Chapter 1

Which of the following is TRUE?

A. Methodical review of systems is important to elicit features of an underlying disease that might not be
mentioned in the patient’s narrative.
B. Putting the patient at ease will not contribute substantially to obtaining an adequate history.
C. Both A & B
D. None of the above

Rationale: A. Methodical review of systems is essential to elicit features of an underlying disease that the
physician might missed.

Chapter 3

Which of the following is not part of four key steps in practicing EBM?

A. Formulating the management question to be answered

B. Searching the literature and online databases for applicable research data

C. Appraising the evidence gathered with regard to its validity and relevance

D. All of the above

Rationale: D. All of the above: (1) Formulating the management question to be answered, (2) Searching the
literature and online databases for applicable research data, (3) Appraising the evidence gathered with
regard to its validity and relevance, (4) Integrating this appraisal with knowledge about the unique aspects
of the patient (including the patient’s preferences about the possible outcomes)

Chapter 329

Which of the following is TRUE?

A. Typical physical findings in liver disease are icterus, hepatomegaly, hepatic tenderness, splenomegaly, spider
angiomata, palmar erythema, and skin excoriations
B. Hepatomegaly is not a highly reliable sign of liver disease because of variability in the liver’s size and shape
and the physical impediments to assessment of liver size by percussion and palpation.
C. Several skin disorders and changes are not common in liver disease.
D. A & B.

Rationale: A&B. Several skin disorders and changes are common in liver disease.

Chapter 45

A 60-year-old male is noted to have mild jaundice and 15-lb weight loss. The patient has noted pruritus and pale,
clay-colored stools. On examination, the gallbladder is palpable. Alkaline phosphatase is very elevated.

Which clinical description with the most likely disease process of the case given?

A. Pancreatic carcinoma
B. Acute viral hepatitis
C. Crigler-Najjar syndrome
D. Cirrhosis of liver
Rationale: A. The patient may have an obstructive process, as his pale stools suggest the lack of bilirubin in
the stool. A high alkaline phosphatase also indicates that there is obstructive jaundice. Pancreatic carcinoma
would be the most likely cause of obstructive jaundice in this patient

Chapter 12
An otherwise healthy 40-year-old woman sees you because of recurrent abdominal pain. In the past month she has
had four episodes of colicky epigastric pain. Each of these episodes has lasted about 30 minutes and has occurred
within an hour of eating. Two of the episodes have been associated with sweating and vomiting. None of the
episodes have been associated with fever or shortness of breath. She has not lost weight. She does not drink alcohol
or take any prescription or over-the-counter medications. Other than three previous uneventful vaginal deliveries,
she has never been hospitalized. Her examination is negative except for mild obesity (BMI = 32). A complete blood
count and multichannel chemistry profile that includes liver function test is normal. A gallbladder sonogram reveals
multiple gallstones.

Which of the following state is TRUE about the recurrent abdominal pain of the patient?

A. Cholelithiasis (gallstone disease) is very common and risk factors for development of gallstones include
female gender, obesity, prior pregnancies which are present in the patient.
B. The patient has Cholelithiasis and the treatment of choice acid reducers such as omeprazole.
C. Patient has IBS as this is one of the most common causes of abdominal pain
D. None of the above

Rationale. A. Cholelithiasisis is very common. Risk factors for the development of gallstones include advancing
age, female gender, obesity, prior pregnancies, native American or Mexican American ancestry, and rapid weight
loss. Many patients are asymptomatic but some develop biliary colic. The treatment of choice is
cholecystectomy, which can usually be performed laparoscopically. Patient may not have IBS since sonogram
reveals pathology.

Chapter 41

A 34-year-old man presents with substernal discomfort with no associated symptoms such as dysphagia,
odynophagia, weight loss, or gastrointestinal bleeding. The symptoms are worse after meals, particularly a heavy
evening meal, and are sometimes associated with hot/sour fluid in the back of the throat and nocturnal awakening.
The patient denies difficulty swallowing, pain on swallowing, or weight loss. The symptoms have been present for 6
weeks; the patient has gained 20 lb in the past 2 years.

Which of the following is the most appropriate initial approach?

a. Therapeutic trial of ranitidine

b. Coronary angiography

c. Esophagogastroduodenoscopy

d. CT scan of the chest

Rationale: A. Patient shows no absence of alarm symptoms (such as dysphagia, odynophagia, weight loss, or
gastrointestinal bleeding), a therapeutic trial of acid reduction therapy is reasonable. Mild to moderate GERD
symptoms often respond to H2 blockers. If the patient has recurrent symptoms or has had symptomatic GERD for
over 5 years, endoscopy may be indicated to rule out Barrett esophagus (intestinal metaplasia of the lower
esophagus). In the absence of alarm symptoms, a therapeutic trial is generally favored over more expensive
diagnostic studies (endoscopy, CT scan). Classic symptoms of GERD do not mandate an evaluation for coronary
artery disease unless other features suggest this diagnosis.

Chapter 33

A 50 year old patient came in with chief complaint of difficulty breathing upon exertion. The patient noted that he
walks slower than people with similar age and stops to rest after walking 100m or after walking few minutes on level
ground.

What is the patient’s grade of dyspnea based on Modified Medical Research Council Dyspnea Scale?

A. Grade 1
B. Grade 2
 C. Grade 3
D. Grade 4

Rationale: C. Grade 3 Stops to rest after walking 100 m or after walking a few minutes on level ground

Chapter 34

Which of the following states about impaired cough is FALSE?

A. Ineffective cough compromises to clear lower respiratory tract secretions predisposing to more serious
infections and their sequalae.
B. Cough strength is generally assessed qualitatively.
C. Inspiratory muscle weakness or paralysis and chest wall or abdominal pain are foremost on the list of causes
of impaired cough.
D. All of the above

Rationale: C. Expiratory muscle weakness including abdominal and intercostal muscles and chest wall/abdominal
pain are foremost on the list of causes of impaired cough. (chapter 34, page 230)

Chapter 35

A 60-year-old male patient came in with massive hemoptysis. What will you do first?

A. Protect the non-bleeding lung by inserting endotracheal tube and use it to suction to effectively means of
removing blood and clot than the cough reflex.
B. Protect the non-bleeding lung by positioning patient with the bleeding side down, to use gravitational
advantage to keep blood out of the non-bleeding lung.
C. Order bronchoscopy to locate the cause of bleeding
D. Both A & B

Rationale: B.

When the amount of hemoptysis is massive, there are three simultaneous goals: first, protect the non-bleeding lung;
second, locate the site of bleeding; and third, control the bleeding. Thus, ordering bronscospy is not recommended .
Endotracheal intubation should be avoided unless truly necessary, since suctioning through an endotracheal tube is a
less effective means of removing blood and clot than the cough reflex.

Chapter 278

What are the examples of Obstructive lung disease?

A. Pulmonary embolism
B. Pulmonary arterial hypertension (PAH)
C. Asthma
D. Pneumonia

Rationale: C. Asthma. Other examples are chronic obstructive pulmonary disease (COPD) and Bronchiectasis