INTERNAL MEDCINE 1. The treatment of choice for anemia of chronic renal disease: a. Ferrous sulfate b. Folic acid c.

Erythropoetin d. blood transfusion Answer: C 2. P. 1658

A patient was brought to the ER in a comatose state. Serum electrolytes drawn on admission showed the following: Na+ 133 meq/L, K + 8.0 meq?l, Cl 98 meq/L, HCO3 13 meq?L. ECG showed absent P waves, widend QRS and peaked T waves. Which would b the mot appropriate initial step: a. b. c. d. Repeat electrolyte measurement and observe Attempt cardioversion Administer intravenous calcium gluconate Administer sodium polystyrene sulfonate (Kayexelate) Answer: C P. 262

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Low serum complement level would be seen in patients with hematuria, proteinuria and hypertension resulting from all of the following, EXCEPT: a. Mixed essential cryoglobulinemia b. Hepatitis C associated membranoproliferative glomerulonephritis c. Diffuse proliferative lupus nephritis d. Henoch-Schonlein purpura Answer: D P. 1680

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A 37 y.o. man is admitted with confusion. PE showed a BP of 140/70 with no orthostatic changes, normal jugular venous pressure and no edma. Serum chemistries are notable for Na+ 120 meq/L, K + 4.2 meq/L, HCO3 24 meq/L and a uric acid of 2 mg/L. The most likely diagnosis is: a. Hepatic cirrhosis b. SIADH c. Addison’s disease d. Severe vomiting and diarrhes Answer: B p. 256

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TRUE statement/s about acute poststreptococcal glomerulonephritis (PSGN) EXCEPT: a. The latent period appears to be longer when PSGN is associated with cutaneous rather than pharyngeal infection b. Serologic tests for a streptococcal infection may be negative if antimicrobial therapy is begun early c. PSGN leads to permanent and progressive renal insufficiency more often in adults than in children d. Long-term antistreptococcal prophylaxis is indicated after documented cases of PSGN. Answer: D p. 1680-1681 1

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The a wave of the jugular venous pulse (JVP) represents: a. right ventricular contraction b. right atrial contraction c. ventricular septal defect d. atrial septal defect One of the following is not true in the assessment of acute GI Bleeding: a. The presence of large quantities of bright red blood per rectum rules out the source before the ligament of Treitz b. Melena almost always represents UGIB c. Black stools can be caused by lesions in the colon d. A bilous NGT return flow in a patient who just had hematochezia rules out an upper GI source of hemorrhage Which of the following is true regarding gastric ulcer? a. presence of gastric acid excludes malignancy b. weight loss is distinctively unusual in benign ulcer c. ulcers along the greater curve favor malignancy d. coexisting duodenal ulcers favor benign nature of gastric ulcer A 55-year-old diabetic patient presents with heartburn and acidic eructation for 2 years. Endoscopic biopsy of a patch of hyperemic mucosa 3 cm. above the gastroesophageal junction showed squamous epithelium with inflammatory cells. The patient most likely has: a. Barrett’s esophagus b. Gastroesophageal reflux disease c. Candidal esophagitis d. Herpes simplex esophagitis Which of the following statements does NOT describe secretory diarrhea? a. Diarrhea continues during fasting b. Stools are scanty and mucoid c. Fecal fat is low d. Cholera can cause it A 16-year-old male patient presenting with hepatitis syndrome has the following serologic exam findings: (+) HBsAG (-) Anti-HBe (+) HBeAG (+) Anti-HAVIgm (+) Anti HBclgM (-) AntiHBclgG The patient most likely has a. Acute Hepatitis A and Acute Hepatitis B simultaneous infection b. Acute Hepatitis A superimposed on Chronic Hepatitis B in the replicative phases c. Acute Hepatitis A superimposed on Chronic Hepatitis B in the non-replicative phase d. Acute Hepatitis A; a previous immunization to Hepatitis B The most common organism isolated from the ascitic fluid of patients with spontaneous bacterial peritonitis is: a. Streptococcus pneumoniae b. Staphylococcus aureus c. Escherichia coli d. Bacteroides fragilis 2

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True of Ascaris infestation: a. may cause ground itch b. Loeffler’s pneumonitis results from allergy to ascaris eggs c. adult worms reside mostly in the small intestines d. the drug of choice in biliary ascariasis is Mebendazole because it paralyzes the worms and prevents their further migration Which of the following risk factors has been directly associated with Bronchogenic Carcinoma? a. Asbestos exposure b. Aflatoxin ingestion c. Cigarette smoking d. Chronic Bronchitis This group of drugs reduce airway inflammation in bronchial asthma: a. Catecholamines b. Methylxanthines c. Clucocorticoids d. Anticholinergics The American Thoracic Society defines chronic bronchitis as persistence of cough and excessive mucus production for most days out of 3 months for ________ successive years: a. 2 b. 3 c. 4 d. 5 A patient with CAP requires hospitalization when one of the following is present: a. age < 65 years old b. COPD in exacerbation c. temperature of 38.5C d. unilobar CXR infiltrate One of the following is NOT a useful clue to the microbial etiology of CAP (Community Acquired Pneumonia) a. edentulous persons likely to develop pneumonia due to anaerobes b. susceptible people exposed to an infectious aerosol in Legionellosis c. patients with severe hypogammaglobulinemia at risk of infection with S. pneumoniae d. anaerobic lung abscess occuring in patients prone to aspiration

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16.

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19.

In a patient suspected of PTE, presence of this symptom heralds the occurence of pulmonary infarction: a. unexplained dyspnea b. hemptysis c. sudden onset of cough d. syncope 3

20.

Gold standard in the diagnosis of PTE: a. ventilation-perfusion scan b. pulmonary angiography c. Helical/Spiral CT Scan d. transesophageal echocardiography One of the disorders below does NOT have vesicles or bulla as presenting lesions: a. Impetigo b. Chicken pox c. Herpes Simplex d. Psoriasis Annular lesions with raised erythematous border and clear centers, distributed over the trunk area: a. Tinea unglum b. Psoriasis c. Tinea versicolor d. Tinea corporis Grouped vesicles arranged in a segmental pattern over the right side of the trunk, T7-8 level: a. Herpes Simplex b. Chicken pox c. Verruca vulgaris d. Herpes Zoster A pregnant woman with brown macules with irregular borders, symmetric pattern on her cheeks, forehead, upper lips, nose and chin most likely has: a. SLE b. melasma c. Addison’s disease d. Psoriasis One of the following statements is NOT true of typhoid fever: a. Salmonella typhi has no known hosts other than humans. b. Most cases result from ingestion of contaminated food or water. c. Incubation period ranges from 3 to 21 days. d. Stool culture is best done during the first week of fever. In typhoid fever, which of the following specimen will have the best sensitivity for culture if a patient has been given antibiotics? a. blood b. bone marrow c. stool d. urine

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Drug of choice for Schistosomiasis: a. Albendazole b. Ivermectin c. Diethylcarbamazine d. Praziquantel

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The fungus which is a normal inhabitant of the human mucocutaneous body surfaces and is a frequent cause of fungemia is: a. Aspergillus b. Candida c. Cryptococcus d. Histoplasma An 18-year-old boy had sex with an HIV+ prostitute a week ago. He is frightened and wants assurance he has not been infected. You should: a. tell him you regret that there is no way at this time to tell if he has been infected or not b. ask for an immediate AIDS ELISA test c. ask for an immediate Western Blot test d. assure him that if it was a one night affair he probably did not get infected The most likely organism/s causing secondary bacteremia following manipulation of a furuncle is/are: a. anaerobes and gm (-) bacilli b. anaerobes and Staph aureus c. Staph aureus and gm (-) bacilli d. Staph aureus Which of the following vaccines is especially indicated in a splenectomized patient: a. pneumococcal b. hepatitis B c. tetanus d. polio A patient with Bell’s Palsy has a pathology involving which cranial nerve? a. III b. V c. VII d. III and VII A patient suspected to have meningitis undergoes spinal tap. Upon insertion of the spinal needle, the opening pressure is recorded to be markedly elevated. You should: a. continue draining the CSF to decrease the pressure b. withdraw the needle and run IV mannitol c. continue draining the CSF while running IV mannitol d. withdraw the needle and reinsert at a lower site The first drug of choice in a patient presenting with frank seizures is: a. Diphenylhydantoin IV b. Phenobarbital IV c. Carbamazepine p.o. d. Diazepam IV Lower motor neuron type of paralysis is characterized by: a. hypotonia b. spasticity c. pathologic reflexes d. involuntary movement of the affected extremities 5

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A Cavernous sinus lesion could involve several cranial nerves. Which of the following is least likely to be affected? a. oculomotor nerve b. Trochlear nerve c. Abducens nerve d. facial nerve Bitemporal hemianopsia means involvement of the a. optic nerve ipsilateral to the lesion b. optic chiasm c. optic tract d. optic radiation Elevated urea in patients with chronic renal disease occurs because of a. an increased reabsorption of urea by the proximal tubules b. decreased secretion of urea by the distal tubules c. decreased urea excretion d. an increased renal blood flow Asymptomatic bacteriuria should always be treated in: a. pregnant women b. catheterized elderly patients c. sexually active patient d. post CVD patients What is the most conservative management for chronic renal failure? a. dietary proteins of 0.6 g/kg/day b. allopurinol 300 mg OD c. dialysis d. kidney transplant One of the following is NOT a pathophysiologic mechanism of DM nephropathy: a. injury of the glomerular filtration barrier manifested by microalbuminuria b. Ig G deposits along GBM resulting in immune complex mediated glomerulonephritis c. mesangial matrix expansion resulting to enlarged kidneys d. atherosclerosis of the renal vascular bed due to hypertensive arteriosclerosis Not a characteristic laboratory feature of hepatorenal syndrome: a. elevated BUN b. Fractional excretion of NA+ < 1% c. Proteinuria d. Urinary Na+ > 40 mmol/L

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43.

The single most important parameter of renal function is: a. edema b. Creatinine clearance c. Serum Creatinine d. Serum BUN

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A 50-year-old male with ESRD 20 diabetic nephropathy was brought to the emergency room because of weakness and light headedness. He has just completed his first dialysis, and was observed to be somewhat confused. BP = 90/40, CR = 80/min., RR = 20/min. The most likely explanation for his condition is: a. Dialysis disequilibrium syndrome b. Dialysis dementia c. Poor dietary intake during dialysis d. Reduced dialysate temperature In the presence of anemia, the ability to produce adequate circulating red cells is best measured by: a. WBC count b. Serum iron binding capacity c. Reticulocyte count d. Total eosinophil count Reticulocytosis is NOT seen in: a. aplastic anemia b. acute blood loss c. hemolytic anemia d. treatment of iron deficiency All of the following anemias except one are chronic developing over weeks. Which anemia may develop acutely? a. aplastic b. pernicious c. hemolytic d. iron deficiency In the tumor cell cycle, the cells refractory to chemotherapy are the: a. Cells in the G2 phase b. Cells in the M phase c. Cells in the G0 phase d. Cells in the active S phase Multiple osteolytic lesions, hypercalcemia and neurologic abnormalities are most often seen in: a. Prostatic CA b. Non-Hodgkin’s lymphoma c. Plasma cell myeloma d. CNS tumors Thrombocytopenia is not expected in: a. SLE b. G6PD deficiency c. Acute Leukemia d. Disseminated intravascular Coagulation (DIC) This finding in Chronic Myelogenous Leukemia can differentiate it from leukemoid reaction: a. decreased leukocyte alkaline phosphatase b. increased WBC count c. anemia d. hypercellular marrow with increased granulocyte precursor

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Lung cancer that is associated with significant progressive dyspnea and increasing hypoxemia a. Squamous cell carcinoma b. Oat cell CA c. Adenocarcinoma d. Bronchoalveolar CA The most common form of arthritis characterized by progressive deterioration and loss of articular cartilage: a. Rheumatoid arthritis b. Osteoarthritis c. Gouty arthritis d. Septic arthritis The characteristic feature of Rheumatoid arthritis is: a. fibrotic changes of the skin b. osteoporosis c. persistent inflammatory synovitis d. asymmetric involvement of large weight-bearing joints Heberden’s nodes are found in a. Systemic lupus erythematous (SLE) b. Gouty arthritis c. Osteoarthritis d. Rheumatoid arthritis (RA) Loss of hair at the lateral part of eyebrows, thickening of speech, coarse hair and dry skin, dulling of intellect, sluggish movements. Most likely diagnosis is: a. Cushing’s syndrome b. Adrenal insufficiency c. Hypothyroidism d. Acromegaly Psamomma bodies are characteristic of: a. Follicular Thyroid CA b. Papillary Thyroid CA c. Parathyroid Adenoma d. Parathyroid CA Jodbasedow phenomenon is: a. iodide-induced hyperthyroidism b. blocking of organic binding of iodine with large doses of the substance c. hyperthyroidism due to hyperfunctioning thyroid adenoma d. due to a thyroxine-producing ovarian tumor

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A 50-year-old obese woman with hypertriglyceridemia without hypercholesterolemia. The most appropriate first management step would be a. weight reduction b. gemfibrozil c. clofibrate therapy d. liposuction

8

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The diagnosis of diabetes mellitus is certain in which of the following situations? a. persistently elevated nonfasting serum glucose levels b. successive fasting plasma glucose of 147, 165, 152 mg/dL in an otherwise healthy 40-year-old female c. A serum glucose level of 140 mg/dL in a pregnant woman in her 26th week AOG d. glycosuria in a 30/F Which of the following medications can cause hyperprolactinemia? a. Propranolol b. glucocorticoids c. metoclopramide d. levothyroxine Obese persons are at increased risk for a. hypothyroidism b. Type I diabetes mellitus c. Cholelithiasis d. elevated LDL cholesterol Dietary deficiency of thiamine produces which of the following clinical syndromes? a. color blindness b. osteoporosis c. bruising d. peripheral neuropathy A 24/M who took megadoses of vitamins develops severe headache and papilledema. The cause for this is intoxication of a. Vitamin B6 b. Vitamin D c. Vitamin A d. Vitamin E In using Serum albumin as gauge for malnutrition, which statement is correct? a. a low serum albumin always indicates malnutrition b. the half-life of albumin in 21 days, so it cannot be used to assess acute malnutrition c. albumin levels are unaffected by changes in extracellular volume d. the bone marrow synthesizes albumin Prolonged fasting causes the intestinal villi to a. hypertrophy b. atrophy c. necrose d. proliferate A person with known allergy to penicillins should not be given a. cotrimoxazole b. tetracycline c. erythromycin d. cefalexin Lymphokines are secreted by 9

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a. b. c. d. 69.

polymorphonuclear cells monocytes lymphocytes lymphoma cells

A 30-year-old female has severe perennial allergic rhinitis. Her house is frequently flooded. She has a dog and sleeps on kepok pillow. As part of management of her allergy, you should advice her to a. get a new kapok pillow and launder it frequently b. try to scoop out the flooded water as soon as the rain pours c. keep the dog out or get a cat instead d. replace the kapok pillow with foam rubber, cover the pillow and mattress with allergen proof encasings IgE has high affinity for which type of cells? a. eosinophils b. mast cells c. platelets d. macrophages A 65/M is brought to the ER due to chest pain. He suddenly becomes unresponsive and pulseless and cardiac monitor reveals ventricular fibrillation. You should immediately: a. begin CPR, followed by intubation, then defibrillation with 100 J  200 J  360 J b. begin CPR, followed by intubation, then defibrillation starting at 200J c. begin CPR, then defibrillation at 200 J, 300 J then 360 J d. begin CPR, defibrillate at 200 J, then intubate If despite defibrillation, a pulseless patient has persistent ventricular fibrillation, the use of which drug would be most appropriate? a. lidocaine b. procainamide c. amiodarone d. epinephrine If only one person is present to provide basic life support, chest compressions should be performed at a rate of ______ per minute, and breaths twice in succession every 15 seconds a. 50 b. 80 c. 60 d. 40

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One of the following is associated with an increased risk of sudden cardiac death: a. frequent PVC’s (>30/min) b. hyponatremia c. smoking d. hyperlipidemia Elevation of Serum Potassium is toxic to the: 10

75.

a. b. c. d. 76.

kidneys brain heart liver

Anti – Tuberculosis drug that can cause hyperuricemia: a. Isoniazid b. Pyrazinamide c. Rifampicin d. Streptomycin MPL: 0.25 p:964

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Which of the following tests is required to diagnose Chronic Obstructive Pulmonary Disease: a. Arterial blood gas b. Chest X-ray c. Chest CT scan d. Spirometry MPL: 0.25 p:1551 Marantic endocarditis is commonly associated with this lung cancer: a. Squamous cell b. Large cell c. Adenocarcinoma d. Small cell MPL: 0.25 p: 509 This is considered as the most frequent cause of Acute Respiratory Distress Syndrome a. Smoke inhalation b. Severe sepsis c. Pulmonary contusion d. Acute pancreatitis MPL: 0.50 p:1592 The most common form of Lung cancer arising in lifetime of a non smoker young women a. Small cell carcinoma b. Adenocarcinoma c. Squamous cell carcinoma d. Large cell carcinoma MPL: 0.50 p: 507 The most common cause of acute renal failure a. Pre renal acute renal failure b. Renal acute renal failure c. Post renal acute renal failure d. Pre renal with renal acute renal failure MPL: 0.50 p: 1644 The most significant risk factor for cancer is: a. Sex b. Age c. Nationality d. Dietary factors MPL: 0.50 p: 435 11

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DNA synthesis phase a. G1 b. G2 c. G0 d. S MPL: 0.333 p: 469 This is the most common local manifestation of lung cancer at presentation a. Dyspnea b. Cough c. Hemoptysis d. Chest pain MPL: 0.50 p: 508 Painless myocardial infarction is greater in patients with a. hypertension b. diabetes mellitus c. homocystinemia d. dyslipidemia MPL: 0.50 p: 955 In typoid fever this diagnostic exam is not affected by prior antibiotic use: a. Bone marrow culture b. Blood culture c. Urine culture d. Stool culture MPL: 0.25 p: 899 British Thoracic Society major category for diagnosis of severe pneumonia a. P/F ratio of <250 b. Multilobar pneumonia c. Systolic pressure of less than 90 mmHg d. Need for mechanical ventilation MPL: 0.50 p: 1532 This anti-TB drug may cause “barrel vision” a. Rifampicin b. Isoniazid c. Pyrazinamide d. Streptomycin MPL: 0.25 p: 961

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Most common cause of pneumonia in ambulatory patients: a. Streptococcus pneumoniae b. Mycoplasma pneumoniae c. influenza viruses d. Chlamydia pneumoniae MPL: 0.25 p: 1531 Most common etiologic agent in uncomplicated cystitis: 12

90.

a. Pseudomonas aeruginosa b. Staphylococcus aureus c. Escherichia coli d. Proteus vulgaris MPL: 0.50 p: 1715 91. The best parameter to differentiate chronic bronchitis from emphysema a. Simple spirometry b. Lung volume studies c. DLCO d. Arterial blood gas MPL: 0.333 p: 1503 The duration of treatment for acute cystitis in pregnant patient : a. single dose b. 3 days c. 5 days d. 7 days MPL: 0.25 p: 1520 Diagnosis of Diabetes Mellitus is defined as: a. Random is defined as with regard to time since the last meal. b. Fasting is defined as no caloric intake for at least 12 h. c. The test should be performed using a glucose load containing the equivalent of 50 g anhydrous glucose dissolved in water; not recommended for routine clinical use. d. A random plasma glucose concentration =11.1 mmol/L (200 mg/dL) accompanied by classic symptoms of DM (polyuria, polydipsia, weight loss) is sufficient for the diagnosis of DM MPL: 0.333 p: 2153 Type 2 DM is characterized by one of the pathophysiologic abnormalities: a. impaired insulin absorption b. peripheral insulin resistance c. decrease hepatic glucose production d. increase gluconeogenesis MPL: 0.333 p: 2157 Acute complication of Type 2 Diabetes Mellitus : a. Hyperosmolar Hyperglycemic State b. Coronary artery disease c. DM neuropathy d. Gastroparesis MPL: 0.25 p: 2161

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93.

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Target blood pressure in Diabetes Mellitus a. 140/90 b. 150/80 c. 130/80 d. 120/80 MPL: 0.25 p: 2170 Risk factor for adverse prognosis in hypertension: 13

97.

A. elderly B. female sex C. smoking D. pregnancy MPL: 0.25 p: 1466 98. The most common form of suppurative intracranial infection: A. viral meningitis B. bacterial meningitis C. fungal meningitis D. parasitic meningitis MPL: 0.50 p: 2472 Precipitating cause of heart failure: A. smoking B. exercise C. infection D. stroke MPL: 0.50 p: 1368 Underlying cause of heart failure: A. cardiomyopathy B. cardiac tamponade C. respiratory diseases D. anemia MPL: 0.333 p: 1368 Minor criteria of congestive heart failure: A. S3 gallop B. cardiomegaly C. rales D. tachycardia MPL: 0.25 p: 1371 Levine’s sign: a. tenderness on palpation b. slowly progressive dyspnea c. clenching of the fist in front of the sternum d. difficulty of breathing MPL: 0.25 p: 1435 An important factor predisposing to bacteriuria in men is urethral obstruction due to: A. prostatic hypertrophy B. catheter insertion C. infection D. ureteric stones MPL: 0.25 p: 1716 The most common finding on physical examination in leptospirosis aside from fever: A. calf tenderness B. conjunctival suffusion C. jaundice D. rash MPL: 0.50 p: 990

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The most common cause of partial or generalized epilepsy in the elderly is : A. stroke B. brain tumor C. infection D. trauma MPL: 0.50 p: 2537 Definition of severe pneumonia by American Thoracic Society: A. need for mechanical ventilation B. systolic BP of >90 mmHg C. single lobe involvement D. PaO2/FiO2 < 200 MPL: 0.333 p: 1532 Cause of transudative pleural effusion: A. mesothelioma B. sarcoidosis C. cirrhosis D. meigs syndrome MPL: 0.25 p: 1567 Hallmark of COPD: A. airflow obstruction B. clubbing of digits C. flail chest D. hoover’s sign MPL: 0.25 p: 1551 Most commonly involved in extrapulmonary TB: A. meninges B. peritoneum C. pericardium D. lymph nodes MPL: 0.25 p: 957 Primary Pulmonary TB frequently involved the: A. middle lobe B. lower lobe C. middle and lower lung zones D. upper lobe MPL: 0.333 p: 956 The most common complication of measles: A. subacute sclerosing panencephalitis B. chronic encephalitis C. otitis externa D. hepatitis MPL: 0.50 p: 1150 The drug of choice for primary generalized seizures is: A. phenytoin B. carbamazepine C. valproic acid D. gabapentin MPL: 0.50 p: 2374 Type of anemia in Malaria: 15

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A. normochromic normocytic B. hypochromic normocytic C. hypochromic microcytic D. normochromic microcytic MPL: 0.333 p: 1226 114. Cerebral Malaria is caused by: A. P. falciparum B. P. malariae C. P. ovale D. P. vivax MPL: 0.25 p: 1222 The most common presentation of amoebic infection is: A. asymptomatic cyst passage B. amoebic colitis C. liver abscess D. central nervous system infection MPL: 0.25 p: 1640 Duodenal ulcer occur 90% located within: A. 3cm of the pylorus B. 4cm of the pylorus C. 5 cm of the pylorus D. 10 cm of the pylorus MPL: 0.333 p: 1749 The most common type of gallstone: A. cholesterol B. black pigment stone C. brown pigment stone D. green pigment stone MPL: 0.25 p: 1881 Gold standard in diagnosing gallstone: A. abdominal xray B. ultrasound C. CT Scan D. Cholescintigraphy MPL: 0.25 p: 1883 The most common risk factor of stroke : A. infection B. hypertension C. diabetes mellitus D. trauma MPL: 0.25 p: 2372 The most specific and characteristic symptom of gallstone disease: A. biliary colic B. vomiting C. constipation D. jaundice MPL: 0.25 p: 1883 Local complication of acute pancreatitis: 16

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A. pancreatic abscess B. pleural effusion C. pericardial effusion D. peptic ulcer disease MPL: 0.50 p.1898 122. 85% of Pancreatic pseudocyst are located at the : A. tail B. body C. body and tail D. head MPL: 0.50 p: 1901 The most common serious complication of chicken pox: A. pneumonia B. hepatitis C. meningitis D. pericarditis MPL: 0.50 p: 1043 Incubation period of chicken pox: a. 10-21 days b. 7-10 days c. 5-10 days d. 21-30days MPL: 0.333 p: 1043 The person recommended to receive influenza vaccine: A. person > 65 years of age B. women in first trimester of pregnancy C. hypertensive patients D. with prodromal phase of upper respiratory infection MPL: 0.333 p: 1042 Most serious complication of influenza B virus: A. pneumonia B. carditis C. reye’s syndrome D. encephalitis MPL: 0.5 p: 1067 Metabolic complication of nephritic syndrome A. hypercalcemia B. bleeding C. normocytic normochromic D. hypoalbuminemia MPL: 0.5 p: 1684 Primary Glomerulopathy which is highly steroid responsive: A. membranoproliferative B. membranous C. focal segmental glomerolosclerosis D. minimal change disease MPL: 0.333 p: 1683 Most common cause of idiopathic nephrotic syndrome in adult: 17

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124.

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A. membranoproliferative B. membranous C. focal segmental glomerulosclerosis D. minimal change disease MPL: 0.5 p: 1687 130. Hallmark of nephrotic syndrome: A. dysmorphic red blood cell B. numerous red blood cell cast C. heavy protenuria D. waxy cast MPL: 0.5 p: 1684 Most common glomerulopathy worldwide: A. minimal change B. lupus nephritis C. membranous D. IgA nephropathy MPL: 0.5 p: 1690 Most common cause of Iron deficiency in adult: A. chronic blood loss B. hemolysis C. dietary deficiency D. chronic inflammatory disease MPL: 0.5 p: 586 Virus serotype associated greatest risk for DHF: A. DEN-1 B. DEN-2 C. DEN-3 D. DEN-4 MPL: 0.5 p: 1161 Most important laboratory test for DHF monitoring: A. Hemoglobin B. hematocrit C. platelet D. liver function test MPL: 0.25 p: 1161 Which of the following is the earliest rabies specific clinical manifestation: A. hydrophobia B. aerophobia C. tingling sensation at the bite site D. delirium MPL: 0.333 p: 1115 The diagnostic laboratory method of choice for typhoid fever in the first week of illness: A. bone marrow culture B. blood culture C. urine culture D. stool culture MPL: 0.25 p: 991 18

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The most important predictor of multi-drug resistant M. tuberculosis organism in all studies is: A. history of treatment tuberculosis B. HIV C. noncompliance D. diabetes mellitus MPL: 0.5 p: 958 Most discriminating symptom of duodenal ulcer: A. nausea and vomiting B. pain occur 90 min to 3 hours after a meal C. relieved by food intake D. pain awakens patient at night MPL: 0.5 p: 1751 Liver cirrhosis is best diagnosed by: A. Ultrasound B. Liver biopsy C. CT scan D. liver function tests MPL: 0.25 p: 1859 Drug of choice for Schistosomiasis: A. mebendazole B. praziquantel C. tinidazole D. metronidazole MPL: 0.5 p: 1271 Spasm that is observed first in Tetanus: A. risus sardonicus B. abdominal rigidity only upon stimulation C. trismus D. opisthotonus MPL: 0.5 p: 1115 Gold standard in the treatment of typhoid fever: A. chloramphenicol B. penicillin C. tetracycline D. ceftriaxone MPL: 0.25 p: 991

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The most common opportunistic fungal infection: A. candida B. aspergillosis C. pneumocistis jeroverci D. fusarium MPL: 0.25 p: 1185 Source of cholera infection: 19

144.

A. contaminated water supply B. food exposed to flies and cockroaches C. food utensils not properly disinfected D. ingestion of live oral cholera vaccine MPL: 0.25 p: 909 145. Classical malarial paroxysms suggest infection with: A. P. malariae B. P. falciparum C. B. microti D. P. vivax MPL: 0.25 p: 1221 Most common cause of pneumonia in ambulatory patients: A. S. pneumoniae B. M. pneumoniae C. influenza viruses D. C. pneumoniae MPL: 0.25 p: 1531 The single most useful clinical sign of the severity of pneumonia: A. BP of 120/80 B. Respiratory rate of > 30/min C. Cardiac rate of 76 D. Temperature of 37C MPL: 0.333 p: 1532 The most common route for bacterial pneumonia : A. gross aspiration B. aerosolization C. microaspiration of oropharyngeal secretions D. hematogenous spread from a distant infected site. MPL: 0.5 p: 1529 Most common site of spinal tuberculosis in adult: A. upper thoracic spine B. lower thoracic spine C. lumbar spine D. cervical spine MPL: 0.5 p: 958 The most common site of gastrointestinal TB: A. appendix B. proximal ileum C. pancreas D. terminal ileum MPL: 0.5 p: 958 Most common site of pancreatic cancer: A. head B. body C. tail D. uncus MPL: 0.25 p: 537 Most consistent risk factor in pancreatic cancer: 20

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A. hypertension B. alcoholism C. cigarette smoking D. obesity MPL: 0.5 p: 537 153. Hereditable gastrointestinal syndromes that has least malignant potential: A. gardner’s syndrome B. turcot’s syndrome C. lynch syndrome D. juvenile polyposis MPL: 0.333 p: 528 The most common infectious complication of varicella is A. bacterial superinfection of the skin B. seizure C. sepsis D. meningitis MPL: 0.333 p: 1043 The most common extracutaneous site of involvement in children A. respiratory system B. CVS C. CNS D. GIT MPL: 0.5 p: 1043 A deficiency of this protease inhibitor is a proven genetic risk factor for COPD A. alpha 1 anti trypsin B. alpha 2 anti trypsin C. M protein D. piZZ alpha 2 anti trypsin MPL: 0.5 p: 1548 Glucose goal in patients with DKA: A. 70 - 100 mg/dl B. 100 -150 mg/dl C. 150 – 250 mg/dl D. 250-300 mg/dl MPL: 0.5 p: 2160 Heart failure with development of symptoms in less than an ordinary activity: A. Class I B. Class II C. Class III D. Class IV MPL: 0.25 p: 1302 Heart failure with warm and flushed extremities and with widened pulse pressure A. Low output B. High output C. Diastolic heart failure D. Systolic heart failure 21

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158.

159.

MPL: 0.5 160.

p: 1369

Cardiomyopathy with primary myocardial involvement A. Infective B. Metabolic C. Connective D. Idiopathic MPL: 0.5 p: 1408 Reversible form of dilated cardiomyopathy A. Alcohol abuse B. Right ventricular dysplasia C. Amyloidosis D. Hemochromatosis MPL: 0.5 p: 1409 Systolic Hypertension with wide pulse pressure A. Arteriosclerosis B. Chronic Pyelonephritis C. Oral contraceptives D. Psychogenic MPL: 0.5 p: 1463 Framingham major criteria for Diagnosis of CHF : Night cough Pleural effusion Tachycardia Positive hepatojugular reflux MPL: 0.25 p: 1371 Characteristic appearance of stools in patients with cholera: A. non-mucoid, non-bilious stools B. mucoid and watery stools C. sour and offensive odor which is non-bilious and non-bloody D. non-bilious,non-bloody, gray, sl. cloudy with flecks of mucus MPL: 0.25 p: 911 Primary pulmonary TB is characterized as: A. typically involves the apices of the lungs B. causes rupture of Rasmussen’s aneurysm C. involves the middle and lower lobes in most cases D. reactivation type of infection MPL: 0.5 p: 956

161.

162.

163.

164.

165.

166.

Class I recommendations for use of an Early invasive strategy in Myocardial Infarction: A. EF < 0.60 B. Recurrent angina at rest/ low level activity despite Rx C. PCI < 8 months, prior CABG D. Negative stress test MPL: 0.333 p: 1477

22

167.

The most common presenting complaint in patients with ST elevation MI: A. Dysnea B. Weakness C. Pain D. Vomiting MPL: 0.5 1449 De bakey classification of Aortic dissection in which dissection is limited to the ascending aorta: A. Type I B. Type II C. Type III D. Type IV MPL: 0.5 p: 1483 Cardiomyopathy with primary myocardial involvement A. Infective B. Metabolic C. Connective D. Idiopathic MPL: 0.25 p: 1408 This form of respiratory failure occurs when alveolar flooding and subsequent intrapulmonary shunt physiology occur: A. Type 1 respiratory failure B. Type 2 respiratory failure C. Type 3 respiratory failure D. Type 4 respiratory failure MPL: 0.25 p: 1583 Heavy drinkers (i.e., those consuming 100 g of ethanol per day for the preceding 2 years) have a higher incidence of acquiring what type of organism in Community acquired Pneumonia? A. gram positive organism B. gram negative organisms C. anaerobes D. enterococci MPL: 0.5 p: 1530 Associated with pandemics and are restricted to influenza A viruses A. antigenic shift B. antigenic drift C. antigenic transformation D. antigenic rotation MPL: 0.25 p: 1066 Most common pathogen in intensive care unit: A. S. pneumoniae B. C. pneumoniae C. M. pneumoniae D. H. influnzae MPL: 0.25 p: 1531 The only known reservoir for Varicella zoster virus is A. humans 23

168.

169.

170.

171.

172.

173.

174.

B. cats C. mosquito D. rodents MPL: 0.25 p: 1042 175. The most common infectious complication of varicella is A. bacterial superinfection of the skin B. seizure C. sepsis D. meningitis MPL: 0.25 p:1043
A. Deep Cerebellum B. Pons C. Thalamus D. Putamen Page 2390 2. The most common cause of ischemic stroke is A. Small vessel thrombosis (Lacunar) B. Large vessel thrombosis C. Cardio embolism due to mural thrombus D. Artery to artery embolism from carotid bifurcation atherosclerosis Page 2376

1. The most common site of hypertensive intraparenchymal hemorrhage is:

3. Currently considered the best initial treatment for primarily generalized tonic
clonic seizures is: A. Phenytoin B. Valproic acid C. Carbamazepine D. Phenobarbital Page 2367 4. Adverse effects such as gum hyperplasia, hirsutism and coarsening of facies is associated with long term use of: A. Carbamazepine B. Valproic acid C. Phenytoin D. Topiramate Page 2368 5. The pathognomonic sign of meningitis is: A. Presence of fever and cranial nerve deficit B. Presence of hemiparesis, headache and fever C. Presence of fever, headache and nuchal rigidity D. Presence of nuchal rigidity and hemiparesis Page 2473 6. The most common cause of community acquired bacterial meningitis in adults >20 years of age A. N. meningitides B. Strep. Pneumoniae C. Listeria monocytogenes D. Group B streptococci Page 2471 7. Which of the following systemic disease is NOT associated with polyneuropathy: A. HIV infection B. Diabetes mellitus C. Carcinoma D. Carpal Tunnel Syndrome Page 2501, 2504

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8. Compressive Metastatic Myelopathies most commonly involve which level of the spinal cord A. Cervical B. Thoracic C. Lumbar D. Sacral Page 2441 9. Which of the following is true of Trigeminal Neuralgia A. More common in males B. Objective sign of sensory loss in the face cannot be demonstrated on examination C. Usually involve the ophthalmic division of the trigeminal nerve D. Affects most adolescents and young adults Page 2434 10. Which of the following disorders causes irreversable dementia? A. Hypothyroidism B. Thiamine Deficiency C. Multi-infarct D. Alzheimer’s disease Page 2396 11. The most powerful risk factor for osteoarthritis is: A. Female sex B. Obesity C. Age D. Prior inflammatory joint disease Page 2037 12. Disabilility of patient with knee osteoarthritis is strongly associated with: A. Radiographic severity of joint damage B. Joint pain C. Quadriceps muscle weakness D. Obesity Page 2037 13. Which of the following is the characteristic physical examination finding of patient with osteoarthritis? A. Localized tenderness B. Swelling of bony and soft tissue C. Periarticular muscle atrophy D. Bony Crepitus Page – 2039 14. Which of the following is considered as the most common form of idiopathic osteoarthritis A. Bouchard’s nodes B. Heberden’s nodes C. Gelatinous dorsal cyst D. Osler nodes Page 2040 15. A 30 y/o female with SLE is noted to have a prolonged partial thromboplastin time. This abnormality is associated with: A. Leukopenia B. Central nervous system vasculitis C. Central nervous system hemorrhage D. Deep venous thrombosis Page 1964 16. The best screening test for the detection of SLE is: A. Anti-Sm B. Anti- dsDNA C. Antinuclear antibodies D. Anti-Ro Page 1961

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17. Diagnosis of gouty arthritis is base on the finding of crystals in the synovial fluid and which of the following crystals is diagnostic of gout? A. Apatite crystals B. Birefringent needle-shaped crystals C. Rod-shaped weakly birefringent crystals D. Rhomboid strongly birefrintent crystals Page 2046-2049 18. The preferred treatment of acute gouty attack in elderly patient is: A. Colchicine B. NSAID C. Intraarticular steroid infection D. Oral steroid Page 2046 19. Joint pain among patient with Rheumatoid arthritis is cause mainly by which of the following mechanism? A. Muscle spasm B. Stretching of periostal nerve endings C. Stretching of the joint’s ligaments D. Distention of joint capsule Page 1971 20. Axial (vertebra) joints involvement in Rheumatoid arthritis is usually limited to the: A. Cervical vertebrae B. Thoracic vertebrae C. Lumbar vertebra D. Sacral vertebrae Page 1971 21. Evidence suggests that early aggressive treatment of rheumatoid arthritic patient with Disease-Modifying Antirheumatic Drugs (DMARD) maybe effective at slowing the appearance of bone erosions. Which of the DMARD is currently considered the best initial choice? A. D-penicillamine B. Gold compound C. Methotrexate D. Sulfasalazine Page 1975 22. Which of the following Vitamins is capable of eliciting systemic anaphylactic reaction? A. Cobalamine B. Pyridoxine C. Riboflavin D. Thiamine Page 1949 23. Which of the following medicine or drug is NOT effective in the treatment of the acute event of systemic anaphylactic reaction? A. SC Epinephrine B. IV Dopamine C. IV Diphenlydramine D. IV Glucocorticoids Page 1950 24. Majority of acute diarrheas are due to A. toxic ingestion B. medications C. infectious agents D. ischemia Page 225 25. Clostridium deficile causes acute diarrhea by A. mucosal invasion B. cytotoxin production C. pre-formed toxin production

26

D. enteroadherence Page 226 26. Majority (>50%) of all esophageal cancers are of which cell type? A. adenocarcinoma B. squamous cell carcinoma C. lymphoma D. sarcoma Page 542 27. Not considered as risk factor for the development of Pancreatic cancer? A. smoking B. cholelithiasis C. long standing DM D. obesity Page 537 28. Which of the following is a protective antibody against Hepatitis B infection? A. Anti-HBe B. Anti HBs C. HBsAg D. Anti HBc Page 1825 29. Drug that is contraindicated in the treatment of chronic Hepatitis B infection with decompensated liver is: disease A. Interferon B. Lamivudine C. Adefovir D. Enterocavir Page 1847 30. Minimum amount of ascetic fluid which can be detected by shifting dullness is: A. 100 cc B. 300 cc C. 500 cc D. 700 cc Page 1866 31. Secretion of water and bicarbonate rich solution from the pancreas is stimulated by: A. secretin B. cholecystokinin C. gastrin D. somatostatin Page 1895 32. Most common complication of Peptic Ulcer Disease is: A. perforation B. penetration C. bleeding D. obstruction Page 1752 33. Which of the following isconnsidered as a non-pharmacologic management of Gastroesophageal Reflux Disease? A. wearing tight belts B. Proton pump inhibitors C. Smoking D. Decreased amount of fluids at night Page 1743 34. Who among the following is considered to be diabetic? A. a 34 y/o male who complained of excessive thirst, weight loss and casual blood sugar of 120mg% B. asymptomatic 40y/o female with Fasting Blood sugar of 120mg% C. a 45 y/o female with polyuria and +4 sugar in the urine D. a 40 y/o male executive with HbAiC of 8%

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Page 2153 35. The best way to assess blood sugar control is to monitor the: A. Fasting blood sugar B. Post prandial blood sugar C. Glycosalated Hemoglobin D. Urine sugar Page 2172 36. A patient who is Hypertensive and Hypokalemic, should make one consider which of the ff. as the most likely cause of the hypertension? A. Pheochromocytoma B. Conn’s Syndrome C. Cushing’s disease D. Addison’s disease Page 2138 37. What is the most common cell type of Thyroid Carcinoma? A. Follicular carcinoma B. Papillary carcinoma C. Medullary carcinoma D. Anaplastic carcinoma Page 2125 38. Which of the following physiologic condition can stimulate prolactin secretion by the pituitary gland? A. Phenothiazines B. Menstruation C. Stress D. Post meal Page 2085 39. Which of the following is NOT consistent with Diabetic Ketoacidosis? A. pH of 7.12 B. HCO3- of 14 mmol/L C. Blood sugar of 240mg% D. Urine ketone of +4 Page 2159 table 323-4 40. What is the expected laboratory findings in Grave’s Hyperthyroidism? A. elevated thyroid hormones with low TSH B. elevated thyroid hormones & TSH C. low thyroid hormones & TSH D. elevated TSH with low thyroid hormones Page 2115 41. Which of the following is NOT a feature of Hypocalcemia? A. short QT interval B. increased urination C. depression D. diarrhea Page 2252 42. Which of the following test is recommended as the initial screening for Cushing’s Sydrome? A. overnight dexamethasone test B. low dose dexamethasone test C. high dose dexamethasone test D. plasma ACTH determination Page 2135 43. Which of the following have the most potent glucocorticoid effect? A. Triamcinolone B. Betamethasone C. Dexamethasone D. Paramethasone Page 2147

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44. The most potent risk factor for development of active TB disease is: A. Malnutrition B. Old age C. Late adolescence D. HIV co-infection Page 955 45. Tuberculosis treatment failure is suspected when appropriate regimen is prescribed but: A. sputum cultures remain positive after 3 months B. AFB sputum smears remain positive after 5 months C. Either D. Neither Page 963 46. The most important impediment to cure Tuberculosis is: A. Drug resistance B. inappropriate assessment of its severity C. Cheap medicine D. non-compliance Page 962 Case: A 58 years old male presented with 4 days fever and lately weakness and dizziness whenever he sits or stands up; disorientation. Upon PE: BP=90/60mmHg, PR=112/min., RR=28/min., T=39.8ºC. The only remarkable finding is an ulcerated skin lesions in the lower leg with black discoloration. Lab tests: WBC=2,500cells/m3; gram negative bacilli from smears of the skin lesion. 47. This patient has A. SIRS B. severe sepsis C. septic shock D. sepsis Page 1606 48. The most probable organism that has causes severe febrile illness with changes in sensorium and associated with ulceration and black discoloration of the skin is: A. S. aureus B. B. anthrasis C. Cl. Perfringens D. P. aeruginosa Page 310 49. The following anti microbial agent is effective for the treatment of Pseudomonas infection: A. Nafcillin B. Tetracycline C. Ceftazidime D. Any of the above Page 708 50. The major anatomic site for the establishment and propagation of HIV infection is: A. Genital organs B. Lymphoid organs C. Vascular system D. Lymphocytes Page 1080 51. Central to the pathogenesis of severe falciparum malaria is/are: A. cytoadherence in capillary and venular endothelium B. rosette formation by non parasitized RBC’s C. agglutination of parasitized RBC’s D. all of the above Page 1221

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52. Sequestration and microcirculatory arrest occur in which of the following Plasmodium? A. P. falciparum B. P. vivax C. P. malariae D. all of the above Page 1221 53. Hypoglycemia in severe malaria is associated with poor prognosis and it may result from A. failure of hepatic gluconeogenesis B. increased glucose consumption by host and parasite C. increased insulin secretion in treatment with Quinine D. all of the above Page 1222 54. The diagnostic test of malaria that is also used to monitor response to treatment is: A. Serology B. Stained blood film C. either D. neither Page 1224 55. Dengue Hemorrhagic fever can occur following: A. Primary infection with a virulent serotype B. Second infection with the same serotype C. Second infection with a serotype different from that involved in primary infection D. All of the above Page 1164 56. Diagnosis of Dengue fever is made in a clinically Compatible disease manifestation by A. IgM ELISA B. Hemoconcentration C. Leucopenia D. Thrombocytopenia Page 1164 57. The main clinical manifestations of Chronic Schistosomiasis are dependent on A. Species B. site of egg deposition in the host’s tissues C. Both D. Neither Page 1269 58. The following are effects of tetanospasmin EXCEPT A. blood release of inhibitory neurotransmitters B. increased circulating catecholamine levels C. block neurotransmitter release at the neuromuscular junction D. all of the above Page 841 59. The following laboratory findings are suggestive of Iron Deficiency Anemia EXCEPT A. koilonychias B. decreased serum ferritin C. decreased total iron binding capacity D. low reticulocyte response Page 589 60. Which of the following statement regarding Polycythemia Vera is correct? A. anemia is common B. transformation to acute leukemia is common C. an elevated plasma erythropoietin level excludes the diagnosis D. phlebotomy is used only after hydroxyurea and interferon have been tired

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E. thrombotic risk is mainly attributed to Thrombocytosis Page 627-628 61. Diagnosis of Acute Myeloid Leukemia is established by the presence of: A. ≥ 10% myeloblasts in the bone marrow B. ≥ 20% myeloblasts in the bone marrow C. ≥ 5% myeloblasts in the bone marrow D. < 5% myeloblasts in the bone marrow Page 632 62. Which of the following syndrome have autoimmune hemolytic anemia with immune thrombocytopenia? A. Raynaud’s syndrome B. Evans syndrome C. Hemolytic uremic syndrome D. Thrombotic thrombocytopenic purpura Page 612 63. Which of the following is the cytogenetic hallmark of Chronic Myelogenous Leukemia? A. t(15:17) B. t(9;22) C. inv 16 D. t(8;21) Page 638 64. What is the most common symptom of patient with Myeloma? A. Fever B. Bleeding C. Bone pain D. Numbness Page 657 65. Cryoprecipitate is produced by centrifugation after thawing of this particular blood component A. Packed RBC B. Single donor apheresis platelet C. Fresh frozen plasma D. Cryosupernate Page 664 66. Asthma is a disorder characterized by: A. Acute airway inflammation followed by bronchoconstriction B. Persistent subacute airway inflammation C. Sensitivity to metacholine and histamine D. Hypertrophy and hyperplasia of bronchial mucus glands Page 1508 67. Major infectious cause of asthma exacerbation in adults is: A. Respiratory syncitial virus B. Influenza virus C. Streptococcus D. Mycoplasma Page 1510 68. The hallmark of COPD is airflow obstruction as evidenced by A. Increased FEV1/FVC B. Increased FEV1 C. Decreased FEV1/FVC D. Decreased residual volume (RV) Page 1551 69. Paradoxical inspiratory inward movement of the rib cage seen in patients with severe COPD is called the: A. Palla’s sign B. Tripod posture C. Hamman’s sign D. Hoover’s sign Page 1551 70. The single most useful clinical sign of severe pneumonia among patient without underlying lung disease is: A. RR>30/min B. T>38ºC C. BP<110 systolic D. CR>100 Page 1532

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71. Recurrent pneumonia in the same location is most likely due to the presence of: A. Immunodeficiency B. Bronchial obstruction C. Lung hypoplasia D. Interstitial lung disease Page 1537 72. The presence of pus in the pleural space is termed as: A. Parapneumonic effusion B. Chylothorax C. Empyema D. Exudative effusion Page 1566 73. Sudden severe dyspnea, and P.E. finding of unilateral absent breath sounds and hypertesonance in a COPD patient without antecedent injury should make one suspect: A. Primary spontaneous pneumothorax B. Secondary spontaneous pneumothorax C. Traumatic pneumothorax D. Tension pneumothorax Page 1568 74. Subcutaneous emphysema and Hamman’s sign is seen in: A. COPD B. Pneumomediastinum C. Pleural effusion D. Hemothorax Page 1569 75. Hospital acquired pneumonia (HAP) is consider if pneumonia occur: A. Occurs 24 hours after being placed on a respirator B. Occurs 48 hours after hospital admission C. Occurs 72 hours after ICU admission D. Occurs rarely in large, variegated-patient medical centers Page 1538 76. A 56 y/o female admitted for Acute Pyelonephritis was started on Amikacin 500 mg IV every 6 hours. After 7 days repeat serum creatinine=5.7 mg/dL (Initial was 1.3 mg/dL). Urinalysis at this time will reveal: A. RBC casts B. Pus cell casts C. fine granular casts D. muddy brown granular casts Page 1649 77. A 65 y/o male with poorly controlled diabetes had renal colic and underwent an IVP. He develop oliguria 1 day after the procedure. Repeat serum creatinine=6.9 mg/dL (Initial=2.9 mg/dL). The risks factors on this patient that predispose him to develop contrast dye nephropathy are the following, EXCEPT: A. Diabetes B. Renal Insufficiency C. Infection D. Elderly Page 1647 78. The findings of eosinophiluria in patient with acute Renal Failure is suggestive of: A. Acute Allergic Insterstitial Nepritis B. Acute Glomerulonephritis C. Acute Tubular Necrosis D. Acute Uric Acid Nephropathy Page 1649

79. Which of the following statement is true regarding the measurement of GFR?
A. BUN overestimates GFR because urea is reabsorbed by the tubules

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B. Serum creatinine is ⇑ after ingestion of cooked meat C. Cockcroft-Gault equation is similar for both male and female D. Insulin clearance is affected by both tubular absorption and secretion Page 246-247 80. A patient with Chronic Renal Disease and GFR of 40 ml/min has serum K of 6.2 meq/L. the elevated K is due to the following, EXCEPT: A. ⇓ urinary K+ excretion B. constipation C. ⇑ dietary K+ intake D. drugs that ⇓ K+ secretion in tubules Page 1655

81. A 36 y/o female with Chronic Renal Disease complains of restless leg syndrome. Screatinine=5.2 mg/dL. You should advice the patient to: A. consult neurologist B. therapeutic trial of high dose B6 & B12 C. therapeutic trial of phenytoin D. initiation of Dialysis Page 1659 82. A 46 y/o hypertensive patient serum creatinine=9.8 mg/dL and with marked pallor. The anemia is primarily due to: A. hemolysis B. ⇓ EPO synthesis C. bone marrow suppression D. Iron deficiency Page 1658 83. The most prominent findings in patient with nephritic syndrome is: A. hypoalbuminemia B. edema C. proteinuria > 3.5 gm/1.73m2 D. hyperlipidemia Page 1684

84. A 20 y/o male, smoker was admitted because of oliguria and hemoptysis.
Initial lab: revel serum creatinine=8.6mg/dL. Urinalysis shows rbc casts and dysmorphic rbc. (+) anti GBM Ab’s. The expected histopathologic findings is A. thickened glomerular basement membrane B. prominent mesangial deposits of IgA C. crescents formation D. glomerulosclerosis Page 1683 85. Duration of treatment of acute uncomplicated cystitis in non pregnant woman is: A. single dose B. 3 days C. 7 days D. 14 days Page 1718-1719 86. Which of the following is a chronic clinical manifestation of Atherosclerosis? A. Myocardial infarction B. Cerebrovascular accident C. Sudden cardiac death D. Stable effort induced angina pectoris Page 1425 87. Atherosclerotic plaque that ate vulnerable to rupture is characterized by which of the ff.? A. Thick fibrous cap B. Large lipid cores C. A high content of lymphocytes

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D. Abundance of smooth muscle cells Page 1429 88. Which of the following risk factors is a coronary heart disease risk equivalent? A. Hypertension B. Diabetes Mellitus C. Dyslipidemia D. Obesity Page 1431 89. The abnormal lipoprotein profile associated with insulin resistance known as Diabetic dyslipidemia? A. High LDL low HDL B. High Triglyceride, High LDL C. High Triglyceride, Low HDL D. Low HDL, Low LDL Page 1431 90. Microvascular angina is a condition caused by: A. Abnormal constriction or failure of normal dilatation of the coronary conductance vessels B. Normal constriction the coronary resistance vessels C. Abnormal constriction or failure of normal dilatation of the coronary resistance vessels D. Abnormal dilatation of the coronary resistance vessels Page 1434 91. The major sites of atherosclerotic disease are the: A. Conductance vessels B. Resistance vessels C. Epicardial arteries D. Endocardial arteries Page 1434 92. CAD manifested as symptoms of dyspnea, fatigue and faintness is known as A. Unstable angina pectoris B. Angina equivalent C. Stable angina pectoris D. Angina decubitus Page 1435 93. The typical physical examination findings of patients with Stable Angina Pectoris is: A. (+) atrial gallop B. (+) ventricular gallop C. Mitral systolic murmur D. Normal Page 1436 94. Which of the following is typical of hypertensive crises? A. Diastolic blood pressure is > 140 mm Hg B. Normal mental status C. Iron deficiency anemia D. Grade I fundus Page 1480 95. Class I drug used in the treatment of symptoms of patients with Chronic stable Angina pectoris include which of the following? A. Dipyridamole and chelation therapy B. Clopidogrel and long acting dihydropiridine CCB C. ASA, beta blockers and NTG D. Long acting nitrates and beta blockers Page1439 96. Stenosis of the left main coronary artery on three vessel disease in patients with Diabetes Mellitus or severe LV dysfunction are best treated with: A. Traditional medical management B. PCI

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C. CABGS D. Thrombolysis Page 1442 97. To achieve revascularization of the ischemic myocardium in patients with asymptomatic IHD and suitable stenoses of the epicardial coronary arteries, the best treatment option is: A. CABGS B. PCI C. Thrombolysis D. Low molecular weight heparin Page 1442 98. The most common presenting symptom of patients with STERMI is: A. Dyspnea B. Chocking C. Deep and visceral pain D. Nape pain Page 1449 99. The initial ECG changes in STEMI is: A. ST segment depression B. ST segment elevation C. Deep Q D. Tall T wave Page 1450 100. In which of the following pattern of MI will the use of morphine be restricted because of its vagotonic effect? A. anterior MI B. antero lateral MI C. Postero inferior MI D. Massive MI Page 1452

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