85. True statement re garding management of metabolic acidosis in diabetic emergencies
a. Given NaHCO3 for all pts with pH below 7.35
b. NaHCO3 is better given per IV bolus than by drip
c. IV bicarbonate is given only for those with DKA w/ pH < 7
d. Pts with hyperosmolar hyperglycemic states are prone to severe acidosis and usually
re quire corre ction with bicarbonate
86. The following statement/s is/are true re garding hypoglycemia
a. Hyp oglycemia is defined as a plasma glucose level of < 60 mg/dl
b. The first defense against hypoglycemia is decreased in sulin secretion
c. Cortisol and epinephrine serve as the primary glucose counterregulatory re sponse
during hypoglycemia
d. Endogenous hyperinsulinism is established with low C-peptide, an normal insulin level,
with a lo w plasma glucose concentration
87. The crite ria for the diagnosis of diabetes mellitus is/are
a. 2 hour plasma glucose > 200 mg/dl during an OGT
b. FPG > 126 mg/dl in 1 occasion with typical symptoms
c. Symptomatic patient with RBS > 200 mg/dl
d. All of the above - ?
88. True re garding renal complications in DM
a. Recommended protein intake is 0.6 g/kg/day for those with microalbuminuria
b. Smoking does not have any effect on renal function
c. It is almost always certain to have concomitant re tinopathy
d. Strict BP control <140/80 mmHg - ?
89. All of the following are metabolic effects of insulin EXCEPT
a. Decrease lip olysis
b. Increased gluconeogenesis
c. Decreased glycogenolysis
d. Decreased ketogenesis
90. The progression of nephropathy and retinopathy in DM is correlated with
a. Duration of the diabetes
b. Hyp ertension
c. Glomerular filtra tion ra te
d. All of the above - ?

[Type text]

44