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 P. 1658

2. 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. Repeat electrolyte measurement and observe

b. Attempt cardioversion
c. Administer intravenous calcium gluconate
d. Administer sodium polystyrene sulfonate (Kayexelate)

Answer: C P. 262

3. 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

4. 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 - decreased Na due to hemodilution,
c. Addison’s disease - no aldosterone, hypotensive
d. Severe vomiting and diarrhea

Answer: B p. 256

5. 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.
(only in rheumatic fever)
Answer: D p. 1680-1681

6. 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

7. 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

8. 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

9. 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 – adenoca
b. Gastroesophageal reflux disease
c. Candidal esophagitis
d. Herpes simplex esophagitis

10. 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

11. A 16-year-old male patient presenting with hepatitis syndrome has the following serologic exam findings:

1
 (+) 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
12. 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

13. 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

14. 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

15. This group of drugs reduce airway inflammation in bronchial asthma:

a. Catecholamines
b. Methylxanthines
c. Clucocorticoids
d. Anticholinergics

16. 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

17. 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

18. 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

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

20. Gold standard in the diagnosis of PTE:

a. ventilation-perfusion scan
b. pulmonary angiography
c. Helical/Spiral CT Scan
d. transesophageal echocardiography

21. One of the disorders below does NOT have vesicles or bulla as presenting lesions:
a. Impetigo
b. Chicken pox
c. Herpes Simplex
d. Psoriasis

22. 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

23. Grouped vesicles arranged in a segmental pattern over the right side of the trunk, T7-8 level:
a. Herpes Simplex

2
 b. Chicken pox
c. Verruca vulgaris
d. Herpes Zoster

24. 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

25. 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.
st
(1 week- blood, second – urine, third – stool (BUS)

26. 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

27. Drug of choice for Schistosomiasis:

a. Albendazole
b. Ivermectin
c. Diethylcarbamazine
d. Praziquantel

28. 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

29. 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

30. 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

31. Which of the following vaccines is especially indicated in a splenectomized patient:

a. pneumococcal
b. hepatitis B
c. tetanus
d. polio

32. A patient with Bell’s Palsy has a pathology involving which cranial nerve?
a. III
b. V
c. VII
d. III and VII

33. 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

34. 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

35. Lower motor neuron type of paralysis is characterized by:

a. hypotonia
b. spasticity
c. pathologic reflexes
d. involuntary movement of the affected extremities

3
36. 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

37. Bitemporal hemianopsia means involvement of the

a. optic nerve ipsilateral to the lesion
b. optic chiasm
c. optic tract
d. optic radiation

38. 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

39. Asymptomatic bacteriuria should always be treated in:

a. pregnant women
b. catheterized elderly patients
c. sexually active patient
d. post CVD patients

40. 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

41. 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

42. 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

43. The single most important parameter of renal function is:

a. edema
b. Creatinine clearance
c. Serum Creatinine
d. Serum BUN

44. 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

45. 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

46. Reticulocytosis is NOT seen in:

a. aplastic anemia
b. acute blood loss
c. hemolytic anemia
d. treatment of iron deficiency

47. 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

48. 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

4
 d. Cells in the active S phase

49. 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

50. Thrombocytopenia is not expected in:

a. SLE
b. G6PD deficiency - hemolysis of rbc
c. Acute Leukemia
d. Disseminated intravascular Coagulation (DIC)

51. 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

52. 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

53. 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

54. 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

55. Heberden’s nodes are found in

a. Systemic lupus erythematous (SLE)
b. Gouty arthritis
c. Osteoarthritis
d. Rheumatoid arthritis (RA)

56. 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

57. Psamomma bodies are characteristic of:

a. Follicular Thyroid CA
b. Papillary Thyroid CA
c. Parathyroid Adenoma
d. Parathyroid CA

58. 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

59. 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

60. 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

61. Which of the following medications can cause hyperprolactinemia?

a. Propranolol
b. glucocorticoids
c. metoclopramide
d. levothyroxine

5
62. Obese persons are at increased risk for
a. hypothyroidism
b. Type I diabetes mellitus
c. Cholelithiasis
d. elevated LDL cholesterol

63. Dietary deficiency of thiamine produces which of the following clinical syndromes?
a. color blindness
b. osteoporosis
c. bruising
d. peripheral neuropathy

64. 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

65. 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

66. Prolonged fasting causes the intestinal villi to

a. hypertrophy
b. atrophy
c. necrose
d. proliferate

67. A person with known allergy to penicillins should not be given

a. cotrimoxazole
b. tetracycline
c. erythromycin
d. cefalexin

68. Lymphokines are secreted by

a. polymorphonuclear cells
b. monocytes
c. lymphocytes
d. lymphoma cells

69. 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

70. IgE has high affinity for which type of cells?

a. eosinophils
b. mast cells
c. platelets
d. macrophages

71. 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

72. 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

73. 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

74. One of the following is associated with an increased risk of sudden cardiac death:
a. frequent PVC’s (>30/min)

6
 b. hyponatremia
c. smoking
d. hyperlipidemia

75. Elevation of Serum Potassium is toxic to the:

a. kidneys
b. brain
c. heart
d. liver

76. Anti – Tuberculosis drug that can cause hyperuricemia:

a. Isoniazid
b. Pyrazinamide
c. Rifampicin
d. Streptomycin
MPL: 0.25 p:964

77. 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

78. 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

79. 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

80. 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

81. 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

82. The most significant risk factor for cancer is:

a. Sex
b. Age
c. Nationality
d. Dietary factors
MPL: 0.50 p: 435

83. DNA synthesis phase

a. G1
b. G2
c. G0
d. S
MPL: 0.333 p: 469

84. 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

85. Painless myocardial infarction is greater in patients with

a. hypertension
b. diabetes mellitus
c. homocystinemia
d. dyslipidemia
MPL: 0.50 p: 955

86. 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

7
87. 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

88. This anti-TB drug may cause “barrel vision”

a. Rifampicin
b. Isoniazid
c. Pyrazinamide
d. Streptomycin
MPL: 0.25 p: 961

89. 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

90. Most common etiologic agent in uncomplicated cystitis:

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

92. 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

93. 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

94. 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

95. 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

96. Target blood pressure in Diabetes Mellitus

a. 140/90
b. 150/80
c. 130/80
d. 120/80
MPL: 0.25 p: 2170

97. Risk factor for adverse prognosis in hypertension:

A. elderly
B. female sex
C. smoking
D. pregnancy
MPL: 0.25 p: 1466

8
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

99. Precipitating cause of heart failure:

A. smoking
B. exercise
C. infection
D. stroke
MPL: 0.50 p: 1368

100. Underlying cause of heart failure:

A. cardiomyopathy
B. cardiac tamponade
C. respiratory diseases
D. anemia
MPL: 0.333 p: 1368

101. Minor criteria of congestive heart failure:

A. S3 gallop
B. cardiomegaly
C. rales
D. tachycardia
MPL: 0.25 p: 1371

102. 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

103. 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

104. 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

105. 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

106. 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

107. Cause of transudative pleural effusion:

A. mesothelioma
B. sarcoidosis
C. cirrhosis
D. meigs syndrome
MPL: 0.25 p: 1567

108. Hallmark of COPD:

A. airflow obstruction
B. clubbing of digits
C. flail chest
D. hoover’s sign
MPL: 0.25 p: 1551

109. Most commonly involved in extrapulmonary TB:

A. meninges
B. peritoneum
C. pericardium
D. lymph nodes
MPL: 0.25 p: 957

110. Primary Pulmonary TB frequently involved the:

A. middle lobe

9
 B. lower lobe
C. middle and lower lung zones
D. upper lobe
MPL: 0.333 p: 956

111. The most common complication of measles:

A. subacute sclerosing panencephalitis
B. chronic encephalitis
C. otitis externa
D. hepatitis
MPL: 0.50 p: 1150
112. The drug of choice for primary generalized seizures is:
A. phenytoin
B. carbamazepine
C. valproic acid
D. gabapentin
MPL: 0.50 p: 2374

113. Type of anemia in Malaria:

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

115. 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

116. 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

117. 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

118. Gold standard in diagnosing gallstone:

A. abdominal xray
B. ultrasound
C. CT Scan
D. Cholescintigraphy
MPL: 0.25 p: 1883

119. The most common risk factor of stroke :

A. infection
B. hypertension
C. diabetes mellitus
D. trauma
MPL: 0.25 p: 2372

120. The most specific and characteristic symptom of gallstone disease:

A. biliary colic
B. vomiting
C. constipation
D. jaundice
MPL: 0.25 p: 1883

121. Local complication of acute pancreatitis:

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

10
 D. head
MPL: 0.50 p: 1901

123. The most common serious complication of chicken pox:

A. pneumonia
B. hepatitis
C. meningitis
D. pericarditis
MPL: 0.50 p: 1043

124. 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

125. 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

126. Most serious complication of influenza B virus:

A. pneumonia
B. carditis
C. reye’s syndrome
D. encephalitis
MPL: 0.5 p: 1067

127. Metabolic complication of nephritic syndrome

A. hypercalcemia
B. bleeding
C. normocytic normochromic
D. hypoalbuminemia
MPL: 0.5 p: 1684

128. Primary Glomerulopathy which is highly steroid responsive:

A. membranoproliferative
B. membranous
C. focal segmental glomerolosclerosis
D. minimal change disease
MPL: 0.333 p: 1683

129. Most common cause of idiopathic nephrotic syndrome in adult:

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

131. Most common glomerulopathy worldwide:

A. minimal change
B. lupus nephritis
C. membranous
D. IgA nephropathy
MPL: 0.5 p: 1690

132. 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

133. Virus serotype associated greatest risk for DHF:

A. DEN-1
B. DEN-2
C. DEN-3
D. DEN-4
MPL: 0.5 p: 1161

134. Most important laboratory test for DHF monitoring:

A. Hemoglobin
B. hematocrit
C. platelet
D. liver function test

11
 MPL: 0.25 p: 1161

135. 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

136. 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

137. 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

138. 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

139. Liver cirrhosis is best diagnosed by:

A. Ultrasound
B. Liver biopsy
C. CT scan
D. liver function tests
MPL: 0.25 p: 1859

140. Drug of choice for Schistosomiasis:

A. mebendazole
B. praziquantel
C. tinidazole
D. metronidazole
MPL: 0.5 p: 1271

141. 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

142. Gold standard in the treatment of typhoid fever:

A. chloramphenicol
B. penicillin
C. tetracycline
D. ceftriaxone
MPL: 0.25 p: 991

143. The most common opportunistic fungal infection:

A. candida
B. aspergillosis
C. pneumocistis jeroverci
D. fusarium
MPL: 0.25 p: 1185

144. Source of cholera infection:

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

146. Most common cause of pneumonia in ambulatory patients:

12
 A. S. pneumoniae
B. M. pneumoniae
C. influenza viruses
D. C. pneumoniae
MPL: 0.25 p: 1531

147. 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

148. 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

149. 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

150. The most common site of gastrointestinal TB:

A. appendix
B. proximal ileum
C. pancreas
D. terminal ileum
MPL: 0.5 p: 958

151. Most common site of pancreatic cancer:

A. head
B. body
C. tail
D. uncus
MPL: 0.25 p: 537

152. Most consistent risk factor in pancreatic cancer:

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

154. 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

155. The most common extracutaneous site of involvement in children

A. respiratory system
B. CVS
C. CNS
D. GIT
MPL: 0.5 p: 1043

156. 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

157. 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

158. Heart failure with development of symptoms in less than an ordinary activity:
A. Class I

13
 B. Class II
C. Class III
D. Class IV
MPL: 0.25 p: 1302

159. 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
MPL: 0.5 p: 1369

160. Cardiomyopathy with primary myocardial involvement

A. Infective
B. Metabolic
C. Connective
D. Idiopathic
MPL: 0.5 p: 1408

161. Reversible form of dilated cardiomyopathy

A. Alcohol abuse
B. Right ventricular dysplasia
C. Amyloidosis
D. Hemochromatosis
MPL: 0.5 p: 1409

162. Systolic Hypertension with wide pulse pressure

A. Arteriosclerosis
B. Chronic Pyelonephritis
C. Oral contraceptives
D. Psychogenic
MPL: 0.5 p: 1463

163. Framingham major criteria for Diagnosis of CHF :

Night cough
Pleural effusion
Tachycardia
Positive hepatojugular reflux
MPL: 0.25 p: 1371

164. 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

165. 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

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

167. The most common presenting complaint in patients with ST elevation MI:
A. Dysnea
B. Weakness
C. Pain
D. Vomiting
MPL: 0.5 1449

168. 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

169. Cardiomyopathy with primary myocardial involvement

A. Infective
B. Metabolic
C. Connective
D. Idiopathic
MPL: 0.25 p: 1408

14
170. 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

171. 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

172. 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

173. Most common pathogen in intensive care unit:

A. S. pneumoniae
B. C. pneumoniae
C. M. pneumoniae
D. H. influnzae
MPL: 0.25 p: 1531

174. The only known reservoir for Varicella zoster virus is

A. humans
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

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

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

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

15
 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

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

16
 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

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

17
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
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:

18
 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%
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 – increased aldosterone secretion
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

19
 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

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

20
 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

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

21
 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
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

22
 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
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

23
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
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 - none
B. edema- yes
C. proteinuria > 3.5 gm/1.73m2 (less than 3gm)
D. hyperlipidemia - nephrotic
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

24
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 - thin
B. Large lipid cores
C. A high content of lymphocytes - macrophages
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?

25
 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
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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