1 .Youve been seeing Mrs.

Reyes, 42/F at theOPD for

chronic heart failure and she has been minimally
symptomatic on a beta blocker. She comes back to you
with acute decompensated heart failure. Which of the
following might have triggered her decompensation?
A. Alcohol abuse
B. Smoking
C. Pregnancy
D. Fluid restriction

4. Diagnostic feature of cardiac tamponade

I. Kussmauls sign
J. Pulsus Paradoxus
K. Thickened/calcified pericardium
L. Incresed myocardial thick ness

Alcohol and Smoking acute renal failure

Pregnancy fetus added to blood volume which causes
decompensatory heart failure
Fluid restriction is a treatment.

**Cardiac Tamponade
Too much fluid in the Pericardial sac
Becks Triad
o Hypotension
o Soft/muffled heart sound
o Distended neck veins
Pulsus Paradoxus (HALLMARK): greater than
normal (10mmHg) inspiratory decline in systolic
arterial pressure
Prominent x descent
Electrical alternans
Pericardial effusion
Equalization of diastolic pressures

2.

You remember that Mrs. Reyes has rheumatic heart

disease since she was 25 years old. On examination,
she has an accentuated S1, a diastolic rumble over the
apex and a wide notched P wave on 12L ECG. Which
valvular lesion does she most probably have?
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation

.
Accentuated S1 mitral valve
Mitral Stenosis
Most common in RHD
Others congenital dse, SLE and RA
Left atrial myxoma mimics symptoms
Accentuated S1, Diastolic rumble and opening
snap
3. Which ECG findin distinguishes acute MI from
pericarditis?
E. ST elevations are concave
F. Development of Q Waves
G. Tall P waves
H. T wave inversiotns usually seen within
days before ST segments become
isoelectric
ECG on Myocardial Ischemia:
Aggravated by effort or activity
The diagnosis of acute myocardial infarction is not only
based on the ECG. A myocardial infarction is defined as:
Elevated blood levels of cardiac enzymes (CKMB
or Troponin T) AND
One of the following criteria are met:
o The patient has typical complaints,
o The ECG shows ST elevation or
depression.
o Pathological Q waves develop on the
ECG.
o A coronary intervention had been
performed (such as stent placement)
ECG on Pericarditis:
Aggravatesd by lying on supine
In pericarditis four stages can be distinguished on the
ECG:
stage I: ST elevation in all leads. PTa depression
(depression between the end of the P-wave and
the beginning of the QRS- complex)
stage II: pseudonormalisation (transition)
stage III: inverted T-waves
stage IV: normalization
Keep into account that in stage I pericarditis, ST-elevation
is present in all leads except in aVR, V1 and III.
**Dresslers Syndrome Pericarditis after MI
triad of features:
o fever,
o pleuritic pain and
o pericardial effusion

** Kussmaul's sign is a paradoxical rise in jugular

venous pressure (JVP) on inspiration. Usually present in:
Constrictive pericarditis and restrictive cardiomyopathy

** See also figure 1

5.Initial anti-hypertensive therapy with Thiazide diuretic
should be given to which patient:
A. 48/MCHF Functional Class III, BP
160/90
B. 50/M BP 140/90 with gouty arthritis
C. 23/F with CKD stage 5 from chronic
glomerilonephtitis BP 150/90
D. 55/F with dyslipidemia and bronchial
asthma, BP 150/90
** (seefigure 2)
6.Treatment of choice for acute pericarditis
occurring post-STEMI
A. Ibuprofen 20mg 3 times daily
B. Aspirin 650mg 4 times daily
C. Prednisone 1mg/kg daily
D. Warfarin 2.5 to 5mg daily
___________ Syndrome
Initial dose for MI: Aspirin 80 mg tab
2nd choice: Ibuprofen (studies show it increases 2nd
chances of MI again.)
Prednisone is contra-indicated due to this thinning effect
on the pericardial sac
Warfarin is also CI due to its effect on the sac to bleed.
7.A 64/M came to the ER for chest heaviness starting 3
hours prior, unrelieved by nitrates given to him at the
previous hospital On PE, BP 80/50 HR 64 RR20 neck
veins were flat, breath sounds clear while heart sounds
were distinct. On 12L ECG, ST elevation was seen in leads
II, III and AVF. What is the next step in stabilizing this
patient?
A. Give morphine
B. Give intravenous fluid
C. Start dopamine drip
D. Start dobutamine drip
The patient has Inferior wall MI so the preload is not
enough going to the heart which causes the hypotension.
Dobutamine and Morphine nitrate not given due to
its vasodilation effects which can even worsen the low BP
status
Dopamine not given due to the ST elevations on ECG
finding which could worsen due to effects of increase
cardiac activity.

8.Fibrinolytic therapy can be given to which of the

following patients as treatment for STEMI
A. 64/M presenting with severe, tearing
chest pain.
B. 49/M diabetic with BP 190/110
C. 45/F with lupus nephtritis and active
menses.
D. 40/M who had ischemic stroke months
ago.

Acute Myocardial Infarction

Symptoms:
o Chest pain
o Dyspnea
o Diaphoresis
o Light-headedness
o Weakness
o Palpitations
o Nausea and vomiting

Absolute Contraindications to Fibrinolysis:

History of Cerebrovascular hemorrhage at any
time
Non-hemorrhagic stroke or other
Cerebrovascular event within the past year
Marked hypertension (SBP>180 mmHg and/or a
DBP>110mmHg) at any time during the acute
presentation
Suspicion of aortic dissection (tearing chest pain)
Active internal bleeding (excluding menses)

Pulmonary Embolism
Symptoms of pulmonary embolism include
difficulty breathing,
chest pain on inspiration, and
palpitations.
Clinical signs include
low blood oxygen saturation
cyanosis,
rapid breathing, and a
rapid heart rate.
**Severe cases of PE can lead to collapse, abnormally low
blood pressure, and sudden death.

9. In assessment of blood pressure, using an

inappropriately small BP cuff will result in:
A. Overestimation of the true blood
Pressure
B. Underestimation of the true blood
Pressure
C. No change in the true blood pressure
D. Overestimation only of the systolic blood
pressure.
10. A 59 year old male presents with chest pain.
On
auscultation, you were able to appreciate a midsystolic
murmur radiating to the carotids. You also noted a weak
and delayed pulse.
Your likely diagnosis is:
A. Aortic stenosis
B. Aortic regurgitation
C. Acute myocardial infarction
D. Pulmonary embolism
Aortic Stenosis - The three cardinal symptoms of aortic
stenosis are:
syncope,
anginal chest pain and;
dyspnea
Other symptoms of heart failure such as:
orthopnea,
exertional dyspnea,
paroxysmal nocturnal dyspnea, or
pedal edema.
It also has Pulsus parvus et tardus which is may be
a slow and/or sustained upstroke of the arterial
pulse, and the pulse may be of low volume
It also has the apical-carotid delay which is the
pulse radiating to the carotid artery.
Aortic Regurgitation: aka Aortic Insufficiency
The leaking of the aortic valve of the heart
that causes blood to flow in the reverse
direction during ventricular diastole
Auscultation of the heart to listen for the
murmur of aortic insufficiency and the S3
heart sound
o S3 gallop correlates with
development of LV dysfunction
Early diastolic and decrescendo, which is
best heard in the third left intercostal space
and may radiate along the left sternal border.
Symptoms of Aortic Reg are same as Heart Failure such
as:
orthopnea,
exertional dyspnea,
paroxysmal nocturnal dyspnea,

11.A 75 year old male comes in for angina. He is a heavy

smoker and alcoholic beverage drinker. He was also said
to have a fatty liver by ultrasound. On further history,
he admits to have been taking the the blue pill
(sildenafil) for erectile dysfunction (last intake was the
day prior). Which anti-anginal drug is absolutely
contraindicated for this patient:
A. Metoprolol
B. Diltiazen
C. Nitroglycerin
D. Aspirin
Since the patient is taking in Sildenafil, we should not give
Nitroglycerin for his angina because the BP will decrease
lower than the normal and cause significant hypotension.
12. A 35 year old male with a heavy smoking history
develops claudication on the right foot with gangrene on
the tips of tips of the toes. Popliteal pulses on both
extremities are normal. Your likely diagnosis is:
A. Atheroembolism
B. Deep venous thrombosis
C. Fibromuscular dysplasia
D. Thromboangiltis obliterans
13. A 65 year old male was hospitalized for stroke 8
months prior and was subsequently bedridden after. He
was rushed to the emergency room for sudden onset
difficulty of breathing. Upon arrival at the emergency
room there was note blood-tinged sputum, with the
following vital signs BP:110/70 HR: 72 regular, RR:34
and there was clear breath sounds. Emergency 2D echo
showed McConnells sign. What is the most common
cause of death for patients with this condition?
A. Pump failure from myocardial ischemia
B. Progressive right heart failure
C. Respiratory failure from hypoxemia
D. Sudden cardiac death from cardiac
dysrhythmia
Pulmonary Embolism
Dyspnea is the most common symptom
Tachypnea is the most common sign
Risk Factors:
o Bedridden > 3 days
o Active Cancer
o Major Surgery < 12 weeks
Progressive right heart failure is the usual cause
of death
** Mc Connels Sign:
This is the finding of akinesia of the mid-free wall
but normal motion of the apex
Right side of heart is failing

14. A 54 year old diabetic male, with a 60 pack year

smoking history sought consult at the OPD 1 week ago for
exertional dyspnea and cough with whitish sputum which
started 8 months ago. He was rushed to the emergency
room for a 3 day history of worsening difficulty of
breathing, cough and decreased sensorium. Upon arrival,
he was seen drowsy with absent breath sounds and
bipedal edema. Which of the following should be the next
step in managing this patient?
A. Intubate the patient
B. Nebulize with Salbtamol
C. Start theophylline drip
D. Give Furosemide IV boluses
15.A diagnostic thoracentesis is warranted for which of
the following situations?
A. Pleural effusions are equally present on
both lung fields
B. Patient is febrile
C. Isolated left sided effusion
D. Sputum AFB is positive
Lights Criteria: Transudative vs Exudative
Pleural Fluid protein/serum protein >0.5
Pleural fluid LDH/serum LDH > 0.6
Pleural fluid LDH > 2/3 normal upper limit for
serum
Factors indicating the likely need for a procedure more
invasive than a thoracentesis (increasing order of
importance)
Loculated pleural fluid
Pleural fluid pH < 7.20
Pleural fluid glucose < 3.3 mmol/L (<60mg/dL)
Positive Gram stain or culture of the pleural fluid
Presend of gross pus in the pleural space
16.A 50 year old female, on chronic dialysis, was
transferred from a nursing home for decreased in
sensorium. On history, there was a 1 week history of
cough with yellowish sputum, associated with high grade
fever and progressive difficulty of breathing. On
examination, she was drowsy, with coarse crackles on the
right lower lung field. Vital signs were BP: 70/50 HR 118
and RR 27 and febrile at 39.2C.
Which of the following would put her risk of
Pseudomonas aeruginosa infection?
A. Chronic dialysis
B. Family member with a Pseudomon infection
C. Hypotension despite fluid
D. Living in a nursing home
**See Figure 3
17. A 30 year old patient sought consult for chronic cough
for 3 months. She was previously diagnosed with
pulmonary tuberculosis but only completed treatment 3
months Laboratory test showed positive sputum TB
culture and chest x-ray revealed cavitary TB. Which of the
following makes patient most likely to transmit PTB?
A. Age of the patient
B. Positive sputum TB culture
C. Presence of cavitary TB on chest ray
D. Previous TB treatment
18. When should treatment failure in pulmonary
tuberculosis be suspected?
A. Chest x-ray remained unchanged after 6 weeks
B. Sputum AFB smears remain post after 5
months.
C. Sputum cultures remain positive after 2 months
D. If patient stops medications for 1 week

**TB Treatment Failure/Resistance

If sputum AFB is positive at 3 months and patient
is adherent
If sputum cultures remain positive at 3 months
In some like extensive cavitary disease and large
numbers of organisms, AFB smear conversion
may lag behind culture conversion.
**Cavitary lesions = Increased Bacilli burden
19. What is the mechanism of action of Rifampicin?
A. Inhibits fatty acid synthase and mycolic
acid synthesis
B. Inhibits arabinosyltransferases involved
in cell wall synthesis.
C. Inhibits mycobacterial DNAdependent RNA polymerase, blocking
RNA synthesis
D. Mechanism is unclear
***Mechanism of Action of Anti-Koch Drugs
Rifampicin Inhibits mycobacterial DNA-dependent
RNA polymerase, blocking RNA synthesis
Isoniazid - prodrug and must be activated by a bacterial
catalase-peroxidase enzyme that in M. tuberculosis is
called KatG.
KatG couples the isonicotinic acyl with NADH to
form isonicotinic acyl-NADH complex.
This complex binds tightly to the enoyl-acyl
carrier protein reductase known as InhA,
thereby blocking the natural enoyl-AcpM
substrate and the action of fatty acid
synthase.
This process inhibits the synthesis of mycolic
acid, required for the mycobacterial cell wall.
Ethambutol - It works by obstructing the formation of
cell wall.
Mycolic acids attach to the 5'-hydroxyl groups of
D-arabinose residues of arabinogalactan and
form mycolyl-arabinogalactan-peptidoglycan
complex in the cell wall.
It disrupts arabinogalactan synthesis by
inhibiting the enzyme arabinosyl transferase.
Disruption of the arabinogalactan synthesis
inhibits the formation of this complex and
leads to increased permeability of the cell
wall.
Pyrazinamide - Pyrazinoic acid was thought to inhibit
the enzyme fatty acid synthase (FAS) I, which is required
by the bacterium to synthesize fatty acids and kills
dormant bacteria and newly replicated M. tuberculosis
Streptomycin- is a protein synthesis inhibitor.
It binds to the small 16S rRNA of the 30S subunit
of the bacterial ribosome, interfering with the
binding of formyl-methionyl-tRNA to the 30S
subunit.
This leads to codon misreading, eventual
inhibition of protein synthesis and ultimately
death of microbial cells.
20..Which of the following laboratory/imaging finding
suggests the presence of chronic hypoxemia?
A. Compensatory increase of bicarbonate In
arterial blood gas
B. FEV1/FVC < 0.7 on spirometry
C. Low hematocrit
D. Right ventricular hypertrophy

21. A 30 year old female came in for severe abdominal

pain radiating to the back. Amylase and lipase were
significantly elevated. On the 3rd postoperative day, she
had sudden worsening of dyspnea with a respiratory rate
of 34. Arterial blood gas showed a PO2 of 40 with an FiO2
of 40%. Best management for this patient will be:
A. Give stat dose of Furosemide IV bolus
with BP precautions
B. Start piperacillin tazobactam and
observe after three days for
improvements of symptoms
C. Start heparin, aspirin and clopidogrel,
and refer for emergent coronary
angiography with revascularation
D. Institute ventilatory support with a
low tidal volume (6cc/kg)
22.How is Paragonimus westermani (Lung Fluke)
transmitted?
A. Respiaratory droplets
B. Ingestion of craysfish
C. Transfer from infected blood and
body fluids
D. Inhalation of infectious larva
23.A 22 year old college student sought consult for a 7
day history a high grade fever. He also complained of
headache, body malaise, and abdominal pain. On physical
examination, vital signs were as follows: Bp 110/60 HR
70 RR 18 Temp 39.4C, the liver was enlarged; there was
splenomegaly and blaching, maculapapular rash over the
anteriror chest.
A. Dengue hemorrhagic fever
B. Leptopirosis
C. Malaria
D. Typhoid fever
Typhoid Fever prolonged high grade fever 1 to 2
weeks duration and continuous; relative bradycardia;
relative leucopenia with rashes on the chest. This also
has enlarged liver and spleen.
DHF purpuric rashes are present on the 3rd day of fever
or after lysis of fever
Usually theres abdominal pain
Flu-like symptoms
Bleeding
Platelet count decreases after lysis of fever
Leptospirosis
Flu-like symptoms + hepatic damage (jaundice)
Malaria
Flu-like symptoms with fever as paroxysmal
o The classic symptom of malaria is
paroxysma cyclical occurrence of
sudden coldness followed by shivering
and then fever and sweating, occurring
everytwo days (tertian fever) in
P. vivax and P. ovale infections,
and every three days (quartan
fever) for P. malariae.
P. falciparum infection can
cause recurrent fever every 36
48 hours or a less pronounced
and almost continuous fever
24. Aling Dahlia is a 55 year old diabetic patient you
havent seen in years. She comes back to you with
burning pain when she urinates and vulvar itching. On
closer inspection, you note clumped white vaginal
discharges on a background of erythematous vaginal
epithelium. What is your treatment of choice?
A. Metronidazole 2g orally single dose
B. Metronidazole 500mg BID for 7 days.
C. Fluconazole 150mg orally single dose
D. Azithromycin 2g orally single dose
**SSx suggests infection from Candidiasis so an antifungal is the drug of choice

25. Your cousin complains to you that she had a episode

of vomiting around 10 episodes of watery diarrhea with
abdominal cramping for the past 3 hours. She denies any
fever and did not notice blood in her vomitus or stools.
She tells you that she just come from a friends wedding 4
hours ago where she ate fried rice, potato salad, roast
beef and prawns.
Which of the following is a reasonable treatment regimen
for your cousin in addition to oral rehydration?
A. Bismuth or Loperamide
B. Bismuth plus Clindamycin
C. Ciprofloxacin plus Metronidazole
D. Ciprofloxacin
26.Most common clinical findings in the acute clinical
syntdrome of HIV.
A. Mucocutaneous ulceration, Kaposis
sarcoma
B. Diarrhea, myaldia, urethral discharge
C. Pharyngitis, lymphadenopathym fever
D. Weight lostm nights swears ,prostration
27. True regarding treatment of schistosomiasis
A.Drug of choice is praziquantel in 2 to 3
doses given in 4 weeks.
B. Early hepatomegaly and bladder lesions
Do not resolve with chemptherapy
C. Treatment of severe acute schistosomiasis
involves parasite elimination and
supportive treatment such as
glucocorticoids.
D. Treatment of schistosmiasis in a patient
with co-infection with HIV will reduce
HIV viral load and increase CD4 counts.
28.Which of the following vaccines can be given safely to
pregnant women?
A. Measles, mumps, rubella (MMR)
B. Varicella
C. Tetanus toxoids
D. Herpes zoster
29.Capt. Reyes is a naval officer who is now going to be
assigned to Papua New Guinea. He consults you since he
is concerned about malaria in the area and intends to
bring his pregnant wife and 12 y/o son with him.
Which of the following should be your advice to them?
A. It is very important to apply anti-mosquito
repellants especially in mid-afternoon
when the anopheline mosquitoes most often
feed.
B. Travellers should take their
Chemoprophylaxis 12-24 hours
prior to departure and continue until 1
week after departure
C. Pregnant women can be given Mefloquine
D.Chemoprophylaxis for malaria when
given appropriately assures protection for
travelers and diagnosis other than malaria
should be sought when they present with
fever.
30. Which of the following is true regarding serologic
tests for syphilis?
A. RPR remains the standard in examining
examining cerebrospinal fluid (CSF)
B. VDRL is the test of choice for rapid
Serological diagnosis in clinical setting.
C. RPR titers correlate with VDRL titers
during treatment and may be used
interchangeably
D. A non-reactive FTA-ABS test on CSF
rules out asymptomatic neurosyphilis

**Syphilis Diagnostics: Non-treponemal

RPR test is easier to perform and uses unheated
serum; test of choice for rapid serologic
diagnosis in a clinical setting and can be
automated.
VDRL test remains the standard for examining
CSF.
RPR and VDRL tests are recommended for
screening or for quantitation of serum antibody
VDRL titers do not correspond directly to RPR
titers
Syphilis Diagnostics: Treponemal
Treponemal antibody-absorbed (FTA-ABS)
test and the T. pallidum particle
agglutination (TPPA) test
Confirmatory test for syphilis
Has high false negative rate
Cannot distinguish between current and
treated syphilis
31. Mucocutaneous lesions, generalized non-tender
Lymphadenopathy, skin eruptions that involves
palms and soles and rarely, lues maligna or
severe necrotic lesions, occur in which stage of
syphilis infection?
A. Primarily syphilis
B. Secondary syphilis
C. Latent syphilis
D. Late syphilis
Stages of Syphilis infection
Primary
Gumma
Approximately 3 to 90 days after the initial
exposure (average 21 days) a skin lesion, called a
chancre, appears at the point of contact. This also
has Lymphadenopathy.
This is classically (40% of the time) a single, firm,
painless, non-itchy skin ulceration with a clean
base and sharp borders between 0.3 and 3.0 cm
in size. The lesion, however, may take on almost
any form. In the classic form, it evolves from a
macule to a papule and finally to an erosion or
ulcer.
Secondary
Secondary syphilis occurs approximately four to
ten weeks after the primary infection.
symptoms most commonly involve the skin,
mucous membranes, and lymph nodes.
There may be a symmetrical, reddish-pink, nonitchy rash on the trunk and extremities, including
the palms and soles.
The rash may become maculopapular or
pustular. It may form flat, broad, whitish,
wart-like lesions known as condyloma latum
on mucous membranes. All of these lesions
harbor bacteria and are infectious.
Latent
Latent syphilis is defined as having serologic
proof of infection without symptoms of disease.
It is further described as either early (less than 1
year after secondary syphilis) or late (more than
1 year after secondary syphilis) in the United
States.
The United Kingdom uses a cut-off of two years
for early and late latent syphilis.
o Early latent syphilis may have a relapse
of symptoms.
o Late latent syphilis is asymptomatic, and
not as contagious as early latent syphilis

Tertiary
Tertiary syphilis may occur approximately 3 to
15 years after the initial infection, and may be
divided into three different forms:
o gummatous syphilis (15%),
o late neurosyphilis (6.5%), and
o cardiovascular syphilis (10%).
Without treatment, a third of infected people
develop tertiary disease.
People with tertiary syphilis are not infectious
32. This blood fluke is now classified as human
carcinogen.
A. Schistosoma japonicum
B. Schistosoma hematobium
C. Schistosoma mekongi
D. Schistosoma intercalartum
33. . Most common clinical manifestation of
Neisseria meningitides in human:
A. Asymptomatic colonization of the
nasopharynx
B. Bacterial meningitis
C. Meningococcal septicemia
D. Occult bacterermia
34. 40 year old female wondered why despite her
appetite she seemed to be wasting away. She has been
having vague abdominal pain and watery diarrhea for a
month now, despite treatment which Ciprofloxacin. She
consults you regarding this wondering if it has anything
to do with her love for raw fish. Upon doing a battery
tests, you note an albumin level of 12 (normal value: 40).
Fecalysis results showed peanut-shaped eggs.
What is your diagnosis?
A. Trichinella
B. Capillariasis
C. Enterobiasis
D. Acariasis
35.A 53 year old male came in at the OPD for jaundice. On
history he was a heavy chronic alcoholic beverage
drinker and has a strong family history for hepatocellular
cancer. On physical examination, he has gynecomastia
and a few spider angionata. Hepatitis profile:
HBsAg, anti-HCV: Non-reactive
AST was twice elevated as the ALT, low albumin,
prolonged PT
CBC: HGB 92 HCT 0.23 MCV 102 MCH 35 Platelet 166
Which would be the most likely cause of this patients
chronic liver disease?
A. Alcoholic liver disease
B. Chronic hepatitis B infection
C. Hepatocellular carcinoma
D. Fatty liver
36.What is you interpretation of the following hepatitis
profile?
Hbs()
Anti-HBs (+)
Anti-Hbc IgG (+)
HBeAg () Anti HBe(+/-)
A. Chronic hepatitis B high infectivity
B. Late acute or chronic hepatitis B, Low
Infectivity
C. Recovery from hepatitis B
D. Vaccination against HBV
**See Figure 4

37. A 30 year old female sought consult for

mlena. She is complaining of 1 year history of
recurrent burning epigastric pain, sometimes
awakening the patient in the middle of the night and
was relieved by intake of antacids or food. On
Physical examination, she has epigastric tenderness,
orthostatic hypotension, melena on DRE.
A. Barium swallow
B. Abdominal CT scan
C. Upper GI endoscopy
D. Lower GI endoscopy
38. Mr. Tan is 58 year old male company executive who
came in for a preventive check-up. History and physical
examination are unremarkable but you noted microcytic,
hypochromic anemia in his CBC. Urinalysis, blood
chemistry and chest x-rays are normal. What is next step?
A. Reassure him that the anemia might
be from stress
B. Order for abdominal CT scan
C. Order PSA, CEA, AFP and LDH
D. Refer to GI for flexible sigmoidoscopy

40. Which of the following is true of Crohns

disease ?
A. Usually involves the rectum
B. Limited to the mucosa and
superficial subucosa
C. Pathology is segmental with skip
areas
D. Backwash ileltis is common
Crohns vs Ulcerative Colitis
Difference
Crohns
Ulcerative
Location
Anywhere in GIT Colon usually
Inflammation
Patches (skip
Continuous
lesions)
lesions
Pain
Lower Right
Lower Left
Abdomen
Abdomen
Appearance
Colon may be
Colon wall is
thickened and
thinner and with
rocky (due to
continuous
skip lesions)
lesions
Ulcers are deep
and may extend
into all layers of
the bowel

**if age > 50 with microcytic and hypochromic anemia,

consider colonic masses possibly malignant, hence, to be
checked with sigmoidoscopy.
39. A 30 year old male presents with dysphagia to solid
and liquids. A barium swallow x-ray done showed
tapering of esophagus with a beak-like appearance.
Diagnostic criteria by esophageal manometry would
show:
A. Over-activity of peristalsis
B. Impalred LES relaxation
C. Air fluid level
D. Dilated esophagus
Esophageal Disorders
Achalasia
o Barium swallow
Esophageal dilatation
Tapering at the GE junction
Air-fluid level within the
esophagus
o Manometry: Impaired LES relaxation
and absent peristalsis

Diffuse Esophageal spasm

o Corkscrew esophagus on barium
swallow
o Manometry: simultaneous contractions,
uncoordinated (spastic) activity
Candida esophagitis
o Characteristic white plaques with
friability

Bleeding (From
rectum during
bowel
movement is)

NOT COMMON

Crohns Disease
Abdominal pain,
cramping or
swelling
Anemia
Fever
Gastrointestinal
bleeding
Joint pain
Malabsorption
Persistent or recurrent
diarrhea
Stomach ulcers
Vomiting
Weight loss

Mucus lining of
large intestine
may have ulcers
but they do not
extend beyond
the inner lining
COMMON

Ulcerative Colitis
Abdominal pain or
discomfort
Anemia caused by
severe bleeding
Bloody diarrhea
Dehydration
Fatigue
Fever
Joint pain
Loss of appetite
Malabsorption
Rectal bleeding
Urgent bowel
movements
Weight loss

41. Which among these diseases will have a

serum-ascites albumin gradient of >1.1g/dL?
A. Cirrhosis
B. Peritoneal carcinomatosis
C. Tuberculous peritonitis
D. Nephrotic syndrome
42. Mr. Loyola is 34 year old male who came to the ER for
abdominal pain. A week ago he has been having vague
epigastric pain for which he took antacid but with no
relief. He noted the pain to migrate to the right lower
part of his abdomen and slight fever. Upon examination,
he grimaces with pain after coughing and you note a rigid
abdomen with tenderness. Which of the following is the
appropriate treatment?
A. Ceftriaxone IV
B. Ceftriaxone plus Metronidazole IV
C. Surgery
D. B and C

43. What is the role of lactulose in patients withhepatic

encephalopathy?
A. Evacuateblood from the
gastrointestinal tract
B. Inactivate colonic bacteria
C. Induce diarrhea
D. Promote colonic alkalinization
44.Which of the following should you consider accurate in
the management of gallstones and its complications?
A. You can employ Ursodeoxycholic
Acid
B. Prophylactic cholecystectomy may be
considered for those young patientswith
low surgical risk
C. Morphine should be employed in the
management of severe pain in acute
Cholecystitis
D. Cholecystectomy is advised in
allpatients with porcelain gallbladder
45.Which of the following is NOT a criteria inthe ChildPugh Classification for staging of cirrhosis?
A. Billrubin
B. Partial thromboplastin time
C. Serum albumin
D. Ascites
Child- Pugh Classification
Serum Albumin
Serum Bilirubin
Prothrombin time
Ascites
Hepatic Encephalopathy
MELD Classification: Internation normalized ratio (INR),
serum bilirubin, and serum creatinine
46. A 75 year old male with hypertension and
dyslipidemia presents with hematochezia of about cup.
Which of the following will you consider first as it is the
most common cause of hematochezia among the elderly?
A. Bleeding hemorrhoids
B. Colon carcinoma
C. Peptic ulcer disease
D. Diverticular bleeding
47. What is the standard radiological procedurefor
diagnosis of nephrellthiasis?
A. Abdominal CT scan with IV contrast
B. KUB-IVP
C. Plain helical CT scan of the abdomen
D. Ultrasound of the abdomen
48. R.F is a 65 year old male recently admitted
for his first cycle of chemotherapy for acute
leukemia. Two days after his initial chemo dose,
you not that his urine out put has been going
down. Physical examination revealed
undistendded bladder and positive Chvosteks
sign, rest is unremarkable
Stat blood chemistry revealed normal creatine
kinase, hypocalcemia, hyperphosphatemia,
hyperuricemia and mild hyperkalemia.
Urinalysis unremarkable except for uric acid
crystals.
What is your treatment of choice?
A. Glucocorticoids
B. Intravenous crystalloids with
allopurinol
C. Intravenous crystalloids only
D. Intravenous furosemide

49. In which of the following individuals would you

recommend kidney biopsy?
a. 64/M with diabetes and
Hypertension for 15 years, poor
compliance to meds, complains to you of
prucitus and insomnia serum
Creatinine 350 mmol/L
b. 21/F complaining of headache and
Hypogastric pain. BP 170/100 HR 90,
Urinalysis reveals protein 1+RBC 3+,
WBC 1+, RBC casts 1 +
c. 23/M complaining of edema. He
Claims to be healthy except for a bout
sore throat 2 weeks ago. BP
160/90 , HR88, urinalysis reveals
protein trace, RBC 2+,WBC1+
d. 25/M came to the ER for no urine
Output. You note stable vital signs and
unremarkable physical exam except for
multiple bruises on his thighs and legs.
Serum BUN 14.0 mmol/L, creatinine 380
mmol/L foley catheter has minimal teacolored urine.
50. Which of the following features is highly
Suggestive of renal disease from multiple
myeloma?
a. Hyperuricemia
b. Dipstick negative proteinuria
c. Normocytic anemia
d. Hypercalcemia
51. A 45 year old female has been complaining
of dysuria and urinary frequency which started 1
week prior to admission. She now presented to
the emergency room because of fever, chills,
nausea and persistent vomiting and CVA
tenderness on the right. When should you
contemplate on further imaging studies or
urologic consult for this patient?
a. If we find WBC casts on urinalysis
b. When fever persists after therapy
c. When urine culture does not reveal
any organism
d. Imaging studies and urologic
consult are always needed to
establish diagnosis in this case
52. Treatment of choice for acute kidney injury
from scleroderma or scleroderma renal crisis
a. Glucocorticoids
b. ACE inhibitors
c. Sildenafil
d. Hemodialysis
53. A 57 year old diabetic, weighing 60kg, came to the
emergency room for difficulty of breathing. She
presented to the emergency room due to difficulty
of breathing.
Blood chemistry results are the following
(in mmol/L):
BUN 15.56
Creatinine 266
Na 140
Ca 1.45 Alb 14
Which of the following would you expect
to see in this patients ECG?
A. Peaked T waves
B. Prominent U waves
C. Prolonged QT interval
D. Shortened QT interval

54. 40/M diagnosed with lung cancer

Underwent Chest CT with IV contrast.
Baseline creatinine prior to introduction of
IV contrast was 100 mmol/L. Repeat serum
Creatinine determination was 215 mmol/L
After 24 hours. What was the best intervention
that could have prevented this from occurring?
A. Hydration with saline solution
B. N-acetylcsteine
C. IV Sodium Bicarbonate
D. Use of iodinated contrast material
55. Condition characterized by hematuria,thinning and
splitting of the GBMs, mild proteinuria, chronic
glomerulosclerosis leading to rental failure and
sensorineutral deafness
A. Anti-GBM disease
B. Alports Syndrome
C. Thin Basement Membrane disease
D. Nail-Patella Syndrome
56. Most common acute complication of hemodialysis
particularly among diabetic
Patients
A.
B.
C.
D.

Infection
Muscle cramps
Bleeding
Hypotension

Cushings Syndrome usual SSx:

Rapid weight gain
Central obesity
Buffalo hump
Moon facies
Hyperhidrosis
Telangiectasia
Thinning of skin and mucous mems
Purple or red striae
Hirsutism
Baldness
Clinical Features More Specific to Cushings Syndrome
Fragility of the skin, with easy bruising and broad
(>1cm)
Purplish striae
Proximal myopathy
** If ectopic ACTH production, hyperpigmentation of the
knuckles, scars or skin areas exposed to increased friction
is seen
Dont Confused with the ff:
Cushings triad (for Increased ICP)is a clinical
triad variably defined as having:
o Irregular respirations (caused by
impaired brainstem function)
o Bradycardia
o Hypertension

57. Most common type of renal stones

A. Calcium stomes
B. Uric acid stones
C. Cystine stones
D. Struvite stones
58. A 22 year old female sought consult at theoutpatient department for an enlarging anterior neck
masses noted 3 years ago. This was accompanied by
heat intolerance,palpitation,tremors. On physical
examination there was no exophthalmos, perlorbetal
edema, hyperreflexia, enlarged anteriror neck mass
that moves with deglutition and absence of cervical
lymphadenopathy andtachycardic with and
irregularly irregular rhythm. What is the expected
finding for this patient on nuclear imaging?
A. Focal areas of increased uptake
B. Homogenous gland with decreased
Uptake
C. Increased tracer uptake distribute
Homogenously
D. Normal
59.
Which of the following correct regarding
radioactive iodine (RAI) therapy?
A. Propylthiouracil should be stopped 2 days
before RAI treatment
B. Lactating women may receive RAI treatment
with caution
C. .RAI may be given to selected patients with
thyroid storm
D. Antithyroid drugs should be given to
elderly and those with cardiac diseases
before RAI treatment
60. Which of the following clinical features seen in
Cushings syndrome are considered more specific and
more useful in its diagnosis?
A. Facial plethora
B. Thin, silvery striae
C. Distal myopathy
D. Easy bruisability

Cushings Disease
o is a cause of Cushing's syndrome
characterised by increased secretion of
adrenocorticotropic hormone (ACTH)
from the anterior pituitary (secondary
hypercortisolism)
o Same SSx as Cushings Syndrome

61. Which of the following is appropriate precaution

regarding exercise in patients with Type 1 diabetes
A. Perform formal exercise testing in
Patients with autonomic neuropathy
B. Cancel the activity if blood glucose
is less than 100 mg/dl prior to exercise
C. Avoid vigorous exercise if there is
untreated nonproliferative DM
retinopathy
D. Inject insulin into exercising muscle
If blood glucose is more than 300
mg/dl
62.

Which of the following is appropriate in the

comprehensive management and follow-up of a
patient with diabetes?
a. Screening for diabetes at the time of
diagnosis
b. Annual monitoring of blood pressure
c. Lipid profile and creatinine quarterly
d. Eye and foot examination by doctors
annually

63. What is the earliest symptom of pituitary failure

(trophic hoemone failure) amongadults?
A. Hypogonadism
B. Growth retardation
C. Hyperprolactinemia
D. Headache
64. Most sensitive hormonal test for
phaeochromocytoma and paragangliomas, that is
also considered to be less susceptible to falsepositive elevations from stress
a. Plasma metanephrine
b. Urine vanillylmandelic acid
c. Urine catecholamines
d. Plasma catecholamines

65. This agent for dyslipidermia may increase insulin

resistance and worsen glycemic control at high
doses
a. Simvastatin
b. Nicotinic acid
c. Gemilbrozil
d. Fenofibrate
66.Which of the following represents definite risk from
hormone replacement therapy for menopause?
A. Colorectal cancer
B. Coronary heart disease
C. Endometrial cancer
D. Ovarian cancer
Hormone Replacement Therapy
Definite Risks
Endometrial Cancer
Venous thromboembolism
Gallbladder disease
Breast Cancer
Definite Benefits
Symptoms of menopause
Osteoporosis
Uncertain Risks and
Coronary heart Dse Stroke
Benefits
Ovarian Cancer
Colorectal Cancer
Diabetes Mellitus
Cognitive function
67.A 50 year old patient came for consult for progressive
generalized body weakness.Laboratory examination
revealed anemia and hypercalcemia and the presence of a
Pulmonary mass on chest x-ray. Which of the following
will be appropriate differential/s for the case?
A. Squamous cell Lung cancer
B. Small cell Lung cancer
C. Pulmonary tuberculosis
D. All of the above
68.After one week, patient complained of
dyspnea, facial swelling, hoarseness, difficulty of
breathing. On physical examination, there was
dilated neck vein, increased clateral veins over
the anterior chest and edema of the face and
arms. What is the treatment of choice for his
condition?
A. Intravenous diuretics
B. Intravenous glucocorticids
C. Emergent radiotherapy
D. Emergent surgery and decompression
**These are SSx of SVC syndrome among patients with
Chest mass especially pulmonary masses.
69. Which of the following suggests a better prognosis for
patients with breast cancer?
A. Estrogen/progesterone receptor
Positivity
B. High proportion of cells in S-phase
C. Overexpression of HER2-neu gene
D. Hypernucleated cells
70. Which drug is monoclonal antibody againstHer2/neu
and and is being used in treatment of breast and gastric
carcinoma?
A. Cyclophosphamide
B. Trastuzumab
C. Rituximab
D. Imatinib mesylate

71 A 45 year old female was brought to theemergency

room because of dizziness. On further inquiry, there was
note of menorrhagia for the past 4 months. Oncomplete
blood count, hemoglobin was 70g/L, hemotocrit was
0.25; the MCVand MCH were low, rest of CBC were
normal. What is the most appropriate form
of treatment to correct her anemia?
A. Blood transfusion
B. Folic acid tablets
C. Intravenous iron
D. Intravenous Vitamin B12
72. Hans is a 29 year old who came to the clinic
because he passed out blood instead of urine. On
further investigation, you note anemia both on
physical examination and complete blood count,
increased reticulocyte count and LDH levels,
hemoglobinuria on urinalysis and normal KUB
ultrasound. Bone marrow aspirate microscopy
reveals erythroid hyperplasia. Which of the
following lab results will confirmthe diagnosis in
this case?
A. Decreased bone marrow iron stain
B. Undetectable haptoglobulin
C. CD 55 and CD 59 cells
D. Fetal hemoglobin pattern
73. A 20 year old female presents with pallor,
jaundice and icteric sclerae. Hemoglobin 55g/L,
hematocrit 17%, RBC 2.5 x 1012, reticulocytes
increased indirect hyperbilirubinemia, positive
direct Coombs test. Peropheral smear shoes
many spherocytes. Polychromatophilic
macrocytes and nucleated red cells. What is your
diagnosis?
a. Iron deficiency anemia
b. Aplastic anemia
c. Megaloblastic anemia
d. Autolmmune hemolytic anemia
74. During your duty in the ER, a patient was
referred to you for dyspnea. She is a 40 year
old female who was diagnosed with mitral
stenosis previously stable on low dose
Digoxin. She has a history of fever, malaise
And more frequent bowel movement in the
Past 2 days. On PE she was agitated, BP
70/40 110 RR24 Temp 39; mucosa was
dry neck veins were flat however breath
sounds were clear, heart sounds were
distinct but irregularly irregular, abdomen
was soft.
A. Hydrate the patient with lactated
Ringers
B. Start low dose dopamine drip
C. Start dobutamine drip.
D. Do immediate DC cardioversion at
200J
75. You are making rounds with your OB
Consultant. In front of you is a 35week AOG
pregnant patient that has been having elevated
blood pressure since 2 days ago. Right in front of
you, the patient had a seizure. Blood pressure
was taken and BP = 200/110mmHg. What do
you do?
a.

Give Captopril 25mg tab sublingual

Stat every 15 minutes

b. Give magnesium sulfate

c. Hook the patient to Nicardipine drip
d. Load with Phenytoin IV

76. 60 year old male suddenly had dizziness and

diaphoresis. BP id 60/40mmHg with cold
clammy extremities. ECG shows the following.
What do you do?
a. Give IV Streptokinase
b. Give Verapamil 5mgIV STAT
c. Provide synchronized electrical c
Cardioversion
d.

Start CPR

77. A 59 year old male was brought in for

drowsiness. Serum calcium was significantly
elevated. A malignancy is suspected as an
etiliology for the hypercalcemia. Which of the
following will you NOT be able to use for this
patient?
a. Intravenous furosemide
b. Intravenous saline
c. Pamidronate
d. Calcitonin
78. A 65 year old patient, known hypertensive but
poorly compliant to medications, came in for
altered mental status severe headache. Blood
pressure taken on admission was
260/100mmHg. Management would include:
A. Give captopril 25mg sublingually for
B. three doses. If there is poor response,
startnicardipine drip
B. Start nicardipine drip immediately
C. Give captopril 25mg every 8 hours per
orem
D. Observe for 1 hour. If symptoms resolve,
discharge on short acting antiihypeersentives.
79. A 60 year old male sought consult for right
knee joint pain which started 1 year ago. Now he
presents with right knee tenderness and effusin since
4 days ago and he also complains of fever
38.0C. You decided to perform arthrocentesis.
Synovial fluid analysis shows 30,000 cells/uL with
70% neutrophils. Positive for rod shaped strongly
negative birefringent crystals.
What is your diagnosis?
A.
B.
C.
D.

CPPD disease
Gouty asthritis
Osteoarthritis
Septic arthritis

80. Which of the following characteristrics

symptoms will favor the diagnosis of rheumatoid
arthritis?
a. Migratory polyarthritis
b. Morning stiffness of 10 minutes
c. Symmettric involvement
d. Subacute monoarticular arthritis
81. Diagnostic test specific for rheumatoid arthritis
And useful in predicting its prognosis
A.
B.
C.
D.

Rheumatoid Factor
ESR
Anti-CCp antibodies
CRP

82. Which of the following is an inhibitor of inosine

Monophosphate and purine synthesis used in the
Treatment of SLE?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate mofetil
D. Allopurinol
83. Autoantibody seen more frequently in drug-induced
lupus than in SLE
A. Cyclophosphamide
B. Methotrxate
C. Mycophenolate mofetil
D. Allopurinol
84. Two weeks after starting allopurinol in your patient
with gout, the patient noted development of blisters over
8% of the body with note of oral ulcers and associated
diarrhea. Whats is your impression?
A. Toxic Epidermal Necrolysis
B. Stevens Johnsons Syndrome
C. Staphylococcal Scalded Skin
D. Bullous Pemphigoid
85.Nina came to your clinic due to a possible cellulitis.
She mentioned that she experienced wheals, chest pain
and difficulty of breathing shortly after taking
Amoxicillin. Which of the following antibiotics may still
be given safely?
A. Piperacillin-tazobactam
B. Cefuroxime
C. Clindamycin
D. Co-amoxyclav
Adverse drug reactions to Amoxicillin
The answer is Clindamycin because:
There is a cross-reaction between
cephalosporins and penicillins
7-aminocephalospuranic acid closely resembles
6-aminopenicillinic acid
o these both target cell wall of bacteria
completely structurally unrelated drugs but can
be used if the one of them has allergic reactions
to the patient.
86. Most frequently associated with the transfusion of
cellular blood components
A. Febrile nonhemolytic transfusion
reaction
B. Graft versus host disease
C. Transfusion related acute lung injury
D. Hepatitis c infection
87.Which of the following patients will you dignose
with Anaphylaxis?
A. 45/F with maculpapular rashes 3
weeks after starting Alliopurinol
B. 50/M feels light-headed with rashes
After taking Co-amoxyclav BP is 60/40
C. 18/M with hives within minutes after
After eating crabs
D. 28/F OR nurse with rashes on her hands
usually noted after her duty
**Anaphylaxis
rapid onset = HALLMARK!
Hypotension
Systemic manifestation (cutaneous, GIT,
mucosal etc)

88. Which of the following diseases is the most likely

diagnosis for these spinal tap findings:
High leukocyte count (up to 1000/L).
With a predominance of lymphocytes a protein
content of 1-8g/L (100-800mg/): and a low
glucose concentration
A. Herpes simplex encephalitis
B. Tuberculous meningitis
C. Streptococcal meningitis
D. Gonococcal meningitis
**Spinal tap
used in CNS infections
Parameters
Opening
pressure
Leukocytosis

Glucose

Bacterial
Meningitis
Increased
(>180mmHg)
Present with
Neutros predo.
(10000/uL)

TB Meningitis
Not increased
Present first is
neutro then
lymphocytes
increase
Very low to none

<40 mg/dL;
CSF gluc <0.4
Protein
>45 mg/dL
Very high
Culture
Gram Stain
AFB culture
**TB Men = Cryptococcal Men
Pathognomonic sign = very low to no glucose
**S. Pneumoniae = most common pathogen in BacMen
89.What is the most common cause ofsubarachnoid
Hemorrhage
A.
B.
C.
D.

Bleeding from an AV malformation

Ruptutre of a saccular aneurysm
Head trauma
Hemiplegia

**Most common cause of subarachnoid hemorrhage

Rupture of Saccular Aneurysm
How? HEAD TRAUMA.
** HALLMARK: Blood in CSF so do a plain CT within 72
hours.
90. In a rabies endemic area like the Philippines, the
diagnosis of Rabies must be considered even without
symptoms of hydrophobia and aerophobia with:
A. Aseptic meningitis
B. Dumb paralysis with fever
C. Incresed intracranial pressure
D. Hemiplegia
**Diagnosis of Rabies
Transmission: Bite
Incubation: 20-90 days
Prodrome: 2-10 days: constitutional symptoms:
o paresthesia,
o pain and
o pruritus in wound site
80% encephalitic: 2-7 days:
o anxiety
o agitation
o hyperactivity
o bizarre behavior
o hallucinations
o autonomic dysfunction
o hydrophobia
o aerophobia
20% paralytic 2-10 days:
o Flaccid paralysis on limbs (bitten area)
o Quadriparesis
o Facial paralysis
Coma then death 0-14 days if left UNTREATED.

91. Kernig sign is performed and elicited by:

A. Patient in supine position thigh, flexed,
knee extended. Pain during passive
extension of the knee
B. Patient in supine position, thigh flexed, knee
extended. Pain during passive flexion of the knee
C. Patient in supine position passive fexion of the
neckresults in spontaneous extension of the hips
and knees
D. Patient in supine position passive extension of
the neckresults in spontaneous extensionof the
hips and knees
**Kernig Sign
Knee flexed pain (head jerk)
** Brudzinskis Sign
Batok flex lower limb pain
92. A 55 year old male, previously diagnosed with a
glioblastoma multiforme came in for decreased
sensorium, imaging revealed perilesional edema. What is
the appropriate treatment?
A. Furosemide
B. Hypertonic saline
C. Hydrocortisone
D. Dexamethasone
** Glioblastoma multiforme
Most common and most aggressive malignant
primary brain tumor
** Cerebral Edema
Vasogenic edema BBB disruption, Inc vascular
permeability
Cytotoxic edema Inc in ICF due to neuronal,
glial and endothelial cell membrane injury
(ex. Tumors)
Generalized edema both Vaso and Cyto
Interstitial edema Inc. Intravascular pressure
o has abnormal flow of fluid from
intraventricular CSF across the
ependymal injury to periventricular
white matter
** DOC:
Dexamethasone (Cytotoxic edema from
TUMORS)
Mannitol (sugar alcohol) aka Osmotherapy
(for Interstitial and Vasogenic edema)
o To decrease re-absorption of water and
sodium
o To decrease ECF
93. What feature would favor seizures over syncope?
A. No precipitating factor
B. Duration of unconsciousness: seconds
C. Less than 15 seconds duration of tonic
movements
D. Duration of diorientation after the even: less than
5 minutes
Syncope vs Seizure
Syncope
Seizure
Less common
Typically with
myoclonus
myoclonic jerks
Shorter loss of
Loss of
consciousness
consciousness > 5
minutes
Less muscle aches
post-attack
Post-ictal
confusion
Can have urinary
incontinece
Rarely preceded
by emotion or pain
Autonomic
manifestations
Urinary and fecal
incontinence
Usually preceded
by emotion or pain
Autonomic
manifestations

94. A 45 year old male sought consult at OPD because of

multiple sharply demarcated, erythematous plaques with
scaling located predominantly in the elbows and knees as
well as occasional shoulder and knee pains. What is your
diagnosis?
A. Lichen planus
B. Pityriasis rosea
C. Psoriasis
D. Tinea versicolor
**Psoriasis
Multiple sharply demarcated erythematous
plaques with scaling = CLASSIC CHARS.
Locations
o Elbows
o Knees
o Navel lesions
o Shoulders + knee pain

96. True regarding Type Lepra reaction or ENL?

A. The most dramatic manifestation is footdrop
B. Edema is the most characteristic microscopic
feature
C. Fever is not common
D. Other symptoms include neuritis,
lymphadenitis, uveitis, orchitis, and
glomerulonephritis
Lepra Reactions
Type 1

95. Which primary skin lesions is correctly paired with its

description?
A. Macule: Flat, colored lesion, <2cm in diameter,
raised above the surface of the surrounding skin
B. Tumor: >5m firm lesion raised above the
surface of the surrounding skin
C. Plaque: >1cm, flat-topped, raised lesionwith edes
that are always distinctly demarcated
D. Vesucle: small, fluid-filled lesion, >0.5cm in
diameter, raised above the plane of surrounding
skin.
Primary Skin Lesions:
Macule
Flat, colored lesions, < 2c in diameter
Tumor
> 5cm, firm lesion raised above the
surface of surrounding skin
Plaque
>1cm, flat-topped raised lesion with
edges that are sometimes distinctly
demarcated.
Vesicles Small, fluid-filled lesion, <0.5cm raised
above the plane of surrounding skin
Bullae
Bigger than a vesicle >0.5cm

Occurs in
borderline forms
of leprosy
Classic signs of
Inflammation
within previously
involved macules,
papules and
plaques
Most Dramatic
manifestation
isFOOTDROP
EDEMA is the
most
characteristic
microscopic
feature

Type 2 or Erythema
Nodosum Leprosum (new
lesions)
Lepromatous end
of the leprosy
spectrum
Crops of painful
erythematous
papules that
resolve
spontaneously in a
few days
With systemic
manifestations:
Profound fever,
neuritis,
lymphadenitis,
uveitis, orchitis
and
glomerulonephriti
s
Skin biopsy of ENL
papules reveals
vasculitis or
panniculitis
Anemia,
leukocytosis and
abnormal liver
function tests

97. This test is performed on scaling skin lesions when a

fungal infection is suspected
A. Tzanck smear
B. Diascopy
C. KOH preparation
D. Patch testing
Tzanck test is for Herpes dermal infection
Diascopy is a test for blanchability performed by
applying pressure with a finger or glass slide and
observing color changes.
It is used to determine whether a lesion is
vascular (inflammatory), nonvascular (nevus), or
hemorrhagic (petechia or purpura).
Hemorrhagic lesions and nonvascular lesions do
not blanch; inflammatory lesions do.
Diascopy is sometimes used to identify sarcoid
skin lesions, which, when tested, turn an apple
jelly color.
Patch Test is a method used to determine whether a
specific substance causes allergic inflammation of a
patient's skin. Any individual suspected of having allergic
contact dermatitis and/or atopic dermatitis needs patch
testing.

98. Am exa,[;e pf a category A bioterrorist agent

A. E. coli 0157:H7
B. Extremely-drug resistant (XDR) M. tuberculosis
C. SARS coronavirus
D. Variola major
Micro Bioterrorism
A Anthrax, Botulism, Plague, Smallpox and
Tularemia
Arenaviruses: Lassa, New World (Machupo, Junin,
Guanarito, and Sabia)
Bunyaviridae: Crimean-Congo, Rift Valley
Filoviridae: Ebola, Marburg
B Brucellosis
Epsilon toxin of Clostridium perfringens,
Glanders Melioidosis
Psittacosis Q fever
Ricin toxin from Ricinus communis Typhus
Fever
Staphylococcal entertoxin B; Viral Enceph
Water safety threats (Vibrio cholerae,
Cryptosporidium parvum)
Food safety threats (Salmonella spp. Escherichia coli
0157:H7, Shigella toxin)
C Emerging infectious diseases threats such as Nipah,
hantavirus, SARS coronavirus and pandemic
influenza.
99. Best preventive measure for high altitude pulmonary
edema
A. Acetazolamide
B. Nifedipine
C. Limitation of fluid intake prior to ascent
D. Gradual ascent
100. Mrs. C is a 48 y/o female who consulted you a few
years back for dyspepsia. She comes to your clinic now
with easy fatigability, weakness, incoordination and
memory disturbances. She claims she cannot tolerate
eating withough taking antacids. Physical and neurologic
exams are unremarkable. Among the labs you ordered,
only her CBC is abnormal showing red blood cells with
high MCV and high MCH. Which of the following
nutrients is she most likely deficient with?
A. Iron
B. Folate
C. Cyanocobalamin
D. Vitamin D
101. Cause of normal anion gap metabolic acidosis:
A. Diarrhea
B. Alcoholic Ketoacidosis
C. Uremia
D. Salicylate ingestion
**Urine Anion Gap = Na +K Cl
RTA
Type 1
Type 2
Distal tubule
Proximal tubule
Decrease K
Decrease K
Failure of acid
FANCONI
secretion by
syndrome
alpha
(osteomalacia)
intercalated cells
of cortical
**ricketts due to
collecting duct of wasting
distal nephron
Metabolic
acidosis
Hypoalbunemia
Hypocalcemia
Hyperchloremia
Nephrocalcinosis

Type 3
Adrenals
Increase K

High Anion Gap Metabolic Acidosis

Lactic acidosis
Ketoacidosis
Ingestion of alcohol INH methanol ethylene
glycol
Renal Failure
Massive rhabdomyolysis
102. Which of the following is a risk factor for stroke in a
patient with atrial fibrillation? (HPIM p1428 table 226-1)
A.
B.
C.
D.

Age more than 65 years old

Mitral regurgitation
Diabetes Mellitus
Marked right atrial enlargement

**Risk Factors for stroke in a patient with atrial

fibrillation
History of CVA or TIA
Mitral stenosis
Hypertension
DM
> 75 years old
CHF
Left Ventricular dysfunction
Marked Left atrial enlargements > 5.0
Spontaneous echo contrast
103. True of Manifestations of Myxomas
A. Most appear singly
B. Most are pedunculated on a fibrovascular
stalk
C. Most are located in the left atrium
D. They have characteristic tumor plop
appreciated during diastole
** ALL OF THE CHOICES are CORRECT!!!!!!!
104. Which of the following medications should not be
started in patients with hyperkalemia?
A. Carvedilol
B. Dobutamine
C. Captopril
D. Furosemide
** Drugs that cause HYPERKALEMIA
ACE I and ARBs
K-sparing diuretics (amiloride and
spironolactone)
NSAIDs
Tacrolimus
Timetoprim, Pentamide
105. For angina, nitrates may be administered.
Nitroglycerin is most commonly administered
sublingually in what dose?
A. 5mg
B. 10mg
C. 0.4mg
D. 4mg
106. A 19 year old female comes in for dyspnea. As a
child, she had cyanosis, selectively involving the toes only
(but not the fingers). She was said to have a defect in her
heart, but was lost to follow up. On auscultation, you
should expect:
A. A fixed splitting of S2(ASD L to R shunt)
B. A holocystolic murmur(Mitral Regurgitation,
Pulmonic Stenosis)
C. A continuous machinery murmur
D. Early diastolic murmur(MR, MVP)

107. The most common congenital heart valve defect is:

A. Pulmonic stenosis
B. Mitral stenosis
C. Bicuspid aortic valve
D. Mitral regurgitation
108. A 40 years old female came in for dyspnea. Blood
pressure on admission was 120/20 mmHg. Auscultation
revealed a high-pitched, blowing, decrescendo diastolic
murmur at the right sternal border. You also noted
capillary pulsations (alternate flushing and paling of the
skin) at the root of the nail while pressure is applied to
the tip of the nail. This is called?
A. Corrigans pulse
B. Quinckes pulse
C. Traubes sign
D. Duroziezs sign

Large-volume, 'collapsing' pulse also known

as:
o Watson's water hammer pulse
o Corrigan's pulse - rapid upstroke and
collapse of the carotid artery pulse
Low diastolic and increased pulse pressure
de Musset's sign - head nodding in time with the
heart beat
Quincke's sign-pulsation of the capillary bed in
the nail
Traube's sign - a 'pistol shot' systolic sound
heard over the femoral artery
Duroziez's sign - systolic and diastolic murmurs
heard over the femoral artery when it is
gradually compressed with the stethoscope

109. A 35 years old male comes in for dyspnea and

orthopnea. On examination, he had a heart rate of 110
with an irregularly irregular rhythm. An opening snap,
followed by a diastolic rumble was audible on
auscultation. You requested a chest x-ray and expect to
find:
A. Widening of the carinal angle
B. Left ventricular enlargement
C. Tubular heart with a widened mediatinum
D. Paucity of pulmonary vasculature
** SSx pertains to Mitral stenosis
110. Most common parasitic cause of cardiomyopathy is
Chagas disease. What is the etiology?
A. Trypanosoma cruzi transmitted by the
reduviid bug
B. Trypanosoma brucei transmitted by the Tsetse
fly
C. Toxoplasmosis transmitted by cysts
D. Trichinella spiralis caused by ingestion of larva of
undercooked meat
111. A 35 years old male came in for dyspnea. He had a
blood pressure of 60/40 mmHg with muffled heart
sounds and distended neck veins. Your acute
management is:
A. Immediately start intropic support
B. Place in Trendelenberg position and observe
C. Give Furosemide 40 mg IV stat bolus
D. Do 2D Echo-guided pericardiocentesis
112. Most out of the hospital deaths from STEMI is due
to:
A. Heart Failure
B. Ventricular fibrillation
C. Premature ventricular contractions
D. Pulmonary edema

113. A 22 years old male will be working abroad as a

construction worker in Dubai. This patient came in tor
your clinic for clearance. He is asymptomatic. On PE, you
noted grade II/IV midsystolic murmur at the apex. Chest
X-ray and ECG were normal. What would be your next
step?
A. Reassure and clear him for work, no further
tests
B. Dela giving of clearance and schedule for 2D
Echocardiography
C. Refer to cardiologist for clearance
D. Admit for further work-up: Holter monitoring,
cardiac enzymes and possible coronary
angiography
** Only the DIASTOLIC murmur is pathologic!
114. What is a relative contraindication of thrombolysis
in ST-segment elevation myocardial infarction?
A. History of Cerebrovascular hemorrhage
B. Suspicion of aortic dissection
C. Active internal bleeding
D. Pregnancy
115. Presents as refractory hypertension, mostly
asymptomatic but infrequently may have paresthesias,
polyuria, or muscle weakness secondary to
hypokalemic alkalosis.
A. Cushings syndrome
B. Phaeochromocytoma
C. Primary aldosteronism
D. Aortic coarctation
116. Abdominal aortic aneurysm repair is indicated for
asymptomatic patients if the diameter is:
A. > 4.5 cm
B. > 5.5 cm
C. > 6.0 cm
D. > 7.0 cm
117. Which of the following physical examination
findings, if present in COPD suggest advanced disease?
A. Barrel chest
B. Temporal wasting
C. Clubbing of the digits
D. Cyanosis
118. The standard monotherapy for lung abscess
A. Ceftriaxone
B. Metronidazole
C. Clindamycin
D. Ampicillin-Sulbactam
119. Which of the following points to an exacerbation in a
patient with established COPD?
A. Exertional dyspnea
B. Increased dyspnea
C. Presence of airflow obstruction
D. Resting hypoxemia
120. The following are true regarding non-imaging tests
in diagnosisng pulmonary embolism EXCEPT:
A. The D-dimer is a useful rule in test
B. The D-dimer has a limited role in hospitalized
patients
C. Arterial blood gas lacks diagnostic utility for
pulmonary embolism
D. Elevated cardia biomarkers predict an increased
mortality from pulmonary embolism
121. When after initiation of adequate therapy in
pneumonia, when do you expect fever to resolve?
A. 24 hours
B. 36 hours
C. 48 hours
D. 72 hours

122. Among COPD patients, supplemental oxygen should

be provided to maintain arterial oxygen saturation at
what level?
A. 80%
B. 85%
C. 90%
D. 95%

129. Type of emphysema usually observed in patients

with alpha1-antitrypsin deficiency, which has
predilection for the lower lobes:
A. Centriacinar emphysema
B. Peripheral emphysema
C. Lobar emphysema
D. Panacinar emphysema

123. Occupational lung disease characterized by the

characteristic HRCT pattern known as crazy paving
A. Chronic beryllium disease
B. Coal workers pneumoconiosis
C. Asbestosis
D. Silicosis

** Types of Ephysema:

124. What is the most common cause of repiratory

hypoxia, which is usually correctable by inspiring 100%
oxygen?
A. Hypoventilation
B. Intrapulmonary right to left shunting
C. Pulmonary atelectasis
D. Ventilation perfusion mismatch
125. Which among the following is an example of
obstructive lung disease?
A. Bronchiectasis
B. Asbestosis
C. Pulmonary fibrosis
D. Gullain-Barre syndrome
Obstructive Lung

Restrictive Lung Diseases

Diseases
Chronic obstructive
pulmonary disease
(COPD), which
includes
emphysema and
chronic bronchitis
Asthma
Bronchiectasis
Cystic fibrosis.

Interstitial lung disease,

such as idiopathic
pulmonary fibrosis
Sarcoidosis, an
autoimmune disease
Obesity, including obesity
hypoventilation syndrome
Scoliosis
Neuromuscular disease,
such as muscular
dystrophy or amyotrophic
lateral sclerosis (ALS)

126. An asthmatic patient was given ipratropium

bromide for rescue medication. What is its most common
side effect?
A. Tachycardia or palpitations
B. Tremors
C. Dry mouth
D. Urinary retention
127. What is the most common cancer associated with
asbestos exposure?
A. Lung cancer
B. Mesothelioma
C. Tumors of the pericardium
D. Laryngeal carcinoma
128. A 60 years old male presented with cough and
dyspnea of three days duration. You requested for a
sputum gram stain and culture. An adequate sputum
sample has:
A. Presence of organisms
B. Presence of >25 neutrophils
C. Presence of >25 squamous cells
D. Presence of >25 white blood cells

Centriacinar emphysema begins in the

respiratory bronchioles and spreads
peripherally. Also termed centrilobular
emphysema, this form is associated with longstanding cigarette smoking and predominantly
involves the upper half of the lungs.

Panacinar emphysema destroys the entire

alveolus uniformly and is predominant in the
lower half of the lungs. Panacinar emphysema
generally is observed in patients with
homozygous alpha1-antitrypsin (AAT)
deficiency. In people who smoke, focal panacinar
emphysema at the lung bases may accompany
centriacinar emphysema.

Paraseptal emphysema, also known as distal

acinar emphysema, preferentially involves the
distal airway structures, alveolar ducts, and
alveolar sacs. The process is localized around the
septae of the lungs or pleura. Although airflow
frequently is preserved, the apical bullae may
lead to spontaneous pneumothorax. Giant bullae
occasionally cause severe compression of
adjacent lung tissue

130. During the natural course of ARDS, which phase do

we expect clinical recovery wherein patients are usually
liberated from mechanical ventilation?
A. Proliferative phase
B. Fibrtoic phase
C. Recovery phase
D. Exudative phase
**Phases of ARDS
Exudative

Proliferative

Fibrotic

Alveolar Edema
Neutrophil-rich
leukocytosis
Subsequent formation of
hyaline membranes from
diffuse alveolar damage
7 days after Exudative
stage
Prominent interstitial
inflammation
Early fibrotic changes
Substantial fibrosis
Bullae formation
Recovery stage

131. Chest radiograph finding specifically indicating past

exposure to asbestos and not pulmonary impairment:
A. Pleural plaque
B. Pleural Effusion
C. Pleural fibrosis
D. Pleural mesothelioma
132. A 30 year old male comes in for dyspnea.
Examination on the right basal lung field revealed:
dullness on percussion, increased fremitus and crackles.
Your diagnosis is probably:
A. Asthma
B. Pneumothorax
C. Pleural effusion
D. Consolidation / pneumonia
**See Figure 6 in attached paper

133. The following cause of ARDS is due to a direct lung

injury:
A. Sepsis
B. Chest trauma
C. Near drowning
D. Multiple blood transfusion

139. Most common mode of transmission of HIV in

developing countries such as the Philippines:
A. Perinatal transfer
B. Homosexual transmission
C. Heterosexual transmission
D. Contaminated IV drug paraphernalia

**Direct Lung Injury

Pneumonia
Aspiration of gastric contents
Pulmonary contusion
Near drowning
Toxic inhalation injury

140. The heart valve most commonly affected with

infective endocardidtis among IV drug users is:
A. Mitral valve
B. Tricuspid valve
C. Pulmonic valve
D. Aortic valve

134. What is the prevailing mechanism for the

development of emphysema?
A. Dutch hypothesis
B. British hypothesis
C. Hygiene hypotsesis
D. Elastase: Anti-elastase hypothesis

141. Most common clinical manifestation of Infective

Endocarditis:
A. Fever
B. Chills
C. Heart murmur
D. Janeway lesions

** Dutch / British hypothesis

provides one of several biologically plausible
explanations for the pathogenesis of chronic
obstructive pulmonary disease (COPD), a
progressive disease known to be aetiologically
linked to environmental insults such as tobacco
smoke

**SSx of IE:
Fever occurs in 97% of people; malaise and
endurance fatigue in 90% of people.
A new or changing heart murmur, weight loss,
and coughing occurs in 35% of people.
Vascular phenomena: septic embolism
(causing thromboembolic problems such as
stroke in the parietal lobe of the brain or
gangrene of fingers),
Janeway lesions (painless hemorrhagic
cutaneous lesions on the palms and soles),
intracranial hemorrhage,
conjunctival hemorrhage,
splinter hemorrhages,
renal infarcts, and
splenic infarcts.
Immunologic phenomena: Glomerulonephritis
which allows for blood and albumin to enter the
urine,
o Osler's nodes (painful subcutaneous
lesions in the distal fingers),
o Roth's spots on the retina,
o positive serum rheumatoid factor
Other signs may include; night sweats, rigors,
anemia, splenomegaly

** Hygiene hypothesis
allergen / germ theory
135. The CURB-65 criteria is used in pneumonia as a
severity of illness score. Which is INCORRECTLY paired?
A. C: Creatinine > 250
B. U: Urea > 7mmol/L
C. R: Respiratory rate > 30/ min
D. B: Blood pressure < 90/60
**CURB scoring:

Confusion of new onset (defined as an AMT of

8 or less)
Urea greater than 7 mmol/l (19 mg/dL)
Respiratory rate of 30 breaths per minute or
greater
Blood pressure less than 90 mmHg systolic or
diastolic blood pressure 60 mmHg or less
age 65 or older

136. What is the most common cause of hemoptysis

worldwide?
A. Pneumonia
B. Tuberculosis
C. Bronchogenic carcinoma
D. Upper respiratory tract infection
137. A 60 year old male was previously diagnosed with
tuberculosis but was never compliant to medications. He
presented with three month history of productive cough
and dyspnea. Chest x-ray revealed presence of tram
tracks. What is your diagnosis?
A. Asbestosis
B. Emphysema
C. Brochiectasis
D. Lung Abscess
138. A 45 year old female with an ovarian malignancy
comes in for dyspnea and hemoptysis. On examination,
she was tachycardic and tachpneic, but with stable blood
pressure. Her entire left lower extremity is swollen and
tender with erythema. To confirm your diagnosis you
would request for:
A. D-dimer
B. Pelvic CT scan
C. Chest CT scan
D. Venous duplex scan, lower extremity

Diagnosis of infective endocarditis can only be said to be

"possible" if only 1 major and 1 minor criteria are fulfilled
or if only 3 minor criteria are fulfilled.
Major criteria include:

Positive blood culture with typical IE

microorganism, defined as one of the following:
Typical microorganism consistent with IE from 2
separate blood cultures, as noted below:
o Viridans-group streptococci, or
o Streptococcus bovis including
nutritional variant strains, or
o HACEK group, or
o Staphylococcus aureus, or
o Community-acquired Enterococci, in the
absence of a primary focus
Microorganisms consistent with IE from
persistently positive blood cultures defined as:
o Two positive cultures of blood samples
drawn >12 hours apart, or
o All of 3 or a majority of 4 separate
cultures of blood (with first and last
sample drawn 1 hour apart)
o Coxiella burnetii detected by at least one
positive blood culture or antiphase I IgG
antibody titer >1:800

Evidence of endocardial involvement with positive

echocardiogram defined as
Oscillating intracardiac mass on valve or
supporting structures, in the path of regurgitant
jets, or on implanted material in the absence of
an alternative anatomic explanation, or
Abscess, or
New partial dehiscence of prosthetic valve or
new valvular regurgitation (worsening or
changing of preexisting murmur not sufficient)
Minor criteria include:

Predisposing factor: known cardiac lesion,

recreational drug injection
Fever >38C
Evidence of embolism: arterial emboli,
pulmonary infarcts, Janeway lesions, conjunctival
hemorrhage
Immunological problems: glomerulonephritis,
Osler's nodes
Positive blood culture (that doesn't meet a major
criterion) or serologic evidence of infection with
organism consistent with IE but not satisfying
major criterion

142. True about the diagnosis of Infective Endocarditis

(IE):
A. Diagnosis is based on the Jones Criteria
B. Organisms can often be cultured from blood
despite prior antibiotic therapy
C. Diagnosis of IE is rejected if fever and
symptoms resolve in less than 4 days of
therapy
D. Typical organism recovered in blood culture are
E. coli and S. viridans
143. Which sexually transmitted disease is associated
with gummas?
A. Syphilis
B. Human papilloma virus
C. HIV
D. Donovanosis
144. Pasteurella multocida is known to commonly infect
dog and cat bites. What is the antibiotic of choice for this
organism?
A. Cloxacillin
B. Penicillin G
C. Co-amoxiclav
D. Clindamycin
145. Remains the standard and recommended duration
of IV antibiotic therapy for osteomyelitis.
A. 2-4 weeks
B. 4-6 weeks
C. 8-12 weeks
D. 3-6 months
146. Antibiotics that may be used for only 3 days in acute
uncomplicated cystitis in women
A. TMP-SMX
B. Nitrofurantoin
C. Quinolones
D. All of the above
147. Dramatic but mild reaction consisting of fever, chills,
myalgias, tachycardia with mild hypotension noted after
initiation of antibiotic therapy for leptospirosis
A. Lucio reaction
B. Weils Syndrome
C. Nicolandi Branham Sign
D. Jarisch-Herheimer Reaction

** Lucio reaction
It is characterized by recurrent crops of large,
sharply demarcated, ulcerative lesions, affecting
mainly the lower extremities, but may generalise
and become fatal as a result of secondary
bacterial infection and sepsis.
** Weils Syndrome
Leptospirosis + Kidney failure, Jaundice and Lung
bleeding
** Nicolandi Branham Sign
the slowing of the heart rate in response to
(manual) compression of an arteriovenous
fistula.

148. Most important risk factor associated with the

development of perinephric abscesses
A. Diabetes mellitus
B. Prior urologic surgery
C. Chronic kidney disease
D. Nephrolithiasis with obstruction
149. Most commonly implicated organism/s in Primary
Bacterial Peritonitis:
A. Escherichia coli
B. Pseudomonas aeruginosa
C. Anaerobic bacteria
D. Mixed infection
**Primary Bacterial Peritonitis = E. coli
** Secondary Bacterial Peritonitis = Mixed Infection
150. Single most reliable laboratory parameter in liver
abscess
A. Increased AST and ALT
B. Increased alkaline phosphatase
C. Normocytic, normochromic anemia
D. Increased direct bilirubin
151. Most common extrapulmonary manifestation of
tuberculosis
A. TB meningitis
B. TB adenitis
C. Potts disease
D. Genitourinary TB
152. In which tuberculous infection are systemic steroids
like dexamethasone proven to positively influence
outcomes?
A. TB meningitis
B. Potts disease
C. Tuberculous pericardial effusion
D. Miliary TB
153. The single most important agent of Travelers
diarrhea
A. Enterotoxigenic E. coli
B. Salmonella typhi
C. Campylobacter jejuni
D. Rotavirus
154. Least common but the most severe of the
pneumonic complications of influenza.
A. Secondary bacterial pneumonia
B. Primary influenza viral pneumonia
C. Mixed viral and bacterial pneumonia
D. Chronic bronchitis with aspiration pneumonia
Secondary Bacterial pneumonia = Most common
complication of influenza

155. Which Plasmodium species has 72-hour duration of

erythrocytic stage, 15 day duration of intrahepatic phase
and prefernce for older red cells
A. P. vivax
B. P. ovale
C. P. malariae
D. P. falciparum
156. A 30 year old male comes in for agitation and
hydrophobia. On further probing, his relative recall a
history of dog bite 2 weeks prior. The most characteritic
pathologic finding in this disease is:
A. Nigiri body
B. Amyloid body
C. Babes nodules
D. Filamentous virion
157. Largest intestinal nematode parasite of humans,
reaching up to 40 cms in length
A. Trichuris trichiura
B. Ascaris lumbricoides
C. Strongyloides stercoralis
D. Enterobius vermicularis
158. A 30 year old commercial sex worker comes in for
recurrent whitish material on her tongue. She has had
weight loss, daily febrile episodes, and generalized
lymphadenopathies. To confirm your diagnosis, you will
request for:
A. ELISA(Screening for HIV)
B. RNA PCR
C. Western blot (Confirmatory test for HIV)
D. P24 antigen capture
159. Mainstay preferred diagnostic test for Leptospirosis
A. Culture assays
B. Serologic tests
C. PCR identification
D. Dark-field microscopy
160. Condition with increased susceptibility to
Salmonella infections
A. Alcoholism
B. Antacid ingestion
C. Age less than 5 years
D. Maternal colonization
161. Best diagnositic test for localized and generalized
tetanus infection
A. Wound culture
B. Tetanus toxin PCR
C. Clostridium IgM
D. None needed
162. Preferred antibiotic for tetanus infection
A. Ceftriaxone
B. Penicillin G
C. Clindamycin
D. Metronidazole
163. Infection predominantly transmitted by sexual
intercourse
A. Hepatitis C virus
B. Sarcoptes scabiae
C. Chlamydia trachomatis
D. Gardnerella vaginalis
164. Most common cause of acute epididymitis in
sexually active men less than 35 years old
A. Chlamydia trachomatis
B. Neisseria gonorrhea
C. Enterobacteriaceae
D. Herpes simplex virus type 2

165. Most common manifestation of infection with

Clostridium difficile
A. Fever
B. Diarrhea
C. Abdominal pain
D. Leucocytosis
166. What is the normal mean annual decline in
glomerular filtration rate with age in ml/min/body
surface area?
A. 0.5
B. 1.0
C. 1.5
D. 2.0
167. Which of the following suggest a chronic etiology for
the kidney disease?
A. Bilateral size of kidney on ultrasound 10 cm
B. Elevation of serum creatinine > 6 weeks
C. Osteitis fibrosa cystica
D. Presence of oliguria

** Chronic etiology for the Kidney Disease

Kidney size > 10 cm on UTZ
Elevation of Serum Creatinine > 6 months
Osteitis Fibrosa Cystica is present
Anemia is present
168. This diuretic reversible inhibit the resoption of NaK-Cl in the thick ascending limb of Henles loop?
A. Bumetanide
B. Thiazide
C. Metolazone
D. Spironolactone
**Bumetanide = loop diuretic which inhibits NKCCC
Na-K-Cl symporter in the thick ascending limb of
loop of Henle
** Metolazone, thiazide, spironolactone
dCT NaCl symporter
** Triamterene = K sparing
blocks epithelial sodium channel in the collecting
tubule
169. Which of the following diuretics can retain
potassium?
A. Furosemide
B. Chlorthalidone
C. Triamterene
D. Ethacrynic acid
170. The pentad of thrombotic thrombocytopenia
includes the following, EXCEPT:
A. Hemolytic anemia
B. Thrombocytopenia
C. Neurologic symptoms
D. Hepatic failure
171. Primary renal pathophysiologic lesion in acute
leptospirosis is injury of the:
A. Glomerulus
B. Ascending loop of henle
C. Descending loop of henle
D. Proximal convoluted tubule
172. Most common cause of nephritic syndrome in the
elderly
A. Minimal change disease
B. Memranous glomerulonephritis
C. Focal segmental glomerulocsclerosis
D. Membranoproliferative glomerulonephritis
173. Kimmelstiel-Wilson nodules are seen in:
A. Fabrys disease
B. Urate nephropathy
C. Diagbetic nephropathy
D. Analgesic nephropathy

174. First line of therapy for the management of

hypertension in CKD
A. Salt restriction
B. ACE inhibitors
C. Loop diurectics
D. Calcium channel blockers

181. Microadenomas differ from macroadenomas in size.

What is the cut off?
A. 5mm
B. 10mm
C. 15mm
D. 20mm

175. Diagnosis for thyroid biopsy revealing psammoma

bodies with Orphan Annie appearance
A. Anaplastic thyroid cancer
B. Follicular thyroid cancer
C. Papillary thyroid cancer
D. Thyroid lymphoma

182. A 35 year old female presents with amenorrhea,

infertility, and galactorrhea. Prolactin level was
significantly elevated at >200 g/L. An MRI revealed
findings suggestive of microadenoma. The mainstay of
therapy is:
A. Dopamine agonist
B. Surgical debulking
C. Transphenoid resection
D. Radiotherapy

176. A 55 year old diabetic female came in for decrease in

sensorium. CBG showed 780mg/dl, ABG done showed pH
of 7.32, HCO3 20 pO2 92 pCO2 30. On further inquiring,
she was poorly compliant to her medications and was
complaining of cough with yellowish sputum for 3 days,
vomiting abdominal pain for 1 day. There was glucosuria
and +1 ketonuria on urinalysis.
What is the most likely diagnosis?
A. Diabetic ketoacidosis
B. Hyperglycemic hyperosmoloar state
C. Cerebral infarct
D. Sepsis syndrome
**HHS Dx:
Plasma glucose level of 600 mg/dL or greater
Effective serum osmolality of 320 mOsm/kg or
greater
Profound dehydration, up to an average of 9L
Serum pH greater than 7.30
Bicarbonate concentration greater than 15
mEq/L
Small ketonuria and absent-to-low ketonemia
Some alteration in consciousness
** Diabetic ketoacidosis

177. What is appropriate initial resuscitation step?

A. Give insulin IV bolus with potassium
B. Hydrate with plain NSS
C. Order for STAT plain cranial CT
D. Start broad spectrum IV antibiotics
178. What BP level is considered hypertension in diabetic
patients?
A. >120/80
B. >125/75
C. >130/80
D. >140/90
179. Which of the following insulin preparation provide
basal insulin?
A. NPH insulin
B. Insulin aspart
C. Regular insulin
D. Insulin glargine
180. Diabetes medications that can cause hypoglycemia
even if used alone
A. Metformin
B. Alpha-glucosidase inhibitor
C. Thiazolidinediones
D. Sulfonylureas

183. A 20 year old male was found to have a parathyroid

adenoma, pituitary adenoma, and pancreatic tumor. This
familial pituitary syndrome is called:
A. MEN 1
B. MEN 2A
C. MEN 2B
D. MEN 3
**
MEN 1 Parathyroid tumors, Pancreatic tumors and
Pituitary tumors
MEN 2A Meduallary thyroid cancers,
Phaeochromocytoma and Parathyroid tumors
MEN 2B Medullary thyroid cancers,
Phaeochromocytoma and Neuroma
** MEN 3 no such thing!!!
184. A 46 year old female has a 3cm thyroid nodule at the
isthmus. Which feature is a risk factor for thyroid
carcinoma for this patient?
A. Age
B. Sex
C. Nodule size
D. Nodule location
185. A 35 year old female with palpitations has low TSH
and a normal FT4. Your next approach to management:
A. Treat as Graves disease with methimazole
B. Get an MRI to rule out a TSH secreting pituitary
adenoma
C. Treat as subclinical hyperthyroidism and
observe
D. Measure FT3 to rule out T3 toxicosis
186. A 28 year old prenant female was diagnosed with
Graves disease. You prefer propythiouracil for this
patient because:
A. Has better bioavailability during pregnancy
B. It has low transplacental transfer
C. It is more effective than methimazole in prenant
patients
D. Methimazole does not cross the placenta during
pregnancy
187. Screeing for diabetes mellitus is recommended for
all individuals who are:
A. > 25 years old
B. > 35 years old
C. > 45 years old
D. > 55 years old
188. Which of the following finding is consistent with
portal hypertension?
A. Hypoalbuminemia
B. Obliterated Traubes space
C. Spider angioma
D. AST:ALT ratio more than 2

189. What is the role of lactulose in patients with hepatic

encephalopathy?
A. Evacuate blood for the gastrointestinal tract
B. Inactivate colonic bacteria
C. Induce diarrhea
D. Promot colonic alkalanization
190. Associated with increased risk of peptic ulcer
disease:
A. Atopic disease
B. Nephrolithiases
C. Blood group A
D. Acute renal failure
191. Least common complication of pertic ulcer
A. Gastric outlet obstruction
B. Perforation
C. Bleeding
D. Gastritis
192. A 20 year old female comes in for abdominal pain
occurring 3 days per month in the last three months.
Associated symptoms include improvement of pain with
defecation and soft frequent stools. She most likely has:
A. Irritable bowel syndrome
B. Inflammatory bowel disease
C. Gastrointestinal tuberculosis
D. Intestinal parasitism
193. A 50 year old male, smoker, alcoholic drinker comes
in for sudden severe non-remitting abdominal pain.
Heart rate was noted to irregularly irregular. There was
only very minimal tenderness, our of proportion to the
symptoms. The gold standard of diagnosis is:
A. Radiograph showing bowel-wall edema
(thumbprinting)
B. Demonstation of pneumatosis intestinalis
C. Oral and IV dynamic CT scan
D. Laparotomy
194. Single most common risk factor for hepatitis C
A. HIV
B. Blood transfusion
C. Injection drug use
D. Risky sexual behavior
195. Best therapy for hepatorenal syndrome
A. Dialysis
B. Ocreotide
C. Midodrine
D. Liver transplant
196. Most common cause of rectal bleeding in infancy
A. Trauma
B. Anal fissure
C. Hemorrhoids
D. Imperforate anus
197. Best imaging study for initial evaluation of a
suspected pancreatic disorder and for the complications
of acute and chronic pancreatitis
A. CT
B. MRI
C. ERCP
D. Ultrasound
198. Leading cause of acute pancreatitis
A. Idiopathic
B. Alcoholism
C. Cholelithiases
D. Hypertriglyceridemia

199. Which of the following lab tests used in the diagnosis

of acute pancreatitis remain elevated for 7 to 14 days
after the initial bout?
A. Lipase
B. Calcium
C. Amylase
D. Hematocrit
200. Hallmark of anaphylaxis
A. Vascular collapse leading to hypotension
B. Urticarial eruptions which are intensely pruritic
C. Respiratory Distress from laryngeal edema
D. Rapid onset after introduction of antigen
201. Chronic Urticaria is define as attacks lasting more
than
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks
202. Key effector cell of the biologic reponse in allergic
rhinitis, urticarial, anaphylaxis and systemic mastocytosis
A. Mast cell
B. Basophil
C. Eosinophil
D. Dendritic cell
203. A 20 year old patient develops severe
maculopapular rashes all over after a bee sting.
Associated signs and symptoms include dyspnea,
wheezing, vomiting, and dizziness. Drug of choice is:
A. Diphenhydramine
B. Hydrocortisone
C. Norepinephrine
D. Epinephrine
204. Most common pulmonary manifestation of SLE
A. Pleuritis
B. Pneumonia
C. Pleural effusion
D. Pulmonary fibrosis
205. Salt and pepper appearance of the skin is seen in:
A. Systemic Lupus Erythematosus
B. Systemic Sclerosis
C. Ankylosing Spondylitis
D. Becets Syndrome
206. The pathergy test is used in the diagnosis of:
A. Henoch Schonlein purpura
B. Takayasu Arteritis
C. Behcets syndrome
D. Ankylosing spondylitis
207. Accounts for most non-gonococcal isolates in
infectious arthritis in adults of all ages
A. Staphylococcus aureus
B. Gram negative bacilli
C. B-hemolytic streptococci
D. Mycobacterium tuberculosis
208. Most common varity of psoriasis
A. Guttate
B. Pustular
C. Plaque-type
D. Inverse
209. Most common dermatophyte infection
A. Tinea corporis
B. Tinea cruris
C. Tinea capitis
D. Tinea pedis

210. this differentiates primary from secondary causes of

polycythemia
A. RBC mass
B. EPO levels
C. Arterial O2 saturation
D. Carboxyhemoglobin levels
211. Most convenient laboratory test to diagnose iron
deficiency anemia
A. TIBC
B. Serum iron
C. Serum Ferritin
D. Serum Transferrin
212. Thalassemia might favor a natural protection agains
which infection:
A. Malaria
B. Dengue Fever
C. Typhoid Fever
D. HIV
213. Mainstay of treatment for sickle cell anemia
A. Hydration
B. Hydroxyurea
C. Red Cell transfusion
D. Bone marrow transplant
214. Osmotic fragility test is used to diagnose:
A. G6PD deficiency
B. Sickle cell anemia
C. Hereditary spherocytosis
D. Paroxysmal nocturnal hemoglobinuria
215. Most common physical finding in Chronic
Myelogenous Leukemia:
A. Pallor
B. Petechiae
C. Lymphadenopathy
D. Splenomegaly
216. A 50 year old female diagnosed with leukemia
showed smudge or basket cells on perpheral blood
smear. Your diagnosis is:
A. Acute promyelocytic leukemia
B. Chronic lymphocytic leukemia
C. Acute lymphoblastic leukemia
D. Mantle cell lymphoma
217. Most rapidly progressive lymphoma
A. Diffuse large B-cell lymphoma
B. Burkitts lymphoma
C. Mantle cell lymphoma
D. Follicular lymphoma
218. Given with Cyclophophamide chemotherapy to
reduce the risk of bladder damage
A. N-acetylcysteine
B. Mesna
C. Acrolein
D. Leucovorin
219. Coadministered with 5-fllurouracil to enhance
cytotoxicity in the treatment of GI cancers
A. N-acetylcysteine
B. Mesna
C. Acrolein
D. Leucovorin

220. Hematologic malignancy associated with an

increased risk for Disseminated Intravascular
Coagulation
A. Chronic Myeloid Leukemia
B. Acute Promyelocytic Leukemia
C. Non-hodgkins Lymphoma
D. Multiple myeloma